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Old 07-10-2008, 06:31 PM   #1
Beth Moscov
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sleep apnea and fitness

Does anyone know anything about training someone with severe sleep apnea? Is there anything to consider? From my research, I understand that sleep apnea can lead to underlying heart issues as well as metabolism issues. Not to mention that for severe apnea (in this case the person is choking and partially waking, along with the severe heart disruptions, an average of 61 times per hour as measured by a 7 hour sleep study), can simply create havoc with normal recovery from a workout.

Anyway, I am doing a ton of research but would like to know if there is anyone out there with solid research for helping these people. I don't plan to treat the apnea - the sleep doctor is going to be doing that with CPAP. I just want to help them to maintain fitness as they recover from this sometimes fatal disease.
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Old 07-11-2008, 12:34 AM   #2
Frank E Morel
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Re: sleep apnea and fitness

Quote:
Originally Posted by Beth Moscov View Post
Does anyone know anything about training someone with severe sleep apnea? Is there anything to consider? From my research, I understand that sleep apnea can lead to underlying heart issues as well as metabolism issues.
Biggest thing from the client side is fatigue. He will burn out sooner than expected as due to his lack of sleep. Recovery will not be there as his brain and body never get to recover when it's suppose to. Growth hormone pulses will be way low, thyroid levels will be messed up. There is a whole gambit of system issues that could be present.

Quote:
Originally Posted by Beth Moscov View Post
Not to mention that for severe apnea (in this case the person is choking and partially waking, along with the severe heart disruptions, an average of 61 times per hour as measured by a 7 hour sleep study), can simply create havoc with normal recovery from a workout.
61 wake ups in a hour for a 7 hour period... ahhhh... this person is basically experiencing torture. His brain will not let him sleep cause it knows that it will die hence the heart arrhythmias are from the sudden adrenalin pumps to restart itself. usual scenerio.. airway is blocked by the soft palate or the weight of the fat on wind pipe ( very very basic explaination this) lack of oxygen begins to slow the heart down as the heart muscle itself is not breathing.. then the brain realizes that it too is not getting oxygen fed, so it restarts the body by kicking its self by having the part of the brain that doesnt require oxygen .. the brain stem aka reptile brain .. uses the fight or flight response to get the body in working order again by dumping a blast of adrenalin to the life system systems. Since sleeping at night is not happening, the person must be taking naps through out the day as they are exhausted.

Quote:
Originally Posted by Beth Moscov View Post
Anyway, I am doing a ton of research but would like to know if there is anyone out there with solid research for helping these people. I don't plan to treat the apnea - the sleep doctor is going to be doing that with CPAP. I just want to help them to maintain fitness as they recover from this sometimes fatal disease.
firstly beth.. its always fatal if untreated. I am sure that you have heard the term " he died in his sleep" this is the reason why, since sleep apnea is now better under stood.

I honestly think that given the number of nightly awake ups, this person is in a very very morbid state of illness. Meaning a near psychotic state, he surely must be packing on weight due to cortisol levels are through the roof and his thyroid too must be taking a hammering.
I would say, beth, maybe the best way to help this person is to pass on him from doing crossfit itself. But not on exercise.

Here is my thoughts
(1) I would let him focus on adjusting to the cpap machine, they are NOT fun or easy to settle into. Best way to explain the feeling is .. stick your head, mouth open, out the window of your car and sprint the car then stop and repeat. It takes about a good 6 weeks of hard effort to be able to wear the thing for 8 hours. Some people adjust easy, most people, its hard.
(2) Do keep him as a client but teach him better nutrition as I am sure the person is overweight. Better diet, means more efficient metabolism, better weight loss that stays off.
(3) fitness aspect, maybe get him to go for a walk with their other or dog or something. But doing crossfit will burn out his carb stores, and his brain needs it for function as its working triple overtime.
perhaps a farmers walk or waiters walk, stretching, light rowing . More than that, beth, you maybe over taxing his body and could end up bad.
(4) Once he has 4 months on the cpap and is sleeping a full 8 hours and little napping during the day. Then ramp it up in the exercise department.

Here is a study that looked at people with sleep apnea. It looked at the areas that I just mention. Well being/weight loss/ exercise.
Keep in mind that people in this study has an ave of 5 wake up per hour. Your client is way above that study group which tips the scale away from the study. But it proves that it can be done, perhaps on a slower time line.

each subject were
6-month exercise program was primarily designed to be a low
impact, moderate intensity aerobic type exercise program. The
training program began at a low-moderate intensity over the
first 1-2 weeks and progressed to a moderate intensity
program, 50-80% max VO2, and monitored by heart rate
response (60-85% maximum heart rate reserve). All subjects
had progressed to exercising 30-45 minutes, with at least 20
minutes being in their training heart rate range, by three weeks.
Intensity of the exercise program was not increased until a
minimum continuous exercise duration of 20 minutes at the
training heart rate level was achieved. The exercise sessions
were conducted at the university wellness center. Subjects
were supervised three times per week for the first four months,
and then once a week for the next two months with instructions
to exercise at least twice more each week.

wfs
http://www.sro.org/pdf/3006.pdf


OH... beth, Medical waiver on this one is a very good thing, coupled with a letter from a Heart doctor that he in fact can partake in an exercise program, Is crucial.
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Last edited by Frank E Morel : 07-11-2008 at 12:51 AM.
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Old 07-11-2008, 10:27 AM   #3
Beth Moscov
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Re: sleep apnea and fitness

Frank,

Thanks. This is excellent feedback. I knew someone in the crossfit community would know a bunch. Yes, at the moment, we are scalling workouts so they are mostly things like, "walk 400 meters, wall pushups, rest, again". We are only working him out once per week and he walks the rest of the time. I am also doing a lot of flexibility stuff since he likes it and feels more able to relax at night when he does the stretches again later about an hour before bed.

