Introduction to common Sleep disorders
Sleep is one of the most important functions of the body; sleep allows the body to heal and the brain to reconsolidate memory. In our modern lifestyle, many of us have sacrificed our sleep for various reasons; some do it for work or study, some do it for parties and fun, not having the proper sleep-wake cycle can adversely affect our long-term health (Medic, Wille, & Hemels, 2017). This is the first of a series of blogs on the topic of SLEEP. My parents suffer from chronic health issues due to sleep disorders, from my personal and professional experience, I would say sleep disorders were frequently managed poorly by the western health system. My parents are both western medical doctors and one of the issues I observed was the use of western medications for sleep without understanding the cause of the sleep disorders or understanding of the medications on sleep. For example, Endep (amitriptyline) is one of the most frequently used medications for pain and insomnia, however, in order for the body to heal we need quality deep sleep, while Endep assists onset of sleep it adversely affects REM sleep (Postuma et al., 2013; Wichniak, Wierzbicka, Walęcka, & Jernajczyk, 2017), and potential worsen sleep apnoea (Jullian‐Desayes et al., 2017). There are many different sleep disorders; common sleep issues are listed in Figure 1, Sleep apnoea and insomnia being the most common ones (Cleveland Clinic, 2013).
Sleep apnoea occurs when a person’s airway is obstructed or when a person stops breathing and causes a drop in the oxygen saturation level in the blood. Insomnia is when a person struggles to fall asleep or having trouble staying asleep. Sleep apnoea has strong links to many chronic health conditions which include anxiety, depression, arrhythmia, high blood pressure, congestive heart failure, type II diabetes, obesity, stroke, impotence (Heatley et al., 2013). Sleep apnoea also impaired cognitive function, head posture and craniofacial growth of the growing population (Chambi‐Rocha, Cabrera‐Domínguez, & Domínguez‐Reyes, 2018; Lee, Guilleminault, Chiu, & Sullivan, 2015)
It is estimated 30% of Australians have experience insomnia, the leading causes of insomnia are poor sleep hygiene, consumption of stimulants (caffeine, nicotine) and mental stress (healthdirect.gov.au, 2019). Western medical treatments for sleep apnoea are:
Advantages: effective short to long term
Disadvantages: result in sleep fragmentation, adverse cranial facial changes, requires compliance.
2. Oral appliance
Advantages: high compliance, effective
Disadvantages: possible dental changes, requires compliance and good dental condition.
3. Surgical treatment
Disadvantages: invasive, depending on the type of surgery, there can be many side effects.
Dr Chan’s opinion:
There is only 36% of patients use CPAP 4.46 hours a night only (Rotenberg, Murariu, & Pang, 2016), which means if the patient sleeps for a recommended 8 hours a night would still suffer from sleep apnoea for half of the night, it is also interesting to find that these patients have an increased risk of kidney cancer and melanoma (Gozal, Farré, & Nieto, 2015; Gozal, Ham, & Mokhlesi, 2016). In order for an effective result, patients require a holistic treatment combining Chinese medicine with western modalities.
Many patients with sleep apnoea suffer from nasal obstructions without being assessed before being prescripted CPAP or oral appliance; however, western medical treatments are effective there can be limited long-term results (Cheng et al., 2018; Sohn, 2018). Acupuncture was shown to be effective in improving nasal obstructions (Arguder, Yilmaz, Ates, Misirligil, & Bavbek, 2012; Liang, Lenon, & Yang, 2017; Ma, Bu, Li, LÜ, & Zhang, 2018; Zhang, Li, Xu, & Ernst, 2012). Many patients would also be asked to lose weight with very little guidance while Chinese medicine diet therapy can provide personalised advice for these patients according to their constitution.
Western medical treatments for insomnia often involved drugs that affect deep restorative sleep; as a result of lack of slow-wave sleep (restorative sleep), not only decreases the healing capacity of the body, but it also increases daytime fatigue as well as impair cognitive function (Gilles Lavigne, 2011).
One of the reasons I decided to study Chinese medicine was because I have seen too many patients taking various drugs to “help” their sleep but as a result of worsening their long term health. Chinese medicine practitioners routinely ask about sleep during our patient interviews because sleep is one of the most important restorative (healing) functions of the body.
