Nutritional Advice For Sleep Apnoea Patients

Via the people I got my CPAP machine and masks from, I got in touch with Clare Jeffries who runs a Nutritional Therapy Practice in Surrey called Healthy Influence. We all know dietary choices have an effect on our body and sleep apnoea condition so it helps to know the do’s and don’t when it comes to food intake. Clare kindly agreed to be interviewed about how nutrition influences disorders such as OSA. Our forum members also pitched in with a few questions.

Coincidentally, yesterday I was watching The Truth About Food on the BBC in which the volunteers dropped an average of 23% in their cholesterol levels after eating raw fruit and veg only for just 10 days. Many reported weight loss and increased energy so it clearly illustrates how making the right food choices can help sleep apnoea sufferers with very quick results.

Interview with Nutritional Therapist Clare Jeffries:

JMcM: How long have you been a Nutritional Therapist for?

CJ: Studying for 4 years and practising for 1 year.

JMcM: How did you first learn about OSA?

CJ: It came up in my reading on obesity as something many overweight people suffer from.

JMcM: As you know a lot about the human anatomy, can you summarize the effects of sleep apnoea on an otherwise healthy body?

CJ: Because sleep apnoea restricts, sometimes severely, the amount of oxygen being delivered around the body whilst sleeping, cells are not able to get rid of wastes to keep them healthy and this can have many long term effects. Also, the brain registers this drop in oxygen and tells the heart to pump harder to deliver more blood faster. This can then lead to high blood pressure and over time sleep apnoea can cause other heart abnormalities. And of course, due to the lack of good sleep, sufferers will be excessively sleepy in the daytime and may get morning headaches.

JMcM: As we all know, untreated OSA affects blood oxygen levels. Is there anything nutrition-wise sufferers can do to improve the condition of the blood or to make sure the little oxygen in there gets used up best?

CJ: Ideally, you want the blood to be able to carry as much oxygen as it can and having adequate iron levels is required for this. When a person is anaemic, they have reduced capacity for carrying oxygen on their red blood cells. However, most men who eat a varied diet will be getting sufficient levels, unless they have a disorder of some kind that means they are losing blood, such as bowel disorders or haemorrhoids. Another factor that is important is to ensure you are well hydrated. When we don’t consume adequate levels of fluids, the blood becomes slightly ‘thicker’ and therefore harder for the heart to pump around the blood vessels. Think of it like sucking a McDonalds thickshake as opposed to orange juice through a straw! So, make sure you have at least 1.5 litres of water (herbal teas can count towards this) in addition to tea & coffee.

JMcM: A feeling of sleepiness is possibly what bugs us most. Are there any foods specifically full of energy, aiding staying awake and alert?

CJ: B vitamins and magnesium are crucial for energy production and are found in fish, wholegrains, brown rice, mushrooms, green vegetables, beans & pulses, some meats & eggs. It will also be helpful to keep your blood sugar balanced, by not eating too many refined carbohydrates such as white bread, cakes, biscuits, chocolate and sweets, and not leaving very long gaps between meals. When we do eat lots of these foods and leave long gaps (more than 4 hours) between eating, your blood sugar levels resemble a rollercoaster, with big peaks & troughs. In the ‘troughs’, you can feel very tired and lethargic. Aim to eat little and often and have foods that contain fibre (fruits, veg, wholegrains), as these keep the blood sugar on an even keel.

JMcM: What about the use of coffee or energy drinks in a desperate attempt to stay awake; good or bad?

CJ: Understandably, these must be appealing at times, but using them in the long run often disrupts your blood sugar balance as described above, because they push your body to churn out stress hormones like adrenalin & cortisol which can make you feel a bit ‘wired & fired’ but then comes the inevitable crash after they’ve worn off. If you do feel you can’t do without these though, coffee (good quality filter best) is better than energy drinks which are full of caffeine, chemicals & sugar.

JMcM: Many OSA sufferers often feel depressed or easily agitated. Can food help with controlling one’s mood?

CJ: Balanced blood sugar levels is also very important for this as the brain is very sensitive to drops in blood sugar, and one can feel low mood, irritable, angry, get headaches and generally feel under par when levels drop too low. Again B vitamins are important for producing ‘happy hormones’ in the brain and having good intake of essential fats (oily fish, nuts, seeds, olive oil, avocado are all good sources) has been found to reduce depression.

JMcM: With a CPAP machine and a mask on, it can be difficult falling asleep at times. What is the role of food in a good bedtime routine and for promoting a restful sleep?

CJ: Serotonin is needed to induce sleep and this is produced from something called tryptophan. This is a part of protein and is absorbed best from walnuts, milk, soy, eggs, bananas & fish. So eating fish or an omelette for your evening meal or having a snack including these foods 1/2 hour before bed can help you drop off easier. Obviously, its best to avoid coffee, tea or chocolate in the evening due to the caffeine levels and again if you have something very sugary in the evening, your blood sugar levels may drop off too steeply in the night which can then wake you up.

