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CPAP for Upper Airway Resistance Syndrome?

I recently came across a post on a sleep apnea support forum where a member asked about upper airway resistance syndrome (UARS) and how being on CPAP took care of a variety of his medical problems:

"So many things are better on the CPAP: 

My severe peripheral neuropathy of 5 years is almost gone. 
All the aches and pains are pretty much gone. 
My peripheral edema is gone. 
The age spots on my face are going away. 
I’m not huffing and puffing just doing simple things (like walking my son to his classroom.) 
My night sweats are gone. 
No more getting up to go to the bathroom at night. 
My heat intolerance is resolving -no longer sweat when I blow dry and curl my hair. 
I can exercise again and it’s enjoyable.  I no longer come home and go straight to bed. 
I don’t get so sore after exercise. 
My calf muscles are relaxing.  They used to just stay contracted all the time and I couldn’t get them to relax. 
My morning tremors are gone. 
Haven’t lost any weight, but dropped two pant sizes."

Fortunately, this person tolerated and responded very well to CPAP, whereas most people with UARS can’t stand having anything on their faces due to their hypersensitive nervous systems. Unfortunately, he was given CPAP by mistake before it was approved and the insurance company is refusing to pay for it anymore. Since his AHI was below the cut-off line of 5 for diagnosing obstructive sleep apnea (his was 1.9), officially he didn’t have sleep apnea. But he did stop breathing 8 times every hour on average. This is the dilemma with UARS.

My point here is that if the anatomic sleep-breathing problem is fixed definitively, regardless of the method (CPAP, dental devices or surgery), the patient will feel better. I describe a similar, very dramatic story about a young woman with even worse problems in my book, Sleep, Interrupted.

 

Multiple Sclerosis And Obstructive Sleep Apnea: Is There A Link?

I participate on a medical forum called Medhelp.org, where I’m the sleep-breathing expert. I answer people’s questions on various topics related to sleep and breathing. Somehow, I stumbled onto the multiple sclerosis (MS) community and was surprised to see that many people have severe fatigue issues, cold hands and various sleep issues. Their symptoms sounded surprisingly like upper airway resistance syndrome, which I’ve described before. So I decided to take a poll: I asked three questions: 1. How many MS patients have cold hands or feet? 2. How many MS patients have one or both parents that snore heavily, and if so, what kind of medical problems do they have? And 3. What’s your favorite sleep position (back, side, or stomach)?

The answers to this informal and unscientific poll was surprisingly lopsided. Out of 36 responses, 31 people said that they had either cold hands or feet. Many had to wear socks before going to bed, but some had to kick them off later. Fifteen out of sixteen stated that a parent (usually their father) snored heavily, and many also had major heart disease. Lastly, 26/30 responded that they prefer to sleep on their sides or stomachs. Many complained of intense fatigue.

This is the exact pattern that I see in patients with upper airway resistance syndrome, where they also have cold hands or feet, has a parent that snores, and wears mittens and socks to bed. Typically one or both parents snore, and have various degrees of heart disease. As many people with UARS slowly gain weight over the years, their cold hands may get better, but they’ll slowly develop into obstructive sleep apnea.

It’s a given that both UARS and MS will have a physiologic stress response, for different reasons. This can lead to various autonomic nervous system dysfunctions, such as cold hands or feet. It’s also known that chronic low-grade physiologic stress can stimulate the immune as well as the nervous system, heightening both these systems, leading to various pain issues or autoimmune conditions. I can’t say if there’s a definite cause and effect relationship between UARS and MS, but one thing for sure is that both have problems staying in deep sleep. The only definitive way to find out is is examine these MS patients with a flexible fiberoptic camera to examine the airway.

Am I going too far with my sleep-breathing hypothesis, or could I be onto something big?

 

 

 

Stressed and Starving? Three Simple Solutions To Stop Emotional Eating

 

It’s a well known fact that if you have a sleep breathing problem the stress of not sleeping well at night can make you eat more. Equally, if you’re an emotional eater, and use food to cope with stress you’re also more likely to develop sleep breathing problems, like obstructive sleep apnea, since weight gain can aggravate this condition.

