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UARS: The Hidden Sleep Condition

You’ve gained some weight over the years and you’re just not sleeping well. Your husband says you’ve begun snoring. You know that your father has obstructive sleep apnea and is doing well with CPAP. You mention this to your doctor and she orders a sleep study. The sleep study comes back completely normal. Now what?

The Real Reason for Your Chronic Fatigue

Before you begin searching for other reasons for your chronic fatigue, don’t rule out a sleep-breathing problem too quickly, even if you don’t have obstructive sleep apnea. In fact, a sleep-breathing problem can cause if not aggravate conditions such as hypothyroidism, chronic fatigue syndrome, depression, insomnia, and even irritable bowel syndrome.

Sleep doctors have defined obstructive sleep apnea as having at least 5 apneas or hypopneas every hour on average. An apnea means you stop breathing completely for 10 seconds or longer. Hypopneas are similar 10 second or longer pauses but with restricted airflow. But what what happens if you stop breathing 25 times every hour but each episode lasts only a few seconds?

In the early 1990s, Dr. Christian Guilleminault of Stanford University looked at young, thin men and women who were tired all the time, no matter how long they slept. These people were found not to have obstructive sleep apnea after undergoing formal sleep studies. However when they placed thin pressure catheters in their chest and throat, they found the they had frequent episodes of partial obstruction which led to subtle, but significant limitation of nasal airflow, along with very negative vacuum pressures in the throat. Most of these minor episodes were not apneas or hypopneas, but still lead to an arousal—from deep to light sleep. What was happening was multiple partial obstructions and arousals that were not severe enough to be called apneas or hypopneas, but enough to wreak havoc on deep sleep quality.

It’s been shown that even very subtle levels of restricted breathing can lead to deep brain stimulation and arousals that prevents your ability to stay in deep sleep. These reflex signals to the brain can be so weak that it doesn’t even reach the outer layers of the brain where standard scalp electrodes can pick up these disturbances.

Blame It On Your Parents (And Your Jaws)

The fundamental problem in UARS is due to smaller upper airway anatomy, caused by having smaller jaws and dental crowding. The smaller the space behind the tongue, the more likely you’ll obstruct while breathing when on your back (due to gravity, the tongue can fall back), and when in deeper levels of sleep (when your muscles relax). This is why most people with UARS can’t, or prefer not to sleep on their backs. The problem is that you can still have breathing problems despite sleeping on your side or stomach, just not as bad as being on your back.

Lack of sleep and especially lack of deep sleep has been found to cause a whole host of physiologic changes. In general this happens due to chronic overstimulation of your sympathetic nervous system. This is the fight-or-flight half of your involuntary nervous system. Since your body thinks it’s under attack, it heightens your nervous system, making you en garde, edgy, hypersensitive or overreact to normal situations. This also leads to diversion of blood flow, energy and resources away from less essential body parts and organs, such as your digestive system, reproductive organs, skin, hands, feet, and other “end organs.”

Due to this “hypersensitivity,” the nose and sinuses can be overly sensitive, reacting to stimulants such as weather changes, chemicals, scents, and even allergies. Chronic stress that results from sleep deprivation also can heighten your immune system.

Is It Hormones or Your Breathing?

A number of other studies point out that UARS patients are more prone to have cold hands or feet, hypothyroidism, irritable bowel syndrome, depression, chronic fatigue, and various other “somatic” syndromes. I see this all the time in my practice. In fact, a recent study even showed that chronic long-term sleep deprivation caused significant lowering of the TSH and T4 levels, with women being much more susceptible to this effect compared with men.

With time, as people age, and especially as they gain weight, most people will progress into true obstructive sleep apnea. You’ll find that most younger, thinner people with UARS will have one or two parents with significant obstructive sleep apnea.

Now that you’re convinced that you may have this condition, what can you do about it? For the most part, it’s treated just like obstructive sleep apnea. You should start with all the conservative options first, such as weight loss (if you’re overweight), diet, exercise, improving your nasal breathing, and not eating late. If these options don’t work, then all the formal options for treating obstructive sleep apnea are possible including CPAP, oral appliances, and even surgery.

Unfortunately, if you don’t officially have a sleep apnea diagnosis based on a sleep study, then insurances generally won’t cover any of the treatments. The irony is that our health care system won’t treat or prevent diseases in the early stages, and would rather wait until it’s much more severe before covering for medical services.

