I Drug Information

Sleep Apnea

In people who have sleep apnea (also recalled sleep-disordered breathing), breathing briefly stops or becomes very shallow during sleep. This change is from intermittent blocking of the upper airway, usually when the soft tissue in the rear of the throat collapses and partially or completely closes the airway. Each breathing stop typically lasts 10 to 20 seconds or more and may occur 20 to 30 times or more each sleeping hour.
If a person has sleep apnea, not enough air can flow into the lungs through the mouth and nose during sleep, even though breathing efforts continue. When this happens, the amount of oxygen in the blood decreases. The brain responds by waking up enough to tighten the upper airway muscles and open the windpipe. Normal breaths then start again, often with a loud snort or choking sound. Although people who have sleep apnea typically snore loudly and frequently, not everyone who snores has sleep apnea.
Because people who have sleep apnea frequently rouse from deeper sleep stages to lighter sleep during the night, these people rarely spend enough time in deep, restorative stages of sleep. These people are therefore often excessively sleepy during the day. Such sleepiness can trigger mood and behavioral problems, including depression and such sleepiness more than triples the risk of being in a traffic- or work-related accident.
The many brief drops in blood-oxygen levels can result in morning headaches and a decreased ability to concentrate, think properly, learn and remember. In sleep apnea, the combination of the intermittent oxygen drops and reduced sleep quality triggers the release of stress hormones. These hormones in turn raise blood pressure and heart rate and boost the risk of heart attack, stroke, irregular heartbeats and congestive heart failure. In addition, untreated sleep apnea can lead to altered energy metabolism that increases the risk for developing obesity and diabetes.
Anyone can have sleep apnea. Approximately 12 to 18 million American adults have sleep apnea, making it as common as asthma. More than one-half of the people who have sleep apnea are overweight. Sleep apnea is more common in men. More than 1 in 25 middle-aged men and 1 in 50 middle-aged women have sleep apnea along with excessive daytime sleepiness. About 3 percent of children and 10 percent or more of people over age 65 have sleep apnea. This condition occurs more frequently in African Americans, Asians, Native Americans and Hispanics than in Caucasians.
More than one-half of all people who have sleep apnea do not receive a diagnosis. People who have sleep apnea generally are not aware that breathing stops in the night. These people just notice not feeling rested when in the morning and are sleepy throughout the day. Some bed partners are likely to notice, however, that the other person snores loudly and frequently and even often stop breathing briefly while sleeping. With these symptoms present, doctors suspect sleep but must confirm the diagnosis with overnight sleep monitoring. (See "How Are Sleep Disorders Diagnosed?"). This monitoring will reveal pauses in breathing, frequent sleep arousals and intermittent drops in levels of oxygen in the blood.
Like adults who have sleep apnea, children who have this disorder usually snore loudly, snort or gasp and have brief stops in breathing while sleeping. Small children often have enlarged tonsils and adenoids that increase their risk for sleep apnea. But doctors may not suspect sleep apnea in children because, instead of showing the typical signs of sleepiness during the day, these children often become agitated and may be considered hyperactive. The effects of sleep apnea in children may include diminished school performance and difficult, aggressive behavior.

Types of Complementary Medicine

Complementary medicine practices fall into broad categories, such as natural products, mind and body medicine and manipulative and practices based on the body. Although these categories are informal, they are useful for discussing complementary medicine practices. Some complementary medicine practices may fit into more than one category.

Natural Products

Natural products in complementary medicine include the use of a variety of herbal medicines also known as botanicals, vitamins and minerals. Many places sell natural products over the counter as dietary supplements. Doctors do not consider some uses of dietary supplements, like taking a multivitamin to meet minimum daily nutritional requirements or taking calcium to promote bone health, complementary medicine.
Complementary medicine natural products also include probiotics and live microorganisms (usually bacteria) that are similar to microorganisms normally found in the human digestive tract and that may have beneficial effects. Probiotics are available in foods like yogurts or as dietary supplements. Probiotics are not the same as prebiotics, which are non-digestible food ingredients that selectively stimulate the growth and/or activity of microorganisms already present in the body.
Interest in and use of complementary medicine and natural products have grown considerably in the past few decades. The 2007 NHIS found that 17.7 percent of American adults had used a non-vitamin non-mineral natural product. These products were the most popular form of complementary medicine among both adults and children. The most commonly used product among adults was fish oil or omega 3s. 37.4 percent of all adults who said they used natural products used fish oils and omega 3s; popular products for children included Echinacea where 37.2 percent used and fish oil/omega 3s used by 30.5 percent.