Since Valentines is just around the corner, and many of you are just getting started on your New Year’s resolution to lose weight and keep it off this year, I’ve invited Peter Lappin, a holistic nutritional counselor to help you steer clear of your emotional eating problems. Hope it helps!
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You’re happy – you just got a promotion! – so you treat yourself to pizza and Coke.  You’re anxious – Can I handle this new job? – so you grab a candy bar and coffee.  You’re lonely – you come home and there’s no one to celebrate with – so you turn to your two friends in the freezer, Ben & Jerry.  In short, you are eating to manage your feelings, rather than in response to physical hunger.

According to a study done by the National Eating Disorders Organization, 95% percent of Americans eat for pleasure or comfort.  What makes emotional eating so challenging is that, like a criminal returning to the scene of the crime, there’s no escaping food: we generally eat every day.  Unfortunately, we are eating ourselves into compromised health, with skyrocketing rates of diabetes, obesity, and heart disease.

In a typical urban (and even suburban) environment, cheap food is all around us, tempting us.  There are vending machines in every office, coffee carts on every street corner, and shelves of savory snacks by the cash register of every drug store, gas station, and corner bodega.  Television commercials and magazine ads remind us to reward ourselves with General Mills International Coffee or indulge in a Sara Lee dessert.

Eating seems like an effective solution to our emotional turbulence.  When we’re stressed or depressed and use food to take the edge off, we DO feel better, at least temporarily.  It feels good to satisfy our cravings.  But this “medicine” not only has dangerous side effects, it also never gets to the cause of the feelings we’re trying to manage.

What can we do?

We need to stop medicating ourselves with food and start checking in emotionally.  

First, we can look at how we are doing with the other things, beside food, that nourish us.  Do we have work we find meaningful?  Do we have relationships that sustain us?  Do we feel connected to something larger than ourselves, like a spiritual practice or a sense of personal purpose?  Do we have an exercise routine we enjoy that “takes the edge off” when life feels stressful?  We can start to address some of these areas where we may be lacking (one small step at a time. of course – we don’t need to create more stress).

Second, if you think you’re hungry, ask yourself, How hungry am I?  If your hunger feels like a bottomless pit, you’re desperate for a something to put in your mouth and you ate within the last few hours, you may be experiencing emotional hunger.  Breathe.  Take a work break.  Go outside to get some fresh air.  Call a friend.  Find sources of pleasure other than food.

We can’t eat ourselves more love, more friendship, a better job, or more understanding.  But we can feed our hearts with the things we really need to go through life feeling nourished and content.

As always, go gently, and treat yourself like someone you really love – because you are!

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Holistic Health Counselor Peter Lappin works with adults with emotional eating issues in his private practice in Manhattan.  To e-mail Peter, click here.  For more information about Peter, visit his website by clicking here.

Rosie O’Donnell and the 5 Sleep Myths That Women Have

A couple of years back, when Rosie O’Donnell was still on a popular morning talk show called The View she shared something about herself that many women would feel too ashamed to admit:  Rosie declared that she had a sleep breathing problem called obstructive sleep apnea.  She even proudly demonstrated to many thousands of women viewers on how she uses the CPAP (continuous positive airway pressure) mask every night.  I’m sure that by doing so she was hoping to raise awareness for more women to get tested for this all-too-common yet frequently undiagnosed condition.

Unfortunately, her frank disclosure may have done little to dispel the myths surrounding sleep apnea. Estimates suggest that 85% of sleep apnea patients go undiagnosed with a higher percentage of that number being women.

Listed below are 5 of the most common myths that get in the way of women being treated effectively for this condition. Discover for yourself what, if any ramifications sleep apnea may have on your health and take measures to prevent this problem from affecting you.

