Treating sleep apnea - alternatives versus traditional techniques
By Brittney Edelman
"I am confident enough that I am out of the woods with sleep apnea," Herb Rickloff, 62, said. Rickloff, from Ann Arbor, Michigan, has been doing Buteyko breathing exercises for about six months. This alternative to traditional medicine, he said, cured his apnea.
"If you are going to do alternative medicine, you are going to have to do it yourself, because doctors will not support you," Rickloff said.
Alternatives to traditional medicine have been available for decades. From herbs to lotions to meditation, there is an holistic approach that claims to cure most ailments, including sleep apnea.
Forty million people in the United States of America have sleep apnea and a majority of those people are undiagnosed. Obstructive sleep apnea occurs when a person’s throat collapses repeatedly during sleep. This causes them to stop breathing. The condition leaves people extremely exhausted and at risk for heart disease, stroke, high blood pressure and even cancer death.
"People wake up exhausted because they have been trying to save their life all night long," Carol Baglia, registered respiratory therapist and certified Buteyko practitioner, said. Baglia teaches a five-week Buteyko breathing class at the Orange Recreation Center, which is advertised to stop snoring and sleep apnea.
Buteyko is a program of retraining one’s breathing. It claims to improve respiratory conditions by continuously doing a series of breathing exercises to restore natural breathing patterns. Baglia urges that exhalation should be effortless.
"If you work on a standard of breathing while awake, it will transfer to your breathing when you sleep," Baglia said.
This belief is not maintained by Dr. Joseph Golish, a doctor at the NorthCoast Clinical Trials Sleep Center and Sleep Resource Foundation in Beachwood and MetroHealth Medical Center in Cleveland.
"Changing your breathing pattern when you are awake does not change your breathing when sleeping," Golish said. "Buteyko is a voluntary change in your breathing pattern. When you are asleep, all bets are off. You revert back to your normal physiological breathing pattern."
Holistic and alternative medicine can be helpful as long as the patient is not at risk, Golish said. But, if they are not safe, holistic therapy is worse than no treatment at all because the patient thinks they are being treated when they are not.
"The problem is when people replace standard care with something like Buteyko. The patient says it make them feel better during the day, which is good and I do not want to discredit that, but apnea is life threatening and should be treated with scientifically-proven methods," Golish said.
Rickloff was diagnosed with moderate sleep apnea about 10-years ago, which means he stops breathing 15 to 30 times each hour. His wife said he looked as if he was dying in his sleep. He attempted to use a continuous positive airway pressure (CPAP) machine for 12-years.
"It made me look like I was traveling to the moon," Rickloff said. "I unconsciously tore it off every night in my sleep."
Rickloff discovered Buteyko in January 2012. He studied the technique over Skype with Patrick McKeown, certified Buteyko practitioner, and Baglia. Six months later, Rickloff does Buteyko exercises 2 or more times a day and has stopped using his CPAP machine. He also bought a personal oxygen sensor to perform mini-sleep studies. According to the sensor, his apnea is gone, Rickloff said.
"Now, I am not killing myself with sleep apnea."
He would like to have a lab sleep study to prove that his apnea is cured, Rickloff said.
"If a person had apnea to begin with, Buteyko is not doing anything for their apnea," Golish said. "Unfortunately, after 60-years of use, there is not a single scientific paper in the world's medical literature that has looked for effect apnea, let alone demonstrated any benefit. It has only been briefly looked at for asthma."
A new treatment for sleep apnea is provent, an expiratory positive airway pressure (EPAP) device, which consists of a single-use valve inserted in each nostril and held in place by adhesive. The value makes it easy for a person to breathe in, but hard to exhale through their nose. Once asleep, it also forces the person to breathe through their nose, not their mouth. The technology is simple. Exhaled air is released so slowly that pressure builds up and opens the back of the throat. In additional, the key is for a patient to sleep on their side at night – this helps prevent the throat from collapsing.
"For one in 10 patients, you can cure their apnea if you just get them off of their back. Gravity is not their friend and when they are on their back there is additional collapse in the throat," Golish said. "Provent works 95 per cent of the time if you add side-sleeping."
Most of the at-risk individuals Golish has studied overnight in the sleep lab are individuals who failed CPAP, dental appliances or surgery, he said.
Bob Bleck, 47, living in Mentor, believes he has had sleep apnea since he was a teenager. He travels frequently for work and about two-years ago found his level of fatigue and stress out-of-control.
"Sometimes I had to pull over into a rest stop and take a 15 minute naps just to keep my head up," Bleck said.
Bleck was diagnosed with severe sleep apnea – he stopped breathing over 30 times an hour throughout the night – and was prescribed a CPAP.
"It was a great device, it worked on the apnea for me, but I simply could not sleep with it tethered to me," Bleck said. "I would subconsciously pull it off when I slept and I would dream that I was tied down."
Bleck stopped using the CPAP after about three months. His apnea returned and he needed an alternative. Golish prescribed Bleck provent eight months ago. Like anything, it was hard to get used to, Bleck said. He already sleeps on his side, so that was one less change to make.
After 30-days, Bleck had another sleep study conducted at Golish’s lab. He went from having severe to mild apnea.
"I am feeling a little evangelical about it," Bleck said. "I did not have to live with apnea for 30-years.
The Journal of Clinical Sleep Medicine published a study by Dr. Meir H. Kryger, Dr. Richard B. Berry and Clifford A. Massie, PhD., of the long-term use of EPAP to treat obstructive sleep apnea. It birthed positive results. The major finding was that patients who were using EPAP nightly and had positive result after three months continued to have positive results at one-year. Patients’ presurgical apnea-hypopnea index (AHI), which determines whether one has normal to severe apnea, significantly decreased, as well as their sleepiness.
Buteyko may help someone with sleep apnea feel better while awake, but they cannot leave behind their traditional medical treatment, Golish said.
"Apnea is a dynamic ‘plumbing’ problem that only happens during sleep," Golish said. "We all want to live forever. We all want to feel that we have control over our health, so we do not want to take pills or use artificial gadgets."
"It is scary that people may be giving up their medical treatments for alternative techniques that are not scientifically proven," Golish said.
"To prove that a person has been made safe, you need to measure objective outcome."
Sleep apnea is a growing problem in North America due to the obesity epidemic and people living longer. Obesity and old age are two significant causes of sleep apnea.
EPAP is going to be discussed at the National Sleep Meeting in Boston June 11 to 16, 2012.
"Provent is a major item for discussion and may change the way we have approached sleep apnea over the last three decades," Golish said. "Most importantly, along with the recent discovery that apnea increases cancer deaths five-fold, it will 'flush-out' the millions of undiagnosed and untreated apneics. Having a new and effective tool that patients actually use and want to use is truly a game-changer."
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