The Best Sleep Apnea Treatment Without CPAP
30 million Americans suffer from sleep apnea. How can breathing retraining help?
Imagine a day in the life of Michael, who has sleep apnea. He wakes up from a full night of sleep feeling like he didn’t sleep at all. His mouth is dry and his head is pounding. To wake up, he turns to a sugary double-shot latte for some quick energy. He’s noticed that he’s hungry all the time and doesn’t have any energy to do the things he used to enjoy. He can barely make it through his work day and he keeps himself going with an energy drink after lunch. On the way home, he has trouble not falling asleep behind the wheel. After dinner, he sits down to watch some TV and only realizes he fell asleep when he wakes up just in time for bed. Michael’s wife has trouble sleeping, too, because of his snoring. She’s tried to get him to go for a sleep study, but he replies, “I just can’t wear a mask when I sleep.”
If you have sleep apnea, you may not need to imagine Michael’s experience. Of course, the symptoms of sleep apnea vary from person to person. Women can experience sleep apnea quite differently than men, which can lead to the diagnosis being missed. In children, sleep apnea can cause hyperactivity and it can be misdiagnosed as an attention deficit disorder. However, sleep apnea can significantly affect quality of life in all age groups.
Sleep apnea could be called a modern epidemic. The American Academy of Sleep Medicine states that 30 million Americans suffer from sleep apnea1, while a study from 2019 estimated that 1 billion adults worldwide 30-69 have obstructive sleep apnea2. Once sleep apnea is diagnosed, most are prescribed a machine with a mask (CPAP), which can be difficult to tolerate. If you or a loved one has sleep apnea, keep reading to find out how breathing retraining can be life-changing! I’m first going to talk about what sleep apnea is, what symptoms it can cause, and how it is traditionally treated. However, if you’re the kind of person that likes to skip to the end of the book to get to the juicy ending, in this case, how the Buteyko breathing method is the best sleep apnea treatment without CPAP, please feel free to skip to the last subheading “Breathing Exercises for Sleep Apnea”.
What Is Sleep Apnea?
The first step in understanding sleep apnea is defining the word apnea. An apnea is when breathing stops temporarily and sleep apnea is when this happens only during sleep. This can cause sudden drops in blood oxygen levels. There are different types of sleep apnea:
Obstructive Sleep Apnea (OSA) — This is the most common type of sleep apnea. As the name suggests, the tongue and tissues in the throat relax too much and “obstruct” or block a person’s airway.
Central Sleep Apnea (CSA) — In central sleep apnea, it is the brain that doesn’t send the correct signals to the breathing muscles.
Complex Sleep Apnea Syndrome — For some people with obstructive sleep apnea, when treatment with CPAP (Continuous Positive Airway Pressure) is started central apneas develop or persist. Central apneas can’t be treated with CPAP, so some people have to be treated with a more advanced sleep apnea treatment (see below).
Related Disorders:
Upper Airway Resistance Syndrome (UARS) — In this syndrome, the soft tissue in the throat relaxes and reduces the size of the airway, causing many of the same symptoms as OSA, but sometimes less severe. The increase in breathing effort due to the reduced airway diameter causes brief awakenings throughout the night and the sufferer may not even be aware of this.
Primary Snoring — This very common disorder involves loud snoring without any apnea. Contrary to what some believe, snoring during sleep is not normal. Snoring doesn’t only disrupt one’s bed partner. A 2015 study showed that snorers sleep less, are more tired, and are more at risk for coronary artery disease and depression3.
All types of sleep apnea and related disorders involve unhealthy and dysfunctional breathing during sleep. Most also involve mouth breathing, which comes with its own problem list4.
So, what are the symptoms of sleep apnea? Some of the most common ones are in adults are:
Snoring
Excessive daytime sleepiness
Fatigue
Restless sleep
Unrefreshing sleep
Sudden gasping or choking feeling during sleep
Morning headaches
Morning dry mouth or sore throat
Insomnia (difficulty falling or staying asleep)
Irritability
Difficulty focusing
Night sweats
Memory issues
Depression or anxiety
Sexual dysfunction
Needing to go to the bathroom frequently at night
The symptoms can be different in children:
Snoring
Hyperactivity
Attention problems
Behavioral issues
Poor performance in school
Sleepy or sluggish
Restless sleep
Gasping or choking during sleep
Mouth breathing
Unusual sleeping positions
Bedwetting
Night sweats
That’s quite a list of possible symptoms, isn’t it? Sleep apnea and associated disorders seriously affect both the physical and mental quality of life of the sufferers5. Moreover, untreated sleep apnea strains the cardiovascular system and can lead to other serious problems like high blood pressure, heart problems, and type 2 diabetes. People with sleep apnea are at a higher risk of having a car accident, due to falling asleep at the wheel6. Additionally, leaving sleep apnea untreated can cause other coexisting conditions, like asthma or COPD, to get worse or to flare up. So, how is sleep apnea typically treated*?
