Why Shaq Has Sleep Apnea

May 26, 2011

The Shaq has sleep apnea. Besides Michael Jordan, the Shaq is probably one of the most popular professional basketball players that we have. He recently made big news by announcing that he had obstructive sleep apnea, and even had his sleep study taped by Harvard Medical School and placed it on YouTube. If you look at his physical structures, it’s no surprise that he has significant obstructive sleep apnea.

But one thing that you may be surprised about is that many of his fellow players probably have sleep apnea, and won’t get diagnosed for years. Basketball players don’t fit the typical profile for sleep apnea (male, overweight, big neck, snorer), but as you can see, many basketball players are not only tall, but somewhat bulky on top.

We already know that up to 1/3 of NFL linemen have significant obstructive sleep apnea. Anecdotally, most bodybuilders and weightlifters probably have undiagnosed obstructive sleep apnea. Now you should add basketball players as well.

It’s well known that some professional basketball players may have gigantism, or acromegaly, which is a disorder where too much growth hormone is secreted by the pituitary gland. We also know that acromegaly patients have up to 75% chance of having obstructive sleep apnea. It makes sense that you don’t have to have formal acromegaly, but only mild gradations.

You may be asking by now, if they have sleep apnea, how can they be so fit and almost superhuman in their athletic abilities? Perhaps their drive to overcome the fatigue is what leads to intense workouts and 110% effort during competitions. This situation may also apply to professional distance runners. I know for a fact that many top elite runners can’t sleep on their backs and have trouble waking up in the morning.

Sometimes, the sport itself can make sleep apnea worse. Football players or body builders typically bulk up their upper bodies as well their neck muscles, which can narrow your upper airway even more. It’s not only fat that can compress your breathing passageways.

Whenever I watch a top level sports program, whether live or on TV, I always look at the jaw structures of the top athletes. In many cases, you’ll see jaw narrowing or recessed chins. Often the bite is off, and if you can sometimes peek into their mouths, you’ll see a high arched hard palate. One great example of this is Michael Phelps.

Do you know any elite or top level athletes, and if so, how well do they sleep? Ask them which position they like to sleep in. Do either of their parents snore? You’ll be surprised at the consistency of the answers you hear.

Written by Steven Park · Filed Under Blog | 2 Comments

Can Sleep Apnea Cause Chronic Sinusitis?

May 25, 2011

Here’s my response below to a NY Times article on chronic sinusitis. They talk about cutting edge research in diagnosing and treating sinusitis, but completely miss an important point. Please read my post below to see what I mean, and feel free to comment on anything that I’ve said.

Biofilms are the pathology de jour in chronic sinusitis research right now. A few years ago, it was our immune system’s response to funguses. Before that, it was allergies, and before that, bacteria. As long as we’re convinced that it’s a bad organism or agent that’s attacking our body (sinus) cavities, you may get rid of the infection, but you’re doing nothing to treat what’s actually causing the inflammation that leads to blockage of the sinuses. The same analogy can be made for anti-reflux medications. None of the proton pump inhibitors (like Prilosec or Nexium) or H2 blockers (like Zantac) actually do anything to prevent reflux. It only lowers acid production, without doing anything to prevent regurgitation of stomach juices into the esophagus or throat.

Interestingly, a recent large scale study showed that the vast majority of people who suffer from recurrent sinus infections, pain and headaches are actually suffering from migraines. This is a neurologic form of inflammation in the sinuses, which over-reacts to weather changes, chemicals, scents, or odors. Chronic inflammation can lead to swelling, leading to blockage of sinuses, which can predispose to infections by bacteria that normally live in your nose.

Saline is also commonly recommended for chronic sinus sufferers, but it’s a double edged sword: A recent study showed that people who used nasal saline irrigation frequently had more episodes of infection than those who didn’t. Yes, saline irrigation flushes out pollutants and bacteria, but it can also cause paralysis of the cilia, which are finger-like projections that move nasal mucous back into your throat. Saline is like a mild version of Afrin – it’s still a decongestant. This is why some people have to use saline every day, sometimes 3-5 times per day. They’re addicted, just like with Afrin.

Sinus problems are much more common these days due to underdevelopment of our facial bones, which also include our jaws. Over the past few hundred years, due to a radical shift in our diets, as well as our eating habits (soft, mushy foods, bottle feeding, etc.), our jaws are not expanding to their full potential. If your facial skeletons don’t grow as much, the natural nasal and sinus passageways will be more narrow, becoming more predisposed to obstruction with colds, allergies, or any kind of inflammation.

This is why most people with chronic sinusitis can’t (or prefer not to) sleep on their backs. Due to smaller oral cavity volume, the tongue takes up relatively too much space, which leads to more frequent obstruction while breathing at night. Breathing pauses (apneas) then can suction up your normal stomach juices into your throat, lungs and nose, causing more inflammation. Most people with chronic sinusitis will also have sleep-difficulty and one or both parents will be heavy snorers with typically undiagnosed sleep apnea.

