Sleep Apnea: Bodybuilders and Strength Athletes at Risk
If you're a big guy, do you suffer from sleep apnea? Do you even know?
I recently hammered out an article about why I thought so many bodybuilders were dying at relatively young ages in seemingly disproportionate numbers to the general population. I blamed a lot of it on their sheer size – the size of their bodies and even, perhaps surprisingly, the size of their prostates. Either directly or indirectly, each factor affected how hard their poor hearts had to work and likely led to many of their deaths.
Part of them, their subconscious starship engineers, probably kept warning them, "Captain, the engines can't take much more of this," and eventually, their subconscious engineers were right.
In retrospect, though, I should have included another potentially life-threatening factor, one that's also often related to size: sleep apnea.
The disorder isn't exclusively a plague of big people, but it most often affects men (by a 5 to 1 margin over women), particularly those who have a neck circumference over 17 inches or who have a body mass index of over 25. And in this instance, it doesn't matter if the high BMI is a result of muscle or fat.
Here's everything you need to know.
To most people, or at least to most significant others of people who suffer from it, sleep apnea just means that the big bastard they share a bed with is snoring so loud that the porcelain figurines on the dresser are vibrating across the surface like the players on the electric football game dad had when he was a kid.
The much suffering bedmates usually pick up their pillow and blankets and retire to the living room couch when the ballerina/running back crashes off the side of the dresser onto the floor.
First, the term itself. Apnea is from the Greek, and it means "without breathing," and that's damn accurate. People afflicted with the disorder suffer fragmented sleep. Those with "mild" cases might suffer 5 to 15 instances each hour where they stop breathing for 10 seconds or longer. Those with more severe cases can stop breathing for 20, 30, 40, 50, or more seconds, 30 or more times an hour.
You don't have to wear a white coat and stethoscope to assume that kind of thing is detrimental to your health (more on exactly what the repercussions are below).
So, what is it about being a big bastard that makes someone more susceptible to sleep apnea? It's largely their big-bastard necks, regardless of whether the size is from muscle or fat; the extra girth affects the diameter of their windpipes.
At night, particularly when they're lying on their back, the extra girth, along with the relaxation of the muscles that occurs at night, causes a partial collapse of the airway. The sound they issue is from the vibration of those tissues.
This particular brand of sleep apnea is aptly termed "obstructive sleep apnea," or OSA.
Having OSA isn't just about being so tired that you routinely nod off during dinner and do a face plant into the lasagna; it's far more serious. For starters, the decrease in oxygen leads to hypoxia, a major contributing factor to atherosclerosis.
OSA also means the heart has to work all that much harder, so the risk of stroke, heart attack, or sudden cardiac arrest occurs (see bodybuilders, prematurely dead).
Further, OSA is strongly correlated to type 2 diabetes, hyperlipidemia (too many types of fat in the blood), hypertension, heart failure, depression, and various cerebrovascular diseases (those that affect blood vessels in the brain).
If none of that causes unease in you, maybe this will: Over half of OSA patients complain of sexual problems and/or erectile dysfunction. Testosterone metabolism is a slave to circadian rhythm, with levels being higher in the morning and lower at the end of the day. Levels start to increase upon falling asleep, generally peaking during the first three hours of sleep, which is right around the time rapid-eye-movement (REM) sleep kicks in.
Levels tend to stay this elevated until morning, but lack of sleep or fragmented sleep screws up REM sleep. No REM sleep, no proper or adequate testosterone production and metabolism.
This isn't just conjecture, either. A meta-study that compiled the results of 18 studies involving 1823 men found a significant relationship between OSA and male serum testosterone levels.
In short, your sexual engine ends up running on fumes. Putting on muscle becomes increasingly difficult. You feel a compulsion to wear Crocs and watch daytime television. That's not pretty, but I'm thinking the death thing is a much better reason to be concerned with OSA.
Roughly 900 million people around the world suffer from sleep apnea, but the vast majority (80 to 90%) of them haven't been officially diagnosed. As stated, it's often thought of as a fat person's disease, but they're not the only ones that suffer from it. Other big people are particularly prone to it too, and by big, I mean muscular.
Unfortunately, there aren't many studies involving strength athletes and OSA. However, we do have at least one study on NFL players and OSA from 2003. It found that they're 4 to 5 times more likely to suffer from sleep apnea than the normal-sized people who watch them play. The study also found that a disproportionate number (approximately 34%) of linemen were afflicted.
And, as an aside, consider that the study of NFL players was done in 2003 when linemen hadn't yet evolved into their current gigantosaurian state. A study at Grand Valley State University found that the average interior lineman gained 1 to 1.5 pounds per year over the last seven decades. While only three NFL players weighed more than 300 pounds in 1980, there are now over 400 men playing over that weight.
So yeah, linemen – and in fact, most other position players – are even larger now, and the percentage of sleep apnea sufferers has likely risen.
Given these observations of NFL players, it doesn't take much of a deductive leap to conclude that strength athletes are in the same sleep-deprived boat.
The only way most people realize they suffer from sleep apnea is by putting two and two together after waking up with a sock in their mouth and noticing that their grumpy significant other has taken to sleeping on the couch.
