It’s 3:00 in the morning and the deep snoring seems to be coming from every room in the small beach house. Is it my husband, one of my brothers, or maybe even my sister? All of them refuse to wear their (what they consider embarrassing) appliances for obstructive sleep apnea (OSA) while on vacation.
OSA causes frequent pauses (five to 30 per hour) of normal breathing during sleep and is marked by loud snoring at night as well as dry throat and daytime sleepiness. It’s not only irritating to bedmates but also is associated with serious health effects including increased blood pressure, CVD, stroke, and mortality.
My family isn’t alone in its desire to forgo uncomfortable nighttime equipment such as continuous positive airway pressure (CPAP) machines to manage their OSA. While using a CPAP machine is an essential first-line treatment, the easy-to-follow Mediterranean diet offers numerous benefits that can reduce OSA symptoms and lead to better quality of life. In fact, certain individual foods can be added to a healthful Mediterranean dietary pattern to possibly improve sleep.
The Mediterranean diet has proven itself time and again to reduce risks of chronic diseases such as type 2 diabetes, CVD, and even Alzheimer’s disease. Now, it’s being researched for its potentially positive effect on the ever-increasing population with OSA. Several small studies have shown that people who followed a Mediterranean diet had a reduced number of OSA occurrences during REM sleep. An interventional randomized clinical trial, Mediterranean-type diet for Older Adults with Obstructive Sleep Apnea, or MedOOSA, is underway to assess the benefits of this diet in older adults with OSA. The MedOOSA trial’s progress can be followed here.
The Mediterranean diet also has been shown in small studies to decrease abdominal fat, an essential element, as the link between obesity/overweight and OSA is well established. While conservative estimates are that 5% of US adults experience OSA, this percentage rises to as much as 45% among those with obesity. Those with overweight and obesity often have extra tissue in the back of their throat that can block the flow of air into their lungs during sleep, aggravating OSA symptoms.
The benefits of the Mediterranean diet for OSA seem to go beyond possible weight reduction. The Mediterranean diet may provide a promising approach to reduce mechanical loads (eg, waist circumference) and thus improve OSA severity, compared with a low-fat, calorie-restricted diet that may be difficult for many to follow. With the abundance of plant foods consumed on the Mediterranean diet (and these foods’ anti-inflammatory and antioxidant effects), there may be an improvement in upper airway neuromuscular control and upper airway muscle force-generating capacity, according to a 2017 article published in the European Respiratory Review.
Other research, published in the American Journal of Lifestyle Medicine in April 2018, noted that subjects who ate a diet higher in processed meats and consumed >35% of calories from fat and more than two servings of dairy daily experienced an associated increased severity of OSA (measured by the apnea-hypopnea index or AHI).
In addition to the Mediterranean diet showing promise for reduction in OSA symptoms, exercise—encouraged as a lifestyle component of the Mediterranean diet—has an independent protective effect on vascular health, potentially countering the occurrence of increased oxidative stress, inflammation, and sympathetic activation in those with OSA.
While the Mediterranean diet’s benefits are fairly well known, a focus on foods that can promote a better sleep cycle through increased levels of tryptophan, melatonin, and a variety of other vitamins and minerals may be a new twist you can share with your clients. According to the National Sleep Foundation, the following foods (which fit in nicely with the Mediterranean diet) may help promote a good night sleep:
- whole grains such as popcorn, oatmeal, and whole wheat crackers;
- tart cherries and tart cherry juice;
- oranges; and
- herbal tea such as chamomile, ginger, and peppermint.
Wearing a prescribed appliance, getting some exercise, and following a Mediterranean diet, including foods that can improve sleep cycles, may be the perfect recipe for success for your clients with OSA. Perhaps if my family implements a Mediterranean diet, loses a bit of weight, increases its exercise, and drinks tart cherry juice instead of beer after dinner, there may be hope for a more restful family vacation in 2020!
— Sue Linja, RDN, LD, is cofounder, officer, and president of S&S Nutrition Network, Inc, a company that provides geriatrics nutrition services to skilled nursing facilities, hospitals, psychiatric homes, assisted living, and other health care entities. She’s also a sought-after speaker on various nutrition and aging topics.