September 28, 2011
Not too surprisingly, focusing on lifestyle habits that control heart disease or taking medications to lower high blood pressure or cholesterol levels can also help symptoms of erectile dysfunction (ED).
Dr. Stephen Kopecky, professor of medicine and cardiovascular diseases at the Mayo Clinic, and author of the paper published in Archives of Internal Medicine, quotes, “It’s a fascinating thing, but all the arteries are connected. We know that the risk factors for stroke are the same as for heart disease. We know that the risk factors for ED are the same as for heart disease. And we are finding that the risk factors for dementia and Alzheimer’s are the same as for heart disease.”
It’s frustrating that doctors are connecting all the dots, but rarely ever include obstructive sleep apnea as a major component of all these conditions. In this vein, having ED could mean that you’re at higher risk for obstructive sleep apnea, which causes diminished circulation to various parts of the body, including the penis and the brain. You can make a strong argument that everyone with ED should be screened for obstructive sleep apnea.
What’s your opinion on this issue? Please enter your viewpoints in the text area below.
September 27, 2011
This is a special edition of my Expert Interview Series, on Apnex‘s Hypoglossal Nerve Stimulation Therapy device.
Mr. Brian Erickson from Apnex joins us to answer your questions.
In this interview, we answer the following questions:
- What are the inclusion and exclusion criteria?
- Can I be included if I had a UPPP performed?
- Will I be compensated?
- What were the initial results from the original feasibility study?
- What are the potential complications?
- How long does the study last?
- Is it available near where I live?
- What does it feel like when it’s on?
- And much, much more.
Please enter your information below to receive free access to the MP3 recording and the PDF of the slides:
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September 26, 2011
A recent study revealed that having depression was found to increase the risk of having a stroke by 45% in people who were followed from 2 to 29 years. Your risk of dying from a stroke also increases by 55%. The article talks about people with depression being more overweight. What else can being overweight cause?
We know that having insomnia significantly increases your risk of developing depression later on in life. Having untreated severe obstructive sleep apnea also significantly increases your chances of having a stroke. Not sleeping well from any reason (insomnia or sleep apnea) can cause major biochemical and structural changes in your brain. Do you see the connection?
September 20, 2011
Here’s a new study out of Japan showing that people with uncontrolled diabetes had about a 35% increased risk of developing dementia. The article talks about how diabetes can cause clogging and blocking of the arteries, leading to lack of oxygen and brain damage. But guess what else causes lack of oxygen? Obstructive sleep apnea. Hypoxia has been shown to cause brain damage in numerous sleep apnea as well as Alzheimer’s research studies. As always, researchers are careful to point out that association never implies causality.
September 19, 2011
In this Expert Interview program, Ms. Lisa Brateman will talk to us about the psychology of obstructive sleep apnea. This is an important topic that affects not only those of you with sleep apnea, but also your loved ones, your friends, and family members.
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September 17, 2011
With the start to the new school year, millions of college freshmen will begin their academic endeavors, gaining knowledge, newfound independence and new life skills. But there’s one more thing that many students will gain this year: 10 to 15 pounds. Weather or not the Freshman 15 actually exists (on average they gain about 5 pounds), this commonly seen phenomenon is thought to be due to a lack of exercise, eating buffet style cafeteria food, late meals and snacks, unhealthy diets, and excessive alcohol.
However, there’s one more important, but under-appreciated condition that is expected to occur when you gain even a small amount of weight: Fat cells take up space in your throat, leading to a gradual progression into obstructive sleep apnea. As I’ve mentioned before on numerous occasions, eating late promotes more obstructions and arousals, as well as increased gastric contents reaching the throat. This causes more swelling and damage to the protective upper airway receptors in the throat, leading to more frequent and prolonged breathing pauses. Poor quality sleep promotes weight gain, through hormonal, metabolic, and neurologic mechanisms. Drinking alcohol close to bedtime an also relax your throat muscles, leading to more frequent apneas. There’s no need to remind you about sleep deprivation and poor sleep hygiene in college students.
It’s also no coincidence that anxiety and depression peaks in college-aged men and women. Poor sleep quality can not only cause neuro-biochemical changes, but also promotes poor sleep habits and hygiene. It’s no wonder college students are at higher risk of delayed sleep phase syndrome, where one’s sleep clock cycle is shifted many hours later. I suspect that students who are most prone to weigh gain have narrowed jaws and dental crowding to begin with, prefer to sleep on their sides or stomach, and one or both parents probably have undiagnosed obstructive sleep apnea.
Have you or any of your children experienced the Freshman 15?
September 13, 2011
Here’s another article which confirms what we already know: That lack of deep sleep can cause high blood pressure. We’ve known for years that sleep fragmentation can increase your adrenaline response at night during sleep, preventing the normal lowering of your blood pressure during sleep. Not having this “dipping” phenomenon is tied to having hypertension during the day.
If you look at this study in light of statistics from the CDC, the implications are frightening: Almost 1/3 of Americans have high blood pressure, and about 70% of these people are on medications, but less than 50% are being adequately controlled. Another 25% have pre-hypertension. Over 70% of people over 65 have hypertension. Take into consideration how sleep deprived we are as a society, and that 90% of people with obstructive sleep apnea are not diagnosed, this should be wake-up call for everyone.