I hadn't thought about the health waiver. I will do that. I have had good results with clients who let me actually talk to their docs and the docs have been helpful - plus they get educated more about crossfit. In fact, this guy told me his sleep doc has tried crossfit and loved it. So that is a good sign.

Beth
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Old 07-11-2008, 10:42 AM   #4
Frank E Morel
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Re: sleep apnea and fitness

glad to be of help.

If you know someone that does yoga and meditates.. maybe they can teach you a couple of simple meditation tips. He could do it as a bedtime ritual to help him relax. At that volume of wake ups, I would suspect the poor guy is fearful of going to sleep.
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Old 07-11-2008, 06:19 PM   #5
Beth Moscov
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Re: sleep apnea and fitness

I already know that stuff. Been meditating more than 25 years. I had been thinking of that. He told me that his sleep architecture shows he only entered rem sleep once and stage four sleep never. So he is definately needing some work. But my understanding of meditation is that it still mostly helps in the higher (level 1,2, and 3) brain wave states. Is that incorrect?
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Old 07-11-2008, 06:38 PM   #6
Frank E Morel
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Re: sleep apnea and fitness

good question... I do not know the answer. Most of the body's repair work is in the deepest of sleep, where most of the brain practically shuts down to reboot. We know that his sleep disorder is not really in his control sort of speak ( at this point his physiology is keeping him awake) but if he feels that he is taking control his health, it may just help him cope better.

Think how *****y and cranky people you know get when they get tired. For this guy, its 24/7 .. I am surprised the dude has gone alittle postal. So he must have good coping skills, and would venture a guess that are nearly depleted. I wonder how he feels deep inside.

Shift workers basically talk about sleep or need for sleep. If you have any nurses for friends or clients, ask them about it. Then compare notes with him.


Try it, a little thought fitness its not going to hurt.
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Old 07-11-2008, 09:31 PM   #7
Beth Moscov
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Re: sleep apnea and fitness

well looking online, it seems only the deepest meditation reaches the delta state. Most is alpha or gamma (beta is our every day state it seems).
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Old 07-11-2008, 09:51 PM   #8
Jared Ashley
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Re: sleep apnea and fitness

Quote:
Originally Posted by Beth Moscov View Post
Does anyone know anything about training someone with severe sleep apnea? Is there anything to consider? From my research, I understand that sleep apnea can lead to underlying heart issues as well as metabolism issues. Not to mention that for severe apnea (in this case the person is choking and partially waking, along with the severe heart disruptions, an average of 61 times per hour as measured by a 7 hour sleep study), can simply create havoc with normal recovery from a workout.

Anyway, I am doing a ton of research but would like to know if there is anyone out there with solid research for helping these people. I don't plan to treat the apnea - the sleep doctor is going to be doing that with CPAP. I just want to help them to maintain fitness as they recover from this sometimes fatal disease.
Beth,

I don't have actual research, but I had some clients with sleep apnea... don't know if it's as bad as your person, they didn't go into details.

I didn't change anything for the sleep apena specifically, but they said it had seemed to get a little better since they'd started working out.

I just had them doing simple bodyweight/freeweight lifts and sometimes a short, very watered down, CF-type workout at the end. Pretty limited folks, but they made great progress.
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Old 07-11-2008, 11:54 PM   #9
Beth Moscov
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Re: sleep apnea and fitness

There is certainly research out there showing benefits for the apnea when people exercise. I am mostly interested in finding out about what exercise limitations they might have and when/why, etc. Heart, diabetes, and stroke are all higher in people with sleep apnea. They are more resistant to losing weight and some weight gain may actually be caused by it - so says my research. Apparently there is a three way hit - it messes with the hormone that tells you when your full, it messes with the hormones that make you store fat, and it messes up your metabolism basically moving you towards syndrome X.

Also, apparently it is not only fat middle aged men who snore who get it. You can be thin, fit, and female as well. You also may not even snore. Because it is more common in obese men, the other groups (fit men, fit women, obese women, etc) are often misdiagnosed for years before finding out what is causing underlying issues - which include back pain, random aches and pains, generalized inflammation, heart issues, stroke, diabetes, and more.

I am sure learning a lot. Guess I will be one of the resident experts after more of this study.
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Old 07-23-2008, 05:42 PM   #10
Seth Hollen
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Re: sleep apnea and fitness

as far as just the apnea it will affect their energy levels and appetite. (sleep fragmentation screws up hormone levels which affect appetite)

With an RDI of 61 events pre hour it's severe apnea. but I've seen many people worse.
to get an index that high his events will be shorter in duration but more frequent.
I'll guess this person is not in the greatest health anyways so hopefully you know other parts of their medical history like heart and breathing problems which can all be made worse from the apnea of course.

Yes CPAP is the best thing for it and there are many types of masks and machines available to help them use it. also even if they use if half the night it will help them quite significantly than not using it at all.

I'm a registered sleep tech. if you have any sleep questions I'll try to help.
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