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The Deviated Septum Myth

Dr. Park debunks one of the most common myths about the nose.

The Deviated Septum Myth

Elite Runners, Jaw Size, And Insomnia

I came across this article in Runner’s World about an up and coming marathoner, Tera Moody, who suffers from chronic insomnia. She was found to have obstructive sleep apnea, but could not tolerate CPAP or a dental device. She eventually found some help by undergoing CBT, or cognitive behavioral therapy. She still suffers from insomnia occasionally, and take sleeping pills for emergencies. It’s clear that she’s not treating her sleep apnea. This puts her at significantly increased risk later in life for depression, diabetes, high blood pressure, heart disease, heart attack and stroke.

While the article was well written, the writer brings up the same old stereotypical thinking that sleep apnea patients must be older, male, heavy set, snores, and with a big neck. We now know that even young thin women that don’t snore can have significant sleep apnea. 

One thing that’s striking about her picture is the smallness of her jaw. It’s significantly recessed. Coincidentally, while I was searching for other profile pictures of her, I came across a profile picture of Joan Benoit Samuelson, the 1984 Olympic marathon winner. Not too surprisingly, her jaw is pretty recessed as well.

One thing I’ve noticed is that certain elite distance runners (and even the most avid distance runners in my track club), all have various sleep problems. They can never get deep refreshing sleep, and they prefer not to sleep on their backs. I’m guessing that continuous running is what makes them feel alive, so they thrive on it, leading to their elite statuses. Some athletes (in running and in other sports) are literally addicted to exercise. Not exercising for a day or two can lead to depression and lethargy. Sleep-breathing problems can definitely aggravate, if not cause insomnia. One recent study showed that surgery for sleep apnea cured chronic insomnia in many cases.

Do you know any intense athlete that also has a major sleep problem?

 

Alzheimer’s Risk Increased with Modest Cholesterol Elevation in Middle Age

Pregnant Women On CPAP For Pre-eclampsia

Q: Severe OSA or UARS?

Q:
Hello Dr. Park,
 
I am a 24 year old male and have been suffering from moderate-severe sleep problems for at least 7 years now.  For as long as I can remember, I have had issues waking up in the morning.  No matter how hard I try or what methods are used, I couldn’t get up when desired.  In the past 2 years I have noticed a big decrease in my level of energy.  Oftentimes I feel fatigued to the point where my day is compromised. 
 
In early April I had a sleep study performed which found that I had severe OSA.  Apparently I stopped breathing up to 85 times an hour when I was on my back, which was slightly worse than when I was on my side or stomach.  I have been using the CPAP for almost 2 months now and honestly don’t feel that much better.  I would say that it is a little easier to wake-up in the morning, but that’s about it.  I still suffer from fatigue and lack of energy throughout the day.  My doctor is saying that the CPAP has returned my AHI to normal levels, but I am not noticing the difference.
 
In my attempt to locate more information, I came across your journal entry “Tired of Being Tired” to learn more about UARS.  My main question, is how possible is it that I have a moderate-severe OSA as well as UARS?
 
I greatly appreciate your assistance and service and wish you the best!

JPBESpoke

A:  Sorry to hear about all that you’re going through. It must be frustrating. If you’re using CPAP regularly and have data from the machine that confirms it (good compliance and no leaks with minimal AHIs), then the best thing to do is to be patient. You’ve had this condition for years, and sometimes it can take months (sometimes 6-12) to begin to feel better.

It does sound like you do have upper airway resistance syndrome, but you also have severe obstructive sleep apnea. What I see is that some people with UARS go on to develop what may look like chronic fatigue syndrome. Your involuntary nervous system is severely unbalanced, and you have to give it time to come back into alignment. Your situation is complicated and and endoscopic exam will only confirm what you already know. But it’s probably a good idea to take one look to make sure there’s nothing else that’s going on.  By definition, you’re susceptible to any of the somatic syndromes, since these are intimately linked to sleep-breathing problems.

