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How Bulldogs Are Similar To Humans

I just came across an interesting article in the New York Times about the problem with bulldogs. The articles focuses on Uga VII, who would rather take naps than perform his official duties as the school mascot for Georgia. In short, the bulldog’s face is too short—just like humans. One of the sought-after features in bulldogs is a flat face, something that experts speculate may mimic humans faces, thus adding to their appeal. In fact, bulldogs are now the 6th most popular breed in America, just behind golden retrievers. 

The problem with bulldogs is that they’re much more prone to medical ailments than many other breeds. They can suffer from ear and eye problems, skin infections, respiratory problems, immunological and neurological problems. They also have the highest rate of hip dysplasia of any breed. Bulldogs are also notorious for very loud snoring, and a variation of the uvulopalatopharyngoplasty procedure is commonly performed for this condition.

Having a flat face can cause major breathing problems, as evidenced by the very high rate of obstructive sleep apnea in modern humans. The ability to talk made things even worse for us. Shrinking of the jaws is known to cause crowding of the soft tissues in the upper airway, as well as facial wrinkling. Could it be possible that bulldogs have excess facial skin due to significant shrinkage of the underlying facial bones, that would normally stretch out the facial skin?

 

Can Eating Canned Foods Cause Sleep Problems?

The next time you eat anything out of a can, think about this study: Researchers at Harvard found that levels of BPA (bisphenol-A) had a 1,221% increase in urine levels after eating canned soup once daily for 5 days. BPA is commonly found in the lining of bottles and cans. Recently, manufacturers have voluntarily removed this substance from baby bottles, but not from commonly used containers such those used for canned foods.

BPA is a known endocrine disruptor, as well as being linked to increased rates of cancer. These molecules mimic estrogen and stimulate estrogen receptors artificially. In the process, it can also suppress progesterone levels, which can alter one’s sleep-breathing status by lowering your upper airway muscle tone, particularly the genioglossus muscle of the tongue.

Since the combination of estrogen and progesterone have protective effects on upper airway muscle tone, any disruption of this delicate balance can affect how well you breathe at night. Having artificial levels of a synthetic estrogen can suppress natural estrogen function as well. The end result can have a subtle, but significant effect on your sleep quality. 

Another good reason to eat organically.

8 Glasses of Water Per Day: Is it Really Healthy?

In his “Really?” column in the New York Times, Anahad O’Connor brings up recent research which suggests that drinking 8 glasses of water every day can be beneficial, especially for your kidneys. The authors found that those who had the highest urine volume had lower rates of kidney disease.

On the other hand, another recent study showed that renal hyper-filtration can significantly increase your chances of stroke. They also noted that kidneys tend to overwork in people with the metabolic syndrome, and type 2 diabetes. Notice how obstructive sleep apnea by itself has been linked to increased risk of hypertension, obesity, high cholesterol, and insulin resistance (the metabolic syndrome, or Syndrome X)). In fact, Syndrome Z describes metabolic syndrome plus obstructive sleep apnea.

Knowing that untreated obstructive sleep apnea can also increase urine production by increased levels of atrial naturietic peptide/hormone, it’s not surprising that increased urine production can be linked to higher rates of stroke. Many people who go to the bathroom often at night are found to have untreated obstructive sleep apnea (which increases your risk of stroke). It’s actually been shown that people wake up due to breathing pauses, and not from too much urine production. But the overall levels of urine to go up significantly.

I think that you have to use common sense when it comes to recommending certain volumes for water intake. People have different metabolic needs, and there’s additional water in the normal food that you eat throughout the day. Drinking too much water before bedtime can also increase urine production, leading to more frequent awakenings and poor sleep quality.

Expert Interview: Robson Capasso of Stanford University on Sleep Apnea Surgery

This month, I’ve invited Stanford University’s sleep surgeon, Dr. Robson Capasso to talk to us about his institution’s philosophy on sleep apnea surgery. Here’s a short list of questions that are answered on the program:

1. What’s the success rate for sleep apnea surgery?

2. Can you wait until someone is asleep to image the site of obstruction? 

3. What is the progress in getting UARS recognized as a real condition?  How is it diagnosed and managed at Stanford?

4. How do you decide whether to recommend surgery or an oral appliance in a CPAP intolerant patient?  

5. Can you explain the different techniques for performing the MMA, and how successful these are for reversing OSA?  Is it possible to achieve an AHI of zero after an MMA?

6. Do you recommend adult jaw development as an alternative to surgery?

7. Is sleep apnea surgery covered by insurance?

….and many more.

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Why Most Doctors Know Almost Nothing About Sleep

Studies in the past have shown that when someone complains about not being able to sleep to a doctor, more often than not, a sleeping pill is prescribed. The reason is that young doctors are taught in training that pharmaceuticals like Zolpidem (Ambien) stimulates GABA receptors in the brain, promoting sleep. There’s essentially no mention that cognitive behavioral therapy for insomnia works just as well for insomnia in the short term, but is superior to drugs in the long term.

