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Snoring, Sleep Apnea and other breathing related sleep disorders affect millions of Americans.
Symptoms of sleep disordered breathing include
snoring ,nocturnal choking episodes, apnea, night sweats, daytime sleepiness, chronic tiredness, headaches, sexual dysfunction, anxiety and/or depression, irritable and aggressive behavior, memory problems, difficulty concentrating, reflux.
The term apnea is used to describe a pause in breathing of 10 or more seconds. The stoppage of breathing can last anywhere from 10 to 30 seconds per incident – up to 400 seconds over the course of a single night with multiple occurrences. The criteria for being diagnosed with sleep apnea is an average of 10 apneic episodes over the course of an hour of sleep.
Apnea occurs due to abnormal ventilatory drive or upper airway resistance or obstruction. Snoring is associated with hyperventilation, nasal obstruction, upper airway narrowing and vibration.
There are three types of sleep apnea – obstructive, central and mixed. Of the three, obstructive sleep apnea (OSA) is by far the most widespread. OSA can be mild, moderate or severe. And because it is a progressive condition, the severity can worsen over time.
Approximately 6 million Americans suffer from moderate to severe sleep apnea – sometimes requiring a late-night emergency room visit. 24% of men suffer from sleep apnea of some form while only 9% of women do. Women are far more likely to suffer from sleep apnea after going through menopause. After menopause, the percentage is roughly the same as it is for men.
Estimates are that 50% of those who suffer from sleep apnea also have a snoring problem. According to the National Commission on Sleep Disorders Research, roughly 38,000 cardiovascular deaths annually are in some way related to sleep apnea. The links include high blood pressure, hypertension and stroke.
Why apnea occurs
In conventional medicine sleep apnea is still misunderstood for a large part.
According to Professor Buteyko’s theory , hyperventilation is considered to be the fundamental cause of OSA. He argues that apneas or pauses in breathing are the body’s defense mechanism against the excessive loss of carbon dioxide due to hyperventilation and consequent hypoxia (lack of oxygen).
Buteyko, Naughton and Javaheri* have shown that sleep apnea happens subsequent to over-breathing. Heavy breathing and snoring is associated with a drop in airway carbon dioxide levels. If the CO2 concentration goes below a critical level, the “apneic threshold”, apnea occurs. Breathing stops temporarily due to this dangerous imbalance in blood gases. In some cases this is accompanied by collapsing of the airway. These processes allow the CO2 levels to return to normal. Then breathing recommences usually with a snort, sigh or sharp intake of breath. Both the lack of oxygen during the apnea and the inhibition of oxygenation during the hyperventilation, (Bohr effect) can lead to hypoxia. Prolonged periods of hyperventilation may result in severe tiredness and exhaustion and can lead to temporary paralysis of muscles in different parts of the body, including throat musculature. Poorly oxygenated tissues lack tone.
1. Naughton M et al
University School of Medicine. Postgraduate Medicine Volume 53.
3. Javaheri S, Corbett WS. Assoc. Effect of continuous positive airway pressure on central sleep apnea and nocturnal PCO2 in heart failure.
American Journal of Respiratory Care Medicine 1994; 1509-1604
2. Lewis, B I. 1959. Stanford iation of low PaCO2 with central sleep apnea and ventricular arrhythmia in ambulatory patients with stable heart failure. Ann Intern Med 1998 Feb1;128(3):204-207
1. CPAP machine – the application of continuous positive airway pressure during sleep. CPAP is effective in preventing the episodes of apnea. However some people may find it uncomfortable, and wearing a mask while sleeping is inconvenient. Some find the noise of the machine disturbing and complications of CPAP may include nasal congestion, runny nose, dry mouth, air swallowing and flatulence. The machine is to be used in bed every night, as it has no “curative” action on the snoring and apnea.
2. Sometimes surgery will be suggested. This involves pharyngeal soft tissue reduction and /or stiffening of the soft palate. Tracheotomy, which requires the surgical insertion of a tube into the trachea, may be suggested for people with very severe symptoms.
3. Dental appliances may be suggested
4. Breathing retraining – this option aims to correct the faulty breathing pattern that is typical for people with snoring and apnea.
The research by Naughton (see ref. in Why apnea occurs section above) shows that the mechanism by which CPAP improves apnea is by raising the pressure in the airways, which reduces the breathing volume (reduces hyperventilation) and increases the CO2 level above the threshold for apnea and keeps it there whilst the machine is applied.
The Buteyko breathing technique aims to teach you to do this for yourself by correcting the hyperventilation breathing pattern that is associated with snoring and apnea. You retrain your breathing when you are awake, reducing your breathing volume, increasing the airway CO2 towards normal, which can prevent apnea and results in quieter breathing. Oxygenation is improved. Practice of the breathing exercises can effect a resetting of the automatic respiratory drive to the correct rate. This carries over into the sleep stage.
By using the Buteyko exercises, people commonly report reduced nasal blockage, snoring and sleep apnea within a few days. Weight normalization is commonly experienced. Improved oxygenation reduces fatigue and daytime drowsiness. The cardiovascular system benefits. Improvements in exercise capacity and resting and performance heart rate are reported. Heart rate recovery post exercise is enhanced.
(*Large part of this article is quoted from Sleep Disordered Breathing by Tess Graham BSc Grad Dip Phty. Dip.BM)
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