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Sleep Apnea

Sleep Disorders | June 12, 2018 | Author: Naturopath

sleep disorders

Sleep Apnea

Feel like you've just been hit by a bus when you wake up? Headaches all morning, and extreme fatigue throughout the day? You may have sleep apnea.

Apnea means “no breath” and sleep apnea is a serious medical condition where breathing is halted during sleep. This can be due to an obstruction of the airways or irregular respiratory signals from the brain. All forms of sleep apnea result in a build-up of carbon monoxide and too little oxygen circulated throughout the body, which can contribute to sleeplessness, fatigue, and serious health conditions.

Symptoms of Sleep Apnea:

  • Snoring *
  • Choking or gasping during sleep
  • Frequent waking during the night
  • Grogginess and headaches in the morning
  • Falling asleep during the day
  • Irritability and moodiness
  • Low libido
  • Poor concentration
  • Forgetfulness
  • Indigestion
  • Sore throat upon waking [1] [4][5]

NOTE: While almost all people who suffer from sleep apnea snore, not everyone who snores has sleep apnea!

Snoring VS Sleep Apnea

Snoring VS Sleep ApneaSnoring can be a clear sign of sleep apnea, but in many cases it is not an indicator of a breathing disorder. To tell the difference between sleep apnea snoring and “normal” snoring, ask your sleeping partner. 
Snoring may be an indicator of obstructive sleep apnea if you snore loud enough that it wakes them up, if they notice that you stop breathing while sleeping, choke or wake up gasping for air.

Snoring usually doesn't cause the mood symptoms of sleep apnea, but may contribute to a sore throat, frequent waking and mild fatigue. Seek advice from a qualified practitioner if your tiredness is extreme or you experience mood or personality changes.
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Obstructive Sleep Apnea

The most extreme and most common form of sleep-related upper airway resistance is OSA, where breathing stops for over ten seconds when the upper airway becomes completely or partially closed during sleep. OSA is the most common breathing disorder – it occurs in 2 – 9% of adults, but up to 80% of cases are undiagnosed [12]. It is a serious condition that is associated with high blood pressure, atrial fibrillation, heart failure and hypersomnolence (falling asleep randomly during the day, which can cause accidents and even death when driving a car). [1]
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In the most common forms of sleep apnea, the muscles of the upper airway relax too much during sleep or the muscles. This causes the airways to narrow, causing reverberation and snoring, and limiting the amount of oxygen delivered to the lungs. If the airway narrows further, it can become completely blocked and stop air for over 10 seconds at a time – this can happen repeatedly, even over 100 times every night!

Symptoms of OSA are the same as other sleep apnea conditions, but more frequently include snorting, gasping, or choking during sleep.

Risk Factors for OSA include:

  • Anatomical risks, such as having a short jaw, prominent tongue or tonsils
  • Rounded head shape or short neck
  • Large neck circumference
  • Bulk around the neck due to obesity
  • Age (over 45)
  • Alcohol use
  • Sedative use
  • Family history
  • Hypothyroidism
  • Poor sleep hygiene

Central Sleep Apnea

Central sleep apnea is far less common that OSA, and occurs due to an issue with signals sent from the brain to the thoracic and abdominal muscles that control breathing. It doesn't involve any obstruction of the airway – rather, the brainstem is often affected, failing to send accurate and consistent signals to the respiratory system. Rather than recurrent moments of obstruction, central sleep apnea is characterised by repetitive episodes of shallow or absent breathing. When oxygen and carbon dioxide levels become out of balance, they will eventually signal the brain to wake up, causing poor quality sleep.

Central sleep apnea is commonly caused by:

  • Congestive heart failure or stroke
  • Drugs (particularly opioids, including codeine and oxycodone)
  • High altitude causing rapid, shallow breathing
  • Treatment of obstructive sleep apnea by a continuous positive airway pressure (CPAP) machine [2] [3]

Mixed or Complex Sleep Apnea

Mixed or Complex Sleep ApneaMixed sleep apnea, also known as complex sleep apnea, involves both OSA and central sleep apnea occurring at the same time.

This usually happens when OSA is treated with a continuous positive airway pressure (CPAP) machine that then causes central sleep apnea.

Health Risks of Sleep Apnea

All types of sleep apnea have been associated with an increased risk of:

  • Insulin resistance
  • Metabolic syndrome
  • Fatty liver disease
  • Heartburn and GERD
  • Worsening atrial fibrillation
  • Heart failure
  • High cholesterol
  • Adult asthma
  • Weakened immune system
  • Depression
  • Memory loss [4][5]

Natural Remedies for Sleep Apnea

As mentioned, conventional treatment for sleep apnea includes a CPAC machine which can help and hinder sleep quality. Complementary therapies may help to reduce the frequency or severity of airway closure in OSA and may help to regulate breathing in central and mixed sleep apnea.

