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A Surprising Finding About Women and Heart Attacks

Men who suffer from heart attacks typically complain of chest pain, shortness of breath, and radiating pain from the neck to the left arm. But for women, it’s completely different. A recent study financed by the NIH (and summarized in the New York Times) showed that in the weeks before their heart attacks, 70% of women complained of severe fatigue and 48% reported sleep disturbances. Less than 50% had shortness of breath, anxiety, or indigestion. 

Post-menopausal women have a much higher risk of developing heart disease compared with their pre-menopausal peers. We know that obstructive sleep apnea can cause heart disease, and menopause can aggravate sleep-breathing problems. We also know that 90% of women with sleep apnea are not diagnosed. I think it’s safe to assume that many if not most of the women in this study had some degree of a sleep-breathing problem. It’s not surprising that the initial symptoms by women who were about to have heart attacks had mainly sleep-related symptoms. Oddly, these symptoms were called "atypical."  Sadly, 90% of women with sleep apnea will continue to go undiagnosed. 

Old Wives’ Tale or Eastern Wisdom?

After our third son Brennan was born, I noticed that my wife wasn’t eating the tofu that she made for dinner. She commented matter of factly that post-partum women shouldn’t eat tofu or any soy products. This seems to be common knowledge in East Asian cultures, handed down from mothers to daughters. 

In retrospect, it makes total sense, medically. During pregnancy, progesterone is very high, but drops significantly after delivery. We know from studies that progesterone, in addition to it’s reproductive functions, acts as a respiratory stimulant and upper airway muscle dilator. It’s been found to stimulate muscle tone in your tongue. Since all humans’ tongues can fall back due to gravity when we lie on our backs, and sometimes obstruct when we’re in deep sleep (due to muscle relaxation), having less progesterone can cause more frequent obstructions and arousals and prevent achieving deep, efficient sleep. This is what also happens during menopause (very slowly) or just before before women’s periods.

 

We all know that women naturally gain weight as they progress through pregnancy, and this would expect to cause or aggravate sleep-breathing problems due to gradual narrowing in the throat. But progesterone acts to protect the upper airway by increasing muscle tone and respiratory drive. Once you deliver your baby and progesterone drops, you’re left with all the extra weight, but no more progesterone to help you out. This is one good explanation for post-partum depression.

 

Soy has known estrogenic properties, so if you increase your soy intake just after delivering a baby, along with significantly lowered progesterone levels, the estrogen to progesterone ratio increases, lessening progesterone’s effectiveness.  This can lead to worse quality sleep and not feeling refreshed after waking up in the morning. 

 

It seems that the early Chinese medical doctors realized this through astute observation, and this wisdom has been handed down through the centuries. 

The Value of Genetic Testing in Alzheimer’s

ABC News’ Terry Moran wrote a poignant piece on why he decided to get tested for the gene that carries markers that are linked to Alzheimer’s disease. He states that he has a strong family history of Alzheimer’s and wanted to take the test not only to know more about his future health, but also to take responsibility for his own health. He does state that this test does not definitively predict whether or not he will get Alzheimer’s. It only gives statistical information based on his innate genetic risks. It ends up that he has a 19% chance of getting Alzheimer’s. It’s about 10% greater than the average population.  

Alzheimer’s is a devastating disease, not only for the patient, but also for the immediate family members. Research so far has focused on the molecular and genetic mechanisms, with progress being made day by day. However, I can’t help but to wonder if we’re going about this the wrong way. 

 

Let me explain: We know that Alzheimer’s is linked with cardiovascular conditions such as heart disease, heart attack and stroke. Untreated obstructive sleep apnea is a major risk factor for developing heart disease and significantly increasing your risk for sudden cardiac death and stroke. Sleep apnea is something that you don’t just develop when you’re older—you’ve had some degree of it all your life. 

 

Recent sophisticated imaging studies have revealed a much higher incidence of multiple areas of brain injury or damage in people with untreated sleep apnea compared with normals. MRIs in people with sleep apnea show many more areas of "lacunar infarcts," or small areas of strokes. Rats with the Alzheimer’s gene that were subjected to chronic hypoxia were found on autopsy studies to have very similar histologic findings as in humans with Alzheimer’s. We also know that chronic hypoxia and inflammatory state that results from sleep apnea can cause microscopic areas of blood vessel clotting (rather than your more typical large vessel stroke). The authors of some of these studies were very careful in only alluding to the implications of their findings: That obstructive sleep apnea can lead to Alzhiemer’s. 

