Just a few days ago, an estimated 200 million viewers watched as the Philadelphia Eagles and the Kansas City Chiefs faced off in New Orleans during the biggest game of the National Football League’s season. What many sports fans—and even players—don’t realize is that a significant number of these pro players are up against an unseen opponent: obstructive sleep apnea (OSA).
Estimates suggest the prevalence of OSA in the NFL ranges from 14% to 19%, which is seven to 10 times higher than the approximate 2% to 5% of the general population affected.1 Some studies have found that as many as 50% of former NFL players suffer from sleep apnea, with many cases likely undiagnosed.1
Dealing with untreated OSA, many of these players experience fatigue, impaired cognitive function, and increased risk of injury, ultimately impacting both their performance and long-term health.
Although the excitement of the Super Bowl is quickly fading, it’s important to keep the spotlight on these elite athletes—and their sleep health. Raising awareness about the increased risk of sleep-disordered breathing in this population and treating this condition can not only improve the well-being of players, but it can also have a profound effect on the general public. Many of these athletes are influencers with a powerful platform, and when they embrace treatment, it can inspire others to follow suit.
Sleep Problems in Professional Athletes
Despite high levels of performance and a focus on maintaining physical fitness, elite athletes often have low sleep quality and quantity.2 Research has suggested that insufficient sleep among athletes may be due to scheduling constraints and sleep falling lower on the totem pole of priorities relative to other training demands.2
A 2023 literature review that appeared in Current Sleep Medicine Reports looked at the relationship between sleep and performance in professional athletes.3 After analyzing 38 studies published between 2018 and 2022, the authors concluded that professional athletes face several unique challenges that make them more vulnerable to sleep problems and sleep-related disorders. A few of the key factors included high training loads, frequent travel across different time zones, and late competition start times that delay sleep.3
In order to tackle this deadly and debilitating problem, the authors underscored the need for more collaboration between professional athletes, coaches, teams, and medical professionals to improve knowledge of sleep health, increase awareness of sleep disorders and risk factors, and to develop tailored interventions to improve sleep health among athletes.3
Majel Carnell, RRT, is excited to be part of efforts to do just that. An avid football fan and health care professional with more than 15 years of experience in the field of sleep medicine, Carnell founded Treat-Sleep-Breathe in 2021. As president of Treat-Sleep-Breathe, she’s had the opportunity to educate and treat hundreds of former NFL players by working closely with the Living Heart Foundation (LHF) and the NFL Players Association (NFLPA), an organization dedicated to protecting the welfare of NFL players and helping them transition in their post-career lives.
LHF is an organization founded in 2001 by Arthur “Archie” Roberts, MD, who played three seasons in the NFL as a back-up quarterback in the mid-1960s with the Cleveland Browns and the Miami Dolphins while attending medical school. Dr. Roberts went on to have a successful decades-long career as a well-known heart surgeon.
After having a stroke, he wanted to raise awareness about underlying health risks that face former football players, especially because of comorbidities related to large body mass. He established the national health wellness program LHF Hope (Heart-Obesity-Prevention-Education) and teamed up with the NFLPA to provide nationwide health screenings that aid in early detection of health risks in former pro-football players.
Building a Strong Defense
Sleep medicine first became a part of these comprehensive health screenings around 2012, and it’s become a crucial part of the LHF National Wellness health program. “I realized that for so many former NFL players, they were really living in the danger zone when it came to sleep and sleep apnea episodes,” said Andre Collins, executive director of the Professional Athletes’ Foundation, in an interview with sleep specialist Rudi Ferrate, MD, for the American Sleep and Breathing Academy. “The bottom-line impact is that we’re saving players’ lives [with this program].”
Carnell first became involved with these screenings in 2021. She often collaborates with Dave Gergen, CDT, a renowned dental lab technician who specializes in oral appliances for OSA treatment and is also president of the Pro Player Health Alliance. “It’s a team effort,” she says. “We work together to get players treated. I provide education about sleep health and coordinate access to sleep testing, and he handles the oral appliance aspect.”
“About every two months, I go to a different state where they’re offering health resources for all the retired players in that area,” she explains.
She talks to these former players about their increased risk for sleep apnea, encourages them to establish a baseline by distributing convenient, easy-to-use home sleep tests, and ultimately, helps them decide on which treatment option is right for them if they’re diagnosed.
“One of my goals with the players is to debunk misconceptions about sleep apnea and treatment options,” she says. “We have so many tools to help individuals with sleep apnea who are suffering, but a lot of people don’t even know they could be at risk.”