Sleep Apnea Then and Now
Obstructive sleep apnea was first described in the 50s and 60′s as a rare condition in very obese, older, snoring men who kept falling asleep during the day.  But even now, about 40 years later, every medical lecture I attend about sleep apnea begins with a picture of Joe the fat boy from Dicken’s The Pickwickian Papers.  Although anyone who knows anything about sleep apnea these days knows that this is merely a caricature of real sleep apnea, nothing has been done to dispel these prevailing myths. 
It’s now known that about a 23% of men and 11% of women in this country have some degree of obstructive sleep apnea. This number gets even higher in older women, especially after menopause.  The reason why this is so problematic is that untreated, the sleep apnea patient has a 2 to 3 time increase in risk of cardiovascular complications, such as high blood pressure, heart disease, heart attacks or even strokes. There are also known associations with depression, obesity, sexual dysfunction, and headaches. However, many sleep apnea patients, especially a lot of women aren’t being properly diagnosed due to the many myths surrounding this condition.   

Where Do These Myths Come From?

Myth Number One: “I’m Not Rosie O’Donnell”

The first myth is that one has to be an older, heavy-set, snoring man to have sleep apnea.  While this may be true in this particular population, it can also occur in young thin women.  This has been proven in multiple published research studies.  But many young women will look at a celebrity like Rosie O’Donnell and think, "I’m not like her. I’m skinny. I can’t have sleep apnea".  The sad truth is, even many doctors still think that a young thin person can’t have obstructive sleep apnea.  Therefore, because of these biases, the diagnosis of obstructive sleep apnea is never considered even when you present with many of the common signs and symptoms of sleep apnea.  In my practice, there’s an even split with about 1/2  of the men and women who are diagnosed with sleep apnea that are overweight, and 1/2 that are relatively thin.

Myth Number Two: “I’m not lazy”

Another misconception many people have is that those who have sleep apnea tend to sleep too much or are just plain lazy.  Yet the truth is, many sleep apnea patients, contrary to their drowsy appearance, tend to be high achievers since they must over compensate for their lack of deep restful sleep. Also, apneas or airway stoppages only happen when you’re in “deep sleep”, so these people, even though they may seem to sleep long hours, aren’t really getting the quality restful sleep they require (for a more in depth discussion on this topic read my recent article: The Real Reason Why Some People Are Lazy).

Myth Number Three : “I don’t snore.”

Many people associate obstructive sleep apnea with severe snoring. Again, in the severe sleep apnea patients this is usually the case, but many people with mild to moderate conditions may not snore at all. Remember that snoring, by definition, means that one is still breathing (somewhat). Apnea means total blockage. So,if you are not breathing, you are not snoring. This is the third myth that must be set straight.                 

Myth Number Four: “I’m a light sleeper”

"I know that I don’t have sleep apnea." This is one of the most common statements that I hear from women when I even mention a possibility In fact, studies have shown over and over again that you as a patient, are very poor at predicting whether or not you have obstructive sleep apnea. This is because it only happens while you are sleeping. Of course there are various minor exceptions to the rule such as waking up while one is snoring, but in general, the above statement is true. Research has even shown that bedmates are also poor at predicting sleep apnea.  Would you know if your spouse’s cholesterol was elevated just by looking at him?

Myth Number Five: “Sleep tests are inaccurate”

The last myth has to do with the actual sleep study itself to determine the degree of sleep apnea you have.  Many patients preempt these formalized tests by saying "I won’t be able to sleep in a sleep lab." Being in a strange bed with multiple monitors and leads attached to your body is an uncomfortable and annoying experience, but it’s rare when I have someone that really could not sleep enough to gather useful data. We don’t need an entire night’s sleep; we only need about 3-4 hours of continuous or even interrupted sleep. Some even complain that they did not sleep at all. But the brain waves on their sleep study results, by definition, shows that there was significant sleep present. Another frequent scenario I run across is when a patient undergoes a sleep study and the test does not reveal any significant obstructive sleep apnea. But just because the sleep study did not reveal any apneas does not mean that the quality of your sleep is still good. The reason for this is that an "apnea" is defined as a total stoppage of breathing due to obstruction in the throat for 10 seconds or longer. There is a lesser form of an "apnea" where there is still some airflow, but greatly diminished, yet it lasts more than 10 seconds (hypopneas). If the minimum threshold for obstructive sleep apnea is 15 "apneas" every hour.  and if you stop breathing 30 times every hour, but if each episode lasts for only 8 seconds, then you will have zero apneas and hypopneas.  As confusing as that sounds, in this case, you are told that you don’t have sleep apnea, but you still feel lousy when you wake up in the morning. This is a common situation with patients who have upper airway resistance syndrome, which is a preliminary stage before they proceed to having OSA (To learn more about UARS listen to our podcast on this topic by clicking here).

