Acupuncture Lowers Sleep Apnea By Almost 50% After One Treatment
March 30, 2011
In a follow-up study (PDF) to their previous paper (PDF) showing that 10 acupuncture treatments can lower the AHI by 50%, the same authors performed sleep studies just before and after one acupuncture treatment, and found a 49% improvement in the apnea hypopnea index. The apnea index improved by 86%, and the hypopnea index dropped 39%. This was in the traditional, manual acupuncture group. In the group that received electrical stimulation acupuncture, the results were slightly better. The study authors proposed that acupuncture somehow alters the serotonergic pathways that are related to the caudal raphe neurons that control the muscles of the upper airway. One of the needles was also inserted into the genioglossus muscle, which is the main upper airway dilator muscle.
Personally, I’ve had mixed results using the same protocol for sleep apnea. But when it works, it works really well. Regardless, there’s minimal risk of complications, and even if your sleep apnea doesn’t improve, you’ll get the relaxing benefits of acupuncture treatment.
Has anyone experienced better sleep after acupuncture treatment?
Too Many Bathroom Trips At Night? See A Sleep Doctor First
March 24, 2011
There have been numerous studies that show that a major reason why people go to the bathroom to urinate frequently are doing so not because of irritable bladders or enlarged prostates, but due to an underlying sleep-breathing problem. Here’s another study that showed that about 58% of men with nocturia had obstructive sleep apnea. When treated for sleep apnea, nocturia can be significantly improved, if not completely cured in many cases. Prescription medication for this problem can’t even come close to these results.
Another recent study showed that going to the bathroom 2 or more times per night increased the mortality rate by 50% in men and 30% in women.
It’s been shown in numerous studies that the reason why you wake up is not because your bladder is too full—it’s because you’ve stopped breathing and you think your bladder is full, but it’s not. Here’s what happens: Every time you stop breathing, blood flow to the heart diminishes, but once you start breathing again, blood rushes back in your heart which dilates the heart chambers, making your heart think that you’re fluid overloaded. The heart then makes a hormone called atrial natriuretic hormone (or peptide), which makes your kidneys make more urine. At a certain point, with even a small amount of urine, you’ll feel like you have to go but only after you’ve woken up after an apnea event. Notice too, that urine volumes are typically not that large.
The thing that get me upset about all this is that despite all that we know about urinary frequency and its’ connection to obstructive sleep apnea, PCPs and urologists haven’t changed their ways at all. They continue to place patients on medications that help to relax the bladder, shrink the prostate, or even do surgery, which is like placing a band-aid. Treating with medications may help people go to the bathroom less often, but it won’t prevent cardiovascular morbidity and mortality. Treating an underlying sleep-breathing problem will not only treat nocturia effectively, it’ll also significantly lower your chances of dying.
I’m not saying that all cases of nocturia is from sleep apnea but since it’s so common, why not rule it out before looking at the more traditional options that require medications? (The same argument can be made for ADHD, depression, anxiety, heart disease, diabetes, etc.) If you have sleep apnea, treat that first, and if you still have symptoms, get checked by a urologist. What do you think about this idea?
Are Ear Infections Linked to Childhood Obesity?
March 23, 2011
Here’s another interesting connection with an explanation that may surprise you. Researchers in South Korea found that children with chronic otitis media had measurable taste changes that could explain why these same children tended to be more overweight. This link between chronic otitis media and obesity has been made before, but this is the first time researchers showed what was suspected as a possible culprit: That chronic inflammation of the middle ear can adversely affect the taste-sensing chord tympani nerve, which travels through the middle ear. They showed that children with chronic otitis media had reduced taste capacity to sense sweet and salty flavors, and that this could make children eat more.
The problem with this study is that it doesn’t prove that having fluid in the middle ear causes obesity. It only shows a relationship. What’s more plausible is that these children have significant sleep-breathing problems that can lead to both ear infections and increased weight. We know that obstructive sleep apnea can lead to pharyngeal and nasal inflammation, which can prevent proper eustachian tube function. Poor sleep from poor breathing also promotes weight gain by increasing one’s appetite for sugary, fatty foods.
