Sleep Apnea Relief: Acupuncture more effective than CPAP

Researchers (Zheng-tao, et al.) find acupuncture effective for the treatment of obstructive sleep apnea and conclude that it is a potentially valid and successful substitute for the CPAP machine. The findings indicate that acupuncture is a proven treatment option for sleep apnea patients looking for a cost-effective alternative to standard treatment or for those who find sleeping with the machine difficult to manage.

Sleep apnea, often associated with snoring, is the condition where the airway is restricted during sleep, usually due to either an anatomical abnormality or a reduced function of the dilator muscle in the upper airway. This means that the person affected with sleep apnea will have inclement episodes throughout the night where they stop breathing in their sleep several times in the night, reducing the oxygen levels in their bodies. This is a growing health concern as it results in a decrease in quality of life and overall health.

Sleep apnea leads to sleepiness, irritability, depression, reduced concentration and memory, erectile dysfunction, and even cardiac and metabolic conditions. Sleep apnea can affect adults and children alike, but it tends to be more common in men and people with preexisting medical conditions like obesity, thyroid conditions, nasal obstruction, and alcohol consumption. Due to the effects of sleep apnea, this condition can become a real economic burden; therefore, it is important to both diagnose and treat it immediately.
While there are other methods available, the standard treatment for sleep apnea typically involves a machine called nCPAP, nasal continuous airway pressure, which involves a mask or tube on the mouth and/or nose and provides continuous oxygen. When used properly, the nCPAP is effective at managing the apnea and shallow breathing, known as hypopnea, thereby eliminating the lack of oxygen in the bloodstream caused by sleep apnea. By controlling the oxygen levels, the symptoms of sleep apnea, like fatigue and cardiovascular disease, are mitigated and the patient resumes a better quality of life.

In patients with severe obstructive sleep apnea caused by anatomical abnormalities or in cases where the nCPAP fails or is inadequate, a dental appliance may be recommended. Surgery may also be recommended in cases where the anatomical abnormality is obvious, such as large palatine or lingual tonsils. However, standard treatment with the nCPAP has been a proven method to reduce upper airway restrictions and, therefore, improves quality of life. Despite this effectiveness, it is not a permanent solution to ending obstructive sleep apnea.

The researchers sifted through research articles across several languages using a combination of medical search terms like “sleep apnea, obstructive,” “upper airway resistance sleep apnea syndrome,” and “acupuncture therapy.” For the Chinese database they used search terms “zhen” and “shuimian” or “ditongqi.” The reports included in this mega study had to have participants diagnosed with obstructive sleep apnea (OSA), but there were no restrictions on age, sex, or race. Patients with sleep apnea in the experimental groups received both manual acupuncture  and electroacupuncture while the control groups received either no treatment or nCPAP treatment. Patients that received sham acupuncture, which is essentially a placebo effect where patients believe they are receiving acupuncture but in fact are not being inserted with needles or the needles are being placed on non-acupuncture points, were included in the control group. There was no differentiation of the types of needle materials or the acupoints chosen. The researchers only included studies that were randomized controlled trials, and threw out anything that involved animal experiments, case reports, reviews, or duplicates

All of this yielded about 216 potential studies, which were narrowed down to 6 studies that met all of the rigorous inclusion requirements set by the researchers. Two studies were conducted in Brazil and the other four by Chinese investigators within a single center. Between 2007 and 2015 there was a total of 362 participants enrolled in the various trials (197 patients in the acupuncture group and 165 in the control group, with ages ranging from 35–76). Outcomes of the study were based on reported Apnea-Hypopnea Index (AHI), apnea index, hypopnea index, and mean Sa02 levels, which is the percentage of oxygen saturation in the blood. What they discovered was amazing. The researchers discovered that acupuncture was more effective in the improvement of all AHI, apnea index, hypopnea index, and SaO2 levels than nonspecific treatment and that electroacupuncture was even more effective at treating AHI. What is even more astounding is that acupuncture in these studies proved to be more effective than even nCPAP at improving AHI, and had no side effects.

