Easing Sleep Apnea May Be Key to Stroke Recovery

Sleep apnea is a known risk factor for stroke, and new research suggests that curbing the condition might also aid the recovery of people who’ve suffered a stroke or mini-stroke.

Patients in the study typically used the CPAP mask — “continuous positive airway pressure” — to ease their nighttime breathing difficulties.

The investigators found that, among stroke patients, “treatment of sleep apnea with CPAP therapy provides significant benefits, even greater than the benefits of tPA, the FDA-approved drug treatment for stroke,” said study lead researcher Dr. Dawn Bravata.

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“That’s a substantial clinical effect,” she said. “The added good news for stroke patients is that CPAP has been used as a sleep apnea therapy for many years, and it has an excellent safety record.” Bravata is a research scientist with the Regenstrief Institute and Roudebush VA Medical Center in Indianapolis.

According to the researchers, sleep apnea is common among people who’ve had a stroke or mini-stroke, but few are currently diagnosed and treated for the condition. It’s estimated that two out of three stroke patients are thought to have the condition, which causes irregular breathing during sleep. Sleep apnea can lead to low oxygen levels, high blood pressure and an irregular heartbeat.

In the new study, Bravata’s group tracked outcomes for 252 people who had experienced a stroke or mini-stroke (known as a transient ischemic attack, or TIA) for up to one year. Patients were treated at one of five different hospitals in two states.

The patients were randomly divided into three groups: a control group who received standard care without sleep apnea treatment; standard care plus CPAP therapy; or enhanced care with CPAP therapy. Patients who used CPAP did so for an average of 50 percent of nights.

The researchers reported that 59 percent of patients who received CPAP therapy showed marked improvement in their recovery, in terms of improvements in neurological symptoms. This compared with 38 percent of those who didn’t get CPAP.

Timing of therapy may be key, as well, the study authors said.

“Preliminary data suggests the sooner you treat sleep apnea in stroke patients with CPAP, the more potent the effect of that treatment,” Bravata said in a Regenstrief news release.

“Usually, diagnosing sleep apnea is an outpatient service. But we need to make sleep testing acutely available to stroke and TIA patients in the hospital as part of their work-up,” she said, “just as we do brain imaging, lab testing and cardiac monitoring as part of the initial stroke/TIA evaluation.”

Two experts in stroke care believe the approach has real merit.

“This study is very interesting — it shows that a simple intervention, treating obstructive sleep apnea, can improve outcomes in stroke patients,” said Dr. Andrew Rogrove. He is director of stroke services at Northwell Health’s Southside Hospital in Bay Shore, N.Y.

Rogrove said it would be even more interesting to assess recovery rates when CPAP was used more frequently than the 50 percent of nights observed in this study.

Dr. Salman Azhar directs stroke care at Lenox Hill Hospital in New York City. He noted that several studies have shown sleep apnea to be a factor in poor stroke recovery.

Testing for sleep apnea shouldn’t add much to the burden of care for stroke survivors, Azhar added.

“With the current ease of doing home sleep studies, the diagnosis of obstructive sleep apnea has become much simpler and should be considered in all stroke patients with positive screening questionnaire results,” he said.

The findings were published earlier this month in the Journal of the American Heart Association.

Sleep and Aging

Is your sleep different than it used to be when you were younger? It happens to a lot of people.

Nearly half of men and women over the age of 65 say they have at least one sleep problem. With age, many people get insomnia or have other sleep disorders.

It’s true that as we get older, our sleep patterns change. In general, older people sleep less, wake up and go back to sleep more often, and spend less time in deep sleep or dreaming than younger people.

But at any age, you still need quality rest to be healthy.

What Causes Sleep Problems With Age?

Some common reasons include:

Poor sleep habits: If you don’t keep a steady schedule for going to bed and waking up, it can affect your body’s internal clock and make it even harder to get good sleep. Also, at any age, it’s a minus if you drink alcohol before bedtime, nap too much, or stay in bed when you’re not sleeping.

Medications: Some drugs make it harder to fall or stay asleep, or even stimulate you to stay awake. If you think that might be true for you, ask your doctor to check.

Worry, stress, or grief. Aging brings many life changes. Some are positive. Others are really hard. When you lose someone you love, move from your family home, or have a condition that changes your life, that can cause stress, which can hamper your sleep.

If changes like these affect you or an aging loved one, talk with your doctor or a counselor. It could help ease your mind so you can sleep better.