If you think you may have upper airway resistance syndrome, you may be disappointed to find that the medical community in general will not be responsive to your queries. With a few exceptions, many sleep doctors are not convinced that UARS is even a legitimate condition, and would rather lump it into the spectrum of snoring to obstructive sleep apnea. Time after time, whenever I see patients who are told they don’t have obstructive sleep apnea and I treat the upper airway narrowing and inflammation, patients almost always feel better. Your best option is to continue to educate yourself and be persistent. Your first priority should be to be able to breathe better so that you can sleep better.

Tongue Exercises For Sleep Apnea: Expert Interview With Janet Bennett

Tongue Exercises For Sleep Apnea   

Tongue exercises can be a noninvasive way of promoting muscle tone in the throat, which can be helpful for some people with snoring or obstructive sleep apnea.

Register below for a FREE replay of this interview with Ms. Janet Bennett, speech pathologist and creator of the I Just Want To Sleep website, about her unique tongue exercise program.

Learn:

•  What tongue exercises can and can't do
  

•  How tongue exercises can help your snoring
  

•  What recent studies say about the effectiveness of  tongue exercises
  

•  Which exercises if done just 5 minutes a day can help you  breathe better and sleep better 
  

•  and much, much more…
  

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What You Can Do About Your Stuffy Nose

Although many people assume that big nosed people naturally breathe better, there's nothing further from the truth.  The shape and size of your nose is mostly cosmetic. How well you breathe actually depends on what your internal breathing passageways look like. And for many sleep apnea sufferers, a stuffy nose can make or break their treatment therapy.

Yet, opening up the nose through medical therapy or even surgery has been found to “cure” sleep apnea in only 10% of people. Patients will definitely feel and breathe better, but it’s unlikely that their sleep apnea is addressed definitively. However, I have seen many of the people in the “10%” group derive significant benefits from clearing up their nasal congestion. Besides breathing better for the first time in years, opening up the nose can allow the person to tolerate and benefit from other treatment options for OSA besides CPAP.

 

Why Is My Nose Stuffy?

Problem #1:  Deviated Nasal Septum

One of the more common reasons for a stuffy nose is due to a deviated nasal septum. A “septum” is a term that describes a structure that acts as a wall or separator between two cavities. Your heart has one too. No one has a perfectly flat or straight septum.

All septums, by definition, have slight irregularities or curvatures. A major reason for a crooked septum, unbeknownst to many people, even other doctors, is because your jaw never developed fully. Most people with sleep apnea have narrow upper jaws, which pushes up the roof of your mouth into your nasal cavity, which causes your septum to buckle.

If medical options don't help you to breathe better through your nose, then you may be a candidate for a septoplasty. To get a much more detailed explanation about this procedure see the accompanying article, Myth and Truths About Septoplasty.

Problem #2. Flimsy Nostrils

In some people, the space between the nasal septum and the soft part of both nostrils is either too narrow to begin with, or they collapse partially or completely during inspiration. In many cases, this can be seen years after reduction rhinoplasty, where the nose was made smaller or narrowed for cosmetic reasons. Occasionally, people can have naturally thin and floppy nostrils.

Another common reason for flimsy nostrils is due to a narrow upper jaw. The width of your nose follows the width of your jaw. If the angle between the midline septum and the nostril sidewall is more narrow than normal, then it’s more likely to collapse with any degree of internal nasal congestion. It’s not surprising that people with sleep-breathing disorders will typically have narrower jaws, and thus more susceptible to nostril collapse. Certain ethnicities are also more prone to this phenomenon than others.

One way that you can easily tell if you have this problem is to perform the Cottle maneuver: Place both index fingers on your face just beside your nostrils. While pressing firmly against your face and simultaneously pulling the skin next to the nostril apart towards the outer corners of your eyes, breathe in quickly. Then let go and breathe in again. If there is a major improvement in your quality of breathing while performing this maneuver, then you have what’s called nasal valve collapse.

The simplest way of correcting nasal valve collapse is by using nasal dilator strips, or Breathe-Rite® strips. If you do the Cottle maneuver and there is no significant difference in your breathing, don’t waste money buying these strips. If you perceive an improvement in your breathing, you can continue using the strips at night while you sleep. For some people, these “strips” are not strong enough to hold up the nostrils, or may cause irritation to the skin.

There are also many other “internal” options available over the counter, including metal springs or plastic cones that are placed inside the nostrils. People tolerate these particular devices differently, so the only way to know if you’ll like them is to try them. Three examples are Breathe With EEZ, Nozovent, and Sinus Cones.

