Sleep Apnoea – a bit more than just snoring

As an osteopath, patients come to me with one problem but often during our conversation and my assessment, it becomes apparent that something else is going on. In the last few months, I’ve had a few patients come in who I’ve known or suspected have had sleep apnoea.

So what is sleep apnoea and how does it relate to snoring?

Lots of people snore and the reason for most of us is that at night, the soft tissues of our neck and palate relax and become narrower, causing the air to move in and out faster and causing the tissues to vibrate. Things that make this more likely are being overweight, drinking alcohol (which is a muscle relaxant) particularly in the evenings, smoking or being congested in either the nose or throat (e.g. from colds, nasal allergies or inflamed tonsils) or taking sedatives  (source: http://www.nhs.uk/Conditions/Snoring/Pages/Causes.aspx)

This can become a vicious circle, since it is thought that the vibration damages blood vessels that supply the muscles of the head and neck, hence increasing the likelihood of the airways narrowing as the muscles relax, thus making the problem worse. In some people, it might be a relevant factor in neck pain and jaw problems (which might also affect the snoring) – and it’s often a big cause of friction with partners, whose sleep is disturbed (often more so than the snorer’s).

So it’s important if you snore to try to do something about it – this website gives lots of helpful suggestions http://www.helpguide.org/articles/sleep/how-to-stop-snoring.htm.

Another reason for doing something about it is that it may indicate (or progress to) sleep apnoea – which is a condition with potentially serious implications.

Sleep Apnoea occurs when the relaxing and narrowing of the airways during sleep is so severe that it interrupts the sufferer’s breathing, reducing oxygen supply to the brain and causing them to wake up. This can happen 100s of times a night, but the sleeper may not be aware (although often partners will be), however they often suffer from symptoms that are more than just snoring e.g.
– restless/unrefreshing sleep
– frequent trips to the toilet every night
– morning headaches
– excessive daytime sleepiness and irritability
–  impaired concentration
– loss of libido
(source: http://www.nhs.uk/Livewell/snoring/Pages/sleepapnoea.aspx)

Daytime sleepiness increases the risks of accidents while driving or operating machinery at work and sleep apnoea increases the risk of high blood pressure, diabetes and stroke, but many people are living with this problem without realising.

If you want to know more about snoring and sleep apnoea, this video explains the difference between them and talks about some of the treatments http://www.nhs.uk/Video/Pages/snoring.aspx

The British Snoring and Sleep Apnoea Association, just round the corner from my Reigate clinic, has a great website with lots of information (www.britishsnoring.co.uk) and offer consultations, or you can see your GP if you suspect you may be suffering from sleep apnoea.

In the meantime, if you are a snorer, there are lots of things you can do for yourself – lose weight, give up smoking, don’t eat heavy meals or drink alcohol less than a couple of hours before bed and tone up your neck and throat muscles.

In a small study of people with sleep apnoea who were given exercises to do, a significant number had improvement in their symptoms and a reduction in their collar size just by doing exercises – you can download my compilation of exercises from that study and other sources here Throat exercises to reduce snoring and sleep apnoea you don’t have to do them all but pick a few to do each day in rotation.   Or if you want to tone up your throat muscles while having a bit of fun and stimulating your brain why not take up singing or playing the trumpet or even the digiridoo – another study showed reduction in snoring for taking up this instrument, which (like the trumpet) requires a technique called ‘circular breathing’ to play it successfully.

Make Exercise Fit Your Life… not the other way round!

As an osteopath, I’m often giving exercises, either stretches or strengthening, as ‘first aid’ to help patients out of trouble, but also to prevent problems recurring in the future. Because people are so busy these days, I’ve always tried to find ways my patients can fit simple exercises into their normal day instead of having to find a particular time and place to do them, so that there’s some chance they can fit them into their life and reap the benefits.

Examples might be – stretching shoulder or calf muscles while waiting for the kettle to boil; strengthening the pelvic floor while waiting at the bus-stop or in the supermarket queue (no-one can see you doing them!); turning your core muscles on and off while walking the dog or pushing the buggy or walking the kids to school; doing neck and shoulder stretches while at your PC. Most people find these kind of suggestions really helpful in fitting beneficial exercises into their daily life.

