The X-files

[tmoody]

I'm starting this thread out of curiosity, and an open mind. I'm inviting people to share their forays into alternative or "fringe" therapies for sleep apnea--and of course their results.

In another thread, I've already told how I took up didgeridoo playing, which was, and is, great fun. But I can't say it has done anything for sleep. Yet.

Your turn.

[shewhorn]

I don't know of anything that will treat sleep apnea, other than something blowing air into your lungs but in terms of helping sleep...

There are numerous clinical studies which show that meditation helps with sleep and stress reduction. Using biofeedback to manage HRV (heart rate variability) also has clinical results which show reduced stress and improved sleep. HeartMath (I use InnerBalance) is one such product but if you get an Ant+ or a Bluetooth heart rate monitor there are various free or very inexpensive apps that do the same from what I understand. This Wikipedia article has a list of apps towards the bottom:

https://en.wikipedia.org/wiki/Heart_rate_variability

Exercise... exercise definitely helps improve sleep (works best when done earlier in the day).

I have a circadian rhythm sleep disorder. My sleep doctor has me using a blue light at 10,000 lux for 30 minutes in the morning (I use a Philips goLITE Blu) and then 0.5 mg of melatonin 12 hours later (or 3 hours before I want to go to bed).

[shewhorn]

BTW if you're interested in mindfulness based meditation I would highly recommend "Search Inside Yourself", especially, if, like me, you aren't the crunchy granola type and like to have some solid science backing up the claims and methodologies. This particular book was written by the only engineer in the history of Google to leave the engineering department to go work for the HR department. "Breathe" is a great app for guided meditation (available for iOS although I'm sure it's probably available for Android as well).

ETA - The truth is out there. I want to believe (cue X-Files theme song)

[chill]

I practiced denial for a good long while. Success rate: 0%

[tmoody]

I don't know of anything that will treat sleep apnea, other than something blowing air into your lungs but in terms of helping sleep...

Personally, I doubt that sleep apnea is purely a mechanical problem. I suspect there is a neuromuscular component to it. This is clearly true for central apneas, but I think there's some overlap with obstructives too.

Even the modest improvement that has been seen in studies of didgeridoo playing is hard to explain in purely mechanical terms. I doubt that it changes the form of the airway much, if at all. But it perhaps makes the muscles in the throat more responsive. Maybe.

There are numerous clinical studies which show that meditation helps with sleep and stress reduction. Using biofeedback to manage HRV (heart rate variability) also has clinical results which show reduced stress and improved sleep. HeartMath (I use InnerBalance) is one such product but if you get an Ant+ or a Bluetooth heart rate monitor there are various free or very inexpensive apps that do the same from what I understand. This Wikipedia article has a list of apps towards the bottom:

https://en.wikipedia.org/wiki/Heart_rate_variability

Yes, that's a good point. I've practiced meditation on and off for years, but I no doubt would do better to practice more consistently. I've also done some basic breathing exercises--count four to inhale, eight to exhale--but again it's only been a sporadic thing for me.

I looked at some of those apps, which tend to have equal durations for inhalation and exhalation. That doesn't feel quite right; I'll keep looking.

Exercise... exercise definitely helps improve sleep (works best when done earlier in the day).

Yeah. I do get to the gym three times a week, but it tends to be late in the afternoon, and I've noticed higher AHI on those days. It'd be better to go earlier, but it's not so easy to arrange.

I have a circadian rhythm sleep disorder. My sleep doctor has me using a blue light at 10,000 lux for 30 minutes in the morning (I use a Philips goLITE Blu) and then 0.5 mg of melatonin 12 hours later (or 3 hours before I want to go to bed).

Interesting. Does this enable you to sleep longer?

[green wings]

Great thread!

One treatment that I was using for about 6-8 months before I had my sleep study, but didn't realize that it had been proven to improve both central & obstructive sleep apnea, was the antidepressant mirtazapine. (I took 15 mg the night of my diagnostic sleep study, and I am still taking it each night.)

I started taking it to help insomnia of the delayed sleep onset type.

The NIH study that I've referenced below doesn't recommend mirtazapine for treatment of sleep apnea because of weight gain and sedation.

The study found that mirtazapine decreases AHI by around 50%. That's a big improvement, but it's not good enough unless a person only had mild sleep apnea to begin with.

I think it could be a good treatment for people with mild sleep apnea, but they might need some sort of help with avoiding weight gain, like a weight and nutrition accountability group.

I gained 16 pounds during the first six months that I took mirtazapine, and then my weight stabilized. I haven't found it to cause binge eating. It seems to cause sporadic increases in overall appetite and a craving for carbohydrates.

I also don't find it to be sedating during non-sleep time. I started off at a dosage of 3.75 mg, though, not 15 mg like some of the people in the study. I think some of the reported daytime sedation could be due to their starting at 15 mg.

From the study abstract: (I bolded and italicized sentences below that I thought were particularly important.)