To find out if your nasal valve collapse is from weak or flimsy cartilages or is aggravated by internal nasal congestion, you can spray nasal saline (which is a mild decongestant) into your nose. If your nostrils doesn’t collapse as much, then you need to address your internal nasal congestion first. A stronger over-the-counter medication that you can use is oxymetazoline, which is a topical spray decongestant. There are many brand name and generic versions that are sold that contain this ingredient. It’s very important that you don’t use this medication for more than two to three days—otherwise, you may get addicted to it.

If you want a permanent solution to this problem without having to use dilator strips or internal devices, the only option is surgery. The traditional way of dealing with this issue is to perform a kind of reconstructive rhinoplasty surgery, usually by taking small portions of your nasal septal cartilage or ear cartilage and placing in underneath the weakened portions of your nostril walls. A newer, simpler way of addressing this problem is by attaching a permanent suture just underneath the eye socket and tunneling the suture under the skin and looping it around the weakened area to suspend the nostril to prevent collapse.

Problem #3: Wings in Your Nose

Another common source of nasal congestion is from swelling of your nasal turbinates, which are the wing-like structures on the side-walls of the nasal cavity opposite the septum. Turbinates are comprised of bone on the inside and mucous membrane on the out- side. The area just underneath the mucous membrane is filled with blood vessels which can swell significantly. As the turbinates swell due to allergies, colds, or weather changes, the air passageways narrow further, especially if you have a mildly deviated nasal septum, and particularly if you have nasal valve collapse.

One of the most common misunderstandings that I see by both doctors and patients alike is that they think that swollen turbinates are polyps. The nasal turbinates can swell so much that you can sometimes see the reddish-pink, fleshy grape-like mass through your nostrils. Once decongested, they shrink dramatically and the air passageways open up again.

If conservative treatment including prescription allergy medications don’t work, various surgical options are available from very conservative 5 minute in-office procedures to more aggressive procedures that are performed in the operating room. These procedures are usually performed alongside a septoplasty to improve nasal breathing.

 Problem #4: Sinusitis

If you suffer from sinusitis, this can cause nasal congestion and inflammation combined with post-nasal drip, sinus pressure, and pain. Put simply, pure misery. Sinus infections typically follow either a routine cold or allergy attack; they cause both swelling and blockage of the sinus passageways, leading to negative pressure initially and, if allowed to progress, can turn into a full-blown sinus infection, with yellow-green discharge, fever and severe facial pain. Your teeth can also hurt since the roots of the upper molars jut up into the floor of the maxillary sinuses. Similarly, dental pain can sometimes feel like sinus pain.

Fortunately, most cases of sinus congestion will eventually go away. The body has a remarkable ability to take care of these issues without any intervention. Sometimes bacterial infections occur, and with proper conservative treatment using saline and decongestants, the infection gradually resolves. Rarely, you may need an antibiotic to control stubborn bacterial infections.

Problem #5: Poor Sleep

As you can see from the above discussion, there are a number of various reasons for having a stuffy nose. But the most common reason for nasal congestion that I see routinely is due to inefficient breathing and poor sleep. This is why sleep apnea sufferers, more often than not, suffer relentlessly from nasal congestion. 

Without a doubt, structural reasons like allergies or nasal polyps can definitely block your nose and these issues must be dealt with appropriately. But in general, it’s the inflammation that’s created by a combination of your hypersensitive nasal nervous system and possible stomach acid regurgitation into the nose from multiple obstructions and arousals, that causes nasal congestion. Without addressing this underlying source of inflammation, correcting a deviated nasal septum or treating for nasal allergies will only provide a temporary solution.

7 Simple Ways To Get Rid of Your Snoring For Good

If your spouse or bed-partner snores and keeps you up at night, then you're not alone. Most people snore at least occasionally, while about 25% snore all the time. Snoring is a major problem that not only can affect your relationship, but your health as well (snorer and snoree).

Snoring may be a sign that you have obstructive sleep apnea, a condition where you literally stop breathing repeatedly while sleeping. Untreated obstructive sleep apnea can cause or aggravate depression, anxiety, hypertension, diabetes, heart disease, heart attack, and stroke.

Even if you don't have sleep apnea officially, studies have shown that snorers have a much higher risk for relationship problems, car accidents, and cognitive impairment.

One important thing to note is that you don't have to snore to have sleep apnea. Even young, thin women who don't snore can have significant sleep apnea.

