Is Your Computer Screen Ruining Your Sleep?

July 30, 2011

As I’m writing this post at 9:30 PM, using my computer is likely to keep me up later into the night. It’s not so much the activity or the content that’s overly stimulating, but the type of computer screen that might prevent me from falling asleep. The newer, brighter backlit LED screens that are almost commonplace with computers these days (especially laptops and tablets) have a much higher level of blue light (460 nm), which is known to have stimulating properties on the circadian system. A study published in the Journal of Applied Physiology showed that subjects who used backlit LED screens had higher rates of attention, wakefulness, and declarative memory compared to subjects who used conventional computer screens. On the flip side, melatonin levels were significantly supressed. As you may know, melatonin levels go up as you’re falling asleep.

This has huge implications since many people (including me) use these type of screens while working later in the evening. It may be great during the day so that you can be productive and get more work done, but it’s counterproductive in the evening hours, especially just before bedtime.

Notice also that most of the newer appliances, traffic lights, cars, toys, and even medical equipment, have LED lights, which are significantly more intense than standard lightbulbs. If you have a few electronic appliances in your bedroom, it’s likely that once you turn the lights out, three or four LED lights can light up your entire room, shining much brighter than many night-lights. I cover my LED lights with black electrical tape.

For some reason, driving has been a bit more annoying for me lately, especially in local traffic, and I realized that it may be due to the fact that I have to look at the very bright LED brake lights on the car in front of me, which makes me squint. It just barely seems to give me a headache, sort of like a very mild migraine. I find myself squinting, and I know that my iris is closing down to shut out the light, kind of like clamping down on the aperture on a camera. This would likely stimulate your sympathetic nervous system (your fight or flight response).

The traffic lights bother me a bit too. If all these little things bother me, I’m sure they’re bothering many other people subconsciously, and it will manifest in different ways. It’s also likely to significantly disturb sleep for millions of Americans.

Do you work with backlit LED computers just before bedtime? Do the brighter LED light bother you too?

Written by Steven Park · Filed Under Blog | 4 Comments

Why Pregnant Women Have More Strokes

July 28, 2011

Rates of stroke went up 47% for expectant mothers and climbed to 83% in the first three months after delivery. This was the finding that was published in the journal Stroke: Journal of the American Heart Association. They cite rising rates of additional risk factors such as high blood pressure, obesity, and gestational diabetes, but didn’t give a plausible explanation. Here’s a story about this study published in the Wall Street Journal.

Here’s a simple explanation: Sleep-breathing problems. Whether it’s obstructive sleep apnea or more likely upper airway resistance syndrome, pregnant women tend to have more frequent breathing pauses, especially as they gain weight. One protective mechanism is through progesterone, which acts as a tongue muscle stimulant, but the forces of upper airway collapse is likely to overwhelm these protective effects. What’s even more striking is that the rate almost doubles immediately postpartum. Remember that progesterone drops soon after delivery, but you’re still left with all that additional weight. We know that obstructive sleep apnea can significantly increase your chances of stroke and heart attacks. There are even reports that suggest that preeclampsia can be successfully treated with CPAP.

Overall, the numbers are still very low, but the sudden rise in the rate of stroke in new mothers leaves researchers scratching their heads.

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Interrupted Sleep And Memory Loss

July 26, 2011

Remember the last time you forgot something? Did you forget about the last time this happened? Chances are, you were probably sleep deprived.

There are tons of studies showing that even mild sleep deprivation can have detrimental effects on memory and executive functioning. Now there’s new research from Stanford University showing that sleep fragmentation can be just as detrimental as sleep deprivation. The researchers figured out a way of fragmenting sleep in mice without causing any stress, using special lights to control genetically engineered brain neurons that control sleep and wake. By pulsing these cells with 10 second bursts of light, they could fragment sleep without significantly altering the quality and the composition of sleep, or the total sleep time.

Their conclusion was that “regardless of the total amount of sleep, a minimal unit of uninterrupted sleep is crucial for memory consolidation.”

Another research tool that’s used to measure deep sleep instability is what’s called cyclic alternating pattern (CAP) analysis. Cyclic patterns of brief brain wave arousals were found to be more common in people with upper airway resistance syndrome (UARS) and fibromyalgia.