 

I’m not discrediting all the great research out there on Alzheimer’s, but at least consider the possibility that in some cases of Alzheimer’s, untreated obstructive sleep apnea can lead to Alzheimer’s, with the same clinical symptoms, biochemical and histological changes that are seen in classic Alzheimer’s patients. 

 

Mr. Moran is more likely to know about his future health if he screens himself for obstructive sleep apnea, rather than undergo genetic testing for Alzheimer’s. At least there’s something you can do about sleep apnea.

 

(See related article by guest columnist Dr. Mack Jones.)

 

 

What’s Your Real Age?

A recent story in the New York Times describes Dr. Mehmet Oz’s online quiz that calculates your "real" age based on a series of health and lifestyle questions. The slant on the article was to bring up the fact that major pharmaceutical companies were using this data to market to people who use this service, but what I want to point out is that there’s another, simpler way of determining how quickly you’ll age:  the size of your breathing passageways. 

 

I’ve described in my book, Sleep, Interrupted, a concept called the sleep-breathing paradigm, which proposes that all modern humans are susceptible to breathing problems at night to various degrees. Our ability to talk caused anatomic changes that predisposes tongue collapse in deep sleep. Your genes determine the size of your jaws, and the smaller your jaws (with more dental crowding), the more susceptible you’ll be to breathing problems while sleeping. As one ages chronologically, our airways begin to narrow due to various factors, including obesity, inflammation, and gravity. The upper extreme end of this continuum is called obstructive sleep apnea, but even "normal" people are on this line.

 

Poor quality sleep due to multiple obstructions causes a myriad of physiological stresses, leading to everything from weight gain, hypertension, anxiety and depression to heart disease, heart attack and stroke. This process heightens your nervous system, making you edgy and hypersensitive. It also makes you more susceptible to external stresses.

 

So the next time you are brushing your teeth, take a look inside your mouth in the mirror. Is the space behind the tongue wide open? Can you see the back of your throat easily? Do doctors tend to cause you to gag using a tongue depressor to see the back of your throat? Is the roof of you mouth arching sharply upward, rather than a flat slope? Is there a family history of heart disease or early death in your family? Do you feel much older than your real age? 

 

Post your answers below—I’d like to know. I promise, I won’t give your information to pharmaceutical companies.

 

Q: Is My Sleep Test Reliable?

Q:  Dr. Park,

Is my sleep study reliable? I was told to sleep on my back only during the test and then were given two different diagnosis by the clinic and the interpreting doctor. Would a repeat of the original study be advisable?
Danielle

A:  Without looking your study results, it’s hard to say if it’s reliable. Most sleep studies are standardized, and there are various ways of determining from the report whether or not there was enough reliable data to analyze. Different doctors may interpret the raw data differently, just as different polysomnographic technologists can interpret tests differently.

Also forcing you to sleep on your back when you normally like to sleep on your side is not natural.

Ultimately, together with your sleep physician, you should re-evaluate your medical condition in light of the sleep study interpretation and decide what to do.

 

Can A Sleep Problem Give You Alzheimer’s?

There’s been a lot of press recently about the side affects that poor sleep quality has on our cognitive functioning not to mention what it means for those who suffer from neurological problems like Alzheimers.

This month, our expert article is contributed by noted neurologist and author of Deadly Sleep, Dr. Mack Jones, who explains the reason why he thinks everyone who has Alzheimers or is at risk for this problem should get tested for a sleep breathing problem like OSA.

——-

 Is it possible that Obstructive Sleep Apnea (OSA) causes Alzheimer’s Disease (AD)? I believe so. As a retired clinical neurologist and former patient with Obstructive Sleep Apnea, I have a special interest in sleep disorders medicine. I am thoroughly convinced of the connection between OSA and AD and will remain so until credible studies prove otherwise. Numerous short term studies have been done on cognition (mental processes) and sleep or the lack thereof, but there are few or no long term studies to determine OSA’s relationship to Alzheimer’s Disease (AD) and/or the other dementias.