Here's a checklist of the 7 “musts” of snoring cessation. Try these simple strategies before you resort to more invasive and expensive options:

1. Don't eat within 3-4 hours of bedtime.
If you snore, chances are, you'll stop breathing once in a while. When you do stop breathing, you'll create a vacuum effect in your throat which suctions up your normal stomach juices into your throat, causing you to wake up partially or fully. This also causes more swelling and inflammation which narrows your throat and nose even further. This leads to less efficient sleep, leading to weight gain, which narrows your throat even further.

2. Don't drink alcohol within 3-4 hours of bedtime.
Alcohol is a strong muscle relaxant, so it will make your throat muscles more slack and more apt to collapse and obstruct. And any obstruction around your airway as you sleep means more snoring.

3. Don't sleep on your back.
Due to gravity, everyone's tongues can fall back when on our backs. This narrows the space behind the tongue and along with muscle relaxation during deep sleep, you'll snore more and stop breathing more often. The traditional recommendation for pinning a tennis ball to the back of your pajama shirt ma work for a few people, but there are a lot more sophisticated ways to keep you off your back.

4. Clear up your nose.
Make sure that you're able to breathe properly through your nose, since having a stuffy nose will create a slight vacuum effect in your throat, aggravating partial to total collapse of the soft palate and the tongue. Whether through over-the-counter remedies, prescription medications, or with surgery, get this taken care of first. Unfortunately, this works only sometimes and in many cases, nothing changes. Regardless, if you need further treatment, you need to be able to breathe through your nose for the other options to work. It's been shown that definitively optimizing nasal breathing through surgery cures obstructive sleep apnea in only 10% of cases.

An interesting study published about 10 years ago showed that when given a nasal decongestant as well as a medicine that helps to empty the stomach faster, about 80% of snoring was significantly improved.

5. Lose weight.
Needless to say, this is easier said than done. One of the reasons why you may be overweight is because you don't sleep well. Less efficient sleep promotes weight gain, which not only cause you to expand on the outside, but also narrow in on the inside of your upper airways. But how about some of you who are not overweight, or even very skinny? Snoring and sleep-breathing problems occur due to a structural narrowing of the entire upper airway, from the tip of your nose to your voice box.

6. Try any of the various over-the-counter anti-snore gadgets, devices, and pills.
But don't expect dramatic results. Yes, sometimes, it'll help with your snoring, but even if it works, the effects don't usually last. The reason why you snore is due to your jaw anatomy and additional inflammation. Covering it up with any of these options is only a temporary solution. A study showed that compared with controls, the throat spray, nasal dilator strips, and anti-snore pillow was not any better.

7. Seek medical help.
If all the above don't work, it's time to see an ear, nose and throat doctor. A comprehensive exam is needed to find out which areas of your upper airway (from the tip of the nose to the voice box). We know that for most people it's the soft palate that flutters, making the annoying, chainsaw sounds. Usually, snorers will have a combination of areas that contribute to snoring, with the tongue being the most common culprit, due to having small jaws.

In most cases, a sleep study is needed to check to see if you have obstructive sleep apnea. If you do have sleep apnea, then treating this condition will help your snoring. Even if you don't have obstructive sleep apnea, all the different treatment options for sleep apnea can be used. As I mentioned in Step #4, you must first optimize nasal breathing and then deal with your tongue. The timing for eating and drinking alcohol is something that you should continue for a lifetime.

Unfortunately, things only tend to get worse as you age. The soft tissues in your throat tend to sag and collapse, especially after decades of repeated strong inspiration. This is why it's important to get your snoring taken care of, first using the conservative steps outlined in his article, and later by seeing a physician that can help you with this condition.
 

Free Shipping on Sleep, Interrupted

Here's Your Answer To a Healthy New Year…

To help you get off to a great start on your New Year's resolution to get healthy this year, I'm offering FREE shipping to anywhere in the US if you purchase Sleep, Interrupted from now until 1/9/10.

The 5 Dangers of Benign Snoring

Snoring is so common these days that it’s synonymous with sleep. In the movies or on TV, a sleeping person is depicted with snoring sounds. Even in the comics, the ZZZZZZZZs that you see coming from the sleeper may signify snoring.

 

Within the sleep community, we often use the term benign snoring to mean snoring without any sleep apnea. We see it as the least important form of obstructed breathing, without any medical consequences. Every time I see this in our medical journals or in the media, I get mildly annoyed, since there’s so much information to show that snoring is never benign.