These studies support the general observation that people with people with UARS, fibromyalgia, or idiopathic hypersomnias have increased levels of subtle arousals that don’t get scored on a routine sleep studies.

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Headache Success Stories

July 23, 2011

One of the most gratifying things that I like to hear from patients (besides “I’m sleeping better than ever”) is to be told that “my headaches are gone.”

I had two such events over the past two days. One patient underwent a conservative tongue base reduction using the Coblator tool, along with a modified uvulopalatopharyngoplasty. Overall, it’s too soon to say if she’s cured of her obstructive sleep apnea, but she did mention that her headaches, which she suffered from on a daily basis for years, is now gone. Another patient told me today that after multilevel surgery for obstructive sleep apnea, his debilitating cluster headaches are now gone.

Not sleeping well due to major breathing problems can cause or aggravate a variety of different headaches. So these results are not too surprising.

Once in a while, someone will mention to me that just by not eating so close to bedtime, their headache disappeared. Others have told me that using Breathe Rite strips helps with headaches. This goes to show that anything you can do to breathe better and sleep better can potentially help with various headache syndromes.

If you used to suffer from headaches and not any more, what did you do to get rid of it?

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The Connection Between Migraines & Sleep-Breathing Problems

July 22, 2011

Michelle Bachmann’s recent revelation that she suffers from migraines brings up an important point that most doctors and the lay public don’t appreciate: the importance of proper breathing at night. It’s commonly known that sleep deprivation can cause or aggravate migraines, but what’s usually assumed is that migraine sufferers are breathing well at night. If you’ve read my articles or listened to my teleseminars, I can make a convincing argument that migraine sufferers all have some variation of a sleep-breathing disorder, of which only a small fraction have obstructive sleep apnea.

Not Your Normal Migraines

The classic migraine headache is described as a one-sided, debilitating, pounding, intense headaches that’s associated with nausea, vomiting, light or sound sensitivity. Notice that classically, migraines get better with sleep. Recently, neurologists have expanded the definition of a migraine attack. Any time the nerves in any part of your body becomes oversensitive or overly excitable, then you’ll experience symptoms that are specific to that part of the body.

For example, if the nerve endings in your sinuses are suddenly extra sensitive, then you’ll feel pain, pressure, nasal congestion, and post-nasal drip. In fact, it’s been shown that the vast majority of chronic sinus headache and pain sufferers actually have a variation of a migraine, with normal CAT scans. Many people are placed on oral antibiotics empirically, when there’s no bacterial infection.

You can also have migraines in your stomach. This can present as nausea, vomiting, diarrhea, constipation, or bloating. It’s been suggested that children who suffer from chronic abdominal pain actually suffer from migraines.

If you have a migraine attack in your inner ears, you’ll feel dizzy, lightheaded, feel fullness, or have hearing loss or ringing. This is called vestibular variant of migraine.

Problems Due to Your Tongue?

One anatomic feature that I see all migraineurs have in common is the very small nature of their upper airways, especially in the space behind the tongue and in the nose. I talk about how most modern humans have smaller jaws and facial skeletons due to a radical change in our diets and lifestyles. This leads to dental crowding, which narrows the space behind your tongue, especially if you lay flat on your back. When you go into deep sleep, since your muscles will relax, you’ll stop breathing and wake up to turn over to your side or stomach. This is why most people with this type of anatomy can’t sleep on their backs.

You Are A What?

These breathing pauses usually aren’t long enough to be called apneas (at least 10 second pauses), and usually don’t lead to lowered oxygen levels. However, it does lead to more frequent arousals and sleep fragmentation. Essentially, you can’t stay in deep sleep. In most cases, you won’t even realize that you’re waking up. What you will feel is not feeling refreshed when you wake up in the morning, or feeling like you only slept for 2-3 hours.

In the early 1990s, a new type of sleep-breathing problem called upper airway resistance syndrome (UARS) was described. Young women and men who didn’t meet the official criteria for obstructive sleep apnea were recruited and underwent esophageal pressure monitoring. What they showed was gradually increasing negative inspiratory pressures leading to an arousal, but not severe or long enough to be called apneas or hypopneas. Officially, apneas require at least 10 second breathing pauses, whereas hypopneas require 30 to 50% drop in airflow, along with arousals or oxygen level drops. However, if you don’t reach the 10 second threshold for apneas or hypopneas, then they’re not scored at all. So in theory, you can stop breathing 20 to 30 times every hour and not officially have obstructive sleep apnea.

