• Home
• About Dr. Park
  • Dr. Park’s Bio
  • My Mission
  • Testimonials
• My Practice
• Articles
• Sleep Apnea Basics
  • Obstructive Sleep Apnea – A Primer
  • Upper Airway Resistance Syndrome
  • Surgery For Snoring & Sleep Apnea
  • Usual and Unusual Ways to Stop Snoring
• Expert Interviews
• Blog
• Press Room
• Resources
• Contact Us

Subscribe: Email RSS 

My First Apnea?

Dr. Mack Jones suggested that I get tested for sleep apnea in response to my last post about feeling depressed all last week from what I thought was the gloomy weather. He may have a point here. Last week, as I was dozing off to sleep, my wife did mention that I stopped breathing suddenly and started breathing again after a short snort. I vaguely remember it happening. It was also a time when my nose was a little stuffy. Technically, this wasn’t an apnea, since it lasted only a brief second or two. On a sleep study, it would be classified as a respiratory event related arousal (RERA).

 

Having just passed my 42nd birthday, I’ve come to terms with the fact that this was bound to happen eventually. I’ve said again and again that all modern humans are susceptible to breathing problems while sleeping, and I’m no exception. The only comfort I take is the fact that I did undergo a sleep study many years ago to see what it was like, and it revealed an AHI of 1, which is considered "within normal limits."  It did show that I had some mild disruptions in my deep sleep stages. I suspect it may creep up slowly as I get older. Fortunately, my weight has not changed—if anything, it’s gone down since I began running regularly. 

 

More recently, I’ve been sleeping well, and my energy level is pretty good, despite that fact that our 5 month old has been up at night repeatedly due to teething.

 

There’s now even more reason for me to follow the advice I give to my patients: don’t eat late, exercise regularly, keep your nose clear, and don’t sleep on your back. The one thing I’ll have to work on is to try sleeping more on my side since that brief obstructive episode happened while I was on my back. I’ll keep you posted.

Under The Weather Or Depressed?

For whatever reason, until today, I’ve been feeling really run down with no energy or motivation to do anything. My sleep’s been OK, but I felt more tired than usual. My ability to focus and concentrate was definitely affected, and my wife even called my mood "morose." Ouch. I hope my bad mood didn’t rub off on my three boys.

The reason for bringing this up is that today, I feel great all of a sudden. The only difference that I can think of is that the sun shined in New York City for the first time in days, maybe even over one week. We’ve had either rain or overcast weather most of June. 

I realize now that I was probably suffering from a mild case of seasonal affective disorder (SAD), which affects susceptible people who either don’t get enough sunlight or during the winter season, when there’s much less sunlight. I didn’t think I could have this, but I guess things change as you get older.

For prolonged cases of SAD, bright light therapy is one way to treating this condition. Another way is to spend more time outdoors, even with the overcast skies. 

How many of you were also under the weather this past week?

 

Sleep Your Way To Better Creativity

There’s a common phrase that’s used when people are searching for creative answers: "Let’s sleep on it." A new study that was summarized in the New York Times shows that this is literally true. By sleeping more, we now know that you’ll be more creative. However, this study revealed that the type of sleep stage was more important than the length of time in sleep. In particular, researchers found that napping which included time in REM sleep lead to significantly better in word association test scores. REM sleep (rapid eye movement) is the sleep stage when you’re dreaming. 

 

Although napping without REM sleep resulted in slightly better test scores, naps that included REM sleep resulted in close to a 40% improvement over pre-nap scores.

 

This study is interesting in that we know that most of our REM sleep is in the second 1/2 of the night. If you’re only getting the bare minimum 5 hours, you’ll get enough of the non-REM deep sleep stage, but you’re probably missing out on most of your REM time. 

 

Plus, if you have a sleep-breathing problem, REM sleep is most commonly the time when you’re most likely to stop breathing and wake up. This will prevent you from staying in REM sleep, and more likely to have strange dreams or nightmares (since you’re waking up while dreaming). 

 

Even more reason to prioritize your sleep time.

Interview with Tara Marie Segundo on Children’s Topics

Just reminding everyone about my interview tonight with fitness expert Tara Marie Segundo, host of Hotradio125.com‘s The Time is Now. We’re going to continue our discussion about children’s issues, including snoring, ADHD, bedwetting, tonsils and ear infections. It’s at 8PM Eastern, and you can hear the live stream at http://www.hotradio125.com/showpages/taramariesegundo.htm. You can also download the recording after the show.

Can Snoring Cause Stroke?