I presented a poster many years ago looking at the incidence of obstructive sleep apnea in people who had persistent or recurrent symptoms after nasal or sinus surgery. Almost 80% were found to have significant obstructive sleep apnea. Now that I look for and treat sleep-breathing problems before considering surgery, the need to go on to sinus surgery has plummeted. Plus they sleep better.

Written by Steven Park · Filed Under Blog | 9 Comments

ADHD & Autism Rates Spike—Is Sleep Apnea Responsible?

May 25, 2011

Researchers were surprised that that rate of ADHD and autism have spiked over the last 10 years. ADHD increased 33%, whereas autism increased from 0.19% to 0.74% over the same time period. Honestly, I’m not surprised by these results. Here’s my explanation for the continued rise in these two common developmental disorders:

There’s definitely more awareness of these two conditions (ADHD and autism), as well as more inclusive criteria for diagnosis
Implementation of the back to sleep campaign about 20 years ago
Worsened diet
Bottle-feeding
Environmental endocrine disruptors
Less total sleep time
increased incidence of allergies and food sensitivities.

There’s even evidence showing that common motor-skill milestones are often coming in delayed, since infants are not spending as much time on their tummies, even during the day. As expected, skull deformities (flat head) are much more common since the back to sleep campaign.

What does this have to do with obstructive sleep apnea? Here are 3 important reasons:

Factors 2 to 6 all significantly increase your risk for obstructive sleep apnea, through either poor jaw development or inflammation of the upper airway.
Obstructive sleep apnea can predispose to obesity, which narrows your airway even further
Sleep-breathing problems begin during infancy, and the lack of deep, efficient sleep, not to mention frank hypoxia from apneas, can be detrimental to the infant’s brain development and biochemical pathways.

I realize that there are a number of other possible reasons for ADHD or autism (probably a combination of many factors), but not getting deep sleep can be a major barrier to proper brain development. Studies are definitely needed in this matter. Unfortunately, the medical/pharmaceutical industry is unlikely to change the status quo.

What do you think about this study? It is from over-reporting or more awareness, or is it for real?

Written by Steven Park · Filed Under Blog | Leave a Comment

Myths About Tonsillectomy, Sleep Apnea, and Bedwetting

May 23, 2011

One of the biggest myths within the sleep community is that taking out tonsils in children can cure sleep apnea. Yes, it can work to various degrees, sometimes dramatically, but it doesn’t work in all children. In fact, a recent large-scale meta-analysis showed that adenotonsillectomy was found to be significantly effective in about 60% of children. My 11 year old son was one such child. He had a dramatic response initially when he had his tonsils and adenoids taken out at age 5. But now, it’s slowly coming back, as expected.

Two recent studies continue to repeat the same kind of studies showing that removing tonsils and adenoids can help many children with their sleep apnea or bedwetting (sleep apnea is known to cause bedwetting in children as well as having to go often at night in adults). When the press reports on these kind of studies, they imply that surgery can be a “cure” for sleep apnea or bedwetting.

The adenotonsillectomy for sleep apnea article reported significant drops in the AHI in the mild group (2.6 to 1.5) as well as in the severe group (16.3 to 2.7). But notice that if you use the accepted AHI level of 1 as being abnormal, then their results weren’t that good. What they stressed, however, was that left heart enlargement improved with sleep apnea treatment.

The bedwetting article showed that in children who wet their beds only at night, they had about a 50% drop in bedwetting episodes. Those that had problems at night and during the day didn’t see any significant improvement. They went on to list various risk factors such as prematurity, such as prematurity, higher BMI, male sex, severe bedwetting and family history of bedwetting.

The reason why many of these children don’t respond to adenotonsillectomy (as well as those that respond only partially or relapse later on) is that they still continue to have narrow jaws and dental arches. They have various degrees of craniofacial narrowing and underdevelopment. Having smaller jaws and dental crowding can also make your tonsils larger (which causes more obstructed breathing).

I’m not minimizing the importance of these two studies. However, I wanted to point out that these type of solid scientific studies only perpetuate our black and white understanding of any type of intervention for obstructive sleep apnea.

If you had your child’s tonsils and/or adenoids taken out, did his/or problems improve? And if so, did it last?

Written by Steven Park · Filed Under Blog | 2 Comments

Can Sleep Apnea Cause Skin Cancer?

May 18, 2011

I’ve alluded to the possibility of cancer development from chronic hypoxia that’s seen with obstructive sleep apnea. Here’s one study that supports my hypothesis: Researchers in Spain injected melanoma cells into mice and subjected one group to intermittent hypoxia and the other group to normal oxygen levels. At the end of 14 days, the tumor weight in the hypoxia group was almost two times that of the normal oxygen group.

