I want you to reflect on something for a moment. I want you to reflect on your last month of training at your gym and the training program you're currently using. Go ahead, take a moment. The next line will be ready once you have finished.Good? Okay. Now that you have done that, reflect on just a few more things. Reflect on your supplement regime: your protein powders, your pre-workout, your vitamins, your post workout supplements. Go ahead. Keep reflecting.If you're still with me, it's time to start thinking about the holes in your training. We all have these; they are the times when you might have faltered in your training, times when you might have missed or forgotten or ran out of your supplements for the day or week or month. Think about them. I guarantee you they are there.When it comes to training programs and supplementation, we are trying to get the most out of our bodies to make us stronger and more powerful. The end result, if all things go well, is bigger numbers. Ultimately, powerlifters are number chasers. We all are.
Truth be told, we can never be sure if the program we are on will give us the best possible result, as each program has a different efficacy for different individuals. We have differing percentages of fast twitch, we have differing levels of myostatin, we have different body types, tendon strength, and a host of so many unique-to-us variables that we truly will never know which program will give the best results. We get good results when we truly stick to a program and have few holes in our training, but we will never know if they are the best results. We can never quite be sure of the exact number of sets or reps we should do for own unique body makeup. We are never wholly sure if the BCAAs we consume are the right type for us, or are ingested in the right amount or taken at the best time for us, or even if they work with our own body’s chemistry. These variables makes us unsure of which aspects of our over-all program are making us grow in power to our maximum potential. We, simply put, cannot count on them to be 100% the best for us.

What can we count on?We can count on the programs that came with us and on the mechanics we were born with to perform the tasks that we are programmed to perform. For instance, when you consume calories, your body burns them and magically creates energy. You don’t have to focus on digestion; peristalsis just occurs without you even being aware of it. You simply swallow your food and your body’s programming takes over. When your hand touches something too hot, your body reacts and you instantly remove it. You don’t have to think, “Hey, I didn’t realize that was too hot, and I could burn my hand, I had better move it.” The programming you came with includes a neurological system that takes over without you having to do a single thing. When you cut your finger or bruise your arm, you don’t focus on healing. The body knows exactly what to do. It is this miraculous thing that, unless interfered with, unless interrupted or obstructed, carries out the programming that it is designed to, so that you can perform in your designed fashion.....unless interfered with, interrupted or obstructed.We can count on the most natural occurring, the most performance enhancing, the most metabolic stimulating, the most anabolic sustaining, the most muscularly recuperative function of our bodies' programming: sleep. Particularly deep REM sleep. Sleep is more consistent than your training, exponentially more powerful than your supplementation, and it is designed to prepare your body in all ways for the next training session. Other than the all-nighters you might have pulled in college or the early morning days left over from the late night festivities, a good night’s sleep is always there for you, always prepared, and never fails you. But this is only a good night’s sleep.What happens when you don’t have that all important deep REM sleep?
Quick lesson in sleep: There are four stages of sleep.
Stage 1
The start of your sleep cycle when you produce theta waves. This is a light stage of sleep and a short stage lasting 5-10 minutes as it is the gateway to the stage
Stage 2
Where your body temp begins to decrease, your brain waves become rapid and rhythmic and your heart rate begins to slow. Second stage lasts about 20 minutes.
Stage 3
This is when the delta waves begin to emerge and this is a time when things that normally would get your attention (a sound or some environmental activity) no longer generate a response. There is some bouncing back and forth to stage 2, but for the sake of this article, we move on.
Stage 4
REM sleep is when the brain activity increases, respiration increases and skeletal muscles become more relaxed and lose tenacity for that 90 or so minutes.
It is between stages 3 and 4 that in addition to muscle relaxation, HGH is released by the brain into the blood stream and its plays a vital role in the restoration function of sleep itself. Two things produce this essential hormone. One is exercise and the other is, you guessed it: sleep.
What happens when you are in bed for eight hours, but you never manage to reach stages three and four of sleep? Or you reach stage three or four but you are constantly being pulled out of those critical HGH producing, muscle relaxing, increased body reparation stages?
Think about this: what happens to your training, your strength, and your body when you are in bed eight hours per night, but you never manage to reach stage three or four sleep? What if this goes on for weeks or months? What if you do it for a year straight?

What happens is this: you do not produce the HGH required to meet the demands of your powerlifting, your immune system becomes somewhat compromised, your respiration is not revved to the level it should be, and your skeletal muscles do not reach the relaxed status they require to fully recover from the squats, benches and deadlifts. You are not getting the O2 at the 95-99% your body needs, so your body increases blood pressure to compensate for this lack of O2. Your body does not stop producing urine like it should in stages three and four, so there are many night-time trips to the restroom. When your deep sleep is interfered with, interrupted or obstructed, your body goes into a survival mode. This does not achieve what an athlete’s body needs in order to make progress toward their powerlifting goals.