Ask Dr. Park Teleseminar on Obstructive Sleep Apnea (4/12/11)
March 23, 2011
In this month’s (April 12, 2011) Ask Dr. Park Teleseminar I answer your questions on anything related to obstructive sleep apnea:
1. Do UARS patients progress into obstructive sleep apnea?
2. Given how common sleep apnea is, why hasn’t universal screening been implemented?
3. Despite using CPAP 5 to 8 hours every night, why am I still tired?
4. What do you think about the Pillar implants for snoring and sleep apnea?
5. How do I know when I can come off my CPAP machine as my sleep apnea improves?
6. What comes first, depression or sleep apnea?
7. How do you know if your sleep apnea machine is set for you correctly for you?
8. What surgery is recommended for nasal congestion?
9. Is it possible to underdiagnose sleep apnea in a sleep study?
10. What tips do you have for us dentists regarding UARS?
11. Can nasal congestion alter other areas of the upper airway?
12. Do you do turbinate reduction with the microdebrider?
13. What is UARS?
14. How much does lack of understanding of OSA and its’ consequences play in poor compliance? Are sleep doctors to blame?
15. Where are the best doctors or medical centers to go to on the West coast for fibromyalgia and UARS?
16. Why not add a hyoid procedure to the UPPP?
17. Can white matter lesions on DTI scans be responsible for sleep apnea patients’ symptoms?
18. Can hyperbaric oxygen therapy have a role in treating complications of sleep apnea?
19. What is expiatory sleep apnea?
20. Is bi-level use becoming more common?
21. Does high altitude make sleep apnea worse?
22. Is it worth trying the oral appliance for sleep apnea?
23. Is there any connection between cervical stenosis and sleep apnea?
24. What’s an SV Unit?
Click here to order the MP3 recording ($17).
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The Fountain of Youth, Revealed
March 22, 2011
Ponce de Leon is well known as the Spanish explorer that searched for the fountain of youth in the early 1500s. Even today, that search continues through the multi-billion dollar cosmetics industry, plastic surgery procedures, and nutritional products. Anti-aging medicine even has a certifying organization for doctors. Some experts are even claiming that they can reverse the aging process.
Knowing what we know about the importance of sleep and the havoc it can cause on your body, I can confidently say that the best way to slow down aging is to optimize your sleep quality. Sleep is known to be vital in tissue healing and regeneration, hormone regulation, as well as in helping to consolidate memories and thought processes. For example, non-REM deep sleep is important for tissue repair, growth hormone release, and other regenerative processes. REM sleep is needed for memory consolidation and creativity.
When most people read or hear about better sleep, they think about going to bed earlier or sleeping longer. People with insomnia are also inundated with “warm milk” recommendations, such as valerian, green tea, turkey, melatonin, meditation, and probably dozens of other vitamins, supplements, or relaxation techniques that help to calm or numb the mind to allow for faster sleep onset. Many of these options can work to various degrees, but won’t be helpful at all if you stop breathing at night. Once your breathing passageways obstruct while sleeping, you have to wake up. You can either wake up violently in a state of panic with sweating and your heart racing, or just get taken out of deep sleep into a lighter stage of sleep.
About 1-2 times per month, I see women who complain of various ear, nose or throat symptoms, let’s say for about 6 weeks. They also usually complains of increased fatigue, headaches, and poor sleep. They usually see their medical doctors and have tried multiple courses of antibiotics or allergy medications. They will typically say that they sleep on their backs when questioned about their preferred sleep position. Looking at their oral cavity exam, I don’t believe them. When questioned further, they all admit that they used to be stomach sleepers, but changed to back sleeping after reading an articles on various magazines, usually by a dermatologist (or sometimes a chiropractor) that recommends avoiding stomach sleeping since it can cause facial wrinkles. Almost every time, their health problems began just after they made the switch in their sleep position. Once they go back to their normal sleep position, their health problems usually resolve.
The cosmetics industry’s fight against facial wrinkles is a classic example our quest to delay aging. In the above example, the reason why some people have to sleep on their stomachs is so that they can breathe properly. Being on their backs causes the tongue to fall back due to gravity, and when in deep sleep, it relaxes completely, leading to obstruction and arousal. Having smaller jaws and dental crowding can aggravate this problem even more. Not getting sufficient amounts of deep sleep causes a generalized state of physiologic stress and adrenaline production, which tends to constrict blood vessels that supply certain parts of the body that are considered “unessential” when you’re under stress. This includes your digestive system, your reproductive organs, as well as your skin. Not receiving proper circulation deprives the tissues of oxygen, preventing proper nutrition and not allowing for healing, regeneration, and waste removal. Hypoxia also creates an environment that’s toxic to the local tissues, leading to further damage and accelerated aging. The bottom line is that not getting good sleep accelerates your aging process.
Another important concept that has profound implications is the fact that underdevelopment of the bony midface and jaw structures leads to wrinkles earlier in life. Having smaller facial bony structures does not stretch the facial skin over the bones as much compared to larger facial structures. Since elastic properties of facial skin tend to degrade over time, having smaller facial bones allows wrinkles to show up earlier, with the same degree of environmental, dietary, or genetic factors.
