Why Sleep Apnea Gets Worse and How Early Action Can Change Everything

Sleep apnea is going to typically progress and get worse over time. Keep in mind that weight gain can be happening because of the worsening of the sleep disorder. So sleep apnea results in weight gain. Snoring is not normal. If you snore, that means you have a resistance or restriction in your airway somewhere. And posture is a big thing. When you see somebody shoulder down on one side versus the other, or their forward head posture, your forward head posture is your body trying to do CPR on itself.

Hello and welcome back to Breathing for Better Sleep. Today we're exploring the root causes of sleep apnea, snoring, and airway-related sleep issues. Today we're talking about something many people quietly wonder but rarely ask. Can sleep apnea get worse over time? For some patients, symptoms stay relatively stable, but for others, things gradually change. More fatigue, louder snoring, more disrupted sleep, and it's not always obvious why. So today we're breaking down how sleep apnea can progress, what causes it to worsen, and what signs you should be paying attention to. Hi, Dr. Eck. We're back again speaking about sleep apnea, getting even a little deeper in the topic today. When patients are diagnosed with sleep apnea, is it something that typically stays the same or can it worsen over time?

Sleep disorders, in particular sleep apnea, is going to typically progress and get worse over time if we're managing symptoms, which we've talked about in the past, right? So if all we do is manage the symptoms, then we're not treating the problem. And so it will progress. This is why CPAPs and Mendibular advancement appliances at some point usually quit working for people.

And what are the most common reasons someone's sleep apnea might progress?

Aaron Powell Well, as we age, we lose muscle tone, right? Because we don't produce collagen. And uh so loss of muscle tone is a big one. Uh weight gain uh can have an impact. And with that said, uh it's very rare for the weight to be the root cause, the only cause. Uh it can make it worse, especially the snoring, uh, but it's rarely the root cause. It just makes it worse if you already have it. Keep in mind that weight gain, it can be happening because of the worsening of the sleep disorder. So sleep apnea results in weight gain for a lot of people. So it's a big cycle, right? Big snowball effect. One thing causes the other, then that causes the other, and it just it's a big snowball effect. Um, cortisol and insulin resistant, increased levels of cortisol and inflammation, uh, people developing diabetes or insulin resistance, all these things can have a negative impact uh on our breathing disorders as well.

And like you mentioned, it's a it's a loop there, right? Um when you don't sleep properly, it's hard to lose weight or maintain weight. Uh I I've heard I've heard this uh um I've heard this from personal trainers even or dietitians where they're like, if you're trying to lose weight and you don't sleep properly, you won't see your weight change. So I'm guessing that's what they're referring to. Like if you don't sleep properly.

Yes, when you sleep in your body, your body is designed to burn calories and and repair itself while you're sleeping. So if you don't sleep enough, then you won't get that result, right? In addition to obviously if you don't have the motivation because you're tired all the time, then you're not going to work out or exercise or anything else. But you know, it's been it's been shown that treating a sleep disorder, in order to treat sleep apnea, it actually reduces a thing called the visceral fat. So not just the fat that's outside over top the muscle that we all see, it's the visceral fat that is inside around the organs, which is what's really bad for us. Um and that has been shown to decrease significantly by treating sleep apnea.

And many people assume snoring is normal. We've talked about this, but when does snoring become a sign that something more serious may be developing?

Snoring is not normal for an adult or a child. I mean, if you snore, that means you have a resistance or restriction in your airway somewhere. Uh people have just normalized it, just like grinding their teeth, just like bad sleep, oh, I don't sleep well. It's just become normalized to say I have these things when none of it none of it is normal. Uh when you see a child that's snoring, it should be looked at very quickly and addressed. Because if they're snoring, that usually means they're mouth breathing. And as we've talked about in the past, if you're mouth breathing while you're growing, you're just going to lead to a lot of abnormal growth and development.

So we we have to be able to differentiate uh normal versus common. So it's common, but it's not normal.

Correct.

And how does worsening sleep apnea begin to show up during the day?

Well, sometimes you you it may not show up during the day. So I'll use me as an example. When I was diagnosed with sleep apnea, I had no symptoms. I was a long distance runner, skinny as could be. I didn't fit any profile for somebody that would have sleep apnea. And I had no symptoms. So uh you can't always go by symptoms, okay? But some people have no symptoms, other people have a lot. Some people find it it starts by just feeling harder to get up in the morning. You know, whether you're an adult or a child, if it's difficult to get up in the morning after being in bed six or eight hours, then you probably have some sort of sleep disorder, right? If you need to take a nap in the middle of the day, if you have a lack of energy or ability to focus, okay, cognitive declines, whether it be an adult or a child, right? Those are all signs that uh we can have a breathing disorder that is progressing.

And going back to your uh experience, how were you diagnosed? Like what made you go and take a sleeping test if you didn't fit any of the criteria?