Mind Body Medicine

Mind body practices focus on the interactions among the brain, mind, body and behavior, with the intent to use the mind to affect physical functioning and promote health. Many complementary medicine practices embody this concept in different ways.
Meditation techniques include specific postures, focused attention or an open attitude toward distractions. People use meditation to increase calmness and relaxation, improve psychological balance, cope with illness or enhance overall health and wellbeing. Various styles of yoga used for health purposes typically combine physical postures, breathing techniques and meditation or relaxation. People use yoga as part of a general health regimen and for a variety of health conditions.
Acupuncture is a family of procedures involving the stimulation of specific points on the body using a variety of techniques, such as penetrating the skin with needles that an administrator then manipulates by hand or by electrical stimulation. Acupuncture is one of the key components of traditional Chinese medicine and is among the oldest healing practices in the world. Acupuncture is part of mind body medicine, but it is also a component of energy medicine, manipulative and practices based on the body and traditional Chinese medicine.
Other examples of mind body practices include deep breathing exercises, guided imagery, hypnotherapy, progressive relaxation, qi gong and tai chi.
Several mind body approaches ranked among the top 10 complementary medicine practices reported by adults in the 2007 NHIS. For example, the survey found that 12.7 percent of adults had used deep breathing exercises, 9.4 percent had practiced meditation and 6.1 percent had practiced yoga. The use of these three complementary medicine practices had increased significantly since the previous 2002 NHIS. Progressive relaxation and guided imagery were also among the top 10 complementary medicine therapies for adults; deep breathing and yoga ranked high among children. Acupuncture had been used by 1.4 percent of adults and 0.2 percent of children.

Manipulative and Body Practices

Manipulative and body practices focus primarily on the structures and systems of the body, including the bones and joints, soft tissues and circulatory and lymphatic systems. Spinal manipulation by chiropractors and by other health care professionals such as physical therapists, osteopaths and some conventional medical doctors is medicine. Practitioners use their hands or a device to apply a controlled force to a joint of the spine, moving it beyond its passive range of motion; the amount of force the doctor applies depends on the form of manipulation. Spinal manipulation is among the treatment options that people with low-back pain have.
The term massage therapy encompasses many different techniques. In general, therapists press, rub and otherwise manipulate the muscles and other soft tissues of the body. People use massage for a variety of health purposes, including relieving pain, rehabilitating sports injuries, reducing stress, increase relaxation, address anxiety and depression and aid general wellbeing.
Physicians have used spinal manipulation since the time of the ancient Greeks. Doctors incorporated spinal manipulation into chiropractic and osteopathic medicine in the late 19th century. Massage therapy dates back thousands of years. References to massage appear in writings from ancient China, Japan, India, Arabic nations, Egypt, in Greece Hippocrates defined medicine as the art of rubbing and Rome.
According to the 2007 NHIS, chiropractic and osteopathic manipulation and massage ranked in the top 10 complementary medicine therapies among both adults and children. The survey found that 8.6 percent of adults and 2.8 percent of children had used chiropractic or osteopathic manipulation and 8.3 percent of adults and 1 percent of children had used massage.

Other Complementary Medicine Practices

Complementary medicine also encompasses movement therapies, which include Eastern and Western movement approaches used to promote physical, mental, emotional and spiritual wellbeing. Examples of movement therapies include Feldenkrais method, Alexander technique, Pilates, Rolfing Structural Integration and Trager psychophysical integration. According to the 2007 NHIS, 1.5 percent of adults and 0.4 percent of children used movement therapies.
Practices of traditional healers are a form of complementary medicine. Traditional healers use methods based on indigenous theories, beliefs and experiences handed down from generation to generation. A familiar example in the United States is the Native American healer or medicine man. The 2007 NHIS found that 0.4 percent of adults and 1.1 percent of children had used a traditional healer usage varied for the seven specific types of healers identified in the survey.
Some complementary medicine practices involve manipulation of various energy fields to affect health. Experts sometimes categorize such fields as veritable (measurable) or putative (yet to be measured). Practices based on veritable forms of energy include those involving electromagnetic fields like magnet therapy and light therapy. Practices based on putative energy fields, which experts also call bio-fields, generally reflect the concept that human beings are infused with subtle forms of energy; qi gong, Reiki and healing touch are examples of such practices. The 2007 NHIS found relatively low use of putative energy therapies. Only 0.5 percent of adults and 0.2 percent of children had used energy healing/Reiki the survey defined energy healing as the channeling of healing energy through the hands of a practitioner into the body of the client.
Finally, experts also consider entire medical systems, which are complete systems of theory and practice that have evolved over time in different cultures and exist apart from conventional or Western medicine, complementary medicine. Examples of ancient entire medical systems include Ayurvedic medicine and traditional Chinese medicine. Other modern systems that have developed in the past few centuries include homeopathy and naturopathy. In 2007, the NHIS asked about the use of Ayurveda, homeopathy and naturopathy. Although relatively few respondents said they had used Ayurveda or naturopathy, homeopathy ranked tenth in usage among adults 1.8 percent and fifth among children 1.3 percent.