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Are You Breathing Well at Night? 5 Common Myths About Sleep-Disordered Breathing

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Sleep is an important pillar of health. Yet, according to the CDC, one third of US adults report that they are not getting the recommended 7 hours of sleep per 24-hour period. And that’s just counting the number of hours, not the quality of sleep during those hours!

While there are several factors that can lead to poor quality sleep, sleep-disordered breathing is a big one. According to dentist Dr. Mark Burhenne, as much as 80% of the population may have an undiagnosed sleep-breathing disorder – like sleep apnea – which can significantly decrease the quality of one’s sleep.

Why is Sleep Important?

We know that not enough sleep is a risk factor for many chronic diseases and health conditions, so to minimize our risk, we need to make sure we’re not just getting enough sleep, but that we’re also getting good quality sleep. Even if you sleep 8-hours per night, an undiagnosed sleep-breathing disorder could be robbing you of the uninterrupted, deep, restful sleep that is critical for your body to rest, detox, and repair.

Adding emphasis to the importance of sufficient and high-quality sleep is the discovery of the brain’s glymphatic system and the role it plays in brain detoxification. (If you haven’t seen the new footage of Cerebral Spinal Fluid (CSF) pulsing and “washing” our brain at night, you’ve gotta check it out!). In addition to the established links between poor sleep, type 2 diabetes, cardiovascular disease, and depression, new research is demonstrating additional connections between aging, sleep deprivation, and a heightened risk for Alzheimer’s disease.

Unfortunately, with all we know about the importance of sleep to our overall health, sleep-disordered breathing is still under diagnosed, and often misunderstood. Today, we’ll tackle 5 myths about sleep-disordered breathing. If any of them hit home for you, read on to learn about next steps for working with your doctor and dentist to assess and diagnose a sleep-disordered breathing problem.

Sleep determines our destinies.

Dr. Mark Burhenne
Author of The 8-Hour Sleep Paradox

Myth #1 – The Only People with Sleep-Disordered Breathing Are Those Who Are Overweight and Those Who Snore

It’s a common association – if you have sleep apnea you must be a major snorer, or overweight. And while sleep breathing disorders are common in overweight people and snoring can be a sign of a sleep breathing problem, there are many other people who have sleep breathing problems, and are falling through the cracks.

According to Dr. Burhenne, “some of the most common groups of people with undiagnosed sleep disorders are athletes, allergy sufferers, children with ADD/ADHD, petite women, and people who grind and clench their teeth.” (The 8-Hour Sleep Paradox, p. 17). These people often seem healthy. And the younger and more symptom-free you are, the less likely anyone is to suspect you might have a sleeping problem – yourself included!

Early on, you may be fit, have sufficient energy, and no major health complaints. But with the critical role that sleep plays in our growth, recovery, and detoxification, a sleep breathing problem will catch up with you. To be healthy, we need deep, restful sleep. And the ability to breathe well at night is critical for that.

Myth #2 – Sure, I Grind My Teeth At Night. But That’s Just Stress

It’s still the common understanding – you grind your teeth? Oh, you must be stressed. But, dental professionals, especially those specializing in dental sleep medicine, are now realizing that grinding our teeth is actually a way of opening up our airway at night. It’s a critical response by our autonomic nervous system that saves us when our muscles relax, our airway closes, and we’re not able to get air into, or out of, our lungs.

Why does that matter? You probably won’t remember those moments in the morning, but your body does. And after a while, you may start to develop TMJ pain. Or, you may find that your memory isn’t what it used to be; your digestion is off; your immune function is low; and even after a full night’s sleep, you don’t wake up feeling rested.

If you tell your dentist or doctor that you grind your teeth at night, they may recommend a night guard. And that might help protect your teeth when you grind, but it probably won’t fix your airway problem. To diagnose and treat an airway problem, you’ll need to find a sleep doctor and a dentist that specializes in dental sleep medicine – and ask them to join your healthcare team.

Myth #3 – My Only Problem with Sleep is That I Have to Get Up in the Middle of the Night to Pee

You may hear it from your parents – now that I’m old, I have to get up during the night to pee. My bladder isn’t what it used to be; but that’s my only issue with sleep. Sure, getting up in the middle of the night does lead to fragmented sleep, especially if you have trouble falling back to sleep after you get back in bed. But, did you know that the urge to pee during the night could actually be a sign of a sleep breathing problem?

When we are peacefully in deep sleep, our body secretes a hormone called ADH (Antidiuretic Hormone). This hormone helps prevent you from needing to urinate overnight, thus allowing you to get a full night of restful sleep. If you have a sleep breathing problem that is interrupting your deep sleep, your body won’t secrete enough ADH, and you may wake up during the night with the urge to pee.

It’s also possible that underlying your sleep breathing problem is a jaw alignment problem. And as Dr. Dwight Jennings points out in an episode of Bulletproof Radio, bite misalignment can increase blood levels of Substance P, which makes the bladder more sensitive, thus increasing the likelihood of nighttime trips to the bathroom.

So, while getting older, in and of itself, may increase the likelihood of an overnight bathroom trip, why settle for interrupted sleep?

Ask “why?”, talk with your doctor, and consider if an underlying sleep breathing problem or bite misalignment might be at play.