Many polysomnograms (PSGs) or in lab sleep tests have been done on patients with AD revealing an incidence of OSA of up to seventy to ninety percent.  The assumption has been that AD causes OSA, or they just happened to coincide, but I contend that OSA is the cause of AD.

There are no studies that either prove or disprove my hypothesis that long standing undiagnosed OSA is a cause of AD, but evidence is accumulating. For example, OSA is a recognized risk for Type 2 Diabetes. In the April 2008 issue of The Archives of Neurology, type 2 Diabetics had an increased risk or developing Mild Cognitive Impairment (MCI)(1) which is the earliest stage of dementia.  Fifty to sixty percent of patients with MCI progress to AD at rate of twelve percent per year.
 
Additionally, OSA is a known risk for the development of high blood pressure.  Like patients with Type 2 diabetes, those with high blood pressure were also found to have an increased risk of developing MCI.(2)  Since the majority of patients with MCI eventually progress to Alzheimer’s Disease at a rate of approximately twelve percent per year, then it’s not a stretch to conclude that OSA is a cause of Alzheimer’s Disease.
 
In 2006 a study in the Proceedings of the National Academy of Sciences showed low brain oxygen (hypoxia) raises Alzheimer’s risk in the mouse brain with a genetic susceptibility.(3) A group of mice with an Alzheimer’s gene were given a maze test in which they all performed normally. They were separated into two groups, one exposed to 16 hours of a reduced oxygen environment (hypoxia) daily for several weeks; the other group in a normal environment.

The maze test was repeated and revealed the hypoxic mice performed poorly, whereas the control groups performance remained normal as before. All the mice were sacrificed and their brains examined under the microscope. Plaques and neurofibrillary tangles typical of Alzheimer’s Disease were present in the hypoxic mouse brain specimens, whereas the controls were normal. According to investigators, the study suggests that preventing brain hypoxia (as occurs in OSA) may reduce the risk of developing Alzheimer’s Disease.
 
Reported in the June 27th issue of Neuroscience Letters, sleep apnea patients have shrunken brain structures called “mammillary bodies” involved in memory according to Rajesh Kumar, PhD and colleagues from the University of California at Los Angles (UCLA).  High resolution MRI brain scans revealed mammillary bodies to be twenty percent smaller in patients with sleep apnea than in normals.  “These findings are important because patients suffering from memory loss from other symptoms, such as alcoholism or Alzheimer’s Disease, also show shrunken mammillary bodies,” Dr. Kumar said in a press release.
 
A recent study form San Diego showed that Sleep Disordered Breathing, including OSA, is and important risk factor for cognitive impairment in older women. (4)

Neuroimaging studies have been performed on patients with OSA including CT, MRI. PET and SPECT scans, revealing a variety of defects, but none has displayed anything quiet as dramatic as in a study published in SLEEP July7, 2008, by Dr. Paul M. Macey et al. (5)  The report reveals results of a new MRI technology called DTI (Diffusion Tensor Imaging). It is an extremely sensitive method of determining damaged nerve fibers (axons). This new imaging technique reveals multiple areas of brain damage in OSA patients not known to exist until now. DTI revealed various sized color-coded yellow-orange patches of brain damage scattered throughout the brains of a group of forty-one men and women subjects with OSA. Their ages ranged from thirty-eight to fifty two years old and they had not yet been treated. The areas of nerve fiber injury were wide-spread, located in critical regions of brain including prefrontal, temporal and parietal lobes. The cerebellum and brainstem were equally involved. This is the first report of DTI imaging of a group with OSA to my knowledge. The findings have far-reaching implications.

One can anticipate finding even more areas of damage in an older population as studies are done. What problems result from each one of these areas of brain damage?  It is possible that they are responsible for difficulties with cognition, mood, behavior, memory, heart regulation, high blood pressure, breathing control, fear, anxiety and other emotional disorders including depression? Those findings are yet to be reported. Could this brain damage eventually accumulate enough to cause Alzheimer’s Disease and/or the other dementias? 

