Sleep apnea is a disorder characterized by a reduction or pause of breathing (airflow) during sleep. It is common among adults, becoming more common in children.

An apnea is a period during which breathing stops or is markedly reduced. In simplified terms, apnea occurs when a person stops breathing for 10 or more seconds. If a person stops breathing completely or takes less than 10% of a normal breath for a period that lasts 10 seconds or more, this is an apnea. This definition includes a complete stoppage of airflow.

Other definitions of apnea that may be used include at least a 4% drop in oxygen in the blood, a direct result of the reduction in the transfer of oxygen into the blood when breathing stops.

When apnea occurs, sleep usually is disrupted due to inadequate breathing and poor oxygen levels in the blood. Sometimes this means the person wakes up completely, but sometimes this can mean the person comes out of a deep level of sleep and into a shallower level of sleep.

Apneas are usually measured during sleep (preferably in all stages of sleep) over 2 hours. An estimate of the severity of apnea is calculated by dividing the number of apneas by the number of hours of sleep, giving an apnea index (AI in apneas per hour); the greater the AI, the more severe the apnea.

Hypopnea

Hypopnea is a decrease in breathing that is not as severe as apnea. Hypopneas usually occur during sleep and can be defined as greater than 30% of a normal breath. Like apneas, hypopneas also may be defined as a 3-4% or greater drop in oxygen in the blood. Like apneas, hypopneas usually disrupt the level of sleep. A hypopnea index (HI) can be calculated by dividing the number of hypopneas by the number of hours of sleep.

Under normal circumstances, the brain monitors several things to determine how often to breathe. If it senses a lack of oxygen or an excess of carbon dioxide in the blood it will speed up breathing. The increase in breathing increases the oxygen and decreases the carbon dioxide in the blood. Some people with heart or lung disease have an increase in carbon dioxide in their blood at all times.

When there is a chronic increase in blood carbon dioxide, the brain starts to ignore the oxygen level and monitors the blood carbon dioxide level to determine when to take the next breath. The control of breathing also becomes slower to respond to changes in carbon dioxide levels; so when a person takes more or deeper breaths and “blows off” carbon dioxide the drive to breathe decreases and the rate of breathing decreases. As a result of a slower rate of breathing, carbon dioxide builds back up in the blood and the rate of breathing increases again. The brain, slow to adjust, continues to signal for more rapid breathing until the carbon dioxide level drops too low. Breathing then slows down or stops until the carbon dioxide level rises again.

This pattern of abnormal breathing is called Cheyne-Stokes breathing. It is characterized by repetitive cycles of fast breathing followed by slow breathing and apnea. The full cycle is roughly around 90 seconds. This breathing pattern happens when the person is awake or asleep but becomes more of a problem when asleep. Some patients with heart failure have central sleep apnea associated with a Cheyne-Stokes pattern of breathing.

The apnea-hypopnea index

The apnea-hypopnea index (AHI) is an index of severity that combines apneas and hypopneas. Combining them gives an overall severity of sleep apnea including sleep disruptions and desaturations (a low level of oxygen in the blood). The apnea-hypopnea index, like the apnea index and hypopnea index, is calculated by dividing the number of apneas and hypopneas by the number of hours of sleep.

Another index that is used to measure sleep apnea is the respiratory disturbance index (RDI). The respiratory disturbance index is similar to the apnea-hypopnea index; however, it also includes respiratory events that do not technically meet the definitions of apneas or hypopneas but do disrupt sleep.

Sleep apnea is formally defined as an apnea-hypopnea index of at least 15 episodes/hour in a patient if he or she does not have medical problems that are believed to be caused by sleep apnea. This is the equivalent of approximately one episode of apnea or hypopnea every 4 minutes.

Sleep apnea can cause or worsen symptoms of the following:

• High blood pressure.
• Stroke.
• Daytime sleepiness.
• Congestive heart failure (low flow of blood to the heart).
• Insomnia.
• Mood disorders.

In the presence of the conditions above, sleep apnea is defined as an apnea-hypopnea index of at least five episodes/hour. This definition is stricter because these individuals may be already experiencing the negative medical effects of sleep apnea, and it may be important to begin treatment at a lower apnea-hypopnea index.

There are three types of sleep apnea:

1. Central sleep apnea (CSA).
2. Obstructive sleep apnea (OSA).
3. Mixed sleep apnea (both central sleep apnea and obstructive sleep apnea).

During sleep, the brain instructs the muscles of breathing to take a breath.

• Central sleep apnea
• Obstructive sleep apnea
• Mixed sleep apnea (occurs when there is both central sleep apnea and obstructive sleep apnea).

Central sleep apnea (CSA) occurs when the brain does not send the signal to breathe to the muscles of breathing. This usually occurs in infants usually born before 37 weeks of gestation (sudden infant death syndrome) or adults with heart disease, cerebrovascular disease, or congenital diseases, but it also can be caused by some allopathic medications and high altitudes.

It is defined as apneas lasting more than 20 seconds, usually with a change in the heart rate, a reduction in blood oxygen, or hypotonia (general relaxation of the body’s muscles). These children often will require an apnea monitor that sounds an alarm when apneas occur.

Central sleep apnea usually occurs in adults with other medical problems. In infants, it usually occurs with prematurity or other congenital disorders. Central sleep apnea can be diagnosed with a sleep study or overnight monitoring while the patient is in the hospital.

