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New Year’s Day Heart Attack Rates Soar

I’m willing to bet that tonight we’ll also have the highest rate of apneas during sleep due to alcohol ingestion just before bedtime. Alcohol relaxes your throat muscles, which can aggravate, if not cause obstructive sleep apnea. Sleep apnea is a major source of stress on the heart. We also know that the days after Christmas and New Years Eve have the highest rates of heart attacks.

If you’re inebriated , you won’t have the normal reflexes to wake up and turn over every time you stop breathing. You’ll also have lots of reflux due to vacuum forces suctioning up your stomach juices into your throat. This will cause a lot of sore/dry throats and even much higher rates of pneumonia, asthma, sinusitis and ear infections.

Unfortunately, this is a sad observation and commentary, but likely to be true.

Hysterectomy Linked to Higher Risk of Renal Cell Carcinoma (via Sleep Apnea?)

I just happened to come across a study that showed that hysterectomy is associated with a higher risk of developing renal cell carcinoma. Furthermore, undergoing a hysterectomy at an earlier age increases your chances of renal cell carcinoma even more. There was also a small, but significant increase in the rate of bladder cancer. At first glance, this may have nothing to do with obstructive sleep apnea, but once I began to dig a bit deeper into the research literature, here’s how I connected the dots between hysterectomy and renal cell carcinoma:

1. Hysterectomy generally produces surgical menopause. The study didn’t mention what percentage of women also had their ovaries removed, but I’m willing to bet it’s a significant number. Menopause by definition causes sleep disturbances due to a drop in estrogen and progesterone. Progesterone acts as an upper airway muscle dilator, which helps to tense the tongue. Diminishing progesterone allows your tongue to become more relaxed, allowing more frequent obstructions and arousals. This causes less efficient sleep, leading to slow weight gain.

2. Weight gain narrows the throat even further, aggravating or uncovering obstructive sleep apnea. Poor quality sleep also produces vasomotor (or neurologic) symptoms such as night sweats, hot flashes, insomnia, irritability and mood swings.

3. Chronic hypoxia and physiologic stress on the body shunts blood and nervous innervation away from unnecessary body parts and organs when under stress, such as your digestive system, reproductive organs, skin, and your genitourinary system (which also includes your kidneys).

4. Obesity has been shown to be linked to increased risk certain cancers, including the colon, esophagus, prostate, kidney, gallbladder and in women cancer of the breast and reproductive organs. Notice that these are all digestive or genitourinary organs (expect for esophageal cancer, which is mostly due to reflux from apneas).

5. Here are the most common risk factors for renal cell carcinoma: age 50 to 70, obesity, smoking, and hypertension. Notice how all these are risk factors for obstructive sleep apnea as well. We know that nicotine can relax the lower esophageal sphincter, which aggravates more reflux into the throat.

Early menopause has also been shown to increase your risk of heart disease as well. Since we know that untreated obstructive sleep apnea is a major risk factor for heart disease, all these these findings are not surprising.

What do you think about the connections that I’ve made? Please enter your comments in the text area below.

Ask Dr. Park: Over-The-Counter Snoring & Sleep Apnea Options: Do They Work?

In this Ask Dr. Park teleseminar I reveal which of the following over-the-counter devices and programs for snoring and sleep apnea really work:

3 Myths About Your Hangover for New Year’s Day

As the New Year approaches, there are a number of articles and advice about simple ways to avoid a hangover. Besides not drinking at all, there’s really no proven method that works. This US News & World Report article does give some practical advice on how you can lessen the severity of your hangover the day after New Year’s festivities. As I read through this article, I couldn’t help but to point out some common myths that are still perpetuated in the media and the medical profession:

Myth #1: Alcohol causes dehydration. Just because you pee more doesn’t mean you’re dehydrated. If you drink an excessive volume of liquids, your kidneys will make sure to pee out the excess amount. However, since alcohol is a strong muscle relaxant, which causes you to stop breathing much more often when you’re in deep sleep. For many people, alcohol will temporarily cause obstructive sleep apnea, which is a common sleep-breathing disorder where you literally stop breathing anywhere from 10 to 100 times per hour, lasting anywhere from 10 to 50 seconds.

We know that in sleep apnea patients, due to the intense negative pressures that are generated in the chest, blood flow is partially diminished during these breathing pauses. But as soon as breathing resumes, blood rushes back into the heart chambers, causing your heart to think that it’s fluid overloaded. This causes your heart to make a hormone called atrial natriuretic peptide, which makes your kidneys make more urine. But then, because you’re more likely to wake up every time you stop breathing, you feel a little distention in your bladder, and you think you have to go to the bathroom. Studies have shown that it’s the breathing pauses that wakes you up, and not having too much urine in your bladder.