 

Snoring itself is usually caused by vibrations from the soft palate. Think of a reed in a wind instrument, or a flag flapping in strong winds making lots of noise. In the human throat, any degree of abnormal narrowing of the throat promotes vibrations of the free edge of the soft palate. The loudest recorded snore was found in a British woman whose sound levels reached 113 dB, which is louder than a low-flying jet. There are other areas in the throat that vibrate and make sounds, but they’re probably a secondary effect of the soft palate vibrations.

 

Here are 5 reasons why snoring is never benign:

 

1. If you snore, you have a 35% chance of having obstructive sleep apnea, which is a potentially serious medical condition where you stop breathing multiple times every hour, leading to oxygen deprivation, heart disease, heart attack, and stroke. The best way to diagnose sleep apnea is to undergo a formal overnight sleep study. If you stop breathing at least 5 times every hour, with each episode lasting 10 seconds or longer, then you’re told you have sleep apnea. But what if you stop breathing 15 times every hour, but you wake up after 1-5 seconds for each episode? Then you’re told you don’t have sleep apnea, with no clear explanation why you’re so tired all the time.

 

2. It’s been shown experimentally in rabbits that artificially applying vibrations to the carotid artery causes thickening of the carotid artery walls, similar to what we see in humans with plaques.

 

3. Snoring without sleep apnea has been shown to increase your chances of being involved in a car accident.

 

4. Not only is snoring potentially dangerous for your own health, it also disrupts your bed-partner’s sleep quality, health, and relationships. There have been reports of bed-partners becoming deaf in one ear.

 

5. By not taking snoring seriously, it’s likely that you’ll delay diagnosing obstructive sleep apnea. Many people try various over-the-counter anti-snore aids with mixed results. Most end up giving up until the problem gets worse.

 

If you or your loved one snores, take it seriously and get it checked out by a sleep physician or an ear, nose and throat doctor. Even if you’re found not to have sleep apnea, treat the snoring. Just because the sleep study doesn’t say you have sleep apnea doesn’t mean that you don’t have a sleep-breathing problem.

A Proven Solution for Your Sleepy Child

Finally, Answers to Why Your Child Can't Sleep…

• Why your child’s sleep problems could be a sleep apnea issue
• How your kids can go from sleepless and fatigued to rested and energized after a couple of trips to the orthodontist.
• Even more alternatives to CPAP for sleep apnea, like palatal expansion other orthodontic procedures.

Registration Form
First Name *
Last Name
Email *
Postal Code or Country *
How did you find out about this recording? *	Please select one Patient (received an email) Dr. Park's newsletter On-line article Book: Sleep Interrupted SleepGuide.com Facebook Twitter Referred by a Friend Other/Not Sure
*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.

The ABCs of Oral Appliance Therapy

How to Treat Sleep Apnea with Oral Appliances, Revealed

Dr. Park Interviews Dr. David Lawler, a dentist with extensive knowledge and expertise in treating sleep apnea using oral appliances. During this 60 minute call, Dr. Lawler explains in detail what oral appliance therapy is and how it can be used to treat sleep disorders. Find out:

• Why customized dental devices are good alternatives to CPAP in treating obstructive sleep apnea
• How oral appliances can help you stop snoring
• The major mistakes people make when getting dental devices for their sleep apnea and what you can do to avoid them
• How to lessen the discomfort of using any dental device
• Tips on finding the right dentist in your area to fit you with these devices

Buy your copy of this audio recording today, available in two easy-to-access formats:

  

Can Bottle Feeding Increase the Risk of Sleep Apnea?

Startling News For Parents of Bottle Fed Children…

 In this hour long interview, Dr. Park talks to Dr. Brian Palmer, a former dentist who has done extensive research in the field of infant oral cavity and airway development.  In this discussion, Dr. Palmer shares shocking information as to why parents who bottle feed their children are putting them at higher risk for ADHD, obesity, not to mention sleep breathing disorders and what parents can do NOW to prevent these problems from developing later on.

Learn:

• Why bottle feeding can make your child more prone to sleep problems as adults
• How bottle fed children are more likely to perform poorly in school
• Why bottle fed children are more at risk for sleep apnea,obesity, ADHD, bed wetting and more
• What you can do NOW to prevent health problems for your bottle fed child

Register below to download and listen to this FREE recording.

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How did you find out about this recording? *	Please select one Patient (received an email) Dr. Park's newsletter On-line article Book: Sleep Interrupted SleepGuide.com Facebook Twitter Referred by a Friend Other/Not Sure
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Sleep Apnea & Snoring iPhone Applications

 

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