Snoring is so common these days that no one takes it seriously anymore. One patient commented  that even her dog snores! Yesterday, I saw a man who uses earplugs to cover up his wife’s intense snoring. When someone is caught snoring, giggles and smiles are more common than genuine concern about the snorer’s health.

 

Not all snoring is dangerous, but a significant number of snorers will have undiagnosed obstructive sleep apnea. Recent studies highlight the seriousness untreated sleep apnea. One study showed that untreated apnea patients experience similar changes in brain biochemistry as people who are having a stroke or are dying. Even moderate degrees of oxygen deprivation was found to have profound effects. The abstract can be found here.

 

Another study showed that untreated sleep apnea patients have higher blood viscosity, meaning that their blood is literally thicker than normal. This, coupled with increased inflammation that’s seen in sleep apnea, makes small vessels in the brain more likely to clot.

 

Numerous other imaging studies report finding multiple small areas of damage in different areas of the brain in people with untreated obstructive sleep apnea.

 

Studies in young children found that even very mild degrees of obstructive sleep apnea can lead to cognitive changes and maybe even permanent neurologic injury. 

 

These type of studies go on and on. While we can’t screen everyone who snores for obstructive sleep apnea, if you have any of the potential complications of sleep apnea (such as depression, anxiety, high blood pressure, or heart disease) or if there’s a strong family history of snoring with cardiovascular diseases, there’s good reason to get checked for sleep apnea. 

 

The reason I bring up this issue at all is that once in a while, I’ll see a relatively young patient (in his or her 30s or 40s) who had a stroke. Not too surprisingly, they all snore heavily. If you know anyone that had a stroke at a relatively young age, at least consider the possibility.

Sleep More, Lose Weight

Health care reform is making big news now,  and from what I’ve gleaned from the press, it’s a mess. I’m not too optimistic about any solutions. There are too many interests involved and no one wants to give an inch. 

However, with all the studies coming out showing the benefits of more sleep, I have a suggestion for Mr. Obama: Have a national sleep more month, where everyone in the country makes a commitment to sleep 30 to 60 minutes more every night for one month. There are studies showing that better sleep improves everything from energy levels, to weight loss, to improved memory and cognition,  and lower blood pressure and glucose levels. 

In the February issue of Glamour Magazine, I was quoted in an article where they had overweight women volunteer to change one thing for 10 weeks: sleep 7 1/2 hours every night. Women who stuck to the plan lost anywhere from 6 to 15 pounds automatically, without doing anything else differently. 

Imagine if they continued this regimen for one year. Imagine if everyone in the US followed this regimen. There would be much lower levels of high blood pressure,  depression, diabetes, and heart disease. Think of the billions of dollars in health care savings, just from sleeping a little longer every night.

For those of you that get stressed even thinking about this, think again. You may be thinking that you’ll lose valuable time by sleeping more. What you may not realize is that by sleeping longer, you’ll be much more clear-headed, more energetic, and much more productive.

It’s 10 PM now. I’m going to bed.

“I Know I Don’t Have Sleep Apnea”

A few times every week, when I bring up the possibility of obstructive sleep apnea, a patient will confidently say to me, "I know I don’t have sleep apnea." Nine out of ten times, a sleep study reveals that the person does have sleep apnea. 

A recent study presented at this year’s annual meeting of the Associated Professional Sleep Societies revealed that of all people who were referred for excessive sleepiness, 54% of normal weight people were found to have obstructive sleep apnea. Of these normal weight people with sleep apnea, 54% were found to have moderate to severe levels. 

I’ve been saying for years that young, thin people who don’t snore can have significant obstructive sleep apnea, but it seems like most doctors and lay people still think that only an overweight, snoring man with a big neck can have sleep apnea. Yes, this is the extreme end of the spectrum, but since sleep apnea is an anatomically small jaw problem, you can have this even when you’re young and thin. Later on, you’ll be more likely to gain weight and fit the classic profile, but only after some of the complications of untreated sleep apnea have set in. 

One major reason for this continued myth is that we continue to have studies showing that heavier people are more likely to have sleep apnea. But this doesn’t mean that all thin people don’t. If you’re chronically tired and you don’t have a satisfactory answer for your fatigue, at least think about sleep apnea.

 

Sleep Apnea Causes Sleep Walking and Hallucinations?

