T Nation

Testosterone Therapy and Sleep Apnea


#1

I wonder if any of you guys have read or know about, and can offer your valued input, on the relationship between TRT and obstructive sleep apnea.

In Nov. 2013, I got started on T injections (supplementing with low-dose hcg a little later). I initially sought out the T therapy due to feeling fatigued during the day, that was the primary reason, with the sexual thing not being as much of an issue but still a bit of a problem sometimes. I’m in my 50s. My first blood tests showed a T level of 211, really low.

Last year (2015), I was diagnosed with moderate sleep apnea. One factor is that I had a deviated septum in the left nostril, and I fixed that just about 6 weeks ago with septoplasty surgery. It seems to have improved the apnea problem, just based on listening to iPhone recordings of myself snoring at night. (Yeah, fun times, listening to that during my commute in the morning instead of cranking the tunes, lol.)

So now I discover articles saying that studies were done that point to testosterone therapy actually CAUSING sleep apnea. The articles say that low T can cause or exacerbate sleep apnea, and in turn sleep apnea can cause low T, because the T isn’t allowed to rise at night since it only rises during deep REM sleep and that’s what apnea prevents from happening. So, that’s a vicious cycle. So, you’d think that going on T therapy would break that cycle. But no, they say that T therapy can cause sleep apnea also. (Drugwatch is one such site that says this.) What’s up with that?

Now. I don’t actually know if I had apnea before doing T (although I’m gonna say probably). And I’m wondering if the T therapy is making the apnea worse. But then going off of it and having a T level back down at 200-something would make it worse also, apparently. So this is worrying me, because it seems like I’m screwed no matter if I stay on the T therapy or go off of it. What to do? I’ve yet to talk to a sleep or a T doctor who knows about both subjects and is aware of this relationship between the two.

They gave me a CPAP machine. That thing gave me major sinus problems. I mean, MAJOR sinus weirdness after using it for a while, sneezing, runny nose, congestion, irritation of the inside of the nose, etc. Sounds like cold or flu but it wasn’t; it was the damn machine. HATE that thing and simply cannot use it. So am looking for alternatives.

Just throwing this out there to see if anyone has researched TRT and OSA (obstructive sleep apnea) and has any input. Thanks.


#2

I was diagnosed with OSA in 1998, and with low T in 2014. I was also non-compliant with the CPAP and finally got an oral appliance - it pulls your lower jaw forward and prevents the throat tissue from obstructing your airway. You can google dentists in your area. It usually is not covered by insurance and costs about $1,000.

That being said, I think the T-OSA connection has to do with the tendency to gain water weight on T and only affects a small population. I also gained weight initially but then stabilized, and with more energy, had better results in the gym and lost weight, mostly fat, and no longer wear the appliance at night.

Purely my experience, no science behind it. Good luck.


#3

Myth,
Thanks, interesting about the water weight gain; I didn’t know anything about that. It has not been my experience (gaining water weight, that is), so maybe not a concern for me, then.

I have researched tons of stuff on OSA, including dental appliances. The thing that frankly scares me about those is that it pulls your jaw forward at night and then you have to “reset” it, they say, in the morning. I’m concerned about what that might do, long term, as far as TMJ problems. Seems like the jaw wouldn’t like being essentially dislocated slightly for 8 hours a day.

One treatment my doctor says he could do is a new variation on the Pillar Procedure, except without pillars. It basically scars the palette with a laser (which sounds bad, but hold on), so that the tissue is hardened that way and is now firm and stays in place rather than being soft tissue that relaxes at night and obstructs the airway. Sounds interesting to me.

I know this is getting way off of the T forum subject matter. But the point is, I feel good on TRT and don’t want to stop that if I can help it. But I also don’t want to die from OSA either, and if TRT is causing or worsening the OSA then that would be a huge concern. I just keep searching for answers and trying to fit all of the pieces together.

Congrats on your results in the gym. Just wondering, have you had a sleep study after you stopped wearing the appliance? Is the OSA now gone due to your working out in the gym and losing weight (which can be a contributor to OSA)? If so, that’s awesome.


#4

TRT makes snoring worse and these two conditions are strongly related.

So if a guy had strong natural T levels and snored. Would lowering T levels reduce the problem? Perhaps with many older low-T guys, the low T was masking the tendency to snore and TRT simple takes them to where they would be if they had aged with strong T levels.


#5

I have not had a sleep study done. I strongly dislike my ENT and am too busy/lazy to find a new one. However, my wife doesn’t complain about me snoring anymore. I have also learned to sleep on my side instead of on my back. And, I do have more energy than when I had OSA issues - not sure if that is a function of TRT or of losing weight and not suffering from the apnea.

Do you know that your OSA has gotten worse on T or are you just worried about it? Frankly, it wouldn’t be worth it to me to give up TRT, it’s made such a change.

The appliance wasn’t that bad and the reset, as I understood it, was primarily for the teeth, not the jaw.

Good luck.


#6

It’s not so much the snoring that I’m worried about (though would like to alleviate that too), it’s the stopping breathing that worries me. I mean, after my septoplasty, the snoring problem got better, according to my gf. But do I still stop breathing and then “gasp”? That’s what I was doing, apparently, and might still be doing.

Anyway, I’m not sure if the OSA got worse on T, or even was caused by the T (though I kind of doubt that). But it got me pretty concerned, after taking T for 3 years now, to stumble upon articles that said that (a) low T can cause apnea problems, and in turn sleep apnea can cause low T due to the fact that the T isn’t given a chance to rise during the night because of lack of REM sleep, and (b) treating the low T problem with TRT can cause sleep apnea. It was like, whaaa? So either way I’m screwed?

I’m still a little bit in the dark about (b). The articles didn’t explain exactly how TRT therapy increases snoring and can cause or exacerbate sleep apnea. I’m not even sure, if it has to do with water weight gain, how water weight would cause or exacerbate apnea. I’d like more specifics about that.

I have a few simple goals:

  1. To not simply manage my apnea but to correct/cure it if possible.
  2. To stay on TRT.
  3. If I do have to live with apnea and wear things to manage it, then no CPAP nose hose; that thing is truly terrible and gives me more problems than it solves. The solution has to be something else.

So I’m looking into the laser procedure, will check out the dental appliances again, and…this will sound weird, but…I’m practicing playing the didgeridoo. Google it, YouTube it. A study actually showed that it dramatically helps. And it’s actually kinda fun.

Thanks for the responses, guys.


#7

Water gain aka bloat does seem to be an effect of elevated estrogens.

Do you have E2 [estradiol] lab work?
Do you take anastrozole to mange E2?


#8

Just go buy an OTC mouth appliance. I use VitalSleep. It’s $70 and they give a year of free replacements. I can’t sleep on my side, because I get shoulder pain. The mouth appliance I use is VERY comfortable, way more than others I’ve used. It only hurts my jaw if I adjust it too much. I barely have it at the first adjustment. Since it keeps my mouth more open, I can adjust it less than other mouth guards. The only thing I notice is, I get tightness in my front neck muscles. I assume that is due to the muscles being tightened/strengthened from using the mouth guard and keeping my mouth open all night.