Adults typically require 7-9 hours of sleep per night to function optimally and maintain good physical and mental health. Imagine how exhausting and frustrating it is when a sleeping partner is keeping you up at night, snoring like a warthog, gasping for air and choking. New research has found that an ancient Indian practice, known as Shankh Blowing, may help restore peace and harmony to the bedroom.

Sleep disorders, such as sleep apnoea, are on the increase, disturbing both the sufferer and the sleeping partner. A breath-holding sleep sufferer might not just be an annoying snorer; they could have developed a potentially life-threatening sleep disorder. The disrupted sleep of both people can cause relationship issues and leave couples sleeping in separate bedrooms.

 

What is sleep apnoea and why does it happen?

Sleep apnoea is a condition that can develop in children, women and men. It is a common sleep disorder which needs to be treated. It happens when the muscles in the throat relax too much, cutting off the airway, and breathing stops several times through the night. In fact, it can happen many times every hour. A person may not be aware that they have a sleep disorder until their sleep-deprived sleeping partner tells them.

 

There are 4 types of sleep apnoea:

1. Obstructive sleep apnoea (OSA).
2. Central sleep apnoea (CSA).
3. Mixed sleep apnoea (TE-CSA).
4. Obesity hypoventilation (OHS).

 

Obstructive sleep apnoea

OSA is the most common sleep-related breathing disorder. When sleeping, the throat muscles relax, narrowing the airways, lowering the level of oxygen in the blood and causing a buildup of carbon dioxide. The same muscles support the roof of the mouth, soft palate and tongue. The brain senses the change and briefly disturbs sleep so the airway can reopen. It can make a person snort, snore, gasp or choke. This can happen 5-30 times an hour and stops deep, restful sleep.

 

Central sleep apnoea

CSA is different to OSA and is a less common sleeping disorder. It happens when the brain doesn’t send the proper signals to the muscles that control breathing, and the airways are partially blocked. Breathing pauses, and then a person suddenly awakens. Snoring isn’t as noticeable with this condition. CSA can happen due to other conditions such as heart failure, a stroke or sleeping at a high altitude. A person would be more aware of the disorder.

 

Mixed sleep apnoea

Mixed sleep apnoea is also known as treatment-emergent central sleep apnoea (TE-CSA). It starts as OSA – blocked airways and transitions to CSA – lack of signals to the brain.

 

Obesity hypoventilation

OHS, otherwise known as Pickwickian syndrome, is a breathing disorder which affects people with obesity. It is a combination of obesity, hypoventilation and sleep disorder breathing. It is a life-threatening condition where there is too much carbon dioxide in the blood and not enough oxygen. This is due to hypoventilation, where a person is breathing at an abnormally slow rate.

 

It’s not always a ‘good morning!’

When a sufferer wakes up, they normally feel unrefreshed and not rested. They can experience headaches, dry mouth, brain fog and raised blood pressure, all of which can result in mood changes and depression. Unfortunately, sleep disorders can result in low oxygen levels, which can cause degeneration of certain brain regions associated with memory loss. Find out more here.

 

The science of sleeping.

It’s a mystery; the exact reason we sleep is unknown. It’s a science. Sleeping is a remarkably complex process; it affects nearly all the systems of the body. It alters brain activity, hormone production, and the chemicals that regulate sleep and wakefulness.

Within a minute of falling asleep, changes start to happen to the body and the brain. The body temperature drops, brain activity calms down, and the heart and respiratory system slow down. The body then goes through multiple sleep cycles, each lasting between 70 and 120 minutes, with different sleep stages.

 

There are 2 key drivers for sleep: the sleep/wake homeostasis and the circadian alerting system.

The sleep/wake homeostasis is the body’s built-in mechanism that creates pressure to sleep, biologically driven, making you feel increasingly tired toward the end of the day. During sleep, the pressure decreases, allowing you a good night’s sleep. When you wake, the pressure starts to build again, and the cycle continues.

The circadian rhythm is the body’s internal clock. The alerting system generates a progressive signal for alertness throughout the day. Light is the main cue in the morning; your eyes detect light. At nighttime, light decreases, promoting sleep.

When you wake up, a chemical process happens in the brain, including an increase in neurotransmitters, allowing for wakefulness. The light triggers the production of cortisol and promotes alertness. The chemical associated with drowsiness is broken down, so it reduces sleep drive.

At bedtime, chemicals shift and the brain changes from wakefulness to rest due to a decrease in the neurotransmitters. A sleep-promoting chemical called GABA increases, and melatonin is triggered by darkness, which helps to induce sleepiness. The brain gets told it’s time to rest.

 

How is sleep apnoea diagnosed?

By the time a person visits a doctor about their sleeping disorder, they will have a good indication of symptoms due to their sleeping partner making them aware. The doctor will ask further questions about sleep history, lifestyle, family history, if you’ve had an accident, taking sedatives, smoking, being overweight or drinking alcohol.

 

How can sleep apnoea be treated?

In August, ITV X published an article about the ancient ritual of conch blowing to help those with sleep disorders. It’s a centuries-old Indian ritual with modern health benefits. New research has revealed that blowing a conch shell, known as shankh blowing, can improve sleep.

Dr Krishna K Sharma, director of pulmonology and leading researcher of the latest study at the Eternal Hospital in Jaipur, told ITV News, “This simple practice strengthens the breathing muscles and improves airway tone, helping keep passages open during sleep.” He said, “Many participants slept better, snored less, and felt more energetic during the day.”. Read the full article here.

 

The traditional approach to treating sleeping disorders is:

Lifestyle changes – maintain a healthy weight, take regular exercise, avoid alcohol and sleeping pills. Create a quiet sleeping space, and have a consistent sleeping schedule.

Sleeping position – side sleeping is the best position because it helps to keep the airways open. Pillows can be used to stop rolling over, and specialised pillows are available.

CPAP (continuous positive airway pressure) machine – the machine delivers a continual flow of gentle air pressure through a mask to help keep the upper airway clear.

Nasal pillow mask or nasal cushion mask – the masks deliver pressurised air only through the nose and are suitable for nasal breathers.

EPAP (expiratory positive airway pressure) device – the device is a non-motorised, disposable or reusable valve worn in the nostrils, and it creates pressure during exhalation to keep the airway open.

BiPAP (Bilevel positive airway pressure) device – a non-invasive ventilation device that delivers two different levels of air pressure through a mask during sleep. Higher levels for inhaling and lower levels for exhaling.

Surgery – throat tissue can be removed via a uvulopalatopharyngoplasty (UPP) procedure. A maxillomandibular advancement (MMA) procedure can be done to reposition the jaw. Nasal surgery called septoplasty, turbinate reduction, and tongue-based surgery, or hypoglossal nerve stimulation, are also options.

Chin straps – the straps keep the mouth closed during sleep to prevent air from leaking out and reduce dryness in the mouth, and support the jaw positioning.

Mouthguards – using structural adjustments to open the airway.

 

 

References

https://www.hopkinsmedicine.org/health/conditions-and-diseases/sleepwake-cycles

https://www.ninds.nih.gov/health-information/public-education/brain-basics/brain-basics-understanding-sleep

https://www.mayoclinic.org/healthy-lifestyle/adult-health/expert-answers/how-many-hours-of-sleep-are-enough/faq-20057898

https://www.mayoclinic.org/diseases-conditions/obstructive-sleep-apnea/symptoms-causes/syc-20352090

https://www.mayoclinic.org/diseases-conditions/central-sleep-apnea/symptoms-causes/syc-20352109

https://my.clevelandclinic.org/health/diseases/24393-obesity-hypoventilation-syndrome