Dr Louise Oliver on women and mid-life snoring

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1:31So together with my producer Fee, I'll be deep diving into the latest research sifting fact from fiction. I'll also be talking to all kinds of trusted experts tapping into their knowledge, along with bringing you conversations from a range of interesting women and men finding out how they age well. So this is my show. Welcome along. And as always, thank you so much for listening.

1:59Louise, we love your story. You're a trained doctor and working as an NHS GP, but half of your work now is as a functional breathing practitioner. We do want to talk about breath work, but firstly, I'm really interested in some of the changes that midlife women start to see in their 40s and beyond, because a lot of women notice their sleep radically changes during perimenopause. And for some women, one of those changes is that they start snoring. I don't know about you, but I actually think women and snoring is a bit of a taboo because a lot of people have this ridiculous notion that snoring is a man's issue or is unladylike.

2:35So can you explain the mechanics of why so many women start snoring in their 40s and 50s? Well, thank you for having me on. And literally anyone can snore. So that's children, men and women. And snoring isn't normal. It signals that we're not breathing as efficiently as we could do when we're asleep. And obviously, as you've indicated, breathing does change around the sort of perimenopause and menopause and onwards. And the reason being is we have sex hormone receptors all around our body. We know that, we discuss it, but how often are we discussing those sex hormone receptors in the lung, the tongue, the main breathing muscle, which is the diaphragm and the breathing centre in the brain.

3:15So it makes complete sense that breathing will change around the time that our sex hormones are changing. We need more research. We know it happens and we know snoring's more likely. And we also know a condition called obstructive sleep happening where people stop breathing during sleep becomes more common as women transition through the menopause. But the reasons why that happens, I think we need a lot more research, but various things. So one of them is we are more likely to get a blocked nose. And if we have a blocked nose, more likely to snore. One of the hormones, progesterone, helps improve the tone of our upper airway and we lose that.

3:52But it also actually stimulates our breathing as well. And we lose that as we go through the perimenopause and menopause. We gain weight. If we gain weight, unfortunately, we can gain weight on our tongue and around the muscles of our neck. So that obviously changes it. And we talk about strength training muscles, but how many of us are talking about strength training our breathing muscles and the muscles that are keeping are the airway, which is the tube that we're breathing through whilst we're awake and sleep. So there's so many factors to it. Gosh, it's strengthening those muscles where we breathe from.

4:25Gosh, I had never ever thought about that. Can you also explain the different types of snoring or snorers? And And maybe a weird question, but do our nostrils have anything to do with this? So snoring essentially is we're getting some vibration of tissues around where we're breathing. So actually we can snore in different areas of our body. We could be a mouth snorer or a nasal snorer. So if you're mouth snoring, if you get your mouth closed, you stop mouth snoring. But then a lot of people nasal snore and there's different reasons for nasal snoring. So if we've got small nostrils, that obviously narrows the intake of air.

5:06So it's more likely to vibrate. But you can snore at different points of our sort of mouth and throat. Anatomy clearly has a bearing on this. Also, we're carrying excess weight. But also, it's about is our tongue in the correct position? Do we have strong muscles in our tongue and all the muscles around that upper airway? for me what I've seen is some of us are over breathing and in my observation of coaching people to improve breathing patterns over the last five years I think there is a tendency for women to start to over breathe as they go through the menopause that's not something that's in the research at the moment but I've got some what I think are fairly sound scientific reasons why that might happen but if we're over breathing then we're starting to move more air in and out of that airway so it is more likely to rattle or vibrate which would be snoring so obviously there's different reasons why people snore so then tackling it can involve various different aspects.

6:06So in terms of stopping snoring or mitigating the risk what kinds of protocols or solutions are we looking at? Is it possible to get a long-term snorer to stop? Because judging by an amazing testimonial we've read on your website it absolutely is. Ultimately ideally what we should think about is why is someone snoring? And then you tackle the reasons for that snoring. And obviously, if you tackle them, then generally the snoring will go away. But clearly, it can be complex in some people. And if it involves anatomy, then obviously you're looking at can we change the anatomy, etc. So for me, I started to snore in my perimenopause.