However, when it comes to my own exercise regime, I’m less successful at applying the same principles. I often work long days (12 hours including travelling) and then have things to do at home (chores, cooking, teaching preparation) so I find it really hard to find the time to exercise. If it involves going somewhere to swim/train/take part in a class, I struggle with both time and motivation.

Plus I always have plenty of excuses: swimming – never been again since I bought a pair of goggles and saw what was in public pools; Zumba – too cardiovascularly intense (I have a history of a minor heart problem); running – doesn’t do my left knee cartilage problem any good and besides, I don’t like running in the cold/wet/rain/snow – yes I’m a wimp! Regular classes are hard because my diary is flexible to fit my patients and I struggle to make them regularly; and ‘regularity’ is a really important concept with a new change to one’s routine, because it takes several weeks of repetition to establish a habit.

I tried to think about things I like to do to help motivate me and focus on the things I want to achieve. I love walking and I have a fantastic place to walk at my village clinic location in Newdigate.  But in the winter that involves a lot of mud and a change of clothes, which isn’t exactly convenient in the middle of a clinic day. So, great idea – but it doesn’t fit the practicalities of my working day.

As far as goals, I want to lose weight because I’ve some great dresses I want to wear for a special event later this year – but I know won’t fit into them by simply sitting around. Dieting always loses the first half stone but then I get stuck; I know that changing my metabolism through exercise is a simple way to move that on (I must have lost the same half stone about 4 times now – if I’d lost it sequentially, I’d have made my target weight long ago!).

Another principle to successfully starting something and keeping the habit (apart from motivation, goals and regularity) is making small, easy changes – nothing too radical. I occasionally do a bit of yoga/pilates at home between when I get in and when I eat, which is a good start to fitting my exercise into my day, but I know need to do more, particularly to get a bit of cardiovascular stimulation (which is good for my heart – the fitter it is, the less my problem will affect me).

So I was thinking the other day, what can I do indoors at any time of year, at home or clinic, that’s fun, that won’t hurt my joints, that will get my heart rate up? I was watching BBC this morning and Mike Bushell’s regular segment (where he’s sent off to do some sport for the entertainment of the masses) was on trampolining – and then it struck me – rebounding!

What is rebounding I hear you ask? Rebounding was really popular in the ’70s and 80s after NASA published a paper about how it was more efficient than running for stimulating heart and lungs and increasing oxygen uptake and it’s becoming popular again.  I haven’t looked at the latest research (although I will now, more of which another time). But the idea of bouncing up and down on a small trampoline (inside or outside) to music or while watching TV, with weights to make it harder or just a gentle bounce for health benefits (it’s supposed to help lymphatic drainage) really appealed (and did away with all my excuses too – damn!).

So one E-Bay purchase later, I hope soon to be the proud owner of a portable rebounder – watch out for the videos and posts of my progress on my Facebook page, I can’t wait to share with you how I get on! And the upside is, even if it doesn’t work out for me, my 18 month old grand-daughter (with supervision) will probably love it.

There is another practical point too – as all my patients know, I rarely recommend an exercise or a therapy (or therapist) unless I’ve tried it myself – so I’ll be able to tell any of you who are interested in buying your own rebounder whether it’s worthwhile or not.  Although if I offer to lend you mine, it probably means that it didn’t turn out to be quite as much fun as I imagined….

Look out for my updates on Facebook and comments here – I’m happy to receive yours if you’ve used a rebounder in the past – what did you think of it?

An Osteopath’s View of Carpal Tunnel Syndrome (CTS)

After SPD last month, another TLA (three-letter acronym) this month – Carpal Tunnel Syndrome (CTS). CTS is a relatively common problem with symptoms of pain, numbness, tingling/pins & needles in the hand, commonly (but not exclusively) at night, often temporarily relieved by shaking or ‘pumping’ the hand.