Most of us think of sleep walking or sleep eating as strange, but separate and distinct from obstructive sleep apnea, but a recent study showed that in a group of people with obstructive sleep apnea, almost 10% had one or more of the parasomnias (sleep walking, sleep eating, sleep hallucinations and paralysis, etc.). This is not too surprising since having apneas can cause confusion in the transitions from one sleep stage to another. Another study from 2005 showed that in young men who sleep walked, the majority had a sleep-breathing disorder. When they were treated with either CPAP or surgery, the sleepwalking was completely controlled.

Do you ever sleep walk or eat at night without knowing it? Do you ever feel like you’re paralyzed and you can’t breathe as you’re about to fall asleep or when you’re about to wake up?

What We Take for Granted

As I was running through the Van Cortland park trails on top of the New York Stete aqueduct last Saturday, I was thinking about what would happen if this massive pipe either clogged or had a leak. Sure enough, we had a major water main break in the Bronx on Sunday which lead to no water all day on Sunday. 

 

We tend to take our free natural resources for granted, including water and air. In healthcare, we naturally assume that we’re able to get enough oxygen into our bodies, but for millions of people in this country, this is not the case.

 

Here’s a poignant post on SleepGuide that hit a nerve with me. I have to stress that this situation happens routinely. It seems like the writer’s husband had his CPAP mask slip off just before the fatal event. Not everyone with sleep apnea is at risk for what this man suffered, but as long as you don’t treat your sleep apnea condition (if you know you have it), your chances of suffering the same fate will definitely be higher.

Fundamentals of Medicine, Down the Drain

On a routine follow-up visit for bronchitis/pneumonia, I examined a patient by listening to her lungs. The diminished breath sounds on the right side had improved significantly, and after thumping her chest with my fingers, the sounds were resonant and equal. Not only was she feeling much better, her abnormal exam findings had returned to normal as well.

 

After the examination, the patient remarked that in all her life, no doctor had ever thumped her chest with two fingers. I found her comment surprising, since "percussion" is a basic physical exam technique that all medical students are required to learn and perform. 

 

This brings up an all-too-common issue these days where doctors are dispensing with time-tested traditional good history taking and thorough physical exams and relying instead on tests. Although there are various reasons for this, the most likely one is due to lack of time. When I was in medical school, I distinctly remember being chided for ordering a test unnecessarily. We were taught that tests were to be ordered only to confirm your clinical diagnosis, if necessary. Unfortunately, tests are routinely ordered today to make a diagnosis in place of good clinical decision making.

 

Ordering a test should not be undertaken lightly. It should never be ordered, "just in case." Yes, imaging studies and blood tests do occasionally pick up serious conditions, but in most cases, it just leads to more tests and more anxiety for the patient. 

 

Take, for example, ordering an MRI or CT for headaches. If you order 100 studies, 1-2 will show something significant that explains the symptom. However, in most situations, either the study comes back normal, or comes back with a "suspicious" finding, such as sinus inflammation or polyps. The presence of polyps doesn’t explain the headaches, since many normal people will have sinus inflammation and polyps. The word "polyp" also brings up more worries since we associate it with colon cancer or uterine polyps. Any swelling or growth, even if it’s benign, conjures up the worst case scenario in the patient’s mind. Because of the nature of how studies are interpreted by radiologists, every slight abnormality is pointed out, whether or not it’s clinically relevant. 

 

MRIs are very sensitive and can pick up findings that have no explanation. Unidentified bright objects or UBOs are frequently described on readings, and despite having no clinical significance in most cases, will also add to the anxiety and fear that patients will experience.

 

What I’m idealizing is a situation where doctors order tests more judiciously, only after every possible medical explanation has been ruled out. There are certain situations where a test should be ordered urgently, but this makes up only a small fraction of all situations. 

 

In this era of litigation and stories of missed diagnosis, it’s understandable that doctors may want to order tests prematurely "just in case", and will make some strong justifications for doing so. But in the long run, you end up hurting 99 patients to help one. Not to mention all the extra costs, work hours lost and time worrying over test results. With good follow-up, cooperation between the doctor and the patient, and judicious use of tests, that one patient that actually needs the test will eventually get it done, while saving tests for 99 others.

 

Ultimately, it all boils down to fundamentals. If we focused on the basic fundamentals of medical practice, then we wouldn’t need as much fancy, high-tech gadgets and testing equipment. It’s like a basketball team where each player tries to win by constantly performing trick shots and spectacular lay-ups. Instead, it takes, time, patience, trust, and cooperation between the doctor and the patient to order a test only as a last resort.

Next Page »

Copyright © 2008 Doctor Steven Y. Park, MD | New York, NY | Integrative Solutions for Obstructive Sleep Apnea, Upper Airway Resistance Syndrome, and Snoring · Design by Fervent