HEALTH GUIDE REFERENCE FROM A.D.A.M

People with sleep apnea stop breathing for short periods of time while they are asleep. You generally don't wake up fully when this happens, but in the morning you don't feel rested, and you feel sleepy during the day. Sleep apnea can be caused by a blocked upper airway (called obstructive apnea), by your brain not signaling your lungs to breathe (central apnea), or by a combination of these two problems. Obstructive sleep apnea is the most common form.


Signs and Symptoms

The symptoms of sleep apnea include the following.

  • Loud, irregular snoring, then quiet periods of at least 10 seconds when breathing stops. These episodes can happen up to 100 times or more each hour.
  • Daytime sleepiness, always feeling tired
  • Morning headaches, sore throat, dry mouth, cough
  • Feeling depressed, moody, irritable
  • Unable to concentrate or remember
  • Possible impotence or high blood pressure


What Causes It?

Many physical conditions (such as obesity, or large tonsils and adenoids) can cause sleep apnea. The typical person with sleep apnea is an overweight, middle-aged man who has allergies, but apnea can occur at any age and in women as well as men. Sometimes drugs such as alcohol, sleeping pills, or heart medications can trigger apnea. It can also be inherited.


What to Expect at Your Provider's Office

People who have sleep apnea often seek medical help because they feel tired all the time or because their partner complains of loud snoring. Your health care provider will check your weight and blood pressure and ask about allergies. Your healthy care provider may send you home with a device to check your oxygen levels while you sleep. They may also refer you to a sleep clinic for overnight testing.


Treatment Options

  • The most effective treatment is called Continuous Positive Airway Pressure (CPAP), which uses a machine and mask to blow air through the airway at a pressure high enough to make sure the airway stays open.
  • A few drugs hold promise, but most have some undesirable side effects.
  • Some dental appliances, worn in your mouth, are available. They work by pushing the lower jaw forward, by keeping the tongue from obstructing the airway, or by a combination of both. These may be uncomfortable at first.
  • Sometimes surgery is needed, but your health care provider will most likely recommend that you try devices or drugs first.

Making the following lifestyle changes can help obstructive apnea:

  • Lose weight. Often this will cause obstructive apnea to go away completely.
  • Minimize your use of alcohol, antihistamines, or tranquilizers.
  • Get treatment for allergies and colds or sinus problems.
  • Gargle with salt water (without swallowing) to shrink your tonsils.
  • Develop regular sleep habits, and especially make sure you get enough sleep at night.
  • Sleep on your side rather than on your back or with your body elevated from the waist up. You can use foam wedges (rather than soft pillows, which tend to make apnea worse by pushing the chin toward the chest) to raise your upper body.
  • Use an air humidifier at night.
  • Don't smoke or expose yourself to other irritants (such as dust or perfumes).
  • Raise the head of your bed by placing bricks under the headboard.

Drug Therapies

There is no drug that completely treats sleep apnea. Some of the drugs used in combination with CPAP include:

Medications used to treat central apnea:

  • Acetazolamide
  • Clomipramine -- side effects may include impotence

Medications used to treat obstructive apnea:

  • Medroxyprogesterone -- side effects may include nausea, depression, excess hair growth, breast tenderness, and fluid retention.
  • Protriptyline -- this medication is used rarely. Side effects may include dry mouth, constipation, frequent urination, impotence, and confusion (in the elderly).
  • Modafinil -- sometimes prescribed in combination with CPAP to treat excessive daytime sleepiness.

Complementary and Alternative Therapies

Alternative therapies may be useful in treating sleep apnea caused by allergies. Homeopathy and nutrition are most likely to have a positive effect. While many supplements are touted as good for weight loss, none have proved to be as effective as eating less and exercising more.

