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Why Are Teens So Sleepy In The Morning?

A number of my friends and acquaintances have commented to me that their teenaged children have a lot of trouble waking up in the morning. The usual explanation is that teens' sleep cycles are shifted, going to bed later and waking up later. Some experts in sleep medicine have even recommended that schools start much later in the morning to accommodate for this phenomenon in teenagers. 

 

Besides shifted sleep cycles, here's another interesting perspective on why teens are so sleepy in the morning:

 

I've described in previous blogs and in my book, Sleep, Interrupted, the concept of laryngeal descent. Your voice box (larynx) had to drop down below the tongue to allow for complex speech and language. Comparative anatomists and evolutionary biologists have stated that speech and language development was ultimately detrimental to humans. This is why only humans have various breathing and swallowing problems that other animals, for the most part, don't suffer from. 

 

In humans, the voice box continues to descend throughout life, but there are two major stages of laryngeal descent that are important. The first one occurs around 4-6 months, when the voice box drops down from behind the tongue (at vertebral levels C3-C4) to a position below the tongue. This process also create a space called the oropharynx between the soft palate and voice box, where the tongue can fall back more easily. Before this happens, human infants can suckle and breathe at the same time, but during this transition they have to relearn how to swallow and breathe. Interestingly, this is also the time when the rate of SIDS (sudden infant death syndrome) is at its' highest.

 

The second stage occurs during adolescence. The voice box begins to drop even further, reaching its' final relative position in the late teens (vertebral level C7). In fact, the voice box continues to drop another 1/2 vertebral height well into your 80s (see figure 2.1 in this link). In boys, this happens to a greater degree than in girls, leading to a deeper voice in men. As the voice box drops lower and lower, the more your tongue is susceptible to collapse while sleeping supine (on your backs), and when in deep sleep, since your muscles are most relaxed during this time. If you add to this additional dental crowding and jaw narrowing, you'll see that it can explain many of the health problems that all modern humans suffer from.

 

This leads to less efficient sleep, leading the teen to be attracted to stimulating activities that compensate for this fact. No wonder many teens are so incredibly productive, engaging in sports, clubs, academics, and social activities. Because of this mental, emotional and physical overload, they can't shut down their minds at night, leading to delayed sleep times. But then they are forced to wake up long before they achieve the necessary hours of restorative sleep.

 

Add to this all the distractions of modern society, including cell phones, texting, chats, light bulbs, computers and TV. Also notice how bright the LED lights are in all the bedroom electronic devices. One modern LED is now 10 times brighter than a traditional night light. 

 

Do your teenaged children have trouble getting up in the morning? What kind of activities are they engaged in during the day? What's their nighttime routine before going to bed? Please enter your response to this blog in the comments box below.

Do All Pregnant Women Have Sleep Apnea?

We know that significant weight gain is a common aggravator of obstructive sleep apnea. If you already have narrowed jaws and gain some weight, then you'll move up the sleep-breathing continuum that I describe in my book, Sleep, Interrupted. But why is it that when women become pregnant, sleep apnea is the last thing that's considered whenever they develop depression, high blood pressure or extreme fatigue? 

 

Two recent published studies perpetuate this myth amongst doctors that sleep apnea can't happen in pregnant women. One study showed that about 2/3 of pregnant women responded to depression using acupuncture. Another study showed that antidepressant use during pregnancy led to small, but measurable developmental delays at 19 months. Depression (during pregnancy or post-partum) is a major problem with many women. But rather than saying that it's pregnancy-related depression, it should be looked at as a sleep-breathing problem, since one major reason for depession is lack of deep, quality sleep that's common with all pregnant women. Pharmaceutical companies promoting anti-depression medications to replace deficiencies in brain biochemistries doesn't help either.

 

One reason why not every woman that's pregnant goes into depression during or after pregnancy is due to the effects of progesterone, which has been called the "feel good" hormone. One of the interesting properties of progesterone is that it's an upper airway muscle stimulant. It increases tongue muscle tone and tension. During pregnancy, progesterone goes through the roof, since it's needed for maintaining the uterus and development of the baby. But if the weight gain is too much, or if your jaw is too narrow, then the effects of progesterone won't be as helpful. Once you deliver, progesterone drops, but you're still left with all that weight. This is one major revelation that I had when my wife experienced severe post-partum depression after the birth of our first son, Jonas.

 

We also know that many women who develop pre-eclampsia (dangerous high blood pressure) during pregnancy have various degrees of sleep-breathing problems, which can be treated effectively with standard sleep apnea treatment options.