Remember that chronic physiologic stress that results from hypoxia leads to lowered blood flow, metabolites and resources to unessential body parts and organs. The skin is considered unessential. There are tons of research in the cancer literature showing how hypoxia is a major player in cancer development. Other organs that are commonly affected by cancer are your reproductive and digestive organs: colon, prostate, breast, uterus, and ovaries.

This connection isn’t surprising, given the fact that hypoxia has been shown to cause amyloid plaques and neurofibrillary tangles in mice brains. If the Spanish researchers tested brain tissues as well, they probably would find similar pathology.

How many of you with obstructive sleep apnea also have skin cancer?

Written by Steven Park · Filed Under Blog | Leave a Comment

Urinary Incontinence, Nighttime Urination, Worse With Poor Sleep

May 16, 2011

It’s commonly accepted that suffering from urinary symptoms can prevent you from getting a good night’s sleep. However, a recent study confirms more recent findings that suggest that poor sleep itself can lead to lower urinary tract symptoms (LUTS), such as incontinence, and nighttime urination. This study prospectively followed over 1600 men and 2500 women and found that having poor sleep significantly predicted later development of LUTS.

For example, short sleep duration and poor sleep quality doubled the likelihood of LUTS in men and increased the risk by 66% in women. Poor sleep itself was associated with an 80-90% increased odds of developing urinary incontinence and nocturia.

This study’s results aren’t surprising, since there have been numerous studies in the past showing that most people who go to the bathroom at night do so not because they make too much urine, but because they stop breathing and then wake up to go to the bathroom. (Not breathing at night makes your kidneys make more urine). Another recent study revealed that going to the bathroom two or more times per night increases your risk of dying from any cause by over 50%! This makes sense, since most of these people will have some degree of untreated obstructive sleep apnea.

If you feel like to have to go to the bathroom too often or get up at night to go to the bathroom more than 1-2 times every night, it may be worthwhile to address your sleep problems first before seeing a urologist.

Those of you with known obstructive sleep apnea, how many of you had any of these urinary symptoms before being diagnosed with sleep apnea?

Written by Steven Park · Filed Under Blog | 4 Comments

CPAP vs. APAP vs. BiPAP: Which One Is Best For Sleep Apnea?

May 13, 2011

Positive airway pressure (PAP) machines are the mainstay of treating obstructive sleep apnea. Over the years, with the development of different PAP models with different features, it’s getting more and more confusing to differentiate all these machine from one another, especially since various manufacturers use different names for certain models and comfort features.

As a summary, CPAP stands for continuous positive airway pressure. These machines blow a constant level of positive air pressure through a mask into your nose (or nose and mouth). Bilevel PAP refers to a machine that delivers two different levels, where a higher pressure is used during inhalation and a much lower pressure is given during exhalation. BiPAP is actually a registered brand name from Respironics. Auto-titrating PAP machines adjust your pressures as needed. There are other variations such as auto-bilevel devices and ASV units which are used for complex or central sleep apnea. For this discussion we’ll talk about CPAP, Bilevel and auto-titrating units only.

With so many different models to choose from, people continue to ask me which is the best option. If your insurance company pays for your PAP machine, you don’t have a choice—you have to start with a basic CPAP machine. Most people do well with standard CPAP models, but there will always be people who don’t do well. But before switching to a new machine, you have to first go through the standard trouble-shooting steps to make sure that there’s no leak, mouth breathing, humidity issues, mask fit, etc. It’s also important to use machines that give more objective feedback such as your AHI and leak rates, rather than just the total number of hours used. Some people then end up trying an autoPAP machine and do great, whereas for others, it makes no difference. Sometimes, continuous pressure from a CPAP machine works better than an autoPAP machine. Others do better with bilevel models.

If you look at all the published reports comparing CPAP vs. autoPAP vs. BiPAP machines, there are some differences in terms of compliance, leak rates, or tolerability, but overall, there’s no significant difference between the three in terms of subjective sleepiness, AHI measures, or quality of life scores. This is why some sleep doctors state that essentially, there’s no difference in the overall outcome between these three types of machines.

However, since research studies lump together everyone, including responders and nonresponders, it’s not a true representation of real-life outcomes. There will always be some patients that do better on autoPAP compared to a CPAP machine. Others do better on CPAP than autoPAP. Some others do much better on bilevel devices. So based on evidence based medicine, decisions are being made to downplay the potential advantages of various PAP models. I think that this is not good clinical practice. You should start with the basics first, but for patients that are frustrated and not tolerating PAP therapy, it’s worthwhile to consider other PAP options. In most cases, there are a lot of simple steps that can be taken to fully optimize the patient’s current CPAP machine, but you should never discount other options.