En garde

Not being able to get deep, refreshing sleep can lead to a physiologic state of stress, where your entire nervous system can become heightened and hypersensitive, even carrying over into the daytime. Poor sleep quality also cause muscle tension and tightening, which can predispose to headaches, TMJ, neck spasms or backaches. Even your senses can become overly sensitive, especially to weather changes, chemical, scents or odors. In this particular situation, even your creativity or intuition can be heightened.

Notice how many of the features of a migraine attack are very similar to suffering from a hangover: nausea, vomiting, brain fog, and sensitivity to bright lights and loud noises. This is your involuntary nervous system over-reacting to something that’s not normally bothersome.

Simple Steps to Take

So if you suffer from any of these migraine types, what can you do besides take prescription medications? Here are 5 basic steps for better sleep and less headaches:

1. Don’t eat anything within 3-4 hours of bedtime. Having juices in your stomach can promote reflex into your throat, causing more arousals and less efficient sleep.

2. Don’t drink any alcohol within 3-4 hours of bedtime. Alcohol relaxes your throat muscles, causing more frequent obstructions and arousals.

3. Keep your nose clear. If your nose is stuffy for whatever reason, do everything possible to keep it open. Having a stuffy nose creates a vacuum effect downstream in the throat which causes your tongue to fall back more often. Use nasal saline irrigation systems, nasal dilator strips, allergy medications, decongestants and even surgery if the former options don’t work that well.

4. Don’t sleep on your back. Back sleeping promotes tongue collapse due to gravity.

5. Do more yoga, tai chi, or deep breathing exercises to calm your nervous system. Take 4-5 slow deep breaths anytime you have 15 to 30 seconds, such as while standing in line, in-between major activities, on hold one the phone, or walking to another room. This helps to activate your parasympathetic nervous system, which helps to calm and relax your body. Acupuncture can also help.

Other Steps to Take

Once you’ve tried these conservative options, and you wish to take it to the next level, consider undergoing a thorough ear, nose and throat evaluation to see of you have any narrowing in your breathing passageways. In particular, your doctor should focus on your nasal septum and turbinates, your nostrils (to see if they collapse), tonsils, adenoids, lingual tonsils, soft palate and tongue base areas.

Many people with migraines will have either UARS or sleep apnea. Standard treatment options can help to alleviate migraines significantly. Dental appliances and specialized orthodontics are also an excellent option—these options are more important if you have any significant dental crowding, bite issues, or if you have a very small mouth. Dentists can also help with TMJ, which can overlap significantly with migraines and various other facial pain syndromes.

Botox can also be used for migraines, but just like using prescription migraine medications, are only covering up the causes, rather than treating it.

To a certain extent, OTC medications, and natural herbs or supplement (like feverfew), while they do work to various degrees, doesn’t help everyone. But it’s worth trying, if you’re interested.

Avoiding migraine triggering foods: red wine, aged cheeses, chocolate, and MSG.

I don’t usually recommend surgery, but it can be a viable option if the more conservative options don’t help. There are a number of different options, depending on where the narrowing occurs in your breathing passageways.

Hope for Migraine Sufferers

One of the most gratifying experiences is to have patients tell me that their migraines (or even cluster headaches) went away after various forms of surgery. It even happens sometimes with some of the non-surgical, conservative options.

It’s a given in our culture that migraines must be treated with a pill, and I want to dispel that stereotype. I believe that trying to achieve the best possible sleep (by breathing better) is a better way of improving migraines. It’s important to combine the various conservative steps along with techniques to help you breathe better and sleep better. Rather than focusing on the migraine only, it’s more important to re-evaluate your entire life situation, and be willing to make the lifestyle changes that can not only improve your migraines, but also significantly improve your overall quality of life.

Written by Steven Park · Filed Under Articles | 1 Comment

Expert Interview: Dr. Christian Guilleminault on UARS

July 21, 2011

This month, I interview Dr. Christian Guilleminault of Stanford University, who is one of the pioneers in sleep apnea diagnosis and treatment. We’re going to focus on Upper Airway Resistance Syndrome (UARS), which he discovered.

