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NBA superstar Shaquille O'Neal recently announced that he will retire from professional basketball after 19 seasons and four championship rings. In addition to that announcement, O'Neal announced via a YouTube video that he, like 12 million other Americans, had been diagnosed with sleep apnea.
According to his girlfriend, the seven-feet-tall, 300-plus-pounds center snored excessively during the night, and she noticed that his chest would often cease movement entirely. After participating in a Harvard University–sponsored sleep study he was diagnosed with a mild case of sleep apnea and was advised to begin wearing a CPAP (Continuous Positive Airway Pressure) mask, a respiratory ventilation therapy that assists the wearer’s breathing while asleep. O'Neal's story has a happy ending—because of the recent diagnosis and subsequent treatment, O’Neal reports that he feels more energetic and that his overall quality of life has improved. He is also happy and comfortable with the treatment. Other professional athletes suffering from sleep apnea have not been so fortunate. In 2006, Reggie White, defensive end for the Philadelphia Eagles and Green Bay Packers—one of the greatest players in football history—reportedly died from causes related to sleep apnea.
What exactly is sleep apnea? And how does it affect athletic performance? People with untreated sleep apnea stop breathing repeatedly during their sleep, sometimes hundreds of times during the night and often for a minute or longer. According to the American Sleep Apnea Association, there are three types of apnea: obstructive, central, and mixed. Of the three types, obstructive sleep apnea (OSA) is the most common. Weight can contribute to sleep apnea. In 2009, a study by Sweden's Karolinska Institute showed that overweight and obese men who lost weight during a calorie-restricted diet over nine weeks had major improvements in their sleep apnea symptoms.
Other risk factors for obstructive sleep apnea include certain physical attributes, such as having a thick neck (which describes many athlete body types), deviated septum, receding chin, and enlarged tonsils or adenoids. Allergies or other medical conditions that cause nasal congestion and blockage can also contribute to sleep apnea.
Signs of sleep apnea include loud and chronic snoring, choking, snorting, or gasping during sleep, long pauses in breathing, and daytime sleepiness regardless of how much time you spend sleeping. Other common signs and symptoms of sleep apnea include waking up with a dry mouth or sore throat, morning headaches, restless or fitful sleep, insomnia or nighttime awakenings, going to the bathroom frequently during the night, waking up feeling out of breath, forgetfulness and difficulty concentrating, moodiness, irritability, or depression.
Untreated, sleep apnea can cause high blood pressure and other cardiovascular diseases, memory problems, weight gain, impotency, and headaches. Moreover, left untreated, it may be responsible for job impairment and motor vehicle crashes.
In terms of athletic/sports performance, sleep apnea is a major concern because sleep apnea causes a disruption to healthy sleep patterns, which in turn can affect physical performance. According to a 2007 Stanford University study of sleep and athletic performance, athletes who extend the amount of sleep they get and reduce their sleep debt are more likely to improve their performance. Conversely, if an athlete does not get a good night’s sleep, then the next day he/she is tired, sleepy, or irritable. In such cases, physical performance also is impaired, since there is limited energy reserve due to the lack of adequate or good-quality sleep. Sleep apnea not only has an impact on athletes—it affects the military, as well.
So what can you do if you suspect that you or your sleep partner has sleep apnea? The only way to be sure is to undergo a sleep test, which is done in a sleep lab where patients sleep in a special bedroom with electrodes and other sensors attached to various parts of the body. There, you will be monitored throughout the night to keep track of whether and how often you stop breathing, how low your O2 sat (oxygen saturation) goes, and what your brainwaves are doing while you're sleeping.
For additional resources on sleep and sleep apnea, please visit the following:
Research at USARIEM (U.S. Army Research Institute of Environmental Medicine) was featured in a article by writer Christopher Solomon titled "G.I. Joe and the House of Pain" in a special issue of Outside Magazine about human performance. The author spent time in the research lab's heat chamber, altitude chamber, and cold-water pool—conditions that simulate the extreme environmental conditions found in theater. He interviewed research physiologists there about USARIEM's work over the past 50 years as well as its current studies, all of which address the crucial issues of Warfighter health and performance in extreme environments.
Several weeks ago we started a series on strategies for processing emotions. We have described four "savoring" strategies and four "dampening" strategies. Using more of the savoring strategies and fewer of the dampening strategies can help positive feelings linger from positive experiences. But you must also make sure you use strategies that match your personality and lifestyle. In this research study, those who used multiple savoring strategies (and avoided more of the dampening strategies) were the happiest. The authors also suggest staying in the moment when something positive happens to you and once the moment has passed, stepping back and savoring the experience. Take a moment now to review the tips from weeks one, two, three, and four.