However, if you don't have anyone from whom to absorb death stares that give you a clue as to your condition, see if you're experiencing any of the following symptoms of sleep apnea:
- Being tired in the daytime
- Having trouble concentrating
- Morning headaches
- Sore throat upon awakening
- High blood pressure
- Gasping or choking at night
- Chest pain at night
- Restless sleep in general
You might also want to calculate your BMI just to see if you're in the traditional high-risk zone (over 25 puts you at moderate risk, while 30 or above puts you at high risk). You can do this by taking your weight in kilograms and dividing it by the square of your height in meters.
The equation for this is BMI=kg/M2.
For instance, I'm 6'2" and weigh 210. My height in meters is about 1.87, and my weight in kilograms is about 95. If I square my height, I get about 3.50. And when I divide 95 (my weight in kilograms) by the square of my height (1.87), I come up with approximately 27, which supposedly puts me at moderate risk of getting OSA.
Alternately, you can put down your pencil and just Google one of the many BMI calculators on the net.
Anyhow, by normal medical standards and insurance standards, a BMI of 27 puts me in the "overweight" category. Never mind that I lift weights and my body fat is relatively low. The BMI doesn't recognize such subtleties, and neither, it seems, does sleep apnea.
Muscular or fat, it probably doesn't matter. Both categories are probably equally vulnerable to OSA.
Clearly, obstructive sleep apnea is a scary thing, largely a result of being a big person, but there are other types of sleep apnea that aren't related to body size, some transient and related to environmental or lifestyle issues, and some related to anatomical anomalies.
For instance, in the latter case, some people – normal-sized or super-sized – have deviated septums or have low, thick, soft palates and an elongated uvula, either of which can result in OSA. Others might just have allergies or colds. And then there's alcohol, which can relax the throat muscles and lead to an obstructed airway and the characteristic drunken snore.
If you want to test for sleep apnea and you really wanted to do it right, you'd book a night's stay at one of the many sleep centers around the country.
They'd wire you up and record how often you stopped breathing, your blood oxygen and CO2 levels, heart rhythms, and brainwave activity. Unfortunately, it costs about a grand, not to mention you have to try and sleep while worrying about pitching a nocturnal pup tent in front of the comely sleep tech.
Alternately, there are now take-home sleep monitors that you can purchase for around 200 dollars.
One of the easiest ways to at least ameliorate the problem is to stop sleeping on your back because that position allows gravity to collapse your throat. Stomach sleeping, however, puts gravity back on your side, pulling the tissues of your mouth and throat forward.
Side sleeping helps, too, particularly if you can sleep on your left side because it creates optimal blood flow and reduces the chance of airway "collapse." Right-side sleeping, while not as effective as left-side sleeping, helps airflow too.
If side-sleeping positions are alien to you, you might try employing a thicker pillow to support your head. Alternately, you could buy one of those Japanese love pillows (dakimakura) that have an Anime babe painted on them. A regular body pillow would work, too, but they're a little less exciting. Either way, they can help keep the body in the same position all night.
Easy alternative treatments for minor or transient cases of sleep apnea include rinsing the sinuses at night using a Neti pot, using nasal decongestants or nasal strips, avoiding excess alcohol, and losing weight.
In more serious cases, there are more serious solutions. One is wearing a "continuous positive airway pressure" (CPAP) device where a small compressor blows air into a mask worn over the nose and mouth. The device was reverse-engineered from a common vacuum cleaner in the 1980s by an Aussie doctor. You might have seen one on the "Sopranos" episode where Tony, upon seeing a doctor slip a CPAP mask over Junior's head, cracked wise and said, "How many MiGs you shoot down last week?"
Anyhow, it's easy to see why CPAP compliance is low, anywhere from 29% to 83%, depending on what survey you believe. They're uncomfortable, and they're definitely not sexy.
The remaining alternatives consist of a variety of surgeries, the exact type depending on the OSA patient's particular situation. Some may require palate surgery or an "uvulopalatopharyngoplasty," where they remove part of the palate, along with the tonsils and the uvula.
Adenoid or tonsil removal is also applicable in certain patients, as is laser or cautery assisted uvulopalatoplasty, tongue surgery, nerve stimulation, permanent tracheotomy, bariatric surgery (simply to reduce body weight), and even skeletal surgery where they rearrange your jaw. Others find relief in palate implants where the doc puts rods in the throat, upon which scar tissue forms to stiffen up the palate.
We don't know for sure if OSA played a role in so many of the premature deaths we've seen among bodybuilders lately, but it stands to reason that it could have.
That alone should make you curious about it – never mind feeling crappy and having lower testosterone levels. Do yourself a favor and ask anyone who's gotten under the blanket with you to tell you if you sound like a Wookie when you sleep.
If they confess that you do, you might want to start exploring some of the options I laid out above.
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- Jezan S Obstructive Sleep Apnea and Obesity: Implications for Public Health.
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- Luoma TC Luoma's Big Damn Book of Knowledge. Liverpool Library Press. 2010.
- Su L et al. Association between obstructive sleep apnea and male serum testosterone: A systematic review and meta-analysis. Andrology. 2022 Feb;10(2):223-231.