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More Sleep Apnea Bites the Dust

I had a crazy day today with a packed schedule full of patients, but the one thing that made it worthwhile for me was the feedback I got from three different patients about either how well they were sleeping, or how their lives were changed as a result of sleep apnea treatment.

While rounding at the hospital early this morning to see my post op patient, she was doing remarkably well one day after her multiple soft palate and tongue procedures for obstructive sleep apnea. She was already swallowing liquids pretty well, and ready to go home. She also noted that despite the pain and the poor sleep environment of being in a hospital with all the noises and distractions, she felt more refreshed than normal when she woke up this morning.

Another patient that I hadn’t seen in 6 or 7 years came in for ear wax removal, and just happened to thank me for changing his life. I had no idea what he was talking about. He reminded me that I had sent him to a dentist for his sleep apnea and he has been successfully using his dental device all this time.

A third patient came in one month after routine nasal surgery and remarked that his breathing is not only normal, but he’s not snoring anymore, and his sleep is much more refreshing and he’s dreaming more.

These are some of the examples of patients that have found success with either CPAP, oral appliances, or with surgery. Some people find success after their first option, while others go through everything before finding a solution that works.

Admittedly, not everyone that I see has great results like that ones above, but the vast majority do, while the remainder have partial or limited success.

This is what keeps me going, knowing that I’m able to help people breathe better and sleep better, regardless of which option they choose. It’s truly a privilege for me to be able to help people in this way.

What’s your success story? Please share your story with me in the comments box below.

Bad News For Alzheimer’s Disease

Here’s an article in the New York Times that describes why scientists are baffled as to why we’ve made essentially no progress in preventing or treating Alzheimer’s disease, despite all the recent advances in understanding this all-too-common condition. Could it be because our fundamental explanation for Alzheimer’s is wrong to begin with? Researchers are convinced that buildup and accumulation of plaques in the brain is what causes this condition and that by preventing its’ buildup, we can better control this disease. So far, nothing has worked. No surprises.

This general paradigm of Western medicine is that if you can lower your numbers (cholesterol or blood pressure), or prevent buildup of plaques in your blood vessels or brain, then you can supposedly “cure” the disease. But this is the fundamental problem with Western medicine. Every medicine that we use for chronic medical conditions only covers up the end result, rather than treating what’s actually causing the problem: our stress-filled modern lives, poor diet, lack of exercise, and poor breathing at night. Yes, lowering your cholesterol may lower your risk of heart disease by 10%, but at what cost? Side effects such as liver toxicity are routine in various cholesterol medications. In the same way, side effects from the various Alzheimer’s drugs are also very common.

Knowing what we know about the effects of untreated obstructive sleep apnea on the brain, and with the HUGE number of untreated sleep apnea patients, it’s time that sleep apnea researchers and Alzheimer’s researchers begin talking to each other.

Should scientists continue to go figure out ways to block amyloid plaque production, or should they be looking for an alternative explanation, such as obstructive sleep apnea? I’d like to hear your opinion. Please enter your comments in the box blow.

Listen To Dr. Park on Radio

Please join me on Thursday, September 2nd at 2 PM Eastern when Tara Marie Segundo of Tara Marie Live interviews me about my book, Sleep, Interrupted: A Physician reveals the #1 reason why so many of us are sick and tired. Click on this link to listen live or to download the interview later if you can’t make it. That link again is http://www.healthylife.net/RadioShow/archiveTM.htm.

Hope you can make it.

Should Asymptomatic Sleep Apnea Patients Be Treated?

Once in a while, I’ll come across someone with moderate or severe obstructive sleep apnea who feel fine. They deny any sleep problems or any daytime fatigue. In this situation, it’s hard to convince the patient that he or she should use CPAP or oral appliances. Here’s another study that shows why it’s important to treat obstructive sleep apnea, even if you’re not tired: Researchers from Spain showed that treating asymptomatic sleep apnea patients significant lowered their cardiovascular risks by 28%. Furthermore, sleep apnea patients with hypertension had a 50% reduction in cardiovascular events if they used CPAP for at least 4 hours every night.