The structural changes likely represent accumulated damage over sustained periods of time.  Are they permanent or do they improve or disappear with treatment?  No one knows yet, but my guess is they may improve to some degree or even resolve with treatment, but we will have to wait and see.
 
The implications of these findings are profound. Early treatment of OSA could potentially prevent the development of Alzheimer’s Disease. Now is the time to wake up the public and our snoozing medical community and put an end to this disease.

References:

1. José A. Luchsinger, M.D. et al, Relation of Diabetes to Mild Cognitive Impairment, Arch Neurol. 2007; 64 (4):570-575.
2. Christine Reitz, M.D. PhD, et.al. Hypertension and the Risk of Mild Cognitive Impairment:, Arch Neurol. 2007; 64(12):1734-1740.
3. Xiulian Sun, et al, Hypoxia Facilitates Alzheimer’s Disease Pathogenesis By Up Regulating BACE1 Gene Expression. PNAS (Proceedings of the National Academy of
Sciences) 2006 | vol.103 | no. 49 |18727-18732
4. Adam P. Spira, et al, Disordered Breathing and Cognition in Older Women: Journal of the American Geriatrics Society. Volume 56, issue 1, January 2008, 45-50.
5. Paul M. Macey, et al, “Brain Structural Changes in Obstructive Sleep Apnea," SLEEP vol.32, Number July 7, 2008, 913-1056.

——-
After surviving his four year ordeal in search for a cure of his own sleep apnea, Dr. Mack Jones, a clinical neurologist, felt a need to pass on to others what he learned first-hand as a patient, so that you might avoid the pitfalls he encountered and possibly save your own life or the lives of your loved ones. Dr. Jones in his book, Deadly Sleep, expected publication date, June of 2009, discusses how this common sleep disorder is a likely cause of Alzheimer’s and possibly a host of other life threatening neurological diseases that may have been plaguing us for hundreds if not thousands of years. He can be contacted via e-mail by clicking here.
 

Usual and Unusual Ways to Stop Snoring

What I’ll describe in below is a comprehensive list of all the standard medical, surgical, and over-the-counter options that you’ll hear and read about. If you see one that I’ve left out, please let me know and I’ll give you my opinion. Remember, many of these devices (with a few exceptions) only cover up the snoring, without treating the real cause. If you try a variety of these options to find no relief, it’s time to see your medical doctor or a sleep specialist for a formal evaluation and treatment. Not doing so can cost you more than your sleep. It can cause you to lose your life.

Medical Options For Snoring

Note: Many of the procedures below, although effective for snoring, are never 100 successful. Success rates range from 70% to 95%. There is also a small chance of relapse even if initially successful.

Continuous Positive Airway Pressure (CPAP): This option may be overkill, and you’ll need to pay for it out of pocket if you don’t officially have obstructive sleep apnea. But it does work, if you can get used to it.

Dental devices: There are multiple options with this type of treatment, with the formal mandibular advancement devices that are made by dentists. These devices pulls your tongue forward by pulling your lower jaw forward. There are many different models that all have various features that make it more likely to work depending on your anatomy. Different dentists have different preferences as well. A less expensive way to "test" whether or not these devices may work is to try one of the many over-the-counter (or over-the-internet) boil-and-bite models. These devices are softened in hot boiling water and the set as you softly clench down while simultaneously pushing your jaw forward.

Laser Assisted Uvulo-Palatplasty (LAUP): A laser is used to trim the free edge of the soft palate. It’s somewhat painful, and usually must be performed 2-3 times. It can be performed in the doctor’s office, and is relatively expensive.

Injection Snoreplasty: Any type of scarring agent (sodium tetradecyl sulfate, ethanol, etc.) can be injected just underneath the mucous membrane of the soft palate. Must be performed 2-3 times for maximum effectiveness, is less painful in general, and is the least expensive.

Pillar Procedure: Three thin woven braided polyester rods are inserted inside the muscle layer of the soft palate. It’s usually performed under local anesthesia and is one of the least painful. Typically, only one treatment is needed, and is most expensive.