The goal of treating obstructive sleep apnea is to reduce both sleep disruption and AHI levels to improve overall health and quality of life. While the nCPAP is very effective at treating obstructive sleep apnea, compliance among patients is difficult due to the cumbersome mask placed on their face, and it can be an expensive appliance to obtain. In the studies included in this analysis, acupuncture consistently improved all measures used to assess the effectiveness of treatment. The researchers deliberately chose to use AHI, apnea index, hypopnea index, and SaO2 levels to judge the effectiveness of treatment because it reduced the risk of bias and all these data could be directly recorded overnight during polysomnography (PSG), which is the standard testing used to diagnose obstructive sleep apnea. Both manual acupuncture and electroacupuncture were included in the study, as each differ to some extent in the mechanism of action. For example, electroacupuncture causes the release of beta-endorphin and adrenocorticotrophic hormones into blood plasma, where manual acupuncture releases only beta-endorphins.

All of the studies used in this meta-analysis combined manual acupuncture and electroacupuncture protocols. Varying frequency settings using electroacupuncture devices were applied in differing treatment protocols. While the meta-analysis demonstrates that acupuncture is effective at treating sleep apnea, no conclusions can be drawn as to which type of acupuncture protocol is the most effective.

Reference:
Lv Zheng-tao, Jian W, Huang J, Zhang J, and Chen A. The Clinical Effect of Acupuncture in the Treatment of Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Evidence-Based Complementary and Alternative Medicine. 2016.
 

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Helping Bladder Control and Leakage with Acupuncture

A powerful type of acupuncture is proven effective for the treatment of urinary incontinence. In a Heilongjiang University of Chinese Medicine clinical trial, standard acupuncture stimulation demonstrated a 54% total effective rate, however; a specialized electroacupuncture treatment protocol yielded an 86% total effective rate. We’ll take a look how these remarkable results were achieved.

Urinary incontinence (enuresis) is defined as the involuntary leakage of urine. Due to loss of bladder control, urine may leak during coughing, sneezing, laughing, heavy lifting, or other activities. The condition may also present in the form of urgent urination wherein one may not have enough time to get to the restroom. Urinary incontinence may take on a more insidious nature wherein there may be frequent, often imperceptible, dribbling of urine. In all presentations of the disorder, there is a loss of bladder control.

The discovery that acupuncture can safety and effectively treat this condition is significant. According to the CDC (Centers for Disease Control and Prevention), “incontinence presents a significant financial burden to the individual and to society. In the United States, the cost of bladder incontinence among adults in 2000 was estimated at $19.5 billion, with $14.2 billion incurred by community residents and $5.3 billion by institutional residents (Hu et al.).” Based on these figures, acupuncture is an important and cost-effective treatment option.

Heilongjiang University of Chinese Medicine researchers examined the effects of both manual and electroacupuncture on women with urinary incontinence in their acupuncture continuing education study. A total of 100 patients participated in the clinical trial at the university’s 2nd affiliated hospital. Manual acupuncture treatment was identical for both groups A and B. The only difference in treatment protocols was that group B received electroacupuncture in addition to the manual acupuncture therapy.

Treatment commenced with patients in a supine position. Upon disinfection, a 2 inch filiform acupuncture needle was inserted into each acupoint. For Guanyuan, Qihai, Zhongji, and Qugu, needles were slanted downwards and inserted transverse-obliquely to a depth of 1.2 – 1.5 inches until a deqi sensation was elicited. Next, rotating and reinforcing needle manipulation techniques were applied. For Zusanli and Sanyinjiao, needle were inserted vertically to a 0.5 – 1-inch depth. Subsequently, a needle retention time of 40 minutes was observed for all acupoints. One 40 minute acupuncture session was conducted daily for 30 consecutive days.

For the electroacupuncture group, intermediate frequency electrical acupoint stimulation was conducted simultaneously. An intermediate frequency electrical stimulation device was connected to Zhongji and Huiyin (CV1). The amplitude for each patient was set to individual tolerance levels for comfort. This electrical stimulation was administered for 20 minutes during each acupuncture session.

Huiyin (CV1, Meeting of Yin) is often underutilized in clinical practice due to its location. The modern research confirms traditional indications for use of this acupuncture point. Huiyin is traditionally indicated for the treatment of difficult urination and urinary incontinence. The research finds the addition of electroacupuncture from CV3 to CV1 increases the efficaciousness by 32%. Manual acupuncture had a 54% total effective rate and electroacupuncture increased the rate to 86%.