Ask Your Healthcare Providers About Your Prescription

If you are on any medications, speak to your pharmacist and doctor about their risk of causing sleep apnea. Opioid use is a major risk factor for both OSA and central sleep apnea, and there may be alternative medications available. Taking multiple medications increases the risk of sleep apnea, so ask for a yearly review of your medications – you may be able to cut down on your number of prescriptions [6].

Acupuncture & Acupressure

A 2016 systematic review and meta-analysis of all available studies concluded that acupuncture can improve all measurements of sleep apnea and sleep quality [7]. If needles aren't your thing, ask your acupuncturist for auriculotherapy – acupressure points in the ear are stimulated with tiny magnetic press pellets, and have been shown to improve obstructive sleep apnea [8].

Clean Up Your Sleep Hygiene

Dim the lights after dinner, switch off your screens and pick up a book. Having a consistent and calming bedtime ritual can improve sleep quality, reduce onset of OSA, and may minimise the requirements for sleeping pills [11]. Key bedroom improvements include:

  • Humidifier: Using a humidifier in the bedroom has been shown to reduce symptoms of sleep apnea, even in humid climates! [9]
     
  • Pillow: A supportive pillow is essential. The best sleep position to reduce obstructive sleep apnea is on your side with your head slightly raised. [10]
     
  • Head-of-bed elevation: Investing in a bed that allows the head of the bed to be raised may help to reduce frequency of OSA [13]

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References

[1] Strohl, K. P. (2017) Obstructive Sleep Apnea. Merck Manual Online Database. https://www.msdmanuals.com/en-au/professional/pulmonary-disorders/sleep-apnea/obstructive-sleep-apnea

[2] Muza, R. T. (2015) Central sleep apnoea—a clinical review. J Thorac Dis., 7:5, 930 – 937. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4454847/

[3] Eckert, D. J., et al. (2008) Central Sleep Apnea - Pathophysiology and Treatment. Chest., 131:2, 595 – 607. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2287191/

[4] Spicuzza, L., et al. (2015) Obstructive sleep apnoea syndrome and its management. Ther Adv Chronic Dis., 6:5, 273 – 285. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4549693/

[5] Patil, S. P., et al. (2007) Adult obstructive sleep apnea: pathophysiology and diagnosis. Chest., 132:1, 325 – 337. https://www.ncbi.nlm.nih.gov/pubmed/17625094

[6] Lande, G. R. & Gragnani, C. (2015) Relationships Between Polypharmacy and the Sleep Cycle Among Active-Duty Service Members.  The Journal of the American Osteopathic Association, 115, 370-375. http://jaoa.org/article.aspx?articleid=2300620

[7] Zheng-tao, L., et al. (2016) The Clinical Effect of Acupuncture in the Treatment of Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Evid Based Complement Altern Med., 2016. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4834396/

[8] Lo, C., et al. (2013) The Stimulation Effect of Auricular Magnetic Press Pellets on Older Female Adults with Sleep Disturbance Undergoing Polysomnographic Evaluation. Evidence Based Complment Altern Med., https://www.hindawi.com/journals/ecam/2013/530438/

[9] Soudom, C., et al. (2016) Effect of Heated Humidification on CPAP Therapy Adherence in Subjects With Obstructive Sleep Apnea With Nasopharyngeal Symptoms. Respir Care., 61:9, 1151 – 1159. https://www.ncbi.nlm.nih.gov/pubmed/27220350

[10] Oksenberg, A. & Gadoth, N. (2014) Are we missing a simple treatment for most adult sleep apnea patients? The avoidance of the supine sleep position. J Sleep Res., 23:2, 204 – 210. https://www.ncbi.nlm.nih.gov/pubmed/24118690

[11] Guedes Bahai, M., et al. (2006) [Impact of sleep hygiene on patients with obstructive sleep apnoea syndrome]. Rev Port Pneumol., 12:2, 147 – 176. https://www.ncbi.nlm.nih.gov/pubmed/16804632

[12] Lee, W., et al. (2014) Epidemiology of obstructive sleep apnea: a population-based perspective. Expert Review of Respiratory Medicine., 2:3. https://www.tandfonline.com/doi/abs/10.1586/17476348.2.3.349

[13] Souza, F. B., et al. (2017) The influence of head-of-bed elevation in patients with obstructive sleep apnea. Sleep Breath., 21:4, 815 – 820.

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