Free Teleseminar Recordings: General Sleep Topics
September 2, 2010
Thanks for registering and for signing up for Dr. Park’ e-newsletters, special event alerts, and other relevant email notices. Scroll down to find the Expert interview you’d like to download. On the way, feel free to download any other related Expert Interviews on Sleep.
A Proven Solution For Your Sleepy Child with Dr. William Hang
An interview with premier pediatric orthodontist and palatal expansion expert Dr. William Hang, about the advantages of using orthodontics to straighten your child’s smile and improve his or her sleep. Listen to this riveting and enlightening discussion on pediatric, as well as adult sleep apnea that can help you and your loved one breathe, sleep, and live better. Click here to learn more about Dr. Hang and his California-based practice.
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How Bottle Feeding Poses Risk for Sleep Apnea in Infantswith Dr. Brian PalmerDr. Park interviews Dr. Brian Palmer, a dentist that has done extensive research on the suck and swallow mechanisms of natural breast-feeding. He talks about how bottle-feeding can aggravate dental malformations and development of obstructive sleep apnea later in life. If you have children or even if you’re in the planning stage, this is a MUST listen for any child care provider. Click here to learn more about Dr. Palmer.
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Discover the REAL Reason Why Your Teen Is So Sleepy with Dr. Kasey Li
Dr. Park interviews Dr. Kasey Li, a renowned Stanford researcher and clinician specializing in the treatment of sleep breathing disorders, on the #1 reason why sleepy teens are at higher risk for developing ADHD, obesity, and obstructive sleep apnea. Click here to learn more about Dr. Li.
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Treat Sleep Apnea With Tongue Exercises with Janet Bennett
Tongue exercises can be a noninvasive way of promoting muscle tone in the throat, which can be helpful for some people with snoring and obstructive sleep apnea. Listen to my interview with Ms. Janet Bennett, speech pathologist and creator of the I Just Want To Sleep website about her unique tongue exercise program.
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The Politics of Sleep Apnea with Mr. Edward Grandi
Many of you who suffer from obstructive sleep apnea are wondering why there’s little awareness even amongst many health care providers about this ever increasing health problem despite all the clinical research showing the effects of OSA can have on obesity, diabetes, heart disease, strokes, ADHD and on and on. In this interview, Mr. Edward Grandi, the President of American Association of Sleep Apnea explains why.
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Discover The Surprising Link Between The Neurological And Sleep Disorders with Dr. Mack Jones
Dr. Mack Jones, a neurologist ad the author of Deadly Sleep: Is Your Sleep Killing You? explains what he did to overcome his sleep apnea and to avoid the looming risk of Alzheimers.
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Find out the Latest Developments in Sleep Apnea Treatment with Dr. Steven Y. Park
There was a Sleep 2010 meeting in San Antonio, where all the top sleep researcher gather for their annual conventions.This is my roundup of the latest in sleep apnea treatments as well as to answer your specific questions about the topics that I report.
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10 Steps to CPAP Success with Aurelio Henriquez
Dr. Park’s Expert Interview with Aurelio Henriquez about how to best use your CPAP machine. Since 2002, Aurelio has helped hundreds of CPAP users overcome their struggles while he was with the NY Methodist Sleep Disorder Center as a Polysomnographic technologies and then later as the technical lab director for theColumbia University Sleep Disorder Center.
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Michael Goldman of SleepGuide.com, Sleep Health Evangelist
In this interview I talk with Michael Goldman, Sleep Health Evangelist and creator of SleepGuide.com. He and I talk about important and sure to be 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…
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Why Mothers Are So Tired
May 21, 2010
Mother's Day has come and gone, and despite the short respite that many mothers received from their loved ones, most mothers are in a constant state of exhaustion. There are many explanations for why this is so, including the demands of modern society, family, career, and so on. But as many fathers will argue, these are the same issues and challenges they face. For women however, there are a number of internal, or physiologic factors that can not only contribute to but sometimes cause women, more so than men, in general to be tired all the time.
Blame It On Hormones…Or Your Anatomy?
We all know about hormonal issues, which has been blamed for everything from PMS and menopause to infertility issues. But one relatively unknown fact that most doctors don't know about is that progesterone is an upper airway muscle dilator. Essentially, it stimulates the tongue, giving it more muscle tone. How is this relevant to how much energy you have?
Modern humans have a number of anatomic issues that makes us predisposed to breathing pauses at night, especially when in deep sleep, due to muscle relaxation. Since our voice boxes are lower in the neck beneath the tongue, our tongues can fall back easily due to gravity, especially when on our backs. Add REM sleep (the dreaming stage) along with muscle relaxation, and the more likely you may stop breathing.
Modern humans are thought to have shrinking jaws with dental crowding due to a major shift in our diets. We went from eating completely off the land (ripping, shredding, grinding, chewing) to eating soft, mushy foods with relatively little nutritional value. Bottle-feeding (another modern, Western invention) is also thought to aggravate dental crowding and malocclusion. The smaller the jaws, the less room there is for the normal-sized tongue, which predisposes it to breathing obstruction at night.
So the less progesterone you have, the more likely your tongue will relax and obstruct your breathing, causing you to wake up and turn over. This condition prevents you from staying in deep sleep. Most people with this condition will naturally like to sleep on their sides or stomachs to compensate.
