In addition to the interventions described in this protocol, readers should also review the Life Extension protocols on Weight Loss, Cardiovascular Disease, Chronic Inflammation, and Diabetes, given the strong associations between sleep apnea and metabolic health. In addition, a number of strategies for improving sleep quality and sleep hygiene in general are described in the Insomnia protocol and may be of use for those with sleep apnea.
Cysteine is an amino acid used by the body to synthesize the critical detoxification and antioxidant molecule glutathione; and N-acetyl cysteine (NAC) has mucus-reducing (mucolytic) properties (Tse 2014; Lu 2013). In a placebo-controlled, randomized trial in 20 adults with obstructive sleep apnea, 600 mg of NAC was given three times daily for 30 days. The NAC group experienced multiple significant improvements in measurements of apnea severity and sleep quality. NAC produced marked reductions in snoring and sleepiness compared with placebo. The NAC group showed significant reductions in oxidative stress as measured by lipid peroxidation and total reduced glutathione level (Sadasivam 2011). In an animal model of sleep apnea, supplementation with NAC mitigated oxidative stress and inflammation that occurred as a result of intermittent hypoxia (da Rosa 2015).
In a preliminary study, 10 people with obstructive sleep apnea were found to have dysfunction of the delicate lining of blood vessels (the endothelium) compared with 10 healthy controls. After a single 500 mg dose of intravenous vitamin C, endothelial function improved to a level comparable to that of the healthy subjects (Grebe 2006). In another study, a combination of 100 mg of vitamin C and 400 IU of vitamin E, taken by mouth twice daily for 45 days, led to reductions in apneic episodes and daytime sleepiness, and improved sleep quality, in obstructive sleep apnea patients being treated with CPAP. People taking the vitamin C and E combination were able to reduce pressure settings on their CPAP machines (Singh 2009).
Individuals with obstructive sleep apnea have been reported to have low vitamin E levels (Barcelo 2006). As mentioned previously, combination vitamin E and C treatment was shown to benefit patients with obstructive sleep apnea (Singh 2009). Another study used a combination antioxidant treatment that included vitamin E in a comparison of breathing function in 13 healthy men and 13 men with obstructive sleep apnea. Both groups were exposed to intermittent hypoxia to mimic sleep apnea conditions, but before this exposure participants were randomly selected to receive pretreatment with either an antioxidant cocktail or placebo. The antioxidant treatment was an oral combination of 200 IU vitamin E, 60 mg coenzyme Q10, and 400 mg of the enzyme superoxide dismutase, given with yogurt, along with two intravenous doses of 1000 mg vitamin C. In the placebo group, both healthy controls and those with sleep apnea showed increased involuntary breathing effort, though that effort was significantly greater in the sleep apnea group. However, the men with obstructive sleep apnea who received the antioxidant treatment showed significantly better respiratory function compared with those receiving placebo treatment (Lee 2009).
Coenzyme Q10 (CoQ10) is involved in mitochondrial energy production and is best known for its beneficial effects on the heart and cardiovascular system (Garrido-Maraver 2014). As demonstrated in the study mentioned previously, CoQ10 in combination with other antioxidants favorably influenced respiratory function in men with obstructive sleep apnea (Lee 2009). It should be noted that patients with sleep apnea are at increased risk for cardiovascular disease, high blood pressure, and impaired glucose tolerance; and supplementation with CoQ10 may confer a benefit in all of these conditions (Kizaki 2014; Amin 2014; Garrido-Maraver 2014; Schmelzer 2008).
Selenium is an essential component and regulator of an enzyme called glutathione peroxidase, which is an important part of the body’s cellular oxidative stress defense systems (Rotruck 1973; Baker 1993). In a study of trace minerals in 44 individuals newly diagnosed with mild-to-moderate obstructive sleep apnea compared to 20 healthy controls, those with sleep apnea had lower levels of red blood cell selenium and glutathione peroxidase activity than people without apnea. There were significant differences in these measures between those with moderate compared to mild obstructive sleep apnea. The apnea-hypopnea index, the standard measurement of apnea and hypopnea severity, was higher in patients with lower red blood cell selenium (Chen 2013). One researcher reported on the case of his 70-year old wife whose mild obstructive sleep apnea was subjectively improved after taking 100 mcg of L-selenomethionine per day (Dekok 2005).
