5 Evidence-Based Lifestyle Interventions for Your Sleep Apnea Patients

July 22, 2022

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Did you know 22 million people in the US have OSA, 80 percent of which go undiagnosed? Obstructive sleep apnea (OSA) is a disorder that causes throat muscles to relax, closing off the airway when sleeping. That means about 7 percent of our population struggles to get a good night’s rest.

Dentists often focus on treatment rather than addressing the underlying cause of OSA. OSA is a multifactorial disease requiring careful consideration of why a patient suffers. Dentists are aware that lifestyle modifications can significantly improve their patients’ health but often don’t recommend them.4

Managing OSA can significantly affect your patients and the quality of their daily life. As a dentist, you are in the perfect position to suggest simple lifestyle changes that can alleviate your patients’ OSA. An April 2022 study published in the Journal of the American Medical Association (JAMA) concluded that lifestyle interventions are a critical strategy for managing OSA patients. Lifestyle interventions can be as simple as losing weight, cutting out smoking, eliminating alcohol and sleep aids, cutting dairy and meat out, and managing allergies.5

Let’s discuss lifestyle modifications and how to recommend them to your patients.

Weight Loss 

You may be thinking, “What does weight have to do with breathing?” The short answer is “everything.” Excess weight is the strongest risk factor for OSA.10 About 45 percent of overweight people have OSA. Extra weight contributes to excessive pressure on the throat and systemic inflammation.10 The good news is that once the weight is lost, it cuts down the risk of having OSA. A weight loss of 10 percent can reduce a patient’s apnea-hypopnea index (AHI) by approximately 40 percent (from 10 to six events/hour).4

Recommending weight loss to patients can be a sensitive subject, but it is vital to improving sleep apnea. Below are a few tips to make the conversation seamless:

  • Be straight to the point (don’t sugarcoat the recommendations)
  • Understand their lifestyle
  • Offer specific examples of how they can change their lifestyle.

When recommending losing weight to a patient, be thoughtful in your responses. Weight is a sensitive subject that can evoke high emotions.

Smoking Cessation

Did you know smoking remains the leading cause of preventable death? Recent studies have reported a synergistic effect between smoking and OSA, increasing the risk of cardiovascular disease through oxidative stress, endothelial dysfunction, and abnormal inflammatory response.6 In the Wisconsin sleep cohort study, one of the largest OSA cohort studies, researchers found smokers were “twice as likely to have OSA compared to non-smokers.”4 In the same study, individuals “who smoked more than two packs per day had a 6.7-fold risk of having mild OSA and a 40-fold risk of having moderate-to-severe OSA.”4

Smoking increases the risk of OSA through the following mechanisms:

  • Nicotine relaxes the upper airway muscles, causing the upper airway to collapse and increasing the likelihood of airway obstruction.
  • Nicotine increases sleep arousal, leading to more apnea and hypopnea events.
  • Smoke creates upper airway inflammation and edema.1,4,6

Unfortunately, smoking is addicting, and in most cases, your patients who are experiencing sleep apnea because of smoking have had the habit for a long time. But while quitting isn’t easy, it is necessary to improve sleep apnea. You can start the conversation with your patients by explaining how smoking is an unhealthy habit that impacts more than just their airway. For example, express that smoking can cause tooth decay. Then you can transition the conversation to why smoking is affecting their breathing.

Alcohol and Sleeping Aids 

Alcohol and sleep aids like melatonin, diphenhydramine, and doxylamine relax upper airway muscles, causing upper airway collapse.8,9

Alcohol can induce OSA and results in the following:

  • Decreased genioglossus and hypoglossal motor nerve activities
  • Increased episodes of segmented sleeping
  • Increased snoring severity8,9

Bringing the use of alcohol and sleep aids up to your patients can be a sensitive topic. Consider these icebreakers to start the conversation about why it would be a good idea to stop using sedative-hypnotic drugs before bed:

  • Alcohol is often full of added sugar and can contribute to tooth decay.
  • Alcohol may lead to high blood pressure, which can also contribute to OSA.
  • Sleep aids can cause dry mouth.

Meat and Dairy Consumption 

The average person in the US consumes 274 pounds of meat every year. With dairy and meat being the primary source of protein, cutting them out may be a challenging diet transition for your patients.