Life Changes That Aggravate Deep Sleep Deprivation
There are a number of life changes in a woman's life that promote more frequent obstructions and arousals, leading to increased fatigue and tiredness. During a woman's monthly periods, estrogen and progesterone cycles up and down. The week before she has her period, progesterone drops, leading to a temporary state of deep sleep deprivation, leading to a low-grade state of physiologic stress. This also causes a heightening of the involuntary nervous system, leading to heightened senses, irritability and moodiness.
During pregnancy, progesterone naturally increases significantly. As women gain 20 to 40 pounds during pregnancy, they would be expected to develop sleep apnea, but most don't. One major reason is that progesterone helps to protect the upper airway, by tensing the tongue, despite the added throat narrowing from weight gain. But once mom delivers, progesterone drops, and she's left with all the weight. This only adds to the chronic fatigue, depression and problems with weight loss in the post-partum period for most women.
Similarly, long before menopause begins, progesterone begins to slowly drop beginning the late 30s and early 40s. This leads to a slow and gradual lessening of the woman's sleep efficiency. Later on as the drop intensifies, the relative changes in the involuntary nervous system causes the typical symptoms of menopause such as night sweats, hot flashes, mood swings, weight gain and irritability. Once the hormonal changes stabilize, the symptoms get better.
The Effect of Estrogen Dominance
Like everything else in life, balance is key. The relative proportions between estrogen and progesterone has a huge impact on a woman's sleep quality. With the advances in science, medicine, and industrialization, this delicate balance between these two hormones has been significantly altered.
One major shift comes from oral contraceptives. Despite the potential benefits of birth control pills, having excess estrogen of any type can suppress progesterone levels or functional status. Synthetic variants of estrogen are much more powerful than what the body normally makes. There are various combinations of synthetic and bio-identical estrogens and progesterones that are used, but it's safe to say that the overall relative balance is never perfect.
In addition, many of the byproducts of industrialization produces chemicals that can mimic estrogen. Up until recently, Bisphenol-A (or BPA) has been used in plastics that are found in most plastics, including baby bottles. BPA and many other chemicals are though to leech into our environment, acting as endocrine disruptors. There are various reports of earlier onset of puberty and breast development (premature thelarche) in young girls compared with even 10 years ago.
Blame It on Stress
One of the major consequences of inefficient sleep is a physiologic form of stress. Your body thinks it's under attack all the time. This causes hormonal and neurologic changes that not only increases cortisol, it also heightens your involuntary nervous system. It also makes you more hungry in general, with cravings for fatty, sugary or high-carb foods. This can lead to weight gain, which is hard to get rid of since you're not sleeping well.
Your body also doesn't care where stress comes from. Modern life is full of stresses including family and career obligations, along with the typical financial and health considerations. Any degree of external stress whether it's physical, psychological or emotional stress, can also aggravate any internal stress that's going on.
This is why you should do whatever you can do to help your mother feel loved and more relaxed. Mothers have lots of reasons to feel stressed, sleep deprived, and just plain tired all the time. Now you know the reason why.
Why Is Your Teen So Sleepy? The Answer May Surprise You
April 21, 2010
Looking back at my teen years at Stuyvesant High School in the mid 1980s, it's amazing what I was able to accomplish: Beside the rigors of academics, I was in the symphonic band, orchestra, jazz band, captain of the track team, and a major science geek, entering and placing in various prestigious competitions, including reaching the semi-finals of the Westinghouse Science Talent Search (now renamed Intel). I also remember having the hardest time getting up in the mornings, since I had to commute over an hour by public transportation to get to school. Many of my friends had to travel much further and had even more impressive activities.
Late To Bed, Early To Rise
It's almost a given that if you have a teenager, he or she will be sleepy, especially in the morning. Various experts describe teens' hectic schedules as a major cause of their sleepiness. One particular explanation is that teens' sleep cycles are shifted later into the night, going to bed later and waking up later. But because most of our schools begin at 8AM, teens have to get up hours before their normal wake times. But can there be an alternative explanation to why their sleep times are shifted and why they have trouble getting up in the morning? Is their delayed sleep time a natural part of their development, or is it an artificial product of modern society?
My sleep-breathing paradigm proposes that all modern humans are susceptible to breathing problems while sleeping due to our smaller jaws. Coupled with this paradigm, there are also various developmental and anatomic changes that teens undergo that can explain why teens are so sleep deprived, and why paradoxically, they can be extremely active and productive during the day.
In my book, Sleep, Interrupted, I describe a phenomenon where due to a major change in modern humans' diets along with the invention of bottle-feeding, our jaws are getting smaller with more dental crowding. Another variable that compounds this problem is that we're able to talk and communicate—this make our tongue prone to collapse, especially when on our backs and in deep sleep (due to muscle relaxation).
Growing Up Can Cause Sleep Problems
Throughout life, there are various accelerated periods of growth or change with our voice boxes as it relates to our upper airways. This first period occurs between 4-6 months, when the voice box separates away from the soft palate, creating a uniquely human area in the throat called the oropharynx. The oropharynx is the space that's behind your tongue, between the tonsils and below the soft palate. Humans infants, who are born able to breathe and suckle at the same time, have to relearn this process during this timeframe. Interestingly, this is also the period of time when SIDS (sudden infant death syndrome) peaks.