As you can see there are no absolutes when it comes to obstructive sleep apnea. After all, the myths and stereotypes are based on a distortion of the truth. Unfortunately, these myths can lead to or aggravate untreated high blood pressure, diabetes, obesity, heart disease, heart attack and stroke (read my article on  Women and Heart Disease: What Most Doctors Don’t Know). It’s my wish that you and others you know will be better educated to dispel these myths to promote better breathing, better sleep, and better health for themselves, their family members and their friends.
 

Q: How many hours should I sleep?

 

A:  It depends. Assuming that you don’t have any sleep-breathing problems and no other medical issues exist, the general range is about 5-8 hours. Everyone is different, with various sleep requirements. If you do have a sleep-breathing problem, then since your sleep quality is not as good, you’ll need more.

It’s been shown that the bare minimum "core" sleep that one needs is about 5 hours. By 5 hours, you’ll have gotten most of your non-REM deep sleep. Studies have shown that people who sleep less than 5 hours or more than 9 hours have higher rates of depression and heart disease. In short sleepers, this makes sense. But why is sleeping extra long a problem? Sleeping longer than 9 hours means that you’re not sleeping efficiently, for whatever reason. The most common problem will be a sleep-breathing problem, such as obstructive sleep apnea or upper airway resistance syndrome. If you can’t sleep on your back, or feel tired no matter how long you sleep, get evaluated by a sleep specialist.
 

 

Women and Heart Disease: What Most Doctors Don’t Know

If you’re a woman having chest pain or shortness of breath, it’ll take longer for you to be evaluated by EMS and taken to the emergency room than if you’re a man. This finding was reported this month’s Circulation: Cardiovascular Quality and Outcomes, and summarized for the lay public in the New York Times. What’s worse is that even if women get to the emergency room quickly, a heart attack diagnosis is made much slower than in men.

What this article doesn’t address, however, is how to prevent heart disease in women in the first place. Sleep apnea is a very common condition that if left untreated, can cause anything from depression, anxiety, high blood pressure, diabetes, obesity, heart disease, heart attack or stroke. It’s estimated that up to 1/4 of all men and 1/10 of all women may have at least some degree of sleep apnea. The frightening statistic is that about 90% of women with sleep apnea are not diagnosed. Instead they are being treated for the complications of untreated sleep apnea, rather than the cause itself.

There are three major issues regarding women that prevents proper diagnosis of sleep apnea: The sleep apnea myth, the hormonal factor, and the insomnia bias factor.

Myth #1: Sleep Apnea Is Mostly a Male Problem

One of the biggest myths about sleep apnea is that you have to be a middle to older aged, heavy-set snoring man with a big neck. This stereotypical view of sleep apnea is still common amongst most physicians, so unless you’re in the extreme end of the disease spectrum, a sleep-breathing condition won’t even be considered as a possibility if you’re a woman. When obstructive sleep apnea was first described in the 60s, it was initially described in older, heavy-set snoring men. Even today, medical lecturers continue to put up pictures of this type of patient, and sometimes, a picture of Joe the Fat Boy from Dickens’ The Pickwick Papers. Paper after paper continue to report on associations between weight, neck size, and the male sex and increased risk for sleep apnea.

However, it’s been recently shown what even young, thin women that don’t snore can have significant obstructive sleep apnea. I see patients like this daily in my practice. This also applies to young thin men as well. Whenever these people are diagnosed officially on a sleep study, they always comment that their medical doctors comment, "you don’t look like you have sleep apnea." This just goes to show that there is no "typical" sleep apnea patient.

Myth #2: Men Can’t Have Menopause

It’s commonly known that as women progress through menopause, their rates of heart disease begin to catch up with men (although not completely). The common symptoms of menopause include night sweats, hot flashes, mood swings, weight gain, insomnia and irritability. However, as I’ve alluded to before, young men in their 20s can have the same exact symptoms. How can this be? It’s because these men, as they are slowly gaining weight, are progressing up the sleep-breathing continuum, slowly developing obstructive sleep apnea. It’s the relative change in the anatomy that’s confusing the involuntary nervous system, giving rise the the so-called vasomotor symptoms. Your involuntary nervous system is what controls your heart rate, blood pressure, body temperature, sweating, digestion, and sleep.

