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Breathe Better E-Newsletter>
Does Michael Phelps Have Sleep Apnea?
August 21, 2008
I have a confession to make. I LOVE the Olympics. The
spectacular pageantry, the awe inspiring display of
physical and mental strength, not to mention the sense of
pride I feel watching America's top athletes achieve the
impossible. In the case of swimming sensation, Michael
Phelps, he did what many thought was impossible—winning 8
gold medals out of all 8 events and breaking 7 world
records in the process. Still, having witnessed his
incredible triumphs, I couldn't help but to wonder what his
next challenge would be. If his jaw anatomy is any
indication, I predict that this may come in the form of
obstructive sleep apnea.
Adversity is the Name of The Game
One of the recurrent themes during the Olympics is about
what each athlete had to overcome to reach his or her goal
of winning gold. From suffering through physical injuries,
to being 25 years older than your youngest competitor (like
swimmer Dara Torres), there's probably not one Olympic
athlete who didn't have to undergo years of struggle and
sacrifice to achieve what only a few of us dream of.
Along these lines, the media portrayal shows that Michael
Phelps along with his mother have had to endure more than
their share of adversity. Watching Phelps swim each and
every time, it was obvious that his mother, Debbie Phelps,
struggled when he struggled, and triumphed only when he did
so. It was a poignant picture of mother and son,
consummately connected mentally and emotionally.
What many people probably overlooked, however, was how
closely this mother and son duo mirrored each other
physically. If you observe Debbie Phelps' facial features
and neck girth, along with the fact that her age puts her
at higher risk category for sleep breathing problems like
sleep apnea it's not surprising that her son, Michael has,
what one colleague of mine noted with assured confidence a
severe malocclusion (see below). Similarly, upon closer
inspection, notice how long his face is, and how narrow his
upper jaw is and how much of an overbite he has. At the
very least this is indicative of him being a mouth
breather, if not a strong indication that he has some sleep
breathing issues. Given some other clues, like the fact
that he had had attention deficit problems as a young
child, according to his mother, provides more evidence,
that Phelps may, if all things remain the same, develop
some type of sleep breathing problems as he gets older if
he's not struggling with these issues already.
What Your Face Says About Your Sleep
Because obstructive sleep apnea is not something you all of
a sudden have or don't have, but something that develops
over years and years, the best way to distinguish who may
develop this sleep breathing problem later on, is by
looking at their facial anatomy, and especially their jaw
size since these features are so closely interrelated to
their airway anatomy.
As such, having examined virtually thousands patients with
sleep apnea, and based on tomes of research literature out
there, I can confidently say that almost everyone with
facial features like Michael Phelps' has the following
characteristics of someone with a sleep breathing problem
like upper airway resistance syndrome (UARS) or even
obstructive sleep apnea (OSA).
Those with higher than average proclivity for this
condition usually prefer to sleep only on their sides or
stomach, and never feel refreshed when they wake up in the
morning. The significance of this type of sleep positioning
is that people with sleep breathing issues must sleep on
their sides or stomach to prevent their tongues from
falling back due to gravity. If their jaws are smaller than
usual, then the normal-sized tongue and voice box normally
sits further back in the throat, encroaching on the
breathing space behind the tongue. This has no significant
impact on their breathing during the day, but when they're
on their backs sleeping, the tongue will fall back
partially due to gravity. When they go into deep sleep,
especially in REM sleep, due to total muscle relaxation,
their tongue falls back even further or their airway can
temporarily obstruct, causing them either to light sleep or
to complete arousal. This leads to deep sleep inefficiency,
not only due to a relative deficiency, but also due to too
much deep sleep fragmentation.
Consequently, to compensate for their lack of sleep, or
feeling of sluggishness, many of these patients not only
exercise routinely, but do so fanatically. Some are what
you'd consider "exercise addicts," as this is the only
activity that makes them feel alive. Sustained, prolonged,
and intense physical activity is what often motivates them
to train harder than the average athlete or gym goer. Yet
because they're so highly motivated, they often excel, like
Michael Phelps does, to the point of achieving the
impossible.