The Tonsil Dilemma
During ages 3 to 6, childrens' tonsils grow significantly larger, and not too surprisingly, this is also the time period in which tonsils are most frequently removed, especially for snoring and obstructive sleep apnea. Once tonsils (and adenoids) are removed, most children do well, but recently, we're realizing that this is not necessarily the case.
The problem is that removing tonsils and adenoids only addresses part of the problem—it doesn't address the smaller jaws that these children have. Having smaller jaws means that the tongue can fall back easier and cause more of a vacuum effect in the throat that suctions up normal stomach juices into the throat, causing the tonsils to become even larger. This creates more obstructions, preventing the jaws from widening and developing more fully. This is why rapid palatal expansion alone was found to be equivalent to tonsillectomy, and doing both gave additive results.
Let's say that your child's large tonsils were removed, but the jaws never fully developed properly. Most young teens will eventually need braces to correct for crowded teeth. Unfortunately, most orthodontics is focused on straightening teeth, rather than enlarging the airway.
As your child goes through puberty, an obvious thing also happens: his or her voice becomes lower. One major consequence of a deepening voice is that the voice box has to drop in the neck. This opens up the oropharynx even further, creating even more space for the tongue to fall back. This process continues into early adulthood, where the voice box settles in its' final location (it's been shown that the voice box continues to drop an additional 1/2 vertebral body length slowly even up to age 70).
Delayed Sleep or Deficient Sleep?
As your teen undergoes this transition, by definition, sleep quality diminishes, with various consequences, both good and bad. Because they're not able to sleep efficiently, it's hard to get out of bed in the morning. To compensate for their fatigue, they tend to participate in numerous activities throughout the day, including sometimes very physical sports. I've also commented in my book about a possible connection between mild sleep deprivation and creativity promotion, since your senses are heightened. After a full days worth of school and after-school activities, they'll have dinner and then have another few hours of homework to tackle.
With this schedule, it's not surprising that most teens don't get to bed before 11 or 12 PM, if not later. If you add to this all the media distractions like the computer, phones and television, they'll get even less sleep. Eventually, they crash, and are forced to wake up earlier than they want to to begin the next day. When I was is high school, I didn't have that much homework, so I usually went to bed at a reasonable time, around 9 to 10 PM. These days, I'm sure that teens probably go to bed much later than this. Their minds are so wired at night that it's difficult to go to bed earlier. In essence bad sleep hygiene such as this can lead to delayed sleep times, similar to many adults with delayed sleep phase syndrome.
An Explanation For The Freshman 10
If one or both parents snore or have documented obstructive sleep apnea, the teen has a higher risk of having sleep apnea as well, or developing it later in life. For some reason, sleep apnea in teens is not seen too often. But I'm willing to bet that it's a major problem that's not being addressed. Similar to the natural anatomic changes that occur during menopause, adolescence is a period of change in the sleep-breathing status that can cause paradoxical patterns of moodiness and irritability, along with intense creativity and productivity.
Notice that the incidence of depression and anxiety also begins to spike in the late teens and early adulthood. Imagine taking a teen out of his protected home environment with regular, healthy meals and place him suddenly in college where he'll binge in the cafeteria, stay up late, and even drink alcohol.
All this can lead to, or aggravate underlying sleep-breathing problems. Since inefficient sleep causes weight gain, and weight gain can narrow the throat, all this is not surprising. Perhaps the freshman 10 weight gain is an expected consequence of this expected life transition (an anatomic transition) that can unmask any underlying sleep-breathing problems.
More Breastfeeding Could Save $13 Billion
April 15, 2010
It's common knowledge that breastfeeding is better for your baby compared with formula, and this new study estimated a figure on dollars saved if 90% of new moms breastfed exclusively for 6 months: $13 Billion. The results are not too surprising. One criticism that was mentioned was the fact that there are costs involved in breastfeeding, including unpaid time off work and lost productivity. This is an important issue that our society has to grapple with: What's more important—job productivity and wages that pay for food, or having a healthier baby?
What they found was that 3/4 start out breastfeeding initially, but at 3 months, less than 1/3 are breastfeeding. The excess annual cost associated with poor levels of breastfeeding compared to the ideal 90% compliance rate was: $9.1 Billion (991 estimated preventible deaths due to SIDS, necrotizing enterocolitis, and lower respiratory tract infections). The remaining amounts were due to otitis media, atopic dermatitis and childhood obesity.
What I discovered after reading the full article was interesting—to define breastfeeding, they asked survey respondents if they have “ever breastfed or fed breast milk.” Exclusivity was defined as the following: "…not having fed anything other than breast milk, including water, in- fant food, juice, formula, cow’s milk, or sugar water." What's clear is that either natural feeding from the mother's breast, or pumped milk from the mother is defined as breast feeding.
There are many dentists and lactation experts that would argue that there's a big difference between the two. Dr. Brian Palmer has argued convincingly that feeding from the mother's breast protects against developing obstructive sleep apnea. In other words, bottle-feeding can aggravate malocclusion and dental crowding. If you notice the various related illnesses in the study, they are all potential complications of untreated obstructive sleep apnea. Something to think about.
What's your take on this issue? Please enter your comments in the text area below.
