Written by Garett Reid | NSCA, CSCS, CISSN, M.S.E.S.S
Fact checked by Kiel DiGiovanni, Co-founder
FACT CHECKED
Being overweight and inactive can and will bring about a host of medical problems. Everything from diabetes to heart disease. However, there's another silent killer that's affecting up to 20% of Americans: sleep apnea.
Sleep apnea is a type of breathing disorder that occurs while sleeping. When a person suffers from sleep apnea, they may experience fatigue, weight gain, and drops in mood. However, the effect of sleep apnea can be much more serious and even result in death when it goes untreated.
There are various methods to treat apnea, such as a CPAP machine, but the most effective means and the only true way to stop apnea is by working out to lose weight and build muscle. At the same time, having sleep apnea can make working out harder and mess with your fitness, creating a vicious cycle. Here's what you need to know about sleep apnea.
What Is Sleep Apnea?
Sleep apnea is a sleep disorder characterized by repeated interruptions in breathing during sleep. These interruptions, called apneas, can last a few seconds to minutes and often occur multiple times throughout the night. During each apnea, a person's breathing pattern becomes disrupted, resulting in very shallow breathing or complete cessation.
While we usually refer to "sleep apnea" in the singular, there are actually two different types. The first type, obstructive sleep apnea, is the most common and is primarily caused by being overweight and inactive.
Obstructive sleep apnea is caused by excessive relaxation of the muscles at the back of the throat during sleep. This relaxation causes the airway to become partially or completely blocked, disrupting breathing.
The other type is known as central sleep apnea (CSA). CSA is a neurological disorder in which the brain stops sending the correct signals to breathe correctly. Basically, those with CSA will temporarily stop breathing because their brain repeatedly fails to send that signal to the body to keep breathing. There are several causes for this, such as head injuries, but can also be caused by certain drugs and narcotics.
Both can be terrifying stuff when you realize the loud snoring is basically someone gasping for air.
What are The Symptoms Of Sleep Apnea?
The symptoms for each are very similar. However, as obstructive sleep apnea is the most common and is heavily influenced by lifestyle behaviors, we will concentrate on that.
With that, here's a quick, non-exhaustive list of symptoms;
- Loud snoring
- Observed episodes of stopped breathing during sleep, which can lead to choking in the middle of the night (need a partner to observe)
- Abrupt awakenings with gasping or choking
- Excessive daytime sleepiness due to nighttime sleep loss
- Awakening with a dry mouth
- Awakening with a sore throat or choking
- Morning headaches
- Difficulty concentrating during the day as sleep loss affects cognitive function
- Mood changes, including depression or irritability
- Increased likelihood of accidents because of impaired cognitive ability, balance, and coordination
- Memory problems
Note that some of these are direct symptoms (snoring, gasping) while others are secondary symptoms caused by the lack of sleep (headaches, memory issues).
Of all these, excessively loud snoring is the most obvious and reported symptom of sleep apnea. However, it's essential to understand that not all snoring means apnea. When people try to describe it, it's one of those "you'll know when you hear it" types of things. The snoring is reportedly a very deep, rattling, and gasping type of snore.
The most commonly reported effect of sleep apnea is elevated fatigue and sleepiness during the day. Sufferers report that they never feel rested and are often sleepy. If you know someone, usually a male, who falls asleep the moment they sit down and watch some TV, they may have sleep apnea.
Risks Of Sleep Apnea
We often laugh at those who snore, but sleep apnea is no joke. If you're lucky, the worst thing that happens to you if you have sleep apnea is that you'll be tired. If left untreated, it can get much worse.
Sleep apnea leads to hypoxia, a condition in which the body has low oxygen levels. This triggers a stress response, causing the heart to beat faster and the arteries to constrict.
The cardiovascular effects of sleep apnea include:
- Increased blood pressure
- Elevated heart rate
- Higher blood volume
- Greater inflammation and stress
The accumulation of these factors has numerous effects. For example, a person's cardiovascular health can drop significantly with an increase in the risk of cardiovascular events.