Funny story. Uh so at the time I was tested, as I mentioned, I fit no model that would look like somebody that had sleep apnea. And I was actually at a sleep conference, and at this point, I had been treating sleep apnea for, I don't know, say seven or eight years. So I treated sleep apnea patients every single day and didn't know I had sleep apnea. How I was diagnosed was uh these disposable at-home sleep tests came out. And at the conference, they gave all of us doctors one to do in our hotel room that night. And they were real simple tests. You wore them, you got up in the morning, you threw them in the garbage. They were the first disposable sleep test. So I did the test, and then the next day, the rep comes up and says, You want to see your sleep test? I said, you know, don't waste your time with me. Just, you know, help somebody that needs it. He goes, Oh, you need to see your test. I'm like, what? So yeah, I had severe sleep apnea. I stopped breathing over 400 times, 58.6 times per hour. And um, the good news is I don't have sleep apnea anymore. But that's why I developed a protocol and screening, and one of the things I do is teach doctors how to screen, what to look for. Because when you go back and look at my case, I had signs. Although I had no symptoms, I went back and looked for signs that would be an indication that I had an airway problem. And I created this list of 10 or 12 things to look for, even if somebody doesn't have any symptoms. And that's kind of what we use to screen and what I teach doctors today to use to screen patients to look and try to catch it earlier.

That's really interesting. And I think that's another thing that we should be able to differentiate, right? One thing is having symptoms, and and another thing is to be able to read the signs. And can you share what were those signs for you that you later learned that you that you were showing?

So I had very large what's called tori, which is the extra bone that you can get under your tongue. Um, and that's usually a sign of bruxism and bite problems. And one of the side effects of sleep apnea is grinding. And so we see these happening in people who grind their teeth a lot, right? So, what was the root cause of my grinding? It was my oxygen desaturations. I had a tongue tie, so I had a myofunctional problem, right? I could not position my tongue against the roof of my mouth where it's supposed to go. Hence, as a child, um as an older child, uh, I had orthodontic issues. And because my jaws did not develop, because I had a myofunctional problem, most likely was a mouth breather as a child. Uh, and so uh issues, chronic ear issues as a child, um uh is a common sign of an airway problem. Uh if you have a child that needs tubes put in their ears, uh they probably have an airway problem. So there's lots of signs that we can look at, a collapse in our bite, all kinds of things we can look at um to give us an idea if we have an airway problem.

That's so interesting. And those things for you weren't so apparent, like you couldn't really tell them by looking at you just from outside. Like you had to check inside and do this investigation of of signs that started kind of coming together to understand like the the what would you say, the history or understand the the timeline of how this could have developed, right?

Yes. So you have to look in the mouth, which is one of the issues I have when I'm trying to teach physicians, you know, they're not, you know, dentists and ENT or nose and throat doctors, we're used to getting in the mouth, right? Most physicians are not, and they're not comfortable with it. So I'm like, yeah, all you need is a mirror and a tongue blade. It's all you need in 90 seconds. And I'll just teach you these things to look for. And if they're there, then they likely have an issue. But you know, there's so many signs you can see, and there are signs that you can see uh outside uh by the asymmetries and the asymmetries in the eyes, and uh one ear being more flared out than the other, our nostrils not always being the same side, or corners of our lip is lower on one side than the other. And posture is a big thing. When you see somebody shoulder down on one side versus the other, or their forward head posture, your forward head posture is your body trying to do CPR on itself, trying to get the airway open.

Yeah, the body's incredible. No, it's always looking for ways to survive and it adjusts. Perhaps it it shifts not in ways that are optimal, but it's trying to compensate for what is not being able to do in its natural form, right? And uh, in terms of stress, can stress, illness, or lifestyle changes temporarily make sleep apnea worse?

Yes, and it also goes both ways. So uh stress and inflammation and all these things can affect our body, but I always like to say it goes both ways because one of the things a sleep disorder does is it can alter our body's ability to handle stress. This is why there's such a psychological component to people with sleep disorders, with anxiety and depression and psychological disorders as well. But what happens is we lose our ability to rationally and simply respond to a stress and we over-respond to it. So we take something that shouldn't be that stressful and should take an easy response, and we over-respond. So stress can affect our whole body, but our sleep disorder can affect how we handle stress. So it goes both ways. There's a lot of illnesses that also can contribute to worsening of a sleep disorder. Anything that can affect our muscles, like MS, right? Uh anything that affects our muscles can affect the muscles of our airway. Um, so there's there are lots of conditions that can contribute. That's why when you're doing a workup and you're looking at the diagnostics, it's important to look at everything. Everything that is in the medical history, the family medical history, all medications, both prescription and not. It's important to critically get to that because as we've talked about in the past, if you want to get to root cause, you have to find all of the causes in order to get successful treatment.

Yeah, and I'm guessing uh patients who suffer from Parkinson's disease, since it's a movement disorder and it affects the m muscles, can probably be affected by or maybe prone to developing sleep apnea or vice versa. But I feel that in terms of health, it is always like a chicken or an egg situation. Like you mentioned with the weight. The weight is worsening perhaps the space in your airways or your capacity to breathe at night, but then also the sleep disorder is is keeping the weight up and it's kind of how how you break the cycle. And if someone feels like their symptoms are getting worse, what is the most important first step they should take?

