Sleep apnea

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Signs and Symptoms
What Causes It?
What to Expect at Your Doctor's Office
Treatment Options
Following Up
Special Considerations
Supporting Research

People with sleep apnea stop breathing for short periods of time while they are asleep. They usually don't wake up completely when this happens. But in the morning, they feel exhausted and continue to feel sleepy during the day.

There are two types of sleep apnea. Obstructive sleep apnea is the most common. It happens when your throat muscles relax, blocking your airway. The other type, central sleep apnea, is caused when your brain doesn't send the right signals to the muscles that control your breathing. Some people have a combination of the two types, called complex sleep apnea.

Sleep apnea is a potentially serious condition and should be treated.

Signs and Symptoms

Symptoms of sleep apnea include:

  • Loud, irregular snoring, then quiet periods of at least 10 seconds when breathing stops. These episodes can happen up to 100 times each hour.
  • Daytime sleepiness and always feeling tired.
  • Morning headaches, sore throat, dry mouth, or cough.
  • Feeling depressed, moody, or irritable.
  • Not being able to concentrate or remember things.
  • Possible impotence or high blood pressure.

What Causes It?

Sleep apnea is caused by:

  • A blocked upper airway (obstructive apnea)
  • Your brain not signaling your lungs to breathe while you sleep (central apnea)
  • A combination of obstructive and central apnea

Sleep apnea is also linked to:

  • Being overweight
  • Having large tonsils and adenoids
  • High blood pressure
  • Diabetes
  • Smoking
  • Alcohol use, especially before bed
  • Drugs, such as sleeping pills or heart medications

The typical person with sleep apnea is an overweight, middle-aged man with allergies. But apnea can happen at any age, and in women as well. It can also be inherited.

What to Expect at Your Doctor's Office

People with sleep apnea often go to the doctor because they feel tired all the time or because their partner complains about their snoring. Your doctor will check your weight and blood pressure and ask about allergies. You may get a device to check your oxygen levels while you sleep. Your doctor may also refer you to a sleep clinic for overnight testing. Sometimes, your doctor may request X-rays, computed tomography scans (CTs), or magnetic resonance imaging scans (MRIs) to see what may be blocking your airway.

Treatment Options

Treatment depends on:

  • What is blocking your airway
  • How severe your sleep apnea is
  • Other conditions or medical problems you may have

The most effective treatment is continuous positive airway pressure (CPAP). CPAP treatment includes that use of a machine and mask to blow air through your airway to keep it open. Studies show CPAP also reduces arterial stiffness.

Wearing some dental appliances may help by pushing the lower jaw forward, keeping the tongue from blocking the airway, or a combination of both. These may be uncomfortable until you get used to them.

In severe cases, surgery may be needed. But most often, sleep apnea can be managed with CPAP and lifestyle changes.

Lifestyle changes that may help obstructive apnea include:

  • Losing weight. This may cause your sleep apnea to go away entirely.
  • Limiting your use of alcohol, antihistamines, or tranquilizers.
  • Getting treatment for allergies, colds, or sinus problems.
  • Gargling with salt water (without swallowing) to shrink your tonsils.
  • Developing regular sleep habits, and making sure you get enough sleep at night.
  • Sleeping on your side rather than your back, or with your body elevated from the waist up. You can use foam wedges to raise your upper body. Don't use soft pillows, which tend to make apnea worse by pushing the chin toward the chest.
  • Using an air humidifier at night.
  • Not smoking and not exposing yourself to other irritants, such as dust or perfumes.
  • Raising the head of your bed by placing bricks under the headboard.
  • Exercising. Studies show regular exercise is associated with a lower risk of sleep apnea. Exercise also reduces sleepiness and improves quality of life among people who have the disorder.

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 and medications used to treat obstructive apnea.

Central apnea may be treated with medicines including acetazolamide and clomipramine (Anafranil). Side effects of clomipramine may include impotence.

Obstructive apnea may be treated with modafinil (Provigil), which is sometimes prescribed in combination with CPAP to treat excessive daytime sleepiness.

Complementary and Alternative Therapies

Sleep apnea is a potentially dangerous condition that needs to be evaluated and treated with conventional medicine. Complementary and alternative therapies (CAM) may be helpful when used in addition to medical treatment. But all CAM therapies should be coordinated with your medical doctor. Alternative therapies may help treat sleep apnea caused by allergies. Homeopathy and nutrition are most likely to have a positive effect. While some manufacturers promote supplements for weight loss, none of these products have been proven to work as well as eating less and exercising more.

Nutrition and Supplements

  • Diet -- Try eliminating mucus-producing foods (such as bananas) for 2 weeks, then reintroducing them to see if you notice any difference in sleepiness or other symptoms.
  • To lose weight, eat lots of fresh fruits and vegetables, along with whole grains and low-fat dairy. Limit the amount of saturated fat (found in meats, butter, and processed foods) you consume and use healthier fats like olive oil instead.
  • Chromium -- Chromium or chromium picolonate is a popular supplement among bodybuilders, and those trying to lose weight and build more lean muscle mass. However, results from scientific studies have been mixed, and its effects are small compared to those of exercise and a well-balanced diet. Chromium may improve blood sugar, which is also a risk factor for heart disease, especially in people with diabetes and glucose intolerance. However, you shouldn't take chromium to lower blood sugar without your doctor's supervision. People with psychiatric disorders should be closely monitored by their doctors when using chromium supplements. People with a history of liver disease should avoid chromium supplements. In addition, large doses of chromium may cause kidney damage.
  • Regular exercise will also help you lose weight. If you are not used to exercising, start slowly and build up to about 30 minutes of exercise a day, at least 5 days a week. An ideal exercise program includes aerobic activity (walking, swimming, biking), strength training (lifting weights), and flexibility (stretching). If you are obese, or have other medical problems, talk to your doctor before starting a new exercise program.