There are also many studies that show that people with untreated obstructive sleep apnea have significant brain abnormalities with various degrees of injury. Years of hypoxia can cause temporary or permanent injury. You can imagine how multiple areas of damage throughout the brain can give various signs or symptoms such as chronic fatigue, numbness, hormonal imbalances, etc. This is not proven as of yet, but if you look at all the research in this area, it’s a reasonable explanation. This is why sometimes it can take months or over a year to begin to feel better.

Our Health Scare Crisis

Most people think the birth of their child as a memorable and joyous event, and for us, the birth of Brennan 5 months ago brought an amazing and vibrant boy into our lives. However, there’s always a dark side to every good thing—in this case, it was having to go tread through the health care system.

Even before Brennan was born, a number of events occurred that left a bad taste. During the first trimester, Kathy’s spent a lot of time researching and seeking out an OB that she was comfortable with. Fortunately, she found someone locally that she liked, who was affiliated with a major prestigious academic medical center. The first major fiasco occurred when due to a miscalculation, she was sent for a sonogram too early and another one was scheduled a few weeks later. Since we had a high deductible health plan, we had to pay for everything at the discounted rate.

Not only were we billed for the first useless sonogram, the hospital billed us the full amount for both tests, repeatedly ignoring their contractual obligations with their insurance carrier. After multiple phone calls and hours of wasted time and aggravation, and months later, it was finally resolved. What helped was the fact that my wife is a medical billing and collections expert. Imagine if you had this happen and you had no idea how to read EOB’s (explanation of benefits).

Next, our doctor’s satellite office was closed down with less than a few weeks’ notice, and we were on our own to find another OB. They told us to call the OB department at the medical center to get assigned a new OB. This brought flashbacks from Kathy’s first pregnancy, when she had to find new OBs twice when doctors dropped her insurance.

She called the OB department to inquire about another doctor, but they never called us back. She eventually found someone else through a friend’s referral. Getting the old records sent to the new OB was a nightmare in itself.

When Kathy went into labor, we went to the hospital and went up to the labor and delivery floor. The nurse was told that the contractions were every few minutes. After filling out some forms, we were told by the receptionist at the triage area to have a seat (with a pointed finger and no eye contact).

After waiting another 30 minutes, another nurse who just happened to be walking by saw that Kathy was having a major contraction. When she found of how frequently, she rushed us into an exam area, to be examined by a doctor, who came by about 30 minutes later. When the doctor realized that Kathy was fully dilated, we were rushed into the labor and room immediately.

The delivery itself went smoothly and quickly. Our OB was not on call that night and a colleague was covering. The baby came out so quickly that another OB that happened to be on the floor had to cover for the covering doctor.

It’s almost a given that whenever we interact with the health care system, more often than not, it can be an unpleasant experience. What’s even worse is that almost routinely, billing errors by either the doctor’s office or the insurance company increases the hassle factor multiple times.

Recently, my wife was sent a letter from her old insurance carrier that her last visit to her doctor’s office was not covered. It turned out that although the new insurance information was given at the time of visit, the doctor’s office had billed the old insurance company. When called about this mix-up, the receptionist essentially said that that’s not possible—that they had the correct information on file. My wife explained that she had a denial letter from her old carrier for the date of service. Another few hours wasted due to this simple "mix-up."

This may sound somewhat radical, but if I do get very sick in the future, I’m not afraid of the illness, or even dying. What I am scared of, is to be subjected through our health care system.

Real Life Confessions of a Healthcare Addict

I have a personal confession to make. My father is a prostate cancer survivor. One month after he retired at the age of 68, he was diagnosed with advanced prostate cancer.  After undergoing radiation seed implants and hormonal therapy, he was in remission, until a couple of years ago. That’s when his addiction to health care began.

The Nightmare Begins

Starting a few years back, my father’s PSA would spike up all of a sudden.  When this happened, he underwent several rounds of bone scans, CTs, and blood tests. He ended up receiving cryotherapy, and later, stereotactic radiosurgery. More recently, he underwent chemotherapy. The problem is that his PSA is still very high, but his physicians have no idea where the cancer is hiding. There’s no obvious growth in his prostate, and his bone scans always come back normal. Still upon his physician’s recommendation, my father undergoes his CT, bone scans and blood tests every 6 months or so.

