Winter 2012 True Natural Health Magazine – Your Questions Answered
By Roger French
QUESTION: Can you tell me what causes sleep apnoea and what can be done about it? Is it life threatening? Can it be treated without drugs?
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 Greek word, apnoea, means ‘want to breathe’.
Sleep apnoea typically affects 2% to 4% of middle-aged adults, and more men than women. 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.
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 disturbances to sleep 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, not surprisingly, 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 and 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 too much. The cessation of breathing sounds warning bells in the brain which causes the sleeper to wake and resume breathing.
CSA is more common in older people, possibly affecting one in every four people over 60 years of age.
Heart Disease and Stroke
The greatest concern with sleep apnoea is heart trouble or stroke – which, fortunately, does not occur in many cases.
A sleep laboratory in Gothenburg, Sweden, completed a seven-year study in 1998 and found that in sufferers of sleep apnoea who were not effectively treated, the cardiovascular disease incidence was 57%. In contrast, in those who were effectively treated, the incidence was just under 7%.
A study at the University of Toronto also in 1998 found that a widely used device to maintain pressure in the airways – a ‘CPAP’ machine – significantly reduces the risk of heart failure and heart disease. These machines are now widely used.
Re high blood pressure, a study at Johns Hopkins University, Baltimore, in 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.
After discussing the symptoms with a doctor, it might 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.
Things you can do to improve or overcome sleep apnoea:
- Losing weight can in some cases correct even severe sleep apnoea.
- If the person smokes, quit. Smoking is believed to increase fluid retention in the upper airway.
- Muscle tone is excessively reduced by alcohol, sleeping pills and tranquillisers, so taking these near bedtime is asking for trouble. Avoid alcohol within at least two to three hours of bedtime, and avoid sleeping pills altogether. How to overcome insomnia without pills was described in the Winter 2009 issue of our magazine, then titled Natural Health and Vegetarian Life.
- Avoid caffeine and heavy meals within at least two hours of bedtime.
- Sleeping regular hours will help relaxation and promote better sleep. Adequate sleep tends to decrease apnoea episodes.
- Talk to a sleep doctor about ways to help keep the nasal passages open at night.
Sleep on your side! In many people with apnoea, it occurs only when sleeping on the back. You can prop yourself on your side with pillows, or 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 sleep on one side or the other!
Some improvement may be obtained by elevating the head of the bed by 10 to 15 centimetres, or by raising the body from the waist up using a foam wedge.
People with sleep apnoea tend to have ‘dream deficit’ sleep, that is, they don’t have adequate rapid-eye-movement sleep, which is very important to have. A couple of herbs that promote sound sleep, including REM sleep, are valerian and passionflower. Chamomile can help but should not be used on an ongoing basis.
If drugs are being taken, check with the doctor to make sure they will not affect sleep and breathing.
For serious sleep apnoea, the standard, effective treatment is to use a Continuous Positive Airway Pressure (CPAP) machine. 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 and purchased for ongoing use.
If you’ve tried a sleep apnoea machine, but given it up because of discomfort, be aware that CPAP devices are constantly being improved; they are now lighter, quieter and more comfortable. Many CPAP devices now come with a built-in humidifier, which decreases dryness and skin irritation.
Alternatively, there are mouth devices designed to keep the airway open during sleep. One of these is Provent Therapy. This employs a single-use, disposable device which allows a normal inspiratory breath, but restricts the speed of the expiratory breath. The backpressure created generates substantial pressure in the airway, making the airway less likely to collapse before the next inspiratory breath.
Other devices make the lower jaw protrude, but with long-term use, there is a risk of jawbone dysfunction.
Surgery can be used to correct physical abnormalities such as nasal polyps, abnormal nasal septum bones or malformations of the jaw or upper palate. Doctors would probably recommend removal of enlarged tonsils or adenoids, but in Natural Health we would suggest using cleansing diets to facilitate self-healing. Dr Grunstein explains that surgery rarely cures severe forms of sleep apnoea in adults.