Introduction:

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

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.

Many physical conditions, such as obesity, or large tonsils and adenoids, can cause sleep apnea. The condition is also linked to medical conditions, such as high blood pressure and diabetes. The typical person with sleep apnea is an overweight, middle-aged man with allergies. But apnea can occur at any age, and in women as well. 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 with sleep apnea often seek medical help because they feel tired all the time or because their partner complains they snore loudly. Your health care provider will check your weight and blood pressure and ask about allergies. You may receive a device to check your oxygen levels while you sleep. Your health care provider 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 a patient's airway.

Treatment Options:

Treatment depends on the cause of the obstruction, the severity of the apneas, and other conditions or medical problems you may have.

• The most effective treatment is continuous positive airway pressure (CPAP). CPAP uses a machine and mask to blow air through the airway to keep it open.
• Most drugs have some undesirable side effects.
• Wearing certain dental appliances may help by pushing the lower jaw forward, keeping the tongue from obstructing the airway, or a combination of both. These may be uncomfortable at first.
• Surgery may be necessary, but your health care provider will most likely recommend that you try devices or drugs first.

The following lifestyle changes may help obstructive apnea:

• Lose weight. Often this will cause obstructive apnea to go away completely.
• Minimize 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 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 some manufacturers tout supplements for weight loss, none of these products have been proven to be as effective 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.
• Essential fatty acids (EFAs) moderate inflammatory response and decrease allergic response. EFAs are low in obese people. Fish oil, evening primrose oil, flaxseed oil, and borage oil all contains essential fatty acids. Essential fatty acid supplements can increase the effect of certain blood-thinning medications.
• 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

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 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 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'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.

Patients who have had a stroke and who have obstructive sleep apnea have an increased risk of early death.