It's generally accepted that regular moderate exercise is good for your health, but what if you exercise too much? Do you HAVE to exercise every day? What happens when you don't exercise for a few days? Do you feel more tired and irritable if you skip a few workouts? Does intense vigorous exercise make you feel good? Does skipping a workout make you feel stressed?
Despite all the known benefits of exercise, if you overdo it, this can be a sign that you may be compensating for something else that may be going on. For example, one of the most common conditions that I see in my practice is when people are unable to get a good night's sleep, they compensate in various ways, such as regular exercise, increased caffeine consumption, relaxation or breathing techniques. You'll automatically take part in activities or habits that make you feel more energetic or relaxed. Eating is another form of relaxation, since it stimulates your parasympathetic nervous system (the relaxation half of your involuntary nervous system).
I know a lot of endurance distance runners in my running club, and almost invariably, no one can or likes to sleep on their backs. They can only sleep on their sides or more commonly their stomachs. What does their sleep position have to do with why their addicted to exercise? It all comes down to my sleep-breathing paradigm.
To summarize, my sleep-breathing paradigm proposes that all modern humans have difficulty breathing at night to various degrees due to our unique upper airway anatomy. The voice box is located underneath the tongue, as opposed to animals, where the voice box is located behind the tongue. This location of the voice box under the tongue is necessary for complex speech and language. But this is also what unprotected our airway, leading to all the various breathing and swallowing problems that modern humans have. Comparative anatomists and evolutionary biologists have said that speech and language development was ultimately detrimental to humans.
What's worse, it's thought that due to a radical change in our diets (highly processed foods and refined sugars) over the past century, our jaws are getting more narrow with increased dental crowding. Furthermore, dentists have stated that introduction of bottle-feeding to infants can aggravate dental crowding and malocclusion, which makes everything much worse. All these factors aren't the only reason for everyone's sleep problems, but everyone, by definition, is along a continuum. Your ability to breathe properly while sleeping is ultimately determined by your genes (the anatomy that you're given by your parents), your diet, and how you were fed as an infant.
So why is breathing a problem only when we're sleeping? There are two components to this issue: When lying flat on your back, your tongue falls back partially, due to gravity. This narrows the breathing passageway behind your tongue to various degrees. As you fall asleep, the deeper level of sleep you enter, the more your muscles relax, and at at a certain point, your tongue can fall back and obstruct your breathing. The more narrow your airway (due to smaller jaws or inflammation due to a cold or allergies), the more likely you'll stop breathing and wake up to turn over. When you were young, you tossed and turned and eventually figured out that you can sleep much better when sleeping on your side or stomach. The problem is that even on your side or stomach, it's never perfect, and you're not able to get deep, efficient sleep, no matter how long you sleep.
It's also not too surprising that many personal trainers and fitness professionals have very similar features: Almost invariably they prefer to sleep only on their sides or stomachs. The same can be said about bodybuilders-a personal trainer/natural body builder friend of mine told me that almost every one in her gym snores. Working out intensely for 2-3 hours is invigorating and energizing, but maybe for some people, this is a way to overcome the expected fatigue and lethargy that would result from inefficient sleep.
We know that professional football players have a much higher incidence of obstructive sleep apnea. About 1/3 of all linemen were found to have mild or moderate sleep apnea. It's not only the fat in the neck-it's also the muscle mass that impinges on the soft tissues of the upper airway. So in theory, the more muscle bulk you have in your neck, the more breathing problems while sleeping, which can promote more intense workouts. It's hard to say which came first, but once it's started, it ends up being a self-perpetuating vicious cycle.
The worst case scenario is when you fit the profile above, and you suddenly get injured. Let's say you either can't run anymore. You become more lethargic, and you may end up eating more due to increased levels of stress from increased sleep deprivation. As you gain weight, your upper airway narrows even further, leading to worse deep sleep quality. Another scenario is if you injure your neck or shoulder. This will prevent you from being able to sleep on your side or stomach, which again, aggravates the vicious cycle.
What I just described may seem a little far fetched, but even if a small fraction of the people I mentioned has this anatomic condition, then it can potentially explain various health issues and problems down the road. One way to see where you're headed to to look at your parents. More often than not, one or both your parents may snore heavily, and in many cases will have one or more of the complications of untreated obstructive sleep apnea: depression, anxiety, diabetes, hypertension, heart disease, heart attack or stroke.
Many people will be just fine with their regular exercise regimen, but some others will have various health issues such as chronic nasal or sinus congestion, headaches, throat clearing, hoarseness or post-nasal drip. A thorough history and physical exam is the first step towards feeling better. Educating yourself about your condition is another step-I describe my sleep-breathing paradigm in much more detail in my book Sleep, Interrupted. I also take you through the steps you need to take to finally be able to breathe better, sleep better and feel better.
