Several lifestyle changes can make significant reductions in the severity of sleep apnea. Patients should be educated to sleep lying on one side. Weight loss is imperative, given the correlations of increased BMI and neck circumference with OSA. Even modest weight loss can be significant for reducing apnea symptoms; studies have shown that a 10% weight increase can cause a 32% increase in AHI, while a 10% weight loss could produce a 26% decrease in AHI.43 Avoidance of alcohol and sedatives should also be encouraged.
Although specific studies on alternative treatments for sleep apnea are generally lacking, there are well-documented natural therapies that address the altered biochemistry and etio-logic factors known to exist in sleep apnea. These therapies may prove important as adjunctive interventions, which are particularly important, given the well-documented poor compliance with nCPAP=BiPAP interventions and the invasiveness of many conventional options. Diet, nutritional supplements, and environmental modifications may improve sleep-disordered breathing. Controlling inflammation and allergies is paramount in treating OSA. Allergies can cause an increase in adenoids and tonsil size as well as an increase in mucous production, which can occlude the nasal airway.
N-acetyl-cysteine (NAC) is an acetylated ester of the amino acid L-cysteine. NAC has a significant ability to raise glutathione levels in the body, important for its potent antioxidant activity. NAC is also used to treat lung conditions as an expectorant and mucous thinner, and to produce anti-inflammatory effects.44 Studies suggest that NAC decreases production of pro-inflammatory cytokines, such as TNF-alpha, which have been shown to be elevated in individuals with OSA.45
Essential fatty acids (EFAs) cannot be made in the body and need to be consumed in the diet. Omega-3 Figure 5-1. Stinging nettle fatty acids, such as docosahexaenoic acid (DHA) and
(Urtica dioica). eicosapentaenoic acid (EPA), and omega-6 fatty acids, such as gamma-linolenic acid (GLA), are often taken as supplements to utilize their potent anti-inflammatory properties. EPA and DHA are found in high levels in fish oils and provide both anti-inflammatory and antithrombotic effects. Specifically, EPA's cardioprotective effects include decreasing triglycerides, increasing high-density lipoprotein, and preventing arrhythmias.46 EPA and DHA decrease inflammatory eicosanoids by competing with arachidonicacid (AA) in the lipo-oxygenase and cyclo-oxygenase pathways. Fish oils have been shown to decrease several pro-inflammatory cytokines as well.47 GLA is commonly found in borage (Borago officinalis) seed oil, evening primrose (Oenothera biennis) oil, and black currant (Ribes nigrum) oil. GLA decreases the inflammatory response by inhibiting the production of inflammatory leukotrienes from AA.48
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