Uvulopalatopharyngplasty (UPPP): Usually used for obstructive sleep apnea, but very effective for snoring. In general, it’s only about 40% successful for obstructive sleep apnea.

Some Unusual Ways to Stop Snoring

Note: All the options listed below, although not proven to help snorers on a consistent basis, have been reported to work at least some times in some people. Most of the reports are anecdotal, with no objective supportive data. One major problem is that if it works, it may only delay diagnosing and treating any underlying obstructive sleep apnea.

Tennis balls: For some people, staying off your back can make a big difference. The problem is staying on your back. The most common recommendation is to sew a sock filled with a tennis ball to the back of your pajamas. This method has mixed results, and in general, although it sounds great, doesn’t work that well. It just only annoys the snorer or they just sleep on top of it.

Sleep position devices: There are a number of gadgets and devices that prevents you from rolling onto your back. They range from triangular wedges to shirts filled with foam rods to prevent sleeping on your back. The only way to know whether or not they work is to  try it. For some people, it can make a huge difference, even if you have obstructive sleep apnea. For many others, you may have a mixed response, or no response at all.

Side sleep position pillows: This one positions your arm above your head and somehow forces you to sleep on your side. Again, I’ve heard mixed responses from my patients. If you can sleep with your arm above your head for hours without it becoming numb, then this may work for you.

"Contour" pillows: This pillow works better if you prefer to sleep on your back. The lower end of this pillow is a bit higher than the middle part that the top of your head touches. This forces your head to be cocked back a bit, lifting up your chin somewhat, thereby opening up your airway somewhat. This the the same maneuver that you’re taught to do during CPR to open up the airway before you give mouth-to-mouth. Notice that after you fluff up your pillow you go to bed, the pillow height diminishes slowly, and by the end of the night, your chin is closer to your head, which closes your airway. Another option is to either roll up a towel into a "log" or get one of the Asian husk-filled pillows that are shaped like a roll. You’ll have to experiment to find the right height.

Diet and weight loss: This will help to various degrees for most people who are overweight, but what if you’re already thin? Also, since poor sleep leads to weight gain hormonally and metabolically, it can be very difficult to lose weight no natter how much you diet or exercise. For some, losing 10-15 pounds may help a great deal with your snoring, but chances are, it’ll return sooner or later as you get older.

Nasal dilator clips: Whether external (Breathe-Rite) or internal (Nozovent, Nasal Cones, or Breathewitheez), these work sometimes by pulling your soft flimsy nostrils apart, preventing nostril collapse when you inhale. During sleep, especially when your muscles relax, any degree of nasal congestion can aggravate higher vacuum pressures that can aggravate tongue collapse. Despite being touted to cure snoring, it only works about 10% of the time. Here’s one simple test to see if you should invest any money on these products: take both you index fingers and gently press on your skin, right next to your nostrils. Press gently and pull your cheeks apart on each side towards the outer corners of the eyes. This is called the Cottle maneuver.

Wind instruments: Playing any type of wind instrument (flute, clarinet, trumpet, etc.) can in theory promote throat and tongue muscle tone. Reports of success are anecdotal.

Playing the Didgeridoo: Various studies have suggested that playing this ancient Aborigine wind instrument can help relieve snoring. The mechanism in how it works is similar to any wind instrument.

Singing: The mechanical act of singing promotes profound throat muscle tone and control. Similar to all the wind instruments, prolonged periods of singing promotes relaxation, since exhalation is activated by your parasympathetic nervous system.

Tongue Exercises: Has been found to be helpful for some people, but needs continuous exercises.

Throat sprays: Various mixtures of herbs and natural ingredients are promoted for snoring, but a recent objective study showed that they were not helpful.

Acupuncture: No consistent evidence, but helps with stress and fatigue.

Bedpartner’s elbow: Works to wake you up to stop snoring, but never curative. This is called the "bruised rib syndrome".

Electronic devices that wake you up when you snore: More expensive than a bedpartner elbowing you in the ribs.

Ear plugs for the bedpartner: May help the bedpartner sleep, but not very effective for the very low-frequency snoring vibrations.

Sleeping in another room: Usually alleviates the problem, but bad for relationships, and not very helpful for "heroic" snorers where the sounds vibrate the bedroom walls 2-3 rooms down.
 

