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.

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.

Date: September 14

Time 8 PM Eastern

Registration details to follow…..

Hope you can make it.

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.

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.

Instead, these symptoms are the beginnings of the most common throat problem sleep apnea sufferers face. And as I explain below, without understanding why this occurs, it can be one of the hardest problems to treat.

Beware of the “Vacuum Effect”

People with obstructive sleep apnea are more prone to breathing problems at night due to partial or total collapse of one or more areas of the entire upper airway, from the nose to the tongue. It’s usually worse when on your back, since the tongue can fall back more in this position. During deep sleep, your muscles naturally relax and you’ll be more susceptible to breathing stoppages.

Pressure sensors placed inside sleep apnea patients reveal that every time an apnea occurs, a tremendous vacuum effect is created inside the chest and throat, which literally suctions up your normal stomach juices into your esophagus and throat. This can happen occasionally, even for normal people, but if you happen to have a late meal or a snack just before bedtime, there will be even more stomach juices lingering in your stomach to come up into the throat. If you happened to drink a nightcap, the situation is even worse since alcohol is a strong muscle relaxant.

What comes up into your throat is not only acid, but also bile, digestive enzymes, and even bacteria. Washings of lung, sinus and ear contents have shown H. pylori, a common stomach bacteria, and pepsin, a major stomach digestive enzyme. So what comes up can cause severe irritation in your throat, provoking the mucous secreting glands of your throat to try to dilute these substances.

Although people generally attribute throat mucous to post-nasal drip, in most cases there’s nothing dripping down the back of the throat. It’s actually coming from your stomach. However, in some cases, since your stomach juices can reach your nose, it can cause nasal congestion and inflammation, which can aggravate tongue and soft palate collapse by creating a vacuum effect downstream. Ultimately, it’s a vicious cycle.

Chronic acid and other irritating substances lingering in your throat can have other detrimental effects. One recent study showed that chronic acid exposure can numb or deaden the protective chemoreceptors in your throat. These are sensors that detect any acid in the throat to prevent aspiration of your stomach contents into your lungs. If these chemoreceptors sense any acid in your throat, a feedback signal is sent to the brain, causing you to wake up so that you can swallow. This is what’s called a reflux arousal.

Treating Reflux For Good

So besides not eating late and avoiding alcohol close to bedtime, what else can you do?

I’m assuming that many of you that are reading this article are already being treated for obstructive sleep apnea, via either CPAP, oral appliances, or even with surgery. The problem is that no matter which option you choose, there will always be some degree of reflux. Taking acid reflux medications can help sometimes, but for the most part, these reflux medications don’t really do anything for reflux. All they do is to lower the acid content content before it comes up into your throat.

Other options include stimulating your stomach via natural remedies or prescription medications to empty your stomach much faster. One fascinating study showed that using a combination of pseudoephedrine (Sudafed) and a pro-motility agent (domperidone) eliminated snoring in most people. Unfortunately, we don’t have the equivalent of domperidone here in the US. Other similar medications are available, but have more serious side effects.

This is why eating early at least 3-4 hours of bedtime is so important whether or not you have obstructive sleep apnea. The same also applies to alcohol. If your nose is stuffy, talk with your doctor to find a way to breathe better through your nose. Make sure you’re sleeping in your preferred or optimal sleep position. Lastly, work with your sleep physician to fully optimize your sleep apnea treatment, no matter which option you choose.

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.

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.

In this Expert Interview, I talk with Michael Goldman, Sleep Health Evangelist and creator of SleepGuide.com. He and I discuss important and surely controversial topics related to obstructive sleep apnea, including:

- Should patients read their own data or make pressure change adjustments on their own?

- How much say should patients have in choosing their own machine types or masks?

- Do patients really need a doctor’s prescription before undergoing a sleep apnea test?

- And much, much more..

Click here to download the mp3 file.