Here are some of the questions we covered:

- Describe to us what UARS is and how it’s different from OSA?

- Why is the AHI limited when it comes to picking up UARS.

- How to diagnose UARS: Esophageal manometry vs. nasal cannula.

- How UARS patients have intact nervous systems, whereas sleep apnea (OSA) patients have diminished nervous systems, and what may cause progression from UARS to OSA?

- How do you treat patients with UARS? How is it different from treating sleep apnea?

- What are the dental options for UARS?

- How common is UARS in children and how can they be treated?

- And much more…

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

Written by Steven Park · Filed Under Audio, Expert Interviews | 3 Comments

Does Michelle Bachmann Have Sleep Apnea?

July 21, 2011

I know I’m going to be accused again of suggesting that another celebrity or politician has obstructive sleep apnea, but here I go anyway:

An article in the New York Times ran an article about Michelle Bachmann’s ability to run our country if she suffers from chronic migraines. This question seems to be a moot point, since she seems to be doing a good job as a legislator for her home state of Minnesota. I’m sure various other political candidates and current leaders all have various health issues that are just as severe than migraines, if not worse.

The reasons for even bringing up this story is to present my observation that almost everyone that I see who has a history of chronic migraines has small upper airway anatomy, small jaws and dental crowding. Ms. Bachmann may or may not have sleep apnea, but it’s likely that she has upper airway resistance syndrome. This is a condition where you have multiple breathing pauses every hour during sleep, but not severe or long enough to be called an apnea, hypopnea, or RERA. Typically, they’ll show up as spontaneous arousals. Or not even scored at all on a sleep study.

These events don’t lead to low oxygen levels, but do result in severe sleep fragmentation and lack of deep, efficient sleep. This can cause a physiologic state of stress, leading to generalized muscle tension, headaches, TMJ, and various other health ailments. It also causes your nervous system to become overly sensitive. A migraine is essentially an exaggerated nervous system response to poor sleep.

Most migraineurs complains of poor-qualtiy, unrefreshing sleep, cold hands or feet, an inability to sleep on their backs, and a parent that snores heavily. Later on, as they gain weight, migraines will typically fade away slowly, and the typical features of obstructive sleep apnea will present. However, some women (and some men) will persist in having migraines until their 60s or 70s.

Notice the classic features of a migraine: headache, nausea, sensitivity of the senses (light, sound, smell, taste). Typically, it resolves by sleeping. These are also very similar to symptoms of a bad hangover. Severe deep sleep deprivation is known to cause symptoms that are very similar to a hangover, including brain-fog.

As Ms. Bachmann approaches her 60s and past the menopausal years, her migraines will probably subside. Unfortunately, her risk of developing obstructive sleep apnea will increase. But she’ll be in good company. A significant number of her fellow politicians already have obstructive sleep apnea (mostly undiagnosed).

Written by Steven Park · Filed Under Blog | 1 Comment

How Second Hand Smoke Can Cause Hearing Loss In Teens

July 20, 2011

Here’s an attention-grabbing headline in Time Magazine—that exposure to second hand smoke significantly increases a teen’s chances of nerve deafness by almost two-fold. It’s already been shown that smoking can cause hearing loss in adults, but the fact that second hand smoke can affect teens’ hearing was quite a surprise.

It’s already known that cigarette smoke can aggravate middle ear infections in teens, leading to reversible hearing loss, but this study reported sensorineural hearing loss, which is generally nonreversible.

The authors of the study from NYU don’t give clear explanations for this finding, so let me put forth a few possible reasons:

Teens probably listen to music at loud levels, which is known to cause nerve deafness, especially at higher frequencies (this study showed hearing loss at the mid to high frequencies).
The teenage years are a period of massive change in the upper airway. These relative changes will destabilize breathing at night, leading to more frequent partial to total obstructions and arousals. Some teens (especially those with dental crowding and small jaws) will be more susceptible than others. Lack of deep, quality sleep has been shown to have detrimental effects on brain development and repair.
Parents of the teens that smoke probably have a higher chance of snoring or having obstructive sleep apnea. Not sleeping well can predispose to increased stress and addictive activities that can stimulate and calm at the same time (such as alcohol and smoking).
Intermittent brain hypoxia has been shown to cause major neurologic damage in multiple parts of the brain, including memory, executive function, autonomic control, and hearing centers
Delayed sleep phase syndrome is more common in teens, contributing to poor sleep.