When meeting with former players, Carnell usually starts each interaction with the same basic question: “Do you know what sleep apnea is?” And the majority of the time, the answer is “no.”
In addition to providing standard patient education about OSA, Carnell details the increased risk and prevalence of sleep-disordered breathing in active and former NFL players as well as some of the factors and key indicators that there may be a problem. She also explains the devastating impact that untreated OSA can have on overall health in just about every area:
- Focus: Lack of sleep can negatively impact your memory and ability to concentrate.
- Heart: Inadequate sleep can increase your risk of high blood pressure and heart disease.
- Lungs: Disrupted breathing can increase your risk of respiratory infections and diseases.
- High blood sugar: Lack of sleep impacts your insulin production, increasing your risk for developing diabetes.
- Fatigue: Sleep deprivation can lead to daytime drowsiness, increasing your risk of car accidents and injuries.
- Immune system: Poor sleep may make you more susceptible to illness, and recovery from illness may take longer.
- Appetite: Interrupted sleep can lead to late-night snacking and overeating, contributing to weight gain.
- Acid reflux: Sleep apnea and poor breathing can cause or worsen symptoms of heart burn.
A Game Plan for Success
At this point, most of the players she talks with are eager to take the next step: establishing a baseline assessment of their sleep. Players are provided a home sleep testing device and the support needed to complete the study in the comfort of their own home.
The device Carnell uses is called the WatchPAT One, developed by Itamar Medical (now part of ZOLL Medical), a fully disposable sleep apnea diagnostic device that connects to a smartphone app via Bluetooth. It is an FDA-cleared peripheral arterial tonometry (PAT)-based system that eliminates the need for traditional in-lab polysomnography (PSG) testing in many cases.
Once the test is completed, Carnell talks with them about the results the following day. If treatment is necessary, she talks to them about various options suited to the severity of their diagnosis. “Thanks to advances in medicine, there are so many more options for treatment now,” she says.
Two of the most commonly used treatments among the players she works with are oral appliance therapy and continuous positive airway pressure (CPAP). “Improvements in CPAP technology and design have made CPAP therapy more comfortable and effective as well,” Carnell says. “There are a lot of variables going on when it comes to CPAP, but there’s a solution for almost every problem—issues with the mask, the issues with the tubing. So I tell all my players, don’t suffer, just communicate, and we can work on a solution together.”
Celebrating Wins
Carnell has seen remarkable compliance rates with sleep apnea treatment in the players she’s worked with. “These athletes have been trained to optimize their health and recovery, and in my experience, they want to do whatever it takes to get better,” she says.
For former NFL linebacker James Harrell, that commitment to treatment has been life-changing. “Sleep is essential for improving my overall health, and treatment has given me the energy to power through each day,” says Harrell, who played nine seasons in the NFL and now serves as the Florida Chapter President of the NFLPA.
And Carnell has seen the benefits of treatment extend far beyond the players themselves. “I’ve had so many players’ wives contact me to thank me for restoring peaceful, restful sleep – both for their spouse and for them,” she says. “So many of them say before treatment, they weren’t sleeping because their spouse wasn’t sleeping, and they couldn’t rest knowing their partner was gasping for air right beside them. Sleep apnea has a domino effect on the entire family, especially the bed partner.”
That ripple effect is what fuels Carnell’s passion for raising awareness. Whether she’s helping a retired athlete breathe easier at night or educating the public about the risks of untreated sleep apnea, the impact of Carnell’s work is personal and profound. “Knowing I had a big impact on someone’s quality of sleep, health, and life feels like a touchdown to me,” she says.
By SleepWorld Magazine Staff
References
- Rogers AJ, Xia K, Soe K, et al. Obstructive sleep apnea among players in the National Football League: A scoping review. J Sleep Disord Ther. 2017;6(5):278. doi: 10.4172/2167-0277.1000278. Epub 2017 Nov 23.
- Simpson NS, Gibbs EL, Matheson GO. Optimizing sleep to maximize performance: implications and recommendations for elite athletes. Scand J Med Sci Sports. 2017 Mar;27(3):266-274. doi: 10.1111/sms.12703. Epub 2016 Jul 1.
- Cook JD, Charest J. Sleep and performance in professional athletes. Curr Sleep Med Rep. 2023;9(1):56-81. doi: 10.1007/s40675-022-00243-4. Epub 2023 Jan 17.