In the Sleep AHEAD study, researchers found diet quality is associated with OSA severity. Similarly, a study in the American Journal of Lifestyle Medicine concluded that increased fat and processed meat intake resulted in a greater risk of OSA. In contrast, low-fat dairy intake decreased OSA severity.3

Consider suggesting dietary alternatives such as the following:

  • Plant-based meats
  • Low-fat dairy
  • Almond milk
  • Cashew cheese
  • Soy protein.

As you recommend these alternatives, remind your patients that changing their diet can lead to better sleep and overall health.

Allergy Management

Managing allergic rhinitis (allergies) is also important for OSA patients.2 Allergies cause congestion, resulting in less space to carry oxygen into your lungs and increasing a patient’s risk of sleep apnea.2 Being congested can also result in a dry mouth that can cause the throat to tighten. Patients with allergies are more likely to snore and have an increased risk of sleep breathing disorders.2

When suggesting allergy management to your patients, consider recommending the following medicines to your patients:

  • Nasal sprays
  • Inhalers
  • Eye drops

Suggesting lifestyle changes to improve OSA can be tricky, but your patients must receive quality sleep. By losing weight, stopping smoking, avoiding alcohol and sleep aids, cutting dairy and meat out of their diet, and managing their allergies, your patients can alleviate their OSA and live happier, more fulfilling lives.

For more information you can pass on to your patients, please visit thevivosinstitute.com/blog or attend an upcoming educational event at The Vivos Institute!

1. Esen AD, Akpinar M. Relevance of obstructive sleep apnea and smoking: Obstructive sleep apnea and smoking. Fam Pract. 2020;38(2):180-185. doi:10.1093/fampra/cmaa112
2. Cao Y, Wu S, Zhang L, Yang Y, Cao S, Li Q. Association of allergic rhinitis with obstructive sleep apnea: A meta-analysis. Medicine (Baltimore). 2018;97(51):e13783. doi:10.1097/MD.0000000000013783
3. Bove C, Jain V, Younes N, Hynes M. What You Eat Could Affect Your Sleep: Dietary Findings in Patients With Newly Diagnosed Obstructive Sleep Apnea. Am J Lifestyle Med. 2021;15(3):305-312. doi:10.1177/1559827618765097
4. Kim JW, Lim HJ. Lifestyle Modification in Patients with Obstructive Sleep Apnea. Sleep Med Res. 2018;9(2):63-72. doi:10.17241/smr.2018.00255
5. Kaleelullah RA, Nagarajan PP. Cultivating Lifestyle Transformations in Obstructive Sleep Apnea. Cureus. 2021;13(1):e12927. doi:10.7759/cureus.12927.
6. Krishnan V, Dixon-Williams S, Thornton JD. Where there is smoke…there is sleep apnea: exploring the relationship between smoking and sleep apnea. Chest. 2014;146(6):1673-1680. doi:10.1378/chest.14-0772
7. Carneiro-Barrera A, Amaro-Gahete FJ, Guillén-Riquelme A, et al. Effect of an Interdisciplinary Weight Loss and Lifestyle Intervention on Obstructive Sleep Apnea Severity: The INTERAPNEA Randomized Clinical Trial. JAMA Netw Open. 2022;5(4):e228212-e228212. doi:10.1001/jamanetworkopen.2022.8212doi:10.1097/MD.0000000000013783
8. Burgos-Sanchez C, Jones NN, Avillion M, et al. Impact of Alcohol Consumption on Snoring and Sleep Apnea: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg. 2020;163(6):1078-1086. doi:10.1177/0194599820931087.
9. Simou E, Britton J, Leonardi-Bee J. Alcohol and the risk of sleep apnoea: a systematic review and meta-analysis. Sleep Med. 2018;42:38-46. doi:10.1016/j.sleep.2017.12.005.
10. St-Onge MP, Tasali E. Weight Loss Is Integral to Obstructive Sleep Apnea Management. Ten-Year Follow-up in Sleep AHEAD. Am J Respir Crit Care Med. 2021;203(2):161-162. doi:10.1164/rccm.202007-2906ED.