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10 Tips For CPAP Success

Learn the Insider Secrets of Highly Successful CPAP Users…

Get your FREE access to the audio replay and mp3 download of this interview with Aurelio Henriquez who has extensive experience helping patients with sleep apnea succeed in using their CPAP machine.

Since 2002, Aurelio has helped hundreds of CPAP users overcome their struggles while he was with the NY Methodist Sleep Disordered Center as a Polysomnographic technologist and then later as the technical lab director for the Columbia University Sleep Disorder Center.

Learn:

• What to expect when you first try CPAP in the lab

• How to avoid the #1 mistake every new CPAP user makes

• Where to get the best CPAP equipment for the best price

• What one thing you MUST do BEFORE using CPAP to dramatically increase your chance of success

• What makes some people fail and some to succeed on CPAP and how you can be successful

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*By clicking ‘submit’ above, you are agreeing to receive ongoing communications from Dr. Park including monthly newsletters, events alerts, and other such written correspondences. Your e-mail will remain strictly confidential and will not be disclosed to any third parties without your prior written consent. You may unsubscribe to any or all portions of our e-mail correspondences at any time. Thank you for your cooperation.

Can Sleep Apnea Raise Your Cholesterol Levels?

There's been a lot of press coverage about good and bad cholesterol, as well as studies about various medications that are used to lower high cholesterol levels. The problem with the one variable paradigm of medicine is that illness is not solely a function of one elevated blood test finding. There are hundreds, if not millions of variables that when added together, produces one of the end results that we can measure, like your LDL levels. The same problem applies to allergies, where numerous medications are used to control histamine, which is one of many inflammatory mediators that result from an allergic attack. Amyloid plaques seen in Alzheimer's is another good example.

In all three of the above scenarios (cholesterol, histamine and plaques), wouldn't it be better to control what starts the problem, rather than just covering up the end result? Not too surprisingly, lack of quality or quantity of sleep has been shown again to raise your cholesterol levels (in addition to numerous inflammatory markers and amyloid plaques). In this month's Journal SLEEP, researchers found in teenagers that the less they slept, the higher their risk of developing high cholesterol levels later as an adult. This risk was much higher for women. As a society, we're sleeping about 1 to 1.5 hours less than we did 50 years ago. In a culture where sleep deprivation is glorified ("I get by on only 5 hours of sleep") these findings are not too surprising. 

There are numerous proposed explanations as to how poor sleep can lead to increased (bad) cholesterol levels, but the common pathway seems to be metabolic effects on the liver. There are other studies that show accumulation of fat cells in sleep apnea patients, similar to what's seen in alcoholics. Sleep restriction also causes decreased glucose tolerance, increased cortisol levels, decreased the satiety hormone ghrelin, and increased hunger and appetite.

How many of you were placed on cholesterol medications long before you were diagnosed with obstructive sleep apnea?

Can Tonsils Grow Back After Removal?

My son Jonas had his tonsils taken out about 5 years ago. Initially, his sleep quality improved dramatically, and his snoring disappeared. These days, I hear him snore occasionally, and he does seem tired, but only when he doesn't sleep long enough. Does this mean that his tonsils have grown back?

The short answer is no. When you take out your tonsils, just like taking out your appendix, it can't grow back. If you undergo an appendectomy and still have abdominal pain, than that means that there's another problem that's causing the problem. Similarly, if your snoring comes back after tonsillectomy or any other procedure that opens up the airway, persistent or recurrent symptoms means that, there was something else that was not addressed.

If your child has persistent or recurrent snoring after undergoing tonsillectomy, it usually means that there are other areas in the upper airway that is causing narrowing of the breathing passageways, from the tip of your nose to the space behind your tongue. 

Missing The Boat With Stroke and Sleep Apnea

Here's another large scale population-based research study that completely misses the boat. The INTERSTROKE study compared 3000 people with stroke with 3000 controls across 22 countries. The researchers concluded that hypertension appeared to be the strongest predictor of stroke, with a 2.64 increased odds ratio. Other factors included smoking, abdominal obesity, diet, exercise, alcohol, diabetes, depression, heart disease, and lipid problems. They note that 1/2 of these are modifiable.