The United States Department of Agriculture (USDA) released MyPlate as the new Dietary Guidance graphic. MyPlate replaces the Food Guide Pyramid and is split into five sections for fruit, vegetables, grains, dairy and protein. The new recommendations focus on the importance of eating fruits and vegetables (half a “plate”). Go to www.ChooseMyPlate.gov for the new graphic and recommendations. For the USDA press release issued about MyPlate,
The National Center for Complementary and Alternative Medicine (NCCAM) has produced a series of fact sheets on specific herbs and botanicals. Find information on common names, uses, potential side effects, and other information by choosing any of the 45 herbs or botanical fact sheets.
The United States Department of Agriculture’s (USDA) new cooking guidelines for meats include a reduced “safe” cooking temperature for whole cuts of pork to 145ºF (down from 160ºF). They recommend using a food thermometer and allowing a three-minute rest time before serving. For whole cuts of beef, veal, and lamb, the safe temperature is the same—145ºF—but the new guidelines add a three-minute rest time after these meats, too, are removed from a heat source. For additional information, including the recommendations for cooking ground meats and poultry, read the new cooking guidelines.
Since the beginning of Operation Enduring Freedom and Operation Iraqi Freedom, approximately two million U.S. troops have deployed. The operational tempo associated with these conflicts has led to longer and more frequent deployments with fewer rest periods in between. The inevitable stress is a challenge for military and civilian communities, even as families work hard to reintegrate their families and normal routines.
In response to these ongoing demands, the Chairman of the Joint Chiefs of Staff directed the development of the Total Force Fitness (TFF) initiative, a new Department of Defense model that focuses on the health, readiness, and performance of our Warfighters. (See the Total Force Fitness section of HPRC’s website for more information on this initiative.)
Following this initiative, a team of Joint-Service and DoD experts lead by COL Bowles of the Uniformed Services University of the Health Sciences (USUHS) came together to create a model that promotes family fitness, resilience, and optimal well-being for service members and their families. This model, which is still in development, is called The Military Family Fitness Model (MFFM).
The MFFM first examines stress-inducing demands placed on military and civilian families from sudden deployment and the return home. Then, looking to build on the resilience of the family, MFFM provides guidelines, skills, and resources for the individual, family, and community to protect against the negative effects of stress. As sources of stress increase, certain behaviors indicate the need for more support (e.g., family strife, children acting out, job instability for non-service members, family role conflict, non-supportive relationships outside the family, and/or domestic violence). With MFFM, families have individual, family, and community resources for additional support. The aim of the model is to foster a multi-level approach that strengthens family resilience and, as a result, Warfighter resilience.
Individual approaches to addressing stress include breathing exercises, yoga, mindfulness exercises, and cognitive restructuring. Family strategies include developing and maintaining strong communication skills, shared family routines, and the building of support networks. The bottom line of the MFFM is that at any point along the model, individuals, families, and communities can strengthen resilience resources to promote total family resilience and fitness.
Members of the MFFM team presented the Military Family Fitness Model at the USDA/DoD Family Resilience conference at the end of April. We encourage you to get more information on the conference presentation, read the abstract, and see the PowerPoint slides presented.
WIC is the Special Supplemental Nutrition Program for Women, Infants, and Children. It provides food, nutrition counseling, and access to health services for low-income women, infants, and children. Eligibility to receive services is based on income, state residency, and “nutrition risk.” WIC is available for military families who qualify based on income. For more information, including eligibility and program services, see the Nutrition Program Facts.
Men and women in the military who operate in and around open water need protection against drowning and immersion syndrome. Quick response to cold-water immersion is important because of its immediate impact on the body. Immersion syndrome could cause cessation of breathing and/or cardiac arrest in certain people. Cold water causes a loss of heat much faster than cold air does and can quickly cause performance impairments such as not being able to fasten a life jacket or other safety equipment. Making an effort to tread water or swim only increases the body’s heat loss and hastens the onset of hypothermia.
A person alone can extend survival time by using body posture that covers areas especially vulnerable to heat loss. Those in the water should avoid movement and use the “heat-escape lessening posture” (H.E.L.P.). This posture minimizes the exposure to cold water of the individual’s groin and chest because the arms are folded across the chest and pressed to the sides and the knees are drawn up with the legs crossed at the ankles, creating a fetus-like position (see figure 13-6 in the article linked above for an illustration). Note that this technique does require the use of a personal floatation device that allows the knees to be drawn up.
If more than one person is involved, the “huddle position” should be used to reduce heat loss. In this position, individuals should press together their chests, abdomens, and groins. In addition to conserving each individual’s body heat, the huddle position helps prevent the swimmers from becoming separated before they are rescued, provides a larger rescue discovery target, improves morale, reduces shock and panic, and may reestablish a chain of command.
These survival techniques require practice and the use of personal flotation devices. Treading water in the H.E.L.P. position in heavy seas is a major challenge, and the huddle position requires that all participants be able to tread water, so being fit and prepared is essential.