Two common habits that are thought to accelerate aging and even wrinkles are sun tanning and smoking. Sun tanning may make you look “healthy” temporarily, but sun damage takes a toll on your skin, especially if you’re susceptible to the sleep-breathing problems that I describe. Imagine if you already have diminished circulation to the skin, with diminished levels of oxygen. By definition, you’ll have more levels of oxidative stress, where free-radical oxygen molecules are formed, which can damage DNA. Add ionizing radiation, and it’s a double whammy.
Nicotine is a known stimulant which also has been proven to constrict blood vessels, especially in the skin. It also has a calming effect the way Ritalin helps to calm children with ADHD: Stimulants help to counteract the effects of sleep deprivation from not breathing well at night. It’s also been shown that it takes nicotine about 45 seconds to reach the brain once you inhale smoke into your lungs. This doesn’t make any sense, since most smokers will tell you that they feel more relaxed after the first one or two breaths. What’s making smokes relaxed is the relaxing properties of deep breathing, along with the stimulating effects of nicotine. But by relaxing more using deep breathing techniques to inhale a stimulant, you’re cutting off blood flow to your skin, which if already sun damaged, is more likely to suffer from wrinkles.
The basic thesis of my sleep-breathing paradigm states that all modern humans stop breathing once is a while. But as we get older, not only do we sag on the outside, but also on the inside. If you think about it, the rate at which we age is directly proportional to how narrow your upper airway gets. Add to this additional gravity and the typical weight gain that tends to occur during middle age, it’s no wonder so many people have sleep-breathing problems as we all get older. We’ll never run out of more pills, gadgets, devices and diets that tout their anti-aging properties, but without addressing how well you breathe while sleeping, you’ll continue to suffer from accelerated aging.
Struggling with an addiction? Check into a Long term drug rehab facility and get the help you deserve!
Tim Ferris, Michael Phelps, ADHD, & Sleep Apnea
March 21, 2011
I wrote in my last post about how creativity can be linked to ADHD, mainly due to inefficient sleep from breathing problems at night. ADHD can also be linked to tremendous achievements in sports or physical activities. People who don’t sleep efficiently will take measures during the day to compensate for their inability to stay focused or stay awake. Some people drink lots of coffee. Others exercise like crazy. Some even become olympic swimming or ballroom dancing champions.
I’ve written before about how Michael Phelps, the olympic swimming champion, has a major malocclusion, and seems to be a mouth breather. It’s well documented in the papers that he had ADHD as a child. Swimming is a great way to not only stay active, but also has a calming, relaxing property that’s almost like doing deep-breathing meditation exercises. Swimming forces you to take slow, rhythmic breaths. His mother has known hypertension, and being clearly overweight, it’s likely that she has obstructive sleep apnea. Many long distance runners feel alive only when they’re running. It’s shocking how often people who are addicted to endurance sports can’t or prefer not to sleep on their backs.
Even with Tim Ferris, best-selling author of The 4-Hour Work-Week, in his new book, The 4-Hour Body, he describes how he and his entire family have major insomnia. He even recommends sleeping on your stomach, which is what he most likely prefers due to his jaw anatomy. He’s excelled in almost every physical activity, from running to swimming, to body-buiding, and even ballroom dancing. I do enjoy reading his books, but I have to admit that his writing style is definitely scattered, in the stereotypical style that’s typical for ADHD.
Problems can arise if you get injured or are forced to sleep on your back for some reason (an injury or surgery). Poor sleep quality can promote rapid weight gain, and then it’s really difficult to take off, especially since you’re not sleeping well, and you’re not able to exercise at your normal levels. Time and time again, people with these issues tell me that they get really down and depressed even if they miss a few workouts.
I know many of you reading this have this condition. Do you agree or disagree?
ADHD, Creativity, & Sleep
March 18, 2011
One important concept that I propose in my book is the idea that mild sleep deprivation due to any cause (but especially from mild sleep-breathing problems) can promote creativity. This hypothesis was recently supported by a study that showed that college students that had ADHD had more creative achievements than students without ADHD. If you accept my sleep-breathing paradigm’s prediction that poor sleep can lead to symptoms of ADHD, then it’s also likely that your nervous system will be overly activated. This leads to heightened senses and emotions, enhancing creativity or even intuition. In fact, numerous studies have shown that a significant percentage of children with ADHD on medications actually have a treatable sleep-breathing disorder.