We know from numerous past studies that obstructive sleep apnea increases your risk of stroke up to 3 times normal. If they had included obstructive sleep apnea in their list of risk factors, it would be at #1. Obstructive sleep apnea is a treatable condition. Unfortunately, it's estimated that 90% of sleep apnea is not diagnosed. It's likely that these people are being treated instead for their hypertension, elevated lipids, depression, heart disease, etc.

What this study implies is that more medications are needed to control hypertension. But we also know that obstructive sleep apnea is a major independent predictor or hypertension as well. Some researchers are saying that perhaps untreated obstructive sleep apnea is THE major cause of hypertension.

 

Is That Scratchy Throat Really A Cold? The Case Against Strep Throat (Part 2)

In my last post I described a typical person that sees me for a few day history of throat pain. She has cold-like symptoms, but her exam is essentially normal. Her voice box does show mild swelling and inflammation, consistent with laryngopharyngeal reflux disease. 

Upon further questioning, she remembers that she did have a late dinner with alcohol the night before she woke up with her throat pain. This confirms her laryngopharyngeal reflux disease diagnosis. But why does eating late cause throat pain the next morning, accompanied by cold symptoms? As I describe with my sleep-breathing paradigm, most modern humans stop breathing to various degrees at night while sleeping. If you're susceptible to this condition (due to having smaller jaw structures), having any additional stomach juices when you go to sleep will allow it to be suctioned up into the throat every time you stop breathing. 

Not only does this cause throat pain and additional swelling and inflammation, it also aggravates more frequent obstructions and arousals, which suctions up more stomach juices.

Well, that explains throat pain, but why would you have fever, chills, and sweats? Isn't this classic for cold symptoms?

Whether inflammation begins with a cold or from reflux, they both cause additional swelling in the throat, aggravating more tongue collapse. When the tongue falls back more and more frequently, this process upsets the balance with your involuntary nervous system. This causes vasomotor symptoms such as fever, night sweats, flashes, and chills. So what may seem like a cold can actually be a nervous system overreaction, with no sign of infection whatsoever.

In this example patients, I just had her stop eating close to bedtime (along with alcohol), as well as to optimize her nasal breathing, by using nasal saline and nasal dilator strips. Usually, most of these problems  go away within a few days.

What can you do if it doesn't go away? Find out my answer in a future blog.

Is That Scratchy Throat Really A Cold? The Case Against Strep Throat (Part 1)

Here's a typical patient that I see 2-3 time every day in my practice: A young woman comes in complaining of waking up Sunday morning with a sore and scratchy throat. She thinks she may have caught her husband's cold, since she is also experiencing some sweats, low-grade fever and unrefreshing sleep. I ask repeatedly if she did something out of the ordinary a few days prior to the onset of her symptoms, and she says no. She denies any traveling, flying, eating or drinking late. She normally sleeps on her stomach, and her father snores like a train. She's worried that she has Strep throat. 

Her general exam, as expected, is normal. No throat inflammation, redness or swollen glands. Looking via a flexible endoscope, the back of her voice box is slightly inflamed and swollen, but there's absolutely no evidence of infection? What would you do?

Final Thoughts On The Sleep Conference

I've had a few days to mull over what I experienced at the Associated Professional Sleep Societies meeting in San Antonio last week, and here are my conclusions:

1. Unless something changes dramatically, I'm not planning on going back to this meeting in the future. I went to a sleep meeting many years ago in Denver, and the type of studies and research presented was very similar, with no new revelations or new discoveries. There was absolutely nothing that I learned that will ultimately help my patients sleep better. However, I did clutter my brain with numerous facts and conflicting clinical recommendations.

2. I can't tell you how many studies concluded that sleep deprivation is detrimental to your body in every way, including your physical, hormonal, mental, cognitive and emotional states. On the flip side, sleeping longer was finally proven to improve cognitive and physical skills! Yeah.