In infants, central sleep apnea is treated with an apnea alarm. This alarm monitors the infant’s breathing with sensors and sounds a loud noise when the infant experiences apnea. The alarm usually wakes the infant and the parents. Most infants usually “out-grow” the central apnea episodes, so the alarm monitoring is stopped after the episodes resolve. In infants with other congenital problems, apnea monitoring may be needed for a longer period.

In adults with central sleep apnea, the apneas are treated by treating the underlying heart disease, medication interaction, high altitude, or other primary problems.

In obstructive sleep apnea (OSA), apneas have four components:

First, the airway collapses or becomes obstructed.

Second, an effort is made to take a breath, but it is unsuccessful.

Third, the oxygen level in the blood drops as a result of unsuccessful breathing.

Fourth, when the amount of oxygen reaching the brain decreases, the brain signals the body to wake up and take a breath. (This is what the bed partner hears as a silence followed by a gasp for air.)

First, it is necessary to describe a “normal breath.” A normal breath of air passes through the nasal passages, behind the soft palate and uvula (part of the soft palate), then past the tongue base, through the throat muscles, and between the vocal cords into the lungs. An obstruction to the flow of air at any of these levels may lead to apnea. The following are some examples:

• Airflow can become diminished if a person has a deviated septum (the middle wall of the nose that separates the two nostrils). A septum can be deviated to one or both sides narrowing the air passages.
• There are filters in the nose called turbinate that can obstruct airflow when they become swollen.
• If the palate and uvula are long or floppy, they can fall backward and close the air flows.
• The back of the tongue can also fall backward and obstruct breathing especially when individuals lay flat on their backs.
• The side walls of the throat can fall together to narrow or close the airway.

To break it down even further:

• The muscles of breathing work to expand the chest and lower the diaphragm to generate a negative pressure between the airways of the lungs and outside.
• This negative pressure sucks air into the lungs. The nasal passages, palate, tongue, and pharyngeal tissues can all contribute to the narrowing of the airway.
• If during an attempt to breathe the airway collapses or is obstructed the tissues of the airway are sucked together by the negative pressure.
• The harder the chest tries to pull air in the greater the negative pressure and the more the tissues of the airway are sealed together.
• Finally, when the oxygen in the bloodstream decreases the person wakes up or the level of sleep becomes shallower to more consciously take a breath.

People with obstructive sleep apnea have an airway that is more narrow than normal, usually at the base of the tongue and palate. When lying flat, the palate is above the air passage. When the pharyngeal muscles relax the palate can fall backward and this can obstruct the airway.

The genioglossus muscle is located where the base of the tongue attaches to the jawbone in front. Most people have enough space behind the tongue to take a breath without needing to pull the tongue forward. However, when obstructive sleep apnea patients are awake, this muscle needs to be active to pull the base of the tongue forward to open the airway. During sleep, most muscles including the genioglossus relax. During the stage of rapid eye movement (REM), the muscles completely relax. Relaxation of the genioglossus muscle during sleep allows the base of the tongue to fall backward and the airway closes.

Patients with obstructive sleep apnea often don’t report waking up during the night with each episode of apnea. Frequently, during the apnea, the brain only awakens from deep sleep (stages N3 [non-rapid eye movement Stage 3], or REM) to a shallow level of sleep. The genioglossus muscle then contracts and pulls the tongue forward so that a breath can be taken. The patient may remain asleep, but the deep sleep that is important to be fully rested the following day is disrupted.

Obstructive sleep apnea (OSA) is estimated to affect about 24% to 31% of men and 9% to 21% of women. In one study of people over 18 years of age, obstructive sleep apnea was estimated to develop in 1.5% of people per year over the 5-year study. It is probably more common than either of these numbers because the population is becoming more obese, and obesity worsens obstructive sleep apnea.

Who Develops Apnea?

Some groups are more likely to develop obstructive sleep apnea.

• Men are more likely to have obstructive sleep apnea than women before age 50.
• After age 50, the risk is the same in men and women.
• Among obese patients, a majority have obstructive sleep apnea. Obstructive sleep apnea worsens in severity and prevalence with increasing obesity.
• Among patients with heart disease, a significant portion have obstructive sleep apnea, and among patients with strokes, a majority have obstructive sleep apnea.
• White and blonds over the age of 65 have a 2.5 times greater risk of obstructive sleep apnea than Caucasians.
• The prevalence of sleep apnea in nonobese and otherwise healthy children younger than 8 years old is considered as high as 1% to 10%. Obstructive sleep apnea may develop in children of all ages, even in infants. Premature infants are at a higher risk of developing sleep apnea.

Patients with disrupted sleep cannot concentrate, think, or remember as well during the day. This has been shown to cause more accidents in the workplace and while driving. Thus, people with obstructive sleep apnea have a three times greater risk of accidents than the general population.

Sleep apnea symptoms at nighttime include:

• Snoring, usually loud and bothersome to others.
• Gasping for air, witnessed apneas, or choking sensation.
• Insomnia.
• Restless sleep.

Sleep apnea also can cause significant and sometimes serious daytime symptoms as a result of insufficient sleep at night, including:

• Daytime sleepiness.
• Nonrestorative sleep (feeling as tired in the morning as before going to bed).
• Fatigue.
• Headaches.
• Irritability.
• Poor memory and attention.
• Confusion.
• Mood and personality changes, depression and anxiety.
• Sexual dysfunction.