For example, a 2010 study found that sleep apnea can almost double or triple the risk of stroke.¹ At the same time, the Yale School of Medicine reported that sleep apnea can raise the risk of heart attack or death by 30% over four to five years!²
These are just a couple of studies that show sleep apnea significantly increases the risk of death from heart-related complications. This includes sudden cardiac death.
It's important to understand this connection as sleep apnea is rarely the direct cause of death, as in a person suffocates in their sleep. However, it's often associated with these adverse effects. It's been estimated that 60% of people with heart failure also suffer from sleep apnea. In addition, those treated for both conditions had a higher two-year survival rate than those without.
The National Sleep Foundation also notes a connection with individuals who suffer from sleep apnea and atrial fibrillation, an irregular heart rhythm.³ When both are treated, the likelihood of additional heart treatment drops to 40%. If sleep apnea is left untreated, the need for further treatment for atrial fibrillation increases to 80%.
Research has also linked sleep apnea to various metabolic disorders such as insulin resistance and type 2 diabetes.⁴ This correlation is so large that it's believed that people with sleep apnea are more than twice as likely to develop diabetes compared to those without the condition. This has even been found to be true regardless of your BMI.
Sleep Apnea Can Kill You
As mentioned, while sleep apnea often plays a contributing factor to various health conditions that result in death, it's rarely the direct cause. Unfortunately, it does happen. In fact, there are quite a few famous individuals, as well as athletes, who have died due to sleep apnea.
For example, the Reggie White Foundation was established to promote research and spread awareness of sleep apnea. Further, it assists with diagnosing and purchasing medical equipment to treat sleep apnea. This is due to the major role that sleep apnea played in Reggie White's death.
Another athlete affected by sleep apnea was Strongman Mike Jenkins. Like many professional Strongman athletes, Mike was massive at around 400lbs. This size is definitely going to have an impact regardless of how much muscle you have.
Regardless, he passed away on November 28, 2013, in his sleep due to a cardiac event. He was using various PEDs, which likely played a role as well, but he had been having issues due to sleep apnea. In a cruel twist of fate, he had reportedly been prescribed a CPAP machine earlier in the day the night he passed.
3 Ways Sleep Apnea Affects Building Muscle & Fitness
What you're going to realize is that once you have sleep apnea, you enter a cyclical problem. Maintaining a healthy weight and exercising is the best way to prevent sleep apnea. However, if this is not done, a person can gain excess weight and experience sleep apnea.
Sleep apnea makes a person more tired, increases fatigue, and makes it harder to lose weight and build muscle. This, in turn, causes an increase in weight; from here, you can wind up in a downward spiral.
Therefore, your best bet is to stay in shape. If you don't, here's a better look at how sleep apnea will affect your fitness.
1. Promote Muscle Loss Over Fat Loss
Sleep apnea's primary mechanism for disrupting sleep is wreaking havoc on fitness levels. However, this goes further than just being tired; another issue.
Getting either a lack of sleep or low-quality sleep has a strange effect on body composition. Research shows that a person with a caloric deficit will lose the same amount of weight even if their sleep is poor.⁵ However, what changes is where the weight loss comes from.
Studies have shown that missing just a couple hours of sleep a night will promote the loss of muscle rather than fat as you sleep. Specifically, you could burn up to twice as much muscle mass when sleep is affected by sleep apnea!
2. Decrease Hormone Production
The anabolic hormones responsible for muscle growth, such as testosterone and growth hormone, are secreted while you sleep. What this means is that if you don't get sleep, you lose out on their secretion – the body doesn't release more during the day to catch up.
With a drop in these hormones due to sleep apnea, your muscles will suffer from lower muscle protein synthesis and recovery processes.
In addition, this alteration in hormone levels is believed to cause an increase in appetite during the day and overeating.⁶
Related: How To Boost Testosterone Naturally
3. Decrease Activity Levels With Increased Fatigue
Training takes energy. We've all had days where we wish we had gotten another hour of sleep, and our training just lags. It happens occasionally, and when it's that, once in a while, it's not a big deal.
However, a person with sleep apnea can always be like this. Having your training always blunted by fatigue will eventually result in blunted muscle growth and strength gains.