 

For the women that's reading this blog, did you have any significant depression during or after pregnancy? How did you deal with it, and if your saw a doctor about it, what did they recommend? Please enter your answer in the comments section below.

Sleep Apnea, Migraines and Multiple Sclerosis: Is There a Link?

It seems like study after study is published that links two previously unlinked conditions to one another. In this study, the presence of migraines was associated with a 47% increased risk of developing multiple sclerosis (MS) later in life. Researchers again point to a genetic wastebasket explanation, with no practical implications. In a previous post, I noted that MS was linked to heart disease. Since we know that Alzheimer's is linked to heart disease, why can't migraines be linked to heart disease or even Alzheimer's? Ultimately, if you connect all the dots of all the associations between various medical conditions, then almost every medical condition can be linked in one way or another. 

 

My sleep-breathing paradigm easily explains the link between migraines and MS via the following mechanism: Migraines are a common symptom of poor quality sleep due to an inability to breathe properly at night. By definition, all modern humans are susceptible to these events, where only the extreme end of the spectrum is called obstructive sleep apnea. If you're not able to sleep deeply, then your entire nervous system is hypersensitive, causing an over-reaction to your senses, leading to symptoms such as headaches, TMJ, sinus pain and pressure. 

 

MS is thought to be an autoimmune condition with flareups of inflammation and "plaques" in any part of the brain that are seen on MRI. Sleep apnea is known to cause not only chronic sympathetic nervous system overload, but also thickening of the blood with patients being prone to either diminished blood flow or small microscopic clots in the brain. Studies have shown that sleep apnea patients have multiple areas of decreased gray matter density in various parts of the brain. This could in theory lead to either "lesions" in the brain, neurotransmitter abnormalities, or hormonal dysfunction.

 

It makes sense that in people who have sleep-breathing problems long before they go into sleep apnea, their nervous systems are overly active (waking up too quickly), whereas sleep apnea patients' nervous systems are underactive (not waking up quickly enough). Chronic low-grade stress is also known to upregulate your immune system, leading to the classic autoimmune conditions that are often seen in people with upper airway resistance syndrome (cold hands, anxiety, fatigue, etc.). 

 

Rather then reducing human illnesses down to genetic factors or biochemical deficiencies, it makes more sense to treat the patient as a whole person. But with modern medicine, that's not allowed. Yes, there has to be progress in medical research, but as a whole, are we going in the wrong direction? I'd like to know your opinion on this issue. Please enter your opinion in the comments box below.

New Discovery Makes Sleep Apnea Sexier?

New research has found that people with severe sleep apnea have significantly less nightmares (21%) compared with over 2/3 of healthy people. The lead author of the study was quoted as saying that after years having a bad reputation, the results of this study makes the condition "a little sexier."

I don't get it. How is not dreaming related to being "sexy"? It's clear that when you have severe apneas, you can't stay in REM sleep (the dreaming stage) since your muscles are most relaxed. REM sleep is essential for memory consolidation and proper brain function. 

What do you think about the author's remarks? Please enter your comments in the text box below.

Why Do Men Snore More Than Women?

For all of us, snoring is a fact of life. Either you snore, your bedpartner snores, or you've been rudely awakened by a loud snore at some time or another. Most of the time, the snorer is a man, but sometimes, it can be the woman. So why is it that men snore more than women?

 

Ultimately, it has to do with your upper airway anatomy. One of the main reasons why humans are susceptible to snoring and obstructive sleep apnea is because of the fact that we can talk. For complex speech and language, the voice box has to drop down from behind the tongue to below the tongue. This opens up a space behind the tongue called the oropharynx, which only humans have. As a result of this "laryngeal descent," the tongue can fall back relatively easily, especially when on our backs, and during deep sleep when our muscles relax. Men's voice boxes also drop lower in the neck, thus the lower pitched voices. 

 

I remember hearing during a plastic surgery lecture during residency the fact that aesthetically, the ideal woman's lower jaw has to be slightly recessed, whereas with men, the jaw should be more prominent, and more defined. What this means is that the smaller the jaw, the less room there is for the normal sized tongue, and the more susceptible for the tongue to fall back and obstruct your breathing while in deep sleep.

 

If you start off with a larger space behind the tongue (in men), then some degree of muscle relaxation during deep sleep will cause a partial obstruction behind the tongue. With the same inspiratory forces created by the lungs, air is forced by the soft palate at a much faster rate, and with additional muscle relaxation, the free edge of the soft palate begins to flutter. 

 

With women, since the space behind the tongue is smaller to begin with, the same degree of tongue muscle relaxation causes you to stop breathing, leading to an arousal from deep sleep. This is why in general, the man snores, and the woman, being a "light" sleeper, is bothered by the man's snoring. 