It is important to note that the bed partner of individuals with sleep apnea may also suffer from poor nighttime sleep and can have some of the same symptoms.

Diagnosis

Obstructive sleep apnea can be diagnosed and evaluated by subjective (perceived or biased) and objective (factual, based on empirical data) methods. An example of a subjective method that measures the effects of obstructive sleep apnea on patients is the Epworth Sleepiness Scale.

The Epworth Sleepiness Scale is a self-report test that establishes the severity of sleepiness. A person rates the likelihood of falling asleep during specific activities. Using the scale from 0 to 3 below, the risk of dozing can be ranked from the chart below.

• 0 = Unlikely to fall asleep
• 1 = Slight risk of falling asleep
• 2 = Moderate risk of falling asleep
• 3 = High likelihood of falling asleep

After ranking each category, the total score is calculated. The range is 0 to 24, with higher scores suggesting greater sleepiness.

Scoring

• 0 to 9 = Average daytime sleepiness.
• 10 to 15 = Excessive daytime sleepiness.
• 16 to 24 = Moderate to severe daytime sleepiness.

Breaking it down further, excessive daytime sleepiness is greater than 10. It is important to note that patients with insufficient sleep (less than 7-7.5 hours for most adults), can also have daytime somnolence even without obstructive sleep apnea.

Primary snorers usually have a score of less than 10, and individuals with moderate to severe sleep apnea usually have a score greater than 16. Self-reported, subjective measures such as the Epworth Sleepiness Scale usually are combined with a thorough medical history. The history includes questions about:

• Work performance.
• Daytime sleepiness.
• Driving and accident history.
• Napping.
• Falling asleep during meetings.
• Decreased memory.

Next, a physical examination is performed to examine the areas of possible airway collapse.

• In the nose, this includes the septum, turbinate, nasal polyps, adenoid hypertrophy, and nasopharynx.
• In the mouth, the palate, tonsils, uvula, pharyngeal walls, and neck circumference.
• A flexible nasopharyngoscopy is usually performed to examine the airway during active breathing and simulated snoring maneuvers.

Polysomnography

The primary objective test for obstructive sleep apnea is polysomnography or sleep study. During attended polysomnography, a technician observes a person sleeping and monitors recording equipment in the setting of a sleep laboratory. A typical polysomnography test includes:

• An electroencephalogram (EEG) monitors brain waves and determine the level of sleep or wakefulness. It helps determine if an event (respiratory or limb movement) disrupts the level of sleep.
• An electro-oculogram (EOG) monitors eye movement. This measurement can help determine the duration of REM sleep.
• An electromyogram (EMG) monitors muscle activity. During stage 1-4 sleep there is a baseline muscle tone; however, during REM sleep all muscles relax. The EMG also helps to determine the duration of REM sleep. An EMG of the legs can be used to detect “restless legs syndrome” or periodic leg movements during sleep.
• Measurement of oral and nasal airflow, to help determine the size and frequency of breaths during sleep. Chest and abdominal movements occur with each attempt to breathe and can be used to distinguish between central sleep apnea and obstructive sleep apnea. (During central sleep apnea, the signal to take a breath is not given, so the muscles do not attempt to take a breath. During obstructive sleep apnea, the muscles attempt to take a breath, but no air moves.)
• Measurement of the chest and abdominal movement.
• Audio recording of the loudness of snoring.
• Blood oxygen levels (oximetry), to measure the decrease in oxygen in the blood during apneas and hypopneas.

Video Monitoring

The video monitor is most helpful for detecting movement disorders, parasomnias, or seizures during sleep. (Often a patient will not remember sleepwalking, sleep talking, or other parasomnias).

Although the primary objective test for obstructive sleep apnea is the sleep study (polysomnography); other tests for obstructive sleep apnea include the:

• Multiple Sleep Latency Tests (MSLT). To measure how sleep and how fast the patient sleep during daytime and after treatment for sleep disorder. The average time to fall asleep is calculated for all four or five tests. Normal time would be greater than 10 minutes to fall asleep. Excessive sleepiness is less than 5 minutes to fall asleep.
• Maintenance of Wakefulness Test (MWT), it measures daytime sleepiness. This is repeated for four 40-minute sessions 2 hours apart. Not falling asleep in all four tests is the strongest objective measure of no daytime sleepiness.

Severity levels in obstructive sleep apnea

Obstructive sleep apnea can be categorized as mild, moderate, or severe. This stratification assists in determining the direction of treatment. For example, some treatments that are excellent for mild sleep apnea nearly always fail for severe sleep apnea.

The severity level is measured with polysomnography. In one grading scale using the apnea-hypopnea index, mild obstructive sleep apnea is 5 to 15 events per hour, moderate obstructive sleep apnea is 15 to 30 events per hour, and severe obstructive sleep apnea is more than 30 events per hour.

The nonsurgical treatments for obstructive sleep apnea are similar to the non-surgical treatments for snoring with a few differences. Treatments include:

• Behavioral changes.
• Dental appliances and mouthpieces.
• CPAP (continuous positive airway pressure).
• Medications.

