Part 2: Unexpected reasons you might have fatigue

by Gavin Guard, PA-C, MPAS, CISSN, Pn1

Medical Director, Roots Integrated Care

In part 1, we discussed how your gut health may be impacting your energy and how dysfunctional digestive health can lead to fatigue.

Let’s move to reason #2: sleep-disordered breathing.

Sleep-disordered breathing includes conditions such as sleep apnea that characterize the restriction of air into the lungs during sleep. It is an often overlooked cause of fatigue and excessive daytime sleepiness (e.g. falling asleep at a business meeting).

It affects 15-30% of males and 10-15% of females. Being overweight increases the odds that you might have sleep-disordered breathing. For example, a 10% increase in weight is associated with a 6x increased risk of sleep apnea. Sleep-disordered breathing is also found at higher rates in those with atrial fibrillation (up to 60%), hypothyroid, family history of sleep apnea, and smokers.

Symptoms of sleep disordered breathing include:

● Daytime sleepiness/ fatigue

● Snoring

● Apnea (choking)

● Morning Headache (found in 10-30%)

● Dry mouth

● Drool on pillow

Validated questionnaires (here and here) can also be helpful to identify this condition. More rigorous ways to evaluate sleep-disordered breathing include sleep tests. This includes a physician-attended sleep study inside a sleep center. However, this can be especially difficult for those in remote areas like the San Juan Islands. The good news is that a home sleep test shows good accuracy when compared to in-clinic sleep tests for diagnosing sleep-disordered breathing (but may miss other sleeping issues). These home sleep tests are cheap, portable, and the best news is that you can sleep in your own bed!

The gold standard for addressing sleep apnea and sleep-disordered breathing is a CPAP machine which some of my patients have referred to as “wearing an octopus on your face while you try to sleep.”

Fortunately, there are other options to sleep disordered breathing, especially for mild-to-moderate cases. This includes the following:

• Weight loss can be a powerful strategy to help sleep apnea. One study found that even a reduced calorie diet can improve sleep apnea independent of weight loss.

• Improving your gut health can improve sleep issues through the gut-sleep connection. For example, those with IBS report worse sleep and higher rates of insomnia. One study found that probiotics can improve insomnia.

• Another therapy is called myofunctional therapy and is practically physical therapy for your mouth. This is where you strengthen the muscles around your oral cavity to prevent the collapse of your airway when you sleep.

• A “smart pillow” has also shown to be effective in two studies. This smart pillow senses when you are snoring (a sign of sleep disordered breathing) and adjusts your sleeping posture to prevent the collapse of your airway.

• Finally, oral devices are similar at improving symptoms when compared to CPAP therapy. In addition, more patients prefer them over CPAP therapy.

Don’t let sleep-disordered breathing go unaddressed. There are many therapies and options at your disposal to help you solve this issue.