The Uncommon Sleep Apnea Patient
We assume sleep apnea only happens in someone with obesity or thick, short neck. It’s incredibly frustrating to be lean and waking up exhausted because you couldn’t get enough oxygen at night.
For skinny individuals, OSA is usually a structural or muscle-tone issue, not a weight issue.
The good news is that you can help your neck and facial muscles function much more effectively. A few specific exercises and some lifestyle changes for a few minutes a day is all you need.
1. The Physics of Sleep Apnea
When you sleep on your back, gravity pulls your tongue and soft palate down, blocking your airway. So, avoiding falling asleep on your back is a good place to start.
Actionable Steps:
- You can tape or sow a tennis ball to the back of your PJs or shirt. There are lots of variations to this Tennis Ball Technique. Give it a try.
- You can also invest in a wedge pillow to elevate the head of the bed by 4 to 6 inches.
Pro-Tip: If you want to get techy, smart wearables or positional buzzers can vibrate when you flip onto your back.
If this resonated with you, I work with a small number of clients to figure out what’s actually going on behind their symptoms to build a plan that works for them.
If you want help with this:
2. Sabotaging Airway Relaxants
Certain substances chemically force your throat muscles to go completely slack, triggering collapses.
The Culprits:
- Alcohol – Establish a strict “no drinking 4–6 hours before bed” rule.
- Medications – Muscle relaxants, anti-anxiety meds, or sedatives are all culprits. You’d be amazed how many of your meds fall into this category.
- Sleep Deprivation – There’s a paradox where being too tired makes your muscles relax too much during deep rebound sleep, collapsing your airway.
3. Myofunctional Therapy – Exercising the Tongue
Just like hitting the gym builds biceps, specific exercises build upper airway tone so it doesn’t collapse under negative pressure (when you suck air in).
Actionable Steps:
- Try 2-3 quick daily exercises, like pressing the tongue firmly against the roof of the mouth for 10 seconds, or repeating vowel sounds loudly.
- You can also press the tongue against the side of the cheek to improve tongue tone.
Clinical data shows this can reduce mild-to-moderate apnea severity by up to 50%. This rivals some sleep apnea machines!
4. Nasal Blockage & Aging
A stuffed or congested nose forces mouth breathing. Mouth breathing naturally drops the jaw backward, narrowing the airway.
Actionable Steps:
- Tackle your allergies by using saline rinses, nasal sprays, or nasal dilator strips.
- Smoking/vaping increases airway inflammation in some people, creating a blockage.
Airway tone naturally decreases with age, meaning consistency with these habits matters more as we age.
Your Next Steps
Lifestyle changes are incredibly powerful tools to lower your “apnea score” (AHI), but they are adjuncts to clinical solutions, not always replacements.
Be sure to get proper testing if you suspect you have sleep apnea. There are lots of effective and affordable ways to get this done.
You don’t need to start all of these steps all at once. What do you think is the biggest driver for you? Start there. Adjust as needed.
Disclaimer:
Dr. Mohammad Ashori is a U.S.-trained family medicine physician. The content shared here is for education and general guidance. It is not personal medical advice, diagnosis, or treatment, and it does not create a doctor-patient relationship. Humans are complicated and your personal details matter. Your healthcare team is your best resource before making medical decisions, changing medications, or managing symptoms. This information is to help you add more depth to those conversations.