Myth #2: Your pounding headache is from the alcohol. Notice how the typical features of a hangover—pounding headache, nausea, sensitivity to bright lights or noises—are almost identical to a migraine. Many people with obstructive sleep apnea wake up every morning with very similar symptoms, without having ingested any alcohol. Deep sleep deprivation is a major cause of headaches.

Myth #3: Eat crackers, toast, bananas or pretzels. The reason is to make up for a drop in blood sugar and lost potassium from increased urination. While this advice may be true, and can be helpful if you don’t stop breathing at all. But since by definition a hangover means you stop breathing much more often than normal, having any food in the stomach is the worst thing you can do. Every time you stop breathing, you’ll create a vacuum effect, which suctions up your stomach juices into your throat. This not only wake you up more often from deep to light sleep, it’s what also causes you to have a sore or dry throat in the morning. It’s not from dehydration. This can then go into your nose and cause a stuffy nose.

Looking at hangovers from my sleep-breathing paradigm, the smaller your jaws, or if you prefer to sleep on your side or stomach, the more likely you’ll suffer from a hangover after a night of drinking. The smaller jaw volume allows your tongue to fall back and obstruct your breathing more easily with the same amount of alcohol. This is why in general, it’s a good idea to avoid any alcohol within 3-4 hours of bedtime.

There’s one simple tip that may help some people from having a hangover (but not everyone): Use Afrin nasal spray and Breathe Rite strips just before going to bed. Since alcohol causes nasal congestion, it can cause your tongue to fall back easier and obstruct your breathing. Having an overly open nose may be enough to prevent your tongue from falling back too often.

For those of you who plan on celebrating this New Year’s eve and indulge in alcohol, try this simple nasal tip. Please report to me your experiences. Did breathing better through your nose lessen or eliminate your hangover after a night of drinking?

How Alcohol Is Linked To Psoriasis In Women

Women who drink 2 or more times per week, particularly nonlight beer, are found to have a higher risk of developing psoriasis. This study out of Harvard University showed that the risk increased by 1.72 times normal. One hypothesis that was proposed was that non-light beer is made from wheat products, and that wheat contains gluten, which is a common component that provokes an autoimmune response in Celiac disease.

I’ve written before about how sleep apnea could cause psoriasis in men, and this situation can apply to women as well. Sleep-breathing problems at night, whether or not they’re apneas, can cause a low-grade physiologic stress response which heightens your immune system. When your body’s immune system is in a constant state of stress, it can easily attack normal tissues or proteins. Furthermore, when your body is under stress, certain parts of your body (like your skin, digestive or reproductive organs) will be deprived of blood flow and nervous innervation. Hypoxic states can cause oxidative stress, which has been shown to be linked to autoimmunity, atherosclerosis and even cancer.

Knowing how prevalent obstructive sleep apnea is in our population, this connection is not surprising. Is there anyone reading this blog that had their psoriasis go away completely after your sleep apnea was treated?

Breast-Fed Boys Grow Up To Be Smarter

Here’s a study that showed that boys that were breast-fed as infants for at least 6 months do better in school compared with boys that were bottle-fed. Enhanced nutrients in breast mild and mother-infant bonding were thought to be reasons for this finding. Breast-fed girls also has mild increases in test scores, but the results were not statistically significant.

One major omission from the conclusion of this study is the fact that breast-feeding protects against developing obstructive sleep apnea. Dentists have long said that bottle-feeding promotes malocclusion and dental crowding. The smaller the jaws, the less room there is for the tongue, and the more often you’ll stop breathing at night.

Another important point is that pumped breast milk is not the same as breast-feeding. Unfortunately, our society and modern time don’t make it easy to exclusively breastfeed.

What are your thoughts on this? If you have sleep apnea, do you remember if you were breast or bottle-fed?

My Two Major Panic-Anxiety Episodes

In this modern age of anxiety, it’s almost a given that you’ll have some anxiety over certain things, such as financial, health, relationship, or academic concerns. If you have a sleep-breathing disorder, it’s likely your stress and anxiety levels will be much higher. Any degree of sleep deprivation or inefficient sleep can heighten your nervous system, and make you over-react to situations that normally wouldn’t stress you out.

Looking back, I distinctly remember two episodes in my life, where I had some major panic attacks, beyond the typical life stresses or anxiety provoking states, such as death, relationship issues, or even job interviews.

I’ve always considered myself an introvert, but not shy. In high school, I was active in music (orchestra, symphonic band, and the jazz band), was captain of the track team, and was active in science research. I don’t remember having any problems giving presentations and speaking in public, but that changed once I got to medical school.

In the second year of medical school, I was sitting in a small psychiatry class, where each student had to interpret and critique an interview that was just observed. For some reason, as my turn came near, I could feel my heart pounding away, and broke out in a cold sweat. My heart was beating so fast and intensely, I though I was going to have a heart attack and die. Even my kidneys hurt. Fortunately, I said a few words about the interview, and didn’t die. This type of panic and anxiety persisted to some degree for the rest of the year. Fortunately, by my my third year clinical rotations, it problem went away completely.