If the patient is still resistant, I give the following example: If you had high blood pressure or diabetes, you’ll feel fine, right? But if your doctor told you that despite dieting and exercise, your numbers (blood pressure or glucose levels) are still on the high side and medications were recommended, would you consider it?

Do you have obstructive sleep apnea and are completely symptom free? If you’re on some sort of treatment, what motivated you to start treatment? I’d like to know. Please enter your reasons in the text area below.

Migraines, Heart Disease, & Sleep Apnea

One of the most common conditions that I see in my ENT practice is migraines. Not your typical classic migraine with the auras, light sensitivity and nausea, but the variations of migraine that involve the ears and sinuses. In fact, the vast majority of people who suffer from sinus pain and headaches are found to have migraines—if you perform CT scans, the sinuses will be completely normal. However, patients usually won’t believe me until they see the CT images, and after they respond to anti-migraine treatments.

In an often repeated study on migraines, researchers showed again that having migraines is linked with an increased risk of cardiovascular disease and even death.

These results are not surprising, since obstructive sleep apnea is strongly linked to cardiovascular disease and increased risk of death (46% in people with severe sleep apnea). Poor sleep quality that results leads to hypersensitivity of various nerve endings. If it happens in your sinuses, you’ll feel pain, pressure, headaches, nasal congestion and post-nasal drip. If in your ears, hearing loss, ringing, dizziness, fullness and sensitivity.

Having a migraine is not normal. If you suffer from migraines, it’s you’re body’s way of telling you that something is wrong, that you’re not getting quality deep sleep.

Do you suffer from migraines? If so, do your parents have heart disease or died early from cardiovascular complications? Is like to hear your response in the response box below.

Lou Gehrig, Head Trauma, & Sleep Apnea

A recent study showed that head trauma can sometimes mimic Lou Gehrg’s disease (or amyotrophic lateral sclerosis – AML). This condition was named after the famous New York Yankees baseball player that develop muscle weakness, paralysis and eventually, death. The journalist displayed a vintage photo of Gehrig just after being knocked unconscious by a runaway pitch.

Knowing what we know about the effects of untreated obstructive sleep apnea, you could say that any type of brain injury, whether due to blunt head trauma, or small to large vascular events, cannot be good for memory, breathing, executive function, and motor control. But these are the same areas that are known to be affected when someone has untreated obstructive sleep apnea.

Chronic hypoxia causes inflammation and clotting in small vessels. One study showed that sleep apnea patients have much thicker blood, and that ear-brain reflexes where diminished, but improved after treatment. Hypoxic conditions in mice have been even shown to produce amyloid plaques—the same thing that’s seen in Alzheimer’s disease.

We also know that sleep apnea patients have much higher number of lacunar infarcts than people without, as well as having anywhere from 3-5 times increased risk of stroke. I would think numerous small strokes added together over years could lead to at least some degree of brain dysfunction.

It’s also safe to assume that if you have head trauma, having obstructive sleep apnea can prevent proper healing and regeneration.

Given all this, isn’t it possible that when a certain part of the brain is “injured” due to obstructive sleep apnea, depending on where it occurs, you’ll get various symptoms that correspond to where it’s happening? For example, we know that in sleep apnea patients, brain density, volume and metabolism are significantly diminished in areas that control breathing, respiration and autonomic control. What if you clotted a small vessel that feeds this area? Could it lead to central sleep apnea? What if you damage areas that produce dopamine, or hypocretin? Could this process lead to symptoms that mimic Parkinson’s or even narcolepsy? What if you had fluctuating areas of diminished blood flow that returns to normal? Could this lead to symptoms that are similar to multiple sclerosis?

I realize that much of this may be a stretch, but it never ceases to amaze me how devastating obstructive sleep apnea can be to the brain, no matter how mild it may be.