Why Sleep Loss Can Make You Gain Belly Fat
February 5, 2010
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Dieting and weight loss has surpassed baseball as America's national pastime. It's estimated that 2/3 of all Americans are officially overweight, and 1/3 are obese. Besides the routine bulges that you see on the outside, the presence of visceral fat (or belly fat)—not the flabby fat under the skin that you can grab—but the fat deep within your abdomen that's attached to your intestines, is thought to increase your risk of heart disease, diabetes, metabolic syndrome, high blood pressure, colon cancer, and in women, breast cancer.
With all the news about the importance of belly fat as a risk factor for heart disease and other medical conditions, it's almost gotten to the point where the press and the lay public perceive belly fat as a cause of all these various medical condition, rather than just an association. The real question is, what causes belly fat to begin with?
The Link Between Stress and Belly Fat
Any type of stress, whether physiologic, or external, can cause dramatic changes in your physiology. The sympathetic nervous system, or the classic fight or flight response, is activated when you're under stress. This in turn diverts blood flow away from less essential body parts and organs, such as your gastrointestinal system, your reproductive organs, your skin and distant extremities. It’s like if you were being chased by a lion—every nerve and fiber of your being will be focused on getting away, not on digesting what you had for lunch.
Although you’re probably not being chased by a lion, any type of prolonged periods of stress which results in low blood flow to the intestines causes biochemical changes that lead to accumulation of belly fat. It's also thought that increased estrogens created by belly fat further suppress the natural progesterone levels in both men and in women, aggravating the vicious cycle even more.
Poor Circulation Can Cause Belly Fat
You don't need a serious medical condition to cause these rapid changes in intestinal blood flow. Even your emotional state, and the various life stresses that you experience every day can significantly affect the rate of blood flow to your stomach and your intestines.
Researchers have found that periods of low oxygen in the intestines can cause biochemical changes that lead to fat accumulation. Is this low oxygen level the result of the standard atherosclerosis that's seen with cardiovascular disease as we get older, or can there be something else? Is there anything else that can cause intestinal hypoxia?
How Your Jaw Size Can Affect Your Waist Size
As I describe in my sleep-breathing paradigm, modern humans have difficulty breathing properly while sleeping at night, especially when on our backs and when in deep sleep, due to muscle relaxation. This is from a slow but significant narrowing of our jaws, due to a major change in our diets and with the addition of other feeding tools, like infant bottles and pacifiers.
The smaller the jaws, the less room there is for the tongue, and the more likely it'll fall back during deep sleep, especially when lying flat and in deep sleep. Depending on how often this tongue collapse obstructs our breathing at night, we all fall somewhere along this continuum, where the end extreme is officially called obstructive sleep apnea. It's not surprising that periods of interrupted breathing, whether very brief or pauses of 10 to 30 seconds (apneas), is known to cause physiologic states of stress.
And this sustained form of stress can in turn, slow down our metabolic rate making it difficult to lose weight if not gain it.
Hormones and Weight Gain
In women, there is yet another major variable that can cause you to gain weight as you get older, and that's the role of diminishing progesterone, which begins during the late 30s and early 40s.
Progesterone is a major upper airway muscles stimulant, which essentially tenses or stiffens the tongue, especially when in deep sleep. This is why as the levels of progesterone diminish during perimenopausal age, women begin not to sleep as well as they did before the onset of menopause. A relative change in a woman's sleep-breathing status can then lead to neurologic symptoms, such as night sweats, hot flashes, weight gain, mood swings, and irritability. Not too surprisingly, these same symptoms can be seen even in young men who are moving up the sleep-breathing continuum. Lack of deep or efficient sleep is a major cause of physiologic stress.
Sleep Your Way to Weight Loss
A recent article in Glamour magazine profiled 7 women who where all slightly overweight, and asked them to do one thing for 4 weeks: sleep more. Without making any other changes, they all loss anywhere from 7 to 21 pounds. Sleeping longer is one way to restore health in our sleep deprived culture, but increasing sleep efficiency while you sleep is another way to increase your energy levels, improve your health, and lose weight more easily.
Not Only Your Breathing Problem
Not being able to breathe well at night while sleeping, and not sleeping long enough are important factors to address, but there are many other factors that also prevent you from achieving the quality sleep that you need: Eating late close to bedtime is a common modern ritual that occurs for a variety of different reasons. Gastric juices still lingering from your last meal (or snack) can be suctioned up into the throat, causing more swelling and inflammation, causing more obstructions and arousals. Drinking alcohol close to bedtime causes your throat muscles to relax more, leading to more frequent obstructions and arousals, as well as louder and more frequent snoring.
The Right Way to Lose Weight
Before you begin that new diet plan, or take advantage of your new gym membership, make sure that you're able to breathe properly at night. If your nose is stuffy for whatever reasons, do everything possible to straighten it out first. If you've had a stuffy nose for years or decades, you may not realize that your nasal breathing is compromised. Proper sleep and lowering your stress levels is critical to getting rid of that excess belly fat.
Do You Really Grow Out Of Your Tonsils? The Possible Link Between Sleep Apnea and Autism
January 18, 2010
In the 1950s to 1970s, it used to be a rite of passage for young children to get their tonsils taken out. These days, we're a lot more conservative with tonsillectomy, and frequently, parents are told that their child will grow out of their tonsils. While this is true in some cases, there's a consequence to the watching and waiting option.
