Restorative sleep is essential for a vibrant and healthy life. Obstructive Sleep Apnea (OSA) is the most prevalent type of sleep apnea, characterized by repeated episodes of upper airway obstruction during sleep, leading to reduced blood oxygen levels and fragmented sleep. Research strongly connects excess body weight with increased severity of OSA. Fortunately, lifestyle modifications, including diet and exercise, can significantly improve sleep quality and reduce the severity of sleep apnea. The American Academy of Sleep Medicine recommends dietary-induced weight loss and exercise as lifestyle treatment options for OSA.
Understanding Sleep Apnea
Obstructive sleep apnoea (OSA) is characterised by repeated episodes of extrathoracic upper airway obstruction or reductions in breath amplitude that result in intra-arterial hypoxaemia and hypercapnia and transient arousals from sleep, leading to fragmented sleep [1]. The prevalence of OSA among middle-aged adults is estimated to be 24% in males and 9% in females, with 7% of the general population estimated to have moderate to severe OSA [2].
The Crucial Role of Weight Management
Obesity, particularly central obesity, is a strong predictor of OSA. Weight loss has long been recognized as an effective OSA treatment. Weight loss seems to especially help people with mild or moderate OSA, and the reduction in their OSA symptoms after weight loss may last for years, even if they regain some of the weight. The American Academy of Sleep Medicine recommends weight loss through lifestyle modification (e.g. dietary change and exercise) as behavioural treatment options for improving the apnoea-hypopnoea index (AHI) in obese patients with OSA [7]. This recommendation has been bolstered by data from several large randomised controlled trials demonstrating that significant reductions in apnoea and hypopnoea indices with lifestyle programmes (e.g. dietary-induced weight loss, behavioural counselling and increased physical activity) are observed among overweight patients with mild OSA [8], obese OSA patients with diabetes [9] and moderate to severe OSA patients undergoing continuous positive airway pressure treatment (CPAP) [10].
Setting Realistic Weight Goals
Set a realistic weight goal - Don’t create such an enormous goal for yourself that you give up before you try. Ask for support - Ask your friends and family for support in your journey.
The Power of Exercise
One of the most common sleep apnea-related questions is whether exercise and losing weight can help cure sleep apnea. Exercise is only half of the equation. Experts routinely recommend that people with obstructive sleep apnea exercise to the extent that they can. Even modest activity levels can significantly improve sleep apnea symptoms.
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Getting Started with Exercise
Start with easy exercise routines - You don’t need to sign up for a marathon or sign up for an intense boot camp class right away. It’s more important to simply get moving. Start with things that you know you can do, like taking a brisk walk a few times a day. Make exercise fun - Half the battle of making exercise part of your routine is mental. If you’re only doing things you don’t like, it’s too easy to go off track. You don’t have to spend your time on a treadmill to get in a workout. Find something you enjoy to do, maybe it’s playing a sport, riding a bike or even taking your dog to the park. Turn exercise into a lifestyle - Small changes in your life make bigger activities less intimidating.
Specific Exercises to Consider
Exercises for your mouth and facial muscles involve increasing the airflow through your windpipe may improve your sleep. Pick up a musical instrument - It’s never too late to take up music. Singing - Pick your favorite karaoke song, and belt it out. Tongue exercises - It may look silly but going through a series of tongue exercises can help train your tongue to stay in place and not fall back to block your airway as you sleep.
The Importance of a Healthy Diet
Maintaining a healthy diet goes hand-in-hand with helping maintain your weight and giving you more energy to exercise. Eating the right foods can make a significant difference when managing sleep apnea. Simple adjustments in diet can lead to better sleep and fewer sleep apnea symptoms. By understanding the relationship between diet and sleep apnea, we can make informed decisions that contribute to a restful night's sleep.
Foods to Incorporate
- Tryptophan-Rich Foods: If you have sleep apnea, it may be a good idea to incorporate in your diet foods that are high in tryptophan like poultry, legumes, canned tuna, and whole grain oats.
- Omega-3 Fatty Acids: Research suggests that including omega-3 fatty acids in your diet may reduce inflammation and reduce the risk for OSA. Omega-3 fatty acids may improve your overall sleep quality, help you fall asleep quicker, and improve your daytime energy levels.
- Fruits and Vegetables: Many fruits and vegetables that are rich in antioxidants also include both vitamin C and vitamin E. Fruits and vegetables help you feel full longer which may help you sleep better,” she concludes.
- Whole Grains: Eating whole grains that are rich in fiber and made up of complex carbohydrates is a good way to promote weight loss, which may help improve obstructive sleep apnea symptoms.
