New Study Reveals That Drinking Water Cures Dehydration

September 26, 2008

You may have thought after reading this post’s title, “I know that already.” But in science, you can’t say A causes B without double blinded prospective randomized placebo-controlled studies. Even then you can’t say definitively that A causes B—all you can say is that there is a very high likelihood that A is associated with B.

In the fields of sleep medicine and ENT, I see occasional studies that are similar to the water curing dehydration title. For example, in one article, “The nasal decongestant effect of xylometazoline in the common cold,” the authors show that applying an over the counter topical decongestant spray can help you breathe better. Here, a double-blinded placebo-controlled study was performed, where the placebo was nasal saline. Other common titles that I see frequently go something like this: “CPAP improves quality of life in patients with obstructive sleep apnea,” or “Lack of sleep is associated with drowsiness and poor concentration.”

There are many well-intentioned investigators that publish good papers, but sometimes you have to question the value of some of these studies. How does it help you and me, now? Of course, for three reasons, no one will ever do a large, expensive prospective study on the merits of giving water for dehydration. First, it’s just common sense that it’s true, and two, there’s no profit in marketing water for dehydration. Third, you can’t say that something cures or helps a medical condition without FDA approval. Essentially, mothers are practicing medicine without a license by giving water, an unapproved “supplement,” to their young children whenever they get dehydrated from diarrhea.

If you scan the health news headlines, it’s the same old stuff – exercise can reduce your weight, or lowering stress can prolong your life. Yes, there’s been tremendous advances with technology, but why is it that as a whole, our country is sicker than ever?

I think this is one of the major reasons why there’s not too much progress in medicine. We continue to perform studies to confirm previous confirmed studies which confirm previous confirmed studies, and so on. For this reason it’s rare to ever see a radically new approach to treatment.

Do you think our current scientific method is adequate for our health care needs, or de we need to revamp the entire system?

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Q: If You Need Your Tonsils, Why Take Them Out?

September 25, 2008

A: Tonsils are part of the immune system, but when they are too large or are prone to frequent infections, then surgical removal is a consideration. One or two infections every year is not too worrisome, but having an infection every month can be debilitating for most people. For many children (and some adults), very large tonsils can lead to breathing problems at night.

More Questions About Tonsils

Q: What are tonsils?

A: Tonsils are paired lymphoid or glandular tissues that sit on the side-walls of your throat just behind your tongue. They are part of a complete circle of lymphoid tissues that is involved in programming your immune system what is foreign and what is self. The adenoids sit in the mid-line at the back of your nose and the lingual tonsils are also in the mid-line at the rear of the tongue, just above the voice box. They are most active from ages 3-5, and this is the time that most problems arise.

Q: Do you need tonsils?

A: Yes, especially when you have an infection. Most of the immune system programming occurs in early childhood. As you get older, the tonsil shrink to a much smaller size in adulthood. However, if there is chronic irritation, such as from allergies, colds or acid reﬂux, they can remain enlarged. Tonsils and adenoids are only a small part of a much larger system of lymph glands and immune mechanisms.

Q: What happens if my tonsils are too big?

A: Just because your tonsils are big does not mean they have to be removed. If you have no problems, then with time, they should shrink. But if you have signs or symptoms of a sleep-breathing disorder, such as daytime fatigue, poor concentration, memory problems, attention problems, asthma, cough, nasal congestion, or snoring, then they should be looked at by an ear, nose and throat physician. Sometimes I see young children who snore heavily, with severe asthma, attention and behavioral problems, and who are on Ritalin for ADHD. On exam they are found to have very large “kissing” tonsils. Due to the prevalent myths about tonsils and surgery, the parents refuse any form of surgical therapy. They would rather treat the end result of their child’s sleep-breathing problem (asthma, ADHD) with long-term medications, when surgery could be curative. On the ﬂip side, there are also too many people with tonsils that are taken to the operating room prematurely, with no clinical reasoning whatsoever.

Q: Can large tonsils cause snoring?

A: Yes. Anything that narrows the upper airway, from the nose to the voice box, can cause snoring or other breathing problems. In children, large tonsils are a common cause of snoring. Snoring itself in children has been linked to behavioral, memory and concentration problems, asthma, and chronic cough. A signiﬁcant number of children (and adults) who snore are also found to have obstructive sleep apnea, which can lead to fatigue, depression, high blood pressure, heart disease and many other conditions. It’s also associated with sexual dysfunction and frequent urination at night.

Q: Doesn’t undergoing a tonsillectomy hurt?