Your tonsils are lymphoid tissue that's part of Waldeyer's ring, which is a ring of lymphoid tissue made of the palatine tonsils (your typical tonsils), the adenoids (in the back of the nose), and the lingual tonsils (at the base of the tongue in the midline). In some children with overdeveloped lymphoid tissues, you'll see a communication between all four of these glands, forming a complete circle. These tissues are normally involved in educating your immune system, since everything you breathe or swallow has to go through this ring. As a result, it's expected that the tonsils (and adenoids) will be enlarged during the ages of 3-5.
However, with the shrinking size of modern human jaws, now there's less room for the normal-sized tonsils, which takes up relatively more space. This aggravates more frequent obstructions and arousals, leading to more inflammation from refluxed stomach contents and more swelling of the tonsils. The chronic negative pressure created from this process can prevent proper jaw enlargement, similar to what can occur with bottle-feeding. In many children, their snoring and sleep problems will prompt the parents to see an ENT for tonsillectomy. For children with mild to moderately enlarged tonsils that are not causing any symptoms, or those that are symptomatic but are told that they'll outgrow it, there can be permanent long-term consequences.
In children with huge tonsils, one of the reasons why they look so big is that the space that the tonsils sit in is too narrow. Taking out the tonsils can make a dramatic difference is most children, but there are some children that won't respond to tonsillectomy or only partially. One recent meta-analysis showed that adenotonsillectomy was helpful in about 2/3 of all children. But the remaining 1/3 still had residual symptoms or signs of obstructive sleep apnea. These are the children that have smaller jaws than the children who responded to the procedure.
In a recent Stanford University study, children who were scheduled for tonsillectomy were divided into two groups. One group underwent standard tonsillectomy, and the other under went rapid maxillary palatal expansion. The results were equivalent for both groups. When children in both groups were crossed over and given the other procedure, the overall results were additive. This just goes to show that one reason why you can have large tonsils that that your jaw is too small. Of course, everyone is on a continuum, and as usual in modern medicine, you're treated only if you are at the extreme end of the continuum.
This is pure speculation, but I wonder if the significant increase in the rate of ADHD in the 1980s and 1990s could be related to the dramatic decline in the rate of tonsillectomies. Furthermore, since the peak incidence of autism is around ages 3-4, it's interesting that this is also the time that the tonsils become enlarged in most children. If you have enlarged tonsils to begin with, any simple cold or infection (even vaccines!) can cause swelling which starts a vicious cycle, leading to a sudden increase in breathing problems and poor sleep. Sleep apnea by definition causes systemic inflammation and an increased susceptibility to form microscopic clots in the brain.
This is also the time (around age 4) when the voice box reaches its' final position below then tongue as it descends from its' original position behind the tongue. A space is created behind the tongue and between the soft palate and the epiglottis called the oropharynx, which exist only in humans, and allows for complex speech.
One last interesting phenomenon to point out is that in the early 1990s, parents were recommended to place infants on their backs, to prevent SIDs. We know that back sleeping lowers your time spent in deep sleep and leads to more frequent arousals.
All these factors taken together may be what's developed into the "perfect storm," leading to the dramatic rise in ADHD and autism in our current times. Obviously, there are many other dominant theories for ADHD and autism, but from a sleep-breathing standpoint, what I propose is something that definitely needs to be proven in clinical studies.
What do you think about all this? Please enter your responses in the comments box below.
Can Sleep Apnea Cause Celiac Disease?
December 30, 2009
I know that the topic of this post may inflame a lot of readers out there, but please hear me out.
Celiac disease is a well-defined autoimmune condition that was originally described in children with chronic, severe gastrointestinal symptoms (diarrhea, cramping, abdominal pain and bloating). It’s known to exist in around 1/100 people in this country (97% don’t know they have it), and it’s responsible for various non-gastrointestinal symptoms, including a specific skin rash called dermatitis herpetiformis, migraines, ADHD, numbness, depression, chronic fatigue, and seizures. Others have reported a link between celiac disease and migraines, PCOS, and infertility. Only 1 out of 6 people have classic abdominal and gastrointestinal symptoms. For unexplainable reasons, the incidence has increased 4 time in the past 50 years.
The theory behind this widespread condition is that the in susceptible people, antibodies in the small intestines attack gluten, a common protein in wheat-based food. Humans don’t have the enzyme to digest gluten, so it passes harmlessly, but in people with celiac, an immune response is created which causes severe inflammation in the small intestines, leading to the classic symptoms. The only known effective cure is to avoid eating anything that contains wheat, in favor of alternatives such as rice, flax, oats, quinoa, teff, and buckwheat.
People who are eventually diagnosed and who go gluten free have remarkable success stories, with more awareness within the medical community and the lay public. One proposed explanation as to why this condition is so underdiagnosed in the US compared to other developed countries is that there’s no pharmaceutical drug that treats this condition, and that in other countries with centralized medical systems, prevention is stressed, rather than just treating the symptoms.
So far, pretty basic information, right?
Here’s my take on celiac disease: For the past few years, whenever I see patients with known celiac disease who come to see me for various ear, nose and throat symptoms, they all have various degrees of sleep-breathing problems. Almost invariably, they have small jaws, cold hands, can’t sleep on their backs, are tired all the time, and have at least one parent that snores heavily. If you look at the space behind the tongue, the airway is extremely narrow. I’ve always suspected that there’s a link between celiac disease and a sleep-breathing disorder such as upper airway resistance syndrome, but I’ve been waiting to accumulate enough studies and evidence before adding celiac disease to my sleep-breathing paradigm.
