Sleep Apnoea Syndrome

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[UPDATED SEPTEMBER 2023]

Background

A few years ago, I spent at day at a sleep laboratory with Dr Vesselinova-Jenkins at the Lister Hospital in London. Dr Vesselinova-Jenkin set up the first sleep laboratory in UK and was the first person to describe central and obstructive sleep apnoea. She also was the first in UK to use melatonin to treat sleep disorders and brought melatonin here to the UK from her homeland, Bulgaria. She is primarily a researcher and has produced many papers on sleep problems. See below for a selection:

I was interested in Dr Vesselinova's work because I know that sleep is so important, and often a clinical issue for my CFS and ME patients - see Sleep is vital for good health - especially in CFS. She was interested in me because she was doing new research into food allergy, had found that many sleep disorders were related to food intolerance (and IBS) and that these patients did well on EPD. She wanted to learn about EPD. See Enzyme Potentiated Desensitisation (EPD) - how it works and EPD - the practical details of what to do for each dose.

Patients Who Don't Sleep


CAUSE = LOW MELATONIN

Dr Vesselinova has been measuring blood and salivary melatonin levels through the night and found them to be depressed in CFS patients. This was reported in "Too little melatonin at night in M.E. sufferers" ,'Interaction' Magazine Issue 25 (1998: 26). I cannot find a link for this - if anyone can, please do contact me! This is to be expected since we know that hormone output from the hypothalamus/pituitary/adrenal axis is abnormal - see :

And please also see My Book - The Underactive Thyroid - Do it yourself because your doctor won't which discusses all these issues on detail.

So the pineal, a similar gland, is likely to be affected.

She uses low dose melatonin 2mg at night. This helps restore the normal sleep rhythm. Patients must put themselves to bed at a more "normal" hour, darken the room (or wear shades), cut out noise etc to allow sleep to come naturally. She tells me most patients can reduce their sleeping tablets and then stop them once they are on melatonin.

It is now possible to measure melatonin levels by a salivary test melatonin profile. Please contact my office - Ordering Tests or see Smart Nutrition Melatonin Profile Test - saliva

This tells us when you are producing melatonin and how much. But, I am happy to recommend melatonin on a speculative trial basis. Some patients get depressed on melatonin - so this needs watching out for.

See article Melatonin

Patients Who Sleep Excessively


CAUSE = SLEEP APNOEA

These are the patients she monitors for breathing disorders. What Dr Vesselinova is finding is that these patients stop breathing whilst asleep. There are two common reasons for this. One is called "obstructive sleep apnoea" and occurs when the body is trying to breathe (the respiratory muscles are active), but there is a blockage and no air passes through. Often these patients snore and may be overweight. Snoring aids can help here - for one example see SleepRight Nasal Breathe Aid

The other type of sleep disorder is called "central sleep apnoea". In this case patients have abnormal respiratory centres which simply forget to tell the body to breathe. This may be caused by viral damage or toxic damage from chemicals. This is the common type of sleep disorder in patients with CFS and ME. It is part of the autonomic neuropathy we see in CFS.

When the body stops breathing, oxygen levels fall in the blood. Dr Vesselinova can measure this using a pulse oximeter and showed me some recordings. It is quite extraordinary to see how patients just stop breathing with no muscle movements and no respiratory efforts whilst the level of oxygen in the blood steadily falls by more than 10% of what it should be. Suddenly the body "wakes up" to this dire situation and starts to breathe again. Patients have no idea they are doing this but their sleep is abnormal, they often wake regularly through the night without realising why, they do not feel refreshed in the morning, often waking with morning headache. There is also excessive daytime sleepiness and intellectual deterioration. This is hardly surprising because low levels of oxygen will damage brain cells - the cells in the body most sensitive to oxygen levels.

Treatment Of Sleep Apnoea

Some patients have sleep apnoea because of food intolerance. The commonest foods are wheat and dairy products. However, if avoidance of these foods does not correctly "reset" the respiratory centre, then other things can be tried. The first is low dose aminophyline which is a mild respiratory stimulant. Too much causes sleeplessness. She suggests using Slo-phyllin 60mgs at night. Another possibility for obstructive sleep apnoea is low dose amitriptyline 5mgs, which improves the muscle tone of the airways and helps prevent the airways collapsing.

However, Dr Vesselinova's main treatment for sleep apnoea is to use oxygen at night. This prevents the very low oxygen levels developing and so sleep becomes more normal. She insists this must be done every night for at least 6 months to allow the respiratory centre to adjust back to normal. Most patients just need 6 months of oxygen, but some need long term oxygen at night. But since they feel so much better and are able to function as normal human beings, the effort is well worth it.

Oxygen is given via an oxygen concentrator. This is a machine which concentrates oxygen from room air and delivers it via nasal prongs into the nose at a rate of 1.5 litres/min.

Patients are not breathing 100% oxygen, merely enriched air. These machines are available on the NHS, usually for patients with severe airways obstruction. They can be purchased privately. However, they will not be cheap and an accurate diagnosis is vital before investing this sort of money. My experience is that once the The Paleo Ketogenic Diet - this is a diet which we all should follow is in place and issues of allergy and hypoglycaemia sorted out, oxygen is rarely required. Please see also My book - Paleo-Ketogenic: The Why and The How

Diagnosis of Sleep Apnoea

Ideally all patients should be worked up in a sleep laboratory and the exact nature of their sleep disorder worked out. However, this is simply not possible due to cost restraints and lack of availability.

However, there are some great Sleep Trackers now available - see here for a good review article - The Best Sleep Tracker - ZedNet

Maybe you'd rather not use a Sleep Tracker - some people have serious EMF response to them. So, if you have a sleep partner, ask them to watch you asleep -

  • A healthy person sleeping normally breathes in and out slowly, rhythmically and regularly and each breath is even. For sleep apnoea, look for cessation of breathing or so called "Cheyne-Stokes" respiration, where the breathing becomes progressively heavier, then progressively lighter before stopping a while before building up again to heavier breathing.

See Sleep Foundation - What is Cheyne Stokes respiration?

Any of these observations would support a diagnosis of central sleep apnoea.

For obstructive sleep apnoea (i.e. the airways are blocked) you will see the patient making muscular efforts to breathe (ribcage, chest and abdomen working hard) but no air passes through the mouth or nostrils. When air suddenly gets through, there may be a grunt or snore and the patient may partly wake.

The commonest causes of obstruction sleep apnoea are allergy (the PK diet usually sorts this) and being overweight.

Please refer to the Food allergies section in this website also.

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References

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