Buteyko Sleep Apnea. According to K. P. Buteyko, MD-PhD, the level of co2 dioxide in the lungs is the primary limiter of many bodily functions. When this level is below normal, the body is thrown off balance: the pH level is negatively influenced along with the oxygenation of various organs (for more information, please, read the Theory of the Dr. Buteyko’s method). Over time the CO2 degree in the lungs could become dangerously low because of this of hyperventilation. This creates a life-threatening situation. The body will attempt to prevent this from happening and will fight to keep the CO2 level in the lungs as near the norm as possible.
More information about Buteyko Sleep Apnea
Dr. Buteyko found out that many people habitually hyperventilate, which lowers their CO2 level. Hyperventilation becomes especially strong when a person breathes through his or her mouth. Nasal breathing is essential for maintaining health. Unfortunately, switching to sinus breathing can sometimes be a difficult task for individuals who constantly breathe through their mouth during the day and especially during the night.
Buteyko Method – Sleep Apnea by Patrick McKeown
1. Breathing re-education to achieve nasal and normal second volume for sleep MEAT MCKEOWN MA ButeykoClinic. com
2. Increased inflammation of upper and lower airways Increased stickiness of higher airways Reduced lung volume Reduced nasal NO Decreased ventilation/perfusion Reduced messages to upper dilator muscles Lowered ETCO2 Increased ventilatory respond to CO2 Lighter sleep Dental Breathing
3. More wet upper and lower airway Reduced stickiness of top airways Improved lung quantity Nasal NO Improved ventilation/perfusion Increased messages to higher dilator muscles More normal ETCO2 Reduced ventilatory response to CO2 Deeper sleep Nasal Breathing
4. Reduced negative pressure in higher airways Enhanced concentrations of nasal NO Improved ventilation/perfusion More normal ETCO2 Improved functioning of nasal airways- starling resistor model Easier to maintain nasal inhaling and exhaling as less feeling of ‘suffocation’ Reduced ventilatory reaction to CO2 Normal Inhaling and exhaling Volume
5. Four key traits Four key qualities of upper airway anatomy and neuromuscular control interact to varying degrees within individuals to cause OSA. (1) Pharyngeal critical concluding pressure (2) Stability of ventilator chemoreflex feedback control (loop gain) (3) The negative intraesophageal pressure that triggers arousal (arousal threshold) (4) The level of stimulus necessary to activate top airway dilator muscles (upper airway recruitment threshold). AnnalsATS Volume 13 Number 1| January 2016
6. Pcrit – Air pressure at which the passive respiratory tract collapses – Fat deposition both around the pharynx and within upper air passage dilator muscles including the genioglossus (tongue) decreases airway lumen size and causes detrimental changes to upper airway muscle function. AnnalsATS Volume 13 Number 1| January 2016
7. Pcrit – Belly obesity compresses the abdomen and thoracic cavities, minimizing lung volume which reduces tracheal tension and therefore affects pharyngeal mechanics. AnnalsATS Quantity 13 Number 1| Jan 2016
8. Pcrit – Therefore , fat deposition around the pharynx and body both increase airway collapsibility AnnalsATS Volume 13 Amount 1| January 2016
9. Pcrit & Breathing Re-Education Bernoulli Principle – Since fluid flows, a negative pressure develops at the periphery of the movement and that as the flow velocity increases, so will the negative pressure. – (sucking through a paper straw) Snoring and Obstructive Sleep Apnea. David In. F. Fairbanks and Samuel A. Mickelson
10. Pcrit & Breathing Re-Education – 15 (? 3) L/min (Twenty obese men with OSA and normal chest function) – 12. 8 (? 3. 5 )11 obese men with terme conseillé syndrome (OSA & COPD) Radwan L, Maszczyk Unces, Koziorowski A, Koziej M, Cieslicki J, Sliwinski L, Zielinski J. Control over inhaling in obstructive sleep apnea as well as in patients with the overlap syndrome. Eur Breath J. 1995 Apr; 8(4): p. 542-545.
11. Pcrit & Breathing Re-Education – Minute ventilation mouth inhaling and exhaling (8. 43) – Nasal area breathing (9. 37 ) Douglas NJ, White DP, Weil JV, Zwillich CW. Effect of breathing route on ventilation and ventilatory drive. Respir Physiol. 1983 Feb; 51(2): 209-18.