Sleep Apnea Treatment Options
CPAP
The gold standard for treating obstructive sleep apnea is a CPAP, or Continuous Positive Airway Pressure. CPAP is also used to treat UARS. The positive pressure, which feels like a strong wind, is delivered by means of a mask that fits on the nose or over the nose and mouth. The pressure “stents” open the airway, or keeps the airway open, thus preventing apnea. This treatment is very effective if a person can tolerate it. Some of the challenges CPAP users face are intolerance of the pressure (air blowing), or the mask, air leaks, skin redness or pressure sores from the mask, dry nose or mouth, nose bleeds, air swallowing, etc. While a skilled sleep professional can often help with these issues, many patients get discouraged and stop using their CPAP or use it infrequently.
BiLevel
Also commonly known as BiPAP™ (a Philips Respironics tradename), Bilevel therapy uses the same types of masks, but instead of having the same pressure during inhalation and exhalation (breathing in and breathing out), there is a higher pressure during inhalation than during exhalation. BiLevel may be prescribed if a person with OSA is unable to tolerate the CPAP pressure or if someone has CSA or Complex Sleep Apnea. BiLevel users face the some of the same challenges that CPAP users have.
Inspire®
Inspire® is a device which is surgically implanted. It is used for people 18 or older with moderate to severe OSA that cannot tolerate CPAP. It works by stimulating the hypoglossal nerve to keep the airway open.
remedē®
This is another device that is surgically implanted, but this device treats moderate to severe CSA. This device “stimulates a nerve in the chest (phrenic nerve) to send signals to the large muscle that controls breathing (the diaphragm)”7.
Oral Appliances
Oral appliances can be an option for people with mild to moderate OSA. These devices are worn in the mouth during sleep and can stop the tongue from blocking the airway and/or move the jaw forward. Although these devices are typically easier to tolerate than CPAP, they can cause bite changes, jaw or tooth pain, or excessive drooling.
As you can see, there are a number of treatment options for these disorders. While many have found these treatments to be effective and have found symptom relief, none of these traditional treatments for sleep apnea address one of the sources of breathing dysfunction – breathing too much or over-breathing. Only by retraining your breathing during the day can you address this root problem†. This can improve, not only your sleep apnea, but also other conditions that can go hand in hand with sleep apnea, like high blood pressure, fatigue, insomnia, asthma, COPD, diabetes, etc. This breathing retraining is called the Buteyko breathing method. Read on to find out about this method which does not involve any masks, machines, surgeries, or devices!
Breathing Exercises for Sleep Apnea
Proponents of the Buteyko breathing method suggest that many health issues, including sleep apnea, are caused by breathing too much, or over-breathing. This may sound strange at first, since in our culture we are often encouraged to take big breaths to be healthy. However, just as we can eat too much, drink too much, or even sleep too much, breathing too much also has health consequences.
What exactly does the Buteyko breathing method involve? It simply includes breathing exercises that are done several times per day. The Advanced Buteyko® method uses a cutting-edge app for both iOS and Android to guide students through the process. It is recommended to learn the method with the help of an instructor, because, while simple to practice, it does take skill and knowledge to apply the method correctly. I personally tried to do Buteyko on my own and failed, although I’m usually pretty good at self-learning. It was only when I took a course and my instructor customized the method to me and my health challenges that I was able to do it effectively.
So how does this relate to sleep apnea, if the exercises are done during the day and sleep apnea happens at night? Specifically in sleep apnea and snoring, heavy and fast breathing throughout the day means that pattern will continue at night. At night, all of our muscles are more relaxed, including the muscles of our upper airway, which can make the airway more prone to collapse. When this is combined with heavy breathing, especially through the mouth, the turbulence from this type of breathing can cause snoring. Large volume inhalations also create negative suction pressure, which can cause the airway to collapse and block.
Therefore, by retraining breathing patterns during the day through regular practice, the natural breathing pattern changes even during sleep. Breathing becomes calm and light and a person learns to breathe through the nose day and night. If you’re interested in more of the science behind how Buteyko breathing helps sleep apnea, you can read this article.
But the real question is, will the Buteyko breathing method help me feel better, right? According to a 2010 survey of Buteyko breathing practitioners conducted by the Buteyko Institute of Breathing & Health greater than 95% of clients had a “significant improvement in sleep” after taking a Buteyko breathing course and about 80% were able to stop using their CPAP machine7.
Often people who use an AutoCPAP machine will start to see their average pressures decrease as they make progress practicing Buteyko or snorers will report that their partner hears them snore less and less. They report other symptom improvements, like better quality of sleep, more energy, less sleepiness or fatigue, fewer headaches, appetite reduction, improved calm, and more.
The Buteyko breathing method uses an easy test you can do with just a timer. This video will teach you step-by-step how to do the test and interpret your results, so you can see if Buteyko breathing might be for you.
Have you tried CPAP and found you couldn’t tolerate it? Or have you hesitated even to get tested for sleep apnea, out of fear of having to wear a mask at night? Or maybe you wear your CPAP every night, but you still wake up tired and struggle with other health issues. Then Buteyko breathing could be just the next step you’ve been looking for. Why not schedule a free consultation today? There’s no obligation and it could be your gateway to a life without snoring or sleep apnea!
Korina
Buteyko Breathing Instructor, Registered Respiratory Therapist, and Certified in Clinical Sleep Health
* This is an overview of sleep apnea treatment options, not an all-inclusive list.
† Another root cause of OSA is a narrowed upper airway (the nose, mouth, and throat). However, even in this case, implementing the Buteyko breathing method by breathing slowly and softly can reduce breathing turbulence and improve OSA.
