Plummeting testosterone? Can’t remember things you should? Depressed, anxious, overweight, pre-diabetic or diabetic?
If you suffer from apnea or sleep disordered breathing, your brain may be partially to blame. Obstructive apnea means your tongue periodically blocks your airway at night. It suggests poor tone in your upper airway muscles. You must wake up to breathe every time this happens, often hundreds of times a night. If you snore, it may be only a matter of time before you progress to apnea – and don’t be too sure you don’t already have apnea because the consequences are severe and seem to extend to every facet of your health. Before you rush to denial, keep in mind almost no one realizes their sleep is interrupted by apnea unless they’ve had a partner’s tip off or a formal sleep study.
With every sleeping breath, your tongue moves forward slightly away from your airway, but during rapid eye movement sleep cycle (REM), only eye and diaphragm (breathing) muscles remain unparalyzed. If your lower jaw did not develop forward as it should (often due to poor oral posture – read Facial Meltdown), you continue to have poor oral posture, or you are overweight, your tongue is less able to move out of your airway to breathe no matter how forceful your tongue is. As I’ve written elsewhere, a scalloped tongue border indicates your tongue is trying to move out of your airway so you can breathe without obstruction.
If you are a male or a female past menopause, risks elevate. If you drink alcohol less than two hours before bedtime, choking on your tongue is much more severe.
Sleep Disruption and Your Hormones
If you wake up constantly during the night to breathe, you must continuously re-start hormone production critical to your ability to survive. While men may be dismayed by plummeting testosterone levels, important hormonal changes from fragmented sleep don’t stop there.
- Human Growth Hormone (HGH) levels sink. HGH is an expensive supplement favored by those who want to slow aging, lose body fat, or improve sports performance. Supplements are an inferior substitute for your own natural hormone production.
- Leptin levels also plunge if you have apnea. Leptin levels are significantly dependent on sleep cycles. Leptin is a hormone released by fat cells that tell your brain you are full.
- To further confuse appetite signals, ghrelin levels rise. Ghrelin is an appetite stimulant that particularly selects for high carbohydrate foods (sugars, breads, and other starchy foods). If you are on a calorie restriction weight loss plan, you face a huge uphill battle if you don’t consider you might have apnea.
- Cortisol levels skyrocket. Cortisol is the ultimate stress hormone and is produced by the sympathetic nervous system. Face it. Nothing matters more to life than breathing. Fighting for your life all night is like being chased by tigers. Cortisol levels should naturally drop to their lowest levels during sleep so your body can repair itself. Cortisol is the primary reason stress kills. It pours sugars into your bloodstream, decreases bone density, suppresses your immune, digestive and reproductive systems and restricts learning and memory. It promotes depression, diabetes (insulin resistance), and heart disease. When your sympathetic nervous system is driving, fatty acid blood levels rise, and you’re more likely to have a fatty liver.
- Thyroid stimulating hormone (TSH) markedly drops. TSH is part of a chain of hormones that regulates metabolism – how fast or slowly your brain, heart, muscles, liver, and other parts of your body work. If your organs work too fast or too slowly, you don’t feel well. For example, if you lack sufficient thyroid hormone, you might feel tired, cold, or depressed.
These changes are particularly hard on people with heart conditions and newborns. For example, a rodent study shows damage to the pancreatic cells that produce insulin after just a few hours of fragmented breathing. If you have obstructive sleep apnea, it is almost a guarantee you will have high blood pressure. An obese male with diabetes will probably have moderate to severe obstructive apnea. Obstructive apnea also increases atrial fibrillation – you might feel your heart thumping wildly in your chest at times.
A recent study shows 75% of obese Type II Diabetics have moderate to severe OSA. The rest have mild OSA. Two hours of sleep deprivation leads to a 50 mg/dl rise in blood sugar.
Recall from Facial Meltdown, that if your tongue isn’t suctioned to the roof of your mouth, it also isn’t pushing on the chain of bones that signal the pituitary to release growth, thyroid, sex, and blood pressure regulating hormones.
Decreased Oxygen Delivery to Your Brain Kills Cells
Another reason health goes haywire if you have apnea is that decreased oxygen delivery to your brain kills off enormous areas of it. Ron Harper, a UCLA neurobiologist who studies brain effects from apnea says, “During an apnea episode, which can happen many times an hour, the brain’s blood vessels constrict, starving its tissue of oxygen and causing cellular death. The process also incites inflammation, which further damages the tissue. The fact that patients’ memory problems continue despite treatment for their sleep disorder implies a long-lasting brain injury.” He hopes taking supplemental vitamin B1 may help to restore sleep apnea patients’ memory. The vitamin helps move glucose into cells, preventing their death from oxygen starvation.