What do you think about my theory? Is it plausible, or too far fetched of an idea? I’d like to hear your opinions about this.

Can Antidepressants Cause Obstructive Sleep Apnea?

I do believe that untreated obstructive sleep apnea (OSA) is a major cause, if not the most common cause of depression.  We know from numerous studies that OSA, via massive hypoxia and inflammation, causes brain biochemical and structural changes that can alter almost every aspect of your physiology and psychology.

Almost weekly, I see patients that suddenly gained significant weight after starting an antidepressant medication. We know that certain antidepressants are more likely to cause weight gain. Weight gain can aggravate obstructive sleep apnea, and obstructive sleep apnea can worsen depression. We also know that depression is linked with a higher incidence of insomnia, cardiovascular disease, and even death.

Did you gain weight after starting an antidepressant medication? If so, which one did you take?

Can Sleep Apnea Cause Psoriasis?

How is psoriasis connected to obstructive sleep apnea? You may think I'm crazy for even making the suggestion, but if you look at the studies, the results don't lie—you just have to connect the dots.

I've always wondered about this link, since almost every known medical condition is proven to be or possibly associated with obstructive sleep apnea. I was reminded about this connection when I read about golfer Phil Mickelson's psoriatic arthritis. I already commented on the association between sleep apnea and arthritis, and this time, I'm going to show you that psoriasis may be connected as well.

First of all, numerous studies have shown that people with psoriasis have a much higher chance of having cardiovascular disease. There are other reports that psoriasis is associated with an increased incidence of cancer, lymphoma, obesity, metabolic syndrome (also known as "Syndrome X"), autoimmune diseases (Crohn's disease and diabetes, etc.), psychiatric diseases (such as depression and sexual dysfunction), psoriatic arthritis, sleep apnea, personal behavior issues, chronic obstructive pulmonary disease (COPD).  If you have severe psoriasis, the likelihood that you'll have a heart attack is 3 times normal. Your chance of dying overall is almost doubled than if you didn't suffer from this condition. Average life expectancy is about 3 to 5 years shorter for someone with psoriasis.

We also know that obstructive sleep apnea can cause metabolic syndrome, hypertension, diabetes, high cholesterol, inflammation, heart disease, heart attack, and stroke. Your risk of dying early increases 45% if you have severe obstructive sleep apnea.

There's even a case report of someone with severe psoriasis who was completely cured after undergoing gastric bypass surgery for obesity.

Here's my take on the connection between obstructive sleep apnea and psoriasis: The chronic stress response and repeated episodes of hypoxia deprives the skin of vital blood flow and nutrients. Sympathetic activity overload preferentially shuts down certain parts of the body that are considered unessential, such as the digestive system, reproductive system, and the skin. In addition, chronic low-grade stress also causes your immune system to overreact and cause inflammation, inducing various self-destroying tendencies that are common with autoimmune conditions.

What do you think about this possible connection? I'd like to hear your opinion.

Phil Mickelson, Arthritis, and Obstructive Sleep Apnea

I've always wondered about a possible link between arthritis and obstructive sleep apnea. We know that people with arthritis also have a higher rate of cardiovascular disease and metabolic syndrome. I recently found out that Phil Mickelson has a debilitating condition called psoriatic arthritis. A few days before the last US Open, he could barely walk. 

Sleep Apnea & Menstrual Cramps

Here's a recent study that suggests that menstrual cramping may predispose to brain structure changes.

It's more likely that brain structure changes can predispose women to menstrual cramps. Interestingly, untreated obstructive sleep apnea has been shown to result in lowered brain tissue volume and density in critical areas such as memory, executive function, and autonomic control. So it's not surprising that many women with problem menstrual cramps can't sleep on their backs, and are more tired than normal, since they can't sleep efficiently. Due to smaller jaw structures, the tongue can take up relatively more space in the throat, and can obstruct during deep stages of sleep, especially when muscles begin to relax.

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