A: Yes. But with advances in technology, it doesn’t hurt as much. Traditional tonsillectomy using an electrocautery device will leave you with a very sore throat for 4-7 days. You’ll be on soft or liquid diet until the pain subsides, after which you slowly progress to foods of more solid consistency. The best part is that you can eat lots of ice cream. With newer techniques (such as the Coblator) you’ll have only 2-5 days of pain, with some people not taking any pain medications at all.

Q: What are the potential complications of tonsillectomy?

A: As with any operation, there’s always a very small chance of bleeding or infection. If it occurs, then it will be addressed appropriately. Speciﬁc to the procedure, there is a small chance that you may have persistent symptoms even after surgery. There are many reasons for this, including not taking enough tonsil tissues out, or it may be due to something entirely diﬀerent. Two common reasons include post-nasal drip and laryngopharyngeal reﬂux disease. There’s also a very small risk to general of complications from anesthesia is lower than being hit by a car.

To ask Dr. Park a question, click here.

Written by Steven Park · Filed Under QnA | 44 Comments

Insomnia And Depression

September 25, 2008

A new study reveals that people with insomnia are more likely to develop depression later in life. The traditional thinking is that insomnia is a symptom of depression, but the authors argue that insomnia may come before depression.

This is old news, if you look at it from the sleep-breathing paradigm described in my forthcoming book, Sleep, Interrupted. I address both insomnia and depression as manifestations of interrupted breathing while sleeping that deprives you of deep, restful, restorative sleep. This process begin in childhood, affected by multiple factors, including anatomic issues, diet, infections or stressful situations. The sleep-breathing paradigm doesn’t contradict what’s out there in insomnia knowledge and research, but suggests a different perspective on ideas that we take for granted. For the most part, it even agrees with and supports the evidence in insomnia research. So it’s not important which comes first (insomnia or depression), but that both can coexist together. If so, what can cause both to occur?

This is another example of the peculiarities of medical research when you try to isolate and correlate one variable against another. Yes, you’ll get some interesting results, but more often than not, you’ll end up asking more questions as a result, or end up with multiple conflicting results. Once you look at humans as a complex interaction of innumerable processes, by looking at the “big picture,” things just make more sense.

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Acupuncture: Sham or Science?

September 23, 2008

Amy R. Hausman, L.Ac, Dipl. OM. (NCCAOM)

Guest Columnist

As a licensed acupuncturist, it’s empowering to see your profession cast in an approving light, especially when it’s reviewed by a well respected medical journal. However, since I have witnessed the effectiveness of acupuncture for a myriad of disorders, I am always curious as to why its efficacy is not positively portrayed in more clinical trials. Having reviewed this study for Dr. Park, I now know why.

STUDY OVERVIEW

The purpose of this study was to investigate the efficacy of acupuncture in the treatment of moderate obstructive sleep apnea syndrome (OSAS). It was a randomized, placebo-controlled, single-blinded study, with blinded evaluation of 36 patients presenting with an apnea/hypopnea index (AHI) of 15-30/hour. The patients were divided into 3 groups: an experimental group of 12 people receiving acupuncture once a week for 10 weeks, a sham group of 12 patients who received “fake” acupuncture once a week for 10 weeks, and a control group of 12 patients who received no treatment. The results showed that out of the 26 patients who completed the study, there were significant changes for those in the experimental group that received acupuncture. Not only did the number of respiratory events (or number of obstructions) decrease in the acupuncture group, but there were also marked improvements in the outcome measures as displayed by the SF-36 and Epworth questionnaires. The investigating team concluded that acupuncture is more effective than sham acupuncture in relieving the respiratory events of patients presenting with moderate OSAS.

SHAM VERSUS REAL LIFE RESULTS

My first question regarding this study has to do with the conclusion made by the investigating team. While the research showed that acupuncture is more effective than sham acupuncture in relieving respiratory events in moderate OSAS, there was no mention of a comparison of the experimental group (those receiving acupuncture) to the control group (those not receiving acupuncture).

Granted, real acupuncture versus “sham” acupuncture may prove that there is such as thing as a “good” treatment versus a “bad” treatment. Especially as the research team here utilizes the sham group in the same way that a pharmaceutical company would compare those who were taking ”placebos” to those who were taking the “controlled substance” in question. However, some TCM (Traditional Chinese Medicine) practitioners may disagree with the
study’s conclusion citing faults in its design.