You’d think that medical students would get at least some education about a part of patient’s lives that they spend 1/3 of their lives doing, which is sleep. Well, not really. 

I remember getting only about 2-3 hours of lectures on sleep during medical school. I’m told by a medical school professor that due to stiff competition between various subjects such as molecular biology, anatomy, pathology and pharmacology for student’s time in classes, sleep gets squeezed out in the end. 

This problem was brought to light by a study in a major sleep journal (Sleep Medicine) which showed that the quality and quantity of sleep education varied tremendously between various international countries. For example, the average number of hours on time spent on sleep education was 2.5 hours. In 1990, a survey reported that medical students received about 2 hours of sleep education, and not much has changed recently. In fact, 27% of respondents reported no training in sleep at all. Pediatric sleep topics grabbed a mere 17 minutes on average.

Even now, despite knowing that untreated obstructive sleep apnea can significantly increase your risk of heart attacks and stroke, doctors are still prescribing blood thinning medications and high blood pressure medications, while ignoring the patient’s severe snoring problem. We also know that poor quality and quantity of sleep is strongly linked to increased rates of cancer, sudden death, and motor vehicle accidents.

I think it’s time that physicians finally wake up to the importance of a good night’s sleep. Sadly, most mainstream physicians and surgeons that I know still don’t take sleep very seriously.

How can you as the patient better educate your doctor about the importance of a good night’s sleep?

Women & Insomnia: What Else Could it Be?

Here’s a not-too-surprising finding: A 2007 study front the National Sleep Foundation found that 3 out of every 10 women admit to taking a sleeping pill at least a few nights a week. Prescription sleep aids peak amongst women aged 40 to 59. Many women also report that their sleep has never been the same ever since that last pregnancy. Even with older children, being able to either fall asleep or stay asleep can be challenging for many women. 

Beyond the obvious reasons for poor quality sleep in women (nighttime feedings, stresses of modern life, hormonal changes, etc.), there’s one important additional factor that wasn’t mentioned in a recent New York Times article on this subject: increasing problems breathing at night.

I’ve written numerous times about how pregnancy predisposes women to obstructive sleep apnea, but due to rising levels of progesterone, their airways are protected (as an upper airway muscle stimulant). But after delivery, progesterone drops, but you still have all that weight. Now you’re narrowed your upper airway, but without the protective benefits of progesterone. Add to this the initial sleep deprivation from routine awakenings at night, and the problem is compounded even further.

Notice also that sleeping pill use peaks around peri-menopause. This is also a period when progesterone levels slowly drop, leading to even more breathing pauses while sleeping. Add to this the typical few more pounds that women gain during menopause, and this can lead to worsening obstructive sleep apnea. No wonder women begin to catch up to men when it comes to rates of obstructive sleep apnea and cardiovascular disease as they go past menopause.

You’ll notice that most women who have chronic insomnia prefer not to sleep on their backs, since that’s then the tongue falls back the most due to gravity. Having smaller jaws create less room for the tongue, making them more prone to sleep-breathing problems. Many of these women will have one or two parents that snore heavily. 

It’s also important to realize that you don’t have to have true apneas to have disrupted breathing during sleep. You can have very short obstructions and arousals that don’t count as being apneas if you did a formal sleep study. Younger and thinner women (and men) can have these more subtle events, which can manifest as upper airway resistance syndrome. You can also have different combinations of all these breathing pauses and arousals. The bottom line is that you just can’t sustain deep, continuous sleep. Waking up after 4-5 hours of sleep would be expected when you begin to enter longer periods of REM sleep in the later parts of the night. This is when your throat muscles are most relaxed, and most susceptible to obstructions and arousals.

I’m not discounting all the other reasons why women have so many sleep issues, but untreated sleep-breathing problems is is major source of poor sleep that can frequently masquerade as insomnia, especially in women. 

Ask Dr. Park About Sleep About Sleep Apnea (11/8/11)

For this month’s Ask Dr. Park teleseminar, I answer the following questions:

1. Does sleeping with your head propped up help with sleep apnea?

2. Why is UARS so hard to define?

3. What do you think about all the latest publicity about thyroidectomy in helping with sleep apnea?

4. Can using tape over the mouth help with sleep apnea?

5. As we age how can we gauge whether we have sleep-related breathing issues, or circadian rhythm problems?

6. What if you are using a cpap machine and STILL wake up about every 2-3 hours?

7. How low should one seek to lower the AHI and the AI?

8. Is there a place for hyperbaric oxygen in the treatment of OSA?

9. Does a dental positioning device work for mild sleep apnea?

10. How does the future look for sleep apnea patients£ Will something replace CPAP as the gold standard?

11. Is there a clear distinction between central and obstructive sleep apnea? What are the alternatives if your apnea is primarily classified central?

12. If patient’s airway is examined with camera inserted through nose while patient is sitting upright and airway is found to be clear, is this enough to indicate airway would also be clear if patient was lying down? Should patients be checked in both positions?

And many more questions from the live audience.

Click here to purchase the MP3 recording ($17).

 

 

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