Sleep disorders: Besides insomnia, these include apnea, restless legs syndromeperiodic limb movement disorder, and REM behavior disorder. Your doctor can see if you have one of these conditions.

Too much downtime. Many people stay active well into their golden years. But if your days are too idle, you may find it harder to get good sleep.

Do You Get Enough Sleep?

Everyone is different. If you sleep less than when you were younger but still feel rested and energetic during the day, it might be that you now need less sleep.

But if you have noticed that your lack of sleep affects you during the day, tell your doctor. There are steps you can take to get better rest. Many are simple tweaks to your daily routine, like setting a regular bedtime, being more active, and taking steps to ease your mind before you hit the hay.

Supercharge Your Insulin Sensitivity Naturally with These 5 Proven Daily Routines


Insulin sensitivity refers to the biological response of target tissues such as muscle to the actions of insulin. In other words, insulin sensitivity refers to how well insulin performs its role of transporting and storing fuels in specific cells in the body, particularly glucose.

Insulin sensitivity varies between individuals and is reduced in people with diabetes.

Medication aside, lifestyle plays an important role in helping boost insulin sensitivity and prevent impaired tissue responses (insulin resistance), which, in turn, supports blood glucose disposal and improves diabetes management.

Lifestyle choices do this in a number of ways:

  • Strength training increases muscle mass which serves as a major storage house for glucose.
  • Walking and other forms of low-intensity exercise can reduce blood glucose.
  • Stress management including meditation and a good quality sleep pattern help control excess production of counterregulatory stress hormones, such as cortisol and adrenaline, which increase blood glucose levels.

All of the above help improve the action of diabetes medication and whatever is left of natural insulin production. Obviously, the effects of each lifestyle factor will vary depending on how often they are conducted, their intensity and, of course, inter-individual physiology and genetics.

Treat this article like an accountability checklist.

If you live with diabetes and aren’t following any of the five lifestyle behaviors listed, you might be missing a few tricks for improving health, managing your diabetes, and building that body you always wanted.

Daily Routine #1 – Perform at Least 20-45 Minutes of Anaerobic Exercise Every Single Day

Anaerobic exercise is defined as physical exercise that is intense enough to generate lactate.

You know you have generated lactate when you start feeling a burning sensation in your muscles. High rep squats and sprint intervals get you burning pretty quick. Strength training and high-intensity interval training are prime examples of anaerobic exercise.

The human body responds differently when trained with anaerobic exercise compared to aerobic exercise. The adaptions that occur to the muscle energy systems are of particular interest and benefit to people with diabetes.

Anaerobic training increases insulin sensitivity and stimulates skeletal muscle tissue to absorb glucose from the bloodstream independently of insulin. This is achieved through the stimulation of specific glucose transporters called GLUT-4. The more anaerobic work a muscle fiber has to contend with, the greater number of GLUT-4 rise to the surface of a muscle cell for the purpose of glucose extraction. Once glucose is absorbed from the bloodstream it is stored as muscle glycogen.

Increased insulin sensitivity is just one of the many benefits of anaerobic exercise. There are plenty more, which I will cover another time.

How often and how much anaerobic training should I perform?

Perform anaerobic training at least 3 times per week in the form of:

  • 20-60 minutes of strength training – whole body, body part splits, etc.
  • 10-20 minutes high-intensity interval training – skipping, spinning, battle ropes, sprints etc.

All of these training bouts will improve glucose uptake and improve blood glucose management in people living with diabetes.

Daily Routine #2 – Get and Stay Lean

It is well-established that high levels of body fat result from living in a calorie surplus for a prolonged amount of time. Excess body fat accumulation is not only unsightly, but highly inflammatory and detrimental to the effectiveness of your insulin.

Also proven is the fact that the biological response of target tissues to the actions of insulin (insulin sensitivity) are majorly affected by adiposity, or the amount of body fat one carries. 1

The leaner you are, the better your insulin will work. Period.

5 top tips for getting lean with diabetes:

  • Create a calorie deficit by sensibly increasing your physical activity and reducing food intake in a controlled way.
  • Strength train at least 4-5 times per week.
  • Manage your diabetes.
  • Achieve at least 7 hours sleep each night.
  • Aim to lose between 0.5-1% of your body weight each week.

Daily Routine #3 – Have a Toolbox of De-Stressing Activities

In today’s modern day age, we are increasingly exposed to more chronic stress than ever before: mobile phones, social media, traffic, bills, etc.