The other situation that I remember was after a major highway car accident during residency. I was driving along with Henry Hudson Parkway at night in the express lane, and saw from the rear view mirror that there was a car that was zig-zagging from lane to lane. Within an instant, I saw that he was high beaming me on and off, and then he rammed into me while speeding over 100 miles per hour. My car got pushed onto the divider, turning almost 90 degrees, and I though I was going to flip over and die. Fortunately, my car slid back down and slid along the right side of the elevated highway for another few hundred feet. My car was totaled, and I was taken on a backboard to the ER at Columbia. I came away with only the shock of the experience, but for about a few months after this incident, whenever I saw a car change lanes into my lane behind me, I would have mild panic attacks.

Looking back at both incidents, I was in a period of time when I was majorly sleep deprived. During second year medical school, I was not getting enough sleep due to the various demands of all the courses. During residency, I was still taking first call, working about 100 to 120 hours per week. This is like having a short bout of PTSD, or post-traumatic stress disorder.

The point I wish to make here is that if you don’t sleep long enough, or if your sleep is inefficient (like with sleep apnea), then you’re more likely to suffer from anxiety or pain attacks. My examples are the more extreme conditions that can arise, but most people just get upset a bit quicker or over-react inappropriately in certain situations. This is why good, quality sleep should always be a top priority in your life.

Do you have any experiences where major sleep deprivation caused you to have increased anxiety or pain attacks?

Snoring Men On Commuter Trains

If you’re a bus or a train commuter, I’m sure you’ve sat next to or near a loudly snoring man or woman. Most often, they’ll be older or overweight, but they can be you and thin as well. Whenever it happens, it can be an uncomfortable situation for everyone involved. My first reaction is to wake him up and ask if he’s been treated of obstructive sleep apnea, but that would be rude. I’ve also thought about slipping one of my cards into his pocket.

The snoring sounds and the neck position are classic: His head is bent forward somewhat as he begins to snore louder and louder. He stops breathing abruptly, and then wakes up enough to lift up his head, and the cycle starts all over again.

It just kills me that statistically, this person will go on living with a potentially life-threatening condition that may be harmful to himself or to others. Unless someone is rude to this person and makes him realize that he may have a serious medical problem, he’s never going to find out. Unfortunately, even his doctor is unlikely to ask about his sleep quality, or even inquire about any snoring. He’ll continue to be treated for his high blood pressure and diabetes, wondering why his numbers aren’t coming down.

I make every effort to give out information about sleep apnea in any public or social setting (within reason, of course). For example, one of my neighbors in my building just happened to mention that her husband snores heavily after finding out what I do for a living. She eventually gets her husband to see a sleep doctor, who confirms obstructive sleep apnea, and places him a CPAP machine. He’s now sleeping much better, and his wife is sleeping better too. Invariably, one or two people that I meet at social functions have revelations as to why they’re so tired, no matter how long they sleep, eat healthy and exercise regularly.

How often do you see or meet someone what has obvious sleep apnea, but were afraid to say anything? How did it make you feel?

Alzheimer’s & Down Syndrome: What’s The Connection?

Down syndrome is one of the more common genetic disorders, characterized by mental retardation and underdeveloped facial structures. They also have a very high rate of heart disease, and if they live long enough, many will go on to develop Alzheimer’s disease. It’s been shown that the Alzheimer’s disease process in Down patients is identical to what’s seen in regular Alzheimer’s patients, except that it occurs much earlier (40s and 50s).

We know that Down patients have severely underdeveloped mid and lower jaws. Typically, the tongue will seem too big, and quite often they’ll snore. One study in 1991 showed that 45% of Down patients had obstructive sleep apnea. If you recalculate this number based on more recent scoring criteria, that number will probably be much higher.

It’s likely that the more severe the degree of obstructive sleep apnea, the more narrow the jaws, and the more severe the mental retardation. It’s a given that untreated sleep apnea will cause major brain damage. You could also show that the highly functioning Down patients will have less severe sleep apnea. Of course, you’ll have to do a study to prove this. Intuitively, this makes sense.

What do you think about this connection?

Expert Interview: Healthy Eating For Sleep Apnea With Maria Alexandra Bella

In this Expert Interview, dietician Maria Alexandra Bella will talk to us about Good Nutrition for Sleep Apnea. We’ll discuss:

1.Ways to avoid becoming hungry if you stop eating  within 3-4 hours of bedtime.

2. Why is it important to eat a good breakfast?

3. Some common myths and misconceptions about food choices and nutrition

4. Practical tips on choosing healthy ingredients without paying too much?

5. Nutritional pitfalls to avoid during the holiday season.

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