 

This may be an overgeneralization, but I see it happening over and over. Does your spouse or bedpartner snore? If so, does it keep you from getting a good night's rest? 

Everything You Ever Wanted to Know About CPAP Masks

Are you having problems with your CPAP mask? Are you newly diagnosed with sleep apnea, and want to find out which options you have? If so, hear me interview Chip Smith and Brian Werther of Restoration Medical on "Everything You Ever Wanted to Know About CPAP Masks."

During this information packed hour, you'll learn:

 

• The key to getting the right fit
  
• An insider's guide to finding the right mask for you
  
• How to overcome the most common mistake people make when they're choosing a mask
  
• Most common problems people have with their CPAP mask and how to avoid them
  

 

Title: Everything You Ever Wanted to Know About CPAP Masks

Format: MP3 download

Price: $17

 

Click here to order.

Migraines, Heart Disease, and Sleep Apnea

Most of us think of headaches as being separate from heart disease. But with the human body, everything is ultimately related. Take for example, a recent study that found that the presence of migraines raises the presence of cardiovascular risk factors including diabetes, high blood pressure and high cholesterol. This may be new news for many people, but this is what I've been saying for years. 

 

What most research studies never say, however, is what causes what. The scientific method dictates that you can only prove a statistically probably likelihood of association, not cause and effect. While we've made enormous strides in medical research, the scientific method has one major flaw: It can only make assumptions between two independent variables. It can never see the "big picture."

 

The big picture here is that most people with migraines have narrowed upper airways, and narrowed upper airways leads to obstructive sleep apnea and heart disease later in life, along with diabetes, hypertension, high cholesterol, heart attack, and stroke. In almost every situation when I see a younger patient with migraine, one or both parents usually snore severely and most likely have undiagnosed obstructive sleep apnea.

 

The problem is that migraines, and headaches in general, are treated by neurologists, whereas TMJ headaches are treated by dentists and sinus headaches are treated by ENTs. As far as I'm concerned, they're all aggravated by poor sleep quality from frequent obstructions while sleeping.

 

Do you have migraines or headaches in general? Do your parents snore, and if so, what kind of medical problems do they have? Please enter your comments in the text box below.

Does Everyone in Your Family Have Sleep Apnea?

More and more often, I'm coming across entire family members that are on CPAP for sleep apnea, or undergoing various other treatments for this condition. If one parent has sleep apnea, your children have an increased risk of developing sleep apnea, but if both parents have it, then it's safe to assume that your children will have it too, given that fact that they inherit your facial anatomy. 

As I describe in my book, Sleep, Interrupted, all modern humans are on a continuum, where we're all susceptible to breathing problems at night. Only the end extreme is called obstructive sleep apnea. Since sleep apnea is caused by narrow facial structures, young children and even infants can have it too. Many of the various childhood maladies, such as frequent colds, ear infections, bedwetting, night terrors, and even ADHD are probably related to poor breathing and inefficient sleep, aggravating inflammation in the upper airways. There's even speculation that the rate of autism increased after doctors recommended placing infants on their backs during sleep. It's not surprising then, that parents of autistic children are found to have a higher rate of obstructive sleep apnea.

Most young children are treated with tonsillectomy and adenoidectomy for their sleep apnea, and many children do very well. However, about 1/3 who undergo tonsillectomy don't improve significantly. These are the children that probably have smaller jaws. Smaller jaws leads to more reflux and inflammation, leading to enlarged tonsils, causing more frequent obstructions. In these children, rapid palatal expansion was found to be equivalent to tonsillectomy. If you combine both procedures, the results were additive.

Some young children are able to tolerate CPAP, but for most, this is not a practical option. One advantage that children have over adults is the malleability of their jaws. Orthodontics can not only help to straighten teeth, but to expand the jaws as well. Traditional orthodontic dentists tend to remove teeth to make more room for the other teeth, but that ends up making the jaws even smaller. Forward thinking orthodontists make more room for the teeth by enlarging the jaws, both in the front to back and side to side dimensions. The earlier you start, the better the long-term results. Many dentists are beginning treatment as soon as the permanent teeth have come in.

Does everyone in your family have sleep apnea? If not, do you suspect that they all do? Please describe how you're handling this situation in the comments box below.

Why Sleep Loss Can Make You Gain Belly Fat

Dieting and weight loss has surpassed baseball as America's national pastime. It's estimated that 2/3 of all Americans are officially overweight, and 1/3 are obese. Besides the routine bulges that you see on the outside, the presence of visceral fat (or belly fat)—not the flabby fat under the skin that you can grab—but the fat deep within your abdomen that's attached to your intestines, is thought to increase your risk of heart disease, diabetes, metabolic syndrome, high blood pressure, colon cancer, and in women, breast cancer.