Stress stimulates a flight or fight response within the body, a physiological reaction that occurs in response to a perceived harmful event, attack, or threat to survival. The body responds to stress by activating the sympathetic branch of the central nervous system. Stress increases muscle tone, constricts blood vessels, and increases the production of counterregulatory stress hormones which increase blood glucose.

In small doses stress is healthy. It can save your life.

However, excessive stress is unhealthy and works against diabetes management.2

The greater and more prolonged the stress, the more insulin is required to balance blood glucose. It is well established that stress can influence whole-body glucose metabolism and promote insulin resistance. 2,3

Any forms of stress management, like meditation, massage, yoga, breathing exercises, or personal development, are worthwhile if they help reduce stress. Reducing your daily stress is a surefire way to improve insulin sensitivity and reduce incidents of high blood glucose.

Even Apple have cottoned on to this with their new “take a minute to breathe” reminder on their Apple Watch.

Daily Routine #4 – Have a Structured Sleeping Plan

Sleep could also be considered a form of stress management, especially for individuals who are highly active and live with diabetes.

I hate to tell you the obvious, but sleep is essential for good health and diabetes management.

Many laboratory and epidemiological studies suggest that sleep loss may play a role in the increased prevalence of insulin resistance and diabetes.4,5,6,7

One of the best pieces of advice is to set a fixed bedtime and wake time. Not only does this provide structure for your day, but it ensures you get enough restorative sleep for health and optimal diabetes management.

Again, the major tech company Apple and their recent focus on health tech apps have included a set wake/bedtime function in their alarm clock.

At Diabetic Muscle and Fitness, we take sleep seriously. We even developed a 3.5+ hour video module on sleep optimization for improving hormone profiles and body composition.

Daily Routine #5 – Perform Aerobic Exercise Daily

Aerobic exercise such as a light jogging or a brisk walk can increase glucose disposal and lower blood glucose levels – independently of insulin.

One of the main reasons aerobic exercise lowers blood glucose levels so well is due to the fact that there is little to no counterregulatory hormone response like that which occurs during high-intensity anaerobic exercise.

Please bear in mind, it is important to monitor insulin intake around aerobic exercise in order to avoid hypoglycemia.

I highly recommend buying an activity monitor like a Fitbit, Apple Watch, or Garmin. These are awesome for building the habit of doing more aerobic exercise throughout your day.

Take Home

Each and every daily routine I’ve shared in this article will improve insulin action and help your body clear glucose easier. Each and every one of these routines is a prerequisite for a great looking body and high levels of mental and physical performance.

Identify which areas you need to work on and get to it!


  1. Wilcox G. Insulin and insulin resistance. Clin Biochem Rev. 2005 May; 26(2):19-39.
  2. Li L et al. Acute psychological stress results in the rapid development of insulin resistance. J Endocrinol. 2013 Apr 15;217(2):175-84.
  3. Nolan et al. Insulin Resistance as a Physiological Defense Against Metabolic Stress: Implications for the Management of Subsets of Type 2 Diabetes. Diabetes Mar 2015, 64 (3) 673-686;
  4. Kripke DF, Garfinkel L, Wingard DL, Klauber MR, Marler MR. Mortality associated with sleep duration and insomnia. Arch Gen Psychiatry. 2002;59:131–6.
  5. Ayas NT, White DP, Manson JE, et al. A prospective study of sleep duration and coronary heart disease in women. Arch Intern Med. 2003;163:205–9.
  6. Ip MS, Lam B, Ng MM, Lam WK, Tsang KW, Lam KS. Obstructive sleep apnea is independently associated with insulin resistance. Am J Respir Crit Care Med. 2002;165:670–6.
  7. Punjabi NM, Shahar E, Redline S, Gottlieb DJ, Givelber R, Resnick HE. Sleep-disordered breathing, glucose intolerance, and insulin resistance: the Sleep Heart Health Study. Am J Epidemiol. 2004;160:521–30.

Carrie Fisher Causes Of Death Released; What Is Sleep Apnea And How Can It Affect Your Health?

Carrie Fisher died from sleep apnea, among other factors, according to a statement from the Los Angeles County Coroner’s Office. Although she was open about her struggle with drugs and there were signs of use, the medical examiner could not conclude whether they played a role in her death last December.


Therefore, her manner of death will be listed as undetermined, the Associated Press reported.