JMcM: Many of us are overweight, contributing to the causes of OSA. What are your best tips on weight management?

CJ: Sorry to be a bore, but keeping you blood sugar balanced, so that the body knows it has a steady supply of energy, encourages it to let go of excess weight, so simply not eating very much may be bad for losing weight in the long run. Eat 3 small meals per day and two healthy snacks. Eat plenty of vegetables & fruit as these are low calorie but high fibre, so keep you satisfied for longer than cakes & biscuits! As a general rule, try to avoid large portions of carbohydrate (bread, potatoes, rice, pasta) with your evening meal and have them at lunch time instead.

JMcM: I’ve been reading about light therapy possibly having a beneficial effect on sleep. Do you happen to know anything about this subject and if so, what are your views on this?

CJ: Light therapy does indeed have a positive impact on sleep. This is because it helps regulate the circadian rhythm, our ‘body clock’. Without adequate levels of light in the day, the body sometimes gets confused as to when it should be sleeping and sadly with modern living and long ours in offices with artificial light, exposure to full spectrum natural light is often inadequate. I certainly think it is something worth considering as part of our overall health.

JMcM: Finally, not necessarily related to OSA, what is your favourite nutrient-rich food and why?

CJ: That’s hard as there are so many, but certainly oily fish (salmon, mackerel, sardines, kippers, anchovies) cannot be underestimated. These oils help protect the heart from damage, be keeping the blood vessels supple, they protect the brain in a similar way. As heart attacks & stroke are more common in those with OSA, I think they are particularly important. But they do lots more not related to sleep apnoea, such as reduce inflammation so helpful in arthritis, they help the body balance weight and regulate hormones. A real super food!

JMcM: Our forum member katiemcewan asked the following question: “My husband doesn’t ever drink any water. I keep saying he should but he just can’t keep it up for longer than a few hours. I’ve heard drinking too little water can cause back trouble etc. but does it also add to the sleep apnoea symptoms he suffers from?”

CJ: As I mentioned above regarding helping the body deliver oxygen, being adequately hydrated is very important for the blood to flow easily, reducing the change of high blood pressure.

JMcM: Another member, aptly named JackTheSnorer, asked: “Not so much coffee, more Red Bull for me to perk me up. I know it’s full of caffeine so how exactly does it work with blood and the heart etc.?”

CJ: As discussed above regarding using stimulants to stay alert, caffeine makes the body produce more stress hormones (hence the jittery feeling some people experience with high levels of caffeine) which often makes the heart pump harder. Although this might seem like a good thing for delivering oxygen around the body, the heart is artificially being stimulated to work harder than is necessary. The occasional red bull is not a problem, but be aware that it contains a similar amount of sugar to coca-cola. There is a sugar free variety, but due to the possible dangers of artificial sweeteners to the health of your brain, I do not recommend having the diet variety.

JMcM: Thank you Clare, that has been some great advice I’m sure all readers can benefit from. Thanks for taking the time to answer them!

CJ: No Problem!

And of course, if you are curious about nutritional advice more tailored to your specific circumstances, you can contact Clare here to arrange a consultation.

Other helpful links related to this post:

If you would like to discuss nutritional topics with fellow sleep apnoea patients, please visit the forums. You can also leave your feedback in a comment below.

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Sleep Apnoea and Sleepy Driving

We discussed Sleep Apnoea in drivers before when we dug up some frightening statistics regarding the prevalence of sleep disorders amongst drivers in Britain. As this is such an important topic and often asked about in the various forums, we decided to dedicate another post to the matter of Sleep Apnoea and driving cars or trucks.

There are many good sources on the web benefiting drivers with sleep disorders. A good starting point is the road safety charity aptly named Brake. They list a staggering amount of scary statistics, pointing out the large groups of people endangering our roads on a day to day basis. They estimate that one in ten road accidents are down to driver sleepiness; that statistic alone warrants utmost caution among those who know they aren’t sleeping well. Brake quotes:

Sleep scientist Melanie Marshall says, “Untreated, undiagnosed sleep apnoea individuals are more lethal on our roads than individuals who have been drink driving.”

Brake has great further information on Driver Tiredness, Driver Stress & Emotions, Risks for Older Drivers and Laws regarding Death by Dangerous Driving. They also have PDF documents for fleet managers containing information about how they can assist their drivers in road safety. Those relevant to sleep disorders include Stress & Distractions and Driver Assessment & Monitoring.

If you are unsure whether you are just not sleeping well temporarily or a sleep disorder might cause your sleepiness symptoms, take this free online screening test and discuss the results with your doctor. If a clinical diagnosis confirms you have a sleep disorder like Obstructive Sleep Apnoea (OSA) you are obliged to inform the DVLA.

