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Industry: Email Alert RSS FeedSleep apnea & Chinese medicine - Chinese Medicine Update
Townsend Letter for Doctors and Patients, Feb-March, 2003 by Bob Flaws
Keywords: Chinese medicine, acupuncture, sleep apnea
Definition & nosology: Apnea comes from the Greek, a meaning "no," pnea meaning "breathing." Therefore, apnea means "no breathing." Sleep apnea (SA) refers to recurrent cessation of breathing during sleep, each cessation lasting more than 10 seconds and sometimes more than a minute. It was first identified as a medical condition in 1965. This cessation in breathing during sleep may be due to mechanical causes leading to blockage of the airway. This is called obstructive sleep apnea (OSA) and occurs when the soft tissue at the back of the throat collapses and closes during sleep. It may also be caused by failure of the brain to signal the muscles to breathe. This is called central sleep apnea and is less common. It is also possible to have a mixture of these two mechanisms, in which case one speaks of mixed sleep apnea. However, no matter what type of sleep apnea, the brain signals the person to arouse briefly so that they may resume breathing. Therefore, sleep apnea results in fragmented, poor quality sleep, leaving sufferers of this condition unrefreshed in the morning and fatigued during the day. Such a cessation of breathing and arousal from sleep may occur 20-30 times per hour and hundreds of times per night.
Mortality & morbidity: Unfortunately, this condition does not just lead to poor sleep and fatigue. Because sleep apnea may lead to hypertension, dysrhythmia, heart attack, and stroke and is sometimes implicated in sudden infant death syndrome (SIDS) and motor vehicle accidents, it is a serious, potentially life-threatening condition. Fifty percent of people with sleep apnea have high blood pressure. Less serious but still problematic, sleep apnea may also lead to poor memory, weight gain, headaches, impotence, and job impairment.
Epidemiology: Somewhere between 12-18 million Americans suffer from sleep apnea. While anyone of any age can develop this condition, risk factors include being male, overweight, and over 40 years of age. However, most sleep apnea sufferers are not obese. Other risk factors include alcohol use, smoking, and ethnicity, with Afro-Americans, Pacific Islanders, and Mexicans being at greater risk than Anglo-Europeans.
Clinical symptoms: The presenting symptoms of sleep apnea are loud snoring, excessive daytime sleepiness, high blood pressure or other cardiovascular disease, morning headaches, memory problems, depression, reflux, choking sensations, nocturia, and impotence.
Diagnosis: The diagnosis of sleep apnea is not simple, and every person who snores does not have sleep apnea. Definitive diagnosis typically requires polysomnography. This is a test which is done in a sleep laboratory or sleep clinic which measures 16 different parameters during sleep, such as EEG, EKG, eye movements, chin movements, chest movements, leg movements, airflow, etc. The Multiple Sleep Latency Test (MSLT) measures the speed in which a person falls asleep during the day when ordinarily they would be awake. For most people, it takes at least 10-20 minutes to fall asleep during the day. Patients with sleep apnea commonly fall asleep in five minutes due to being so fatigued.
Treatment: As for the Western medical treatment of sleep apnea, the first to try are all behavioral therapies. These include avoidance of alcohol or medications, such as sleeping pills, which relax the airways and/or reduce the respiratory drive; weight loss; and positional therapy (i.e., not sleeping on one's back if an adult). If these fail to achieve the desired effect, oral appliances worn during sleep may be tried or continuous positive airway pressure (CPAP). CPAP refers to wearing a mask to. sleep at night which pushes air into the air passageways. Unfortunately, such a CPAP device may have to be worn one's entire life since it does not correct or cure the condition, and, gathering from on-line discussion groups and sleep apnea forums, patients typically do not like CPAP. In some cases, surgery may be indicated. For instance, sleep apnea in children is often treated by tonsillectomy or adenoidectomy. These procedures are sometimes often tried in adults as well with varying results. Severe, life-threate ning SA may require a tracheostomy which is not a happy prospect.
Chinese Medicine & Sleep Apnea
Although I do not know of any Chinese textbook discussions of sleep apnea, during the 1990s, at least a dozen articles were published in various Chinese medical journals on this condition. Therefore, we can say some things about sleep apnea's Chinese medical disease mechanisms, pattern discrimination, and treatment.
Disease causes & mechanisms: Xiao Quan-cheng gives three causes for snoring: 1) external contraction of wind warm heat evils, 2) liver-lung fire exuberance with recurrent contraction of wind cold, and 3) internal damage due to medications, diet, or taxation fatigue. Xiao says that wind warm heat evils may congest and obstruct the (qi) mechanism and the orifices. Therefore, there is a failure in the transportation of yin fluids which collect and inhibit the free flow of the throat. Secondly, if liver-lung fire exuberance is checked or blocked by wind cold, then internal and external evils may join together to block the throat and nose. Third, internal damage may lead to yang vacuity weakness which may also lead to failure to move and transform yin fluids. If these fluids collect and transform into phlegm, this phlegm may lodge in the throat and block its free flow. (1) According to Cui Hong-sheng et al., the main cause of SA is spleen vacuity not moving and transforming properly. This leads to phlegm, stasis, and inhibition of the qi mechanism. Therefore, Cui and his colleagues talk about a root vacuity and tip or branch repletions. In its early stages, Cui et al. say there is a spleen-lung qi vacuity or a lung-kidney qi vacuity, while in the later stages, the lungs, spleen, and kidneys are all vacuous. (2) Shi Yuan-tao emphasizes being overweight and smoking and drinking as being the causes of phlegm dampness, qi stagnation, and blood stasis. As he quotes, "Fat people [have] a lot of phlegm and dampness." (3) Yan Feng-shan emphasizes phlegm and heat mutually binding and causing depression and obstruction of the qi passageways. (4)
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