It came as no surprise to her family that LSD and other drugs she said she used may have played a role in her death. “I am not shocked that part of her health was affected by drugs,” her brother, Todd Fisher, told The Guardian. “If you want to know what killed her, it’s all of it.”

One of the more surprising factors is sleep apnea. Here’s what you need to know about the serious sleep disorder that played a role in the death of the 60-year-old Star Wars actress.

What is Sleep Apnea?

It’s an often undiagnosed disorder that causes you to start and stop breathing, or have shallow breaths while you sleep, according to the National Institutes of Health. The short or stopped breaths can happen 30 times or more during an hour. There are three main types of the disorder: obstructive sleep apnea, central sleep apnea, and complex sleep apnea syndrome. The most common form of the condition, obstructive sleep apnea, causes the airway to relax or become blocked during sleep. It can affect anyone, but it’s most common in people who are overweight, male, or have a family history of the disorder.

Signs And Symptoms

The signs vary depending on the type of sleep apnea a person has. One of the most distinct signs of obstructive sleep apnea is loud snoring or choking, which signals that normal breathing is starting again. Other common signs include awakening with a dry mouth or sore throat, morning headache, insomnia, hypersomnia, attention problems, and irritability. It’s a common problem that affects more than 18 million Americans, according to the National Sleep Foundation. If left untreated, it can lead to other serious health issues.

“What you die of is not the sleep apnea,” John Bouzis, a dentist who works with sleep specialists, told The Washington Post. “You die of the cardiovascular disease. You die of the stroke. You die of the pulmonary problems … Sleep apnea is a time bomb.”

Sleep Apnea Has Moved Past Darth Vader Masks

People with sleep apnea need not suffer anymore. Long gone are the days of only one or two mask options and loud, noisy and bulky CPAP machines. You can find relief if you have been diagnosed with sleep apnea — or think you may have sleep apnea — but do not want to be strapped to a mask that reminds you of Darth Vader.man sleeping with sleep apnea mask

Sleep apnea is a potentially serious sleep disorder in which breathing repeatedly stops and starts. You may have sleep apnea if you snore loudly and you feel tired even after a full night’s sleep.

“I have been helping patients with sleep apnea for 20 years and have seen many changes in continuous positive airway pressure (CPAP) machines that deliver air pressure through a mask placed over your nose while you sleep,” says Kara Grottke, Mayo Clinic Health Systemrespiratory therapist. “The air pressure is somewhat greater than that of the surrounding air and is just enough to keep your upper airway passages open, preventing apnea and snoring.”

Older devices would take up most of your nightstand, and the machine would keep both you and your significant other awake at night. Or, if you were able to adjust to the noise coming from the machine, you were waking up every hour to readjust your mask because the fit just wasn’t made for the curves and uniqueness of your face.

The machines now are small enough they can be held in one hand and, when coupled with a good mask seal, are whisper-quiet when in use. Manufacturers have heard the consumer and agree that one or two sizes do not fit all. There also are many mask options, sizes and styles from which to choose:

  • Nasal-style masks are small, lightweight and fit over your nose.
  • Pillow-style masks fit just under your nostrils. These are quite small and feel like hardly anything is on your face.
  • Full face-style masks fit over your mouth and nose, but they are much more lightweight and look and feel very different from the big bulky masks from years ago.

“I understand that the thought of going to bed with something attached to your face and blowing air may seem undesirable,” adds Grottke. “However, I continually hear from patients that they didn’t realize how much they were missing out on before they used a CPAP machine. They knew they were tired, and that untreated sleep apnea had many health consequences, but they didn’t know how good they could feel.”

Using a CPAP machine can be frustrating at first, but it is important to stick with it. With time and patience, CPAP can positively affect your quality of life and health.

Diabetes and Sleep Apnea: What You Need To Know .

Do you snore? Do you feel fatigued every day? Do you wake up frequently throughout the night? It may be that the shallow breathing or breaks in breathing caused bysleep apnea are the reason. If you have diabetes, it is critical to manage your sleep apnea in order to manage your diabetes. Some 18 million Americans are diagnosed with sleep apnea, but millions more have it and don’t know it.