Sufferers can also experience weakness in the thumb and ache/pain in the arm. Symptoms are caused by compression of the median nerve which controls movement & feeling in the hand as it passes through a ‘tunnel’ formed by the small bones of the wrists and a ‘roof’ of fibrous tissue.

The NHS website says that ‘it isn’t known why’ the nerve becomes compressed in most cases, although certain conditions are thought to increase the risk of having it:
– genetic predisposition (family links)
– being pregnant (probably due to fluid retention; this often clears in the 3 months after the birth of the baby)
– direct trauma to the wrist (falls, repeated trauma)
– systemic conditions like rheumatoid arthritis or diabetes which cause swelling in the wrist or nerve damage respectively
– repetitive work with the hand e.g. typing, knitting, sewing & many other activities

However osteopaths DO have a model for ‘why the nerve becomes compressed’.  We look at the function of the nerve from where it starts in the neck and all the points between there and the hand where the nerve could have its function compromised through muscular tension, poor joint mobility or compression, all of which could affect the quality and efficiency of circulation to & drainage from the nerve, leading to inefficiency in its conduction.

In our model, compression in the wrist in carpal tunnel is the ‘last straw’.  So unlike medical treatments, which focus purely on the wrist (using splint, cortisone injection or surgery in extreme cases to release the ‘roof’ of the carpal tunnel to give the nerve more room), osteopaths look at how the wrist sits of the end of the arm and all the things that influence that, for example:-
– tension/restriction in the neck joints and surrounding muscles that relate to the nerve’s origin in the spine
– breathing mechanics, muscular tension,  and history of shoulder trauma (since between the collarbone & the upper ribs is an important ‘junction box’ for the nerve as it passes from the neck through the shoulder & ribcage into the arm)
– tightness in the forearm muscles and the fibrous tissue between them (very common in anyone who types or uses a computer), since this can affect the efficiency of the low pressure drainage systems of the arm which runs between these tissues
– stiffness in the wrist bone (again common in typists, but also in anyone e.g. who uses tools which need to be grasped all the time)
– and many other factors individual to the person in terms of what has happened to their body, their posture, their job etc.
– and not forgetting that the neck sits on top of the rest of the spine, so it has to accommodate any problems below, and the position of the shoulder is dictated by the shape of the ribcage, which can be affected by breathing problems such as asthma- so sometimes relevant factors may also relate to other areas of the body.

So for me as an Osteopath, the symptoms in the hand in CTS are just the ‘tip of the iceberg’ – which is why my assessment will look at more than just the wrist, and my treatment is aimed at is making the whole iceberg smaller, not just the bit that pokes above the water!

Of course, Osteopathy is not the only non-medical approach that may help – stretching, massage, changing activities or even diet may also influence how irritable the nerve is or the degree of fluid around it.. but an osteopath can certainly assess what physical restrictions may be contributing to the problem, and treat these as part of an approach to improving overall function & reducing symptoms.

If you suffer from CTS or any other condition and would like to know if and how Osteopathy may help you, do get in touch.

SPD – Symphysis Pubis Dysfunction (Pregnancy Pelvic Pain)

This is pelvic pain that arises predominantly in pregnant women due to the softening effects of pregnancy hormones on the ligaments that support the pelvis. Classically it is felt at the front of the pelvis, but can also be experienced in the groin and low back, and can vary from mild to extremely painful. Typically walking, climbing stairs, getting in and out of the car or bath and standing all aggravate the symptoms.
Medically, not much can be done, since the options for pain-killers in pregnancy are very limited, most medical advice revolves around management, for example:-
• engage your core muscles & pelvic floor, avoid lifting & carrying or stepping over things
• avoid ‘straddle’ movements of the legs, bend the knees & keep the legs ‘glued together’ when turning over in bed, getting out of the car etc.
• avoid twisting movements of the body, sit down for tasks where possible
• avoid sitting in low sofas – try to sit on higher chairs with arms for support
• place a pillow between the knees at night when sleeping on your side