6:46And it was nothing to do with weight, my weight hadn't particularly changed at all. But I recognised that I probably we stopped breathing efficiently when I was about 10 and I corrected how I breathe. And for me, I've completely stopped. I don't snore at all now. Whereas others, it might be more complicated and involve other people from different disciplines, maybe a functional dentist, ear, nose and throat consultant, et cetera, et cetera. But what I will say, if someone is really heavily snoring, so, and I mean, you know, you can hear it from another room, you can hear it from another floor, they're much more likely to actually have the condition I've discussed earlier called obstructive sleep apnea.

7:22And actually, I would encourage that person to go and speak to the health professional and see whether a sleep study is required. But let's just think about basics. So what basic things can people do to help snoring? Well, if you think about it, we're breathing to a tube in our neck. So that's a flexible tube that can vibrate, which is like the snoring, or it can collapse, which is obstructive sleep apnea. So how can we try and improve that foundation? Well, the first thing is we need to be breathing in and out of our nose. So if the mouth is open, we need to re-establish nasal breathing. And that's not just when we're asleep.

7:56We need to be breathing in and out of our nose when we're awake as well. Then it's about tongue position. We actually have a correct position for the tongue. And if the tongue is in the correct position, it helps open up the airway. Then we can look at strengthening the muscles and then making sure we're not over breathing. But from what we can get across on this podcast, because it can be complicated, I would say two things, tongue position and nasal breathing are the two things that are easier to correct. I mean, before we move into breathwork, can you briefly explain what sleep apnea is? Because again, it has this reputation, we think, of being perhaps more of a male issue.

8:36And it isn't, is it? And what are your thoughts on these CPAP machines? Can you explain their use and whether or not you're a fan? So in the UK, if you're an adult in the UK, it is thought that one in five adult UK individuals have obstructive sleep apnea and are undiagnosed. And obstructive sleep apnea is when we're asleep, the airway blocks, and then the person is unable to breathe. Eventually, their body recognises they're not breathing, and essentially the body generates a fight-flight sort of stress response to open that airway. And there are consequences to that. So when we're asleep, generally, we should be more in a relaxation response.

9:18But if you're stopping breathing multiple times per hour, generating a stress response, you'll also generate cortisol. You'll also generate sugar. You'll generate adrenaline. So you get a muscle contraction. Your body will not do the repair processes it is meant to do when you're asleep, if it's doing that. Also, some people drop that oxygen level. And if you drop your oxygen level, we then move into oxidative stress. It increases your inflammation, which then affects your gut health. If it affects your gut health, then it affects everything in your body. So there's huge consequences to it. Women commonly do not present to me as a GP saying they're snoring or stopping breathing during sleep.

10:02What they do is they come in complaining of symptoms related to interrupted sleep. So that might be they're waking up with a headache, they're feeling tired, they're getting up to past urine frequently, they are feeling palpitations when they're in bed at night. There's so many different symptoms that they can present with and actually it's more to do with the fact that their sleep's interrupted. Now some people just improving breathing patterns will not get rid of obstructive sleep apnea so they need assistance to continue to breathe when they're asleep. The most common treatment is something called a CPAP machine, and that's where essentially you wear a mask and it's blowing air into the airway to keep the airway open.

10:47There is another device called a mandibular advancement device, and that almost looks like a sort of dental retainer, but it sort of holds the lower jaw forward to open up the airway. And I've seen lives transformed with both of these treatments. There are other treatments as well, but these are the two most common. If people go on my website, on the homepage down at the bottom, there's a BBC video. One of my patients contacted the BBC because she had such a resolution of her chronic fatigue. She managed to stop four of her pain medications by going on the CPAP machine. What I've seen is nasal CPAP is better tolerated and more effective than the CPAP machine that goes over mouth and nose.

11:30you need to be a nasal breather really to have nasal CPAP and you need to have an efficient breathing pattern so I think the most basic aspect of improving sleep sort of breathing is making sure that somebody is efficiently breathing whilst they're awake because then that will support using these devices. So moving on to your field of expertise which is functional breathing again you've talked about that you probably stopped breathing efficiently when you started holding your tummy in to appear flatter around the age of 10. I think I did similar, but mine was about my mum told me I was slouching my shoulders.