The Master Degree in Chinese Medicine has taught me to investigate all diseases holistically, especially chronic diseases, and to use evidence-based therapies base on good researches. Chinese Medicine therapy has shown to be effective for Nasal obstructions, Weight management (Kim, Shin, & Park, 2018), Chronic Pain-Related Insomnia (Liu et al., 2019), Stress management(Aung, Fay, & Hobbs, 2013).
While western medicine is excellent at correcting structural issues, combining with Chinese Medicine therapies can assist the body to heal and function better.
Arguder, E., Yilmaz, I., Ates, C., Misirligil, Z., & Bavbek, S. (2012). Self-reported knowledge and approaches toward complementary and alternative medicine among physicians dealing with allergic diseases.
Am J Chin Med, 40(4), 671-683. doi:10.1142/s0192415x12500504Aung, S. K. H., Fay, H., & Hobbs, R. F. (2013). Traditional Chinese Medicine as a Basis for Treating Psychiatric Disorders: A Review of Theory with Illustrative Cases. 25(6), 398-406. doi:10.1089/acu.2013.1007
Chambi‐Rocha, A., Cabrera‐Domínguez, M. E., & Domínguez‐Reyes, A. (2018). Breathing mode influence on craniofacial development and head posture. Jornal de Pediatria (Versão em Português), 94(2), 123-130. doi:https://doi.org/10.1016/j.jpedp.2017.08.022
Cheng, L., Chen, J., Fu, Q., He, S., Li, H., Liu, Z., . . . Zhang, L. (2018). Chinese Society of Allergy Guidelines for Diagnosis and Treatment of Allergic Rhinitis. Allergy, Asthma & Immunology Research, 10(4), 300-353. doi:10.4168/aair.2018.10.4.300
Cleveland Clinic. (2013). Common Sleep Disorders. Retrieved from https://my.clevelandclinic.org/health/articles/11429-common-sleep-disorders
Gilles Lavigne, M. T. S., Ronald Denis, and Marco Zucconi. (2011). Pain and Sleep. Principles and Practice of Sleep Medicine, 1442-1451. doi:10.1016/B978-1-4160-6645-3.00126-2
Gozal, D., Farré, R., & Nieto, F. J. (2015). Putative Links Between Sleep Apnea and Cancer. Chest, 148(5), 1140-1147. doi:10.1378/chest.15-0634
Gozal, D., Ham, S. A., & Mokhlesi, B. (2016). Sleep Apnea and Cancer: Analysis of a Nationwide Population Sample. 39(08), 1493-1500. doi:10.5665/sleep.6004
Hamoda, M. M., Almeida, F. R., & Pliska, B. T. (2019). Long-term side effects of sleep apnea treatment with oral appliances: nature, magnitude and predictors of long-term changes. Sleep Medicine, 56, 184-191. doi:10.1016/j.sleep.2018.12.012
healthdirect.gov.au. (2019). Insomnia. Retrieved from https://www.healthdirect.gov.au/insomnia
Heatley, E. M., Harris, M., Battersby, M., McEvoy, R. D., Chai-Coetzer, C. L., & Antic, N. A. (2013). Obstructive sleep apnoea in adults: A common chronic condition in need of a comprehensive chronic condition management approach. Sleep Medicine Reviews, 17(5), 349-355. doi:10.1016/j.smrv.2012.09.004
Jullian‐Desayes, I., Revol, B., Chareyre, E., Camus, P., Villier, C., Borel, J. C., . . . Joyeux‐Faure, M. (2017). Impact of concomitant medications on obstructive sleep apnoea. British Journal of Clinical Pharmacology, 83(4), 688-708. doi:10.1111/bcp.13153
Kim, S. Y., Shin, I. S., & Park, Y. J. (2018). Effect of acupuncture and intervention types on weight loss: a systematic review and meta-analysis. Obesity Reviews, 19(11), 1585-1596. doi:10.1111/obr.12747
Lee, S. Y., Guilleminault, C., Chiu, H. Y., & Sullivan, S. S. (2015). Mouth breathing, “nasal disuse,” and pediatric sleep-disordered breathing. Sleep Breath, 19(4), 1257-1264. doi:10.1007/s11325-015-1154-6