People with upper airway resistance syndrome (UARS) are more likely to fit this picture, since they are never able to achieve quality deep sleep on a consistent basis. Since by definition, this causes a low-grade physiologic stress response, your nervous system is gong to be en garde, edgy, hypersensitive or over-reactive. Even your sense of smell, hearing, vision, or taste can be affected. This is why many people come through during intense times of stress, such as trying to meet a major deadline, or during a major performance.
People with UARS can have apneas or hypopneas, but most of their breathing pauses are too short or subtle to be reported on a sleep study. Many do move up the continuum into sleep apnea territory later in life, especially as they gain weight. Notice that parents of people with ADHD almost always have obstructive sleep apnea.
Problems happen when your sleep quality gets much worse, and then your heightened senses become overly sensitive, where even common smells, sounds or weather changes can bother you. Even mildly irritating situations can lead into major panic attacks or emotional outbursts.
Notice also that most of the creative luminaries in history have or had major sleep problems. Perhaps this is why it’s sometimes difficult to tell the difference between pure genius and sheer madness.
Come to think of it, I did come up with this concept during my book writing process after a few nights of mild sleep deprivation :)
What’s your take on my hypothesis?
Sleep Apnea-Like Mythical Folklore?
March 17, 2011
Here’s an interesting folk lore from the deep south that someone pointed out that possibly refers to sleep apnea. In South Carolina’s Gullah culture, there’s a mythical creature called a Boo Hag, which are similar to vampires. But unlike vampires, they suck on your breath instead while you sleep. After taking the victim’s energy, it flies off, leaving the person short of breath when they awake, and feeling generally tired.
Expert Interview: Dr. Avram Gold on UARS, Chronic Fatigue & Functional Somatic Syndromes
March 16, 2011
In this month’s Expert Interview, I interview Dr. Avram Gold, a pioneer in researching the link between upper airway resistance syndrome, chronic fatigue, and the functional somatic syndromes. Some of the topics will include:
- What are the functional somatic syndromes and how are they related to sleep-breathing disorders?
- What’s the relationship between central sensitivity syndrome and stress?
- How is sleep-disordered breathing related to stress?
- How is anxiety or depression related to functional somatic syndromes?
- How is chronic fatigue syndrome connected to the this condition?
Please enter your information below to gain access to the free recording:
Viagra, Raynaud’s & Sleep Apnea
March 16, 2011
Viagra is still a popular drug that’s used to treat erectile dysfunction (ED) in men. It works by relaxing smooth muscle in blood vessels, allowing blood to enter the penis. A recent study showed that it can also help people with Raynaud’s phenomenon, where small blood vessels in the hands or feet go into spasm and cause cold or numb extremities, sometimes to the point of infection or even gangrene. This condition is commonly seen with autoimmune conditions, especially in lupus. It makes sense that relaxing smooth muscles that constrict blood vessels may increase circulation. Unfortunately, people taking this medication had a number of side effects.
In my book, Sleep, Interrupted, I describe a young woman who had classic Raynaud’s symptoms, needing to wear socks and mittens to bed even in the summer. After undergoing multilevel upper airway surgery for her mild obstructive sleep apnea, her Raynaud’s disappeared completely! Her depression, low blood pressure, irritable bowel symptoms, and daily headaches improved significantly as well.
There are also numerous studies showing the ED is a common complication of obstructive sleep apnea. One of the more common signs that sleep apnea treatment is working (through CPAP, dental devices or surgery) is that men are having erections again upon awakening in the morning. In many cases, ED resolves completely after sleep apnea treatment.
Not getting deep, high quality sleep is known to cause a physiologic state of stress, leading to too much of an adrenaline response. This results in an inability to relax vascular smooth muscles in various parts of the body, including the hands, as well as the digestive or reproductive organs.
If you have obstructive sleep apnea or upper airway resistance syndrome, it’s a given that your body will be under a constant state of stress. This why why after properly treating these conditions, ED and Raynaud’s often improve. These common conditions are not problems specific to the respective body parts—they are the end result of a systemic problem aggravated by not breathing and not sleeping properly.
These sleep-breathing problems are often treated successfully by alternative and complementary practitioners, since they tend to focus on the whole person, including his or her surroundings, rather than the one specific neurotransmitter, hormone, or body part.
However, taking a pill, whether it’s a prescription medication, vitamin or natural herb, or breathing exercises during the day, won’t solve the problem completely if you’re not able to breathe properly at night.
How many of you have had partial or total resolution of your ED or Raynaud’s after treating your sleep-breathing condition?
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