How To Identify Sleep Apnea?
Identifying sleep apnea can be tough, especially if you sleep alone. However, there are signs. The first sign is a significant increase in fatigue and tiredness even though you know you're getting enough, or at least you think so.
You'll probably be tired if you go out all night and only get a few hours of sleep. However, if you get a regular 7-8 hours of sleep yet still feel tired all day, there's a chance it's due to sleep apnea.
Another sign is if you seem to wake up often during the night or experience disturbances. When your body isn't able to breathe, it can send a signal to wake you up. Another possibility is you take a big gasp of air and can wake yourself up through your own snoring.
Other than these, your breathing pattern while you sleep and excessive snoring will likely be the biggest tell.
Normal Snoring Vs. Sleep Apnea Snoring
Now, if you have a partner, they'll probably tell you. Sometimes, the snoring can get so bad that the other person can't sleep in the same room. You could also take an audio recording of your sleep and check it in the morning if you're concerned.
However, we need to remember this isn't a joke. If you have a partner disturbed by your snoring, ask them about it and ask for details other than that it's loud. Specifically, you want to see if they notice you go through short periods when you stop breathing.
Normal snoring may annoy another person, but it's harmless otherwise. You can tell if it's normal because it will be more rhythmic and occur with a regular breathing pattern.
On the other hand, sleep apnea snoring can be very irregular in both timing and intensity. A person will generally stop breathing for an extended duration, sometimes 10 seconds and sometimes 30, some even longer. This is then followed by an extra loud snore, which is hard to ignore.
Here's a video on YouTube. This man has a recording of his snoring. Up until about the 1:09 mark, he's snoring normally. You'll hear him stop breathing for about 30 seconds and then take a big gasp of air.
In addition, the snores are random and can sound deeper, as if the person is having trouble breathing.
4 Ways To Treat Sleep Apnea
The good thing about sleep apnea is that it's relatively easy to treat once diagnosed. We'll go over the most common treatments.
1. CPAP Machine
The most common sleep apnea treatment is using a continuous positive airway pressure machine (CPAP). Have you ever seen a guy wearing what looks like a full-face mask like a fireman? That's a CPAP machine.
These machines create pressure that maintains an open airway while you sleep. As long as you're wearing one, you should be able to breathe normally and have quality sleep. The main issue with these is the comfortability of wearing a CPAP mask. Sleeping may be awkward when you first start wearing one, but most people get used to it.
There's also another machine similar to a CPAP known as BiPAP, or bilevel positive airway pressure. It's similar to a CPAP, except it alters the pressure depending on whether you inhale or exhale.
Regardless, CPAP is the most effective, but if you're in the USA, you'll need to get a prescription from a doctor to buy one.
We'll discuss some other treatments, but we strongly suggest you start by trying to obtain a CPAP machine, as it provides immediate relief. You can then use this in conjunction with other treatments; this is especially important if you have advanced sleep apnea.
2. Medication
Even though CPAP is highly effective, many people just don't want to wear a mask at night. These people often seek medication. Unfortunately, as of today, there aren't any specific medications for sleep apnea.
But that might change soon. Currently, there's a medication known as AD109 that shows promise. It contains two drugs: aroxybutynin, which is used to treat symptoms of an overactive bladder, and atomoxetine, which is used to treat attention deficit hyperactivity disorder.
However, it's currently in phase III of trials and has shown meaningful results, so this may be an option in the future.
3. Change Lifestyle Behaviors
Now, let's talk about things you can start doing today for free. There are quite a few things you can start doing today to reduce your risk of sleep apnea.
- Quit tobacco smoking
- Minimize alcohol
- Avoiding sleeping pills
- Refrain from using sedatives and tranquilizers prescriptions
- Use a humidifier
- Use nasal decongestants
- Sleep on your left side
- Don't use opiates (especially before sleep)
As you can see, many of the things that can cause sleep apnea have to do with excessively relaxing the muscles.
4. Lose Weight And Begin A Training Program
Of everything you can do, the most effective thing you can do is lose weight and start a regular exercise program.