If you have diabetes, sleep apnea can make it almost impossible for you to manage your diabetes. This is because sleep apnea causes a pause in your breathing while you sleep and increases carbon dioxide in your blood, which leads to:

  • Insulin resistance so that the body doesn’t use insulin effectively. This causes more sugar in the blood stream leading to high blood sugars
  • Chronic elevated blood pressure
  • A higher incidence of heart problems or cardiovascular disease
  • Early morning headaches

Inadequate rest or sleep can also lead to lack of motivation to exercise or plan meals. This often leads to irritability, which can affect relationships with family, friends and coworkers. Sleepiness also can cause people to forget to take their medications and lead to further diabetes complications.

Sleep apnea may be genetically linked and it is most commonly found in those who are overweight or obese, people who smoke and are over the age of 40.

Could you have an obstruction?

There are different types of sleep apnea, one of which is obstructed sleep apnea (or OSA), which is when breathing is interrupted by a physical block to airflow. With OSA, snoring is common. The National Institutes of Health report that 12 million Americans have OSA, and for people with type 2 diabetes it is a common condition to have.

Research shows that an increase in severity of OSA is correlated with poorer glucose control. If you have diabetes and have the following symptoms, you should talk to your doctor about doing a sleep study to learn if you have sleep apnea:

  • Daytime sleepiness
  • Depression
  • Irritability
  • Sexual dysfunction
  • Snoring
  • Feeling tired or fatigued most of the time

To diagnose sleep apnea, you can undergo a sleep test called a polysomnogram, which is a test that records body functions while you sleep. The test measures eye movements, electrical brain activity, muscle activity, heart rate, breathing and blood oxygen levels.

Sleep apnea can be treated with CPAP (continuous positive airway pressure). This is a mask that you wear over the nose and mouth when you sleep. Air pressure from the machine forces air through the nose. This keeps the throat from closing during sleep.

If you have diabetes, the bottom line is you want to know if you have sleep apnea, because you need to manage the sleep apnea in order to manage your diabetes. Not to mention, you will feel so much better with a good night’s rest!


How To Stop Snoring With Your Diet: 6 Foods To Help You Snore No More

Cup of tea, honey, wax and pollen granule

We all snore on occasion, but for some of us it happens frequently, leading to late-night jabs, pillows over the ears, and a poor night’s sleep. Whether you’re the snorer or the bed partner of a snorer, it’s a nuisance that not only disrupts the quantity and quality of sleep, but can also cause daytime fatigue, irritability, and increased health problems. Rather than sleep in separate rooms from your bed partner, make these changes to your diet to snooze without snoring.

In the U.S., noisy breathing during sleep is a common problem among people of all ages and genders, affecting approximately 90 million American adults and 37 million on a regular basis, according to the National Sleep Foundation. Snoring occurs when the muscles of the throat relax, the tongue falls backward, and the throat becomes narrow and floppy. This causes the walls of the throat to vibrate, specifically when you breathe in and occasionally when you breathe out, which is what produces the snoring sound.

Snoring can be triggered by several factors, including diet. A diet that lowers or restricts foods high in prostaglandin 2 (Pg 2) — lipid compounds that can create swelling or enlargement of the tissues in the throat and sinuses — can potentially decrease the incidence of both sleep apnea and snoring. Kevin Meehan, a holistic practitioner and founder of Meehan Formulations in Jackson, Wyo., believes “any process which increases the obstruction or reduction in the space of the air passageway will usually initiate the vibration of the respiratory structures, resulting in snoring. … Keeping the obstruction of the throat and nasal passageways down is imperative,” he told Medical Daily in an email.

Sleep Apnea Linked to Depression in Men

Obstructive sleep apnea (OSA) is associated with an increased risk of depression in men, a large Australian study found.

Among 1,875 men ages 35 to 83 who were assessed for depression at two time points about 5 years apart in the Men Androgen Inflammation Lifestyle Environment & Stress Study (MAILES), previously undiagnosed severe OSA was associated with depression (OR 2.1, 95% CI 1.1-4, P<0.05), reported Carol J. Lang, PhD, of the University of Adelaide, at theannual meeting of the American Thoracic Society here.

This statistical significance remained even after adjustment for age, waist circumference, smoking, relationship status, financial difficulties, erectile dysfunction, and nocturia, she noted.

“Depression is highly prevalent in OSA, reaching 39% in clinic studies. However, few population-based studies have been done and results have been mixed,” Lang said.

In one longitudinal study that included 1,400 men and women, a dose-dependent association between a sleep-related breathing disorder and depression was seen, with a 2.6-fold increased risk of depression and a moderate or severe sleep-related breathing disorder.

