Sleep Apnoea: Causes, Effects and Solutions

I’m starting to wonder whether, in one, two or three years from now, most of my private clients will be coming to see me for breathing education and support, perhaps alongside a holistic treatment such as Indian head massage or reflexology. It certainly feels as though things are heading that way.

Since qualifying as an Oxygen Advantage Advanced Instructor this spring, I have become even more fascinated by the role breathing plays in our health, our nervous system and, increasingly, our sleep. It's great to share this knowledge with my clients that are booking in for breathing tuition and health coaching.

After all, what can we not live without for more than a few minutes? Air. We can go a few days without sleep, food or water, but the same cannot be said for air. And yet, although we are all breathing, that does not necessarily mean we are breathing particularly well.

The more I learn from the breathing research, and the more I observe in my own work, the more I notice how common inefficient breathing patterns are. Mouth breathing, noisy breathing, fast breathing, excessive sighing and breath holding are all surprisingly common, and our breathing habits do not necessarily switch off when we go to bed.

This brings me to a condition I would like to put under the spotlight: obstructive sleep apnoea. It is a much bigger issue than many people realise. A landmark study published in The Lancet Respiratory Medicine estimated that around 936 million adults aged 30 to 69 worldwide may have mild to severe obstructive sleep apnoea, with approximately 425 million experiencing moderate to severe OSA.

Even more striking is how many people may have it without knowing it. Previous estimates from the American Academy of Sleep Medicine suggest that a very large proportion of adults with sleep apnoea remain undiagnosed.

So, what actually is sleep apnoea?

An apnoea is a pause in breathing lasting at least 10 seconds. Most of us probably have the occasional little breathing pause during the night without ever knowing about it, and an isolated pause is not necessarily a problem. The concern is when breathing is repeatedly interrupted throughout the night.

With obstructive sleep apnoea, the upper airway becomes narrowed or completely blocked while you are asleep. You continue trying to breathe, but air cannot move freely through the airway. Eventually, your brain responds to the lack of airflow and you partially wake up, your airway opens, and breathing resumes. You may gasp, snort or take a much louder breath before settling back into sleep.

The fascinating, and rather frustrating, thing is that you may have no memory of any of this happening. Your partner, however, might! They may tell you that you stopped breathing during the night, or that your breathing became very loud, raspy or laboured before you suddenly gasped and started breathing again. Sometimes it is your partner who notices the problem before you do.

There are other clues too. Perhaps you sleep for seven or eight hours but rarely wake feeling refreshed. You might have a dry mouth or blocked nose in the morning, wake with a headache, struggle with concentration during the day, feel unusually tired or find that your mood and emotional resilience are not quite what they used to be. These can all be signs worth paying attention to.

Why does the airway close?

There is not one single answer. The muscles and soft tissues that support the upper airway relax during sleep, and in some people this allows the airway to narrow or collapse. Sleeping on your back can make things worse, as can alcohol, nasal congestion and certain anatomical features. Weight, age and family history can also play a role.

This is where I find the work of Patrick McKeown and the principles behind Oxygen Advantage particularly interesting. The upper airway is not simply a passive tube. It is supported and stabilised by muscles, and the way we breathe can influence what is happening around the airway. If your daytime breathing is consistently fast, heavy, noisy or predominantly through your mouth, it is worth asking why.

Are you congested?

Are you habitually mouth breathing?

Are you breathing more than your body actually needs due to nervous system arousal (chronic acute or low grade activation of your fight and flight response)?

Are you holding tension around your jaw, neck and upper chest?

Is your breathing audible when you are simply sitting quietly?

These observations can tell us something about your breathing pattern.

I talk about this in my Transform Your Sleep talk, and I explore it with several private clients each week. One of the things I find particularly useful is looking at what happens during the day, rather than focusing exclusively on what happens once your head hits the pillow.

How you breathe during the day will influence how you breathe at night, and this is one of the reasons I find breathing education so interesting. We cannot simply separate our breathing into "daytime breathing" and "sleep breathing". Our nervous system, airway, posture and breathing habits are interconnected.

That does not mean that every person with sleep apnoea simply needs to learn to breathe through their nose and the problem will disappear. Sleep apnoea is a medical condition with multiple contributing factors, and if you suspect you have it, I would always encourage you to speak to your GP and seek appropriate assessment.

