Summer 2019-21 True Natural Health Magazine – Your Questions Answered
By Roger French
QUESTION: It appears that I have sleep apnoea, and my doctor has advised me to obtain a CPAP machine to be worn during sleep. But I don’t want to wear a mask every night, it would be much too uncomfortable. On the other hand, I don’t want to risk the potentially dangerous consequences of ongoing sleep apnoea.
Are there other ways of treating the condition which are not so ‘invasive’ and which don’t involve drugs?
Yes, there are alternative devices. For a start, here is a detailed explanation of sleep apnoea.
If a person snores, then becomes silent because breathing has stopped, then makes a loud snort or gasp as they begin breathing again, this is sleep apnoea. The name employs the Greek word, apnoea, meaning ‘want to breathe’.
Sleep apnoea affects a small percentage of middle-aged adults, and the snoring can be so loud that it rivals a jack hammer.
Very occasionally children can suffer sleep apnoea if they are overweight or have enlarged tonsils and adenoids.
When the airway at the back of the throat is repeatedly blocked, partly or completely, during sleep, this is obstructive sleep apnoea (OSA). The person stops breathing for 10 seconds or longer, even up to two minutes, and this may occur once or twice during the night or hundreds of times. Needless to say, the disturbance to sleep can cause problems.
The poor quality sleep may result in abnormal sleepiness during the day (you could fall asleep while driving a car), difficulty concentrating, forgetfulness, anxiety, depression and irritability.
Add to this the lack of oxygen from the interrupted breathing and the result could be high blood pressure, which could eventually lead to heart failure, heart attack or a stroke.
How It Occurs
During sleep the muscles of the body relax quite normally and naturally, and this applies to the muscles of the throat and top of the windpipe. However, if the muscles of the soft palate at the base of the tongue and the adjacent area relax and sag, they can obstruct the airway causing laboured breathing and snoring.
If these tissues relax even more excessively, they can close off the entrance to the windpipe and block breathing entirely. As the body feels the need to breathe, sleep is temporarily interrupted which activates throat muscles and clears the airway so that breathing resumes. This type of breathing difficulty is called obstructive sleep apnoea (OSA). It typically occurs in overweight men and often causes blood pressure to rise because the heart must pump harder to deliver enough oxygen to all parts of the body. Women tend not to suffer OSA until after menopause, although it is never as common as in men.
The other type of sleeping disturbance is central sleep apnoea, (CSA). The windpipe remains open, but the muscles responsible for breathing cease working temporarily, perhaps because they have relaxed far too much. The cessation of breathing sounds warning bells in the brain, causing the sleeper to wake and resume breathing.
CSA is more common in older people, perhaps affecting one in every four people over 60 years of age.
Heart Disease and Stroke
The greatest concern with sleep apnoea is when it leads to heart trouble or stroke – which, I hasten to add, often don’t occur.
A sleep laboratory in Gothenburg, Sweden, conducted a seven-year study that was completed in 1998 and found that in sleep apnoea sufferers who were not effectively treated, the CVD incidence was 57%. In contrast, in those who were efficiently treated, the incidence was just under 7%. The authors concluded that apnoea significantly increases the risk of heart disease in middle-age and that efficient treatment significantly reduces the risk.
A study at the University of Toronto in 1998 found that a widely used device to maintain pressure in the airways – a ‘CPAP’ machine – significantly reduced the risk of heart failure and heart disease.
High blood pressure, a major risk factor for heart disease, is significantly associated with sleep apnoea. A study at Johns Hopkins University, Baltimore, in year 2000 found that the incidence of high blood pressure was 37% greater in people who stopped breathing at least 30 times per hour, compared to those who ceased breathing less than 1.5 times per hour.
Some other medical problems interfere with normal breathing. Gastric reflux can cause acid to reach the throat and cause swelling. Nasal congestion can make nose breathing difficult and can worsen OSA.
Clearly, there is a pressing need to effectively deal with sleep apnoea.
After discussing the symptoms with a doctor, it may be desirable to visit a sleep disorders centre and sleep for a night or two in a ‘Sleep Evaluation Laboratory’, where the staff monitor your sleep and make a diagnosis.
