1. Summary and REM sleep apnea is the interruption of breathing during sleep.

These disturbances wake us up countless times during the night. Sleep apnea is associated with heart disease, diabetes, poor cognitive function and many other health problems. In this protocol, understanding the different types of sleep apnea and why correct diagnosis and treatment is so important. And learn about lifestyle and dietary habits that may help improve them. Dietary supplements that address certain causes of sleep apnea will also be described. Effective treatments for sleep apnea, they can dramatically improve quality of life.

But because of the inconvenience or discomfort, many people either do not seek treatment or quickly give up. It's important to work with a sleep specialist to find a solution that works for you, which may require trial and error. Sleep apnea is an increasingly prevalent but undiagnosed condition characterized by recurrent pauses in breathing during sleep that can lead to the following serious health problems: l Cardiovascular disease l Type 2 diabetes l cancer l gout l cognitive dysfunction l Increased risk of unexplained death Fortunately, comprehensive interventions such as Nacetylcysteine (NAC) and Coenzyme Q10 can improve sleep quality and respiratory function in patients with sleep apnea.  

Risk factors for sleep apneasl overweight and obesity l smoking l Allergies and asthmaL signs and symptoms associated with sleep apneasl snoring l apnea l Intermittent wakefulness and insomnia conventional treatment l CPAP (continuous positive airway pressure) l Other oral appliances that help keep the upper airway open when the obstruction is caused by a structural problem, surgery, Examples include new and emerging therapies for enlarged tonsils or glands l estrogen and progestins in women l Hypoglossal nerve stimulation l Sympathetic denervation l Nasal continuous positive airway pressure and oral negative pressure therapy dietary and lifestyle changes l Obesity is the most important modifiable risk factor associated with obstructive sleep apnea. Therefore, weight loss is an important intervention.

l Exercise for 2.5 to 4 hours per week can reduce the severity and symptoms of sleep apnea, even without weight loss. Comprehensive intervention l Nacetylcysteine (NAC) : NAC, which has mucusreducing properties, has been shown to significantly improve measures of apnea severity and sleep quality. Vitamin C: improves endothelial health in patients with sleep apnea along with vitamin E and reduces sleep apnea episodes and daytime sleepiness. Vitamin E: When combined with vitamin C, it reduces sleep apnea and daytime sleepiness, and when combined with other antioxidants, it improves respiratory function. Coenzyme Q10 (CoQ10) : improves respiratory function in combination with other antioxidants in patients with sleep apnea. Patients with sleep apnea are at increased risk for cardiovascular disease and may benefit from coenzyme Q10 supplementation. l Selenium: Patients with lower erythrocyte selenium levels, as measured by the apneahypopnea index, were found to have more severe sleep apnea.

2. Introduction Sleep apnea is an increasingly prevalent and often overlooked condition characterized by recurrent apnea during sleep (Jordan 2014; Hayes 2014;   Strohl 2013).

These frequent apneas can lead to low oxygen levels in the blood, nervous system dysfunction and sleep deprivation, which can lead to a range of serious health problems. Indeed, numerous studies have shown that sleep apnea substantially increases risk for death from any cause (Panossian 2013; Kendzerska 2014).

Sleep apnea is an underrecognized but still prevalent condition with worrisome public health implications. The National Sleep Foundation estimates that more than 18 million people in the U.S. have sleep apnea, but the diagnosis of this occult condition is believed to be extremely low (NSF 2014; Ramirez 2013;   Paiva 2014;   Yu 2011;   Peppard 2013;   Hayes 2014;   Motamedi 2009). Untreated sleep apnea has many consequences, including the hallmarks of chronic sleep deprivation: daytime sleepiness, cognitive difficulties, depression, and an increased risk of accidents and injuries (Seneviratne 2004; Hayes 2014; NSF 2014; Thompson 2012; NIH 2006; Ellen 2006); Findley 1991;   Mayo Clinic 2012).

Furthermore, the spectrum of serious chronic medical conditions associated with sleep apnea is growing, including cardiovascular and neurological disorders, pregnancy complications, obesity, peptic ulcer bleeding, insulin resistance, and type 2 diabetes mellitus (Paiva 2014; Jordan 2014; UMMC 2013b; Mirrakhimov 2013; Hayes 2014). Researchers have also studied possible links between sleep apnea and autoimmune diseases, osteoporosis, and even cancer (Kang 2012; Mirrakhimov 2013; Yen 2014; Noguti 2013; Pamidi 2014).

The firstline treatment for obstructive sleep apnea is a device that delivers continuous positive airway pressure, called CPAP (NSF 2014; Hayes 2014). The device is worn during sleep and introduces moderately compressed air into the airways to keep them open (Mayo Clinic 2012; NSF 2014). The benefits of CPAP are particularly pronounced in persons with sleep apnea who have excessive daytime sleepiness (Chiner 2013). In addition, studies have shown that CPAP use may improve measures of cardiovascular health and glucose metabolism in patients with sleep apnea (Monahan 2011; Gottlieb 2014; Gallegos 2014; Chen Pei 2014; Schlatzer 2014; Ayas 2006).

Some patients cannot tolerate CPAP, in which case other therapies may be considered. Dental devices and surgical procedures can open the airways, which may be beneficial in certain patients with sleep apnea. Other approaches sometimes recommended include bariatric surgery and negativepressure devices (Freedman 2014; Hayes 2014). Dietary and lifestyle interventions may have a major impact on the severity and consequences of sleep apnea. Weight loss, the most common and wellsupported adjunct to CPAP, can be effective alone (Hayes 2014; UMMC 2013a; Thompson 2012).