Various other gastrointestinal conditions have been linked to sleep-breathing problems such as irritable bowel syndrome, Chron’s and ulcerative colitis, so why not celiac? Remember that with upper airway resistance syndrome (UARS), repeated micro-obstructions and arousals prevents deep sleep, which causes a chronic low-grade physiologic stress response. Stress shuts down blood flow to the intestines, which leads to the food just sitting in your intestines without proper digestion and nutrient absorption. After a while, the food becomes an irritant, which causes an inflammatory reaction, creating antibodies in the process, and food being rapidly expelled in the form of diarrhea. Chronic low-grade stress heightens your nervous system and immune system, where your body tends to over-react to normal stimulants or irritants. Just like in the nose, not only will you have an allergic reaction, you’ll also have a nervous system reaction (since your gut has a lot of nerves).
It’s no surprise that every symptom that you see with celiac disease is also seen with upper airway resistance syndrome, including hypothyroidism, migraines, PCOS, dizziness, low blood pressure, and cold hands. There’s even anecdotal evidence that breastfeeding lessens the chance that you’ll develop celiac, which is consistent with what I’ve been saying about how bottlefeeding can increase your risk of upper airway resistance syndrome and obstructive sleep apnea.
I’m not discounting the significant strides made in celiac disease research. There needs to be more awareness and more screening to treat this all-too-common condition. However, even when people go on completely gluten-free diets, they continue to have many of the various other non-gastrointestinal symptoms, including chronic fatigue, migraines, and poor sleep. The way I see celiac is that it’s kind of like a bad allergy, where your main reaction occurs in the intestines. Removing gluten definitely can help, similar to removing a cat from your house if you’re strongly allergic. But ultimately, you’re not treating what’s making you allergic in the first place. Celiac is possibly one of the early signs of an underlying sleep-breathing disorder, just like hypertension, ADHD, depression and heart disease. In modern medicine, we only tend to treat the end result, rather than the cause.
If you have celiac disease, ask yourself the following:
1. Do you prefer to sleep on your side or stomach?
2. Are you tired, no matter how long you sleep?
3. Do you have cold hands or feet?
4. Do you get frequent sinus headaches or nasal congestion?
5. Do either of your parents snore heavily?
What’s your take on my theory? Please enter your feedback in the comments box below.
Attention All Mouth Breathers – 5 Important Reasons Why You Must Breathe Through Your Nose
December 1, 2009
If you’re a chronic mouth breather because of a stuffy nose, you’re not alone. As the weather chills and allergies and colds abound, and nasal congestion becomes a common trend, mouth breathing inevitably follows-especially when you’re sleeping. I’m sure you’ve seen many passengers asleep on the subways and trains, head and pitched back, mouth wide open, and snoring louder than a diesel engine. Mouth breathing can surely ruin your social image, but that’s nothing compared to the havoc it can wreak on your health.
5 Potent Benefits of Breathing through Your nose
One of the most important reasons to breathe through your nose is because of a gas called nitric oxide that’s made by your nose and sinus mucous membranes. This gas is produced in small amounts, but when inhaled into the lungs, it significantly enhances your lung’s capacity to absorb oxygen, increasing oxygen absorption in your lungs by 10-25%. Nitric oxide also can kill bacteria, viruses and other germs. This is why you often hear fitness and yoga instructors emphasize inhaling and exhaling through your nose during workouts.
Also, if you can’t breathe well through your nose, your sense of smell will suffer and therefore your sense of taste, since your smell and taste buds are connected. This can lead to disturbances in your appetite and satiation levels, wreaking havoc on those struggling with weight issues.
Your nose also has vital nervous system connections to your lungs and heart. Not breathing well through your nose can alter your heart rate and blood pressure, as well as increase your stress responses.
Your nose makes about 2 pints of mucous every day. If your nose isn’t working properly and mucous isn’t cleared, the stagnant mucous can lead to infections such as sinusitis or ear infections, not to mention bad breath.
Lastly, not breathing well through your nose can aggravate snoring or obstructive sleep apnea. Nasal congestion alone doesn’t cause obstructive sleep apnea, but it can definitely aggravate it. If your palate and tongue structures are predisposed to falling back easily due to sleeping on your back and muscle relaxation in deep sleep, then having a stuffy nose can aggravate further collapse downstream. Untreated obstructive sleep apnea can lead to chronic fatigue, depression, anxiety, weight gain, high blood pressure, heart disease, heart attack and stroke.
Knowing all these benefits of breathing through your nose, however, doesn’t help much if you don’t know why you’re not able to do so. To stop mouth breathing, the first thing you must do is to figure out what’s blocking up your nose.
What Can Stop Up Your Nose
Nasal congestion is something everyone experiences now and again. Yet, if you’re trying to prevent this from happening it’s important to explore the various reasons behind why and when this occurs.
Here are five of the most common reasons for a stuffy nose:
"I Have a Deviated Septum"
By definition everyone has a slightly crooked (deviated) nasal septum. There are various reasons for having a deviated septum, including trauma, but the most common reason is no reason at all. It’s just the way your nose developed. What’s more important than how deviated your septum is is what’s happening in front of an around your septum.