Behavioral changes

Behavioral changes are the simplest often hardest treatments for mild obstructive sleep apnea. Occasionally, apneas occur only in some positions (most commonly lying flat on the back). A person can change his/her sleeping position, reduce apneas, and improve sleep.

Obesity is a known contributing factor to obstructive sleep apnea. It is estimated that a 10% weight gain will worsen the apnea-hypopnea index, and a 10% weight loss will decrease the apnea-hypopnea index. Therefore, weight loss will improve obstructive sleep apnea.

Sleep hygiene and other behavioral modifications known to improve the overall quality of sleep are also recommended. Below are some common practices that can induce sleep and enhance its quality:

• Reduce lighting and noise in the bedroom.
• Avoid reading or watching TV in bed.
• Avoid eating or exercising before sleep.
• Use the bedroom only for sleeping.
• Keep work-related activities outside of the bedroom.
• Try a period of physical and mental relaxation before going to bed.

Allopathic Treatment for Sleep Apnea

Many allopathic medications have been studied for obstructive sleep apnea; however, it has been difficult to find an allopathic medication that helps. Additional studies are being conducted.

• In people with nasal airway obstruction causing obstructive sleep apnea, nasal steroid sprays are effective.
• Topical nasal decongestants such as oxymetazoline and neo-synephrine also can temporarily improve nasal swelling, but they cannot be used for more than 3 to 5 days without decreased effectiveness and withdrawal symptoms.
• Sleep apnea due to hypothyroidism (low thyroid hormone production) are uncommon. However, some have improved with thyroid replacement therapy.
• Obstructive sleep apnea due to obesity may improve with diet.
• Other medications have been studied, including medroxyprogesterone, acetazolamide, tricyclic antidepressants, and selective serotonin reuptake inhibitors (SSRIs). In these studies, they were shown to have little or no effect. There are also new allopathic medications to help increase alertness. They may be temporarily successful in increasing attention; however, they do not treat sleep deprivation or the cause of obstructive sleep apnea.
• In cases where sleep apnea may be caused by another underlying condition, appropriate treatment of such conditions is recommended, for example, treating underlying heart failure, sinusitis and nasal congestion, the swelling and inflammation of the upper airway passages can cause snoring and sleep apnea etc.
• Medications are also available that could increase daytime wakefulness. These medications stimulate the brain through an unknown mechanism of action. The prototypical drug in this class is called modafinil. Studies have revealed a greater resolution of daytime sleepiness when using modafinil in patients with sleep apnea. A similar, newer drug in this class, called armodafinil, has a longer half-life. Armodafinil has shown similar clinical results in significantly improving daytime quality of life and functioning.

Primary Allopathic Treatment

It is important to note that the primary treatment for obstructive sleep apnea (OSA) remains CPAP (described below). Stimulants, such as modafinil and armodafinil, are recommended for those who have excessive daytime sleepiness despite proper CPAP use at night. They are not meant to replace CPAP use, but rather, as an adjunctive therapy to CPAP in those who have daytime symptoms even with CPAP use. Approximately one-third of people who use CPAP at night for sleep apnea may continue to have somnolence during the day.

Dental appliances

A dental appliance is similar to a mouthpiece and holds the jaw and tongue forward and the palate up, thus preventing the closure of the airway. This small increase in airway size often is enough to control the apneas.

Dental appliances are an excellent treatment for mild to moderate obstructive sleep apnea. It is reported to be effective for these groups. A dental appliance does not require surgery; it is small, portable, and does not require a machine. They may be considered for use in combination with other treatments, including CPAP and nasal or other upper airway surgery. There are some disadvantages to dental appliances. It can cause or worsen temporomandibular joint (TMJ) dysfunction. If the jaw is pulled too far forward, it can cause pain in the joint when eating. For this reason, it is best to have a dentist, oral surgeon, or ENT surgeon who specializes in sleep fit and adjusting the appliance. A dental appliance requires natural teeth to fit properly, it must be worn every night.

Continuous positive airway pressure (CPAP)

Continuous positive airway pressure (CPAP) is probably the best, non-surgical allopathic treatment for any level of obstructive sleep apnea. In finding a treatment for obstructive sleep apnea, the primary goal is to hold the airway open so it does not collapse during sleep. The dental appliances and surgeries focus on moving the tissues of the airway. CPAP uses air pressure to hold the tissues open during sleep. The CPAP machine blows heated, humidified air through a short tube to a mask.

Determining CPAP pressure

With CPAP it is important to use the lowest possible pressure that will keep the airway open during sleep. This pressure is determined by “titration.” Titration frequently is performed with the help of polysomnography.

Effectiveness of CPAP

CPAP is effective in improving subjective and objective measures of obstructive sleep apnea. This effectiveness, however, is only achieved if patients adhere to the therapy, and this has proven difficult for many patients. If CPAP is tolerated,

• It decreases apneas and hypopneas.
• It decreases sleepiness as measured by surveys and objective tests.
• It improves cognitive functioning on tests.
• It improves driving on driving simulation tests and decreases the number of accidents in the real world.

When adjusted properly and tolerated, it is nearly 100% effective in eliminating or reducing obstructive sleep apnea.

An important clinical outcome of CPAP use is in the area of prevention of the potential complications of obstructive sleep apnea. Studies have shown that the proper use of CPAP reduces hospitalization for cardiac and pulmonary causes in people with obstructive sleep apnea.