Solutions for Your Bed Partner’s Worst Sleep Problem

Anthony Burgess, the novelist, once said: "Laugh and the world laughs with you. Snore and you snore alone". Suffice it to say, there’s nothing worse than trying to sleep next to someone who snores.  Snoring is also a common reason why many married couples sleep apart. Besides the whole host of health problems that snoring is associated with, like high blood pressure, heart disease, diabetes, snoring is even linked to erectile dysfunction in men (see our feature article: What the Makers of Viagra Missed). Fortunately, snoring is something you can get rid of. The problem is in knowing how.

Why Snore?

Snoring is probably one of the most frustrating conditions not only for the snorer, but for spouses and bed-partners as well. It’s also one of the least understood medical conditions by most doctors. One of the main reasons for this is that there are a lot of myths perpetuated both by the media and pop culture about snoring. It’s oftentimes seen as something of a farce. The truth is, however, snoring is a sign that the person who snores is most likely struggling to breathe at night, and therefore, is at a much higher risk of having a heart attack or stroke.

Moreover, textbooks and internet resources further mislead people to think that snoring originates at the soft palate, since that’s where most of the vibrations occur. However, the soft palate doesn’t flutter all by itself: the nose as well as the tongue can be involved. Even most doctors focus way too much attention on the soft palate.

The challenging part of eliminating snoring is in figuring out what’s actually causing the snoring. The vibrations of the soft palate is only the end result and not, as many people think, the thing that causes the snoring. Imagine your upper airway as a long, thin tube that has three main areas that can either narrow or collapse when a slight vacuum pressure is applied. Like a flimsy straw that would collapse in the middle if you pinch the tip, or would collapse at one end if you pinched the middle, your airway is also affected by how well you can breathe through your nose not to mention how tone or relaxed your muscles become as you drift off in to deep sleep. Gravity can also play a part in obstructing your airway, since your tongue, as well as the excess tissues around the back of your throat can naturally fall back partially obstructing the airway, as you lie down on your back to go to sleep.

It’s All In Your Jaw Size

Another major factor that determines how well you breathe at night, or how susceptible you are to snoring, is the size of your jaws. It’s been shown that modern human’s jaws are slightly smaller than what we had hundreds of years ago. Various reasons are proposed, but one major reason is thought to be due to a major change in our diets. (For a more complete description of this process, take a look at my book, Sleep, Interrupted: A physician reveals the #1 reason why so many of us are sick and tired.) If your jaw is slightly smaller, then your tongue which grows to its’ normal size, takes up too much space, sitting higher and more backwards in your throat.  As a result, when you lay flat on your back, due to gravity, your tongue will fall back partially, and when you breathe in, a mild vacuum effect is created upstream at the palatal level, which constricts the soft palate closed, which then causes the free edge of the soft palate to flutter and vibrate causing the snoring noise. On the other hand, if your nose is stuffy for any reason, then a vacuum effect is created downstream, which forces the palate and the tongue to slide backwards towards the airway making it narrower and therefore creating sounds we call snoring when the air seeps through the small opening. So this is how a simple cold or an allergy attack can aggravate temporary snoring.

Furthermore, if your muscles relax more than usual (like after alcohol ingestion), then you may even stop breathing altogether. In this circumstance, if these breathing pauses last longer than 10 seconds, then it’s called an apnea (or loss of breath). In those people who have 5 or more of these apneas every hour on average, then are diagnosed with a serious sleep breathing condition called obstructive sleep apnea. Untreated obstructive sleep apnea can then lead to depression, anxiety, weight gain, diabetes, sexual dysfunction, high blood pressure, heart disease, heart attack and stroke.

The really bad news for snorers is that a significant number of heavy snorers have obstructive sleep apnea (about 30-40%, and much higher as you get older or heavier). It’s true that not all snorers have sleep apnea, and not all people with sleep apnea snore. However,  if you’re not snoring, then you may also not be breathing. It’s also been shown that neither you nor your bed-partner can tell if you stop breathing—it can just be silent pauses, without any audible gasping, coking or snorting. When some people say, I used to snore a lot, and now I don’t anymore, but I’m still tired, then there’s cause for alarm since even those that state with certainty, "I know I don’t have sleep apnea" are more often than not, wrong.

