Medically reviewed by
Dacelin St Martin, MD
Triple board-certified in Sleep Medicine,
Internal Medicine, and Pediatrics.
What Is Sleep Apnea? | Diet, Sleep, & OSA | Tryptophan & Sleep | Whole Foods & Sleep | Carbohydrates & Sleep | Proteins & Sleep | Can Certain Foods Worsen OSA? |
Treatment of OSA through Diet And Exercise Without Weight Loss
Overview
Obstructive sleep apnea (OSA) is a sleep disturbance affecting the lives of millions of people worldwide.
The standard treatment for sleep apnea depends on continuous positive airway pressure (CPAP) therapy and weight loss by following a restricted diet.
However, recent studies suggest that regular exercise, cutting back on alcohol, eating foods rich in anti-inflammatories, and avoiding highly processed foods can help treat sleep apnea without losing significant weight.
Continue reading to learn more about the link between diet quality and sleep apnea and how you can improve your sleep with healthy lifestyle changes instead of a low-calorie diet.
What Is Sleep Apnea?
Obstructive sleep apnea (OSA) is a common sleep disorder that causes temporary pauses in nighttime breathing.[1] This condition affects around 20 percent of adults worldwide and is one of the most common reasons for lousy sleep.[2]
OSA happens because the upper airway temporarily collapses during sleep, the muscles in the back of your throat relax, blocking your airway, which causes you to stop breathing.
OSA episodes can lead to loud snoring and waking up abruptly from sleep gasping for air. Because sleep is interrupted, sometimes more than once per night, OSA can result in excessive daytime sleepiness and poor work/school performance during the day.
This sleep disturbance can also increase your blood pressure and negatively affect your mental health.[3]
Diet, Sleep, & OSA
Scientists have already established a strong link between obesity and OSA.[4] Being obese increases your risk of developing OSA, while inadequate sleep during the night can make you gain weight.[5]
To take it a step further, researchers were interested in whether certain foods can affect our sleep. Can the food quality, not just the quantity, affect your sleep?
To answer that question, researchers conducted a narrative review to investigate the effects of diet on sleep. The studies showed that people with insomnia and other sleeping problems often had unhealthy diets.[6]
For example, people who don’t sleep well often report the following poor eating habits:[7]
● Low consumption of vegetables and fish
● High consumption of processed foods, such as sugar-sweetened beverages, energy drinks, and refined carbohydrates
● Skipping breakfast
● Irregular eating
Moreover, studies also showed that consuming certain foods can affect the quality of your sleep.[6]
Tryptophan & Sleep
To make proteins, your body needs tryptophan, an essential amino acid not naturally found in the body. Because our bodies don’t synthesize tryptophan, we need to consume it in our diets.
Foods rich in tryptophan include fish, chicken, eggs, milk, peanuts, and other high-protein foods.
Studies show that eating foods rich in tryptophan can make middle-aged adults sleep longer and better. The authors concluded that a diet low in tryptophan could cause poor sleep quality.[9]
Whole Foods & Sleep
Scientists found that minimally processed whole foods like cherries can improve sleep in young, middle-aged, and elderly individuals.
The consumption of additive-free cherries increased sleep time and decreased the number of times people woke up from sleep at night, especially in the middle-aged and elderly.[10]
Carbohydrates & Sleep
One study showed that eating a carbohydrate-rich meal four hours before bedtime can help you fall asleep faster.[11]
However, people who ate a meal rich in carbohydrates only one hour before bedtime took longer to fall asleep than those who had theirs four hours before going to bed.
Therefore both the quality and timing of your meal can affect your sleep.
Proteins & Sleep
Scientists examined the nutritional effects of foods rich in protein on sleep. The results showed that people who followed a protein-rich diet slept better and had fewer wake episodes during the night than those following a restricted diet.[12]
Can Certain Foods Make OSA Worse?
After confirming that some dietary patterns and eating habits affect sleep, researchers investigated the link between OSA and diet quality.
