Getting to sleep
Do you climb into bed each night, only to lie there staring at the ceiling, wondering when sleep will come? A lot of patients that I see report having difficulty falling asleep. These patients also tend to have a more stimulating breathing pattern: rapid and dominated by upper chest movement. This type of breathing tends to keep the body in a hyper-aroused state - it's ready for anything, anytime. Indeed, research has shown that patients with insomnia have increased brain activity, abnormal hormone secretion, elevated heart rate and sympathetic nervous system arousal when they do sleep. It's as if their bodies don't know how to turn off.
This is where breathing retraining comes in. Learning how to engage in a slower, more effortless breathing pattern, can help to activate our parasympathetic nervous system. This the "rest and digest" part of our autonomic (automatic) nervous system, and helps to put the brakes on the flight or fight side. Those of us who try to cram as many things into the day as possible, running from one activity to the next, dealing with stressful work situations, spouses, kids, etc may not remember what it feels like to turn off, tune out and relax. Learning how to let go as well as using mindfulness to help deactivate the stress response is key to getting the body better prepared for transitioning to sleep. I've had many clients report that they ended up falling asleep practicing finding calm- and that wasn't even the intended goal!
Breathing During Sleep
During normal sleep stages, several changes occur to our breathing. As we transition into sleep, there is a decrease in signals to the muscles of the chest and upper airways. This results in increased resistance in the upper airways and less activation of the chest muscles. During the next transition into REM sleep, all of the skeletal muscles of the body become atonic - meaning they relax nearly completely. The theory behind this being that we do not then act out our dreams. During this time, breathing is critically dependent on the function of the diaphragm, as it will often have an increase in activity. For most individuals, these changes to breathing patterns at night do not pose a problem. However, for anyone that has altered breathing patterns due to diaphragm weakness, this can lead to sleep disorders. Diaphragm weakness is seen in a number of situations:
- Neuromuscular disease - such as multiple sclerosis
- Restrictive disorders - kyphosis, scoliosis and chest wall deformities
- Obstructive Lung Disease - like COPD
- Breathing Pattern Disorders
Treatment for Sleep Disordered Breathing
The gold standard for addressing sleep apnea is continuous positive airway pressure - or CPAP. Essentially a machine will deliver a constant stream of air through the mouth or nose at night to ensure that the airways do not collapse and cause a stoppage in breathing. In addition, lifestyle changes such as weight loss and sleep hygiene are encouraged.
What is also showing some promise in the treatment of sleep apnea, is inspiratory muscle training (IMT). IMT strengthens the diaphragm, and studies are showing that IMT can decrease snoring, improve sleep quality and decrease blood pressure issues related to sleep apnea. IMT is non-invasive, inexpensive and relatively easy to perform and should be considered to help treat sleep apnea.
In addition to strengthening the diaphragm, there has also been some interesting results using didgeridoo playing as a way to tone the muscles of the upper airways. One ear, nose and throat doctor in the UK advocates the use of these exercises to help tone the throat muscles to help reduce snoring. Another study suggests that singing might just do the same!
If you are concerned about your sleep quality, feel free to drop us a line to discuss what kind of treatment options we have here at Breathe Well Physio. We can help you turn off the fight or flight response to help you transition to sleep if you struggle to fall asleep. We can also get you started with an IMT program to strengthen your diaphragm to get you through all sleep phases. And if the problem is your upper airway function, we even offer voice exercises from a professional voice teacher to help tone those muscles to reduce snoring and sleep disruptions!