EASTERN VERSUS WESTERN STUDY DESIGN

The study noted that there were some improvements in the sham group over those in the control group. This implies that even though no real acupuncture points were used on specific meridians, there was some sensation or response that provoked an outcome for the patient. This can lead to conflicting ideas as to whether the sham acupuncture is in fact a real treatment or if it is truly placebo acupuncture as it is meant to be. For this reason, a future study with only 2 study arms, an experimental group and a control group, omitting a sham group altogether in favor of simply comparing the results of acupuncture to no acupuncture may be better from a TCM perspective.

Furthermore, if it is true that a clinical trial must show a certain reliability and reproducibility in order for it to be deemed valid, this same criteria makes it difficult to assay the full impact of acupuncture and other forms of TCM for the treatment of illnesses confined within a Westernized paradigm of disease and health.

DIFFERENT PARADIGMS, DIFFERENT PERSPECTIVES

When I was in graduate school, I was part of a research team that put together a proposal for studying the effects of acupuncture in post-stroke rehabilitation. Our analysis of previous studies addressing the use of acupuncture revealed several fundamental difficulties in the assessment of an ancient Eastern medical paradigm within the framework of modern Western medical research protocols. These difficulties occurred primarily when attempting to apply scientific demands of reliability and validity to the TCM treatment approach based on individual presentation and pattern diagnosis.

TCM sees each person as an individual with a unique set of patterns and presentations regardless of the disease diagnosis. That being said, 5 people presenting with OSAS to a TCM practitioner may be diagnosed with 5 different TCM disease patterns and therefore treated with different acupuncture point prescriptions. While some of the points may be the same, as noted in this pilot study being reviewed, there may be other points specific to each individual that addresses the root of his/her sleep apnea syndrome. Treating the root of the disorder or what is considered the underlying cause is a fundamental treatment principle in TCM. Not only can such a treatment reduce the severity of the symptoms, but it may also reduce the occurrence or recurrence of such disorders altogether. Therefore, it would be interesting to note the long-term effects of using the same point protocol on different patients and whether or not further evaluation at a later date would show more variance in results. Unfortunately, there is no mention in the original article of the different TCM disease patterns used to come up with their acupuncture point prescription or if that was even taken into consideration.

In essence, the basic differences in approach may make a true study of TCM impossible within a Western medical framework. Thus, trying to adhere to strict TCM protocols usually results in studies being conducted with discrepancies in design, intervention and control procedures—all things that in a more statistical evaluation like the study mentioned would compromise the scientific relevance and validity of their results.

Perhaps the future of clinical trials investigating the efficacy of acupuncture lies within a setting that allows for both a TCM approach of customized treatment along with a Western standardization that will be statistically measurable, reproducible, and scientifically valid. While the efficacy of acupuncture has been seen for thousands of years, it seems the progress of acupuncture research is
slow indeed, and the gap between TCM and Western medicine may be the sticking point when trying to conduct a valid clinical study using acupuncture.

—————————————————————–
Amy R. Hausman, L.Ac, Dipl. OM. (NCCAOM) is board-certified in Chinese Medicine. As the founder of Co-Creative Healing Arts and Acupuncture, Amy brings her experience as a licensed acupuncturist and psycho-spiritual counselor to those suffering from anxiety/depression,reproductive issues, sleep disorders, pain management, addictions, chronic sinusitis, migraines, and other acute and chronic illnesses.

Focusing on the body as a whole rather than only the part that is sick is a key to healing all types of disorders. It is this subtle yet powerful approach that Amy integrates using her background in both Chinese medicine and Integrative Energy Medicine in order to help initiate the person’s own healing process.

For a limited time, mention this article and receive $50 off your first consultation and treatment. You can contact her directly at: 917-334-8907.

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*Treatment of Moderate Obstructive Sleep Apnea Syndrome with Acupuncture: A randomized, placebo-controlled pilot trial Anaflavia O. Freire, Gisele C.M. Sugai, Fernanda Silveira Chrispin, Sonia Maria Togeiro, Ysao Yamamura, Luiz Eugenio Mello, Sergio Tufik: Sleep Medicine, 2006, xx(xxxx), 1-8, © Elsevier

Written by Steven Park · Filed Under Articles | Leave a Comment

Can Sleep Apnea Cause Alzheimer’s?

September 23, 2008

A few days ago, I ran across two studies about obstructive

sleep apnea (OSA) and brain structure in my sleep medicine

journals that had me wondering: Could there be a link
between Alzheimer’s Disease (AD) and obstructive sleep
apnea?

The first study showed that people with OSA (see below) had
a much higher incidence of silent lacunar infarcts on an
MRI scan. Lacunar infarcts are very small areas of
clotted small blood vessels in the brain. Essentially,
these are microscopic strokes.

