There are many issues regarding snoring and sleep apnoea that confound current medical thinking. During an interview on ABC Radio Nightlife on Friday December 14 between presenter Rod Quinn and Melbourne sleep physician Dr Maree Barnes, many callers were questioning why they or family members snored heavily or had obstructive sleep apnoea yet had none of the classic risk factors such as middle age and obesity. Blaming heavy snoring and sleep apnoea on genetically inherited face shapes in children, teenagers and young and/or slim adults does not stand up in many cases. It does not explain why a non-obese adult who has had the same facial features for several decades only developed heavy snoring and apnoea in the last few years.
Certainly narrow facial features predispose you to snoring and sleep apnoea but if they were the primary cause then the problem would have been there all along, night after night.
The way you breathe matters
One explanation that fits well in every case of snoring and sleep apnoea is that the person has a “disordered” or “dysfunctional” breathing pattern – that is, they are not breathing correctly. The rate, rhythm, and volume of their breathing during the day, and (more obviously) at night, differs from the “physiological norm” and from the breathing pattern of a healthy, silent sleeper.
The way you breathe during sleep is a reflection of the way you breathe when awake. Your breathing is controlled by the “respiratory centre” in your brain. Normally, it drives you to breathe around 500mls of air, 8 to 12 times a minute in a regular, even pattern. Through various means, poor posture, stress and a high carbohydrate diet to name a few, you can get into a habit of breathing faster and bigger (more air per breath) than this during the day without even being aware of it. Research (1) with men with sleep apnoea shows them breathing during the day, three times more air per minute than the norm. Faster or heavier breathing during the day translates into faster and/or heavier breathing during sleep. Snorers are big breathers. Sucking in fast, big breaths during sleep can vibrate the nasal passages and throat (snoring) and may suction the walls of your throat together, obstructing airflow (obstructive sleep apnoea). Like breathing too fast through a straw.
Alcohol, a large evening meal, carrying extra weight and stress can all increase the breathing rate further and lead to an increase in the severity of the symptoms experienced overnight.
Research (2) shows that the application of continuous positive airway pressure (CPAP) to your airways via a mask worn during sleep, not only raises the pressure in your airway to counteract a vacuum/collapse effect, but also reduces the volume of air you will breathe.
A breathing educator can help you do this for yourself, through the process of breathing retraining. While breathing is automatic, you can also consciously vary it-you can practice breathing at the correct rate, rhythm and volume during the day which resets the “drive to breathe” centre in your brain to deliver quieter, softer more regular breathing at night. Many people notice an improvement within 24 hours of commencing breathing retraining.
Once you are used to breathing more slowly and gently during the day, your body is much less likely to revert to “sucking and blowing” breathing during sleep. (Many a snorer’s bed partner has described those huge exhalations during sleep as “blowing a gale” or “blowing like a whale”.)
Snoring and sleep apnoea are serious conditions and you must do something about them in one way or another. For many people who have not been able to tolerate mouth splints and CPAP machines, breathing retraining has given them welcome relief.
You should always have your doctor’s approval before stopping or modifying any prescribed treatment.
Click here to listen to the interview on The problems of snoring on ABC radio show Nightlife
1. ‘Control of breathing in obstructive sleep apnoea and in patients with the overlap syndrome’. Radwan L, Maszczyk Z, Koziorowski A, Koziej M, Cieslicki J, Sliwinski P, Zielinski J. Eur Respir J. 1995; 8(4): 542–545.
2. ‘Effect of continuous positive airway pressure on central sleep apnea and nocturnal PCO2 in heart failure’. Naughton MT, Benard DC, Rutherford R and Bradley TD. Am J Respir Crit Care Med. 1994; 150: 1598–1604.
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