Obstructive sleep apnea affects around 20 million Americans and can lead to hypertension, heart attack, stroke, depression, muscle pain, fibromyalgia, morning headaches, and excessive daytime sleepiness.

Tuesday, March 30, 2010

IS MY SLEEP APNEA CAUSED BY NASAL CONGESTION?

QUESTION: Hi. I'm 18 years old and I've had moderate sleep apnea (45-50 apnea episodes per night) for almost 2 years now. It seems to be caused by nightly congestion and I was wondering if other patients have had this same specific issue. Thanks.

ANSWER: THERE IS A PROCESS CALLED THE NASAL CYCLE WHERE ONE SIDE OF THE NOSE CLOSES DURING SLEEP AND YOU BREATHE THRU THE OTHER SIDE . IT CHANGES SIDES EVERY 60-90 MINUTES. WHEN WE WAKE FROM AN APNEA EPISODE WE MAY FEEL THAT THIS IS DUE TO NASAL CONGESTION WHERE IT IS ACTUALLYA NORMAL PART OF THIS CYCLE.

IF THERE IS A LARGER NASAL AIRWAY ON ONE SIDE THAN THE OTHER THAN WHEN THE SMALL SIDE CLOSES WE DO WELL BECAUSE THE LARGER AIRWAY SIDE IS OPEN. WHEN THE LARGER AIRWAY SIDE SWELLS UP WE NOW NEED TO BREATHE THRU THE MORE CONSTRICTED AIRWAY.

IT IS POSTULATED THAT THE NASAL AIRWAY CYCLE IS HEALTH BECAUSE IT PROMOTES THE MOVEMENT OF OUR BODY FROM SIDE TO SIDE DURING SLEEP.

BELOW IS FROM WIKIPEDIA:
"The nasal cycle is the alternating obstruction of the nostrils in humans. It is a physiological congestion of the nasal concha due to selective activation of one half of the autonomic nervous system by the hypothalamus. It should not be confused with pathological nasal congestion. The nasal cycle was first described by the German physician Richard Kayser in 1895."
"Later on in 1927 Heetderks[2] speaks about alternating turgescence of the inferior turbinates in 80% of a normal population. The turbinates in one fossa filled up while the opposite turbinates decongested. This cycle, which is controlled by the autonomic nervous system as described above, had a mean duration of two and a half hours. He further observed and documented that the turbinates in the dependent nasal fossa filled when the patient was in the lateral decubitus position. Some postulate that this alternating positional obstruction has the purpose of causing a person to turn from one side to the other while sleeping. The nasal cycle is an alternating one, with the total resistance in the nose remaining constant. In patients with a fixed septal deviation and intermittent nasal obstruction, the interplay of the nasal cycle becomes evident; the sensation of obstruction frequently mirrors the congestion phase."

AN ARTICLE IN CNS Spectr. 2007;12(8):625-634 by David S. Shannahoff-Khalsa, BA discusses how this autonomic phenomenon can have psychiatric implications if only one side is stimulated. The abstract and link to this interesting topic is below: http://www.cnsspectrums.com/aspx/articledetail.aspx?articleid=1163

Research advances have led to three methods for selectively activating one half of the autonomic nervous system in humans. The first method is an ancient yogic technique called unilateral forced nostril breathing (UFNB) that employs forced breathing through only one nostril while closing off the other. The second method works by stimulation of an autonomic reflex point on the fifth intercostal space near the axilla. The most recent method employs unilateral vagus nerve stimulation (VNS) via the mid-inferior cervical branch and requires surgical implantation of a wire and pacemaker. UFNB is non-invasive and seems to selectively activate the ipsilateral branch of the sympathetic nervous system with a possible compensation effect leading to contralateral VNS. UFNB and VNS have been employed to treat psychiatric disorders. While UFNB has been studied for its potential effects on the endogenous ultradian rhythms of the autonomic and central nervous system, and their tightly coupled correlates, VNS has yet to be studied in this regard. This article reviews these three methods and discusses their similarities, putative mechanisms, their studied effects on the endogenous autonomic nervous system and central nervous system rhythms, and their implications for the treatment of psychiatric disorders.

WHY IS THIS IMPORTANT IN REGARDS TO SLEEP APNEA: THE CYCLE CAN BE DISRUPTED BY APNEA AND IF THE NASAL CYCLE TENDS TO ALWAYS AWAKEN THE BODY WHEN THE SAME SYMPATHETIC AND PARASYMPATHTIC INNERVATIONS IT COULD CREAT A HOST OF PROBLEMS INCLUDING HORMONE REGULATION.

An interesting section of this article deals with an ancient Yogi technique that can effect the nasal cycle and other autonomic phenomenon.

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posted by Dr Shapira at 8:19 AM