The second article showed that people with OSA had
multiple areas of brain tissue that received significantly
lesser amounts of blood flow. If a small vessel in your
brain doesn’t get very much blood flow, then there’s a
higher chance of clotting as well. A natural consequence of
this process is that you’ll get scarring and changes that
can overlap with findings that are seen in AD. Also, if you
get less blood flow in your brain region, then you’ll have
less neurotransmitter production and less need for glucose.

One of the hallmarks of (AD) is what’s found under the
microscope during an autopsy. Two common findings of those
with AD are neurofibrillary tangles (NFTs) and senile
plaques (SPs). These are the scar tissue-like end-stage
findings for many types of nerve damage. Although not
specific to Alzheimer’s alone, NFTs and SPs are routinely
stated as being one of the distinctive markers for this
devastating condition. However, despite the millions or
even possibly billions of dollars of research in this area,
we still don’t know why this happens, what causes it or
even how to prevent it.

As I was reading through these two articles, in conjunction
with all the latest research about AD, I couldn’t help but
to see a distinct merger between OSA and AD. This, in turn
made me think about a short satirical video by a renowned
osteopath Dr. Joseph Mercola and then all I could think
about were skid marks on the side of the road.

The Skid Marks of Healthcare

This 10 minute video describes a town called Allopath. Due
to budget cuts and an absence of stop signs at one
especially busy intersection, the town experiences an
alarming number of traffic accidents and injuries. As a
result, a consultant with the Motor Division (MD) is
brought in to diagnose the problem, and after careful
analysis, he proclaims that the reason for all the traffic
accidents is due to the presence of tire skid marks and his
solution?: Cover up the deadly skid marks with teflon.
Bolstered by the facts of this MD’s research the
townspeople rally together to rid the town from offending
skid marks. In doing so, new industries begin to crop up in
their town.
From a Teflon factory to ambulances and hospitals to car
repair shops repairing the cars damaged by the increase in
traffic accidents, the town’s economy booms. Yet, as the
town’s economy grows, the rate of traffic accidents, rather
than going down, inversely gets worse as the slick Teflon
only causes more accidents. Eventually, the town’s economy
crashes as many of the townspeople become disabled. In
short, this video reveals a sad but true account of what’s
happening with our health care system today.

Some of the cutting edge AD research in the prevention of
worsening memory and cognitive functioning focuses on
enhancing certain neurotransmitters and metabolic
processes, such as acetylcholine or glucose. Drugs that
lower enzymes or proteins that naturally degrade
acetylcholine are shown to help with memory and cognition.
Other research focuses on the biochemical and genetic
properties of these NFTs and SPs, which are acknowledged to
be the end-stage result of nerve damage and ultimate death.
The reasoning is that by preventing NFTs and SP, we can
prevent Alzheimer’s.

In so far as these very complex studies go, however, none
has yet to explain how and why all these factors for AD
interrelate. Until you consider, however, the possibility
that Alzheimer’s may be one of many symptomatic end stages
of obstructive sleep apnea (OSA).

OSA and AD: How Are they Alike?

Research reveals that people at risk for AD are also at
risk for the routine cardiovascular conditions like high
blood pressure, diabetes, and heart disease. Some
researchers have stated that AD is a disease of the small
vessels in the brain. Similarly, if you have OSA, you are
more likely to have all of these heart problems, along
with a higher likelihood to have strokes, or be obese.
Another interesting symptom to note is that OSA promotes
the kind of inflammation and clotting not unlike the kind
of small blood clotting and neurotransmitter degeneration
that’s commonly associated with those with Alzheimer’s.

With all these similarities between OSA and Alzheimer’s
Disease, it’s not too far-fetched to consider them
complimentary if not to see that one may be an aggravating
factor for the other. There’s even evidence of a common
gene linking AD with OSA.

Yet, even with all these studies showing strong
correlations between OSA and AD, 80-90% of people with OSA
are still not diagnosed in this country, and if my
hypothesis is right this number probably includes many
patients who are “at risk” for Alzheimer’s (i.e. family
history, evidence of memory loss etc.) In fact, if would
be even more important to screen for OSA when you are much
younger, before neurologic impairment, heart disease, or
more importantly, before Alzheimer’s sets in. In all of
these scenarios, the time and money required in screening
these potential patients for OSA would be miniscule
compared to the rewards of preventing Alzheimer’s for even
a small proportion of this population.

We Can Learn A Lot From a Dummy

As Mercola’s cartoon video showed, much of what we believe
about scientific research is grounded in the premise that
if it’s not too complex, it can’t be scientific. Even in
the case of Alzheimer’s research and studies of OSA, much
of the research is focused on what you can do after the
disease has already set in. It may be that prevention
methods, like eating right, exercising and sleeping well,
seem too simple of a cure for such a complex problem like
AD.

