clinicalupdate 74 AUGUST 2004 By Mary Birch Obstructive sleep apnoea and breathing retraining About the author Mary Birch, RN, BA, MBioE, Grad Dip Soc, is a registered Buteyko practitioner. Introduction Obstructive sleep apnoea (OSA) is a sleep disorder where repeated upper airway obstruction during sleep leads to a decrease in blood oxygen saturation and disrupted sleep. Current treatment options include oral appliances, surgery, and/or the use of a continuous positive airway pressure (CPAP) machine. However, breathing retraining with the Buteyko Institute Method (BIM) is a safe, effective and convenient approach to OSA that could help eliminate the need for surgery or CPAP. This paper examines the role of breathing retraining in OSA and presents a case study to illustrate its effectiveness. Hyperventilation, OSA and
thousands of years, it is only in the last
breathing retraining Apnoea is defined as the total cessation
of airflow at the nose and mouth, lasting
more. Hypopnoea is generally taken to
associated with lack of quality sleep.
Buteyko dedicated his life to researching
tired, irritable, sleepy during the day,
Buteyko developed spreadinternationally in 1991, and is now used
Dysfunctional breathing and OSA
with ageing, obesity or airway anatomy. OSA profile
airway and a drop in oxygen saturation.
2 clinicalupdate pH shift: CO2 deficit HYPERVENTILATION (respiratory (hypocapnia) alkalosis) BUTEYKO THEORY AND Bohr Effect Bohr Effect OBSTRUCTIVE SLEEP APNOEA Compensation: pH normalised 2 increase (hypoxia) Hyperventilation
breaths, snoring, frequent waking at night
sweating, irritability, lack of concentration,
body are critical in many conditions.
The optimal level of CO2 in the air sacs is
consisting of fluticasone and salmeterol).
gradual alkaline reaction in the lungs.
gradual alkaline reaction in the lungs is
machine, but found it was not effective in
while performing daily living activities and
possibility of surgery to alleviate his OSA.
means of a haemoglobin (Hb) molecule.
day. These exercises, totalling around 15
O2 is bound tighter than normal to the Hb
he only used the CPAP intermittently. Assessment
obviously tired and distressed, unable to
available to the tissues. Therefore, when
concentrate or listen effectively, and at
overweight. John’s initial pulse was high
(at 96) and his respiration rate was 20 per
better and the night sweats had stopped.
breathing, ie. mouth-breathing constantly,
night only and stated that he was feeling
A case study
When John, (not his real name) a 44
improved as were his asthma symptoms.
and the Seretide had been withdrawn. BIM breathing retraining
He was now taking Flixotide (fluticasone)
clinicalupdate 3 Conclusion
results obtained in the first clinical trial of
Institute Method offers a safe, effective,
the need for surgery, oral appliances, or
The benefits of breathing retraining have
and the severity of their condition.
clinical practice in teaching BIM courses
20 episodes of apnoea or hypopnoea alternatives, there are no side effects with
throughout the night without the CPAP. Treatment options
His breathing had improved significantly,
generally involve surgery or nightly however, there are currently no trials
breathing exercises three times per day.
elated, to say: ‘I’ve had repeat sleep
studies done and I don’t have apnoeas at
available do not support the use of drugs
all. Based on the results, I don’t need
Every breath you take, New Holland
Publishers (Australia) Pty. Ltd., Sydney, 1997.
3 Bridgman, S.A., et al. Surgery for obstructive sleepapnoea, Cochrane Review, Issue 2, 2004. Available
/AB001004.htm. Accessed 18 June 2004.
4 National Health and Medical Research Council,
Effectiveness of nasal continuous positive airwaypressure (nCPAP) in obstructive sleep apnoea inadults, 2000. Available at http://www.nhmrc.gov.au/
include dry nose, mouth or throat, rhinitis,
7 Bowler, S.D., et al. Buteyko breathing techniques in
Flixotide (very low dose) daily for ‘security
asthma: A blinded randomised controlled trial,Medical Journal of Australia, December 1998, 169,
Incidence, morbidity and mortality
8 McHugh, P., et al. Buteyko Breathing Technique forasthma: An effective intervention, The New Zealand
In Australia, a 1995 clinical study found
Medical Journal, December 2003, 116:1187.
find them noisy and intrusive, and people
12 Smith, I., et al. Drug treatments for obstructive sleepapnoea, Cochrane Review, Issue 2, 2004. Available at
http://www.cochrane.org/cochrane/revabstr/AB003002.htm. Accessed 21 June 2004.
surgery for OSA found that no completedtrials were identified to compare surgical
interventions for OSA with other surgical
daytime sleepiness associated with or non-surgical interventions or no
number of studies have suggested thatOSA is associated with premature
mortality, largely as a result of vascular
controlled trials to be carried out in the
Associate Professor Paul Desmond, MBBS FRAC and
co-author of Hepatitis C: A medical and social diagnosis
research should be undertaken to identify
(Clinical Update 73, ANJ July 2004, pp.23-25) is director
of gastroenterology, St Vincent’s Hospital, Melbourne,
monitoring an individual’s sleep patterns
Victoria. The ANJ apologises for its error.
Medical and Dental History Patient Name_____________________________________ Date of Birth_______________ Please fill out the form completely to the best of your ability. Health problems that you may have, or medication(s) that you may be taking may have an important interrelationship with the dental care you receive. Thank you. Name of Primary care physician ________________________
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