University College of London Hospital and Whipps Cross University Hospital researchers confirm that acupuncture is effective for the treatment of urinary incontinence in independent research. A total of 79% of patients participating in the clinical trial demonstrated clinically significant outcomes. The researchers add that acupuncture “should be considered as a potential alternative to our current therapeutic regimes” for patients with urinary incontinence. The study utilized only 3 acupuncture points, combined with electroacupuncture, for all patients:

SP6 (Sanyinjiao)

CV4 (Guanyuan)

KD3 (Taixi)

Similar results were found across the two aforementioned studies. The first investigation had an 86% total effective rate and the second had a 79% total effective rate. Jin et al. confirm that electroacupuncture reduces urinary incontinence for women in another independent study. Electroacupuncture produced a 78.6% total effective rate. The protocol reduced leakage and urgency. The mean occurrence of urinary incontinence over 24 hours was reduced by 66.67%. The mean quantity of urinary leakage over 24 hours was 39 grams before acupuncture treatments and 18.6 grams afterwards.

Electroacupuncture was attached to BL32 and BL35. A disperse-dense wave was used for 30 minutes. The dense wave was 4 Hz and the disperse wave was set to 20 Hz. The intensity was set to patient tolerance levels. One 30 minute acupuncture treatment was administered 3 times per week for 8 weeks. The protocol achieved a 78.6% total effective rate.

Liu et al. achieved a 93.3% total effective rate for the treatment of stress urinary incontinence in women. The protocol had two components: acupuncture and pelvic floor muscle exercises. Acupuncture with moxibustion was applied to the Baliao acupuncture points:

Shangliao (BL31)

Ciliao (BL32)

Zhongliao (BL33)

Xialiao (BL34)

Needling was applied obliquely with a needle retention time of 20 minutes per acupuncture treatment. Moxibustion was applied to all needles. Acupuncture was administered 5 times per week for 6 weeks. The 93.3% total effective rate suggests that this protocol produces optimal outcomes.

Wang et al. confirm that acupuncture is 90% effective for the treatment of urinary incontinence. In the clinical trial, acupuncture was compared with drug therapy. Solifenacin produced an 86.9% total effective rate. Guiyang College of Traditional Chinese Medicine researchers from the university hospital’s urology department conducted a clinical trial lasting four weeks. Patients taking drug therapy received 4 mg of solifenacin via oral administration, once daily after breakfast.

Manual acupuncture stimulation was applied to the needles. Each acupuncture session lasted 30 minutes and one minute of manual stimulation was applied every 10 minutes. Acupuncture was applied once per day for four weeks.

Solifenacin had an outcome of 4 patients cured, 23 patients with significant progress, and 4 patients with no progress. Acupuncture had an outcome of 5 patients cured, 22 with significant progress, and 3 patients with no progress. The total effective rate for the acupuncture group was 90% and 86.9% for the solifenacin group. The results confirm that of the aforementioned studies; acupuncture is effective for the treatment of urinary incontinence.

References:
Gao X, Xing YL, Dong SQ, Ding Y, Xia M. (2013). Effect of Acupuncture with Intermediate Frequency Electrical Stimulation by Acupoint on Female Stress Urinary Incontinence. Journal of Clinical Acupuncture and Moxibustion. 29(8).

Hu TW, Wagner TH, Bentkover JD, Leblanc K, Zhou SZ, Hunt T. Costs of urinary incontinence and overactive bladder in the United States: A comparative study. Urology 63(3):461– 5. 2004.

Post-treatment, Pre-treatment, and ICIQ-UI Short Form. Acupuncture in the Management of Overactive Bladder Syndrome. 2014.

Philp T, Shah PJR, Worth PHL. Acupuncture in the treatment of bladder instability. British Journal of Urology 1988 Jun: 61(6); 490-493.

Jin CL, Zhou XY & Pang R. (2013). Effect of electro-acupuncture on mixed urinary incontinence in women. Journal of Clinical Acupuncture and Moxibustion. 29(6).
Jain P, Jirschele K, Bostros SM, et al. (2011). Effectiveness of midurethral slings in mixed urinary incontinence: a systematic review and meta-analysis. Int Urogynecol J. 22(8): 923-932.

Liu Jie, Yang Shaoqin, Shi Ying, Curative effect observation of needle warming moxibustion Ba Liao point combined with pelvic floor muscle exercise in the treatment of female stress urinary incontinence, Chinese Community Doctors, 2015 (8).

Wang, Bo, Youping Xiao, Kai Fan, Congjun Huang. “Treatment of female overactive bladder with acupuncture.” Journal of Beijing University of Traditional Chinese Medicine 36.10 (2013): 713-716.

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