I don’t mean to offend all the good-intentioned doctors and
researchers working on a “cure” for AD. Granted,
eventually, there will be many drugs out there to slow the
progression of AD, just like all the medications that we
have for high blood pressure and heart disease. But could
it be that by allowing these drugs to be so freely
dispensed after the onset of disease, we’re providing a
false sense of security for those “at risk” patients who
may have otherwise put more effort into maintaing a
healthier lifestyle?

Similarly, by just covering up the tire skid marks, rather
than installing stop signs at that dangerous intersection,
the town of Allopath thought they could “cure” traffic
accidents. Of course, neither are fail safe measures for
traffic accidents. Although not as sophisticated as
Teflon,however, stop signs would have at least forced the
citizens of Allopath to become more responsible drivers.
Teflon just made the problem spiral out of control.

So the next time you hear screeching tires, stop to note
the skid marks. Better yet, opt for prevention rather than
easy cures. Moreover, if you have a history of AD in your
family, and have noticed lately that you’re exhibiting
signs of chronic fatigue or impaired memory or are
experiencing classic symptoms of OSA, get a sleep study (to
get a listing of sleep study centers in your area visit: ).
Since AD is not (yet) currently reversible, it’s important
to become proactive in preventing anything that can cause
or aggravate it while you’re young to prevent any future
brain injury.

Written by Steven Park · Filed Under Articles | 5 Comments

Commitment and Consistency

September 22, 2008

One of my greatest frustrations is when I reveal to a patient that a major cause of his or her underlying medical issues (such as high blood pressure, dieabetes or weight isues) are from untreated obstructive sleep apnea. Most people are ecstatic about finally finding an answer to many of their medical problems and are excited to find how to go about treating it. But there are some individuals that give me a blank stare, with a glazed over look in their eyes. Some are even adamant that they know that they don’t have obstructive sleep apnea.

At this point, I go over again all the reasons I think they have sleep apnea, but only some are convinced. The rest go on treating their end-stage symptoms such as migraines and chronic throat pain with either pain medications or acid reflux reducers, which may help temporarily, but the problem usually comes back. Many of these same people will come back months or years later after worsening of their problems, admitting that “you were right.”

This phenomenon reminded me of a psychology book I read a while ago called Influence: The Psychology of Persuasion, by Dr. Robert Cialdini. One of the principles that he describes is commitment and consistency. He states that humans prefer to think the same way, act the same way, and take comfort in the consistency of their ways. In their minds, they’ve already committed themselves towards repeating the same steps every time.

For example, if you’ve been taking high blood pressure medications for 20 years, and you’re suddenly told that it was actually obstructive sleep apnea that caused it in the first place, how would you respond? If you’ve suffered from migraines all your life, how would you respond to being told that not sleeping efficiently due to partially obstructed airways can aggravate migraines? Being told something that completely refutes the daily actions (taking pills) you’ve taken for 20 years. It also conflicts with what your doctor said about your health.

If you were told something by your doctor that completely went against what you’ve revolved your life around for years, how would you respond, and how do you think your doctor should handle this situation? I’d like your feedback.

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Heavy Snoring & Stroke

September 21, 2008

We’ve always known that that heavy snorers are at increased risk for stroke. But a recent study from Australia showed that carotid artery narrowing in the worst snorers was 10 times higher than those who snore the least. In typical scientific journal fashion, a much larger sample size was said to be needed to establish a casual relationship. You can read a layman’s summary here from the New York Times. The authors proposed that perhaps vibrations themselves can damage the thin inner wall lining, leading to plaque buildup and eventual narrowing.

There are many more published articles that associate snoring with stroke. We know that a significant percentage of people who snore will have obstructive sleep apnea, and sleep apnea is strongly linked to stroke. The frustrating thing is that despite regular reports like this that warn of the the dangers of snoring, people continue to equate snoring as something to be laughed at and doctors continue to treat the end effects of obstructive sleep apnea (such as hypertension, diabetes, depression, anxiety, heart disease, heart attack and stroke). At least once per week, I see a younger snoring patient that tells me that his (or her) father snored heavily and suffered a stroke or a heart attack in their 40s or 50s. The frightening thing is that we know now that you don’t even have to snore to have obstructive sleep apnea.

Do you have a parent that snores heavily, and if so, did they suffer from a stroke or a heart attack at a relatively young age?
photo credit: achichi