One day, as we were talking during dinner, my father mentioned that his doctors  billed his insurance company "a lot of money for the hormonal implants" as stated on his insurance claim’s Explanation of Benefits (EOB’s). He’d noticed that these claims were denied payment more often than not by his insurance carrier, which concerned him a great deal since he felt that this would sour his relationship with his doctor. He was just as surprised to find out many months later, that these claims would get paid, but after multiple claim submissions and denials, and at a much reduced, discounted rate. Suffice it to say that this experience rattled his illusion of me getting wealthy as a physician.

Seeing how expensive these tests were, my father also felt guilty for being such a burden to the health care system, undergoing test after test every 6 months, with no obvious origin of his cancer. Just the same, his doctors keep telling him that by all measures, his life expectancy looks grim as long as the numbers show evidence of cancer, and so still recommend testing as a precaution.

Healthcare Capitalism

One time, after seeing my father undergo an extensive battery of tests and radiation treatment that almost put him under, I tried using reverse psychology to get him to stop. Reasoning with him hadn’t worked until then, as what his doctors told him always trumped what I, or anyone else who loved him, said.  I sarcastically told my father that it’s his obligation as an American citizen to continue undergoing the testing and the treatments, as long as his physicians recommended it, since this is what drives our health care system. I added that massive consumption of healthcare is a major foundation of our economy. Without it, how else could we spend 17% of our GDP? Little did I realize at that time that he would take me seriously.

What More Could You Want?

A recent op-ed in the New York Times commented on using prostate cancer as a bell-weather for how we structure our healthcare system. Study after study has shown that overall, aggressive testing and treatment for prostate cancer doesn’t really change the overall life-expectancy compared with no treatment at all. Yes, there are some very aggressive tumors, but in comparison, there are much more incidental, benign-behaving growths that don’t grow or cause any problems. Just like thyroid cancer, prostate cancer is very common as men age. Only some behave aggressively.

The op-ed writer’s argument is that how we deal with similar medical conditions can make a major impact on not only cost containment issues, but also in many quality of life issues. He’s not saying we should just ignore it, but for most "routine" prostate cancers, follow it closely, but treat it very conservatively, intervening only when absolutely necessary. Since there’s no difference on life expectancy, what’s the point of spending millions or even billions on tests and treatment options that ultimately don’t make any difference in the long term?

I explained all of this to my father whose doctors recently recommended another round of radiation despite the fact that his stress test showed his cardiovascular functioning was that of someone 10 years younger. My father justifies continuing his current regimen for the following reason: Many of his close friends died of advanced metastatic prostate cancer, and clearly, doing something is better than not doing anything at all. When emotions are involved, logic, financial considerations and common sense all go out the window. It’s only natural, since it’s human nature. His doctors also feel compelled to do everything possible to give him and themselves peace of mind, in knowing every few months that that there’s no obvious return of the cancer.

Despite the cancer diagnosis, my father is healthier, more vibrant and youthful than many of his peers let alone his doctors. He takes undergraduate courses at Hunter College, plays a mean game of tennis, swims regularly, sings in his church choir, hikes on Hunter mountain with those that are 20 years his junior, and goes to the symphony and opera every chance he gets. He even played King Lear recently in a local theater production. Currently, he’s rehearsing for a role in The Fantastics. Although he’s living with a "life threatening" disease, this doesn’t prevent him from living the life he’s always dreamed of at the ripe old age of 78.

When More Is Not Always Better

According to Wikipedia, addiction is characterized as follows:  "the continued use of a substance despite its detrimental effects, impaired control over the use of a drug (compulsive behavior), and preoccupation with a drug’s use for non-therapeutic purposes (i.e. craving the drug)."