September 11, 2011
One of the most common requests I get is for a referral to another ENT (otolaryngologist) that shares in my philosophy when treating sleep apnea. To be honest, I’m uncomfortable making any recommendations, because as far as I know, there are no other ENTs that think the way I do. So far, I’m not aware of one ENT physician that has even read my book (please correct me if Im wrong). There are lots of excellent ENTs that are very good at handling obstructive sleep apnea—many are my mentors and people that I learn from. But whenever I bring up the philosophy of my sleep-breathing paradigm, they all say it’s interesting, but ask if there’s any evidence.
The problem with a paradigm is that it can’t be proven. There are so many pieces to the puzzle that it would take hundreds of years and billions of dollars to perform necessary definitive studies. We give water for dehydration, but so far there are no randomized, prospective, placebo-controlled trials showing that given water actually improves dehydration. In addition, water is not FDA approved for dehydration, which is a clinical diagnosis. When there’s no evidence, we use common sense and reasoning in making clinical decisions. However, modern medicine fails by separating out all the various body parts and systems into separate specialties. Yes, doctors like to say that we look at the whole person, but how much can your doctor truly learn about you in a 15 to 20 minute consultation?
My sleep-breathing paradigm actually pieces together hundreds if not thousands of studies that are already out there, connecting the dots. One of my main goals is to strengthen the links between sleep apnea and various other medical and mental health conditions through rigorous studies. For example, there are numerous studies linking reflux to obstructive sleep apnea, reflux to chronic sinusitis, and chronic rhinitis to reflux. If they’re all linked, why can’t sleep apnea be linked to chronic sinusitis? In fact, I presented a poster many years ago showing that people who undergo nasal or sinus surgery with recurrent symptoms or disease had an almost 80% rate of significant obstructive sleep apnea. Now that I’m looking for sleep apnea beforehand in people with chronic sinusitis, the rate of needing to go on to nasal or sinus surgery has dropped significantly. The same analogy applies to ear infections, depression, anxiety, heart disease, irritable bowel syndrome, psoriasis, nocturia, high blood pressure, or diabetes.
The good news is that there are a handful of sleep doctors that do “get it.” I’ve interviewed some of them on my Expert Interview teleseminar series. Most sleep doctors are very good at what they do, but will probably disagree with me on some fundamental principles when it comes to the airway and sleep. For example, I see a few patients every year who are chronically tired and are given a diagnosis of idiopathic hypersomnia by the sleep physician, with a completely normal sleep study (AHI is 0). Typically, they’re prescribed stimulants. When I examine the airway, I see that the space behind the tongue is very narrow, especially when flat on the back. I refer the patient to a dentist who makes a mandibular advancement device, which improves the patient’s symptoms significantly. Sometimes, even helping the patient breathe better through the nose can “cure” the problem.
So the next time you ask me for a referral, my stock answer will most likely be, “I don’t know.” I may know someone I met at a national meeting or recognize prominent names from published studies I’ve read, but that doesn’t mean that they’re going to agree with my practice philosophy. I’ll continue making recommendations based on the information that’s given to me, and if I happen to know someone that I trust, I’ll make that recommendation. Just like getting a referral to a good lawyer, there’s no quick and easy answer. You have to do your research, ask around, and go with your gut instincts.
Come to think of it, as far as I know, there are no known studies showing that going to a doctor by referral from another doctor results in improved clinical outcomes.
September 5, 2011
The New York Times confirmed what I’ve been telling patients for years—that eating within 3-4 hours of bedtime can promote acid reflux. What the journalist didn’t mention was the fact that acid reflux and obstructive sleep apnea go hand in hand. Here’s what I wrote in reply to his article:
Having heartburn at night also means that you’re at risk of stomach juices reaching your throat, which not only has acid, but bile, digestive enzymes, and bile. In light of the fact that about 10 to 25% of the population has at least some sleep apnea (the majority in the elderly in some studies), any pauses in breathing will literally suction up your stomach juices into your throat, causing not only arousals, but also swelling and inflammation, leading to post-nasal drip, chronic throat clearing, chronic cough, and even Eustachian tube dysfunction.
The more often you stop breathing at night, the more you’re likely to suction up stomach juices into your throat, which can also lead to desensitization of your pressure and sensory nerve endings. Over time, this can lead to loss of protective upper airway reflexes, predisposing one to obstructive sleep apnea. In addition, vibratory trauma from snoring is thought to not only desensitize sensory nerve endings, but also cause carotid artery wall thickening.
Not eating late will also increase your sleep efficiency, which can promote weight loss. On the contrary, any degree of sleep deprivation or sleep inefficiency will promote weight gain. Gaining weight promotes more reflux and sleep apnea.
Counseling New Yorkers to avoid eating (and drinking alcohol) within 3-4 hours of bedtime is the simple most important recommendation I make, in addition to my routine treatment options.
September 2, 2011
List of questions answered will be updated shortly.