Mouthguards, Sleep and Other Unconsciousness

[Jason Donaldson]

I have three loosely related questions:

1) I have benefitted greatly from a CPAP for some time now. That said, I have been curious whether a dental appliance was worth trying, to have a backup in situations of no power for the CPAP - air travel, outage, disaster, etc. At a recent routine dental visit, I asked my dentist about this, and was shocked at the level of cost this entails (c. $2,500) If anyone has experience with such an appliance, I'm interested, in case of unexpected insurance coverage that makes is worth trying.

2) That said, the conversation also involved him recommending that I consider a mouthguard for lifting. While a dentist-supplied one is also pretty steep (though he'd "throw it in" if I did the sleep apnea one...), I see cheap OTC versions. I understand that some lifters use them, and at $25 or so, it might be worth considering, especially if anyone has experience that can speak to this use case.

3) Here's the interesting part, though... In the conversation with the dentist, I asked offhand about light-headedness or passing out under load. He enthusiastically suggested that the benefits of a mouthguard during lifting can help with alignment and whatnot to reduce pressure on the blood supply to the brain, reducing this risk. I understand he has bills to pay, of course, and that his worldview is decidedly dentocentric by nature, but I am curious about this from the standpoint of knowledge in the lifting domain.

I manage my head rushes just fine on the primary lifts, especially the press. I have had a couple of instances on the pin press, however, where I've lost consciousness, thankfully without injury. I have never experienced this when grinding unsuccessfully and missing a regular press - only when pressing from the pins. One was an isolated incident about five years ago, where I figured out how to deal with it and was fine from then on, continuing to train the lift. However, the other one and a half times (once waking up on the deck, once a "standing eight count" situation) were very recently, and so I've cut out pin pressing altogether.

I don't hold my Valsalva in my mouth - I bare my teeth to prevent that - and I don't relax everything all of a sudden after the lift, making sure to keep my grip and my legs clenched to work against a sudden drop in BP. In fact, the full passing out on this recent pair of incidents came before I'd completed the lift, as verified by an observer.

My suspicion on the whole effect is therefore that it's related to pressure from the musculature around the arteries of the neck that's basically choking me out, and that biting a mouthguard isn't likely to affect this one way or another, but I don't want to lean on my own understanding if I can help it. I also want to make sure I'm not missing something else. The press is my favorite lift, after all.

[Maybach]

The blue book discusses lightheadedness on the press, and as you say, is generally thought to be due to increased pressure on the carotid sinus, which can provoke a baroreflex action at the heart which causes a rapid drop in blood pressure (similar to a "sleeper hold"). The solution given is to take a new breath between each rep (and therefore reduce the exposure of the sinus to high pressure). I have had...mixed success with this technique. The times I get lightheaded on the press seem to be due to the actual muscle contraction in the area (since it appears to be randomly and uniformly distributed among "heavy" reps, such as first reps or singles, rather than merely later or especially effortful reps). This would seem to jibe with your experience of it on the pin press more than the full press. And the loss of "tightness" required to take a breath can in some cases costs at least a full rep. It is perhaps a matter of insufficient skill on my part on taking a shallow enough breath to alleviate pressure but not to lose tightness, but that's as may be.

It is possible, I suppose, that a "heady" Valsalva could increase pressure on the carotid sinus sufficient to provoke this action, and if so, a mouth guard could alleviate this. Then again, a well executed "heady" Valsalva at the right time can also work to alleviate this faintness if it's not too severe.

[Mark Rippetoe]

My advice is to take an open-mouthed valsalva. Works for me.

[gadders]

I have a couple of New Age lifting mouthpieces. Not sure I believe all the neck alignment stuff, but I do clench my teeth a bit when I lift and it stops me grinding them together.

[Faarg]

On point 1, I used a Somna Med moutpiece for nearly 20 years for sleep apnea. It's easier to get used to than a CPAP, easier to travel with, and works fairly effectively for mild apnea. I recently switched over to a CPAP, though, and am sleeping much better. Insurance covered about half the appliance and then I had to pay a separate fitting fee.

[Jason Donaldson]

The blue book discusses lightheadedness on the press, and as you say, is generally thought to be due to increased pressure on the carotid sinus, which can provoke a baroreflex action at the heart which causes a rapid drop in blood pressure (similar to a "sleeper hold"). The solution given is to take a new breath between each rep (and therefore reduce the exposure of the sinus to high pressure). I have had...mixed success with this technique. The times I get lightheaded on the press seem to be due to the actual muscle contraction in the area (since it appears to be randomly and uniformly distributed among "heavy" reps, such as first reps or singles, rather than merely later or especially effortful reps). This would seem to jibe with your experience of it on the pin press more than the full press. And the loss of "tightness" required to take a breath can in some cases costs at least a full rep. It is perhaps a matter of insufficient skill on my part on taking a shallow enough breath to alleviate pressure but not to lose tightness, but that's as may be.

It is possible, I suppose, that a "heady" Valsalva could increase pressure on the carotid sinus sufficient to provoke this action, and if so, a mouth guard could alleviate this. Then again, a well executed "heady" Valsalva at the right time can also work to alleviate this faintness if it's not too severe.

Yeah, it feels exactly like being choked out - and I only get a bit of it on grinding reps, and have only been close to/knocked out on heavy, grinding singles.

I've learned to take expel and take "sips" of air at lockout to deal with it, too...though the most recent blackout set in on the way up, which was new.

My advice is to take an open-mouthed valsalva. Works for me.

I've gotten my parted lips snarl well ingrained, but since you responded with this, I've been working to take it a step further and actually keep my mouth open, to see if that helps at all. Thank you.

I have a couple of New Age lifting mouthpieces. Not sure I believe all the neck alignment stuff, but I do clench my teeth a bit when I lift and it stops me grinding them together.

On point 1, I used a Somna Med moutpiece for nearly 20 years for sleep apnea. It's easier to get used to than a CPAP, easier to travel with, and works fairly effectively for mild apnea. I recently switched over to a CPAP, though, and am sleeping much better. Insurance covered about half the appliance and then I had to pay a separate fitting fee.

If they work okay for mild sleep apnea, that's probably not going to help me enough, sadly. Mine is not mild.

I did an affordable, OTC one that the dentist mentioned (Dentek Comfort Fit) to try, and I can't keep the thing in without retching, which is conducive to neither sleep nor lifting. I was concerned about this, since I was never able to manage sports mouthguards for the same reason.

Still, between that and the high prices, the mouthguard route is likely to be a no-go for me. I'll still experiment with acclimating to it over time, though, out of stubbornness and curiosity. I appreciate everyone's input and experiences.