Exercise even if you don't lose weight; Proper sleeping position; Avoid alcohol and sedatives before bed; Diet and a healthy diet are critical for managing sleep apnea (UMMC 2013b; Hayes 2014). Comprehensive interventions can both reduce the severity of sleep apnea and minimize the consequences of some serious conditions associated with sleep apnea (Grebe 2006; Singh 2009;   Sadasivam 2011;   Lee 2009). In this program, you will learn about the causes of sleep apnea and the factors that increase the risk of sleep apnea. Conventional treatment approaches as well as several novel and emerging treatment strategies will be reviewed. Some lifestyle considerations and natural, integrated interventions that can mitigate the effects of sleep apnea will also be discussed.

3. Background Sleep apnea is classified into two types: obstructive and central.

Obstructive is more common (UMMC 2013a; NSF 2014). In obstructive sleep apnea, the airway collapses and repeatedly blocks airflow during sleep. In central sleep apnea, the respiratory control centers of the brain fail to provide sufficient stimulation to maintain normal breathing during sleep. However, it appears that elements of both obstructive and central mechanisms occur simultaneously in some patients with sleep apnea (Ramirez, 2013; Khan, 2014; ASAA, 2014; Hoffman, 2012; Lehman, 2007).

3.1. In obstructive sleep apnea, swelling, narrowing, or structural abnormalities in the air channel structure block airflow and cause apnea, which must be overcome by a strong signal from the brain's respiratory center to trigger aspiration (Jordan 2014; Schwab 2011;   ATS 2014). Posture often plays a key role in obstructive sleep apnea. The gravity associated with the back sleep position leads to an increased tendency for the airway to collapse and block airflow (Bilston 2014)

3.2 Central sleep apnea The brain regulates involuntary respiratory reflexes in response to carbon dioxide levels in the blood. Normally, as carbon dioxide levels rise in the blood, the respiratory centers of the brain trigger an increase in breathing (Nattie 1999; Guyton 1990). In central sleep apnea, the brain is unable to adequately regulate breathing. Central sleep apnea is often caused by another health condition. For example, central sleep apnea is common in patients with congestive heart failure and in chronic opioid users (Javaheri 2013; Floras 2014). Central sleep apnea can also occur without a clear cause (Ramirez 2013; ASAA 2014).

3.3 Mixed or complex sleep apnea Mixed sleep apnea, sometimes called complex sleep apnea, involves both obstructive and central components. Up to 18% of people with sleep apnea (which includes both apnea and less severe hypopnea (shallow and/or slow breathing)) may have mixed sleep apnea. In many cases, central apnea occurs during CPAP therapy for obstructive sleep apnea (Khan 2014; Hoffman 2012;   Lehman 2007).

Sleep apnea is associated with a variety of serious medical conditions (Thompson 2012; Martinez Ceron 2014;   Yu 2011;   Canales 2008) :

4.1, Cardiovascular disease. Intermittent hypoxia (low oxygen levels) caused by sleep apnea can lead to chronic hypertension and endothelial damage (Ziegler 2011). Patients with obstructive sleep apnea are more likely to have hypertension, coronary artery disease, and abnormal heart rhythms, and they are at increased risk for heart failure, heart attack, and stroke (JeanLouis 2008; Gottlieb 2013; Pepin 2014); Ali 2014;   Hohl 2014;   Oldenburg 2014).

4.2. Type 2 Diabetes and Obesity Up to 40% of people with obstructive sleep apnea have type 2 diabetes, and up to 53% of people with type 2 diabetes who are overweight or obese have obstructive sleep apnea (Bonsignore 2013; Nannapaneni 2013). Sleep apnea is also independently associated with insulin resistance (Martinez Ceron 2015). Obesity, particularly abdominal or central obesity, is a major risk factor for obstructive sleep apnea (Hoffstein 1992; Schwartz 2008;   Thompson 2012;   Stadler 2009;   Hayes 2014). This relationship between obesity and obstructive sleep apnea appears to be bidirectional. Obesity may play a causal role in obstructive sleep apnea, which may contribute to weight gain (RomeroCorral 2010; Pillar 2008; Yu 2011).

4.3. Cancer In a study of 386 adults older than 20 years, moderatetosevere obstructive sleep apnea was associated with a 2.5fold higher risk of new cancer diagnoses and a 3.4fold higher risk of death from cancer (Marshall 2014). In another study, compared with healthy subjects, those with mild sleepdisordered breathing (SDB) had a 1.1fold increased risk of death from cancer, those with moderate SDB had a 2fold increased risk, and those with severe SDB had a 4.8fold increased risk (Nieto 2012).

4.4, Gout and hyperuricemia Gout is a painful arthritic symptom caused by too much uric acid in the blood (hyperuricemia), which accumulates as crystals in the joints (NLM 2014). "Patients with gout appear to be at increased risk for sleep apnea (Roddy, 2013)." In addition, people with high uric acid levels have been shown to be more likely to snore more than five nights per week and to experience daytime sleepiness (Wiener 2012). Uric acid levels are known to rise with increasing frequency of apnea episodes and are considered a marker of sleep apnea severity (Cantalejo Moreira 2013; Hirotsu 2013; Kanbay 2014; Wiener 2012).

4.5. Cognitive and Neurological problems Research suggests that chronic sleep deprivation and disruption may increase risk for chronic cognitive problems and neurological diseases, including Alzheimer's disease (Lucey 2014; Buratti 2014).

                                                             Note: This article is taken from Pauling College, if any discomfort contact deletion