Myth #4 – I Practice Perfect Sleep Hygiene, Therefore I Don’t Have a Sleep Breathing Problem

If you’ve been in the functional and ancestral health space for a while, you’ve probably heard (and implemented) a boatload of sleep hygiene hacks. From maintaining a cool, dark bedroom to using TrueDark Junk Light Dots and wearing your blue-light blockers in the evening, you’ve got sleep down to a science.

Except – none of those things can fix a sleep breathing problem. If you have a compromised airway – whether it’s due to jaw structure, tongue or tonsil size, excess weight, petite bone structure, allergies, etc. – even an air purifier and dust mite covers on your bedding probably won’t cut it.

Don’t get me wrong, practicing good sleep hygiene is important. And if you truly care about your health, you’ll practice good sleep hygiene and take the time to evaluate and improve your sleep breathing too.

Looking for a new sleep hack? Try Mouth Taping.

Myth #5 – I Did an At-Home Sleep Study and My AHI Was Less Than Five. Therefore, I Do Not Have a Sleep Breathing Problem.

This is a tough one. Polysomnography (PSG), is the type of “attended” sleep study where you are in a hospital (or a hotel room) being monitored throughout the night. PSGs are expensive. To cut costs, insurance companies have begun using “unattended” or “at-home” sleep studies as the first line of screening. These at-home tests are more convenient and can yield some useful information, but they record and report different metrics than the PSGs.

One important metric that’s used in both types of sleep studies is AHI, or Apnea-Hypopnea Index. It’s the number of times that your breathing either stopped, or had some resistance per hour of sleep. The apneas (pauses in breathing) must last for at least 10 seconds and be associated with a decrease in blood oxygenation. An AHI of 0 to 5 is considered “normal”.

With the at-home sleep studies, only the average AHI is reported. According to Dr. Burhenne, the problem with that approach is “people with mild sleep disordered breathing may have an AHI of 0 for all stages of sleep, except for REM, when their AHI jumps to 10 or even higher.” (The 8-Hour Sleep Paradox, p. 67). But, because the at-home sleep study reports only an average of your AHI across the entire night, it may come back under 5. Which could mean that your sleep study gets deemed “unremarkable”, and you’re left with an undiagnosed sleep breathing disorder. Additionally, because REM sleep is one of the stages in which our bodies do a lot of healing, interrupted breathing during that time can have a major impact on our health.

So, an AHI of less than 5 on an at-home test does not necessarily mean you are breathing well at night. If you have other signs and symptoms of a sleep breathing disorder, you need to become your own advocate. Especially if you fall into one of those commonly under diagnosed groups (athletes, kids with ADD/ADHD, petite women, etc.). Talk with your doctor and your dentist about your concerns and how you might be able to get an attended PSG sleep study so you can really see how well you’re breathing at night.

HELP! I Think I Have a Sleep Breathing Problem!

So, what now? Having busted these myths about sleep apnea and sleep-disordered breathing, you may have started wondering if you or a loved one needs to take a closer look at how well you are breathing at night. To do that, Dr. Burhenne recommends following the acronym, CAR: Consider, Assess, Referral.

Consider

You’ve likely already started the first step – reflecting on your sleep ability and how you breathe while you sleep. Do you grind your teeth or have TMJ pain? Do you wake up frequently? Do you have to get up and pee in the middle of the night? How often do you feel rested and bounce out of bed in the morning?

An estimated 80-90% of Americans have an undiagnosed and untreated sleep breathing disorder (Source: Dr. B’s Tedx Talk). Now that you’re armed with new knowledge, don’t let yourself be one of them. If you’re not breathing well at night, you will have interrupted sleep, which can lead to a lifetime of suboptimal health and ongoing chronic health issues.

Assess

Start tracking your sleep. You can use a smart phone app, an Oura ring, and a journal to gain a lot of insight into your own sleep at night, all from the comfort of your home. Ask your family what they notice about your sleep, track your observations, and document any symptoms that might be related to a sleep breathing disorder.

If you’re worried about the breathing of a loved one, try sitting quietly in their room, starting an hour or two after they go to bed. Look and listen: Are they sleeping with their mouth closed? Are they snoring? Tossing and turning? Moaning? What do you hear? Jot down your notes, talk with them about what you observed, and ask them how they feel about their own quality of sleep.

Referral

Now that you’ve collected some data and observations, if you think you or a loved one might have a sleep breathing problem, it’s time to talk with a health care professional. Ask your dentist if you’re grinding your teeth. Talk to your doctor about your observations and symptoms and the possibility of doing a sleep study. Remember Myth #1 – if you are an athlete, a petite woman, or a generally healthy-looking person, you may have a harder time getting approved for a sleep study. The effort that you put in to Consider and Assess your sleep, will be critical for you here.

And don’t forget Myth #5 either – if you’re forced to start with an at-home sleep study and your average AHI comes back at less than 5, don’t give up. You know the importance of sleep to your overall health, you’ve been tracking the signs and symptoms of sleep-disordered breathing, and you can work with your doctors and/or dentist to get the testing and treatment you need.

Sleep is innate – but it’s not guaranteed. In fact, you should really seize the night, carpe noctem, and only then, will the day be yours.

Dr. Mark Burhenne
TedX Talk – Want to Be Extraordinary? Start with a Straw.

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