A Matter Of Life And Death: Dr. Borelli’s Wake Up Call

There’s been a lot more studies recently linking untreated obstructive sleep apnea with brain damage. One study out of UCLA showed how obstructive sleep apnea can damage the brain. One of my past guests for my Expert Interviews, Dr. Joseph Borelli, talked about how often he sees brain damage in patients with severe untreated sleep apnea (iTunes Podcast #14). Here’s a recent article featuring Dr. Borelli on Discover

I’ve had many patients tell me that their memory became better after being treated for obstructive sleep apnea. This is in line with a 2010 study showing that damaged areas of the hippocampus can regenerate partially after being on CPAP. 

If you have obstructive sleep apnea, did treatment using CPAP, dental appliances or surgery help your memory? Please enter your comments in the text area below.

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4 thoughts on “A Matter Of Life And Death: Dr. Borelli’s Wake Up Call

  1. Faithful use of CPAP has not helped my memory. Might be because I have CPAP-induced central apneas, not just obstructive apneas. And I can’t tolerate the ASV machine, so I’m not getting optimal treatment.

  2. I think the first thing we all need to understand about the brain damage which accompanies Sleep Apnea is that it creates symptoms which are intermittent in character. The first study which Dr. Mack D. Jones[2] found decisive[3] regarding the brain damage cause by Sleep Apnea showed very notable changes in white matter. In the brain there are short signal runs (microns) and long signal runs (from many microns to inches and up to several feet). The long runs are covered by “white matter” which maintains the energy from the neuron firing as it moves from the originating cell to the receiving cell. If the white matter is affected the likely result is that more energy will be needed to get the signal through. Perhaps that is why all of the “executive functions” that I mention following seem to be fine at times but if I am under stress for hours or days or weeks it is almost as if the inputs from the various parts of the brain have been “turned down” to where I cannot “hear” them. And so what was executive functioning becomes executive dysfunction. I think the poor little neurons simply fatigue. No more to give.

    I think the best model describing the executive dysfunction caused by the brain damage from sleep apnea that I have ever seen was written by Beebe and Gozal in 2002[1]. I have come back to it many times since I read it in 2006 after discovering my own severe sleep apena with extreme hypoxia in 2003. It really helped me to understand what had happened to me.

    In the future I hope to take the data from the various brain studies and correlate them to the executive and other functions of the brain which are affected by Sleep Apnea. By doing so I hope to help others understand what has happened and is happening to them and also to foster understanding for them by those who live nearby. As well I hope to find ways to repair the damage. I will share in my “blog to be” as I do.

    I can recall many examples of what they write about[1] which have played out in my own life. Although I will share these experiences as attached mostly to a specific executive function deficit the reality is that most are a result of two or three of them “ganging up on you” to bring about the result. But here are some examples. :

    [Executive Dysfunction Mentioned] Behavioral Inhibition

    [Example from my own life] What I remember most in this category is yelling at people and deeply regretting it later while also being amazed that I did that. I know that it is better to find ways which foster peace and understanding and so have refrained from yelling. One day in particular I found myself yelling at my co-worker. Normally this would never happen but now lacking my normal “inhibition of the initial prepotent response to an event”[1] I did yell. And sadly now also lacking “stopping of an ongoing response”[1] I was continuing to yell and this was happening in front of customers (bad “interference control”[1]). Indeed a supervisor confronted me and told me I was “out of control”. I considered what he said, concluded he was correct, and asked to leave (we were near the end of service) which he agreed to.

    For me the “interference control”[1] issue can get so bad that I start the day with a specific goal and remember what it was at the end of the day on my way to sleep or perhaps the next day.

    [Executive Dysfunction Mentioned] Set Shifting

    [Example from my own life] Doing things “by rote” does seem to go consistently well but in a new situation the sous chef wanted to see me slicing herbs rather than cutting strait down which tends to smash the edge of the cut. I said I would but did not remember – several times. Very hard to change the way I did things I found.

    [Executive Dysfunction Mentioned] Self-regulation of Affect and Arousal

    [Example from my own life] What comes to mind as I think about this one are the many times one of my cooking trainers would stop me and tell me to “take a break”. I think he simply noted my lack of focus as well as some “(1) heightened reactions to emotionally charged immediate events and (2) decreased ability to modulate overt emotional reactions based upon their social appropriateness”[1] and knew that a break would help. And it always did.

    It is also difficult to remain “on task”. Difficult to maintain focus.

    [Executive Dysfunction Mentioned] Working Memory

    [Example from my own life] My co-workers stopped me and asked me why I was making my normal “trip around the kitchen for supplies” the third time. Yes there is dry storage, the walk in refrigerator, and the dish pit for supplies and getting all that you need in one trip is wise to do – but – forgetting each time what you were starting the trip for is not so good indeed.

    [Executive Dysfunction Mentioned] Analysis/Synthesis

    [Example from my own life] I was very unwise to choose making a new sauce as my first project of the day. I had never done it but knew it was complex. By the time the supervisor became involved the entire kitchen had been hampered. Very simply what should have been started in a large appliance had been started in a pot. I was unwise to choose the project and made many unwise choices along the way which resulted in a real mess and hampered production in what needs to be a very efficient kitchen. I was handed my walking papers the next day.

    I found highest success in repetitive jobs which required little Analysis/Synthesis.

    [Executive Dysfunction Mentioned] Contextual Memory

    [Example from my own life] While I think that issues with working memory and interference control are very involved in this what amazed me is that I would look up at a clock and find that a project that normally would take me twenty minutes just blew an hour! It was one of the ways I was able to know I was having a bad day.

    In terms of the effect of treatment well some positional therapy along with a nasal corticosteroide enabled me to successfully complete a cooking course I was in. CPAP also added to my performance capabilities. It is some help but I wish I had known how to better take care of myself in general earlier, indeed I wish I had known about functional medicine[4] much earlier in my experience. Perhaps using that I will get to the place I no longer need CPAP.

    [1] Dean W. Beebe, David Gozal “Obstructive sleep apnea and the prefrontal cortex: towards a comprehensive model linking nocturnal upper airway obstruction to daytime cognitive and behavioral deficits” J. Sleep Res. (2002) 11, 1–16

    [2] Deadly Sleep: Is Your Sleep Killing You? by Mack D. Jones MD (in chapter two under “Brain Structural Changes in Obstructive Sleep Apnea”)

    [3] Macey PM, Kumar R, Woo MA, Valladares EM, Yan-Go FL, Harper RM. Brain Structural Changes in Obstructive Sleep Apnea. Sleep. 2008;31(7):967-977.

    [4] The Disease Delusion: Conquering the Causes of Chronic Illness for a Healthier, Longer, and Happier Life – March 3, 2015 by Jeffrey S. Bland (Author), Mark Hyman (Foreword)

  3. I started with a cpap device almost 2 years ago, for OSA… about one year ago I was diagnosed with CSA and changed to an ASV unit. I have good nights (80%) and not so good ones(20%) to this day. My mental status has improved, but I still have problems concentrating, my memory is still shoddy, I sometimes have trouble reading and also it seems that I have less concern for completing tasks….to put it bluntly, I have an “I don’t give a damn” attitude regarding work, and pleasure. I don’t have the drive that I used to have, and seem to do everything at the last minute, not planning very well, and not ready for things to get done when they are required to be done. I used to be on the ball, a go-getter. Now I’m a shell of my former self. I am more awake and still alive, but not much more. I used to have an IQ that ranked very high, now I feel left out. A dim bulb. I “was” wondering if some of my brain damage may be permanent, now after learning that more improvement should have occurred already, I’m pretty confident that it is.