Problems with CPAP

People with severe obstructive sleep apnea may never get a normal night of sleep with any allopathic treatment. They often put on the CPAP mask and think it is the best thing ever. They quickly get used to it because it allows them to sleep. They take it on vacations because without it they have no energy and are always sleepy.

Bi-level positive airway pressure (BiPAP)

Bi-level positive airway pressure (BiPAP) was designed for people who do not tolerate the higher pressures of CPAP. It is similar to CPAP in that a machine delivers positive pressure to a mask during sleep. However, the BiPAP machine delivers a higher-pressure during inspiration, and a lower pressure during expiration, which allows the person not to feel like they are breathing out against such a high pressure. It is most helpful for people who require higher pressure to keep their airways open.

Auto-titrating continuous positive airway pressure

The auto-titrating CPAP machine is a “smart” CPAP machine that makes pressure adjustments throughout the night. The goal of auto-titrating CPAP is to have the lowest possible pressure for each position or sleep level. At a given pressure, if a person starts to have apnea or hypopnea, the machine adjusts the pressure higher until the episodes are controlled. If a person is in a sleep level or position that doesn’t need a higher pressure, the pressure is reduced. The benefit is when a lower pressure is all that is required, the machine is not stuck at the highest pressure needed. The downside is, that if the machine does not adjust, a person can be stuck at a lower pressure having episodes of sleep apnea.

With auto-titrating CPAP, the mean pressure throughout the night is lower and two-thirds of the night is spent below the set CPAP pressure. The machine also can adjust for the changes in pressure that are needed to overcome the effects of weight gain and alcohol or sedative use. It may also improve compliance.

The disadvantage of auto-titrating CPAP is that leaks may underestimate pressure or airflow. Each company has a different algorithm for adjusting the pressure and adjusting for leaks. It is unclear which company has the best algorithm, but experiments are ongoing.

There are many surgical options to treat obstructive sleep apnea. The type of surgery that is chosen is dependent on an individual’s specific anatomy and the severity of sleep apnea. However, surgery is not the “miracle cure” either. Most surgeries are not safe, every surgery, no matter how small, carries risks.

Any surgical treatment for sleep apnea must address the anatomic problem areas. There may be one or several areas that compromise airflow and cause apnea. Surgical treatments can address the nose, palate, tongue, jaw, neck, obesity, or several of these areas at the same time. Each surgery’s success rate is determined by whether or not a specific airway collapse or obstruction is prevented. Therefore, the ideal surgery is customized for each patient and depends on each patient’s specific problem. Some surgical options include:

• Nasal airway surgery.
• Palatal and pharyngeal surgery (uvulopalatopharyngoplasty).
• Upper airway stimulation therapy.
• Tongue reduction.
• Tongue repositioning or genioglossus advancement.
• Hyoid suspension.
• Maxillomandibular procedures.
• Palatal implants.
• Tracheostomy.
• Bariatric surgery.
• Combinations of the above.

Many people have several levels of obstruction and, therefore, these surgical techniques frequently are performed together (for example, uvulopalatopharyngoplasty with genioglossus advancement and hyoid suspension).

Homeopathic Treatment for Sleep apnea

There is not any treatment for central sleep apnea while allopathic treatment for obstructive sleep apnea is to long-term, complicated and too costly; on the other hand, in Homeopathy all three types of sleep apnea are not only curable, but the treatment duration is too short and very cost-effective (cheap).

Here are few well proven medicines for sleep apnea of all three kinds:

Lemna Minor

A catarrhal remedy. Acts especially upon the nostrils. Nasal polypi; swollen turbinate. Atrophic rhinitis. Asthma from nasal obstruction; worse in wet weather. Crusts and muco-purulent discharge very abundant. Post-nasal dropping. Pain like a string from nostrils to ear. Reduces nasal obstruction when it is an edematous condition. Dryness of Naso-pharynx. Dry pharynx and larynx.

Dulcamara

Dry coryza. Complete stoppage of nose. Stuffs up when there is a cold rain. Thick, yellow mucus, bloody crusts. Profuse coryza. Wants nose kept warm, least cold air stops the nose. Coryza of the newborn. Saliva tenacious, soapy. Dry, rough tongue, rough scraping in throat, after taking cold in damp weather. Cold sores on lips. Facial neuralgia. Tickling in larynx, spasmodic. Asthma with dyspnea.

Calcarea Carb

Dry, nostrils sore, ulcerated. Stoppage of nose, also with fetid, yellow discharge. Offensive odor in nose. Polypi; swelling at root of nose. Epistaxis. Coryza. Submaxillary glands swollen. Swelling of tonsils and submaxillary glands; stitches on swallowing. Hawking-up of mucus. Difficult swallowing. Goiter. Parotid fistula. Dryness of tongue at night. Extreme dyspnea. Suffocating spells; tightness, burning and soreness in chest.

Teucrium Marum

Polypi. Over sensitiveness. Desire to stretch. A remedy of first importance in chronic nasal catarrh with atrophy; large, offensive crusts and clinkers. Ozaena. Loss of sense of smell. Excited, tremulous feeling. Frontal pain; worse, stooping. Strengthens brain after delirium tremens. Catarrhal condition of both anterior and posterior nostrils. Mucous polypus. Chronic catarrh; discharge of large, irregular clinkers. Foul breath. Crawling in nostrils, with lachrymation and sneezing. Coryza, with stoppage of nostrils. Dry cough, tickling in trachea; moldy taste in throat when hawking up mucus, expectoration profuse.