If you have OSA, be aware that muscle tone is excessively reduced by alcohol, sleeping pills and tranquillisers, and that taking these at bedtime is asking for trouble. Alcohol usually worsens snoring and OSA due to the throat muscles relaxing. Avoid it for at least three hours before bedtime, and avoid sleeping pills altogether as these tend to depress breathing and make the condition worse.
Techniques for overcoming insomnia without pills were described in detail in the Autumn 2017 issue of TNH. If you must take drugs, whether for headaches or anxiety, etc., check to make sure they will not affect sleep and breathing.
If you smoke, quit. Cigarette smoking worsens swelling in the upper airway, making apnoea (and snoring) worse.
Smokers are three times more likely to have OSA than lifelong non-smokers.
Weight loss – For anyone who is overweight, losing weight is the most important action you can take to overcome OSA. Unfortunately, having poor sleep due to sleep apnea can make weight loss more difficult.
While shedding kilos may not necessarily remedy the OSA, it usually improves both it and snoring. Aim to lose about 10 percent of your body weight to make a difference.
In addition to the usual approaches for losing weight, there are adaptogen herbs which can help make the process easier. They include maca, ginseng and rhodiola.
Regular exercise is a prescription for good sleep. Aim for at least 30 minutes of moderate activity, such as brisk walking, most days of the week. If you can squeeze in weight training as well, this is even better.
Sleep on your side! In many people with apnoea, it occurs only when sleeping on the back because of the effects of gravity on the tongue. You can prop yourself on your side with pillows, or a much simpler trick is to sew a pocket onto the middle of the back of your pyjama top and stuff into it a sock or tennis ball. You will then most certainly prefer to be on your side!
People with OSA tend to have ‘dream deficit’ sleep, that is, they don’t have adequate rapid-eye-movement sleep during which dreaming occurs – which is very important. A couple of herbs that promote sound sleep, including the beneficial REM sleep are valerian and passionflower. Chamomile can help but should not be used on an ongoing basis.
For people with mild OSA and very few symptoms, all that may be needed is losing weight, decreasing alcohol consumption and adjusting the sleeping position.
However, people with moderate or severe OSA will often require more specific treatment. The most common techniques are CPAP machine or an oral device. These are described by the National Sleep Foundation (of the USA) – https://www.sleephealthfoundation.org.au/obstructive-sleep-apnea.html.
CPAP machine. For serious sleep apnoea, the standard and very effective treatment is to use a device which pumps air into the lungs and prevents the airway from closing. This is called Continuous Positive Airway Pressure (CPAP). An air compressor delivers air to the airways via a mask worn over the mouth and nose during sleep. The pressure is gentle, but enough to keep the airway open, allowing the person to sleep and breathe normally. A CPAP machine can be rented for a trial period or purchased outright, though they are costly.
Alternatively, there are mouth devices designed to keep the airway open during sleep. Two common ones are:
Dental appliances which push your lower jaw forwards so that your throat opens up, reducing the risk that it will snore or obstruct. The appliances may be called Mandibular Advancement Splints (MAS) or Mandibular Advancement Devices (MAD) or Mandibular Repositioning Appliances (MRA). Before deciding on one of these, consult a ‘sleep’ doctor, who will then refer you to a trained dentist. These are not always effective.
Oral Pressure Therapy. OPT is a proprietorial treatment which does not involve a mask. A mouthpiece is fitted with tubing and a small vacuum console. During sleep, the light vacuum repositions the tongue and soft palate and keeps the airway open. These are available in Australia.
Surgery is considered to be a last resort. It may be appropriate if there is tissue partly blocking some part of the nose or throat, such as nasal polyps, abnormal nasal septum bones or malformations of the jaw or upper palate. Whether surgery is called for may require the guidance of an ear, nose and throat surgeon.
There are professionals who can guide you in dealing with OSA, and it could be well worth the effort to find one and have their advice.
Since you are in the Penrith district, I have been advised that at Nepean Hospital there is a Dr Monica Comsa, who has a special interest in devices for OSA, but has no vested interest in any of them.
There is a bottom line
If you can overcome OSA with diet and exercise, this is the most satisfactory way.