In extreme cases, crutches or a wheelchair may be necessary, but for most women it isn’t that severe, and there are some aids which may help:-
• Sacro-iliac support belt e.g. Serola . This stabilises the ligaments of the pelvis and provides support for the muscles of the back – I have a loan belt at the practice which you can try before deciding whether to buy your own, every mum-to-be I have lent it to has gone out & bought their own, which may not be scientific evidence for whether it helps or not, but certainly says something!
• Axiss Car Seat – for those mums who already have another child between 9 months & 4 years, getting them in & out of the car can involve all sorts of movements on the ‘things to avoid’ list – straddling, twisting & lifting! The Axiss Car Seat has a lockable swivel so that you can turn the seat to face the door to get your child in and out before turning it back & locking it in position. Comes highly recommended by a patient who has suffered from SPD in all her pregnancies.

From an osteopathic viewpoint, with many of the pregnant ladies I see who are suffering from SPD, there are often other areas of the body that are in some way restricted or limited (for example, sacro-iliac joints themselves, pelvic floor & diaphragm tension, old ankle/knee/hip injuries, tension in the upper back and neck) which means that the whole body is not adjusting to the postural and physiological changes of pregnancy as well as it could. Often by working on these other areas, releasing tension, getting stiff joints moving etc., the impact of the changes on the pelvic joints themselves can be reduced, helping mums to be more comfortable during this period of change and preparation for the birth.

To discuss your individual circumstances, please call Helena on 07805 650667 for further information.

Help support research into whether Osteopathy can help Chronic Fatigue

Dr Perrin has asked me to share this appeal with you.. for further details on the Perrin Technique for Chronic Fatigue, visit http://www.theperrinclinic.com.
Appeal:
Please watch this film and realise that with your contribution to the FORME trust (www.forme-cfs.com) we will reach the £60,000 that we need to start a project that should change the way CFS/ME is viewed and hopefully help millions of sufferers worldwide . Any donation is welcome however small. Every penny goes into the research as there are no admin costs. I do not get paid one penny. The money is needed for university costs and for the clinicians involved in examining the participants.
Please help this research as without the funding we cannot start this important NHS project at Wrightington Hospital, Wigan in conjunction with The University of Central Lancashire..
With Thanks
Dr Ray Perrin Chief Investigator
http://youtube.com/watch?feature=player_embedded&v=7s22HX18wDY” target=”_blank”

Singers, Musicians & Osteopathy

For the last 2 weeks I have been treating a professional singer, which for an amateur singer like me is always an enjoyable experience as I always learn something in our discussions – part of the reason I love being an osteopath is that the people I treat are so interesting! And it’s great when I can help them improve performance in their work or their passion, not just reduce their pain.

For a professional singer, their voice is their instrument, and like musicians (or indeed anyone who has mastered a movement-based physical skill at a high level – dancer, dressage rider, plasterer etc.), singers are very aware of what is going on in their body, and if there is any restriction (even though there may be no pain) that is affecting the ease or control of their breath and voice, they will feel it.

This particular singer did have a specific problem – a mild rotator cuff (shoulder) tendonitis following a sprain while gardening. However, they also had an intermittent spasm in the area of the lower ribs & an area of the upper thorax that felt stiff and achy, and generally (as someone both body-aware & some experience as both a cranial patient & practitioner) felt out of sorts. Addressing the underlying deeper tensions through the spine, diaphragm and pelvis using cranial osteopathic techniques (as well as doing massage & movements to the injured shoulder) made a noticeable difference to the patient’s experience of their breath control – at the second appointment this week, they said they could carry long lines through which they’d be unable to do the week previously (and the painful areas were less painful), and their experience of singing was a greater sense of ease than before the treatment.

Another singer I treated – this time an opera singer from abroad with no experience of osteopathy (cranial or otherwise) – fell and injured themselves in rehearsal (oddly enough, another shoulder injury!). I happened to be singing in the chorus, so was happy to treat them as the staging meant they had to climb a ladder – a bit difficult when you can’t lift your arm about 90 degrees! While assessing them using a ‘cranial’ osteopathic assessment, I found another problem unrelated to the injury – tension in a muscle (psoas) that from an osteopathic point of view is integrally linked to diaphragm function. The singer was a bit surprised, as they hadn’t told me about an accident they’d had (hit by a car on that side of the pelvis as a child). They were also surprised that when I treated them, they could feel their ‘spinal cord dancing’ (their words not mine), and similar to my more recent case, after treatment experienced an increased sense of capacity and ease in their singing – sufficient to suggest I might like to move to their country and treat them & their friends!