12:05And so I was very conscious of holding my shoulders up. It definitely has had an impact on my posture. Don't know about my breathing, but it's funny how these childhood things can stay with us. You then talk about the impacts of training to become a doctor, a lot of stress, as we both know. And then later in life, you started to experience perimenopausal snoring. You go on to say that improving what you call your unconscious breathing went on to radically improve, quote, your focus, concentration, energy levels, quality of sleep, ability to exercise, appreciation for life and stress resilience, which I think covers so much that's crucial to our enjoyment of life.

12:45Before we get into what functional breathing actually is, can you bring to life both your story and any particularly interesting client stories in terms of big changes you've seen? Of course. So when I started snoring, I did not think I had a problem with my breathing. So I thought I was absolutely fine. I was running three times a week, no issues with breathing, no asthma, no nothing, and started snoring. And when I read the definition of sleep disorder breathing, I thought, gosh, right. And I actually couldn't even think about it for about two days, I had to shut down the Google browse. I was like, no, that's not me.

13:22But luckily, I'd done a little bit about mindfulness, thought I'm not going to criticise why I'm here. I'm just, I'm here. I'm snoring. What am I going to do about it? And actually, it wasn't until I then corrected it and could actually sleep and feel much better that I could look backwards and think, well, how on earth did I get here? And essentially, when I was 10, another pupil in the playground saw that my stomach looked quite big and sort of said, oh, if you suck your stomach in, it will look flatter. So I probably spent then the next 35 years walking around with it sort of sucked in. But the trouble is when we really suck our stomach in, the main breathing muscle, the diaphragm, which sits underneath the lungs, you impede the movement of that.

13:58So I suspect at that point, I stopped using my diaphragm, my main breathing muscle as much as I could have done. And it's a muscle, if you're not using it, it gets weaker. And then your breathing goes into your upper chest. and obviously then I go through medical school you know it's very stressful so probably got stressed so did even more fast upper chest mouth breathing and then then you qualify and certainly as a GP we uh I see people on very short intervals and I talk really fast to get through the consultation so I can get the information and try and help the person but I don't breathe efficiently when I talk so I think over this time my breathing just got worse and worse and then the critical point, I hit the perimenopause and then the changes around my breathing, then just tip the balance.

14:43And I cannot tell you the difference that it's made to me. And this is why am I as a GP working half-time as a breathing practitioner? It's only because I see these changed lives. And it's like a spectrum. So some people, if they're breathing, you know, some people just say like, oh, you're meant to breathe through your nose and like, oh, right, I've forgotten about that. And then they'll re-establish nasal breathing, no problem. And actually won't actually make them feel any different. But then I've worked with other people who, you know, they were unpicking 50 years of breathing habits and it takes a lot of effort to re-establish 24-hour efficient nasal breathing.

15:19But when they do, the harder it is to change, the more life-changing it is. You know, I've had one of my recent individual clients, so she actually had a thyroid problem and was potentially going to be needing radioiodine. And now her thyroid blood tests have normalized and the consultant doesn't think she needs it. Now that could just be coincidence, but she now isn't snoring. She's now, her breathing's much calmer. She feels calmer. Her inflammation in her body, obviously I don't check these things as a breathing practitioner, but her breathing pattern will be a lot more relaxation driven, which then it helps gut health.

15:55And interestingly in that patient, she has completely normalized her bowel function before she was having lots of issues with her bowels. And now she gets up in the morning and her bowels are completely normal. I've had people who've re-established, they've gained their sense of smell again. The three most common things are the sleep gets better, exercise tolerance is better, and you feel calmer. But I don't wake up to pass urine anymore when I'm asleep. I didn't believe that would happen, but that's happened. And your body's just more relaxation response driven. So it just allows your body to do the repair processes it's meant to do, particularly when you're sleeping.

16:34Also impressive, really, really impressive. And I guess the big question then is, what is functional breathing? And can you give a simple explanation for how most of us breathe and how you'd ideally like most of us to breathe? So we have all been beautifully designed by nature to breathe as we've been designed. So, So, you know, you look at a newborn baby, it breathes in and out of its nose. You'll see its lower ribs move as it's breathing with its diaphragm. So we've been designed at rest that we're breathing in and out of our nose. The breath is quiet. It's gentle. You can hardly notice it. So you won't be seeing people's shoulders move.