Researchers show brain tissue loss in brain regions that regulate memory, thinking, mood [depression and anxiety], hormones [significant drops in testosterone from tissue death in the hippocampus brain region], metabolism [diabetes], and blood pressure, high or low.
The Insular Cortex and the Cerebellum
The insular cortex is one part of the brain apnea is known to suffocate. For instance, if you get up from a chair and feel dizzy or faint, it means the signal from your insular cortex that raises blood pressure was too slow or insufficient. Apnea may be an underlying cause. Oxygen deprivation from apnea also hits your cerebellum hard. Your cerebellum directs precise speech, attention, equilibrium, motor learning, and smooth muscle coordination; in this case, poor guidance of the smooth muscles of your diaphragm and upper airway encourage apnea to worsen in a negative feedback loop. [Macey P, Kumar R, Woo M, et al. Brain Structural Changes in Obstructive Sleep Apnea. Sleep. 2008 Jul 1; 31(7): 967-977.]
Cell Death and Depression and High Blood Pressure
Studies show that apnea can damage parts of the brain stem such as the ventrolateral medulla, which helps control blood pressure, breathing, and depression, and the anterior cingulate, which also plays a role in depression. Those with OSA usually have dangerously low thiamine (B1), B12, potassium, and magnesium deficiencies. Thiamine ferries carbohydrates like bread and sugars into cells. If you have apnea, cells are less able to accept sugars from simple carbohydrates like sugars, breads and other starchy foods. This is called insulin resistance. [Image:Macey et al, AJRCCM, 2002; Sleep, 2008]
Apnea, Alzheimer’s, and Alcoholism Have Destruction of This Part of the Brain in Common
Destruction to mammillary bodies in the brain from apnea mimic the shrunken mammillary bodies of patients suffering memory loss from other syndromes, including alcoholism and Alzheimer’s disease. Image courtesy of Acerland International, 2009]
Get tested for obstructive sleep apnea if you:
- Snore loudly especially if your partner sleeps in another room due to loud persistent snoring or notes you stop breathing or gasp during the night
- If you wake up repeatedly at night
- Wake up tired or with a headache
- Have high blood pressure
- Are overweight
- Have diabetes
- Have a weak jaw or had retraction orthodontics, especially if you had four bicuspids removed
- Have a scalloped tongue upon awakening
- Clench your teeth
- Have acid reflux
- Your tongue feels too big for your mouth
- Have Forward Head Posture (your ear canal doesn’t line up with your shoulder bone)
- Wake up with a very dry mouth
If you do have apnea, consider myofunctional therapy to tone upper airway muscles, train your tongue to attain suction to the roof of your mouth, and to keep a lip seal even during sleep. It is a great adjunct no matter what other therapy you choose to open your airway at night. If you are time or economically challenged, consider renting my self-paced Myofunctional Therapy Companion Video. You can learn more about it here.
Myofunctional therapy plus a C-Pap is the gold standard, but for those who can’t/won’t use one, there are dental solutions, though you must keep in mind dental devices do change the relationship of the upper teeth to the lower teeth over time and reduce space for your tongue in the long run. We shouldn’t have to choose between airway and a major invasive surgery, but many of us must. Had I chosen to move forward with surgery for myself, I would have traveled to see Reza Movahed for his highly gifted hands, mind, and heart and his dedication to helping people regain their airways.
Whatever you choose to do, don’t hesitate to act! All cells of your body are at risk!
Acknowledgements go particularly to Dr. Ron Harper for his dedication to studying this subject and sharing. He, in turn, generously credits the National Institutes of Health’s Heart, Lung, and Blood Institute, the Nursing Institute, and the National Institutes of Child Health and Human Development. He works closely with Dr. Paul Macey, Dr. Rajesh Kumar, Mary Woo, Edwin Valladares, Dr. Frisca Yan-Go, J. Ogren, and R. Cross.
 Kumar R, Lee K, Macey P, Woo M, Harper R. Pediatric Research (2009) 66, 429-434; doi:10.1203/PDR.0b013e3181b3b363 http://www.nature.com/pr/journal/v66/n4/full/pr2009229a.html
Limited Availability: apologies in advance for the impossibility of answering/researching all personal e-mail queries or comments posted to various blogs. I will however selectively answer those of a general nature so readers can benefit from other’s questions. Please note: Carol Vander Stoep is a dental hygienist. Just as a dentist may not legally diagnose or offer personalized dental treatment advice via the Internet, neither may she. Carol will not dispense dental/medical advice via email – if you have dental concerns, please schedule a consultation with a dental professional whose philosophy most closely aligns with yours. Mouth Matters and Primal Dentistry books and database as well as this website is an offering to help enlighten you about possible considerations and choices.
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