The thing that often interferes with the body's ability to enter stage three and four sleep is sleep apnea. Sleep apnea is an extremely common disorder (affecting 22 million Americans) causes pauses in breathing. These pauses can last for seconds to minutes and these pauses disrupt your sleep and pull you out of a deep sleep. There are three types of sleep apnea, but for this article we are talking about obstructive sleep apnea.Enter the most unrealized performance enhancer: a recuperative night’s sleep via the CPAP.
The CPAP or continuous positive airway pressure is for the really, really big guys right? The higher the body fat percentage the more sleep issues, right? I mean, do you hear a non-SHW talk about their CPAP?The reality is that there a few causes to sleep apnea. The aforementioned guys or gals with a higher percentage of body fat often get sleep apnea, but so do people who genetically have small airways in their noses, throats or mouths (or large tongue, tonsils or uvula); smokers; folks with a large overbite; etc. Some of these causes can be made worse by allergies or other conditions that cause congestion. Lastly: individuals with thickly muscled necks suffer from sleep apnea. The Sleep Foundation says a neck on a man of 17 or more inches on a woman of 16 or more inches can be a main cause of sleep apnea. My guess is a large percent of folks reading this fall into this last category, but never knew that an overly developed neck plays such a huge role in sleep apnea.So, let’s put aside the obvious candidates for the CPAP, as the SHW’s already know this secret. These big 300-pound and heavier guys know they had bad apnea (they wake up not breathing and their spouse and pretty much everyone in the house tells them how loudly they snore). The big guys know about this, but what so many powerlifters do not realize is that even the guys/gals with the six pack most likely have some degree of sleep apnea due to their neck circumference.If you are reading this and are not a SHW, I want you to now dump that stereotype. Sleep apnea could be your issue if you are not in this “thick neck” category. Remember, there are variables. You can be a 165-pound lifter with a thick neck because you started out lifting as a 148-pound lifter. Sleep apnea is not exclusive to body fat percentage. You need to be fully aware of this, because not everyone knows they have sleep apnea. It is not always a waking up and gasping for air experience. Maybe you are a thicker-necked powerlifter, or a powerlifter with a smaller airway, or large tonsils or uvula, that just wakes up tired, or feels a little too run down, or leaves the house wanting to have just another 30 minutes snuggled up to a pillow. These are the far more common signs that all too often get attributed to, “I just stayed up too late, or I didn’t quite get enough sleep.”What powerlifters do not necessarily know is that the larger neck muscles become flaccid during stage three and four sleep. The unnatural amount of weight of that muscle tissue then serves to close an airway and cause in sleep apnea. In this case, it is all about the weight of the neck and the amount of air pressure trying to keep an airway open.Here are some numbers to throw at you: Folks with severe apnea can have apnea over 30 times an hour. That is once every two minutes. If you multiply that by eight hours ,you start to see numbers like 200-300 per night. Some even have two, three, or four times that many episodes. Most folks that have sleep apnea are not even aware of it; they have some symptoms but never quite make the connection. They might be tired, or have slightly or moderately raised blood pressure, their short term memory is just not like it was as a kid, their blood sugar is slightly elevated, they have to make a trip to the rest room several times per night, they get twitchy legs at night, toss and turn or are restless when in bed, and the list goes on. This effects lifting by the individual not having energy and the numbers just won't go up.I was initially skeptical of the CPAP. I would hear the bigger guys talking and joking about their CPAP machine (and although it was all said in fun and I would laugh along to their stories) I was also thinking, how is it that these super heavy guys that use a CPAP are not as gassed as I am in the gym? I mean, they are 330 pounds and I am only 230 pounds. I was starting to wonder if my sleep was not all it could be. But that didn’t add up because, although I get up fairly early around 5:30 a.m., I also go to bed early, usually around 9 p.m. — a solid eight hours in bed. But I felt tired a lot, so I looked up the symptoms that these guys had pre-CPAP. Lo and behold, I had them too.So, a very long story short (too late for that), knowing that a good night of sleep is part of my genetic programming and recharges my life battery, I made an appointment with my doctor to have a sleep study done. Here is my experience with sleep studies, the CPAP, and time in bed vs time actually asleep.