Homeopathy

Few studies have examined 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 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 may also help people who are 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 their sleep disorders.
  • 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 who 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 is crucial to stick with your treatment plan. If you are using a mask and ventilator equipment, be sure to take care of them. If they are uncomfortable, talk to your doctor so they can be adjusted. If you have sleep apnea, you may have an increased risk of peptic ulcer bleeding. Talk to your doctor.

Keep in contact with your doctor 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. However, this is not the same as sleep apnea. If you have apnea and become pregnant, be sure to continue your treatment so that your condition will not affect your baby.

People who have had a stroke and who have obstructive sleep apnea have a higher risk of early death.

Supporting Research

Abad VC, Guilleminault C. Treatment options for obstructive sleep apnea. Curr Treat Options Neurol. 2009 Sep;11(5):358-67.

Ackel-D'Elia C, et al. Effects of exercise training associated with continuous positive airway pressure treatment in patients with obstructive sleep apnea syndrome. Sleep Breath. 2012;16(3):723-35.

Asha'ari ZA, Hasmoni MH, Ab R, Yusof RA, Ahmad RA. The association between sleep apnea and young adults with hypertension. Laryngoscope. 2012;122(10):2337-42.

Awad K, Malhorta A, Barnet J, Quan S, Peppard P. Exercise is associated with a reduced incidence of sleep-disordered breathing. The Amer J of Med. 2012;125(5).

Bope & Kellerman: Conn's Current Therapy 2014, 1st ed. St. Louis, MO: Saunders, 2013.

Buchner NJ, Quack I, Stegbauer J, Woznowski M, Kaufmann A, Rump LC. Treatment of sleep apnea reduces arterial stiffness. Sleep Breath. 2012;16(1):123-33.

Chasens ER. Obstructive sleep apnea, daytime sleepiness, and type 2 diabetes. Diabetes Educ. 2007;33(3):475-82.

Dahlqvist J, Dahlqvist A, Marklund M, Berggren D, Stenlund H, Franklin KA. Physical findings in the upper airways related to obstructive sleep apnea in men and women. Acta Otolaryngol. 2007;127(6):623-30.

Dieltjens M, Vanderveken O, Van de Heyning P, Braem M. Current opinions and clinical practice in the titration of oral appliances in the treatment of sleep-disordered breathing. Sleep Medicine Reviews. 2012;16(2).

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.

Freire AO, Sugai GC, Togeiro SM, Mello LE, Tufik S. Immediate effect of acupuncture on the sleep pattern of patients with obstructive sleep apnoea. Acupunct Med. 2010 Sep;28(3):115-9.

Grotz W, Buchner N, Wessendorf T, Teschler H, Grote L, Becker HF, Rump LC. Sleep apnea -- treatment improves hypertension. Med Klin. 2006;101(11)880-5.

Hein H. The sleep apnoea syndromes: alternative therapies. Pneumologie. 2004;58(5):325-9.

Ioachimescu O, collop N. Sleep-Disordered Breathing. Neurologic Clinics. 2012;30(4).

Sahlin C, Sandberg O, Gustafson Y, Bucht G, Carlberg B, Stenlund H, Franklin KA. Obstructive sleep apnea is a risk factor for death in patients with stroke: a 10-year follow-up. Arch Intern Med. 2008;168(3):297-301.

Sengul YS, Ozalevli S, Oztura I, Itil O, Baklan B. The effect of exercise on obstructive sleep apnea: a randomized and controlled trial. Sleep Breath. 2009 Nov 7.

Shah NA, Yaggi HK, Concato J, Mohsenin V. Obstructive sleep apnea as a risk factor for coronary events or cardiovascular death. Sleep Breath. 2009 Sep 24.

Shiao TH, et al. Sleep apnea and risk of peptic ulcer bleeding: a nationwide population-based study. Am J Med. 2013;126(3):249-55,255.e1.

Valentino RM, Foldvary-Schaefer N. Modafinil in the treatment of excessive daytime sleepiness. Cleve Clin J Med. 2007 Aug;74(8):561-6, 568-71. Review

Veasey SC, Guilleminault C, Strohl KP, Sanders MH, Ballard RD, Magalang UJ. Medical therapy for obstructive sleep apnea: a review by the Medical Therapy for Obstructive Sleep Apnea Task Force of the Standards of Practice Committee of the American Academy of Sleep Medicine. Sleep. 2006;29(8):1036-44.

Vozoris NT. Sleep apnea-plus: prevalence, risk factors, and association with cardiovascular diseases using United States population-level data. Sleep Med. 2012;13(6):637-44.

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.

Weaver TE, et al. Continuous positive airway pressure treatment of sleepy patients with milder obstructive sleep apnea: results of the CPAP Apnea Trial North America Program (CATNAP) randomized clinical trial. Am J Respir Crit Care Med. 2012;186(7):677-83.

Review Date: 4/10/2014
Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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