Aesculus Hippocastanum

Stinging and burning in posterior nares and soft palate. Dryness of posterior nares and throat; sneezing, followed by severe coryza. Pain in nasal bone. Tongue feels as if it had been scalded.

Pricking, formication, burning and stinging in faucets, feeling as if something had lodged in faucets causing constant inclination to swallow. Dryness and roughness (or rawness and burning) in throat. Constrictive feeling in faucets. Tightness in chest. Oppression, stitches, soreness and other troubles of chest.

Belladona

Delirium, restless sleep, convulsive movements. Dryness of mouth and throat. Exophthalmic goiter. Tongue swollen and painful. Throat dry, as if glazed; angry-looking congestion. Tonsils enlarged; throat feels constricted; difficult deglutition; worse, liquids. Sensation of a lump. Esophagus dry; feels contracted. Spasms in throat. Continual inclination to swallow. Scraping sensation. Muscles of deglutition very sensitive. Hypertrophy of mucous membrane.

Drying in nose, faucets, larynx, and trachea – worse at night. Larynx feels sore. Respiration oppressed, quick, unequal. Cheyne-Stokes respiration. Larynx very painful; feels as if a foreign body were in it, with cough. High, piping voice. Moaning at every breath. Violent cardiac palpitation, reverberating in head, with labored breathing. Palpitation from least exertion.

Cocainum Hydrochloricum

Throat dry, burning, tickling, constricted, paralysis of muscles of deglutition. Speech difficult. Chorea; paralysis agitans; alcoholic tremors and senile trembling. Local sensory paralysis. Formication and numbness in hands and forearms. Sleep restless.

Pulmo Vulpis

Recent discoveries in the uses of tissues and organs as remedies have thrown light on many curiosities of ancient medicine. As the fox is probably the longest-winded of all animals, the doctrine of signatures pointed to his lungs as a likely remedy for short breath.

Humid asthma. Chronic catarrh and oedema of the lungs. Strong, sonorous bubbling, rattling and whistling sounds. Accelerated short breath amounting to suffocation. Persistent shortness of breath, becoming a paroxysm of asthma on the least bodily exertion. The patient could only live sit up, bent forward, constant lividity of face, lips, and extremities, and dropsy of legs. Heart’s pulsations irregular.

Arsenicum Album

Unable to lie down, fears suffocation. Air-passages constricted. Asthma worse midnight. Burning in chest. Suffocative catarrh. Darting pain through upper third of right lung. Wheezing respiration. Hemoptysis with pain between shoulders; burning heat all over. Throat swollen, edematous, constricted, burning, unable to swallow. Diphtheritic membrane dry and wrinkled.

Heart: Palpitation, pain, dyspnea, faintness. Irritable heart. Pulse more rapid in morning. Dilatation. Cyanosis. Fatty degeneration. Angina pectoris, with pain in neck and occiput.

Natrium Sulphuricum

Slimy, thick, tenacious, white mucus. Bitter taste, blisters on palate. Throat – thick, yellow mucus, drops from posterior nares. Dyspnea. Must hold chest when coughing. Humid asthma, chest feels all gone. Constant desire to take deep, long breath. Delayed resolution in pneumonia. Springs up in bed.

Spongia Tosta

A medicine especially marked in the symptoms of the respiratory organs, cough, croup, etc. Heart affections and often indicated for the tubercular diathesis. Swollen glands. Exhaustion and heaviness of the body after slight exertion, with orgasm of blood to chest, face. Anxiety and difficult breathing. Nasal stoppage. Dryness; chronic, dry, nasal catarrh.

Tongue dry and brown; full of vesicles. Thyroid gland swollen. Stitches and dryness. Burning and stinging. Sore throat; worse after eating sweet things. Tickling causes cough. Clears throat constantly.

Agraphis Nutans

Sleep apnea due to obstruction of the nostrils from enlarged adenoids, enlarged tonsils, throat deafness. Catarrhal conditions and obstruction of nostrils. Throat and ear troubles with a tendency to free discharge from mucous membranes.

Lachesis

Diphtheritic paralysis. Sleep apnea. Sensation of tension in various parts. Bleeding, nostrils sensitive. Coryza, preceded by headache. Hay asthma; paroxysms of sneezing. Trifacial neuralgia. Gums swollen, spongy, bleed. Tongue swollen, burns, trembles, red, dry and cracked at tip, catches on teeth. Aphthous and denuded spots with burning and rawness. Nauseous taste. Teeth ache, pain extends to ears. Pain in facial bones.

Throat sore. Quinsy. Septic parotiditis. Dry throat, intensely swollen, externally and internally. Diphtheria; membrane dusky, blackish. Chronic sore throat very painful. Tonsils purplish. Purple, livid color of throat. Collar and neckband must be very loose.

Acid Nitricum

Blisters and ulcers in mouth on tongue. Ozaena. Stitches, as of a splinter in nose. Caries of mastoid. Nasal diphtheria. Painful pimples on the sides of the tongue. Tongue clean, red and wet with center furrow. Teeth become loose, gums soft and spongy. Ulcers in soft palate, with sharp, splinter-like pains. Salivation and fetor oral. In throat white patches and sharp points, as from splinters, on swallowing. Aphonia. Soreness at lower end of sternum.

