Are you feeling tired all the time but you don’t know why? Friends say that it might be anxiety, hormonal, menopausal, emotional but you feel that those don’t really relate to you. If you live alone, perhaps it’s time to ask your close family or friend to monitor if you snore excessively and breathe properly during your sleep, because you might be suffering from sleep apnea.

Health Xchange, the website of the SingHealth group, says that 15% of people in Singapore (men almost four times more than women) suffer from Sleep Apnea.

What is Sleep Apnea

In TCM, it is called “Han Mian 鼾眠”. Sleep apnea is a serious medical condition in which a person stops breathing many times throughout the night and most people don’t  completely wake up when this happens. Or they are startled when they wake up to “catch a deep breath”. This then drags on to the next day and shows up as daytime symptoms such as headaches, excessive daytime sleepiness, fatigue,decreased vigilance, inability to concentrate (brain fog).

The next day feels like an extension of the previous day… #zombie

Causes

Sleep apnea can be caused by the muscles in the throat relaxing, narrowing the airways and preventing the flow of air. Less airflow leads to lower levels of oxygen in the blood.

• Affect adults – more common in men above 50 years old
• Affect children – more common in those with enlarged adenoids and/or tonsils conditions
• More common in overweight people (BMI above 30)
• Thin people can have it too
• May or may snore – most snore
• More common in those with pre-existing medical conditions:
  • Obesity (cause narrowing of pharynx)
  • Hypothyroidism (extra tissues obstruct the airways)
  • Genetically small and short jaw structures
  • Nasal obstruction

Diagnosis

Sleep apnea is when you  stop breathing completely for 10 seconds or longer during sleep, and the severity is measured by the number of such stoppages per hour.  “Hypopnea” is a partial loss of breathing for 10 seconds or longer. If you do a sleep test in a hospital, your doctor will tell you how many times of apnea or hypopnea per hour and results are calculated using a scale called the apnea-hypopnea index (AHI). AHI of more than 5 (for adults, 2 more children) is when you require treatments.

• Normal sleep: Fewer than 5 events per hour
• Mild sleep apnea: 5 to 14 events per hour
• Moderate sleep apnea: 15 to 29 events per hour
• Severe sleep apnea: 30 or more events per hour

4 Types of Sleep Apnea

1. OSA: Obstructive Sleep Apnea
   Most common
   Often caused by a blocked upper airway.
   
2. CSA: Central Sleep Apnea
   Less common
   Occurs when your brain fails to signal your lungs to breathe. Other causes include obesity, large tonsils and adenoids.
3. MSA: Mixed Sleep Apnea
   Unlucky people have a mixture of OSA and CSA.
4. H: Hypopnea
   Reduction in ventilation of at least 50% which results in lesser oxygen in the blood

TCM treatment

TCM treatment is effective for mild and non complexed types.

In Traditional Chinese Medicine, the 2 main causes of sleep apnea are:

1) Phlegm and Blood stagnation

Symptoms

Sleep apnea + usually overweight, stuffy chest, feel nauseous, body feels heavy, dark dull lips, tongue is swollen with teeth marks on the sides,tongue coat is greasy.

What does it mean
In TCM, we believe that overweight people have more phlegm. More phlegm overtime will cause blood stagnation (think thick blood getting stuck). Thick phlegm and blood cause obstruction in the airways and causing the sudden stop in breathing. Clear Yang Qi and air cannot rise and turbid Qi cannot descend, causing an messed up in the Qi traffic, that’s why you have nausea and stuff chest.

Herbs
Dao Tan Tang to get rid of the phlegm. Plus Tao Hong Si Wu Tang to clear blood stagnation. If there are excess build up of tissues in the throat, add Jiang Can (silkworm larva), Ge Jie (gecko), Hai Fu Shi (Pumice rock) to break up the tough fibrous mesh.

2) Lung and Spleen Qi deficiency

Symptoms

Sleep apnea +  weak limbs, fatigue, poor concentration, daytime sleeping, poor appetite and occasionally have loose stools and digestive issues.

What does it mean

Lung is the Boss of the body’s Qi movement and Spleen is the Qi & blood manufacturing headquarters and controls the muscles. Weak Spleen will not be able to support Lung and hence both will be weak. Then, the muscles including the ones around the throat will be malnourished and won’t be able to stay open to let proper airflow. Hence the muscles collapse and breathing stops. Qi deficiency is the cause for fatigue and the inability for the Spleen to bring clear Yang Qi to the brain means foggy mind.

It’s like your nespresso machine (Spleen) has broken down and you can’t get coffee (clear Qi) to the brain so you can’t function.

Herbs

Bu Zhong Yi Qi Tang to strengthen the Spleen so it can do its job of clearing the phlegm. If there’s excess phlegm and reinforcements are needed, then call for Fu Ling, Yi Yi Ren (coix barley seed) and Ban Xia. If concentration and brain fog is a major problem, add Yi Zhi Ren and Qian Shi. If daytime sleeping is affecting you, add Shi Chang Pu to give your brain a wake up call.

