Restore Sleep
Obstructive Sleep Apnoea (OSA)
Do you wake feeling exhausted and have other signs pointing to OSA such as pauses of the breath or gasping for air in your sleep? Or perhaps you've already had a sleep study and maybe you've been recommended the 'gold standard' treatment with CPAP or a Mandibular Advancement Device (MAD), but you're wondering whether there's anything else you can do to support your diagnosis. After all, 'apnoea' means a pause or cessation of breathing, so surely breathing has to come into the conversation?
What is OSA?
Obstructive sleep apnoea (OSA) is a sleep-related breathing disorder where the upper airway repeatedly narrows or becomes blocked during sleep for a period of 10 seconds or more.
This can happen for a number of reasons, including the soft palate falling towards the back of the throat, the tongue moving backwards and narrowing the airway, the epiglottis folding back towards the throat, or the walls of the throat collapsing.
Excess weight can also contribute to airway narrowing, particularly when sleeping on your back, as additional tissue around the neck and upper airway can place more pressure on the airway. But OSA isn’t simply a condition associated with being overweight, nor is it a condition that only affects men.
Other factors, including airway anatomy, nasal obstruction, craniofacial structure, age and hormonal changes, can also play a role.
I'm particularly passionate about this because OSA is often under-recognised and underdiagnosed in females. Women can present differently from men, with symptoms such as fatigue, insomnia, morning headaches, anxiety or mood changes, rather than the classic picture of loud snoring and obvious daytime sleepiness.
So if you're a woman, slim, relatively young, or you don't fit the stereotypical picture of someone with sleep apnoea, don't assume you're in the clear. If your sleep is poor, you're exhausted during the day, you're waking with headaches or dry mouth, your partner has noticed changes in your breathing, it's worth having the conversation with your GP.
These events can happen repeatedly throughout the night, sometimes without you knowing they're happening. Often it's partners who notice that someone's breathing pauses followed by a gasp for air, snort or change in breathing.
Already had a sleep study?
Learning to breathe better may also help support a more stable upper airway during sleep. We work on the way you breathe during the day, including nasal breathing, breathing volume and respiratory muscle function so that you're giving your airway the best possible conditions to work with at night.
Breathing retraining with a Buteyko Breathing Method (BBM) practitioner can help you understand and work with the breathing patterns you bring into sleep. This is a third of our day, after all. Buteyko looks at breathing patterns that sit alongside your sleep apnea. Research has also begun to explore breathing retraining as an adjunct to conventional OSA management.
A 2021 study explored the role of breathing retraining in wakefulness alongside the different phenotypes of OSA.
AHI (Apnoea-Hypopnoea Index)
An AHI of five or more events per hour is considered within the range used to diagnose OSA. The table below shows the commonly used AHI ranges for adults and children.
For milder cases of OSA, the treatment recommendation is often a MAD. As the severity increases, CPAP and, in some cases, a combination of MAD and CPAP may be recommended.
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Mild
Moderate
Severe
Adults
5–15
15–30
30+
Children
1–5
5–10
10+
But here's where it gets interesting: neither of these approaches is able to support central sleep apnoea, which is is different from Obstructive Sleep Apnoea; the issue isn't primarily that the upper airway is collapsing; it's that the signals from the brain to the muscles responsible for breathing don't send the correct message to breathe.
This is another reason I believe there is value in looking at breathing retraining given we're working to reset the breathing centre of the brain towards more functional breathing patterns.
AHI can look different in women
There isn't a separate “female” or “male” AHI range. The diagnostic thresholds are the same, but women can present differently from men and may experience significant symptoms at lower AHI values.
I've heard Patrick McKeown explain this in his teachings, where he highlights that a woman can have an AHI around 2.5 and therefore not meet the usual threshold for an OSA diagnosis, yet experience symptoms that can feel just as significant as a man with an AHI of 15.
While still feeling exhausted, unrefreshed, foggy, anxious or simply like something isn't right with her sleep.
More than a number on a page. When you have a sleep study, there is much more information available to us than simply your AHI. We can look at things such as:
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Oxygen saturation (SpO₂)
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Respiratory events
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Snoring events
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Sleep position
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Whether events are more pronounced during certain stages of sleep
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Your arousal index
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The difference between apnoeas & hypopnoeas
I also personally recommend redoing your sleep study every 1–2 years. Your breathing and sleep health can change over time, and it's common to see improvements from your original numbers. Having a repeat study allows us to see what's changed and whether your current treatment is still appropriate.
Already using CPAP?
If you've been prescribed CPAP (continous positive airway pressure), keep using it as directed by your healthcare professional. The Buteyko Breathing Method can be learnt alongside CPAP .
Your CPAP machine provides a band aid to stabalise the airways with the continous flow of air whereas breathing retraining teaches you to adapt your breathing habits to help stabilise the airways. Often after completing the Buteyko Program clients will feel ready to request a review of the pressure of their machine.
For some clients, we may also explore mouth taping to support nasal breathing as it's critical that we encourage nasal breathing in sleep. Where appropriate, I currently recommend MyoTape rather than fully sealing the mouth. This product can be comfortably and safetly worn with CPAP devices.
If you're struggling with CPAP, for example because your pressure needs adjusting, your mask needs refitting or you're experiencing other difficulties, these are also things worth discussing with your sleep or medical team.
Already using MAD?
A Mandibular Advancement Device (MAD) is an oral appliance designed to help keep the upper airway open by repositioning the lower jaw forward.
If you've been prescribed or fitted with a MAD, it's still important to improve your respiratory health and breathing patterns. The two approaches are addressing different aspects of the picture. The MAD addresses the physical positioning of the airway and breathing retraining focuses on how you breathe to help maintain a more open airway.
I recommend working with a Functional Dentist who understands the relationship between the teeth, jaw, palete and airways. If you're local to Brisbane, I often recommend Dr David Cowhig at Dental Wellness. I also suggest listening to our podcast episode on Mouth Health Natters.
Often clients find their MAD device bulky and enourages mouth breathing which is only going to add to the domino. A perfect fit and comfort is critical.
Want to start learning? Breathing 101
Learn the foundations of functional breathing and discover the skills no-one ever taught you. A 75-minute introduction to the Buteyko Breathing Method, with practical exercises you can take into everyday life.
Or ready to explore your breathing?
Let’s talk about your story, what you’re experiencing, what you notice, and explore whether breathing retraining could benefit you.