Crotalus Horridus

Tongue red and small but swollen. Tongue fiery red, dry in center, smooth and polished. Moldy smell of breath. Fills up with saliva. Tongue when protruding, goes to right. Spasmodic grinding of teeth at night. Cancer of tongue with hemorrhage. Throat dry, swollen, dark red. Spasm of esophagus; cannot swallow any solid substance. Tight constriction. Gangrenous, with much swelling. Tickling from a dry spot in larynx.

Opium

Face: Red, bloated, swollen, dark suffused, hot. Looks intoxicated, besotted (Bapt; Lach). Spasmodic facial twitching, especially corners of mouth. Veins of face distended. Hanging down of lower jaw. Distorted. Mouth dry. Tongue black paralyzed bloody froth. Intense thirst. Blubbering op lips. Difficult articulation and swallowing. Breathing stops on going to sleep; must be shaken to start it again. Hoarse. Deep snoring; rattling, stertorous breathing. Difficult, intermittent, deep, unequal respiration. Heat in chest; burning about heart. Cough, with dyspnea and blue face; with bloody expectoration.

Great drowsiness. Falls into a heavy stupid sleep. Profound coma. Loss of breath on falling asleep. Coma vigil. Picking at bedclothes. Very sleepy but cannot go to sleep. Distant noise, cocks crowing, etc, keep him awake. Bed feels so hot cannot lie on it. Pleasant, fantastic, amorous dreams. Shaking chill; then heat, with sleep and sweat. Thirst only during heat.

Apis Mellifica

Nose red, swollen, inflamed, with sharp pains. Face swollen, red, with piercing pain. Waxy, pale, edematous. Erysipelas with stinging burning edema. Tongue fiery red, swollen, sore, and raw, with vesicles. Scalding in mouth and throat. Tongue scalded, red hot, trembling. Gums swollen. Lips swollen, especially upper. Membrane of mouth and throat glossy, as if varnished. Red, shining, and puffy, like erysipelas. Cancer of the tongue.

Throat constricted, stinging pains. Uvula swollen, sac-like. Throat swollen, inside and out; tonsils swollen, puffy, fiery red. Ulcers on tonsils. Fiery red margin around leathery membrane. Sensation of fishbone in throat.

Gelsemium Sempervirens

Centers its action upon the nervous system. Various degrees of motor paralysis. General prostration. Dizziness, drowsiness, dullness, and trembling. Slow pulse, tired feeling, mental apathy. Paralysis of various groups of muscles about the eyes, throat, chest, larynx, sphincter, extremities, etc. Post-diphtheritic paralysis. Muscular weakness. Complete relaxation and prostration. Lack of muscular co-ordination. General depression from heat of sun. Sluggish circulation. Nervous affections of cigarmakers. Influenza. Measles. Pellagra.

Sneezing; fullness at root of nose. Dryness of nasal fossae. Swelling of turbinate. Watery, excoriating discharge.  Face hot heavy, flushed, besotted-looking. Neuralgia of face. Facial muscles contracted, especially around the mouth. Chin quivers. Lower jaw dropped.

Mouth: Putrid taste and breath. Tongue numbed, thick, coated, yellowish, tremble, paralyzed. Difficult swallowing. Itching and tickling in soft palate and Naso-pharynx. Pain in sterna-cleidoic-mastoid, back of parotid. Tonsils swollen. Throat rough, burning. Tonsillitis; shooting pain into ear. Feeling of a lump in throat that cannot be swallowed. Aphonia. Swallowing causes pain in ear. Difficult swallowing. Pain from throat to ear.

Slowness of breathing, with great prostration. Oppression about chest. Dry cough, with sore chest and fluent coryza. Spasm of the glottis. Aphonia; acute bronchitis, respiration quickened, spasmodic affections of lungs and diaphragm.

Heart: A feeling as if it were necessary to keep in motion, or else heart’s action would cease. Slow pulse. Palpitation; pulse soft, weak, full and flowing. Pulse slow when quiet, but greatly accelerated on motion. Weak, slow pulse of old age.

Nux Muschata

Marked tendency to fainting fits, with heart failure. Cold extremities, extreme dryness of mucous membranes and skin. Strange feeling, with irresistible drowsiness. Indicanuria. General inclination to become unconscious during acute attacks. Lipothymia. Nose dry, stopped up.

Mouth very dry. Tongue adheres to roof of mouth, but no desire for water. Saliva like cotton. Tongue numbed, paralyzed. Dryness of throat. Cough when getting warm in bed. Heart trembling, fluttering. Sensation as if something grasped heart. Palpitation: pulse intermits.

Ignatia Amara

Hyperesthesia of all the senses, and a tendency to clonic spasms. Histeria. Twitching of muscles of face and lips. Changes color when at rest. Easily bites inside of cheeks. Constantly full of saliva. Toothache; worse after drinking coffee and smoking. Feeling of a lump in throat that cannot be swallowed. Tendency to choke, globus hystericus. Stitches between acts of swallowing. Stitches extend to ear. Tonsils inflamed, swollen, with small ulcers. Follicular tonsillitis.  Dry, spasmodic cough in quick successive shocks. Spasm of glottis. Reflex coughs. Coughing increases the desire to cough. Much sighing. Pain in trachea.