Nutrition and Supplements
  • Diet: Try eliminating mucus-producing foods (dairy and bananas) for 2 weeks, then reintroducing them and noticing any difference.
  • Essential fatty acids (EFAs) moderate inflammatory response and decrease allergic response. EFAs are found to be low in obese people. Fish oil, evening primrose oil, flaxseed oil, and borage oil all contains essential fatty acids.
  • Chromium helps regulate insulin and decrease insulin resistance. Chromium may not be effective at burning fat, but it is effective at stabilizing blood sugar and decreasing sugar cravings. The adequate intake is 45 mcg per day. Studies suggest amounts of 200 mcg per day for up to 6 months are safe. Do not take chromium if you are pregnant. If you have diabetes, do not take chromium without your doctor's supervision.
Homeopathy

There have been few studies examining the effectiveness of specific homeopathic remedies, though it may be helpful as a supportive therapy. Professional homeopaths, however, may recommend one or more of the following treatments for sleep apnea based on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your constitution is his or her physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.

  • Arsenicum album -- for respiratory disorders that worsen at night and are accompanied by fear, agitation, restlessness, weakness, and exhaustion.
  • Lachesis -- for conditions that get worse while trying to sleep. This remedy is most appropriate for those who are intense, talkative, jealous, and may feel depressed (particularly in the morning). It is may help people who may be frightened of going to sleep.
  • Opium -- this remedy may be prescribed for individuals with sleep apnea and narcolepsy (inability to control falling asleep during the daytime). This remedy is appropriate for individuals who may be somewhat confused due to the sleep disorder.
  • Sambucus -- for difficulty breathing at night. This remedy is most appropriate for individuals who may have nasal obstruction or asthma and actually jump up out of bed with a feeling of suffocation.
  • Spongia -- for respiratory symptoms that are worsened by cold air and lying down. This remedy is appropriate for individuals often feel a tightness in the chest area.
  • Sulphur -- for chronic conditions accompanied by sleep disturbances and nightmares, especially if the individual also has skin rashes that become worse with heat. This remedy is most appropriate for individuals who prefer cold temperatures and strongly dislike any kind of restriction.
Acupuncture

Some evidence suggests that a type of acupuncture called auriculotherapy acupoint pressure may help treat sleep apnea.


Following Up

Sleep apnea is a serious condition that can cause fatal heart problems, so it's crucial to stick with your treatment plan. If you are using a mask and ventilator equipment, be sure to take care of them. Keep in contact with your health care provider or sleep clinic to make sure your treatment is working.


Special Considerations

If you are pregnant, you may have nasal congestion that makes you snore in a way that people with apnea do, but this is not apnea. If you have apnea and become pregnant, be sure to continue your treatment so that your condition will not affect your baby.


Supporting Research

Caldwell JP. Sleep: Everything You Need to Know. Buffalo, NY: Firefly Books; 1997.

Cummings S, Ullman D. Everybody's Guide to Homeopathic Medicines. 3rd ed. New York, NY: Penguin Putnam; 1997: 237-239, 306, 320-321, 331-332.

Faccenda JF, Mackay TW, Boon NA, et al. Randomized placebo-controlled trial of continuous positive airway pressure on blood pressure in the sleep apnea-hypopnea syndrome. Am J Respir Crit Care Med 2001;163(2):344-8

Flemons WW. Clinical practice: obstructive sleep apnea. N Engl J Med 2002;347(7):498-504

Jonas WB, Jacobs J. Healing with Homeopathy: The Doctors' Guide. New York, NY: Warner Books; 1996: 260-264.

Morrison R. Desktop Guide to Keynotes and Confirmatory Symptoms. Albany, Calif: Hahnemann Clinic Publishing; 1993.

Pascualy RA, Soest SW. Snoring and Sleep Apnea: Personal and Family Guide to Diagnosis and Treatment. 2nd ed. New York, NY: Demos Vermande; 1996.

Smolley LA, Bruce DF. Breathe Right Now: A Comprehensive Guide to Understanding and Treating the Most Common Breathing Disorders. New York, NY: WW Norton & Co; 1998.

Wang XH, Yuan YD, Wang BF. Clinical observation of effect of auricular acupoint pressing in treating sleep apnea syndrome. Zhongguo Zhong Xi Yi Jie He Za Zhi. 2003 Oct;23(10):747-9.