Similarly, treating musicians can help performance in ways that are about freedom or ease, not just pain reduction. Earlier this year I treated a flautist who had come to me for shoulder & neck pain. In the course of our conversation, I mentioned that I could see they had a bite problem with their jaw, which they then told me they had previously been offered surgery for, but had declined, since it would mean they couldn’t work after the surgery, and even worse, there was no guarantee that their playing would be the same once they’d recuperated. For an osteopath, the relationship between the jaw & the upper neck is crucial, since a failure of compensation in one area (say, the jaw) may lead to other muscles of the head & neck becoming symptomatic through increased compensation or altered mechanics. As part of my assessment and treatment, I used some intra-oral techniques (working with my fingers on the bones inside the mouth) to release tension around the palate – this is what they emailed me after the treatment:
“Just wanted to let you know that I had a fantastic rehearsal tonight following my session with you today. Face/sinus/jaw area felt really free and I was able to play without feeling strain. What a difference to be able to work with my body feeling like that.

Can osteopathy help my dog’s arthritis – Teddy & Harry’s stories

I am often asked this question, in reply I tell the story of Teddy, the 13 year old Bichon Frise and Harry the Westie (also 13).

Me treating Teddy

Teddy’s owners asked me to see him as although he loves the social side of walks, he couldn’t manage the physical side much any more (they have a small cart which he can sit in when he gets tired of walking). He was also crying in the early hours of the morning (whether in pain or to go out to relieve himself they weren’t sure), and they hadn’t been able to stroke his back for some years as he cried or growled when they did.

When I first met him, Teddy was not that interested in me; he just lay on the sofa and cried or growled at every touch, even the very lightest. Because of his distress, I kept the examination to a minimum, and treatment was limited to a small amount of massage & movement to the stiffest area of the spine and some cranial osteopathy.

The next time I saw Teddy, his owners told me that his behaviour had changed markedly – he didn’t cry when his back was touched, he could walk further and was moving better generally, and he didn’t cry to go out any more. I could see that he was a bit more alert & engaged, and by the third treatment, I could really see his character coming through.

I’ve been treating him once a month for a few months now, and his owners say that his behaviour has changed ‘significantly’ – he walks more happily and they’ve promised to send me the video of him running!

Harry

I’ve walked Harry for several years, and have always been surprised at how mobile and fast he was considering his age. Recently however he’s become much slower, and developed a nasty cough – the vet thought he had a lung problem and has been treating him with steroids, but the possibility can’t be excluded that maybe he has an underlying heart condition (he’s always been a very ‘panty’ dog, even when not distressed) which is the reason for his slowing down. His owners had said he’d been a bit ‘out of sorts’ recently too – not his usual puppyish silly self, so I had a look at him.

As far as his musculo-skeletal system went, he’s always been a bit lame on his left fore, but he looked a bit stiff in the hips, particularly on the right (animal compensatory patterns are often on the diagonal opposite) and very stiff in his spine. My observations were confirmed by my palpatory findings when I had a feel of his muscles and joints, and at his age (much like an older human!), one can presume there is probably some arthritic change.

A little bit of treatment made a world of difference – his owners said he was much more his old self, I could see he was moving better, particularly behind, and interestingly his cough had been better too (in fact he’d hardly coughed at all). Obviously if he has an underlying heart or lung condition, I’m unlikely to have changed that – but by reducing the effort he has to make to move, then it’s possible I’ve reduced the strain and so the energy he has to expend will be less. I treat Harry regularly now, as & when he needs it, and his owners say they can always tell when I’ve treated him on a walk, because he’s always ‘full of beans’ when they get home.

Harry ‘full of beans’