Sulphur

Herpes across the nose. Nose stuffed indoors. Imaginary foul smells. Alae red and scabby. Chronic dry catarrh; dry scabs and readily bleeding. Polypus and adenoids. Lips dry, bright red, burning. Bitter taste in morning. Jerks through teeth. Swelling of gums; throbbing pain. Tongue white, with red tip and borders.

Throat: Pressure as from a lump, as from splinter, as of a hair. Burning, redness and dryness. Ball seems to rise and close pharynx. Oppression and burning sensation in chest. Difficult respiration. Aphonia. Heat, throughout chest. Chest feels heavy; stitches, with heart feeling too large and palpitating pleuritic exudations. Flushes of heat in chest rising to head. Oppression, as of a load on chest. Dyspnea in middle of night, relieved by sitting up. Pulse more rapid in morning than in evening.

Aspidosperma

Considered as the digitalis of lungs. Removes temporary obstruction to the oxidation of the blood by stimulating respiratory centers, increasing oxidation and excretion of carbonic acid.

Grindelia Robusta/ Grindelia Squarrosa

Both Grindelia robusta and Grindelia squarrosa have been used for the symptoms. Acts on the cardio-pulmonary distribution of the pneumo-gastric in dry catarrh. Produces a paresis of the pneumo-gastric, interfering with respiration. Smothering after falling asleep. Asthmatic conditions, chronic bronchitis. Bronchorrhea with tough mucus, difficult to detach. Raises the blood pressure.

Nausea and retching of gastric ulcer. Sugar in urine. An effective antidote to Rhus-poisoning, locally and internally; also, for burns, blisters, vaginal catarrh and herpes zoster. Hyperchlorhydria when attended with asthmatic and other neurotic symptoms. Hyperemia of gastric mucous membrane with difficult respiration. Acts on the pulmonary circulation. Asthma, with profuse tenacious expectoration, which relieves. Stops breathing when falling asleep; wakes with a star, and gasps for breath. Must sit up to breathe. Cannot breathe when lying down. Pertussis, with profuse mucous secretion. Sibilant rales. Weak heart and respiration. Cheyne-Stokes respiration.

Sambucus Nigra

Acts especially on the respiratory organs. Dry coryza, snuffles, edematous swellings. Profuse sweat. Constant fretfulness, very easily frightened, fright followed by suffocative attacks. Chest oppressed with pressure in stomach, and nausea Hoarseness with tenacious mucus in larynx. Paroxysmal, suffocative cough, coming on about midnight, with crying and dyspnea. Spasmodic croup. Nose dry and obstructed. Loose choking cough. Nose blocked up, cannot breathe. Patient awakes suddenly, nearly suffocating, sits up, turns blue. Cannot expire. Millar’s asthma.

Ammonium Carb

Mucous membranes of the respiratory organs are especially affected. Fat patients with weak heart, wheezing, feel suffocated. Swollen glands, dark red sore throat, faintly developed eruption. Heaviness in all organs. Discharge of sharp, burning water from nose. Stoppage at night, with long continued coryza. Cannot breathe through nose. Snuffles. Tip of nose congested. Tetters around mouth. Boils and pustules, during menses. Corners of mouth sore, cracked, and burn.

Severe dryness of mouth and throat. Vesicles on tongue. Taste sour; metallic. Cracking of jaw on chewing. Enlarged tonsils and glands of neck. Burning pain all down throat. Tendency to gangrenous ulceration of tonsils. Diphtheria when nose is stopped up.

Sanguinaria Nitricum

Polypus of the nose. Acute and chronic catarrh. Acute pharyngitis. Smarting and burning in throat and chest especially under sternum. Influenza. Lachrymation, pains in eyes and head, sore scalp; sense of obstruction. chronic follicular pharyngitis.

Nose feels obstructed. Profuse, watery mucus, with burning pain. Enlarged turbinate at beginning of hypertrophic process. Secretion scant, tendency to dryness. Post-nasal secretions adherent to nasopharynx, dislodged with difficulty. Dry and burning nostrils; watery mucus, with pressure over root of nose. Nostrils plugged with thick, yellow, bloody mucus. Sneezing. Rawness and soreness in posterior nares.

Throat rough, dry, constricted, burning. Right tonsil sore, swallowing difficult. Ulceration on the side of the tongue. Pressure behind center of sternum. Dryness and burning in throat and bronchi. Tickling cough. Chronic nasal, laryngeal, and bronchial catarrh. Voice altered, deep, hoarse.

P. S: This article is only for doctors having good knowledge about Homeopathy and allopathy, for learning purpose(s).

For proper consultation and treatment, please visit our clinic.

None of above-mentioned medicine(s) is/are the full/complete treatment but just hints for treatment; every patient has his/her own constitutional medicine.

Dr. Sayyad Qaisar Ahmed (MD {Ukraine}, DHMS), Abdominal Surgeries, Oncological surgeries, Gastroenterologist, Specialist Homeopathic Medicines.

 Senior research officer at Dnepropetrovsk state medical academy Ukraine.

Location:  Al-Haytham clinic, Umer Farooq Chowk Risalpur Sadder (0923631023, 03119884588), K.P.K, Pakistan.

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