I’ll be the first to admit that I’m just as guilty in bringing about this healthcare crisis as anyone else. Up until a few years back, I was the same as anyone else-performing surgery, rendering treatment and dispensing medication according to the model standard of care. But over the last decade, the threshhold for what’s considered standard care has spiraled out of control.  In the case of my wife, for instance, who recently delivered our third child 10 years after our first, she had to undergo double the amount of tests and check ups, all the while spending countless hours negotiating multiple disruptions in her continuity of care (see the article Health Scare Crisis). Infant vaccinations have also doubled in the last 10 years, so if I choose to get just 1 shot rather than the recommended 2-3 shots per pediatric visit for Brennan, my newborn, I’d have to pay out of pocket for this expense since my insurance only covers for "routine visits".

In a 20 minute documentary video, The Story of Stuff, (www.storyofstuff.com), Annie Leonard details how as a society, we’ve become addicted to consumption. I highly recommend everyone watch this video. Similarly, we’ve also become addicted to consuming healthcare. It makes us feel good to have more tests, not because there’s any absolute proof it works, but "just because" it’s there. A day doesn’t go by when I don’t consult with a patient who’s on at least 10-20 different medications per day.  When I ask them if they think any of it is making a difference, they’ll say "not really, but at least it’s keeping the (i.e. cholesterol, blood sugar, PH etc) numbers down".  Despite dubious evidence that many pills or surgical procedures make any difference in the long run, doctors perform procedures or order more tests rather than spend time with patients or counseling them to help change their habits–especially when there’s zero compensation from insurance companies for doing the latter.

In another documentary, The Corporation (www.thecorporation.com) the narrator describes how a business entity that was created for the right economic reasons can morph into a paranoid schizophrenic monster. It’s not that the individuals within the corporation are malicious, greedy or even evil, but that the corporation itself takes on the personality traits of a greedy, delusional, psychopathic maniac. As I see it, this is what’s also happened to our health care system in the United States. Despite the good intentions we all had at the outset in providing affordable and accessible healthcare to Americans, our relationship to healthcare has morphed into a skewed dependency. Why should we eat right and exercise, which is so difficult to maintain, when there’s a pill for every ill imaginable and unimaginable?

The Only Thing To Fear is Fear Itself

Everywhere you look these days, there’s one fear mongering message after another being reeled into our consciousness. From the time you’re an infant to the time you’re old as my father, you’re told to protect yourself from encounter after near fatal encounter with every possible disease you can think of. At a picnic recently with some friends and family at a Westchester park about an hours drive from the city, a tiny tick barely the size of a pin-head was found on my friends’ young son. Instantly, everyone who attended was alerted to the possibility of Lyme disease and we begrudgingly woke up our three very sleepy children to comb through every nook and cranny despite the baths they took earlier. The thought going through my mind at the time was: you can never be too sure.

As such, healthcare is a major revenue generator, and as long as fear is what’s driving everyone, and as long as someone else (the government or your employer) is paying for to accommodate this fear, things are not looking too good for our future, despite all the proposed changes.

As for me, I’ve come to terms with my father’s illness. As long as my father continues to stay active and has a positive outlook on life, I’m not concerned about whether or not his cancer returns. My only fear is that if his cancer does return, the "prognosis" that he may be given by his doctors will ultimately come true as a self-fulfilling prophesy. In the meantime, I refrain all judgement of my father who now takes prides in the fact that he can continue to contribute to the health care system and to the economy by undergoing more tests.
 

Sleep And Grow Rich: 5 Steps to More Restful, Rejuvenating, Refreshing Sleep

Napoleon Hill, in his classic book, Think and Grow Rich, details the mindset changes that are necessary to achieve success at life, accomplish goals, and live a life of abundance. In a similar way, your ability to obtain quality and refreshing sleep also requires changes in how you think about sleep before you take the necessary physical steps.

