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Ask Dr. Park: Sleep & Breathing: The 2 Keys to Optimal Health

In this teleseminar, I reveal:

• Why all modern humans stop breathing intermittently while sleeping
• 3 key anatomic concepts that makes everyone susceptible to sleep apnea
• 7 common surgical procedures that can worsen or uncover obstructive sleep apnea
• 5 simple steps to better breathing and better sleep
• 5 ways to treat obstructive sleep apnea.
• What you MUST do first before trying to lose weight.

Topic:  Ask Dr. Park: Sleep & Breathing: The 2 Keys to Optimal Health

Please enter your information below to register and access your free MP3 recording and PDF of the slides:

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*By clicking ‘submit’ above, you are agreeing to receive ongoing communications from Dr. Park including monthly newsletters, events alerts, and other such written correspondences. Your e-mail will remain strictly confidential and will not be disclosed to any third parties without your prior written consent. You may unsubscribe to any or all portions of our e-mail correspondences at any time. Thank you for your cooperation.

Can a Robot Help Cure Sleep Apnea?

Every few years, another new technical innovation is touted as the latest in sleep apnea treatment. One such example is robotic surgery for obstructive sleep apnea. The press plays it up like what they do for lasers and various other high-tech surgical gadgets. What they don’t tell you is that a tool is only as good as the surgeon that’s performing the procedure. I’ve used this example before: Tiger Woods can beat your pants off using $60 Wilson starter gold clubs, even if you’re using top-of-the-line, $3000 custom made golf clubs.

The laser is another such tool that people are still fascinated by—it’s just another cutting amongst a handful of useful options. They key is to know when to use it, and how to use it safely. You should be able to perform the procedure even if the laser or the robot is not available. For sleep apnea surgery, these new tools should not determine whether or not you’re going to perform the procedure at all. 

Being a gadget freak myself, I’m usually one of the first to try anything new that comes along. But one thing I’ve learned over the years is that you shouldn’t depend on these devices to to your surgery for you. It’s inevitable that even in the OR, there will be technical problems or software issues that prevent having the device available. Looking back, I had to spend a lot of time trouble-shooting these devices, and there’s definitely a learning curve with any new technology. One such example is 3-D image guided navigation. I use it only for my most difficult or complex sinus cases. But if you’re using it routinely, what happens when the computer crashes? It’s like having to fly a plane using visual cues and your experience if you lose instrument navigation.

I’m not saying robotic surgery doesn’t work. It can work, but only if you’re choosing the right patients to operate on and you use sound judgement and technique, whether or not you’re using robotic assistance.  

33% of All Cops May Have Sleep Apnea

I’ve always wondered about police officers—just like the rest of the population, many are generally overweight.  A new study published in the Journal of the American Medical Association revealed that about 40% of police officers screened positive for at least one major sleep disorder. Sleep apnea was the most commonly found condition, at 34%. Insomnia and shift word disorder were the two other conditions seen. About 80% were overweight or obese. And 26% reported falling asleep while driving at least once or twice per month.

These findings are not too surprising, since police officers frequently work odd hours that include night shift and weekends. Their poor eating habits can contribute as well. We also know that poor sleep can promote weight gain. The irony is that police officers probably need to be outdoors, walking or driving around, since an indoor desk job will not be stimulating enough. The question is which comes first: poor sleep habits and lifestyles that lead to weight gain and sleep apnea, or anatomic predisposition to sleep apnea that leads to choosing these type of occupations that promote weight gain, which leads to sleep apnea? I’m sure that if you studied fire fighters, you’ll find similar results, and that you’ll agree with me that this is a potentially major public health issue.

Based on these findings, do you think mandatory screening for obstructive sleep apnea should be required on a periodic basis for all police officers?

CPAP Can Help With Metabolic Syndrome

We already know that treating obstructive sleep apnea can help you to sleep better, but there’s been conflicting studies showing the benefits of CPAP on high blood pressure, diabetes, or risk of heart disease. However, for the most part, CPAP has been found to be helpful with hypertension, diabetes and cardiovascular risk factors.

Here’s a small study out of India showing that CPAP significantly lowered various markers for metabolic syndrome (high blood pressure, high cholesterol, and insulin resistance). Eighty-six volunteers (87% had metabolic syndrome) with were randomized to be given CPAP or sham CPAP therapy for 3 months. After 3 months, the two group were reversed. People treated with CPAP had an overall drop of 3.9 mm Hg systolic (top number) blood pressure, and 2.5 mm Hg in the diastolic (bottom) number. Total cholesterol went down 13.1 points, and  LDL dropped 9.6 points. Triglycerides also dropped, by 18.7 points. Thirteen percent no longer had metabolic syndrome.