Group 1 licence holders (car/ motorcycle) diagnosed with sleep apnoea must stop driving until the symptoms have been controlled and confirmed by medical opinion.

Group 2 licence holders (LGV) diagnosed with sleep apnoea must stop driving until the symptoms have been controlled, and must have ongoing treatment. Licensing reviews will be carried out regularly, usually annually.

The Driver & Vehicle Licensing Agency (DVLA) has many pages on their website dedicated to tired driving and Sleep Apnoea in drivers. This PDF leaflet called “Think! Tiredness can kill!” explains the implications of Sleep Apnoea for drivers. Their D9 form tells us:

If you have ever had or presently suffer from any of the following
conditions you must write to the Drivers Medical Group, DVLA,
Swansea SA99 1TU or telephone on 0870 600 0301 with the nature
of your condition, as it may affect your fitness to drive.
FAILURE TO DO SO IS A CRIMINAL OFFENCE PUNISHABLE
BY A FINE OF UP TO £1,000
.

  • Narcolepsy or sleep apnoea syndrome

The DVLA’s medical section has all the information you need including how tell them about your sleep disorder and what happens next. Your licence can be accordingly issued, revoked or refused. In some cases they may contact your doctor, arrange to be examined or ask you to undergo a driving assessment or test. They aim to resolve most medical enquiries within 15 working days. CPAP users tend to get their licence re-issued after they confirm with the patient’s doctor that the CPAP therapy is having the desired effect.

Some people may feel opposed to risking their licence by telling the DVLA or even by seeing their doctor. After all, some rely on driving to pay their bills and food. It is important to realize the full extent of the risks you expose yourself and other road users to if you keep on driving whilst sleepy, fatigued or lethargic. It’s not just yourself who can be harmed or killed. Think about your children in the back seat or the car behind you.

UPDATE: There is a scheme called “Access to Work” run by the Employment Service (ES) which can help people with disabilities and those who’s licence has been revoked for medical reasons to regain access to work. A good write-up can be found here and an evaluation here.

The Government has produced various leaflets and posters to hit home the risks you pose. You can see some of them here and here.

Some of the slogans designed to make you take direct action:

  • [Disabled Parking Sign] Every Hour A Driver With OSA Makes Someone Else Eligible To Park Here
  • Daddy Used To Drive A Big Lorry, Then He Fell Asleep
  • Bet You Wish You’d Crashed At A Mate’s
  • You Drive For A Living But You’d Kill For Some Sleep?
  • Think You Can Do The Job With Your Eyes Closed?

You can watch a video or listen to audio by the THINK! Road Safety initiative here. Also read their publication called “Wake up to the signs of tiredness” here.

If you are worried about nodding off whilst at the wheel, we urge you to do the following:

  1. Take this online test today.
  2. Consult your doctor and if need be, get referred to a Sleep Clinic to get diagnosed.
  3. Based on the outcome of the sleep lab test, consider your sleep disorder treatment options. This can range from surgery or dental splints to CPAP or lifestyle changes and weight loss.
  4. Don’t forget to tell the DVLA about your test results.
  5. For some forms of treatment you may have to join the queue on the NHS waiting lists though most are available privately as well.
  6. Once receiving treatment, arrange a follow-up with your doctor or sleep clinic to confirm the symptoms have sufficiently reduced.
  7. Now re-apply for your drivers license, if applicable.
  8. Don’t drive when feeling tired!

If you have any questions about OSA, CPAP and driving please leave them in the comments below or discuss them with fellow drivers in our forums.

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Online Sleep Apnoea Screening Test

To bridge the gap between those scratching their head, thinking “I’m not sleeping well, what’s wrong with me?” and those booking in their sleep lab visit, there is now a website which can help you determine whether or not it is indeed sleep apnoea you are suffering from.

Take the Online Sleep Apnoea Screening Test!

From frequenting the various online sleep apnoea forums I’ve come to understand that one of the most frequently asked questions is about whether such and such symptoms mean this person has a sleep disorder and whether it’s sleep apnoea.

Until today, there was no convenient way to get a quick answer.

On Sleep-Tests.co.uk you  can now complete 3 straight-forward sets of questions which will help determine whether it’s sleep apnoea or not, that’s been bugging you (or your friend/colleague/family member).

The screening test combines world-renowned surveys such as the Epworth Sleepiness Scale and the Berlin Questionnaire as well as a general health section. Combined they will offer you a giant step in the right direction. You can print out the results so you can discuss them with your doctor (they usually present you with the Epworth test themselves so this may save a few minutes of their precious time).

Awareness and diagnosis are currently major problems in the world of sleep disorders and for sleep apnoea, this is no different. The Sleep Tests website aims to bring the undiagnosed and unaware a step closer to living a fulfilling life again.

Spread the word!

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