With all the news about the importance of belly fat as a risk factor for heart disease and other medical conditions, it's almost gotten to the point where the press and the lay public perceive belly fat as a cause of all these various medical condition, rather than just an association. The real question is, what causes belly fat to begin with?

The Link Between Stress and Belly Fat

Any type of stress, whether physiologic, or external, can cause dramatic changes in your physiology. The sympathetic nervous system, or the classic fight or flight response, is activated when you're under stress. This in turn diverts blood flow away from less essential body parts and organs, such as your gastrointestinal system, your reproductive organs, your skin and distant extremities. It’s like if you were being chased by a lion—every nerve and fiber of your being will be focused on getting away, not on digesting what you had for lunch.

Although you’re probably not being chased by a lion, any type of prolonged periods of stress which results in low blood flow to the intestines causes biochemical changes that lead to accumulation of belly fat. It's also thought that increased estrogens created by belly fat further suppress the natural progesterone levels in both men and in women, aggravating the vicious cycle even more.

Poor Circulation Can Cause Belly Fat

You don't need a serious medical condition to cause these rapid changes in intestinal blood flow. Even your emotional state, and the various life stresses that you experience every day can significantly affect the rate of blood flow to your stomach and your intestines.

Researchers have found that periods of low oxygen in the intestines can cause biochemical changes that lead to fat accumulation. Is this low oxygen level the result of the standard atherosclerosis that's seen with cardiovascular disease as we get older, or can there be something else? Is there anything else that can cause intestinal hypoxia?

How Your Jaw Size Can Affect Your Waist Size

As I describe in my sleep-breathing paradigm, modern humans have difficulty breathing properly while sleeping at night, especially when on our backs and when in deep sleep, due to muscle relaxation. This is from a slow but significant narrowing of our jaws, due to a major change in our diets and with the addition of other feeding tools, like infant bottles and pacifiers.

The smaller the jaws, the less room there is for the tongue, and the more likely it'll fall back during deep sleep, especially when lying flat and in deep sleep. Depending on how often this tongue collapse obstructs our breathing at night, we all fall somewhere along this continuum, where the end extreme is officially called obstructive sleep apnea. It's not surprising that periods of interrupted breathing, whether very brief or pauses of 10 to 30 seconds (apneas), is known to cause physiologic states of stress.

And this sustained form of stress can in turn, slow down our metabolic rate making it difficult to lose weight if not gain it.

Hormones and Weight Gain

In women, there is yet another major variable that can cause you to gain weight as you get older, and that's the role of diminishing progesterone, which begins during the late 30s and early 40s.

Progesterone is a major upper airway muscles stimulant, which essentially tenses or stiffens the tongue, especially when in deep sleep. This is why as the levels of progesterone diminish during perimenopausal age, women begin not to sleep as well as they did before the onset of menopause. A relative change in a woman's sleep-breathing status can then lead to neurologic symptoms, such as night sweats, hot flashes, weight gain, mood swings, and irritability. Not too surprisingly, these same symptoms can be seen even in young men who are moving up the sleep-breathing continuum. Lack of deep or efficient sleep is a major cause of physiologic stress.

Sleep Your Way to Weight Loss

A recent article in Glamour magazine profiled 7 women who where all slightly overweight, and asked them to do one thing for 4 weeks: sleep more. Without making any other changes, they all loss anywhere from 7 to 21 pounds. Sleeping longer is one way to restore health in our sleep deprived culture, but increasing sleep efficiency while you sleep is another way to increase your energy levels, improve your health, and lose weight more easily.

Not Only Your Breathing Problem

Not being able to breathe well at night while sleeping, and not sleeping long enough are important factors to address, but there are many other factors that also prevent you from achieving the quality sleep that you need: Eating late close to bedtime is a common modern ritual that occurs for a variety of different reasons. Gastric juices still lingering from your last meal (or snack) can be suctioned up into the throat, causing more swelling and inflammation, causing more obstructions and arousals. Drinking alcohol close to bedtime causes your throat muscles to relax more, leading to more frequent obstructions and arousals, as well as louder and more frequent snoring.

The Right Way to Lose Weight

Before you begin that new diet plan, or take advantage of your new gym membership, make sure that you're able to breathe properly at night. If your nose is stuffy for whatever reasons, do everything possible to straighten it out first. If you've had a stuffy nose for years or decades, you may not realize that your nasal breathing is compromised. Proper sleep and lowering your stress levels is critical to getting rid of that excess belly fat.