17:13As we breathe in, the sort of lower ribs slightly come out. And as we breathe out, they'll slightly go in. And that's how we've been designed to breathe. but we're not living in a world like we've been designed to breathe you know we're not living outside in nature and moving constantly we spend a lot of time sat on a computer and our posture massively impacts breathing you know if you've got those rounded shoulders you describe that will impact you won't use your diaphragm as well so because we're not necessarily living as nature intended we're not necessarily breathing as nature intended and breathing is the foundation of life If you know, hold your breath, see how long you last.

17:51The free diver can't hold their breath for more than an hour. So breathing is literally the foundation of life. You can go a day or so without fluid, a couple of weeks without food. So your body will do anything. If you're not breathing efficiently, it will make adjustments in all sorts of systems to continue to breathe. But then we can develop symptoms because of those compensations. And is there much data to support all of this? I heard you on another podcast mention a study on Alzheimer's, the brain and oxygen. What do we know that it can help with? And is it true that if we keep having our fight-flight response activated at bedtime to maintain a certain way of breathing, that this can continually cascade cortisol into our body?

18:33Yes. I mean, sleep medicine has been around. It's a relatively new speciality. But the data with sleep medicine is it's very clear. if people are stopping breathing during sleep, they have increased mortality and increased morbidity. And it increases the risk of all sorts of things. So type 2 diabetes, obesity, high blood pressure, heart attacks, strokes, dementia. And it's a self-perpetuating circle. This is what is so sad about it because people feel it's so easy to miss, particularly in women, and people feel rotten. They're constantly having the activation of cortisol, adrenaline, glucose.

19:14That's why type two diabetes is more common. And then the trouble is then, because that affects their metabolism, they then gain weight, partly because it affects their metabolism, but partly, yes, it will make them crave more processed foods. But the trouble is then that excess weight then is they've got more weight on their tongue, more weight around the tissues of their neck. So it makes the obstructive sleep apnea even worse. And when we are asleep, I think we, you know, we talk about sleep all the time and the importance of sleep, but not so often do I see people talking about sleep from a how are we breathing when asleep.

19:48If we're not breathing as nature intended, our body will prioritise survival and not repair and recover. So our body, when we're asleep, goes through the entire body, you know, the sort of immune system works and the gut health. All the repair processes happen when we're asleep, or majority of them, including the dishwasher system of the brain. So the glymphatic system, so it's like, it's spelt like lymphatic system, but it's got a G on the front of it. The glymphatic system only been described in the last 10 years or so. And essentially, most of the evidence suggests that when we're in our deep stages of sleep, the brain actually goes like a dishwasher system.

20:28So essentially, it removes all the sort of toxins. And how we breathe is utterly crucial to that, because the diaphragm has a role in moving the fluid around the brain and the spinal cord and we're most likely to block our airway when we're in our deep stages of sleep. So that's when that system should be on and if we're constantly being woken up, that system's not going to work. What are your feelings about mouth tape? So essentially, if no one remembers anything from this podcast apart from the nose has got all the functions to breathe. So basically, if we're breathing in and out of our nose, that's associated with health and wellbeing, the mouth is there as a secondary mechanism.

21:08So mouth breathing is about survival. So when we can't breathe through our nose or maybe at the high levels of exercise, we switch to mouth breathing. So if we want health and wellbeing when we're asleep, our lips need to be shut. Now, very much what I see is how we breathe whilst awake impacts how we breathe when we're asleep. So it's not just about using mouth tape and then forgetting everything else. It's about improving breathing habits when we're awake. But ultimately, it could just be a habit that people have got their mouth open. Now, unfortunately, in some people who have obstructive sleep apnea, if you force the mouth shut, they can't sustain that.

21:45And actually, you'll make their obstructive sleep apnea worse. And because it's so easy to miss obstructive sleep apnea, I personally only want to recommend a product that encourages nasal breathing. So it's called Myotape, M-Y-O-tape, Myotape. Patrick McKeown, who did my breathing training, he designed it and he designed it because you can still mouth breathe if you need to. So it's an elastic tape that sticks to the face. It goes around the mouth and you stretch it by about 30 % and stick it on. It goes around the mouth and it gently encourages nasal breathing. And what I like about that is the person can still mouth breathe if they need to.