What Can I Do To Stop The Snoring?

So, once you’ve found out where the snoring is coming from, the next step to solving your snoring problem is to find the right solutions. Of course you can start by doing the most obvious like:

    • lose weight
    • don’t drink alcohol before bedtime
    • don’t take any medications that are sedating or relaxing
    • sleep on your side
    • sew a sock stuffed with a tennis ball to behind your back to prevent sleeping on your back.
    • use nasal dilator strips.

Sometimes, any of these options may work to various degrees, but for most, the problem will usually come back. The most important issue here, however, is that if you snore heavily, you have to find out if you have obstructive sleep apnea. Even if you are successful in covering up your snoring, you could still have untreated obstructive sleep apnea. And if this is the case, you’re putting yourself at serious risk for heart disease, heart attack and stroke. The best thing to do to avoid this from happening is to see a sleep doctor and undergo an overnight sleep study if you snore.

If you are found to have obstructive sleep apnea, then treating this condition definitively should take care of your snoring. Not only will your snoring improve, you’ll also feel much better in the morning, and have much more energy during the day. In addition, your increased risk for many chronic health problems mentioned above will be improved as well. You may also lose weight. (you may even feel like having sex again-see What the Makers of Viagra Missed).

So lets say that you don’t officially have sleep apnea. What can you do? Before I go into this discussion, sleep apnea is not something that you either have or don’t have. Everyone is on a continuum. As mentioned before, if your AHI is 5.1, you’re told you have it, whereas if your score is 4.9, do don’t have it, and because you don’t officially meet the formal criteria, it’s not a good enough to cause to ignore your snoring. It’s still a problem that should be addressed as it can make you lose sleep, not to mention put a damper on your love life in more ways than one. 

All Those Snoring Treatments

There are over 300 patented devices and gadgets for snoring (refer to ). Sometimes they work, but with a few exceptions, most of these devices either cover up your snoring without getting to the root cause of your condition, or keeps you awake so that you don’t snore. Three popular anti-snore aids were recently tested for effectiveness in a prospective study: a throat spray, nasal dilator strips and a pillow. None of these three were found significantly better than controls when tested prospectively. There are even devices that wake you up as you enter deeper levels of sleep to prevent muscle relaxation. Regardless of what treatment options you choose, it’s imperative that you first get a proper evaluation from a sleep specialist or a medical professional about your snoring. Doing so could not only help with the snoring, it can help you foster a healthy relationship with your loved ones.
 

What the Makers of Viagra Missed

A recent poll revealed that the most common reason for lack of desire in intimate relations was that people are just too tired. Needless to say, drugs like Viagra and similar medications are selling like hotcakes. And for good reason: Lack of sexual desire and function is rampant in our over-stressed, overly tired society. And just like many other medications for chronic conditions such as high blood pressure, diabetes, depression and anxiety, these medications only cover up the end-resulting symptom without addressing what’s really causing the problem. It may be debatable as to what that original cause is, but one thing’s for sure is that either lack of sleep quantity, or lack of efficient sleep can definitely aggravate, if not cause every disease previously mentioned.

The Connection Behind Sleep and Sex

Sexual desire and arousal, just like every other body function, is regulated by the involuntary nervous system (or the autonomic nervous system). This nervous system is divided into two parts: the sympathetic nervous system (the fight-or-flight state), or the parasympathetic nervous system (what regulates digestion, sleep, and reproduction). There’s a relative balance between these two states, one being more activated, depending on what you need to do. However, if there’s too much stress of any kind in your body, then the sympathetic portion dominates and ends up suppressing the parasympathetic portion. What I’m talking about is an internal, physiologic stress. However, any kind of external stress (psychological, emotional or physical) can aggravate the internal stress as well.

One of the most common reasons for increased stress in our modern society is lack of good, quality sleep. Not only are we not sleeping enough since many of our modern conveniences like the light bulb, cell phones, the internet, and very bright LED lights on our electronic appliances make it much more convenient not to, we are also not able to sleep efficiently due to our inability to breathe properly at night.