Low vitamin D status has been linked to a wide array of common chronic conditions including heart disease, obesity, diabetes, autoimmune diseases, and some cancers (Grineva 2013; Basit 2013; Foss 2009); low vitamin D levels may also be associated with sleep apnea.
A study with 150 participants found vitamin D deficiency to be more pronounced in people with severe sleep apnea compared to those with mild-to-moderate sleep apnea (Mete 2013). This finding was corroborated in another study, in which the authors suggested that vitamin D supplementation be considered in obstructive sleep apnea patients for its role in normalizing glucose metabolism and inflammation (Bozkurt 2012).
As vitamin D level increases, parathyroid hormone level tends to decrease (Muscogiuri 2014). A study in 128 people found that vitamin D levels were lower and parathyroid hormone levels were higher in people with obstructive sleep apnea than in a control group without the condition (Erden 2014). In another study in 826 people with obstructive sleep apnea, those with insufficient vitamin D status were more likely to have diabetes and metabolic syndrome, and those with higher levels of parathyroid hormone were more likely to have hypertension and obesity (Barcelo 2013).
Maintaining healthy vitamin D status may also protect against a host of other chronic diseases, both related and unrelated to sleep apnea (Basit 2013; Muscogiuri 2014).
Omega-3 Fatty Acids
Sufficient levels of the polyunsaturated omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) have been linked to lower degrees of systemic inflammation and lower risk of many chronic diseases, including those correlated with sleep apnea (Scorza 2013). A study that examined the red blood cell membrane fatty acid profiles of individuals with obstructive sleep apnea found that lower membrane DHA levels were associated with increased likelihood of severe sleep apnea. The authors suggest that red blood cell DHA testing could play a role in the diagnosis of obstructive sleep apnea, and further studies should investigate the effects of DHA supplementation in obstructive sleep apnea (Ladesich 2011).
A number of studies have found that people with obstructive sleep apnea have higher levels of homocysteine, an amino acid linked to increased risk of cardiovascular and neurodegenerative diseases (Niu 2014; Monneret 2012; Sariman 2010; Ansari 2014; Jordan 2004).
High homocysteine levels may be more common in people with sleep apnea who also have hypertension, ischemic heart disease, or obesity; in those diagnosed with sleep apnea before age 50; and in those with more severe sleep apnea (Lavie 2001; Niu 2014). A rigorous analysis of six studies in a total of 206 participants concluded that CPAP could effectively lower high homocysteine levels in people with obstructive sleep apnea when they used the device for three months or more (Chen, Niu 2014).
Supplementation with the B vitamins folate, B6, and B12 can reduce serum homocysteine levels (Smach 2013) and may be effective in cardiovascular disease prevention (Debreceni 2014). Because of the close relationship between sleep apnea and heart disease, B vitamin supplementation may be important in people with sleep apnea. Importantly, evidence suggests supplementation with methylfolate, a metabolically active form of folate, may outperform folic acid supplementation for homocysteine reduction (Akoglu 2008; Venn 2003; Litynski 2002).
More information about the importance of keeping homocysteine levels low and strategies to do so are available in the Homocysteine Reduction protocol.
Disclaimer and Safety Information
This information (and any accompanying material) is not intended to replace the attention or advice of a physician or other qualified health care professional. Anyone who wishes to embark on any dietary, drug, exercise, or other lifestyle change intended to prevent or treat a specific disease or condition should first consult with and seek clearance from a physician or other qualified health care professional. Pregnant women in particular should seek the advice of a physician before using any protocol listed on this website. The protocols described on this website are for adults only, unless otherwise specified. Product labels may contain important safety information and the most recent product information provided by the product manufacturers should be carefully reviewed prior to use to verify the dose, administration, and contraindications. National, state, and local laws may vary regarding the use and application of many of the treatments discussed. The reader assumes the risk of any injuries. The authors and publishers, their affiliates and assigns are not liable for any injury and/or damage to persons arising from this protocol and expressly disclaim responsibility for any adverse effects resulting from the use of the information contained herein.
The protocols raise many issues that are subject to change as new data emerge. None of our suggested protocol regimens can guarantee health benefits. The publisher has not performed independent verification of the data contained herein, and expressly disclaim responsibility for any error in literature.