Sleep Better, Live Better

Numerous research studies have shown that a good night’s rest is vital when it comes to your ability to focus, concentrate, remember, be creative, and various other mental and cognitive abilities. Your athletic abilities are also enhanced significantly when you sleep well. Needless to say, consistent, high-quality, refreshing, rejuvenating sleep can enhance almost every aspect of your emotional, mental, physical, sexual, and spiritual live. Unfortunately, in our fast-pased, information-driven, stress-filled modern lives, sleep is the first thing that’s sacrificed when we have too much work to do. The common corollary to getting that promotion or making more money is to work harder, and longer, and in the process, forgo even the most basic necessities. Forgoing a balanced meal, and substituting fast food instead, and sleeping less to work more, becomes the habituated norm for the success minded. Nonetheless, how can you enjoy the fruits of your success if you’re so tired and sick all the time?

Reasons For Your Sleep Deficit

Sleep deprivation can be so insidious and cumulative that you may not realize that your depression or anxiety may be from months or years of chronic low-grade levels of poor quality or quantity of sleep. Not only are we not getting enough sleep, our sleep quality has diminished significantly in modern times. In my book, Sleep, Interrupted, I explain how due to major changes in our diets and with the addition of bottle-feeding, our jaws are much more narrow with dental crowding. Smaller jaws leads to smaller breathing passageways, especially when we’re on our backs and in deep sleep (due to muscle relaxation). This leads to various degrees of partial to full obstruction, disrupting deep sleep, and preventing you from getting restorative, refreshing, and rejuvenating sleep.

Sleep Well and Prosper

Here are 5 habit and mindset changes that will help you to begin your journey towards a better nights’ sleep today.

1. Make an appointment with yourself at bedtime. If you had an important job interview or meeting, would you ever come late because you had some work left to do or you wanted to finish watching your TV show? Think of sleep as an appointment that’s just as important as an important meeting. Dr. Mao of AskDoctorMao.com recommends setting an alarm to go to sleep, as well as for waking up.

2. Plan your activities well during the day so that you can fall asleep quickly and stay asleep. What you do during the day has significant effects on how well you sleep at night. Exercising in the morning exposed to early morning sunshine can strengthen your internal sleep clock. Eating healthy meals with lots of fiber and multi-colored vegetables will not only keep you regular, it can also affect the the type of foods that you’ll crave, since your appetite, weight and sleep are all inter-related.

3. Set SMART goals. Commit yourself to goals that are specific, measurable, attainable, reasonable, and timely. Rather than just saying, "I want to sleep better," say something like, "I’m going to eat 3 hours before (8PM) going to bed (at 11PM) for the next 7 days," or "I will get up at 6 AM to jog 3 miles on Tuesday and Thursdays for 4 weeks. Yes, getting better sleep is your bigger goal, but it’s easier to succeed if you break it down into small bite-sized chunks that have SMART features.

4. Be mindful of how well you sleep in relation to your diet, activities, and your sleep times. The best way to is document this by writing everything down in a sleep journal. Short of doing this, be more aware of how you feel in the morning or during the day after you went out to have a late dinner, or during the weeks when you exercise. Which foods make you feel better and which make you feel more tired or sluggish? Bare minimum, make a quick mental note of how well you slept when you first wake up and how you felt during the day as you’re about to fall asleep.

5. Unclutter your mind just before you sleep. Turn off all forms of electronic stimulation such as your computer, TV, and radio at least one hour before you go to sleep. Watching the news is the worst thing you can do, since not only is it stimulating, but also disturbing stories and images that you don’t want cluttering up your subconscious during sleep. Read a relaxing book, do some light stretching, breathing or meditation before going to bed.

There are plenty more tips I could list here for you, but all of this is a moot point if you can’t breathe properly at night while you’re sleeping. Any by definition, all modern humans are susceptible to breathing problems while sleeping to various degrees. This is the one major flaw with Western medicine as well as alternative and complementary forms of healing. Everyone naturally assumes that you’re able to breathe properly at night. But this is not true. You can do everything I listed in this article, as well as every sleep hygiene recommendation that’s mentioned in thousands of books, articles, and reports, but if you’re not able to breathe well, you can only get so far. Lack of inspiration can definitely hinder your brain’s ability to think at all, let alone sleep or grow rich. Something to think about.

Sleep Apnea And Blindness?

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