Efficacy of mirtazapine in obstructive sleep apnea syndrome

Carley DW1, Olopade C, Ruigt GS, Radulovacki M.
Abstract

STUDY OBJECTIVES:
Decreased serotonergic facilitation of upper-airway motor neurons during sleep has been postulated as an important mechanism rendering the upper airway vulnerable to obstruction in patients with obstructive sleep apnea syndrome (OSA).

Although serotonin reuptake inhibitors have been shown to produce modest reductions in the apnea-hypopnea index (AHI) during non-rapid eye movement (NREM) sleep, they have not been proven to be generally effective as treatments for OSA.

Conversely, antagonists of type 3 (5-HT3) serotonin receptors effectively have been shown to reduce the frequency of central apneas during rapid eye movement (REM) sleep in a rodent model of sleep-related breathing disorder.

We sought to determine whether mirtazapine, a mixed 5-HT2/5-HT3 antagonist that also promotes serotonin release in the brain would effectively reduce AHI during both NREM and REM sleep in patients with OSA.

DESIGN:
A randomized, double-blind, placebo-controlled, 3-way crossover study of mirtazapine in patients with OSA.

SETTING:
Laboratory studies were conducted in the Center for Sleep and Ventilatory Disorders at the University of Illinois Medical Center.

PATIENTS:
Seven adult men and 5 adult women with newly diagnosed (treatment-naïve) and medically uncomplicated OSA were randomized into the study.

INTERVENTIONS:
Each subject self-administered oral medications 30 minutes before bedtime each night for 3 consecutive 7-day treatment periods. These treatments comprised (1) placebo, (2) 4.5 mg per day of mirtazapine, and (3) 15 mg per day of mirtazapine. The order of treatments was randomized for each subject, and orders were counterbalanced for the overall study.

MEASUREMENTS AND RESULTS:
Each subject charted his or her sleep-wake schedule throughout the study and completed the Stanford Sleepiness Scale every 2 hours during the seventh day of each treatment period. Subjects were studied by laboratory polysomnography on the seventh night of each treatment period. With respect to placebo treatment, 4.5 mg of mirtazapine significantly reduced the AHI in all sleep stages to 52%, with 11 of 12 subjects showing improvement over placebo; 15 mg of mirtazapine reduced the AHI to 46%, with 12 of 12 subjects showing improvement over placebo. Sleep fragmentation was reduced only by the higher dose of mirtazapine. Gross changes in sleep architecture were unremarkable.

CONCLUSIONS:
Daily administration of 4.5 to 15 mg of mirtazapine for 1 week reduces AHI by half in adult patients with OSA.

This represents the largest and most consistent drug-treatment effect demonstrated to date in a controlled trial. These findings suggest the therapeutic potential of mixed-profile serotonergic drugs in OSA and provide support for future studies with related formulations.

Mirtazapine also is associated with sedation and weight gain-2 negative side effects in patients with OSA. In view of the above, we do not recommend use of mirtazapine as a treatment for OSA.

I'm starting this thread out of curiosity, and an open mind. I'm inviting people to share their forays into alternative or "fringe" therapies for sleep apnea--and of course their results.

In another thread, I've already told how I took up didgeridoo playing, which was, and is, great fun. But I can't say it has done anything for sleep. Yet.

Your turn.

[shewhorn]

This is clearly true for central apneas, but I think there's some overlap with obstructives too.

Definitely, implants which stimulate the nerve to breathe are already in clinical trials for the treatment of pure centrals.

Even the modest improvement that has been seen in studies of didgeridoo playing is hard to explain in purely mechanical terms. I doubt that it changes the form of the airway much, if at all. But it perhaps makes the muscles in the throat more responsive. Maybe.

Well... I doubt it can hurt! I would hypothesize that playing any instrument that requires you to regulate your breathing (trumpet, flute), especially if you begin your practice by warming up with long tones, would help, maybe not directly with OSA, but at least with sleep and stress as such activities are somewhat meditative, and blowing long tones by definition is a controlled breathing exercise, something that's known to have positive psychological effects. I would be interested to see if such a study was done.

I looked at some of those apps, which tend to have equal durations for inhalation and exhalation. That doesn't feel quite right; I'll keep looking.

The aim of the breathing rate amongst the HRV apps is to have a known respiratory rate in which to measure heart rate against. The basic idea is... when you're in a more stressed state, your HR will be more constant. When you're in a more relaxed state, your HR will be more variable, speeding up and slowing down according to demand, instead of being in a constant steady/ready state. That's my very basic understanding at least.

I initially thought this stuff was snake oil BUT... I asked my psychiatrist about it and he was immediately aware of HRV biofeedback tools and verified the research was legit. My ex-gf (Psy.D. in clinical health psychology) also uses it in her practice.

Yeah. I do get to the gym three times a week, but it tends to be late in the afternoon, and I've noticed higher AHI on those days. It'd be better to go earlier, but it's not so easy to arrange.

Fascinating that you actually see a correlate between exercise time and AHI. I'll have to pay closer attention myself. I also find it difficult to exercise early in the day... unless it's a weekend in which case the entire weekend is exercise (I head to the White Mountains of NH to play every weekend).