Liang, Y., Lenon, G. B., & Yang, A. W. H. (2017). Acupressure for respiratory allergic diseases: a systematic review of randomised controlled trials. Acupunct Med, 35(6), 413-420. doi:10.1136/acupmed-2016-011354
Liu, F., You, J., Li, Q., Fang, T., Chen, M., Tang, N., & Yan, X. (2019). Acupuncture for Chronic Pain-Related Insomnia: A Systematic Review and Meta-Analysis. Evidence-Based Complementary and Alternative Medicine, 2019, 1-10. doi:10.1155/2019/5381028
Ma, Y., Bu, H., Li, X., LÜ, H., & Zhang, X. (2018). Acupuncture–moxibustion therapy of “banking up original qi and consolidating the foundation” for prevention and treatment of seasonal allergic rhinitis: A randomized controlled trial. World Journal of Acupuncture – Moxibustion, 28(1), 33-37. doi:https://doi.org/10.1016/j.wjam.2018.03.018
McNicholas, W. T. (2008). The nose and OSA: variable nasal obstruction may be more important in pathophysiology than fixed obstruction. European Respiratory Journal, 32(1), 3-8. doi:10.1183/09031936.00050208
Medic, G., Wille, M., & Hemels, M. (2017). Short- and long-term health consequences of sleep disruption. Nature and science of sleep, Volume 9, 151-161. doi:10.2147/nss.s134864
Olson, E. J., Moore, W. R., Morgenthaler, T. I., Gay, P. C., & Staats, B. A. (2003). Obstructive Sleep Apnea-Hypopnea Syndrome. Mayo Clinic Proceedings, 78(12), 1545-1552. doi:10.4065/78.12.1545
Postuma, R. B., Gagnon, J.-F., Tuineaig, M., Bertrand, J.-A., Latreille, V., Desjardins, C., & Montplaisir, J. Y. (2013). Antidepressants and REM Sleep Behavior Disorder: Isolated Side Effect or Neurodegenerative Signal? doi:10.5665/sleep.3102
Proctor, A., & Bianchi, M. T. (2012). Clinical Pharmacology in Sleep Medicine. ISRN Pharmacology, 2012, 1-14. doi:10.5402/2012/914168
Rotenberg, B. W., Murariu, D., & Pang, K. P. (2016). Trends in CPAP adherence over twenty years of data collection: a flattened curve. Journal of Otolaryngology – Head & Neck Surgery, 45(1). doi:10.1186/s40463-016-0156-0
Sohn, M. H. (2018). Efficacy and Safety of Subcutaneous Allergen Immunotherapy for Allergic Rhinitis. Allergy, Asthma & Immunology Research, 10(1), 1. doi:10.4168/aair.2018.10.1.1
Sui, Y., Zhao, H. L., Wong, V. C. W., Brown, N., Li, X. L., Kwan, A. K. L., . . . Chan, J. C. N. (2012). A systematic review on use of Chinese medicine and acupuncture for treatment of obesity. Obesity Reviews, 13(5), 409-430. doi:10.1111/j.1467-789x.2011.00979.x
Tsuda, H., Almeida, F. R., Tsuda, T., Moritsuchi, Y., & Lowe, A. A. (2010). Craniofacial Changes After 2 Years of Nasal Continuous Positive Airway Pressure Use in Patients With Obstructive Sleep Apnea. Chest, 138(4), 870-874. doi:10.1378/chest.10-0678
Wichniak, A., Wierzbicka, A., Walęcka, M., & Jernajczyk, W. (2017). Effects of Antidepressants on Sleep. Current Psychiatry Reports, 19(9). doi:10.1007/s11920-017-0816-4
Zhang, J., Li, X., Xu, J., & Ernst, E. (2012). Laser Acupuncture for the Treatment of Asthma in Children: A Systematic Review of Randomized Controlled Trials. Journal of Asthma, 49(7), 773-777. doi:10.3109/02770903.2012.691194
Zhang, K., Zhou, S., Wang, C., Xu, H., & Zhang, L. (2018). Acupuncture on Obesity: Clinical Evidence and Possible Neuroendocrine Mechanisms. Evidence-Based Complementary and Alternative Medicine, 2018, 1-15. doi:10.1155/2018/6409389