22:22So I have some clients who are using it at the beginning they say I'm still mouth breathing through it and like that's exactly why you're using that because at the moment your breathing is not you're over breathing you cannot sustain nasal breathing when you're sleeping that's exactly why I'm using the myotape some of the tapes that I see that fully tape or I've got a tiny hole in them potentially people who have obstructive sleep apnea or have very inefficient breathing patterns it might actually make them worse so yeah and you can get myotape off oxygenadvantage.com and I've got a discount code if you want to use it.

22:52It's Louise Oliver 5. It's all caps lock. But that's the only one that I recommend at the beginning. But sleeping with the mouth closed is utterly crucial. Thank you. And we'll put that link and the discount code in the show notes as well. We have a few quick fire questions. Can you talk to us about breathwork and progesterone intolerance? Is there a link here? Because our research suggests there might be. So progesterone is a respiratory stimulant. So it makes us breathe faster. and if you are already breathing fast and you add more progesterone in you possibly might generate some symptoms of over breathing hyperventilation and obviously you can train your breathing to breathe slower so I think there is definitely a role there.

23:33Can you explain some of the lesser known conditions such as airways resistance syndrome or postural orthostatic tachycardia syndrome? So postural orthostatic tachycardia syndrome is essentially where the body has started to lose control of blood pressure and pulse So blood pressure and pulse are under the control of our autonomic nervous system, which is our part of our body that controls unconscious processes. Complex condition, many factors influence that. But essentially, there's different ways of dealing with it from a medical point of view. But from a breathing perspective, if somebody is breathing as nature intended, it promotes autonomic nervous system function.

24:11So if someone is, so essentially if you've got POCs, it's utterly crucial that you are nasal breathing whilst awake and asleep and you're tolerant to carbon dioxide. And I see this condition for particular, I won't go into it because it's a long answer, but POCs, people with POCs, commonly I see are not tolerant to carbon dioxide. But when you improve that, then that helps improve their blood pressure and pulse control. on. Upper airways resistance syndrome, it's a complex answer. I've got a blog on this that I've just released, so we can put that in the show notes. But essentially, upper airways resistance syndrome is more about you've got increased resistance to the air coming in and out of the airway, but you perhaps aren't, you're not actually fully blocking the airway.

24:56So like an obstructive sleep apnea, but it's still, it interrupts the sleep. It's constantly giving someone an activation of the stress response when they're sleeping. Brilliant and we're definitely going to put that blog on the show notes as you said thank you so much. Can you talk to us about having a dry mouth in the morning? It most likely means your mouth breathing so that's your body trying to tell you not breathing efficiently when you're sleeping. What are your thoughts on perimenopausal palpitations? So this is really interesting so there can be many causes for this and obviously if you've got palpitations ideally suggest you go and speak to your health professional about it but ultimately our body we have a our heart is controlled by the autonomic nervous system so one half of that is a relaxation response one half of that is the stress response i've read a model that's been proposed that as women transition through the menopause our body becomes more stress response driven it's a model because it's not proven but i'd say that certainly the people i've spoken to that my patients they certainly feel that their bodies are more driven towards a stress response.

25:59And I think that stress response then promotes more likely to tip into palpitations. And also, I think this is why we start to breathe faster and more likely to be mouth breathing. So obviously, to fix menopausal palpitations, ideally, you treat the underlying cause. But the most basic thing I would say to people, if you've got palpitations, what's your autonomic nervous system? Is it more stress response driven? Is it more relaxation response driven what can you do to turn down the stress response and what can you do to turn up the relaxation response from my perspective as a breathing practitioner absolutely crucial nasal breathing we're not over breathing and when we're asleep we're not snoring we're not stopping breathing during sleep and we've got our lips sealed that's the most basic help to help palpitations obviously there's lots of different causes and different ways of tackling it and finally from us and I guess this is maybe an obvious question but what's your sleep routine and your sleep favorite things I mean do you use any supplements whether that's magnesium or cbd oil any apps any wearables even any any favorite candles or oils or pajamas or anything at all sleep related that is part of your regime your protocol your favorite things the only supplement I take is vitamin d3 and I don't use any apps or wearables that's just me I had literally no mind-body-breath connection, literally none before I started this.