Foods to Avoid
When managing sleep apnea, it's important to pay attention to the foods you eat. Certain foods can make sleep apnea symptoms worse. High-fat dairy products like cheese and whole milk can increase mucus production, which can block airways and make snoring and breathing issues worse. Similarly, foods that are greasy or fried can cause inflammation in the body, making it harder for air to flow freely through your throat and nose. Processed foods and sugar-loaded snacks should also be avoided. These foods can lead to weight gain, which is a major risk factor for sleep apnea. Foods high in refined sugar can cause spikes and dips in blood sugar levels, affecting your sleep patterns.
Meal Planning Tips
Planning your meals can make it easier to stick to a healthy diet and manage sleep apnea. Start by creating a weekly meal plan that includes a variety of nutrient-dense foods. Incorporate fresh fruits and vegetables into every meal, and choose lean proteins and whole grains to keep you full and energized throughout the day. One helpful tip is to prepare meals in advance. Cook large batches of healthy dishes on weekends and store them in portion-sized containers. This way, you always have a nutritious meal ready, which can help you avoid unhealthy food choices during busy days. Aim to have your last meal a few hours before bedtime to improve your digestion and sleep quality.
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The Mediterranean Diet
The Dietary Guidelines for Americans recommends the Mediterranean diet as a healthy eating plan to promote health and prevent chronic disease, including sleep apnea. It’s beneficial for heart health, improves sleep apnea symptoms, and can reduce the risk of Parkinson’s and cancer. The Mediterranean diet incorporates the basics of healthy eating with universal flavors and cooking techniques.
Low-Carbohydrate Diets
There is strong evidence supporting the efficacy of lower-carbohydrate diets in promoting weight loss [49]. Low-carbohydrate diets can take several forms, ranging from moderate carbohydrate intake (26-45% of total energy from carbohydrates) to very low-carbohydrate ketogenic diet (20-50 g·day−1 or <10% of a 2000 kcal·day−1 diet). While there is no limitation on dietary saturated fat consumption, this is not a necessary component of a low-carbohydrate diet. Moreover, vegetables with a low glycaemic load that are rich in fibre make up the foundation of a well formulated low-carbohydrate diet.
The Role of Hydration
Hydration plays a vital role in managing sleep apnea. Drinking enough water helps keep your throat and airways moist, making it easier to breathe at night. It's essential to be mindful of not drinking too much water right before bed to avoid frequent trips to the bathroom, which can disrupt your sleep. Including herbal teas and water-rich fruits and vegetables like cucumbers and watermelon in your diet can also help with hydration. Avoid beverages that can dehydrate you, such as coffee, sugary drinks, and alcohol, especially in the evening.
The Link Between Sleep Apnea and Cardiovascular Disease
Obstructive sleep apnoea (OSA) is associated with increased cardiovascular disease (CVD) morbidity and mortality. Epidemiological [23] and prospective studies [24, 25] clearly support a causative link between OSA and various manifestations of CVD. The multiple pathways through which OSA sets up the CVD substrate are incredibly complex and have been reviewed elsewhere [26]. Sleep fragmentation occurs with obstructive apnoea and may induce severe intermittent hypoxaemia and carbon dioxide retention during sleep. As a result, the normal structured autonomic and haemodynamic response to sleep is disrupted. Repetitive apnoeas are accompanied by sympathetic activation and consequent vasoconstriction due to the combined influence of hypercapnia and hypoxia [27]. Apart from these acute haemodynamic effects, OSA-induced hypoxia may promote the production of oxidative stress, which, in turn, adversely affects endothelial regulation through nitric oxide-mediating pathways [29].
The Impact of Obesity on OSA Development
OSA susceptibility is determined by the extent to which the upper airway is prone to collapse during sleep. Pharyngeal collapsibility is a consequence of elevations in critical closing pressure (Pcrit). Mechanical and neural factors that regulate pharyngeal collapsibility both determine Pcrit [32]. Obesity is associated with adipose deposition in peripharyngeal fat pads, which increase surrounding tissue pressure (i.e. mechanical load) leading to pharyngeal collapsibility during sleep [33]. Thus, greater risk of OSA is observed in adults who exhibit a predominantly central fat deposition pattern around the neck, trunk and abdominal viscera [2]. Moreover, pro-inflammatory cytokines are secreted from adipose tissue [34], and it has been theorised that their collective activity may depress neuromuscular control of the upper airway [35]. Furthermore, these cytokines induce the production of reactive oxygen species, thereby impairing the force-generating capacity of skeletal muscle and adversely affecting upper airway function by contributing to upper airway neuropathy [36].
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Additional Lifestyle Considerations
- Limit Alcohol and Caffeine: Alcohol relaxes throat muscles, increasing obstruction risks, while caffeine disrupts sleep cycles.