A cardinal symptom of OSA is excessive daytime sleepiness, although not all affected patients report this problem. It’s unclear whether daytime sleepiness is associated with depression in OSA, and in the longitudinal study, sleepiness was not found to be an explanatory factor for the observed relationship between the sleep-related breathing disorder and depression.

Further complicating this relationship was the finding in another study that residual sleepiness persisting after continuous positive airway pressure treatment was linked with refractory depression.

In an attempt to clarify the association of OSA and depression, in 2010 Lang and colleagues conducted telephone interviews asking men if they had ever been diagnosed with sleep apnea with a sleep study, and those answering in the negative were invited to participate. A total of 857 men then underwent at-home polysomnography testing.

Depression was assessed using the Center for Epidemiologic Studies Depression Scale/Beck’s Depression Inventory, and daytime sleepiness was evaluated according to the Epworth Sleepiness Scale.

OSA was defined as an apnea-hypopnea index higher than 10. Mild-to-moderate OSA was an index score of 10 to 29, and severe was 30 or higher.

Logistic regression analysis determined that, along with severe OSA, daytime sleepiness was associated with depression (OR 1.1, 95% CI 1-1.2, P<0.05).

Then, in a model that included both previously undiagnosed OSA and excessive daytime sleepiness, individuals with both had 4.2 times greater odds of depression than those with neither, and 3.5 times greater likelihood of depression than those with either alone.

“The message is that clinicians need to be aware of these risks and assess for the other if one is present,” Lang said.

The precise mechanisms underlying the link between these conditions are uncertain, but may involve low oxygen levels, arterial inflammatory responses, and neurologic changes in the brain, she said.

The press conference moderator, Mihaela Teodorescu, MD, of the department of pulmonary and critical care at the University of Wisconsin in Madison, agreed that this is an important clinical issue.

“Sleep apnea leads to more refractory depression and patients get more treatment, including with benzodiazepines, which can aggravate and further contribute to depression,” she said.

7 Ways To Stop Your Snoring

Before you resort to sleeping in separate beds, try these at-home remedies for snoring. 

7 Ways To Stop Your Snoring

Forget about the monster under your bed. If you have a partner who snores, you’re dealing with a monster in your bed — and it’s often a near-nightly showdown. In a new National Sleep Foundation survey, 40 percent of Americans admitted to snoring a few nights per week (or more).

And the ones who are suffering aren’t usually the folks sawing logs. “The most common side effect of snoring is waking up other people, whether in the same bed or the next bedroom, depending on how loud it is,” says Eric Kezirian, MD, a professor of otolaryngology at the University of Southern California, who specializes in the treatment of snoring.

In fact, people with a snoring significant other tend to lose an hour of sleep per night, according to Craig Schwimmer, MD, founder of The Snoring Center. Perhaps as a result, “couples in snoring relationships report lower marital satisfaction scores, they have less sex, and they often resort to sleeping apart,” he tells Yahoo Health.

That’s why snoring is considered a social issue more so than a medical one, although in some cases, it does indicate a more serious problem: obstructive sleep apnea. “When we go to sleep at night, the muscles in the throat relax, and as we breathe in and out, this relaxed tissue tends to vibrate,” explains Schwimmer. If that tissue simply vibrates — and nothing more — you’ll probably just bother your bedmate. But if that tissue closes as it vibrates, blocking your airway, you may have obstructive sleep apnea. “Snoring and sleep apnea are really just different points on a continuum,” says Schwimmer.

Obstructive sleep apnea, of course, requires serious medical intervention. But simple snoring can often be treated with these at-home remedies:

Adjust your position

If you’re a chronic snorer, back isn’t best. “Most people snore more on the back than they do on the side, and more on the side than they do on the stomach,” says Schwimmer. It can be tough to switch your preferred sleeping position, so sleep doctors often suggest this trick to encourage people to stay on their side: Sew a pocket on the back of a T-shirt between the shoulder blades, and slip two tennis balls inside.

“When people sleep on their side, their shoulder can get sore. So they roll on their back,” says Kezirian. “The tennis balls aren’t very comfortable, so they end up rolling to their other side.”

Not extreme enough? Try the Night Shift Sleep Positioner, a device you wear around your neck that vibrates when you roll onto your back, increasing in intensity until you shift to your side. “I wore it one night, and it drove me crazy,” says W. Christopher Winter, MD, director of Charlottesville Neurology and Sleep Medicine. “But it worked. After a few days of that, you would not be sleeping on your back.”