What I describe in my sleep-breathing paradigm (see my book, Sleep, Interrupted: A physician reveals the #1 reason why so many of us are sick and tired) is the concept that all modern humans are unable to breathe properly at night, especially in deep sleep. Due to a gradual narrowing of our jaws in the last 50 years, along with dental crowding, we have relatively less room for our tongues, leading to potential collapse due to muscle relaxation in deep sleep. Most people with these issues prefer to sleep only on their sides or stomachs, but some people can only sleep on their stomachs.

As a result, even if you can get the requisite 8-9 hours of sleep, those with mild to moderate sleep breathing issues, like snoring (see this month’s article: Solutions for Your Bed Partner’s Worst Sleep Problems) and upper airway resistance syndrome, can be affected. Yet when 85% of the people who have a more severe form of this problem, like obstructive sleep apnea is not being diagnosed, it’s most likely that those who have milder sleep breathing problems get diagnosed and treated inappropriately as well. This may be why viagra and sleep aids are so popular even though they may not be all that effective over the long haul.

Sleep Can Be Better Than Viagra

So how exactly does lack of quality sleep affect sexual desire and functioning?

As I mentioned before, sex is controlled by both the parasympathetic and sympathetic nervous systems, in both men and women. Arousal is activated by the parasympathetic nervous system. In men, this leads to sexual desire and erection. Orgasm is activated by the sympathetic nervous system. But it you have too much "stress," then you can have various problems such as not being able to maintain an erection, or have premature ejaculation. Erection occurs when a certain muscle that surrounds an artery that normally constricts a blood vessel that goes to the penis relaxes. This relaxation response is stimulated by the parasympathetic nervous system. What Viagra and similar medications do is to artificially relax this particular penile muscle, but this can cause symptoms due to increased blood blow in other parts of your body as well (leading to headaches, flushing, stomach irritation, and other numerous side effects).

If you are one of those people who have narrow airways, and therefore aren’t breathing properly at night, or if you have a severe form of this sleep breathing condition called, obstructive sleep apnea, you’re probably suffering from chronic deep sleep deprivation, which causes a low-grade degree of physiologic stress. This can feed into the various sexual arousal and performance problems that I described earlier. Any additional stress from your job, relationships or even your financial worries can aggravate your internal physiologic stress levels. This ends up over-stimulating your sympathetic system, leading to an inability to activate your parasympathetic nervous activation. There are various breathing techniques that can help to stimulate your parasympathetic nervous system, which delays orgasm for men whose sympathetic nervous system comes into too quickly.

On the other hand, even if everything goes according to plan, getting pregnant may be difficult if the woman has similar sleep breathing problems. The other resulting cause of inefficient sleep can be that you’re able to get pregnant, but are unable to maintain the pregnancy. Knowing that elevated stress hormones can significantly alter reproductive hormone levels, it’s not too far fetched to see why our sleep quality can wreak so much havoc on one’s ability to have a healthy and vital sexual functioning.

So if you’re one of those people who think viagra make you more vital, think again. What you may actually need is to breathe better, so you can sleep better.

Why Does Depression Increase Heart Attacks in Women?

Researchers found that women with depression were found to have an increased risk of sudden cardiac death. What other medial condition dramatically increases your chances of sudden cardiac death? If you guessed obstructive sleep apnea, you’re right. What condition is not diagnosed in 90% of women who have it? Correct again. It’s sleep apnea. What’s one of the biggest risk factors for women who go on to develop heart disease? Right again. Sleep apnea. What’s a common complication of sleep apnea? Depression. Do you see a pattern here?In modern medicine, it’s hard to see the forest from the leaves (not trees!). We’re so focused on determining statistical likelihood between two isolated variables, while trying to exclude every other variables, that it’s hard to see the big picture. It’s gotten to the point that you can’t even say A causes B anymore. You can only say that A is strongly associated with B. In the end, most end up saying that causality can’t be proven and that bigger and better studies are needed. Despite this study showing that women with clinical depression are more likely to die earlier, nothing will change to prevent these premature deaths. As long as we focus too finely on individual diseases, rather than looking at how everything is connected, women will go on dying earlier than they should.

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