Make sure you check with your TCM physician before taking any of these herbs. Be responsible for your health.

Acupuncture treatment

Time required: 10 minutes daily

Level: Easy (great for selfcare)

Targets:

• Lung meridian – to help you breathe properly
• Spleen and Stomach meridian – to get rid of phlegm and clear obstructions
• Kidney – it grasps and pull the Qi downward into the Lung
• Local points – on nose and throat
• Calming point – for a good night’s sleep
• LU 6, LU 7, KI 6, LI 4, LI 20, GV 20, CV23, ST 40, SP 6 and extra point

Directions

• Massage these points with your fingers everyday. 1-2 minute per acupoint.
• Be gentle with  CV23 and Shang Lian Quan that is located on the throat.
• Other points should feel sore and tender, like a “good pain”. Stop if you feel any sharp pain.
• Best to go to a acupuncturist to get a full stimulation of the points.

LU 6 Kong Zui –  A Xi-Cleft point is the site where the Qi of the meridian is deeply converged. Qi and blood are stored deeply at these particular points.cough blood, cough and asthma, Sore throat

LU 7 Lie Que – Command Point of the head and neck so it’s useful for any conditions involving these areas. Luo-Connecting point of the Lung Meridian. Master Point of Ren Meridian (couple with KID 6)

KI 6 Zhao Hai – strong connection to the heart and throat, which makes it great for heart palpitations, anxiety, difficulty breathing, sore throat, and thyroid conditions

LI 4 He Gu – Command point to treat all  issues of head and face

LI 20 Ying Xiang – Acupoint on the nose. Solves issues with nose blood and breathing.

GV 20 Bai Hui – Calming acupoint. Controls Liver Yang (good for those with high blood pressure and those with sleep apnea has high risk for that too) . Benefits the brain and the senses and regains consciousness.

CV 23  Lian Quan – Local acupoint to target the throat and tongue.  Helps the tongue to de-obstruct the airways.

Shang Lian Quan – An extra point is located between the hyoid bone and the menton symphysis

ST40 Feng Long – is known as the Phlegm point. It helps resolve phlegm throughout the body.

SP 6 San Yin Jiao – Meaning “ 3 Yin converge” . The 3 YIn meridians are Spleen, Liver and Kidney. This point can, resolves dampness, harmonizes the Liver, strengthens the Kidneys, nourishes Blood and Yin. Your blood needs maximum oxygen especially when you don’t breathe!

Lifestyle changes

Continuous Positive Airway Pressure (CPAP) masks and mouth guards that make you breath easily may keep the airway open to prevent pauses in breathing and restore normal oxygen levels.There’s a procedure called  uvulopalatopharyngoplasty which basically removes excess throat tissue to allow air to flow more freely. For children, the most common surgery is removing the adenoids or tonsils. Masks can be uncomfortable and uvulopalalawhat or jaw reconstruction surgery is not an option then you have got to look into some lifestyle changes.

Sleeping on your side with white noise ambient music and cutting out on relaxants such as alcohol do have temporary effect and will help to decrease the risks of sleep apnea but you can’t be doing that forever. So let’s think of more permanent solutions.

Antioxidants & omega 3

We all know the importance of a healthy diet and maintaining a healthy weight. This goes for everyone and not just for those with sleep apnea. The first step is to add more antioxidants from a plant based diet and fish oils (omega 3) into your diet. Why? Studies show that sleep apnea is associated with oxidative stress, the excessive build-up of free radicals.This then leads to what is known as “endothelial dysfunction,” in which the blood vessels do not properly relax and contract. Just like how we talked about blood stagnation and Spleen can’t control the muscles. So getting the right nutrients will get the body to get the job done at its optimum! Eat better, breathe better.

Water bottle exercise

This is a simple exercise that you can do everyday for 5 mins. Daily exercise can train the over relaxed muscles around the mouth, tongue and throat area. Do at your own pace. If you feel dizzy, remember to take a break.

1. Find a 500ml plastic bottle. Using a softer bottle will be a good start.
2. Hold the mouth of the bottle with your mouth. Suck out the air in the bottle slowly.Make sure you’re looking straight or slightly up. Visualise that the back of the throat opening up.
3. Hold for 10 seconds. Do 5 seconds if you can’t hole that long.
4. Then blow out into the bottle until the bottle goes back to its original shape.
5. Repeat 3 times.  Slowly build to 10 times.

Here’s a video to show you how it’s done.

References:
http://www.acupunctureintegrated.com/articles/sleep-apnea-adrenal-fatigue-and-insulin-resistance
https://www.sleepapnea.org/learn/sleep-apnea/
https://aim.bmj.com/content/28/3/115