Wings in Your Nose
Turbinates are wing-like structures that attach to the sidewalls of the nasal cavity, opposite the midline nasal septum. They normally smooth, warm, humidify, and filter the air that you breathe, but they also become enlarged and produce mucous when inflamed. Turbinates also swell and shrink alternating from side to side, which is a normal neurologic process called the nasal cycle.
Is It An Infection or Allergies?
If you have allergies, a cold or any kind of infection, then your turbinates will swell up, clogging your nose with lots of mucous production. Contrary to popular belief, the color of the mucous has no relation to bacterial vs. viral infections.
Flimsy Nostrils
Once you have inflammation and swelling inside your nose, for some people, depending on the configuration of your nose, your nostrils can literally cave in as you inhale. Different noses have differently shaped nostrils with various nostril thicknesses. The more narrow your nose, the more likely your nostrils can cave in. People who undergo cosmetic rhinoplasty are more at risk years later, since narrowing the nose can weaken the support structures of the nose.
A Nervous Nose?
Some people’s noses are extra sensitive, especially to weather changes, like temperature, humidity, and pressure changes. Certain chemicals, scents and odors can set off a reaction as well. Many people mistakenly think this reaction is an allergy, but it’s really your nasal nervous system over-reacting to the weather or to odors. One of the most common reasons is from poor quality sleep, which causes a low-grade stress response, which can heighten your senses.
It’s All Under Your Nose
A chronically stuffy nose doesn’t happen by itself. Usually it’s part of a bigger picture, where the entire upper and lower jaws are more narrow and constricted, in addition to more narrow nasal cavities. I’ve described this process in my book, Sleep Interrupted, where due to modern human’s eating soft, mushy, processed foods, our jaws are much more narrow than normal, with dental crowding. Bottle-feeding, which is another modern, Western phenomenon, is also thought to aggravate this problem.
If you have a stuffy nose, it can also aggravate soft palate and tongue collapse when in deep sleep, due to muscle relaxation. With more obstruction, more stomach juices are suctioned up into the throat and nose, causing more swelling and more nasal congestion. All this from smaller and more narrow jaws.
Can Bottle Feeding Increase the Risk of Sleep Apnea?
November 12, 2009
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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The Hidden Truth About Allergies Revealed
October 27, 2009
Everyone knows that allergies cause sneezing, itchy, watery eyes, and nasal congestion and that for some people these symptoms can be more severe than for others. For these people allergies can feel like a curse, making them feel sleepy, irritable and downright miserable. There are many medical explanations for allergies, including the theory that the body is overreacting to the typical allergens.
But there’s one other reason why some people with allergies are more affected than others, and this has to do with their jaw size. If you had normal-sized jaw anatomy, then it’s less likely an allergy attack would bother you; in fact, it’s less likely you’ll even have allergies in the first place. Let me explain.
Why Your Jaw Size Matters
If you have smaller than normal jaws, it means that there’s less space for your tongue, so it takes up relatively too much space, especially when you’re on your back due to gravity. Even worse, whenever you’re in deep sleep, due to muscle relaxation, you’ll stop breathing to wake up and turn over. During these breathing pauses, a vacuum effect is created temporarily, which literally suctions up your normal stomach juices into your throat and nose. It’s been shown that stomach bacteria and digestive enzymes can be found in sinus and lung washings. This leads to inefficient sleep, which eventually makes your nervous system and immune system overactive.
This is why it’s important to avoid eating too close to bedtime. The more juices you have in your stomach, the more it’ll come up and cause nasal inflammation. And since alcohol is a strong muscle relaxant, indulging in a glass of wine before bedtime can make you stop breathing more often and cause more stomach juices to come up into your throat, in addition to heightening your immune and nervous systems.
What You May Not Know Will Surprise You
Sometimes, what seems to be allergy symptoms may not be related to allergies at all. Whether or not your allergy testing is positive, you may be suffering from non-allergic rhinitis or chronic rhinitis, which is linked to sleep breathing problems or silent acid reflux (LPRD). With non-allergenic rhinitis, your nose becomes sensitive to temperature, pressure, humidity changes, chemicals, odors, and emotions. Non-allergic rhinitis responds somewhat to allergy medications, so you may think you have an allergy problem.
One of the most under-appreciated things that most allergy sufferers (and doctors) don’t think about is getting a good night’s sleep. It’s been shown that lack of quality (or quantity of) sleep can adversely affect your immune system through the following mechanism: a low-grade physiologic stress response is created which heightens your immune system, making it over-react to common pollens or other allergens. (The same process occurs with your nervous system, too). So how does this relate to allergies?
Hay Fever Defined
Hay fever (or allergic rhinitis) results in congestion, sneezing, runny nose, irritated eyes and other annoying symptoms for more than 35 million Americans every year. It occurs when your body has an allergic reaction to something in your environment. During this time of the year, ragweed is the most common cause of hay fever, though mold, pet dander, dust mites and cockroaches can also cause allergies year-round.
When your body comes in contact with these allergens, your immune system kicks into overdrive. At the initial allergen exposure, the body creates an antibody called immunoglobulin (IgE), which rests on a type of white blood cells called mast cells. After repeated exposure to the same allergen, a massive release of histamines and other inflammatory mediators occurs. The end result—runny nose, watery eyes and sneezing.