The NHS can arrange a sleep study, which can be fascinating in itself. You may be given equipment to take home and wear overnight so that your breathing, heart rate and oxygen levels can be monitored while you sleep. If you are diagnosed with obstructive sleep apnoea, you may be offered CPAP, which stands for continuous positive airway pressure.

CPAP uses a mask to deliver a gentle flow of air that helps keep the airway open while you sleep, and it is an important and effective treatment for many people with OSA.

CPAP does not suit everyone, though. Some people find the mask uncomfortable, experience dryness or problems with mouth leakage, or simply struggle to wear it consistently throughout the night. This is not a criticism of CPAP. It is an effective treatment, but like any treatment, adherence matters. If you cannot comfortably use something night after night, it becomes much harder for it to do its job.

There are other approaches too. For some people, sleeping on their side rather than their back can reduce sleep apnoea events. Positional therapy can be useful, and there are various pillows and devices designed to discourage back sleeping. Mandibular advancement devices, which gently bring the lower jaw forwards, are another established treatment for some people. Addressing alcohol intake, smoking, weight where appropriate and nasal obstruction may also form part of a broader treatment plan.

Weight is another important factor to consider. If someone is carrying excess weight, losing weight can have a significant effect on obstructive sleep apnoea. Patrick McKeown cites a randomised study of 72 predominantly male participants with mild OSA, who weighed around 97 kg on average. Those who lost approximately 11 kg had a 76% lower risk of OSA compared with the control group.

That doesn't mean that everyone with sleep apnoea needs to lose weight, or that weight is the only factor involved. Sleep apnoea can affect people of different body shapes and sizes, and factors such as airway anatomy, nasal obstruction, sleeping position, age and breathing habits can all play a role. But if excess weight is a contributing factor for you, it is certainly worth addressing.

You may also have come across mouth taping online. This is something I would approach with caution, particularly if you have diagnosed or suspected sleep apnoea.

Fully covering the mouth prevents exhalation through the mouth during sleep. For some people, especially those with moderate to severe sleep apnoea, it is important to have the option to breathe through the mouth if needed – an ‘escape hatch’. Completely sealing the mouth with tape could interfere with this natural mouth-puffing response and potentially worsen breathing during sleep.

This is one of the reasons I rate MyoTape. Rather than completely covering the mouth, it sits around the lips, leaving an opening in the middle. This means you can still open your mouth to take a breath if needed, take a sip of water or talk, while the tape gently encourages the lips to stay together and nasal breathing to become the default.

If you have diagnosed or suspected sleep apnoea, I would not recommend simply taping your mouth shut at night without first understanding what is happening with your airway and why you are mouth breathing. Improving nasal breathing can certainly be part of breathing education, but it needs to be approached sensibly and individually.

Where does my work fit into all of this?

I am not officially diagnosing sleep apnoea because I'm not a Doctor, and breathing education is not a replacement for appropriate medical care. What I can do is help you understand your breathing habits and explore whether there are dysfunctional patterns that may be worth addressing.

Through my Oxygen Advantage training, I have various ways of assessing breathing, and from there I can teach personalised exercises designed to help you develop quieter, gentler and more efficient nasal breathing and better breathing control.

I find it helpful to come back to the question: why are you not breathing well at night?

If your airway is repeatedly becoming restricted, what is contributing to that?

Is it your sleeping position?

Nasal obstruction?

Mouth breathing?

The way your upper airway is structured?

A combination of factors?

And what, if anything, can you influence?

Those are the questions I can help you explore.

If you regularly wake feeling as though you have barely slept, if your partner tells you that you stop breathing during the night, or if you snore loudly and wake with a dry mouth or headache, please do not simply put it down to getting older, being stressed or having a busy life. It may be worth talking to your GP and asking whether a sleep assessment would be appropriate.

And if you are already being treated for sleep apnoea, I can work alongside that treatment to help you explore your daytime breathing habits and develop a more functional breathing pattern.

For some people, there are surprisingly practical things that can be changed. It does not necessarily have to feel like an insurmountable mountain to climb. Ultimately, we all deserve to sleep well, to wake feeling rested, to have a nervous system that has had the opportunity to properly recover during the night.

Good, restful sleep is possible, and I genuinely believe that for many people, understanding how they breathe can be an important part of getting there.

Breathe well,

Rose

Myotape mouth tape shop.

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