Restless sleep. Loud snoring. Daytime sleepiness. Fatigue. Poor concentration. These are a few of the primary symptoms of obstructive sleep apnoea 1. This sleep disorder is estimated to affect up to 30% of the Western adult population, however, less than 5% are diagnosed and treated 2. Secondary symptoms that may be seen with the primary symptoms include morning headaches, anxiety, high blood pressure, obesity and poor immunity 3.

 

What is obstructive sleep apnoea?

Obstructive sleep apnoea occurs when the muscles responsible for keeping the upper airway open during sleep narrow or collapse. This causes a decrease in oxygen and a corresponding increase in carbon dioxide in your blood, which in turn triggers the nervous system to rouse you from sleep so you start breathing again. These “apnoeas” (pause of breath) can occur between 5 (mild) – 100 (severe) times per hour. The repetitive loss of oxygen followed by re-oxygenation promotes the production of inflammatory molecules creating oxidative stress that reduces the ability of your blood vessels to dilate by up to 50% 3.

 

Oxidative stress from reactive oxygen species then creates an on-going feedback loop as they contribute to decreased tone in the upper airway muscles making them even more likely to collapse 4,5.

 

The constant arousal from sleep means that less restorative slow wave sleep state is achieved during the night and sufferers of this condition wake up feeling unrefreshed and constantly tired 1.

sleep apnea, sleep apnoea, disordered breathing, flow chart

Pathophysiology of sleep apnoea

Health consequences

Obstructive sleep apnoea has wide ranging impacts on health and quality of life affecting physical, emotional and cognitive functions.

 

The risk of cardiovascular disease is doubled. This is due to the inflammation and oxidative stress on the blood vessels creating an environment favourable to plaque accumulation in the arteries and making your blood more likely to clot. It is common for people with obstructive sleep apnoea to have hypertension 6,7.

 

The lack of restorative slow wave sleep results chronic sleep deprivation and excessive daytime sleepiness that can impact of an individual’s work and personal life 3.

 

Did you know? People who suffer from obstructive sleep apnoea are 4-9 times more likely to be involved in a motor vehicle accident 8.

 

The lack of slow wave sleep also has metabolic consequences. This is the period of sleep where your body regulates the release of hormones that control appetite. Individuals with obstructive sleep apnoea have been found to an imbalance between the satiety hormone, leptin and the hunger hormone, grehlin resulting in an up-regulated appetite that may contribute to and perpetuate weight gain and blood sugar dysregulation 9.

 

Slow wave sleep is also the most restorative part of sleep and missing out on this lowers your immunity 10.

 

Oxygen deprivation in obstructive sleep apnoea has also been found to adversely affect neurons in the hippocampus. This is the part of the brain responsible for transforming short term memories into long term memories 10.

 

Risk factors for obstructive sleep apnoea

  • Aging: more common in middle and old age
  • Male sex: obstructive sleep apnoea affects up to 25% of middle aged men compared to 9% of women
  • Genetic: you are 2-3 times more likely to suffer from this if there is a family history.
  • Overweight or obese
  • Thick neck circumference
  • Smoking: creates more oxidative stress and depletes antioxidants
  • Alcohol consumption: relaxes airway muscles
  • Use of sedatives as they also relax airway muscles

 

Did you know? Pre-menopausal women are less likely to suffer from obstructive sleep apnoea than men due to the stabilising effect of the hormone progesterone on the pharynx dilator muscle 11.

 

 

Treatment

The most widely used treatment is continuous positive airway pressure (CPAP). This involves wearing a face-mask attached to a small pump which provides constant pressure to keep the airways open.  While there is good evidence for the effectiveness of this treatment some people are constrained by the cost of the machine or dislike wearing the mask 2 .

CPAP machine, obstructive sleep apnoea, sleep disorders

 

The role of nutritional supplements

 

While nutritional therapy can’t keep the airways open it can reduce the dependency on CPAP especially in mild to moderate cases.

 

Anti-oxidant nutrients in various trials have been shown to be of benefit in reducing both the symptoms and consequences of obstructive sleep apnoea.

 

Vitamin C is probably one of the most well known and wide ranging antioxidants. It scavenges free radicals and reduces oxidative stress and inflammation. In, studies of obstructive sleep apnoea 500mg/day was found to reduce inflammation in the blood vessels and protect against cardiovascular disease 12.

 

Vitamin E has also shown benefits in obstructive sleep apnoea working on a similar fashion to Vitamin C and when combined these two antioxidants reduced snoring and daytime sleepiness 2,10.