On a side note, this study was funded by Pfizer, which makes many of the popular medications for high cholesterol and high blood pressure. It’s interesting that they would fund a study that would make it less necessary to use their prescription medications. We know that they don’t manufacture CPAP machines, so I wonder why they funded this study. Could they be interested in entering the sleep apnea market?

Expert Interview: Dr. Brian Palmer on “The Evolution of Malocclusion & Sleep Apnea”

Dr. Brian Palmer is an internationally recognized expert on dental malocclusion, infant feeding habits, and its’ relation to obstructive sleep apnea.

Topic: The Evolution of Malocclusion & Sleep Apnea

Guest: Dr. Brian Palmer

Length: 2  hours

Please enter your information below to register and to receive your download links for the MP3 recordings and slides:

Person Information
First Name *
Last Name
Email *
*By clicking ‘submit’ above, you are agreeing to receive ongoing communications from Dr. Park including monthly newsletters, events alerts, and other such written correspondences. Your e-mail will remain strictly confidential and will not be disclosed to any third parties without your prior written consent. You may unsubscribe to any or all portions of our e-mail correspondences at any time. Thank you for your cooperation.

Ask Dr. Park Anything About Obstructive Sleep Apnea (12/13/11)

In this Ask Dr. Park Teleseminar, I answer the following questions:

• Do people with sleep apnea really die 20 years earlier?

• How effective is home sleep testing? Is it covered by insurance?

• How does sleep apnea lead to serious conditions like heart disease?

• Would fixing a deviated septum help with sleep apnea?

• Tell me more about Provent therapy for sleep apnea.

• If one is successful with CPAP, is surgery an option?

• How successful is the Pillar Implant for sleep apnea?

• What ‘s the difference between hypoglossal nerve stimulation therapy vs. a tongue stabilizer device such as the AveoTSD?

• Are you aware of data in the US regarding OSA and traffic accidents?

• What are the risks to patients whose doctors have untreated OSA?

• What’s the difference between snoring and obstructive sleep apnea?

• Are surgical procedures for UARS covered by insurance?

• Why don’t sleep labs recommend oral appliances as an option?

And much more….

 

Please click here to purchase the MP3 recording ($17).

Why Do Some Insomniacs Keep Waking Up At the Same Time?

One of the most common complaints that I get from patients is that they keep waking up at the same time in the middle of the night and are unable to get back to sleep, or they keep waking up every 90 to 120 minutes. This phenomenon is called sleep maintenance insomnia, when you are unable to stay asleep during the night. In contrast, sleep onset insomnia is when you’re unable to fall asleep in the beginning of the night.

A low-dose version of zolpidem (Ambien) was recently FDA approved as Intermezzo to treat these middle of the night awakenings. It’s purpose is similar to zaleplon (Sonata), which is a very short-acting sleep aid, so it can be used in the middle of the night to get back to sleep, without the “hangover” effects that people feel with typical sleep aids.

There are a number of different explanations for why some people keep waking up in the middle of the night. One theory is that people with insomnia are hyperarousable, with higher levels of brain activity and stress hormones. If it’s due to these factors, why is it that insomniacs keep waking up at the same time? One possible explanation is that it has to do with sleep stages. Humans go through 4-5 cycles of sleep, where deep sleep (slow wave) predominates in the first half of the night and REM sleep is more common in the second half. As the night progresses, the periods of REM sleep become longer and longer. Since we know that throat muscles are most relaxed during REM sleep, you’re more likely to have breathing pauses during REM, especially if you’re anatomically predisposed (narrowed upper airway anatomy).

This can explain why many people say that they keep waking up at 3AM, like clockwork. Some people wake up when REM length reaches a critical period, whereas other keep waking up with each successive REM period. Transitions into and out of REM can also predispose one to upper airway instability.

One thing I’ve noticed is that in almost all cases, severe insomniacs have very narrowed upper air passageways. On endoscopy, the space behind the tongue is very narrow, and most people can’t (or prefer not to) sleep on their backs, since the tongue is more likely to fall back then supine. Dr. Barry Krakow did a study a while back showing that the vast majority of insomniacs who were resistant to sleeping pills had sleep-breathing problems.

What I’m describing is not necessarily obstructive sleep apnea. Once you obstruct or have partial obstruction, you can either continue the breathing pause for 10 to 40 seconds (this is called an apnea or hypopnea). But if you wake up quickly within a few seconds, then it’s called an arousal. Insomniacs typically have lots of arousals.

This is why even if you have classic insomnia, you need to look for and treat any underlying sleep-breathing problems, regardless of whether or not you have apneas.

If you are an insomniac, what time do you wake up in the middle of the night?

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