12. Pcrit & Breathing Re-Education Men – Minute ventilation Awaken: 10. 6 – Moment ventilation sleep: 9. 2 Women – Minute air flow Wake: 7. 8 – Minute ventilation sleep: 7. 2 Jordan AS, McEvoy RD, Edwards JK, et al. The influence of gender and upper airway resistance on the ventilatory respond to arousal in obstructive sleep apnoea in humans. The Journal of Physiology. 2004; 558(Pt 3): 993-1004.
13. Pcrit & Breathing Re-Education Minute Volume pre-trial: At three months follow up: BBT 14 L BBT 9. 6 L/min Control Group 14. 2 L/min Control Group 13. 3 L/min The comparative reduction in beta2-agonist use within the BBT group was related to the in proportion reduction in minute quantity Bowler SD, Green A, Mitchell CA, Buteyko inhaling associated with asthma: a blinded randomised manipulated trial. Mediterranean sea J of Australia 1998; 169: 575-578.
14. – The existence of a further upstream obstructive factor (nose) will generate a suction force, that is, a negative intraluminal pressure downstream (oropharynx), leading to pharyngeal collapse in predisposed individuals De Sousa Michels Daniel et al. International Journal of Otolaryngology. Volume 2014 (2014), Article ID 717419 Pcrit & Breathing Re-Education
15. – A shut jaw and proper dental occlusion stabilize the circulation in the upper air passage. – When nasal level of resistance exceeds a certain level, an air bypass occurs and contributes to mouth breathing, resulting in a lower in the retroglossal sizing, due to the succeeding retraction of the tongue, narrowing of the pharyngeal lumen, and increased vacillation and vibration of the taste bud and redundant tissues of the pharynx. Sobre Sousa Michels Daniel et al. International Journal of Otolaryngology. Volume 2014 (2014), Article ID 717419 Pcrit & Breathing Re-Education
16. 10 normal men had full night recordings before and during nasal obstruction. Throughout nasal obstruction, time invested in the deep sleeping stages decreased from ninety to 71 min, whilst a lot more time was spent in Stage 1 rest. Twofold embrace sleep arousals and awakening resulting from an increased number of apneas (34 during control sleep versus 86 during obstructed sleep). Zwillich CW, Pickett C, Hanson FN, Weil JV Disturbed rest and prolonged apnea during nasal obstruction in normal men. J Pediatr (Rio J). 2011 Jul-Aug; 87(4): 357-63. Epub 2011 Jul 18. Pcrit & Inhaling and exhaling Re-Education
17. – Apneas of 20 to 39s in duration became 2. five times more frequent during obstruction. – De-saturation (SaO2 less than 90%) occurred 28 times during control sleeping in contrast to 255 times during obstructed sleep. Disturbed sleep and prolonged apnea during nasal obstruction in normal men. Am Rev Respir Dis. 1981 Aug; 124(2): 158-60. Pcrit & Breathing Re-Education
18. Loop Acquire
19. Loop Gain – While asleep, ventilatory control is dominated by the degree of CO2 and T-MOBILE in the blood. Arterial CO2 has the higher influence, with increasing CO2 stimulating an increase in ventilatory drive. Annals OBTAIN THE Volume 13 Number 1| January 2016
20. Loop Gain – Ventilatory drive determines not only the level of activity of the thoracic pump muscles but additionally the upper airway dilator muscles. – Consequently, the top airway is susceptible to collapse when CO2, and therefore neural drive to the upper airway muscles, is low. AnnalsATS Quantity 13 Number 1| Jan 2016
21. Trap Gain – When the main respiratory output waxes and wanes, the activity of the top airway dilator muscles varies accordingly so that periods of low key respiratory drive are associated with low upper airway dilator muscle activity, high airway resistance, and a predisposition to respiratory tract collapse. – Thus, respiratory control instability (also known as high loop gain) is probably a instrumental factor of obstructive rest apnoea in some patients. Lancet. 2014 February twenty-two; 383(9918): 736-747.
22. Lung Volume
23. Loop Gain – After arousal, most people hyperventilate briefly and if large enough, CO2 concentration in blood can fall below the chemical apnoea tolerance, resulting in a core apnoea. Lancet. 2014 Feb 22; 383(9918): 736-747.