A study in 2019 found that moderate to severe OSA is associated with lower intakes of whole grains and higher intakes of red/processed meat. Hence, eating a lot of processed meat and too few whole grains can either trigger your sleep apnea or worsen it.[13]
A more recent study in 2022 investigated the effects of diet quality on the risk of developing obstructive sleep apnea.[14]
The authors showed that a higher-quality diet rich in anti-inflammatory foods decreases the risk for OSA. Anti-inflammatory foods include green leafy vegetables (spinach, kale, collards), nuts (almonds, walnuts), fatty fish (salmon, mackerel, tuna, sardines), and fruits (strawberries, blueberries, cherries, and oranges).
On the other hand, inflammatory foods, such as ultra-processed foods, increase the risk of this sleeping disorder. Highly-processed foods include refined carbohydrates, sugar-sweetened beverages, French fries, processed meats, and salty snacks.
Therefore, highly processed food can trigger sleep apnea and negatively affect sleep.
Treatment of OSA Through Diet And Exercise Without Weight Loss
Continuous positive airway pressure (CPAP) is the first-line treatment for sleep apnea.[8] A CPAP machine delivers a flow of positive airway pressure through a mask placed over the nose and mouth while sleeping. The steady flow of pressurized air reduces the number of OSA episodes during sleep.
Because obesity is a significant risk factor for sleep apnea, weight loss has also been used to manage the severity of OSA. However, in previous studies, OSA patients had to lose weight by following restrictive diets.
Recent findings about the effects of food quality on OSA inspired researchers to investigate whether healthy lifestyle and diet changes can reduce sleep apnea without weight loss.
A new clinical study published in JAMA Network investigated whether lifestyle changes can effectively treat moderate to severe obstructive sleep apnea (OSA). Instead of a restrictive, low-calorie diet, OSA patients were encouraged to follow a healthy diet and make a few lifestyle changes.[15]
The study included 89 Spanish men aged 18 to 65 with moderate to severe OSA. The men were either overweight or obese and were receiving CPAP therapy. The participants were encouraged to make the following lifestyle modifications:[15]
● Avoid drinking alcohol at night
● Quit smoking
● Exercise more
● Cut back on highly processed foods, such as processed meat, refined carbohydrates, and salty foods
● Eat more healthy foods, such as vegetables, fruits, beans, seafood, olive oil, poultry, and eggs
After only eight weeks, the number of OSA episodes during each hour of sleep at night decreased by 51 percent in the individuals who followed the suggested healthy habits
The participants in the healthy group lost more weight, on average 6.8 kg more, than those in the control group
In 15 percent of the healthy group, sleep apnea was cured, and 45 percent no longer needed their CPAP machines
Six months later, all of these individuals maintained this improvement in sleep and even started sleeping better. Around 30 percent achieved complete remission from sleep apnea, and about 62 percent no longer needed CPAP therapy
Six months after the intervention, individuals in the healthy group lost about 7 percent in body weight, 19 percent in fat mass, and 26 percent in visceral adipose tissue. They also had lower blood pressure, lowering their risk of dying from stroke by 40 percent and heart disease by 30 percent
The authors noted that OSA symptoms and metabolic functions also improved in individuals who underwent healthy lifestyle changes but didn’t lose much weight
The Takeaway
These findings suggest that you can improve sleep apnea with exercise and healthy dietary and lifestyle changes without losing much weight.
They also give insight into why some people have sleep apnea even though they aren’t overweight or obese.
As mentioned above, inflammation plays a role in OSA. Therefore, reducing pro-inflammatory foods (ultra-processed foods) and switching to a diet high in anti-inflammatory foods (leafy vegetables, nuts, fatty fish, fruits) can help you improve obstructive sleep apnea whether you lose weight or not.
References:
- Slowik JM, Collen JF. Obstructive Sleep Apnea. In: StatPearls. StatPearls Publishing; 2022. Accessed April 4, 2022. http://www.ncbi.nlm.nih.gov/books/NBK459252/
- Lechat, B., Naik, G., Reynolds, A., Aishah, A., Scott, H., Loffler, K. A., Vakulin, A., Escourrou, P., McEvoy, R. D., Adams, R. J., Catcheside, P. G., & Eckert, D. J. (2022). Multinight Prevalence, Variability, and Diagnostic Misclassification of Obstructive Sleep Apnea. American journal of respiratory and critical care medicine, 205(5), 563–569. https://doi.org/10.1164/rccm.202107-1761OC
- Jehan, S., Auguste, E., Pandi-Perumal, S. R., Kalinowski, J., Myers, A. K., Zizi, F., Rajanna, M. G., Jean-Louis, G., & McFarlane, S. I. (2017). Depression, Obstructive Sleep Apnea and Psychosocial Health. Sleep medicine and disorders : international journal, 1(3), 00012.
