An Out-Of-The Box Explanation For Chronic Stress

Here’s a very good story about one of my past guest interviewees, Dr. Avram Gold. Sleep Review Magazine published an interesting article that reviews Dr. Gold’s controversial work on functional somatic syndromes (depression, anxiety, chronic fatigue syndrome, fibromyalgia, insomnia, Raynaud’s syndrome, RLS, hypothyroidism, IBS, etc.) and upper airway resistance syndrome. 

It’s a fascinating discussion about how patients with “mild” or no obstructive sleep apnea (OSA) can often be worse off than OSA. My sleep-breathing paradigm is completely in agreement with Dr. Gold’s basic premise, that frequent partial resistance to breathing at night with repeated arousals from deep sleep can cause or aggravate many of the the conditions listed above. What I describe has more anatomy-based descriptors, due to the fact that modern Western humans have shrinking jaws, leading to more narrow upper airways. 

I, too have had patient with many of the various functional somatic syndromes feel significantly better or get better completely after treating their narrowed upper airway anatomy, using CPAP, dental appliances, or surgery. In fact, most of these patients had no significant apneas or very mild levels of OSA on sleep studies. In all cases, upper airway evaluation using a flexible camera showed very narrowed airways. 

If you have or had any of the above conditions improve or resolve completely by using CPAP, dental devices or surgery, please tell us your story in the box below.

Please note: I reserve the right to delete comments that are offensive or off-topic.

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2 thoughts on “An Out-Of-The Box Explanation For Chronic Stress

  1. Hi Dr. Park, Thanks for sharing this article. I am in my mid-thirties. I am fairly slim. I have a family history of sleep apnea on my dad’s side. Also, I had a small, narrow, under developed, recessed lower jaw and an overjet. I had a lot of nasal allergies and congestion too. I had braces put on when I was a pre-teen which I believe exacerbated my sleep breathing disorder. Around my teen years I developed depression, anxiety and insomnia. i would also feel dizzy if i stood up too quickly. When I was in college all these symptons continued in addition to increasing fatigue and cognitive impairment. In my late twenties due to chronic stress from SBD my hair started to fall out, I had unexplained skin bruising, back and wrist pain. I also would also ruminate over past negative events a lot. I also had migraines from teeth clenching at night. I eventually became non-functional, almost bedridden from fatigue. I am the classic patient described in Dr. Gold’s article. My first couple of sleep studies done at local labs showed nothing but spontaneous arousals and mild snoring. I then went to Stanford where I was diagnosed with an RDI of 14 all hypopneas and many flow limitations. I tried CPAP, BIPAP which did not work and then had an MMA done which helped a little my my post MMA RDI was still 14 and i was still symptomatic. I knew it helped a bit though because my hair started to grow back a bit healthier. I believe the culprit was my tongue because post MMA surgery I could actually feel it falling back in my airway right as I would drift off to sleep. I had to wear a neck brace at night which a rolled up sock tucked under my chin to keep my head/chin tilted upward to open my airway. I went back on cpap and bipap which helped but I was still symptomatic. I now have a skin-lined tracheostomy put in which is surprisingly easy to live with. After my tracheostomy surgery, my hair started to grow back very lush, thick and shiny, I get a lot of compliments on my hair now. It has never been this healthy. I did not feel well immediately as I had some underlying heatlh problems that I found were also causing my fatigue mainly blood sugar problems and a weak diaphragm. When they did the trache, they removed part of my thyroid because it was in the way and although my thyroid tests come back normal I believe that it caused blood sugar problems that I did not have anymore. I am now on a low dose of metformin and I do diaphragm exercises daily. I am now feeling much better and all of my past symptons have gone away. Sorry this is such a long post, just wanted to share my story and experiences. I would like to visit you some day Dr. Park.

  2. I see a lot of people with small jaws. I’m not one of them. Plenty big arches, space for fully erupted wisdom teeth even. My minimum cross section is over 200mm^2 and after MMA it will be over 500mm^2. Just goes to show how everyone’s airway is different since my AHI is way at the severe end of the spectrum (I suffer from long face syndrome with anterior open bite).