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Sleep Apnea: An Alternative Approach

Obstructive sleep apnea syndrome (OSAS) is caused by a disruption to the breathing cycle, often for 10 seconds or more at a time, when you are sleeping. Contributing factors vary — from narrow or clogged airways to the tongue falling back in the throat cutting off the air supply. If you snore, keep your partner awake at night and wake up tired every morning, you might have sleep apnea.*

Since sleep apnea is a common breathing disorder, and since your breathing is controlled by your brain and breathing muscles, wouldn’t it make sense to use breathing exercises as a front-line treatment? After all, Physical Therapists and Yoga Therapists use exercises all the time to restore balance to the body’s neuromuscular systems. And, Yoga provides the best system I know of, hands down, for exercising the breathing apparatus — muscles, lungs and brain.

Can we then apply this same treatment logic — of restoring balance to the body with exercise — with years of documented success, to sleep apnea? It seems we can. Two randomized studies have recently been published in support of using different forms of breathing exercises to successfully treat obstructive sleep apnea.

The first, published in the British Medical Journal February 4, 2006, showed that didgeridoo playing is an effective treatment alternative for moderate sleep apnea. Here 25 patients were randomized between a control group of 11 people and a treatment group consisting of 14 participants. The treatment group practiced didgeridoo playing for 25.3 minutes for 5.9 days per week for four months.

The didgeridoo players showed significant improvements in terms of daytime sleepiness and snoring. The sleep apnoea-hypopnoea index (a measure indicating the severity of the disease in terms of sleep disruption and decreased oxygen saturation in the blood) significantly decreased. Happily, their partners also reported less sleep disturbances.

The second study was published February 20, 2009 in the American Journal of Respiratory and Critical Care Medicine. It was a randomized trial of 31 patients with moderate OSAS. For a period of three months, 15 patients received sham therapy and 16 patients received a set of exercises for the mouth, soft palate, face, tongue and throat.

Not surprisingly, the exercise group showed significant decreases in snoring frequency and intensity, a decrease in daytime sleepiness, improvements in sleep quality and a significant decrease in the severity of the measure of OSAS.

Doesn’t it make sense that yogic breathing exercises might have the same desired effects?

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* To get a good diagnosis, please consult with your primary care doctor, who can refer you to a sleep clinic for evaluation.

 

References and Resources

 

Guimarães K, et al, 2009. Effects of Oropharyngeal Exercises on Patients with Moderate Obstructive Sleep Apnea Syndrome. American Journal of Respiratory and Critical Care Medicine Vol. 179: 962-966.
Puhan M, et al, 2005. Didgeridoo playing as alternative treatment for obstructive sleep apnoea syndrome: randomised controlled trial. British Medical Journal, 332(7536): 266–270.
http://www.mayoclinic.com/health/obstructive-sleep-apnea/DS00968
http://www.webmd.com/sleep-disorders/sleep-apnea/sleep-apnea
http://www.nlm.nih.gov/medlineplus/sleepapnea.html

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Your Lymphatic System

Did you know that your breathing habits may positively affect your lymphatic system?

Let’s begin with a review of the anatomy and functioning of the lymphatic system. Closely related to the cardiovascular system both anatomically and functionally, the lymphatic system is composed of capillaries; larger lymphatic vessels, called collecting vessels; the lymph fluid itself; lymph nodes; and numerous lymphatic ducts.

The journey of the lymphatic fluid looks like this: lymph fluid is picked up from the cells, where it travels via the lymphatic capillaries to the collecting vessels, then up to the lymphatic ducts, where it is filtered and  returned to the bloodstream.

What is this lymph fluid? It is a fluid that is the byproduct of cellular function and respiration. It is extra, or interstitial, fluid containing bacteria, fat and proteins, fluid that remains between the cells which was not picked up by the bloodstream. It is a waste by-product discharged from the cells. This clear and colorless fluid is then transported to the lymph nodes, where it is filtered and cleaned of foreign substances, bacteria, proteins and other large particles. From the nodes, the lymph travels to the ducts, formed by the convergence of lymph vessels. They include the lumbar duct, the common duct that empties into the cisterna chyli, the cisterna chyli, the thoracic duct, the left jugular and subclavian ducts and the right lymphatic duct.*

Lymph, then, travels from the cells to the capillaries, to the nodes, through the ducts, to empty in the large blood vessels located at the base of the neck, where it is emptied back into the bloodstream. However, unlike blood, lymph moves in only one direction through a variety of parallel mechanisms:

  1. hydrostatic pressure;
  2. valves to prevent back flow;
  3. voluntary muscle contractions throughout the body;
  4. respiratory movements that create alternating pressures within the chest cavity (pressures created by the contraction and relaxation of the diaphragm and respiratory muscles);
  5. contractions of the abdominal wall upon forceful exhalation — vigorous exercise, coughing, sneezing — creating a positive pressure in the cisterna chyli that pushes the lymph up towards the large veins in the neck;
  6. pulsations of adjacent blood vessels throughout the circulatory system.*

Three liters of lymph enter the bloodstream every 24 hours. Since muscle contractions aid lymph flow, you can see how important general exercise is to aid turnover in your lymphatic system. Furthermore, the thoracic duct, cysterna chili, the lumbar duct and the common duct are all very near the diaphragm, our primary breathing muscle. The thoracic duct passes through an opening in the diaphragm.

On an anatomical level at the very least, you can see how deep breathing exercises may have a direct and positive impact on lymphatic flow. Deep breathing exercises create greater pressures within the chest and abdominal cavities. Additionally, through the contractions of the diaphragm and abdominal muscles, a positive pressure is created in the trunk to further push the lymph upwards towards their emptying ports in the neck.

Another reason to get moving and to do pranayama — powerful breathing exercises!

 

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*Information taken from Anatomy by Ernerst W. April and Grant’s Atlas of Anatomy. Please note also that the above information is not comprehensive of the entire lymphatic system, which also includes the spleen and lymphocytes.

 

Read more about Sharon Gary, Yoga Physical Therapy and what a typical treatment with Sharon Gary looks like.