The Study

Prior to the sleep study, I had to meet with a doctor whose specialty is sleep disorders (Dr. Mari Viola-Saltzman). I filled out the paper work, answered all the questions, and waited to see the doctor. When she walked in, she looked at me sitting in the chair and made a face that said, without speaking, "I know exactly what your issue is." We went over the paper work, she looked inside my nose and mouth at my airway, did things you would typically experience during a routine check-up, and then she sat back and, surprisingly, asked about my lifting. We talked about that while she measured my neck. At this time, I knew next to nothing about CPAP’s, sleep apnea, neck size, etc. I just knew I felt tired and that the SHW’s I know with a CPAP have more energy than I do at the gym. This is when Dr. Saltzman began to tell me about the causes of sleep apnea, specifically how the neck’s weight when awake is not a factor, but when entering those stages of sleep that cause muscle relaxation as I mentioned earlier, the weight of a 17-inch or more neck can serve to partially or fully block air-flow. My neck is a little over 20.5-inch, several inches past the 17-inch threshold. She went on to talk about the concerns with sleep apnea and how to obtain that critically important stage three and stage four sleep. We briefly discussed some surgery options, but most were geared toward people with large uvula’s or tonsils and how most of those surgeries do not bode well and do not help with what appeared to be my issue. She ordered the sleep study and that was that. The deal with a sleep study is this: You go to a medical facility that does nothing but sleep studies. On the outside it looks like an office building, but on the inside it resembles a mini-hotel. There is a corridor, and on each side of the corridor are rooms. These rooms have a TV monitor, a dresser, a queen size bed and a larger dresser, which is really a hollow container for a bunch of sophisticated equipment designed to measure and provide detailed data about your sleep patterns. The process goes like this: You go into the room, you fill out more forms, and you wait for your technician to come in. I have to admit, I was pretty nervous because I am kind of a control freak and this is about as no-control as you can get — you're in a room being monitored via camera and having hundreds of bio-feedback sensors all over your body. So, I checked in, filled out the form, changed into a t-shirt and shorts to sleep in, and my technician came in. Now this is where the universe was good to me. The technician walks in, looks at the Frantz Powerlifting shirt I am wearing, and says, "so you powerlift." Turns out she was a powerlifter, too, and we began talking all things powerlifting. Then she told me about all of the professional footballs players (without naming names) and how body weight for some and neck size for all was the key issue with their sleep. She told me that these guys travel with their CPAPS everywhere they go because sleep is the lynch pin to their recovery in a sport.

As we talked, she began to put biofeedback sensors all over me. They were on my head to measure the stage of sleep, over my eyes to see if I entered REM sleep, on my cheeks to see if I grinded my teeth, a couple of belt type sensors for my chest and stomach so they could read my breathing, two tiny little tubes under my nostrils to measure air output, on my legs to see if I kicked while sleeping, an oxygen level readers on my fingers to measure the percentage of O2 in my blood, yadda-yadda-yadda. In other words, I looked like something out of a NASA astronaut training bio-feedback camp.The powerlifting tech left the room and my job was to sleep. I was in bed with more wires than a wire deadlift brush, the bed was not mine, the room was not mine, the pillows didn't feel like mine, and I was are that when the light were out there were folks in the next room watching me and collecting data through the wires. This is the exact opposite atmosphere for a good night's sleep. Since I sleep with a fan at night and need some breeze and white noise, I asked out loud if they had one that I could use. The tech brought in a little fan for me to use during the study. The whole study was about a ten on the creep-o-meter but hey, I just wanted some answers.I eventually fell asleep and about 2 a.m. the powerlifting tech came in and said, “When you get to stage three and your muscles relax, your neck weight closes the airway and you have apneas.” They let me try the CPAP while I was there.
In layman's terms, this is the deal with the CPAP: It looks like the oxygen masks NFL guys have on their noses and mouths while they're sucking air on the sidelines during a game. It is a transparent plastic mask that fits over your nose and mouth and has soft rubber edges. Straps help keep it tight on your face. Attached to the mask is a hose about an inch in diameter and about eight feet long. That hose connects to a machine which is about the size of two Xbox controllers. (I was going to say a cassette to cassette player, but that would be showing my age.) The machine has two compartments. One that is basically a computer and the other compartment that holds water. As the water gets vaporized, the vapors and the air go from the machine into the hose, and ultimately from the hose to the mask. This is the air you breathe. When you first put that mask on, even though there is air (air, not oxygen like you would get from an oxygen tank) it feels like you are not getting enough oxygen. This phenomenon is called air hunger.