In women as they approach the pre-menopausal years, one of the first changes that they go through is that progesterone levels slowly drop beginning in their early 40s. One of the known interesting properties of progesterone is that it acts as an upper airway muscle dilator and stimulant. This is what makes pregnant women breathe harder and faster. It also tenses your upper airway muscles by promoting more muscle tone.

As I’ve alluded to in my book Sleep, Interrupted, most modern human tongues are susceptible to falling back partially when on our backs. When you add muscle relaxation during deep sleep, our tongues can fall back and obstruct our breathing. This is why so many people can’t sleep on their backs. So if you slowly take away progesterone in women, the tongue relaxes more and more, and wake up more and more, usually from deep to light sleep. Inefficient sleep promotes weight gain, and weight gain narrows the throat even more. These multiple obstructions and arousals lead to a confusion of the involuntary nervous system. Later on, as the period of pauses after one obstructs increased, oxygen levels begin to drop, and obstructive sleep apnea worsens.

This is the reason why in general, women sleep better when on hormone replacement therapy, and they have a lower chance of heart disease as well. Now, due to all the conflicting studies regarding hormone replacement options and a possible increased rate of cancer, this is a very delicate and controversial topic that’s beyond the scope of this discussion. Nevertheless, peri-menopausal women have been using bio-identical progesterone creams for years safely to improve their quality of lives as well as their quality of sleep.

Myth #3:  Insomnia Affects Everyone Equally

Lastly, an older study revealed that women who complain of sleep problems to their doctors resulted in a diagnosis of insomnia more often than in men. Oftentimes, these women were prescribed sleeping pills. Men who complains of sleep problems are more likely to be asked if they snore, and it’s safe to say that obstructive sleep apnea is picked up more commonly in men due to this situation. Again, this brings up the OSA stereotypes that doctors have in men versus women.

There are a number of other reasons why women will get less than optimal heart care compared with men. I’ve touched on just three reasons that prevents women from getting diagnosed promptly for obstructive sleep apnea. Untreated obstructive sleep apnea can lead to heart disease. As long as the medical community segregates medical conditions without looking at the whole picture, we’ll continue to have discrepancies in the quality of care for not only for women, but for men as well.

 

Similarities Between CPAP And Breast-Feeding

 

It’s been three weeks since my wife delivered our third son Brennan, and after doing everything we can to exclusively breast-feed him, we’ve given up. During the first few days, Kathy was doing well, getting into a routine, especially since we had hired someone help us out for for about the first 10 days. Then on day 4, during a visit to the pediatrician’s office, it was discovered that Brennan’s bilirubin was dangerously high. He was admitted to the hospital for UV light therapy. He did fine, and was able to go home in 24 hours, but the whole ordeal wreaked havoc on his breast-feeding regimen. 

 

Because he was under the lights, Kathy was only able to pump and feed the milk via a bottle through the chamber’s holes. Afterwards, he refused to suckle on Kathy. We tried everything, even consulting with a lactation expert, but the stress of not being able to spend the time with Brennan, as well as not having any time to spend with our two other boys was extremely stressful, so we decided to supplement with formula, and breast-feed the the best of her ability. 

 

There’s been a lot of research recently about the benefits of breast milk over formula. There’s even evidence that the act of bottle-feeding (breast milk or formula) has detrimental consequences on jaw development and possibly increasing the risk for developing sleep apnea later in life. The decision to breast-feed has a lot of emotional, practical and financial issues that all new mothers must deal with. Unless one has unlimited time and resources, most new moms are forced to make sacrifices in one area or another. Does she spend 45 minutes breast-feeding every two hours initially, like what the lactation consultant recommended, or does she skip every few feeds (and give the baby formula) to get in more sleep so she can stay sane? Even with help (her spouse or hired help or relatives), things are not always that simple.

