What’s Causing Sleep Apnea?

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At Mercola.com, Dr. Joseph Mercola dives into the factors causing sleep apnea. He writes:

The most frequently cited cause for sleep apnea in adults is obesity, which contributes by putting excess pressure on your upper airways, resulting in collapse and decreased neuromuscular control. As explained by Obesity Medicine:¹²

“Neck circumference, waist circumference, and waist-to-hip ratio are also considerations when addressing overweight or obesity and suspecting sleep apnea. Neck circumference greater than 17 inches for men and 16 inches for women raise the risk of both obesity and sleep apnea.

Waist measurements equal to or greater than 40 inches in men and 35 inches in women also raise the risk factor. Waist-to-hip ratio can also be calculated to assess for additional risk equivalent.

This ratio is determined by dividing the waist measurement by the hip measurement. The greater this ratio, the more significant the risk factors for sleep apnea and other obesity-related disorders …

Weight loss has been found to reduce the severity of sleep apnea as well as the development of the disorder. Overweight and obesity remain the most important modifiable causes of sleep apnea.”

Other common causes include physical obstructions such as enlarged tonsils or adenoids, aging and, believe it or not, vitamin D deficiency. As explained by Dr. Stasha Gominak in the featured video, vitamin D receptors in your brain stem actually control your ability to move in and out of the various sleep phases.

Vitamin D is also needed to produce acetylcholine, a neurotransmitter that helps you get into the deeper, healing phases of sleep, and controls the normal paralysis that occurs during deep sleep. You also need the raw material, choline, to produce sufficient amounts of acetylcholine.

Choline is typically obtained from animal foods. The highest concentration is in egg yolks. To learn more about the hidden connection between vitamin D and sleep, listen to my interview with Gominak, or check out the accompanying Substack article.

Moving Beyond CPAP

While 80% of regular CPAP users report significant improvements in their sleep apnea symptoms,¹³ the machine was never intended to be a lifelong solution. As noted by the inventor of the CPAP, Dr. Colin Sullivan,¹⁴ it was always only intended to be a temporary measure, while the underlying factors are addressed. It was never designed as a permanent therapy.

As mentioned, one such factor would be obesity. Simply losing weight can often ameliorate the problem or eliminate it entirely. Another would be surgical procedures to remove obstructions, such as enlarged tonsils or adenoids.

The size and shape of your mouth and upper airway are also very important, and if this is the root of the problem, you have other options besides CPAP, including:¹⁵

•Oral devices — If your sleep apnea is related to tongue or jaw position, specialty trained dentists can design a custom oral appliance to expand your palate and bring your jaws forward to address the issue.

For adults, these appliances include tongue-retaining devices that shift the tongue forward without moving the jaw, and mandibular repositioning devices, designed to shift the jaw forward. You can learn more about this in “A Mouth Guard as Effective as CPAP for Sleep Apnea?”

The oral appliance approach has been recognized as part of the standard of care for sleep apnea since about 1995, and oral appliances are typically recommended as the first line treatment for mild to moderate sleep apnea for adults. One source where you can find a treatment specialist familiar with oral appliances is the American Academy of Dental Sleep Medicine.¹⁶

•Oral myofunctional therapy (OMT) — OMT is a form of facial muscle therapy that helps reshape your oral cavity and promote proper placement of your tongue, head and neck. To find a qualified therapist, see the Academy of Orofacial Myofunctional Therapy’s website.¹⁷

•Neuromuscular electrical stimulation (NMES) devices — These devices include a removable mouthpiece that is worn for 20 minutes once a day for six weeks, while awake. The device stimulates and tones your tongue and upper airway muscles to prevent them from collapsing during sleep.

•Surgical intervention to enlarge your upper airway by moving your upper and lower jaw forward.

Learning to consistently breathe through your nose rather than your mouth can also be very helpful. Mouth breathing results in over breathing, which lowers the availability of oxygen. By consistently breathing through your nose, your breathing volume will be brought back to normal. This in turn allows for optimal oxygenation of tissues and organs, including your brain.

I have just completed a 40-hour course on respiratory physiology and breathing with the leading breathing expert in the world, Peter Litchfield, Ph.D. I hope to have him on my podcast later this year to discuss his mind-blowing work, which is absolutely essential for anyone with a breathing disorder.

He uses a clinical grade capnometer in his work to objectively assess what is going on with the breathing so there is absolutely no guessing. The capnometer can be purchased for about $3,000 or rented. It’s absolutely fascinating work that I am excited to share in the near future.

Guidance for Parents

As mentioned, more and more children are also being diagnosed with sleep apnea, which can have lifelong consequences. In his article, Rozsa quotes Sullivan, the inventor of the CPAP:¹⁸

“I’ve spent a lot of half my career looking at pediatric sleep apnea, sleep disorder breathing, and I do think that trying to intervene early, identifying kids who have the risk factors, gives us a chance of preventing it.”

While obesity is a risk factor for children as well as adults, an increasingly common root cause is related to an improperly shaped mouth and incorrect positioning of the tongue, caused by lack of breastfeeding and being raised on infant formula and processed foods.

Dr. Weston Price’s pioneering work showed how diet can affect your entire mouth, yet most people are still clueless about this effect, and how the size and shape of your oral cavity affect the placement of your tongue and your overall ability to breathe properly.

Our mouths have actually gotten progressively smaller through the generations due to lack of breastfeeding and not chewing enough, combined with poor childhood nutrition thanks to a preponderance of processed food devoid of crucial nutrients.

Breastfeeding helps expand the size of your child’s palate, shifting the jaw forward — two important factors that help prevent sleep apnea by creating ample room for unobstructed breathing.

Tongue placement also plays an important role, as revealed in a 2015 study on pediatric patients.¹⁹ The newborn palate is as soft as a drum, and if we place into it a bottle, pacifier, a spouted cup or the child finds his or her thumb, the palate may deform, making the nasal airway smaller.

Having an abnormally short lingual frenulum²⁰ can also result in impaired orofacial growth in early childhood, reducing the width of the upper airway. The upper airway is very pliable, so this increases the risk of it collapsing during sleep.

The study found that children with an untreated short frenulum developed abnormal tongue function early in life, which also impacted their orofacial growth and led to disordered breathing during sleep.

The researchers suggested pediatricians and otolaryngologists should systematically examine the lingual frenulum in children exhibiting difficulties such as trouble sucking, speech impediments, snoring or other breathing problems.

They also noted that while removing the frenulum can be helpful, it typically will not resolve all abnormal breathing patterns, so oral myofunctional therapy, both pre- and post-surgery is recommended to restore normal breathing through the nose.

Read more here.