In reality, the air you are breathing in right now is about 3psi. The mask air starts at a level higher than that which means you are getting more air pressure than without the mask. But unless you know that ahead of time, the mask gives you a suffocating feeling. Once I found out about the 3psi vs the mask’s psi, I could deal better with the mask. Wearing it for the first time, for me anyway, made me feel like I was starring in Alien and one had attached to my face.The mask is actually smaller than the palm of your hand, but your brain does not recognize this at first. Each person with a CPAP has a different level of air pressure needed. This air pressure is what keeps your airways open once you hit stages three and four.
Think of it this way: a flag outside with no wind blowing hangs down and lies flat on the flag pole. When there is wind, the flag blows and stays straight out from the flat bole. This is the idea with the CPAP. The vaporized water's job is to keep your nose and throat moist with warm water vapor. You can't tell that there is water vapor, but it keeps your throat and nose from becoming too dry.During the sleep study, the techs determine how much air pressure is needed for an individual, and at what time during the sleep stages. The machine senses how much pressure you need and slowly increases the air flow as you sleep. It accommodates the weight of your neck. The CPAP starts at more than 3psi, but not enough to notice; as you fall asleep, it increases to the level you need. After two or three different masks, I found the one that was the right fit for me. During the sleep study I slept on my back, which I never do. This is the way they can best determine how bad your apnea is. The sleep study, in my case, went from about 8 p.m. to 6 a.m. We started tooling around with masks about 2 a.m. and at 3 a.m. I finally dozed off, only to have the powerlifting technician wake me up at 6 a.m. from the best sleep I could remember in years. I woke up on my back in the same exact position I went to sleep in.
After the sleep study, I got the results (how many times I had an apnea per hour, the type of apnea I had, the air pressure I fall into, the type of mask best for me, etc.). Then I got a prescription for my CPAP and all the things that come with it. When I picked up my CPAP they showed me how to wear it, how to clean it, and everything else I needed to know. Inside the machine is a memory card that is meant to be mailed to the doctor every several months to show them how you've been sleeping and if anything needs to be changed with the prescription or air pressure. If changes need to be made, it's done on the memory card and then sent back to the user. The memory card will automatically change the settings for you once it's inserted into the machine.
There were a couple unexpected perks to the CPAP that I found interesting. If there is ever a power-outage where you live and you can't use your CPAP, you take your prescription with you to any hospital and they will put you in a room (covered by your insurance, if that is how you pay for your CPAP). In that room you can plug in your CPAP and sleep. Speaking of insurance, most insurance policies will cover the study and the unit, but find out first if your insurance will cover it. Ultimately, you cost the insurance company less by being healthy, so they tend to pay 100 percent of the expense. When I got the bill, it had all of the costs itemized and at the bottom, but my total to pay was zero.Some flight airlines will give you seating where there is an electrical plug, so you can even use your CPAP if you plan to sleep on a long flight.
These are all things I never knew about CPAPS. They are used by millions of folks, and only a small percentage are super big guys.Getting used to the CPAP does take time. Just like you won't develop a huge deadlift overnight, the CPAP takes some getting used to. You have to play around with how tight to wear it. The correct tightness is just tight enough to keep air from escaping, but not too tight to be uncomfortable. For me personally, I have some good nights and some other nights when I want to smash the machine into bits. Somewhere around my second week with the CPAP I took a nap in the middle of the day and that way the key for me. I set my iPhone for an hour so I could nap on a Saturday afternoon after training, and that somehow made the CPAP seem less threatening. Ever since, when I put the CPAP on, it feels like my own sleep environment.Around month two, I noticed a Pavlovian style response whenever I put the mask on: I was ready for sleep. I'm able to sleep straight through the night with the CPAP.
If you decided to have the study done and need a CPAP, remember that there is a learning curve. For me, a little nap was the only thing I needed to get used to the machine.There were some thing I noticed after my first month with the CPAP. My blood pressure dropped from 120/85 to 102/80. This is because the body compensates for lack of O2 percentage by increasing blood pressure. For me, as a powerlifter and a Master II Powerlifter, I have had some of the best workouts of my life since using the CPAP. I even found myself doing more than adding reps and sets to my program — I started adding new exercises. I just wasn't getting tired in the weightroom. For those reasons alone, the CPAP has already surpassed my expectations. I no longer need a weekend nap, I am not tired at the end of the work day, and when I get up in the morning, I'm ready to go. The irony is that in the first three months, I put on five pounds of muscle from the combination of rest, added endurance, added reps, added exercises, and my body's full use of O2 so that the muscles can fully relax and allow me to enter stage three and stage four sleep. The muscle was the reason I needed the CPAP, and now the CPAP is helping me build more muscle.