24. – After a switch to oral inhaling during sleep, there is greater CO2 elimination during expiration, caused by an increase in respiratory stimulus. The increase in central apneas suggests that the nose plays an important role in the regulation of respiration and not just in the maintenance of respiratory tract patency. De Sousa Michels Daniel et al. Global Journal of Otolaryngology. Quantity 2014 (2014), Article IDENTIFICATION 717419 Loop Gain
25. Loop Gain – Ventilatory responses were better with mouth than nasal area breathing both for hypercapnia (mouth 2. 29, nasal area 1 . 58 L/min/mm Hg CO2; ) and for hypoxia (mouth 1. 08 nose 0. 91 +/- 0. 21 L/min/% SaO2; ). – (lowers cycle gain. More stable) Douglas NJ, White DP, Von daher JV, Zwillich CW. Result of breathing route on ventilation and ventilatory drive. Respir Physiol. 1983 February; 51(2): 209-18.
26. Loop Gain – Increased loop gain defines less-stable control, as a disproportionately large ventilatory reaction will result in a greater amount of hypocapnia and subsequent lowering of ventilatory drive. Annals ATS Volume 13 Number 1| January 2016
27. Loop Gain – Hence, high loop gain plays a part in perpetuating apneas. Supporting this concept is evidence that patients with OSA have higher loop gain than patients without OSA and that loop gain predicts AHI. Annals ATS Volume 13 Number 1| January 2016
28. – Mouth area breathing boost the ‘dryness’ of the upper airway mucosal surface. – Increased wall ‘stickiness’ will then make the higher airway more difficult to reopen after closure. Manisha Verma, Margaret Seto-Poon, John L Wheatley, Terence C Amis, Jason P Kirkness. Effect of breathing route on upper airway lining water surface tension in humans. J Physiol. 2006 Aug 1; 574(Pt 3): 859-866. Loop Acquire
29. Increased lung volume also probably stabilises the respiratory control system by increasing the shops of O2 and CO2 and thus, buffering the blood fumes from changes in ventilation. Lancet. 2014 Feb twenty-two; 383(9918): 736-747 Loop Obtain
30. Arousal Threshold
31. Arousal Tolerance – Another potentially important factor is the propensity to arouse from rest (the arousal threshold). Lancet. 2014 February 22; 383(9918) – Increasing negative intraesophageal pressure during airway blockage triggers arousal, and the change from sleep to wake increases basal chemoreflex drive and sensitivity. Annals ATS Volume 13 Amount 1| January 2016
32. Arousal Threshold – Individuals with low arousal thresholds might arouse before the dilator muscles are able to reopen the airway. – Delay of arousal with sedatives might help to treat the condition if the upper airway muscles are sufficiently responsive to respiratory stimuli to secure the airway before sexual arousal levels. Amy S. Jordan, PhD, David G. McSharry, MEGABYTES, and Prof. Atul Malhotra, Adult obstructive sleep apnoea Lancet. 2014 Feb twenty-two; 383(9918): 736-747
33. Arousal Threshold – Obstructive events terminated by arousal bring about a greater amount of hyperventilation and consequent hypocapnia and reduction in ventilatory drive, including drive to upper airway muscles. Annals ATS Volume 13 Number 1| January 2016
34. Upper Airway Recruitment Threshold – If the upper airway muscle responsiveness is sufficiently poor, then arousal is important to start airway opening. Annals OBTAIN THE Volume 13 Number 1| January 2016
35. Arousal Threshold – Therefore, arousals may perpetuate successive obstructions. – A high arousal threshold (aroused by more negative pressures) shows up to develop in many patients with OSA being an adaptive mechanism, as a larger magnitude of both negative pressure stimuli and chemostimulation can accumulate to recruit upper airway dilator muscles to terminate the event before arousal. Annals OBTAIN THE Volume 13 Number 1| January 2016
36. Upper Airway Recruitment Tolerance
37. Upper Air passage Recruitment Threshold – Typically the magnitude of stimuli (both negative pressure stimuli and chemostimulation) needed to recruit upper airway dilator muscles properly to overcome negative intrapharyngeal closing pressures is called the upper airway recruiting threshold. Annals ATS Quantity 13 Number 1| January 2016
38. Top Airway Recruitment Threshold – Poor upper airway muscle responsiveness increases the period of obstructive events, as greater stimuli are required to activate the muscles to terminate the obstruction. Annals ATS Volume 13 Number 1| January 2016