When Allergies Cause You Misery
Obviously, a little sneezing and congestion never hurt anyone. For most people, these symptoms are no more than a mere nuisance and most can get by without any medications or for others, simple over-the-counter medications (see chart). However, some people with allergies feel completely miserable, with poor sleep and severe daytime fatigue.
As I alluded to in my book Sleep, Interrupted: A physician reveals the #1 reason why so many of us are sick and tired, anything that causes swelling or inflammation in your nose or throat can set off a vicious cycle where due to narrowing of the upper air passageways, the soft tissues of the throat (palate and/or the tongue) start to obstruct your breathing, which creates a vacuum effect in your throat that suctions up normal stomach juices into your throat. This causes more swelling and inflammation in your throat and nose, aggravating this self-perpetuating cycle.
Steps You Can Take
During allergy seasons (trees during the spring, ragweed during the fall, molds all year round), there are a number of conservative step you can take to lessen your symptoms, to more formal medical treatments:
● Stay indoors during high pollen counts with air conditioning (check pollen counts on pollen.com)
● Wash your hair before going to bed if you’ve been outdoors during the day. You don’t want to rub your face on your pollen-contaminated pillow all night long
● Most plants release pollens in the early morning, so if possible stay indoors until after 10AM. Pollen and molds can also be high in the late afternoon and early evening hours
● Wash your bedding every week in very hot water
●Invest in allergy-free bedding (if you’re allergic to dust mites)
● Try the Asian custom of taking off your shoes before entering your living spaces. Think about all the microscopic dust, pollen, molds and dirt that get tracked into your house, where your toddler is crawling on.
● Invest in a HEPA filter for your bedroom
● Keep pets out of the bedroom
● Remove rug or carpeting from the bedroom
● Finish eating at least 3-4 hours before bedtime
● Avoid alcohol within 3-4 hours of bedtime
● Regularly practice yoga, breathing, tai chi, or some form rhythmic meditative breathing (which also includes swimming).
A few natural and/or herbal remedies include:
● Regular irrigation with nasal saline. There are many options, including a Neti-pot, saline sprays, mists, pumps and squeeze bottles. The key is to find something you’re comfortable with that you’ll use every day. ●
Butterbur and stinging nettle extracts are two herbs that have anti-allergy properties. You can find them at any health food store or order them online. If the above conservative options are not good enough, you can try any of these over-the-counter allergy medications:
● Loratadine (brand name Claritin, Allavert, etc.) or Zyrtec. Zyrtec is stronger, but has a slightly higher chance of making you drowsy. If you take it regularly at night before you got to bed, this any potential drowsiness won’t be an issue and this effect wears off after a few days. ● Diphenhydramine (Benadryl). This is an older, stronger antihistamine, which can definitely make you drowsy. It’s also used to severe allergic reactions and rashes.
● Oxymetazoline (Afrin) can be used for severe nasal congestion only occasionally and should be used no more than 2-3 days at a time.
If you also have nasal congestion, then you can get the "-D" version of the various antihistamines. The D stands for decongestant, which is usually an oral version of phenylephrine or pseudo-ephedrine. This can sometimes be stimulating, so if you’re sensitive to these medications, don’t take it just before bedtime. If you have high blood pressure or a heart condition, talk to your medical doctor before taking these specific medications.
There are a number of prescription medications for allergy: Allegra (which should be coming out over-the-counter soon), nasal steroid sprays (Flonase, Nasonex, Rhinocort, Nasacort, Veramyst), and Singulair. Astelin is an antihistamine nasal spray. Different people respond differently to each of these medications, so it’s important to talk to your doctor about which one may be right for you. My preference for moderate to severe allergies is to use one of the topical nasal steroid sprays on a regular basis, since it works much better at preventing allergies, as well as treating it. In general, these sprays are not absorbed into the body in significant amounts and can be used for long periods.
Allergy shots (immunotherapy) are another option that you may want to consider if your allergies don’t respond to medications or if you don’t want to depend on medications as much. With immunotherapy, the sufferer receives regular injections of purified allergen extracts for between two to five years. The goal of immunotherapy is to rewire the immune system so it no longer overacts to allergens and causes hay fever.
Putting It All Together
If you have an underlying sleep-breathing problem such as obstructive sleep apnea or upper airway resistance syndrome (most people to some degree—I explain why in my book, Sleep, Interrupted), then it’s likely that you’ll have some kind of allergies or nonallergic rhinitis, whether mild or severe. Not only will your nose be overly sensitive to allergens or weather changes, it can also be irritated by your stomach juices.
This process supports observations that children who were bottle-fed as infants have higher rates of allergies later as children. It’s been suggested that bottle-feeding promotes jaw narrowing and dental crowding, which leads to smaller airways. This occurs despite the protective effects of the mother’s antibodies in breast milk, since it may be given in a bottle. So the next time you suffer from seasonal allergies or even year-round allergies, resist the temptation to simply take a pill. Go down the list of conservative options I’ve outlined, and most importantly, optimize your sleep quality. Any activity that’s calming and relaxing to your nervous system (yoga, breathing exercises, tai chi, swimming) can also help to alleviate your symptoms. Many of you will be surprised to find that conservative and simple lifestyle changes can lead to many more allergy-free, symptom-free days.
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