- Gami, A. S., Caples, S. M., & Somers, V. K. (2003). Obesity and obstructive sleep apnea. Endocrinology and metabolism clinics of North America, 32(4), 869–894. https://doi.org/10.1016/s0889-8529(03)00069-0
- Jehan S, Zizi F, Pandi-Perumal SR, et al. Obstructive Sleep Apnea and Obesity: Implications for Public Health. Sleep Med Disord Int J. 2017;1(4). Accessed December 15, 2022. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5836788/
- Binks, H., E Vincent, G., Gupta, C., Irwin, C., & Khalesi, S. (2020). Effects of Diet on Sleep: A Narrative Review. Nutrients, 12(4), 936. https://doi.org/10.3390/nu12040936
- Katagiri, R., Asakura, K., Kobayashi, S., Suga, H., & Sasaki, S. (2014). Low intake of vegetables, high intake of confectionary, and unhealthy eating habits are associated with poor sleep quality among middle-aged female Japanese workers. Journal of occupational health, 56(5), 359–368. https://doi.org/10.1539/joh.14-0051-oa
- Slowik JM, Sankari A, Collen JF. Obstructive Sleep Apnea. StatPearls Publishing; 2022. Accessed November 29, 2022. https://www.ncbi.nlm.nih.gov/books/NBK459252/
- Bravo, R., Matito, S., Cubero, J., Paredes, S. D., Franco, L., Rivero, M., Rodríguez, A. B., & Barriga, C. (2013). Tryptophan-enriched cereal intake improves nocturnal sleep, melatonin, serotonin, and total antioxidant capacity levels and mood in elderly humans. Age, 35(4), 1277-1285. https://doi.org/10.1007/s11357-012-9419-5
- Garrido, M., González-Gómez, D., Lozano, M., Barriga, C., Paredes, S. D., & Rodríguez, A. B. (2013). A Jerte valley cherry product provides beneficial effects on sleep quality. Influence on aging. The journal of nutrition, health & aging, 17(6), 553–560. https://doi.org/10.1007/s12603-013-0029-4
- Afaghi, A., O’Connor, H., & Chow, C. M. (2007). High-glycemic-index carbohydrate meals shorten sleep onset. The American journal of clinical nutrition, 85(2), 426–430. https://doi.org/10.1093/ajcn/85.2.426
- Lindseth, G., Lindseth, P., & Thompson, M. (2013). Nutritional effects on sleep. Western journal of nursing research, 35(4), 497–513. https://doi.org/10.1177/0193945911416379
- Reid, M., Maras, J. E., Shea, S., Wood, A. C., Castro-Diehl, C., Johnson, D. A., Huang, T., Crawford, A., St-Onge, P., & Redline, S. (2019). Association between diet quality and sleep apnea in the Multi-Ethnic Study of Atherosclerosis. Sleep, 42(1). https://doi.org/10.1093/sleep/zsy194
- Yue Liu, Fred K Tabung, Meir J Stampfer, Susan Redline, Tianyi Huang, Overall diet quality and pro-inflammatory diet in relation to risk of obstructive sleep apnea in 3 prospective US cohorts, The American Journal of Clinical Nutrition, Volume 116, Issue 6, December 2022, Pages 1738–1747, https://doi.org/10.1093/ajcn/nqac257
- Carneiro-Barrera, A., Amaro-Gahete, F. J., Guillén-Riquelme, A., Jurado-Fasoli, L., Sáez-Roca, G., Martín-Carrasco, C., Buela-Casal, G., & Ruiz, J. R. (2022). Effect of an Interdisciplinary Weight Loss and Lifestyle Intervention on Obstructive Sleep Apnea Severity: The INTERAPNEA Randomized Clinical Trial. JAMA network open, 5(4), e228212. https://doi.org/10.1001/jamanetworkopen.2022.8212