Well, if they feel like their symptoms are getting worse, um you want to get a sleep test done. You want to see somebody who's gonna critically evaluate that, do 3D imaging of your airways and sinuses, and pay attention to everything on this sleep test. If somebody gives you a sleep test and they're not checking for stages of sleep, which I find about a third of the sleep tests that people bring into me, they never tested the stages of sleep. The stages of sleep are critical. So if we're getting worse, we really got to stop and figure out what's going on and look at more than just that AHI number. Look at more than just the apnea events. Pay attention to our stages of sleep, pay attention to how many events we're having during our different stages of sleep. Because an apnea event that happens during REM sleep is a lot worse than one that happens outside of REM sleep. So we got to start paying attention to stuff like that. Because if you feel like you're getting worse, but yet your sleep test doesn't look a lot worse, we're missing parts of the sleep test. We're paying too much attention to apnea events and not enough time paying attention to all the other stuff on the sleep test.

Yeah, you're you're m missing information there, right? Like you mentioned, I think, in a different episode, how a lot of times we we pay too much attention to the numbers or we pay too much attention of to the data or the information that Yeah, the data from these tests, but can't ignore the symptoms. Yes. That that that contrasts the symptoms that people are having. And symptoms are, I would say, much more important than the data, right? Like that's the most important data that we can have, how we feel. Because if you have great numbers but you don't feel well, then what's the point?

A lot of physicians are missing in the symptoms. They're just they look at a sleep test, they look at a couple numbers in a sleep test and say, Oh, you're good. Well, what you're we're treating a person here. We're not treating these numbers. You have to pay attention to the symptoms. And again, it's just become so bad that we normalize everything. Oh, you're getting older, you're not going to sleep as well. No, uh, you're going through menopause, you're not gonna sleep as well. We gotta quit normalizing it. And and realize that our menopausal and postmenopausal issues can oftentimes be caused, made worse by a sleep disorder. Because you can't control hormones.

Yeah, and I guess it doesn't matter in which stage of life you are in, you deserve to feel well and sleep well, and people shouldn't feel dismissed. Like if if if something doesn't match in your sleep t in your sleep tests, like you mentioned, continue to investigate. Like no no don't don't take oh your numbers are fine. Don't take that for an answer if you're not feeling well, if you're not sleeping well. Because the most important thing here is that you that you feel well, right? And Dr. Eck, when you when those patients come in, the ones that have taken um that have already taken a sleep test and bring it to you, but they they they're lacking some information or they're missing um the sleep stages. Do you take a different test or how how do you proceed with those patients?

Yes, we can get the diagnosis from the pulmonologist and and utilize what's on the sleep test for the actual diagnosis. But again, to treat all symptoms and root causes, uh ultimately we have to get updated test with all that information on there. Um, because otherwise we don't know. First of all, we don't know what we're improving. If I get a sleep test a year down the road and I don't know what my baseline number was from this, I don't know if they're improving or not, right? I don't know if the RIM sleep is 8%, which is low, but it was 2% below. Well, they're getting better. They're just not there yet. So we want a good baseline number on all of the statistics that we should see on the sleep test.

Dr. Eck, we've reached the end of our episode, but what's one thing that you wish patients understood about the progression of sleep apnea and the importance of early intervention?

I mean, the importance of early intervention is is critical. Um, the sooner you get to it, the better you are because there's cognitive deficits and cardiovascular disease and damage to your kidneys and all of these things that are happening, right? I mean, why wait until we have a heart attack? It drives me nuts. You have a heart attack or a stroke and the doctor has you go get a sleep test. Why are we not doing the sleep test first and treating the sleep disorder and preventing the heart attack in the stroke? Right? I always make the I always make the saying um sick kids lead to broken adults. So if we're starting very early with an airway problem, it is a lifetime of problems that just progressively gets worse and worse. So treat early when you can. It's never too late to treat, by the way. The longer you wait, the more damage is done. Um kids get cognitive deficits that cannot be reversed, and and you're not going to detect those in a lot of kids until they get older. They start to get into college and where they have to learn start learning harder stuff, and then that's when this stuff starts to come about.

The best time to start was 20 years ago. The second best time to start is right now.

Correct.

That saying really applies to this situation. And yeah, it's never too too late to start. We should really look into uh getting our sleep test and getting treated because there's always a better life ahead of us if we do sleep better, and we all deserve that, right, Dr. Eck. Um, well, it's been a great conversation with you today, and we'll see you again next time.

See you soon.

Sleep apnea isn't always static, and recognizing changes early can make a meaningful difference in how it's managed. If this episode made you think differently about your own sleep or symptoms, share it with someone who may be experiencing the same thing. To learn more about airway focused sleep care, visit sleeptreatmentdirect.com. Better breathing, better sleep, better life.