Other Factors That Can Make You Sick and Tired
On the other hand, there are those with underlying sleep
breathing problems who stop exercising or working out for
more than a few days or weeks, due to illness or injury.
It's not uncommon for me to see patients who fit this
profile tell me that after a serious injury or even after a
prolonged cold, where they could not run, or work out
anymore, they began to gain significant weight. Upon
further questioning, they usually reveal that they are side
or stomach sleepers, and that their injury prevented then
from sleeping in their favorite position. What results is a
cycle of extreme sluggishness and inability to keep up
their usual exercise regimen. This sudden inactivity leads
them to gain weight, which then aggravates tongue collapse,
which then further aggravates their sleep inefficiency. And
of course, inefficient sleep is known to promote weight
gain and weight gain is known to promote obstructive sleep
apnea.
Another life-changing condition that aggravates the
situation for women is menopause—due to slight weight
increases, onset or progression of sleep-breathing problems
is not unexpected. Another reason for progression of these
symptoms during menopause is due to the gradual decline in
progesterone levels, which is known to promote muscle tone
with the tongue and upper airway muscles. Lower levels of
progesterone and deep sleep can combine to even more
relaxed muscles, leading to worsening sleep quality.
One of the common misconceptions is that obstructive sleep
apnea is something that you only see in older, heavy-set,
snoring men with big necks. Yes, people with these features
are more likely to have it, but we now know that even
young, thin men and women who don't snore can have
significant obstructive sleep apnea. By definition, all
humans are susceptible to sleep-breathing problems due to
our unique upper airway anatomy (and our ability to talk).
We're all on an upward sloping continuum. The classic sleep
apnea patients are the ones at the extreme end of the
spectrum.
Start at the Bottom To Get To The Top
It may be an overused metaphor to say that overcoming
adversity is what promotes human achievement, but I see
this all the time, particularly in elite athletes. I
personally know a number of ultra-distance runners of
various ages that also fit this description. They never
feel refreshed, no matter how long they sleep, and usually
can only sleep on their stomachs.
Michael Phelps' sleep-breathing status is pure speculation,
of course. But if you either breathe or sleep on a regular
basis, this is an issue of utmost importance, particularly
if you have a chronic or debilitating medical condition
which affects your job, school performance or quality of
life.
Some of you who excel now at whatever sport or activity you
choose to do, may discount those who are unable to do
anything at all due to pure physical exhaustion. However
given that the greatest heros and champions always arise
out of adversity, be wary of those who underachieve now.
After all, if the Olympics are any indication, it's
adversity that pushes people to pursue excellence.
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Related Links:
What is OSA?
http://web.mac.com/sypark/iWeb/West%20Side%20ENT/OSA%20.html
What Is a Sleep Study?
http://web.mac.com/sypark/iWeb/West%20Side%20ENT/sleep%20study%20video.html
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To watch an educational video on malocclusions:
Go to:
http://www.myoresearch.com/cms/index.php?id=153,215,0,0,1,0
*Start with Soft Tissue Dysfunction Composite Video – Note
hyperactivity of girl’s perio-oral musculature at end of
that video. Then watch:
Reverse Swallow – 2nd video – of a girl swallowing. Then
watch:
Mouth Breathing – 2nd video – of a boy swallowing – Similar
to Phelps malocclusion.
Compare with Normal Swallow - #3 video – girl with normal
swallow.
Now compare to Phelp’s mouth / breathing / swallowing. His
mouth is never stationary – it is nearly always moving.
*Directions courtesy of Brian Palmer,D.D.S. He has done
extensive research on the importance of breastfeeding as it
relates to total health and how it can possible reduce the
risk of obstructive sleep apnea (OSA), SIDS, otitis media,
bedwetting, hyperactivity and long face syndrome. For more
information visit: www.brianpalmerdds.com
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