 

N-acetylcysteine (NAC) is a building block for one of the body’s most powerful antioxidants, glutathione, which has the ability to reduce free radicals in the body 13. A small, 2011, double-blinded, randomised, placebo controlled study showed that 600mg of NAC given three times a day for 30 days provided numerous benefits. The treatment group in this study saw significant improvements in slow wave sleep, from 27% at baseline to 42% at the conclusion. Apnoea arousals halved, snoring reduced and 30% of participants were able to stop using CPAP entirely. These results are very promising and hopefully will be replicated in larger studies 2.

 

Lifestyle Tips

 

Recommendations

If you suspect you may be suffering from obstructive sleep apnoea:

  • Speak to your health care practitioner and arrange to get tested.
  • Consider CPAP especially if your obstructive sleep apnoea is severe.
  • In conjunction with a healthy diet and regular exercise, speak to your natural healthcare provider about adding in some antioxidant supplements that are appropriate for your individual circumstances.

 

If you enjoyed this you may also like:

Why sleep needs to be a part of your weight loss strategy

 

 

References:

  1. Eckert DJ, Malhotra A. Pathophysiology of adult obstructive sleep apnea. Proc Am Thorac Soc. 2008;5(2):144–53. doi:10.1513/pats.200707-114MG.
  2. Sadasivam K, Patial K, Vijayan VK, Ravi K. Anti-oxidant treatment in obstructive sleep apnoea syndrome. Indian J Chest Dis Allied Sci. 2011;53(3):153–62. Available at: http://medind.nic.in/iae/t11/i3/iaet11i3p153.pdf. Accessed January 10, 2016.
  3. Atkeson a, Jelic S. Mechanisms of endothelial dysfunction in obstructive sleep apnea. Vasc Health Risk Manag. 2008;4(6):1327–1335. Available at: papers://2e21e073-9ccd-431c-9795-22d005492126/Paper/p5516. Accessed January 12, 2016.
  4. Hatipoğlu U, Rubinstein I. Inflammation and obstructive sleep apnea syndrome pathogenesis: a working hypothesis. Respiration. 2004;70(6):665–71. doi:75218.
  5. Veasey SC, Zhan G, Fenik P, Pratico D. Long-Term Intermittent Hypoxia. Am J Respir Crit Care Med. 2004;170(6):665–672. doi:10.1164/rccm.200403-261OC.
  6. Lavie L, Vishnevsky A, Lavie P. Evidence for lipid peroxidation in obstructive sleep apnea. Sleep. 2004;27(1):123–8. Available at: http://www.ncbi.nlm.nih.gov/pubmed/14998248. Accessed January 10, 2016.
  7. Eisele H-J, Markart P, Schulz R. Obstructive Sleep Apnea, Oxidative Stress, and Cardiovascular Disease: Evidence from Human Studies. Oxid Med Cell Longev. 2015;2015:608438. doi:10.1155/2015/608438.
  8. Snore Australia. Obstructive Sleep Apnoea. 2016.
  9. Macrea M, Martin T, Zagrean L, Jia Z, Misra H. Role of leptin as antioxidant in obstructive sleep apnea: an in vitro study using electron paramagnetic resonance method. Sleep Breath. 2013;17(1):105–110. doi:10.1007/s11325-012-0656-8.
  10. Baldwin CM, Bootzin RR, Schwenke DC, Quan SF. Antioxidant nutrient intake and supplements as potential moderators of cognitive decline and cardiovascular disease in obstructive sleep apnea. Sleep Med Rev. 2005;9(6):459–476. doi:10.1016/j.smrv.2005.04.004.
  11. Andersen ML, Bittencourt LRA, Antunes IB, Tufik S. Effects of progesterone on sleep: a possible pharmacological treatment for sleep-breathing disorders? Curr Med Chem. 2006;13(29):3575–82. Available at: http://www.ncbi.nlm.nih.gov/pubmed/17168724. Accessed January 14, 2016.
  12. Grebe M, Eisele HJ, Weissmann N, et al. Antioxidant vitamin C improves endothelial function in obstructive sleep apnea. Am J Respir Crit Care Med. 2006;173(C):897–901. doi:10.1164/rccm.200508-1223OC.
  13. Gropper S, Smith J, Groff J. Advanced Nutrition and Human Metabolism. 5th ed. Canada: Wadsworth Cengage Learning; 2009.

Need help with your sleep apnoea?

Norelle Hentschel is an experienced naturopath with a clinic in Crows Nest, Sydney who enjoys supporting her clients to reach their health goals.

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