Interesting. Does this enable you to sleep longer?

Re: the blue light and melatonin, it doesn't directly help me sleep longer per se... but what it does do is help me to feel sleepy when "normal" people feel sleepy. If left to my own devices, my bedtime will rotate around the clock... 10 PM, 3 AM, 5 AM, 10 AM... it's annoying to say the least. Being tired at 11 PM instead of say, 4 AM allows me to get more sleep before my alarm goes off, so in that sense it helps me to sleep longer as I have a larger window in which to get some ZZzzzz before I need to be an adult!

[0rangebear]

There clearly is a neuromuscular component to circular breathing it is initially driven by a cognitive effort (exercise) Which though practice becomes second nature (instinctive)

The physiological benefit of didgeridoo playing stems from the circular breathing exercise, in which the player inhales through the nose while maintaining an uninterrupted outflow into the instrument through the mouth, using the cheeks as bellows.

http://www.woodwind.org/clarinet/Study/C...thing.html

At the conclusion of the four months, the investigators found that the didgeridoo players' apnea-hypopnea index had dropped from an average of 21 to 11.6. This has been repeat with other wind instrument with similar results among blowers.

In the clinical studies I have read they concluded that trained wind instrument players had higher pulmonary functions and controls, which give them a physiological advantage resulting from regular training of blowing. (exercise) Therefore,the musical instrument application may be used for training patients daily over a period of 1-2 hours/day to improve expiratory muscle strength in chronic respiratory diseases and obstructive sleep apnea.

Ref:International Journal of Science and Research (IJSR), India Online ISSN: 2319-7064

Personally, I doubt that sleep apnea is purely a mechanical problem. I suspect there is a neuromuscular component to it.

Even the modest improvement that has been seen in studies of didgeridoo playing is hard to explain in purely mechanical terms. I doubt that it changes the form of the airway much, if at all. But it perhaps makes the muscles in the throat more responsive. Maybe.

Exercise... exercise definitely helps improve sleep (works best when done earlier in the day).

[tmoody]

Fascinating that you actually see a correlate between exercise time and AHI. I'll have to pay closer attention myself. I also find it difficult to exercise early in the day... unless it's a weekend in which case the entire weekend is exercise (I head to the White Mountains of NH to play every weekend).

I try to do my own very scaled-back version of high intensity intervals. I hate long cardio sessions. Since I'm 62, with BMI=32, I'm no track star. So if I'm going to use something like the treadmill or elliptical, I'll walk for a couple of minutes at 3.6 mph, then do a minute of jogging at 5.4, then back to 3.7 for another minute or two. I'll do four "sprints" (ahem) like that, then two or three intervals of raising the incline to 8 degrees. I'm done in 25 minutes. A lighter, more conditioned person would find this laughable as interval training, but I'm neither of those things. I also do weight training once or twice a week, to try to avoid losing muscle mass.

The point is, both of these workouts are strenuous enough that I can feel the effect for hours. My pulse doesn't remain very high, but it does stay a few beats above normal for a while. Since vigorous exercise does trigger a release of cortisol, it makes sense that a workout later in the day could have a stimulating effect that lasts well into the night.

On another alternative angle, I was impressed with the videos and articles of Stasha Gominak, a neurologist who believes many sleep disorders are caused or made worse by vitamin D deficiency. She doesn't claim that vitamin D can cure apnea, but she does believe it can improve sleep, if your D level is in the 60-80 ng/ml range.

I got tested and my D level was quite low. It's now 66. I can't say I notice any striking change in my sleep. She says you need B vitamins too, to make it work, so I take I B complex with it. So far, nothing to report.

[robysue]

There are two distinctively different, but interrelated conversations going on in this thread:

1) What kinds of things have people been able to use to improve their overall sleep?

2) What kinds of non-CPAP things have people done in order to treat their OSA and is there evidence that those things work?

It's critical for us to remember that PAP fixes sleep disordered breathing. It does not fix bad sleep. If the only reason your sleep is bad is untreated OSA, then CPAP may indeed seem to fix all your sleep problems.

But for many of us on this board and for many people with OSA in general, there's more than one thing that's causing bad sleep. For some of us, the untreated OSA may have been the thing that started the sleep to deteriorate. And then all kinds of other things (including stress) piled on and made our already bad sleep even worse. But some of us had other sleep issues long before we developed OSA. In my case there's good reason that my OSA didn't really kick in until I started to approach perimenopause in my late 40s. But I've had some insomnia issues going all the way back to when I was a teenager. And stress has always made the insomnia worse. I've also probably had some circadian rhythm problems most of my life since left to my own devices I don't tend to get to bed much before 3:00 or 4:00 and seem to sleep best (even with CPAP) if I sleep from 3:00 to 9:30 rather than from 12:30 to 7:00.

A lot of what's been talked about are causes and solutions for fragmented sleep. And that's great. But it's more CPAP + <other things> that allow people with OSA to finally get a genuinely good night's sleep.