Play with pillows

For some people, the tennis ball trick works — but only because it keeps them up all night. If you simply can’t sleep with sports equipment attached to your PJs, try resting a body pillow between your legs, which helps align your spine and makes side sleeping more comfortable. Or wedge a C-shaped pregnancy pillow behind your back, suggests Winter.

If you still can’t adjust to lying on your side, lie on your back, but prop up your head and shoulders. “You want to make a little incline — a wedge — with a couple pillows,” says Kezirian. “It’s not just lifting up your head.” Try placing one underneath your shoulders to elevate your chest, then another two under your head. That may help keep the back of your throat open.

Avoid alcohol before bed

It’s not just your inhibitions that loosen up when you’re drinking. “Alcohol preferentially relaxes the muscles in the throat, so everybody’s snoring is worse after a couple drinks,” says Schwimmer. Plus, since you’re more sedated after drinking, your snoring is less likely to stir you awake, leaving your bedmate to suffer longer. “Most wives will tell you, ‘When Walter goes out drinking with his buddies, he’s going to snore like crazy. I don’t even sleep in the bed with him that night,’” says Winter. The simple fix: Stop your imbibing within four hours of bedtime.

Open your nose

Sometimes, snoring isn’t due to flapping muscles in your throat — it may simply be a problem of clogged or narrow nasal passages. If they’re consistently congested, a saltwater nasal spray may be the only fix you need. “When you brush your teeth in the morning and at night, put a spray or two in either side of your nose,” says Kezirian. Not only will that keep your nostrils clear, it will also maintain the moisture in your nose, preventing the dryness and irritation that can promote snoring.

Another way to keep your nasal passages open: Breathe Right strips. “If your airway is collapsing in the back of your throat, putting a sticker across your nose is not really going to help,” says Winter. But if narrow nasal passages are the problem (or if they’re chronically clogged due to allergies), the sticky strips could make a big difference.

Try this test to see if these strips might be the right remedy for you: While looking into a mirror, inhale deeply through your nose, and see if the sides of your nose collapse. If your nostrils cave in, you probably have narrow nasal passages, so the strips could do the trick, says Kezirian.

Control your acid reflux

What’s happening in your esophagus may not seem relevant to the noises you make at night, but acid reflux can actually play a major role in snoring. When stomach acid coats your throat, it creates inflammation, says Schwimmer. “The tissue is swollen, so that narrows the airway,” he says. “Swollen tissue is more vibratory.” To tame your reflux, stop eating two to three hours before bedtime, and if that doesn’t work, try taking Tums or Rolaids before bed.

Be a mouth breather

People who snore often sound like a choo-choo train while they snooze. “They’re puffing up their cheeks, and exhaling against a closed mouth,” which can lead to snoring, says Winter. ProVent stickers turn your nostrils into a one-way valve, allowing you to breath in, but not out, through your nose. “That creates extra pressure in the back of your airway and holds it open,” he explains. In other words, the stickers force you to exhale through your mouth. “They’re really for sleep apnea, but I have patients who say that they help with their snoring,” says Winter.

Belt it out

Here’s motivation to turn your morning commute into a concert: In a 2013 British study, people who did singing exercises — a series of simple, repetitive noises put to music — for 20 minutes a day showed a significant reduction in snoring after three months. But you don’t necessarily have to do the specific exercises in the study — just belting it out may have a benefit. “There are a lot of muscles in your upper airway that don’t get used a tremendous amount,” says Winter. By singing, you may strengthen and tone those muscles, which could potentially reduce your snoring, he says.

Where There Is Smoke…There Is Sleep Apnea: Exploring the Relationship Between Smoking and Sleep Apnea

Smoking and OSA are widely prevalent and are associated with significant morbidity and mortality. It has been hypothesized that each of these conditions adversely affects the other, leading to increased comorbidity while altering the efficacy of existing therapies. However, while the association between smoking and OSA is plausible, the evidence is less than conclusive. Cigarette smoking may increase the severity of OSA through alterations in sleep architecture, upper airway neuromuscular function, arousal mechanisms, and upper airway inflammation. Conversely, some evidence links untreated OSA with smoking addiction. Smoking cessation should improve OSA, but the evidence to support this is also limited. This article reviews the current evidence linking both conditions and the efficacy of various treatments. Limitations of the current evidence and areas in need of future investigation are also addressed.

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