functional medicine doctor talking about sleep apnea

Beyond CPAP: Functional Medicine for Sleep Apnea

Sleep apnea is a complex disorder and it could have at the root, issues we never thought could be related, such as the metabolic syndrome. The good news is that in your journey to diminish and heal your sleep apnea, your general health will improve as well. 

The Root Cause of Obstructive Sleep Apnea (OSA): Local & Systemic Inflammation

At the root of sleep apnea there is a certain degree of inflammation, either local or systemic. Inflammation may be caused by food and/or environmental allergies, metabolic syndrome and all that it entails, and possible chronic bacterial, fungal or viral infections.  

Conditions associated with Obstructive Sleep Apnea

Snoring is commonly associated with Obstructive Sleep Apnea, however not all people who snore actually have sleep apnea. A 2014 study from Northumbria University and Newcastle University, the Centre for Sleep Research, indicated that snoring is not a simple matter and may be an early sign to look at other disorders that may be developing such as cardiometabolic syndrome, daytime sleepiness, and Upper Airway Resistance Syndrome which eventually may lead to sleep apnea (Deary, Ellis, Wilson, Coulter & Barclay, 2014). This study shows how treating the snoring may be a proactive way to look at sleep apnea prevention. 

Metabolic Sydrome is strongly linked to Obstructive Sleep Apnea

OSA is oftentimes common in people who are overweight or obese. Many patients though, are perfectly fit, but still suffer of sleep apnea. If you are indeed overweight, working on losing weight can make a significant difference. If you are struggling with losing weight, assessing for insulin resistance, possible thyroid problems, and food sensitivities can help speed up the process.

A study done in France and published in the Journal of Clinical Endocrinology & Metabolism (2010) showed that, for some people, solving thyroid problems or losing weight can reduce sleep apnea, or in more rare cases even cure it. 

In another study, published in the Diabetes Care called “Abdominal Fat and Sleep Apnea: the Chicken or the Egg?”, it is suggested that metabolic syndrome and sleep apnea are closely related, with one affecting the other (Pillar & Shehadeh, 2008). 

In the Journal of Clinical Endocrinology & Metabolism (2001) study, it is stated that sleep apnea may be a manifestation of endocrine and insulin resistance. This study suggests an association between Polycystic Ovary Syndrome (PCOS), sleep apnea and daytime sleepiness. This brings up the fact that hormones are also associated with changes in body weight and sleep apnea. 

The importance of understading multi approach treatments

It is of crucial importance to address the root cause of sleep apnea that presents with metabolic syndrome since research shows that the use of the CPAP machine alone, only improves some of the cardiovascular markers, such as decreased high blood pressure (Seetho et al, 2015).

For example, dyslipidaemia has been linked to OSA. A study published in the European Respiratory Journal, shows that the use of CPAP machine does not decrease the lipid numbers in a study done over 2 years (Keenan et al., 2014).

Obviously, a more holistic approach is recommended, that can improve both lipid numbers and the sleep apnea. 

Opiod use and sleep apnea

Opioid use can also be problematic in OSA. Research shows a clear correlations between opioid use and sleep disordered breathing (Ryswyk & Antic, 2016). Interesting to note is that opioid use mostly leads to Central Sleep Apnea (CSA) rather than OSA. CSA is less common than OSA, but unfortunately, it often manifests together with OSA. In CSA the brain fails to give proper signals to the muscles that control breathing, though the symptoms a person is experiencing are very similar to OSA.

Gastroesophageal reflux disease strongly linked to Obstructive Sleep Apnea

Another syndrome that is oftentimes seen in combination with OSA is gastroesophageal reflux disease (GERD). Patients report that if they eat too close to bedtime they certainly notice an aggravation in their OSA symptoms.

A study done in 2018 shows a direct correlation between the two, especially in men and aging adults (Meiling,  Ying., Li, Hong  & Yonggang, 2018).

Furthermore, allergic rhinitis is associated with gastrointestinal disorders including GERD, and as we discussed above, then inflamed air passageway obstructs the breathing even more (Ho, Lin & Ku, 2019). 

Watch the alcohol

Alcohol consumption may also contribute to sleep apnea since the it tends to relax too much the tongue muscle. A system review and meta analysis suggests that higher alcohol consumption may increase the risk of sleep apnea by 20% (Simou, Britton & Leonardi-Bee, 2018).

Nutritional deficiencies associated with sleep apnea

Nutritional deficiency can be either be the partial cause of sleep apnea or they can result from the effects of sleep apnea.

Addressing this deficiencies will help people both prevent the progression of sleep apnea and decrease the severity of it.

Some of these nutritional deficiencies need to be properly assessed for or tested to make sure supplementation is indeed advised. 

The beneficial N-acetylcysteine (NAC)

N-acetylcysteine (NAC) is a possible option to help with OSA according to a small study (Sadasivam, Patial, Vijayan et al., 2011).

The apnea-hypopnea index and apnea arousal decreased significantly, along with oxygen desaturation per hour.

NAC is a safe supplement that may help lipid peroxidation and glutathione levels. The glutathione helps with the oxidative stress caused by sleep apnea. 

Vitamin D supplementation helpful in sleep apnea

In a study published by the Journal of Endocrinological Investigation, Vitamin D level were found to decrease in direct proportion of the increased severity of sleep apnea (Mete et al., 2013).

In addition, another study looks at the Vitamin D low levels in combination with increased parathyroid hormone levels and their association with increased risk of metabolic syndrome and sleep apnea (Barcelo et al., 2013). 

Complex disease with complex implications

Other factors that help with the oxidative stress caused by sleep apnea are copper, selenium, vitamins C and A, and zinc. In addition, high doses of thiamine, coenzyme Q, vitamins E and C, and carnitine were shown to decrease OSA in an adult with Leigh disease (Mermigkis et al., 2013). 

The good old Elimination Diet Plan

Lastly, since food sensitivities and allergies are related to rhinitis, GERD and overall inflammation, an elimination diet done over a month is recommended to assess if any of the foods are contributing to local and systemic inflammation. 

We explored how acupuncture can help obstructive sleep apnea, check out the first part of this article, Beyond CPAP: Natural Treatments for Obstructive Sleep Apnea.

Next steps...

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