It’s conceivable that if you have mild degrees of nerve damage from loud music, the body will have the reserve to reverse or minimize any nerve damage. However, if you add all the other variables such as poor sleep and intermittent hypoxia from breathing pauses, then it’s likely that you’ll be more susceptible to inner ear nerve deafness.

So the next time your teenager seems to be ignoring you, it may be due to hearing loss.

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Chronic Pain & Sleep Apnea: Is There A Link?

July 18, 2011

Here’s a shocking statistic put out by the National Academy of Sciences—that 116 million Americans (37%) suffer from chronic pain. That’s more than diabetes, heart disease, and cancer combined. The article in the New York Times emphasizes the importance of more recognition of this condition by doctors. However, I doubt we’re ever going to make a significant dent in treating chronic pain unless we deal with their sleep issues.

It’s easy to argue that chronic pain can negatively affect your sleep quality. However, you can also argue that poor sleep can predispose you to chronic pain, once you experience a trigger (such as an accident, trauma, weight gain, or an operation). It’s been shown that poor sleep can lower your pain thresholds: Sleep deprived people were found to pull their fingers from a hot environment much quicker than people who had normal sleep. What this means is that the less quality or quantity of sleep you have, the more likely you’ll sense pain at very low levels.

If you think about the total number of people with obstructive sleep apnea (and even UARS), it’s probably about 1/4 to 1/3 of the population. Coincidence?

One general concept that Dr. Christian Guilleminault of Stanford describes is that sleep apnea patients have diminished nervous systems, whereas upper airway resistance syndrome (UARS) patients have intact nervous systems. In fact, I would argue that people with UARS have hypersensitive nervous systems. These are also the people who are overly sensitive to weather changes, chemicals, fumes, perfumes, odors and smoke. So perhaps people who are predisposed to chronic pain also have UARS.

Is it just coincidence that most of the patients that I see who have some sort of chronic pain also can’t sleep on their backs, have had excessive dental extractions, or have a parent that snores heavily? Most people with UARS can’t (or prefer not to) sleep on their backs, since that causes the tongue to fall back from gravity. Excessive dental extractions (usually from modern orthodontics) contracts the oral cavity space, leaving less room for the tongue, especially when in deep sleep, causing more frequent obstructions and arousals. As the person with UARS moves up the continuum, they’re more likely to progress into obstructive sleep apnea (like one or both parents).

If you’re truly committed to treating chronic pain patients, you have to simultaneously treat any underlying sleep-breathing problems. Giving sleeping pills just won’t cut it.

Written by Steven Park · Filed Under Blog | 2 Comments

Can Sleep Apnea Cause Lupus?

July 15, 2011

Probably not. But I can make a strong argument that it’s possible with upper airway resistance syndrome.

I saw a patient with UARS today who underwent removal of her large lingual tonsils a few months ago. As expected, her previous poor sleep quality and headaches are much improved, but not completely normal. Opening up the space behind her tongue definitely made a significant difference in how well she breathes at night.

Interestingly, she happened to get tested again for her known lupus condition a few weeks ago, and was excited to tell me that not only that her ANA level come back negative, but many of her other autoimmune markers were significantly improved as well. ANA is a very generic marker for autoimmune disease in general, and not very specific for lupus. However, the improvements in her clinical symptoms, along with changes in her blood tests, strongly suggests that there may be a connection.

Unlike obstructive sleep apnea, patients with upper airway resistance syndrome have overactive immune and nervous systems. Chronic, low-grade physiologic stress that ensues without hypoxia can set up the perfect storm for autoimmune disease development.

Coincidentally, I just had another patient that remarked that his intractable gout improved significantly after eating earlier and using Breathe Rite strips. Another patient had her severe rheumatoid arthritis resolve almost completely after treatment for obstructive sleep apnea.

Casually looking up connections between sleep-breathing disorders and various autoimmune or unusual disorders, I did find a number of small or anecdotal studies.

Stay tuned for a future teleseminar on this topic.