Lack of sleep has become an epidemic in the United States. It’s estimated approximately 22 million Americans suffer from sleep apnea, a sleep disorder marked by its disruptive breathing patterns that can pose serious risks. While many chalks up the disorder as an inconvenient nuisance, when left untreated, the consequences can be much more severe with side effects including:
- High blood pressure
- Heart disease
- Falling asleep while driving
If you suffer with sleep apnea, definitely work with your doctor to explore the many treatment options available. As a NASM-certified personal trainer, my role in the continuum of care is to help my clients improve their lives through fitness. Since I’m also the lead mattress tester here at The Sleep Judge, a question I’ve gotten more than once is, “can exercise help your sleep apnea?”
The answer could change your life, so keep reading!
Sleep Apnea and Cardio Training
A direct link between exercise and improvement in sleep apnea has been backed by numerous studies. We’re not going to go through them all, but one, in particular, provided some interesting observations. Researchers followed adults who suffered from obstructive sleep apnea and recorded their findings before and after the subjects engaged in exercise. It was discovered the vast majority of participants exhibited a significant reduction in the severity of their condition, most notably through cardiovascular exercise.
To substantiate these findings, another study gave us an even deeper understanding of the link between cardio exercise and sleep apnea. It revealed that the higher a person’s ability to use oxygen efficiently during intense exercise, the lower severity of sleep apnea they experience. In other words, the more cardiovascular endurance you build up, the less sleep you’ll lose to your disorder.
What These Studies Mean for You
Regular cardio exercise helps you improve your oxygen uptake. If it’s been a while, you don’t have to worry about starting off aggressively. Even a walk down the street and back can prove beneficial. Working directly with your doctor and a personal trainer, you can design the right progressions to ensure safety and efficiency.
For my average client, I typically recommend zone training. This allows you to customize your workouts based on your heart rate and progress safely and effectively. There are three stages, so let’s examine how you should approach each:
- Figure out your maximum heart rate. Simply subtract your age from 220. For example, a 20-year-old would have a max heart rate of 200 beats per minute.
- Stage I
- Maintain continuous aerobic activity at 65-75% of your max heart rate. Strive to engage in this level of cardio exercise three to five days per week. Start slow, but try to gradually work your way up to a full hour.
3. Stage II
- When you’re able to complete a full hour of Stage I cardio training, increase your intensity level to 65-85% max heart rate.
- Vary your intensity with bouts of running followed by light jogging with a work-to-rest ratio of 1:3 (one minute work followed by a three-minute recovery).
- Over time, change this ratio to 1:2. When you’re comfortable, advance to 1:1. When you can sustain a 1:1 ratio for 30-60 minutes, you may consider advancing to Stage III.
4. Stage III
- Sustain short bursts of intense exercise followed by longer periods of rest.
- Heart rate should range between 65-95% max.
- As you did in Stage II, progress your work-to-rest ratio starting with 1:3 and working your way up to 1:1.
Stage III is an advanced stage of training and not necessary for everyone. Most people can enjoy improvements in sleep apnea through a combination of Stage I and II training.
A Word on Cardiovascular Loss
It’s important to understand that, when you don’t use it, you lose it. In as little as a week after ceasing cardio training, you can start to lose the ability to use oxygen efficiently. Consistency is key!
Sleep Apnea and Strength Training
When it comes to exercise, it’s not all about cardio. Building muscle comes through strength training, and there are studies that support a connection between strength training and improvements in sleep apnea. Again multiple studies correlate a link.
In one study, 25 outpatients diagnosed with obstructive sleep apnea were observed as half engaged in a strength training program five days per week while the other half made no changes. The exercising group exhibited:
- Improved sleep apnea
- Improved sleep quality
- Improved expiratory muscle strength
Other researchers studying the effects of strength training in the elderly with obstructive sleep apnea gathered similar data. Not only did neuromuscular function improve, but the exercising group experienced less severe symptoms related to their sleep apnea.
What These Studies Mean for You
Strength training offers numerous benefits. Aside from improving your ability to engage in activities of daily living, you may even experience an improvement in your sleep apnea. Again, a personal trainer can help you develop a plan tailored to meet your specific needs. However, these general guidelines can get you started:
- Focus on form, balance and stability in the early stages of strength training. You want to make sure you’re doing it right.
- Workout in front of a mirror so you can recognize issues with technique before they become a habit.
- Start off with more reps and less weight. As you begin to feel more comfortable, start easing up on the reps and adding more weight.
- In the early days of training, use equipment like hand weights, barbells and kettlebells. They challenge your balance and help develop form. Save the weight machines for hypertrophy training after you’ve established a firm foundation.
- Strive to incorporate weightlifting 2-3 times per week.
- Provide your body time to rest. When you’re sore, your muscles need time to repair.
Balancing Cardio and Strength Training
It’s clear there are direct links between cardio, strength training and improvements in sleep apnea. So, how do you balance it all?
Just as you need variety in your diet, you need to mix things up when it comes to exercise. Here are a few tips to ensure your fitness “diet” is properly balanced:
- Stay consistent, and don’t overdo it. It can be overly-ambitious to try to cram strength and cardio both in a single day. Try an every-other-day approach. For example:
- Monday, Wednesday and Friday- 45 minutes of cardio
- Tuesday- Upper body weights
- Thursday- Lower body weights
- Don’t get stuck in a rut. For example, don’t limit your cardio to running. Try the elliptical. Sign up for a spin class. Keep things interesting!
- Recruit a workout buddy. This can work wonders in holding you accountable and keeping it consistent.
Cardio or Strength First?
These are just suggestions. There’s no rule saying you shouldn’t do both cardio and strength on the same day. For those who do, however, a common question arises: should you do cardio or strength training first?
There is no one-size-fits-all answer to this question. For some, getting cardio out of the way first is the way to go. This could be a good solution if you find strength training more enjoyable. However, if you’re working on gaining muscle mass, you may want to save cardio for last. When you do it first, you use up energy needed for focus on lifting heavier weights. As a general rule of thumb:
- If you have a personal preference, go with it. The main goal is to enjoy exercise as this increases your chances of sticking with it.
- Don’t dominate one form over the other. Try to maintain a balance in your time allocation for both strength training and cardio.
- If you’re still in the early stages of your training and haven’t built up endurance, you may want to save cardio for last so you don’t use up all your energy before you hit the weights.
Don’t Leave Your Doctor Out of the Equation!
Of course, my suggestions here are not meant to replace any advice given by your doctor. You should certainly work closely with your healthcare provider in the proper management of your sleep apnea. Especially for severe cases of the disorder, some of the additional solutions they can help you explore include:
- Overnight observation in a sleep lab
- CPAP or BiPAP
- Oral appliances
- Supplemental oxygen
It is very likely your doctor will be on board with your interest in incorporating exercise in the improvement of your sleep apnea, and they can help guide you in the development of the right program. Together, you can explore possible risk factors and determine the right timeline of progression through your exercise regimen. When combined with doctor’s orders, exercise can improve your sleep and overall quality of life.
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