About the same time as I was going through this process, one of the guys on my team went through a sleep study, too. In his first three months Steve added 50 pounds onto his 700-pound deadlift. He is also now hitting his 950-pound squats the way he used to his 750. The difference in his training and power is stark to say the least, amazing to say the most. Here is big Steve taking 960 pounds for a spin, after three-months with his CPAP. Steve is a big guy who is a former WPC World Powerlifting champion. As a Master I lifter, Steve still competes and still bangs out a 1004-pound squat, a 700-pound bench press and a 750-pound deadlift. It is not that the CPAP is getting you strong(er), it is that without the CPAP (for powerlifters that need one), your state of stages three and four sleep deprivation is keeping you from getting stronger. You cannot be sure if your training program is the best program for your own individual training needs, and you cannot be sure of your supplement regime, either. But a good night’s sleep, every night, over weeks, months, years and decades, is the best thing you can do for your body’s recovery — more so than program, supplement, or performance enhancing drug. Your sleep program comes from your own body’s genetic programming. Failure to take full advantage of the body’s rejuvenating REM sleep puts a powerlifter in the direct path of stagnation or regression. Without sleep, even health issues can add up and wreak havoc on your life.My goal in writing this is simple. I know that there are powerlifters that have no idea they have sleep apnea, and even fewer who know that neck or tonsil size are causes for sleep apnea. There are even individuals reading this article who have sleep apnea and, no matter how big and bad they are in the weight room, are nervous about either the sleep study or the CPAP. I want to empower them with this information because sleep apnea is something that you could have for years and not even know it. It is something that you can completely treat with a properly-adjusted CPAP and a qualified physician like I have.
Sleep is the ultimate performance enhancer, and it is already part of your genetic make-up. Take full advantage of it. Deep stage three and four sleep could be the powerlifting breakthrough you have been waiting for.
The following is an interview I conducted with Dr. Mari Viola-Saltzman.
Eric: What are some of the benefits of a CPAP for powerlifters who suffer from sleep apnea?
Dr. Saltzman: There have been some recent studies about obstructive sleep apnea (OSA) and professional football players that you may want to look up, basically showing an increased prevalence in this group. This happens most often with the defensive line type of player, due to increased body mass index/obesity and enlarged neck size (a man with a neck circumference of 17" or greater is a risk factor on its own for sleep apnea).I have not seen specific studies on weight lifters and sleep apnea but it would probably show similar results. As you know, sleep apnea is a significant, independent risk factor for high blood pressure and heart disease and can increase the risk of cardiovascular mortality. The benefit of continuous positive airway pressure (CPAP) is to obviously reduce cardiovascular risk. Other potential benefits are improvement in mood, improvement in cognitive function, reduced daytime sleepiness, improved sexual function (really!) and a happy bed partner (since the snoring is resolved). I also have not seen studies on treatment of OSA and improved physical/muscle performance, but I may need to look deeper for this. There was an article in the last few years showing improvement in golf game and use of CPAP but maybe this is due to increased concentration. CPAP, if at the right pressure, should be nearly 100 percent effective to treat OSA. Some people take to it great, especially the ones that notice the improvement in their sleep or daytime functioning. Others have a harder time getting used to it. Working closely with the physician has been proven to improve adherence to CPAP.
Eric: What do you recommend if you are having trouble getting used to the CPAP?
Dr. Saltzman: If someone has trouble getting used to CPAP, we tend to have them try an alternate mask, we try to lower their pressure, and have them use a couple desensitization techniques: Wear the mask at home while awake for one hour each day. Attach the mask to the CPAP device, and switch the unit "on." Practice breathing through the mask for one hour while watching television, reading or performing some other sedentary activity. Use the CPAP during scheduled one hour naps at home. Use CPAP during initial 3-4 hours of nocturnal sleep. Use CPAP through an entire night of sleep. Advance by one step after each five days, once the step can be carried out without anxiety. In addition, our lab techs will also meet with patients during day to help trouble shoot. Simple questions for someone to screen for sleep apnea:
  1. Do you snore loudly (louder than talking or loud enough to be heard through closed doors)?
  2. Do you often feel tired, fatigued, or sleepy during daytime?
  3. Has anyone observed you stop breathing during your sleep?
  4. Do you have or are you being treated for high blood pressure?
  5. BMI more than 35 kg/m2?
  6. Age over 50 years old?
  7. Neck circumference greater than 40 cm?
  8. Gender male?
High risk of OSA: answering yes to three or more items/ Low risk of OSA: answering yes to less than three items
Dr. Mari Viola-Saltzman, Expertise: General Neurology, Sleep Medicine, Board Certified, Neurology, Sleep Medicine. You can find a Video Profile of her Treatment Philosophy at the NorthShore.org site.