7 Simple Ways To Get Rid of Your Snoring For Good

If your spouse or bed-partner snores and keeps you up at night, then you're not alone. Most people snore at least occasionally, while about 25% snore all the time. Snoring is a major problem that not only can affect your relationship, but your health as well (snorer and snoree).

Snoring may be a sign that you have obstructive sleep apnea, a condition where you literally stop breathing repeatedly while sleeping. Untreated obstructive sleep apnea can cause or aggravate depression, anxiety, hypertension, diabetes, heart disease, heart attack, and stroke.

Even if you don't have sleep apnea officially, studies have shown that snorers have a much higher risk for relationship problems, car accidents, and cognitive impairment.

One important thing to note is that you don't have to snore to have sleep apnea. Even young, thin women who don't snore can have significant sleep apnea.

Here's a checklist of the 7 “musts” of snoring cessation. Try these simple strategies before you resort to more invasive and expensive options:

1. Don't eat within 3-4 hours of bedtime.
If you snore, chances are, you'll stop breathing once in a while. When you do stop breathing, you'll create a vacuum effect in your throat which suctions up your normal stomach juices into your throat, causing you to wake up partially or fully. This also causes more swelling and inflammation which narrows your throat and nose even further. This leads to less efficient sleep, leading to weight gain, which narrows your throat even further.

2. Don't drink alcohol within 3-4 hours of bedtime.
Alcohol is a strong muscle relaxant, so it will make your throat muscles more slack and more apt to collapse and obstruct. And any obstruction around your airway as you sleep means more snoring.

3. Don't sleep on your back.
Due to gravity, everyone's tongues can fall back when on our backs. This narrows the space behind the tongue and along with muscle relaxation during deep sleep, you'll snore more and stop breathing more often. The traditional recommendation for pinning a tennis ball to the back of your pajama shirt ma work for a few people, but there are a lot more sophisticated ways to keep you off your back.

4. Clear up your nose.
Make sure that you're able to breathe properly through your nose, since having a stuffy nose will create a slight vacuum effect in your throat, aggravating partial to total collapse of the soft palate and the tongue. Whether through over-the-counter remedies, prescription medications, or with surgery, get this taken care of first. Unfortunately, this works only sometimes and in many cases, nothing changes. Regardless, if you need further treatment, you need to be able to breathe through your nose for the other options to work. It's been shown that definitively optimizing nasal breathing through surgery cures obstructive sleep apnea in only 10% of cases.

An interesting study published about 10 years ago showed that when given a nasal decongestant as well as a medicine that helps to empty the stomach faster, about 80% of snoring was significantly improved.

5. Lose weight.
Needless to say, this is easier said than done. One of the reasons why you may be overweight is because you don't sleep well. Less efficient sleep promotes weight gain, which not only cause you to expand on the outside, but also narrow in on the inside of your upper airways. But how about some of you who are not overweight, or even very skinny? Snoring and sleep-breathing problems occur due to a structural narrowing of the entire upper airway, from the tip of your nose to your voice box.

6. Try any of the various over-the-counter anti-snore gadgets, devices, and pills.
But don't expect dramatic results. Yes, sometimes, it'll help with your snoring, but even if it works, the effects don't usually last. The reason why you snore is due to your jaw anatomy and additional inflammation. Covering it up with any of these options is only a temporary solution. A study showed that compared with controls, the throat spray, nasal dilator strips, and anti-snore pillow was not any better.

7. Seek medical help.
If all the above don't work, it's time to see an ear, nose and throat doctor. A comprehensive exam is needed to find out which areas of your upper airway (from the tip of the nose to the voice box). We know that for most people it's the soft palate that flutters, making the annoying, chainsaw sounds. Usually, snorers will have a combination of areas that contribute to snoring, with the tongue being the most common culprit, due to having small jaws.

In most cases, a sleep study is needed to check to see if you have obstructive sleep apnea. If you do have sleep apnea, then treating this condition will help your snoring. Even if you don't have obstructive sleep apnea, all the different treatment options for sleep apnea can be used. As I mentioned in Step #4, you must first optimize nasal breathing and then deal with your tongue. The timing for eating and drinking alcohol is something that you should continue for a lifetime.

Unfortunately, things only tend to get worse as you age. The soft tissues in your throat tend to sag and collapse, especially after decades of repeated strong inspiration. This is why it's important to get your snoring taken care of, first using the conservative steps outlined in his article, and later by seeing a physician that can help you with this condition.
 

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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