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Other Physical Signs

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Acid reflux/GERD

Reflux almost always occurs in mouth breathers. One swallows hundreds of times a day, but mouth breathers are swallowing air each time. Eventually, bloating inside of the stomach puts pressure on the esophageal sphincter, causing it to weaken and leak, resulting in acid reflux. Mouth breathing also impacts the air pressure in the oral cavity, resulting in acids being pulled up into the mouth. An apnea will also create this effect: tremendous vacuum forces are created in the chest cavity, leading to a suctioning effect of stomach juices into the throat. Chronic reflux will leave teeth with acid erosion.


Multiple breathing pauses at night (apneas) can literally suction up your stomach juices into your throat, which can then reach your nose or your lungs. This causes your nose and your lungs to become inflamed and over-reactive to allergies, fumes, and even weather changes. Lack of deep sleep also causes your nervous system and your immune system to become hypersensitive, aggravating this vicious cycle.

Carbohydrate cravings

It has been widely documented that, at a neurobiological level, poor sleep induces sugar and carbohydrate cravings. In addition, sleep disordered breathing is a systemic condition with endocrine and metabolic interactions. Decreased sleep means decreased leptin, which is the hormone that’s responsible for letting the brain know you are satiated. It also means increased ghrelin, the hormone that stimulates appetite. And finally, less sleep or non-restorative sleep leads to lower glucose tolerance and lower insulin sensitivity.

Dark shading under eyes

Also referred to as “allergic shiners,” these are usually associated with congestion and sinusitis. The dark color is from blood and fluids pooling in the thin tissue around the eyes. Congested sinuses and inflammation put the squeeze on tiny blood vessels and make it more difficult for blood and lymph to flow smoothly. The skin around the eyes is especially thin and delicate so the effects are more readily visible.

Digestive issues

People with obstructive sleep apnea will have chronic, low-grade degrees of physiologic stress, diverting blood flow and nutrient supply away from the gut. When the sympathetic nervous system (responsible for the “fight or flight” response) takes over, the normal digestive processes of acid secretion, bile formation, peristalsis (rhythmic movement of the muscles) and absorption is impaired. This is because the body is trying to ensure our survival. and slows any functions that are not seen as essential to immediate survival.

Congestion and chronic sinusitis

Sinus problems are much more common these days due to underdevelopment of our facial bones, which include our jaws. A smaller oral cavity volume means that the nasal and sinus passageways will be more narrow, becoming more predisposed to obstruction with colds, allergies, or any kind of inflammation. Additionally, the tongue takes up relatively too much space, which leads to more frequent obstruction while breathing at night. Apneas, in turn, can suction up stomach juices into the throat, lungs and nose, causing more inflammation.


Headaches are commonly reported by sufferers of sleep apnea. As you stop breathing frequently during the night, less oxygen is making its way to your brain. Low oxygen levels initiate the widening of blood vessels and can cause vascular headaches. Along with excessive daytime drowsiness, headaches are usually the symptoms that sleep apnea sufferers complain the most about as they may not be aware that they have symptoms of snoring or breaks in breathing.

Poor posture and/or neck pain

It’s very common for people with a compromised airway to have a “forward head posture,” in which the ears do not vertically line up with the shoulders but rather come farther forward. This is an adaptive behavior that opens up the airway and helps breathing. If you were to lie down in this posture, you’d be in the correct posture for receiving CPR. However, when the head’s center of gravity is out of balance with the spine, muscles work harder to stabilize the head. Neck and upper shoulder areas become painful, and other muscles start to compensate, leading to the whole body being out of alignment.
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Foundation for Airway Health, 355 Lexington Avenue, 15th Floor New York, New York 10017-6603, (212) 297-2193,, 1/19/2022