 

It seems like in the old days, there was a lot more help available, especially in traditional cultures like with our family. You had multiple resources living with you or close by, including your mother-in-law, aunts, sisters, etc. Today, even in traditional societies, everything’s changed. The lactation consultant that we saw made this interesting comment: New moms have a much harder time breast-feeding and producing milk whenever there is a deadline to go back to work. Imagine having this deadline, whether it’s a few weeks or even a few months, and there’s no one to help out.

 

There were many other circumstances with our situation that prevented the ideal: in addition to the hospital readmission for the elevated bilirubin level, Kathy could not use her left arm at all. During the delivery, the IV was placed in the antebrachial vein (at the bend of her left elbow) which not only caused irritation, but during placement, had bruised the nerve that went to her arm and hand. It’s still very difficult to even handle the baby, let alone breast-feed properly.

 

So what does breast-feeding have to do with CPAP? If you’re diagnosed with obstructive sleep apnea (OSA), the gold standard recommendation is continuous positive airway pressure, or CPAP. This is a device that provides gentle positive air pressure through a mask that fits over your nose or mouth. It works by stenting open your airway, preventing multiple obstructions and arousals. Untreated sleep apnea can lead to high blood pressure, diabetes, depression, anxiety, weight gain, heart disease, heart attack or even stroke. 

 

In the ideal situation, CPAP is the best way of treating OSA. Most people do well, but how many people do well depends on the systems that are in place to support using your CPAP machine. Ideally, the patient should be evaluated and counseled in a sleep center where after the diagnosis of sleep apnea, he or she comes back to have a discussion about the results and get counseled about CPAP. The patient should be able to try on various CPAP masks and models in the office and have a period of slow acclimation to the mask. There should be an intense follow-up and feedback routine for weeks to months, to make sure that the patient is effectively using the CPAP. Compliance data should be analyzed regularly and applied promptly to better optimize CPAP usage. Durable medical equipment (DME) vendors should also provide great support and have constant communication with patients and prescribing physicians. Users should also be involved in a community of CPAP users who can give support, as well as to be able to hold the new CPAP user accountable.

 

In the real world, this almost never happens. With a few exceptions, most people are given a CPAP machine at home, and told good luck. There’s very little follow-up, if any. This is why in our country, overall CPAP compliance is dismal. I’m told in other European countries, the overall compliance rate is much better due to the more centralized aspects of their healthcare. 

 

The problem is that there are 4-5 separate entities involved in your care as a CPAP user, and with our current system, there’s not too much communication or coordination amongst all the health care providers. Granted, there are exceptions to what I’m describing, with some great sleep doctors and DME vendors. But for the most part, the service, support and follow-up is pretty dismal. This is why overall CPAP compliance is so poor, as compared with other countries.

 

As you can imagine, many people fall through the cracks, not using their CPAP at all. It’s not that common, but there are some patients that take full responsibility for coordinating his or her own care and make the effort to follow-up with the sleep center and DME vendors, almost to the point of being aggressive. They have to be a squeaky wheel to make any progress. In many instances, they are willing to pay extra or everything out of pocket to get what they need, rather than relying on the DME vendors or be restricted to the bare-bones equipment that insurance usually covers for. These patients generally do well.

 

Then there are the patients who try everything and are still unable to use their CPAPs. Typically, it either due to irritation, discomfort or claustrophobia from the mask, the excessively high pressures or bloating from swallowing air. They go through all the necessary steps to address all of the above issues, but are still unable to use their machines. Some people are fully compliant with their machines, using it religiously, but find no subjective or objective improvement, or sometimes it just makes things worse.

 

The point of these lengthy comparisons between CPAP and breast-feeding is that there’s a lot more that can be done for people to more fully benefit from CPAP and breast-feeding, but at the other extreme, you have to know when to give up and go on to more realistic and practical methods. Not being able to breast-feed or benefit from CPAP in no way implies a failure on the anyone’s part. These are two important issues that I’m sure will need to be addressed by many new mothers and newly diagnosed sleep apnea sufferers.

 

Is Insomnia Really A Sleep-Breathing Problem?

