Sleep Disordered Breathing
- Dr Louise Oliver
- 2 days ago
- 5 min read
Is your unconscious breathing pattern helping or hindering your sleep?
What is sleep disordered breathing (SDB)?
We have been designed by nature to breathe in and out of the nose, quietly using the diaphragm whilst sleeping. SDB is a spectrum which ranges from sleeping with the mouth open, snoring/ noisy breathing or stopping breathing during sleep (obstructive sleep apnoea, OSA).
How do I know if I have SDB?
Use a snoring app to record yourself or if you have a sleeping partner consider asking them about your sleeping breathing pattern. Wearable devices are not always accurate however if it is suggesting a drop in oxygen levels, spikes in stress response or stopping breathing whilst sleeping this may be suggestive of SDB. Consider a sleep study.
Why is SDB important?
Sleep is where the magic happens in repairing and restoring the body.
When the body is distracted by maintaining breathing or needs to generate a stress response when breathing becomes difficult through the collapsible part of your airway the body’s repair and restore process is reduced. The research shows women are less likely to report snoring or apnoeas but are more likely to complain of consequences of poor sleep quality or multiple stress responses whilst sleeping such as daytime fatigue, lack of energy, insomnia, brain fog, morning headaches, mood disturbance, nightmares, palpitations, night sweats, anxiety compared to men.
It is important to identify and treat SDB as it is associated with increased risk of heart attack, stroke, heart failure, high blood pressure, type 2 diabetes, dementia, obesity, accidents, anxiety and depression.
Struggling with sleep as you transition through Menopause? Could how you are breathing be impacting your sleep?
Consider how you breathe during sleep – is your mouth open, do you snore/ have noisy breathing or do you stop breathing during sleep (apnoea)?
The British Menopause Society have published a Tool for Clinicians Managing sleep disturbance during the menopause transition The tool takes a holistic overview at sleep disturbance and marks a momentous moment in women’s health as sleep disordered breathing (SDB) has been included.
What impact does menopause have on breathing?
There is a steep rise in SDB during menopausal transition which is frequently overlooked. Menopausal rhinitis (nasal congestion) occurs in some women. We need more research to understand why rates of SDB increase however it is likely due to the hormonal changes of menopause in addition to weight gain.
What does National Institute for Clinical Excellence (NICE) say?
NICE OSA guidelines state assess people for OSA if they have 2 or more of the following features:
Snoring
Witnessed apnoeas (stopping breathing during sleep)
Unrefreshing sleep
Waking headaches
Unexplained excessive sleepiness, tiredness or fatigue,
Nocturia (waking from sleep to urinate),
Choking during sleep,
Sleep fragmentation or insomnia
Cognitive dysfunction or memory impairment
How can SDB be managed?
Management includes lifestyle change including weight loss, smoking cessation and referral to a sleep clinic for investigation for +/- treatment. The most common forms of treatment are either a continuous positive airway pressure (CPAP) machine or a mandibular advancement device (MAD).
My experience as a functional breathing practitioner helping others with SDB
As a functional breathing practitioner I see how we breathe whilst awake impacts how we breathe whilst asleep and the more the mouth is used to breathe the more the nose becomes congested.
In a CPAP expert workshop it was agreed mouth breathing and nasal congestion were common in people with OSA and interferes with nasal CPAP (mask covers nose only) which the experts felt was more effective and better tolerated than oronasal CPAP (mask covers nose and mouth).
I am grateful I managed to stop snoring just by changing how I breathed and the difference between my sleep as a snorer and an ex-snorer is profound. My sleep is now restorative, and I also feel calmer and have improved exercise tolerance. This is why I spend half of my working life helping others to breathe as nature intended.
Correcting our unconscious breathing pattern takes time and involves 24-hour nasal breathing, helpful posture, avoid over breathing, strengthening the muscles around the airway and those involved in inhaling air into the body, also encouraging a slower, gentler breathing pattern.
Improving nasal congestion depends on the underlying cause however I have found the most overlooked aspect is our tolerance to our waste product (carbon dioxide). If we were walking up a hill trying to maintain breathing in and out of the nose at some point we would feel ‘air hunger’ which is a feeling you want to open your mouth, or you are not getting enough air into your body or a feeling of suffocation.
We have chemoreceptors in our brain’s breathing centre that have a specific tolerance to carbon dioxide that is personal to us. When the carbon dioxide level reaches your tolerance level your body will send a signal to breathe however you can train your body to improve carbon dioxide tolerance which often reduces nasal congestion, improves oxygen delivery to the body (making exercise easier) and breathing becomes gentler and slower so the individual feels calmer
Take Home messages
Sleep is where the magic happens in repairing and restoring the body.
We are designed to breathe in and out of the nose whilst awake and asleep. Breathing as nature intended helps sleep.
How we breathe whilst awake impacts how we breathe whilst asleep.
Mouth breathing and nasal congestion interferes with OSA treatment. Treat the underlying cause of the nasal congestion and re-establish 24-hour nasal breathing.
In my clinical experience the more the mouth is used to breathe the more the nose becomes congested. I have found by improving tolerance to our waste product (carbon dioxide) it often helps to open up the nose and frequently menopausal rhinitis resolves.
Speak to your health professional if you think you have sleep disordered breathing.
Ways to work with me
BREATH DOC® group programme - click for more info
BREATH DOC® individual programme - click for more info
The Balance Breath Retreat - click for more info
Quick, direct access to doctor-led clinical sleep service
Dr Louise Oliver has partnered with Theta Sleep to provide you quick, direct access to their doctor-led clinical sleep service from the comfort of your home.
Theta Sleep provides a personalised and comprehensive assessment investigating sleep conditions, for United Kingdom residents, such as sleep-related breathing disorders (obstructive sleep apnoea (OSA), upper airway resistance syndrome (UARS) etc), sleep-related movement disorders and insomnia disorders.
Dr Louise Oliver has requested that all clients using this bespoke link receive targeted screening for upper airway resistance syndrome (UARS). While UARS can be more challenging to detect on a home sleep study Theta Sleep will incorporate additional analysis to identify it as accurately as possible.
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References
Genta PR, Kaminska M, Edwards BA, Ebben MR, Krieger AC, Tamisier R, Ye L, Weaver TE, Vanderveken OM, Lorenzi-Filho G, DeYoung P, Hevener W, Strollo P. The Importance of Mask Selection on Continuous Positive Airway Pressure Outcomes for Obstructive Sleep Apnea. An Official American Thoracic Society Workshop Report. Ann Am Thorac Soc. 2020 Oct;17(10):1177-1185. doi: 10.1513/AnnalsATS.202007-864ST. PMID: 33000960; PMCID: PMC7640631.
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