Multiple studies have found that exercise can help treat sleep apnea in those who suffer from it. Some studies have shown that this can be true even without weight loss!⁷ These studies have shown a reduction in the severity of sleep apnea and daytime sleepiness. This does not mean you don't need to lose weight, but starting a fitness program can provide some relief until you lose weight.
We should note that both resistance training and aerobic exercise have this effect. However, some indicate that aerobic exercise has a greater effect. This is just one more reason you shouldn't be skipping out on your aerobic exercise!
Again, we strongly recommend you get a CPAP along with your training program. This will help you get sleep immediately, which results in more energy during the day, better workouts, and healthier eating. This will help you lose weight faster so that you can eventually get off a CPAP machine.
Related: Best 4 Week Meal Plan For Weight Loss
How To Train With Sleep Apnea
Many people with sleep apnea may be concerned about training. Do you need to take any special precautions?
The available research doesn't suggest so. The only time you may need to modify your training is if you suffer from a cardio or heart issue due to sleep apnea. However, you can train as usual if you're simply tired from sleep apnea.
The primary obstacle will be being tired. Some people may find that taking a pre-workout helps increase their energy levels to get to the gym. This is a personal choice, but it could help motivate you to get to the gym.
Other than that, we recommend you start increasing your daily activity. Even if you don't go to the gym, get in your cardio or at least steps. Increasing to 10,000 daily steps has been shown to be a major determinant of weight loss.
This can be hard when you first start but keep in mind, it will get easier.
Take Your Sleep Apnea Seriously
We often laugh at snoring, but it can be a sign of a much more serious issue, such as sleep apnea. If you think you may be suffering, you need to get it checked out ASAP, as it will only get worse if nothing is done about it.
Other than seeing a doctor and getting a CPAP, your first action should be to get in the gym, watch your diet, and lose weight. Living with sleep apnea can be much more detrimental than you may think, and dealing with it can literally change your life. The number of people who report having their lives turned around is astounding. It will improve every aspect of your life – mental health, mood, energy levels, body composition, sex life, cognition, literally everything.
Want to improve your sleeping? Check out our post the Best Sleep Routine To Maximize Recovery!
References
- Redline, Susan, et al. “Obstructive Sleep Apnea–Hypopnea and Incident Stroke.” American Journal of Respiratory and Critical Care Medicine, vol. 182, no. 2, 15 July 2010, pp. 269–277, www.atsjournals.org/doi/full/10.1164/rccm.200911-1746OC, https://doi.org/10.1164/rccm.200911-1746oc.
- “Sleep Apnea Increases Risk of Heart Attack and Diabetes.” YaleNews, 24 May 2007, news.yale.edu/2007/05/24/sleep-apnea-increases-risk-heart-attack-and-diabetes.
- Newsom, Rob. “Is Sleep Apnea Connected to Heart Disease?” Sleep Foundation, 5 Feb. 2021, www.sleepfoundation.org/sleep-apnea/sleep-apnea-linked-heart-disease.
- Emsellem, Helene A., and Karen E. Murtagh. “Sleep Apnea and Sports Performance.” Clinics in Sports Medicine, vol. 24, no. 2, Apr. 2005, pp. 329–341, https://doi.org/10.1016/j.csm.2005.01.002.
- Wang, Xuewen, et al. “Influence of Sleep Restriction on Weight Loss Outcomes Associated with Caloric Restriction.” Sleep, vol. 41, no. 5, 9 Feb. 2018, https://doi.org/10.1093/sleep/zsy027.
- Emsellem, Helene A., and Karen E. Murtagh. “Sleep Apnea and Sports Performance.” Clinics in Sports Medicine, vol. 24, no. 2, Apr. 2005, pp. 329–341, https://doi.org/10.1016/j.csm.2005.01.002.
- Emsellem, Helene A., and Karen E. Murtagh. “Sleep Apnea and Sports Performance.” Clinics in Sports Medicine, vol. 24, no. 2, Apr. 2005, pp. 329–341, https://doi.org/10.1016/j.csm.2005.01.002.
Garett Reid
Author