3. I also learned (again) that c-reactive protein was found to be elevated in sleep apnea patients. This conference is unique in that it's a joint venture between sleep clinicians, basic science researchers, psychologists and sleep techs. It's a lot more technical, with a lot more scientific jargon and technical detail than your typical medical conference. We've been hearing for decades that gene therapy and research will eventually cure all our medical ailments, but as far as I can see, there hasn't been a lot of progress made in terms of helping patients sleep better in a significantly improved way.

4. I learned how a famous sleep researcher talks during a presentation after just flying in to the conference with major sleep deprivation.

5. San Antonio is a beautiful city. The Riverwalk is something to see. The final battle at the Alamo was not fought on top of the main building—it was fought at a peripheral area of the walled-off enclosure.

Anti-Snoring Help From SkyMall

On my flight back from my SLEEP conference in San Antonio, I just happened to be leafing through the SkyMall catalogue and I stumbled upon a page where there were three interesting devices to help with snoring.

The first one is called the Relax-N-Nap Pillow. It's a slightly inclined wedge pillow with a cutout in the middle so that you can sleep  completely face down, kind of like when you're getting a massage. Some people are only able to sleep on their stomach, but have various problems with their necks or other issues due to the twisting of the neck. This position is ideal since your head alignment is straight and you're able to breathe optimally, especially if your tongue and/or soft palate tends to fall back when on your side or back. I've always wondered what it would be like to be able to sleep on a massage table with your face down. Now you have that option.

The second device is called the Breathe Fit Anti-Snoring Aid. It's a triangle-shaped clip that helps to "apply gentle pressure to the septum to open nasal passages for maximum oxygen intake, rejuvenating the resting body and stopping disruptive snoring." Initially I thought that this device was similar the Nozovents or Brez, where the nostrils are splayed out, but then I realized that what it probably does is to stent the nasal passageways, to prevent flimsy nostrils from collapsing in completely. 

The third option is called the Snore Terminator. It's a device that's worn on your wrist which zaps you with electricity every time you snore. Yes, it does work, but at the cost of preventing you from sleeping continuously. Bedpartners' elbows can do the same thing.

Has anyone reading this blog tried any of these three products? If you're not sure about each of the products, go to SkyMall.com to find out more information.

Feeling Fat, Fuzzy or Frazzled?:Expert Interview with Dr. Richard Shames

• How your hormone imbalance AND your sleep apnea combine to create a runaway appetite and how you can still lose weight without dieting

•  Which hormonal problems both men and women experience but must treat differently

• Why checking your potassium levels is key to your health-especially if you suffer from constant fatigue

•  What is the #1 hormone deficiency that affects millions of sleep apnea sufferers yet is often ignored by even the most experienced doctors

 

Person Information
First Name *
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Postal Code or Country *
How did you find out about this recording? *	Please select a referral source Patient (received an email) Dr. Park's newsletter On-line article Book: Sleep Interrupted SleepGuide.com Facebook Twitter Referred by a Friend Other/Not Sure
*By clicking 'submit' above, you are agreeing to receive ongoing communications from Dr. Park including monthly newsletters, events alerts, and other such written correspondences. Your e-mail will remain strictly confidential and will not be disclosed to any third parties without your prior written consent. You may unsubscribe to any or all portions of our e-mail correspondences at any time. Thank you for your cooperation.

Want To Be A Rock Star? Sleep On It

If you're a Guitar Hero addict, sleep researchers at the American Professional Sleep Society 2010 meeting are saying that the more you sleep, the better your chances are at winning at this popular video game. Not too surprising, since getting better quality sleep can help with almost every aspect of your life. 

A similar study that was presented found similar levels of improvement with football players at Stanford University. This was also the same sleep team that found in previous years that tennis players that got more sleep had more power, were more accurate, and had more stamina than those that slept less.

Not to diminish the importance of these studies, but I guarantee that you'll see more and more of these type of studies in the future. 

What's improved in your personal or professional life every since you started sleeping better?

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