Beyond CPAP: Acupuncture and Functional Medicine as Holistic and Natural Treatments for Sleep Apnea
Sleep apnea is a serious sleep disorder that happens when a person’s breathing is repeatedly (up to hundreds of times) interrupted while sleeping. The concerns around sleep apnea are many.
Standard of care for sleep apnea - CPAP
Many of the patients are hesitant about the treatment options. Nobody seems to be excited about the prospect of sleeping with a mask on their face for the rest of their lives and compliance is not ideal unfortunately. The Continuous Positive Airway Pressure (CPAP) machine may not be an attractive option, but it is the standard treatment and life saving for many people (Spicuzza, Caruso, & Di Maria, 2015).
The CPAP machine treatment for sleep apnea is addressing the effects of sleep apnea but it doesn’t aim at looking at the root cause. The mandibular advancement device is another choice that can be successfully used to dramatically diminish the effects of the sleep apnea. Tongue and throat exercises can also be useful, usually in combination with another therapy.
Natural treatments for sleep apnea: acupuncture and functional medicine
We will be exploring two beneficial treatments for sleep apnea, acupuncture and functional medicine. Both acupuncture and functional medicine treatments are focused on supporting the healing process and decreasing inflammation in the body so the severity of the sleep apnea is reduced.
I have Obstructive Sleep Apnea, now what?
Obstructive Sleep Apnea (OSA) is the most common type of apnea with an estimated 14% and 49% of middle-aged men having clinically significant OSA (Garvey, Pengo, Drakatos & Kent, 2015). OSA is significantly lower in women, around 4%, possibly higher since many cases go undiagnosed (Kapur et al., 2017).
After a diagnosis has been given by a sleep medicine doctor based on either a home sleep apnea testing or in lab testing, acupuncture can be used as an adjunctive therapy to help decreases the severity of the sleep apnea index.
Acupuncture for Obstructive Sleep Apnea
The scientific evidence shows that acupuncture is a promising therapy for sleep apnea. A study done in a hospital in Brazil, at the Division of Sleep Disorders of the Department of Psychobiology, showed positive results from acupuncture (Freire et al., 2007).
The initial interest for this study was due to the high cost of the CPAP machines for people in Brazil; minimum wage in Brazil at the time of the study was $90/month while the cost of a CPAP machine around $1,000. The acupuncture was performed once a week over 10 weeks in patients with moderate sleep apnea. The Apnea Hypopnea Index (AHI) was reduced significantly in the acupuncture group as opposed to the sham and control group. There was also decreased sleepiness during the day and better mental health outlook.
Acupuncture strengthens the tongue muscles
A follow-up study was done in 2010 by some of the same researches. This showed that an additional benefit of acupuncture is the use of local points around the neck, in particular acupuncture points that aim at strengthening the tongue muscle (Freire, Sugai, Togeiro, Mello & Tufik, 2010). That is important since the tongue tends to collapse in the back of the throat and obstruct the airway.
In addition, acupuncture could be beneficial for the reduced innervation in the pharynx that is associated with sleep apnea (Carlos et al., 2015).
Allergic rhinitis linked to sleep apnea
Allergic rhinitis has been commonly associated with sleep apnea and it is considered a factor that further exasperates the sleep apnea (Cao, Wu, Zhang, Yang, Cao, & Li, 2018; Zijlstra, van den Berg-de Lange, Huygen & Klein, 2003). The constant mucus production causes further swelling and inflammation in the respiratory tissues which makes the air passageway even narrower.
Acupuncture is anti-inflammatory
Acupuncture has an anti-inflammatory effect and can soothe the irritated nasal passageway of patients with runny nose or congestion and postnasal drip (McDonald, Cripps, Smith, Smith, Xue & Golianu, 2013). In addition, acupuncture can reduce the histamine reaction that is triggered due to either food or environmental triggers.
Acupuncture improves blood oxygen saturation
Lastly, acupuncture may be able to improve blood oxygen saturation in patients with OSA, according to a Chinese study (Xu, Niu, Piao, Liu, Wu & Liang, 2009).
A systematic review and meta-analysis of randomized controlled trial shows that the efficacy of acupuncture for treatment of OSA is promising but we could use larger randomized controlled studies (Lv et al., 2016).
My clinical experience reveals that many patients benefit from acupuncture, especially when combined with other approaches to decrease inflammation, such as eliminating allergens and eating a low inflammatory diet.
Learn more about this in the second part of this article, Functional Medicine Treatments for Sleep Apnea.
Cao, Y., Wu, S., Zhang, L., Yang, Y., Cao, S., & Li, Q. (2018). Association of allergic rhinitis with obstructive sleep apnea: A meta-analysis. Medicine, 97(51), e13783.
Freire, O,A., Gisele C.M. Sugai, Fernanda Silveira Chrispin, Sonia Maria Togeiro, Ysao Yamamura, Luiz Eugenio Mello, Sergio Tufik. (2007). Treatment of moderate obstructive sleep apnea syndrome with acupuncture: A randomised, placebo-controlled pilot trial. Elsevier Sleep Medicine. 8, 43–50.
Freire, A., M Sugai, G. C., Maria Togeiro, S., Mello, L. E., & Tufik, S. (2010). Immediate Effect of Acupuncture on the Sleep Pattern of Patients with Obstructive Sleep Apnoea. Acupuncture in Medicine, 28(3), 115–119.
Garvey, J. F., Pengo, M. F., Drakatos, P., & Kent, B. D. (2015). Epidemiological aspects of obstructive sleep apnea. Journal of thoracic disease, 7(5), 920-9.
Kapur, V. K., Auckley, D. H., Chowdhuri, S., Kuhlmann, D. C., Mehra, R., Ramar, K., & Harrod, C. G. (2017). Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 13(3), 479-504. doi:10.5664/jcsm. 6506
McDonald, J. L., Cripps, A. W., Smith, P. K., Smith, C. A., Xue, C. C., & Golianu, B. (2013). The anti-inflammatory effects of acupuncture and their relevance to allergic rhinitis: a narrative review and proposed model. Evidence-based complementary and alternative medicine : eCAM, 2013, 591796.
Lv, Z. T., Jiang, W. X., Huang, J. M., Zhang, J. M., & Chen, A. M. (2016). The Clinical Effect of Acupuncture in the Treatment of Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Evidence-based complementary and alternative medicine : eCAM, 8792167.
Spicuzza, L., Caruso, D., & Di Maria, G. (2015). Obstructive sleep apnoea syndrome and its management. Therapeutic advances in chronic disease, 6(5), 273-85.
Xu Ji, Niu YX, Piao XM, Liu Z, Wu LZ, Liang RL. (2009). Effect of acupuncture on blood oxygen saturation in patients of obstructive sleep apnea-hypopnea syndrome. Zhongguo Zhen Jiu. 29(1):84-6