Sleep doctors have always thought of insomnia as a behavioral or stress aggravated issue, and the standard ways of treating this all-too-common condition is to either give sleeping pills or have the patient undergo cognitive behavioral therapy. However, a recent study directed by Dr. Barry Krakow at the Sleep and Human Health Institute is looking at the possibility that insomnia may actually be caused by a sleep-breathing problem, such as obstructive sleep apnea. 

 

If you’ve read my book, Sleep, Interrupted: A physician reveals the #1 reason why so many of us are sick and tired, I stated my opinion that in my experience, almost all people with insomnia have narrowed upper air passageways, especially behind the tongue. Some will have undiagnosed sleep apnea, but many will have instead something called upper airway resistance syndrome. This is a variation or precursor to sleep apnea where the length of time of each breathing pause is not long enough to be called an apnea. Because of the multiple pauses in breathing in deep sleep, a low-grade stress response is created which causes the insomniac’s mind to race or think about stress-related issues before going to bed. Their nervous systems are edgy and en garde all the time. No wonder it’s hard to fall asleep, especially if you’ve had a stressful day.

 

I’ve also experienced multiple instances where treating an underlying sleep-breathing problem also significantly improves insomnia symptoms as well.

 

You may be asking by now, "why do sleeping pills or cognitive behavioral therapy work?" The older type sleep aids were generally tranquilizers and only helped to numb the nervous system so that you can fall asleep faster. But these medications did nothing to prevent the sleep-breathing pauses. The newer medications don’t have as much of the sedating properties, but it’s very controversial that they even make any significant difference. Although industry supported studies find significant  improvements in sleep scores using sleeping pills, non-industry supported studies show that these same sleeping pills only increase total sleep time by only 5-10 minutes. 

 

Cognitive behavioral therapy (CBT) is another underused option that has been shown to work much better than sleeping pills in general. CBT works by re-programming your thinking and behavior about sleep to promote good sleep hygiene and habits. 

 

CBT will work to some degree even if you have an underlying sleep-breathing problem because you’re addressing the physiologic stress-aggravting end result of the breathing problems that occur during sleep. Multiple micro-arousals from deep sleep to light sleep due to tongue muscle relaxation can definitely aggravate stress and anxiety problems.

 

This process also confirms other recent findings that report increased rates of depression and heart disease later in life in people with insomnia earlier on in life.

 

The main purpose of Dr. Krakow’s study tries to determine what percent of insomniacs have undiagnosed obstructive sleep apnea. Although not part of the study, it would be interesting to perform upper airway endoscopic exams like what I describe, to confirm what I describe in this post. 

 

Here’s my question to all insomniacs: Do you prefer to sleep on your back, side or stomach? If you prefer your side or stomach, there’s your answer.

Do You Have To Go A Lot? Nocturia, Urinary Incontinence, And Sleep Apnea

If you’re one of the millions of men and women who have to go the the bathroom far too often, or have embarrassing leaks of urine once in a while, here’s some important information that you should know. The New York Times (Feb. 3) reported on an article from the New England Journal of Medicine which revealed that postmenopausal women with urinary incontinence issues had significant improvement after losing weight. They also benefitted in other areas such as improvements in their blood pressure, lipids, sleep and libido.

 

Another article in this month’s Journal SLEEP reported that OSA is associated with overactive bladder in men with or without urinary incontinence. The worse the severity of OSA, the worse the level of urinary problems. Not too surprisingly, nocturia (getting up at night to go to the bathroom frequently at night) is a known complication of obstructive sleep apnea. 

 

Most people with these issues end up seeing a urologist initially and are placed on various medications that work to various degrees. However, a recent study suggests why you should see a sleep doctor instead—people who wake up in the middle of the night to go to the bathroom do so not because their bladders were full, but rather because they stopped breathing and then realized that they had a full bladder. OSA has also been shown to increase atrial natriuretic peptide (ANP), which is produced by the heart when it gets too much blood due to the sudden rush of blood after a lack of blood flow during an apnea episode. ANP causes you to make more urine to get rid of the excess fluid.

 

Something new to think about for all our senior citizens (and young adults too).

The Real Reason for Chronic Fatigue in Mono?

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