The same argument can be made for oral appliances and for surgery. A significant number of people do well with these options, if done properly. Unfortunately, most people who are given CPAP fall through the cracks, and are never given the opportunity to truly benefit from therapy. This is why the long-term compliance rate is so low for CPAP.

Ultimately, it’s not which model or which form of therapy is better, but start with the CPAP basics and do everything possible make sure that you’re using it properly. If it doesn’t work, talk with you doctor to discuss other PAP options. If PAP therapy doesn’t work, then consider non-PAP options.

If you’re a PAP user, did you try different models? If so, which one works best for you?

Written by Steven Park · Filed Under Blog | 3 Comments

25% of Children In The United States With Sleep Apnea?

May 11, 2011

Here’s some heartbreaking news that was recently published in the Wall Street Journal and commented on at KevinMD: That 25% of all children in the United States is on regular prescription medications. According to the report, 45 million children are on asthma medications, 24 million on ADHD medications, another 10 million on antidepressants and 6.5 million on antipsychotics. You also have the antihypertensives, sleeping pills, diabetes medications, and high cholesterol medications. This list doesn’t include prescriptions used in acute situations or over-the-counter medications.

You might be asking by now, “What does all this have to do with sleep apnea?”

My answer is, everything. If you happen to follow my blog, I’ve shown studies linking obstructive sleep apnea to almost every chronic health condition out there. This is based on published, peer-reviewed studies. What I did was only to connect all the dots, so to speak, to conceive of my sleep-breathing paradigm: That all modern humans, due to jaw underdevelopment, have various degrees of sleep-breathing problems, where only the end result is called obstructive sleep apnea. This problem begins while you’re an infant, and is aggravated by dietary and behavioral factors such as bottle-feeding, thumb-sucking, and eating the Standard American Diet (SAD). It’s also possible that the back to sleep campaign (although it lowered the SIDS rate by 40%), by forcing infants to sleep on their backs, may inadvertently prevent quality deep sleep in infants. Babies need good amounts of deep sleep for memory consolidation and brain development.

We also know that multiple breathing pauses can cause your stomach juices to reflux into your throat, and then into your lungs (or nose). This can cause various degrees of inflammation. Neurologically, your lungs will tend to over-react to weather changes, such as cold air, or even temperature or humidity changes. Breathing problems can also cause poor quality sleep, leading to major alterations in your brain biochemistry.

Poor sleep can also aggravate or promote the onset of depression. Faulty neurotransmitters or even structural damage from poor sleep can also cause your brain signals to misfire, or activate disinhibition of certain behaviors.

It’s no wonder that in one way or another there are studies (or will be studies) that connect all the various medical conditions already mentioned to one another. So it’s not too far fetched to argue that a large proportion of these children on chronic long-term medications may also have some kind of a sleep-breathing problem.

What do you think about my arguments? A realistic, but scary possibility, or too far fetched?

Written by Steven Park · Filed Under Blog | 2 Comments

Expert Interview: Joy Moeller on Orofacial Myology

May 10, 2011

In this program, I interview Ms. Joy Moeller, an orofacial myologist, on how the way you use your mouth and tongue can profoundly affect the way you speak, swallow, and breathe. Here’s what we discuss:

1. What is orofacial myology (also called myofunctional therapy)?

2. How is this related to snoring and obstructive sleep apnea?

3. What can you do to help TMD/TMJ patients?

4. How does myofunctional therapy help forward head and neck posture?

5. Why is this treatment not taught in medical or dental schools yet?

6. Can young children benefit from orofacial myology?

7. And much more…

Please enter your information below to access your free MP3 recording:

Written by Steven Park · Filed Under Expert Interviews | 4 Comments

How Breast Feeding Improves Children’s Behavior

May 10, 2011

There are numerous studies on the health benefits of breast feeding, and here’s another one that supports my sleep-breathing paradigm, that your overall state of health is directly proportional to how well formed your jaws are as you age (and subsequently your breathing passageways).

Researchers from Oxford University in the UK found that infants who were breast-fed for at least 4 months had a 33% less chance of having behavioral problems by age 5. They speculate that breast milk has higher amounts of healthy fatty acids, growth factors and hormones that contribute to healthier brain development.

The one thing that all these studies fail to address is that bottle-feeding can cause malocclusion and jaw narrowing. The smaller your jaws, the less room there is for your tongue, which can cause breathing problems when the infant is placed on his back. Add muscle relaxation from deep sleep, and you’re going to deprive infants of quality deep sleep which is vital for proper brain development. With the addition of back sleeping in infants to bottle-feeding, it’s likely that this combination is a major reason for the significant rise in pediatric developmental problems that are so rampant these days.

If you have obstructive sleep apnea, were you breast or bottle-fed as an infant?

Written by Steven Park · Filed Under Blog | 2 Comments