39. Upper Air passage Recruitment Threshold – Elevated chemoreflex drive due to both prolonged obstruction and arousal increases the ventilatory reaction after airway starting. Thus, poor upper respiratory tract recruitment treats arousal threshold and loop gain to contribute to repetitive apnea. Annals ATS Volume 13 Number 1| January 2016
40. – SIMPLY NO appears to play a role in maintaining the patency of top of the airways, as a transmitter between the nose, pharyngeal muscles, and lungs. NO is produced in significant quantities in the nose and in the paranasal sinuses. De Sousa Michels Daniel et al. International Journal of Otolaryngology. Volume 2014 (2014), Article ID 717419 Higher Airway Recruitment Threshold
41. – Nitric oxide and carbon dioxide may also act as aerocrine messengers. Physiological, epidemiological, and clinical evidence support a “unified airway” model. James Bartley, Conroy Wong. Nasal Physiology and Pathophysiology of Nose Disorders pp 559-566. Day: 27 June 2013 Upper Airway Recruitment Threshold
42. NO also takes on a role in the maintenance of muscle tone, regulation of neuromuscular paths in the pharyngeal muscles, spontaneous respiration, and sleeping regulation. In general, the role of NO in the regulation of nose OSAS, although probably considerable, is still not completely understood. De Sousa Michels Daniel et al. Global Journal of Otolaryngology. Volume 2014 (2014), Article IDENTIFICATION 717419 Upper Airway Recruiting Threshold
43. Because the total amount of inspired NO varies based on the nasal flow, it appears logical that the decrease in nasal breathing would lead to reduction of NO shipping to the lungs. – Ventilation-perfusion ratio. De Sousa Michels Daniel et ‘s. International Journal of Otolaryngology. Volume 2014 (2014), Content ID 717419 Upper Respiratory tract Recruitment Threshold
44. Prevalence between asthma and OSA ranges from 38% up to as high as 70 percent. – Based on the current concepts of bidirectional relationship of OSA and asthma, it is reasonable to assume that treating one disorder will bring about the other’s better control and vice versa. Abdul Razak MR, Chirakalwasan N. Obstructive sleep apnea and breathing difficulties. Asian Pac J Allergy Immunol. 2016 Dec; 34(4): 265-271. Upper Airway Recruitment Threshold
45. The bottom and upper airways are mechanically linked, so that with increased lung quantities, leading to stiffening and dilation of the pharyngeal respiratory tract. Amy S. Jordan, PhD, David G. McSharry, MB, and Prof. Atul Malhotra, MD Adult obstructive sleep apnoea Lancet. 2014 February 22; 383(9918): 736-747. Upper Airway Recruitment Threshold
46. Research to determine – Controlled, randomized, single-blind examine. Breathing reeducation on asthmatic mouth breathing children. thirty-five children with mild or moderate asthma in the age group between seven and 12 years. – Karla M. P. P. Mendonca, Thalita M. Farrenheit. Macedo, Diana A. Freitas, Ada C. J. H. Silva, Cleia T. Amaral, Thayla A. Santino, Meat McKeown. American Journal of Respiratory and Critical Proper care Medicine 2017; 195: A2204. Buteyko Method for Kids with Asthma and Mouth area Breathing: A Randomized Controlled Demo
47. Research to determine – Breathing re-education group significantly improved the scores on sleep disorders, wakefulness disorders, sleep awaken transition disorders (DTSV), the number of days off school, total sleep hindrance scores, forced essential capacity (FVC), peak Expiratory circulation and forced expiratory flow between 25% and 75% of FVC (FEF25-75%). – Karla M. P. P. Mendonca, Thalita M. F. Macedo, Diana A. Freitas, Ada C. J. S. Silva, Cleia T. Amaral, Thayla A. Santino, Patrick McKeown. American Journal of Respiratory and Critical Care Treatments 2017; 195: A2204. Buteyko Way for Children with Breathing difficulties and Mouth Breathing: The Randomized Controlled Trial
48. volunteers with a diagnosis of asthma and chronic rhinitis, ranging in age from 23 – 60 years were recruited from the general population. Adelola O. A., Oosthuiven J. C., Fenton J. E. Role of Buteyko breathing technique in asthmatics with nasal symptoms. Clinical Otolaryngology. 2013, April; 38(2): 190-191 Research to determine
49. Research to determine
50. Research to determine
51. Research to ascertain – Relationship between minute volume level and OSA – Breathing pattern during wakefulness and sleep – Normalisation of breathing pattern during wakefulness carries into sleep – Can breathing re-education prove to be a highly effective adjunctive measure for patients with CPAP or treated with surgery?
52. QUESTIONS: Electronic: patrick@buteykoclinic. com
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