Flu Shots, Hutterites, and Sleep Apnea

It seems that even in very closed communities, flu vaccinations can help to lower the rate of influenza infections. A recent NY Times article described a study that revealed that widespread flu vaccinations in Hutterite schoolchildren resulted in lower rates of infection throughout the community, including adults. The population that received the vaccine had about a 5% rate of infection, whereas the placebo group had a 10% rate of infection. 

 

Regardless of the implications of this study, what caught my eye were the pictures. In the article, the two children and woman's faces were nice and wide. I went on to google other pictures of Hutterites, and by a wide margin, most of the adults and children have very wide jaws and facial structures. This is in contrast to regular urban people (especially younger adults and children) with more narrow faces and small jaws. Small jaws means less room to breathe at night due to narrowing of the space behind the tongue.

 

This makes sense since secluded communities like the Hutterites tend to eat off the land and breastfeed for extended periods of time. It's expected that they'll have proper dental development, and as a result, will be more immune to the effects of any viral infection, even the influenza virus. 

 

Any degree of inflammation in the upper airways can aggravate further narrowing, leading to more frequent pauses in breathing, leading to aspiration of stomach juices into the lungs and nose, aggravating a vicious cycle into more obstructions. This is why people with sleep-breathing problems suffer more complications such as pneumonia, sinus and ear infections.

 

We know that some people who catch the flu experience it just like a common cold, whereas for others, it can be deadly. It's one thing to show that giving immunizations can prevent infections, but what's the rate of complications in Hutterites that do contract the flu? I'm willing to bet it's much lower than normal. With this in mind, it it even worth vaccinating this particular population?

 

What's your opinion about my theory? 

Aliens, The Future, And Sleep Apnea

As I watched the Pixar Movie Wall-E this past weekend, I was struck by how prophetic the movie was in predicting the state of mankind in the not too distant future. People are so sedentary that everyone becomes morbidly obese, and use roving hover chairs with remotes for everything. Everyone is so fat that they can't even walk. The planet earth is a vast wasteland, and everyone has to live in a mega-shopping mall space station. Consumption and advertising is taken to a new extreme.

 

One thing that struck me was the fact that if they were all morbidly obese, then they most likely had obstructive sleep apnea. However, I don't recall seeing any CPAP masks or machines in the movie.

 

If you also recall some of the older sci-fi movies, notice how all the aliens have huge brains and very tiny faces. If you think about what's happening to our jaws (getting smaller) and our brains (getting larger), it's conceivable that in a few million years, we'll all begin to look like aliens. By then vocal communication will be gone, since complex vocal speech is detrimental to breathing and swallowing. We'll have evolved to the point of communicating only through mental telepathy, and everyone will be hooked up to positive airway pressure machines while sleeping at night. By then they may have the technology to turn on a switch that bypasses the upper airways directly at night to function like a tracheotomy, except that no surgery is needed. Will they have developed a way to function without sleep?

 

Pure speculation, but not too far fetched. What do you think?

Conflicting Reports About Napping

Should we adopt the siesta? A study was recently presented at the American Association for the Advancement of Science showing the benefits of napping on memory. People who napped for 90 minutes after lunch raised their memory recall scores by 10%. However another study just published the the Journal Sleep showed that nappers had a higher chance of having type 2 diabetes.

 

These studies may sound contradictory, but the results are not surprising. There's no doubt about the benefits of napping on memory and cognitive functioning. The fact that you prefer to nap probably means that you're not able to get deep, efficient sleep at night. This causes hormonal changes that elevate glucose levels and also cause insulin resistance. Poor sleep also causes weight gain, which can aggravate sleep apnea. I'm sure that if you tested these nappers with a higher rate of diabetes, their memory scores will be improved compared to those who are not able to take a nap.

 

Do you routinely take naps? Please enter your answer in the comments box below.

Short Sleep Predicts Lower IQ Scores In Healthy Children

Even if you don't have any sleep problems or medical issues, the quality and quantity of sleep can play an important role in how well you function during the day. This study showed that in normal, healthy children, shorter sleep duration was associated with lower IQ scores and perceptual reasoning. 

 

In this age of information and programming overload, children in general have very poor sleep habits. In many cases, parents' poor sleep habits set a bad example. The implications of this study also apply to grownups as well. 

 

How long do your children sleep? Do they have a regular routine before going to bed, or is it a struggle every night?

Why Are Teens So Sleepy In The Morning?

A number of my friends and acquaintances have commented to me that their teenaged children have a lot of trouble waking up in the morning. The usual explanation is that teens' sleep cycles are shifted, going to bed later and waking up later. Some experts in sleep medicine have even recommended that schools start much later in the morning to accommodate for this phenomenon in teenagers. 

 

Besides shifted sleep cycles, here's another interesting perspective on why teens are so sleepy in the morning:

 

I've described in previous blogs and in my book, Sleep, Interrupted, the concept of laryngeal descent. Your voice box (larynx) had to drop down below the tongue to allow for complex speech and language. Comparative anatomists and evolutionary biologists have stated that speech and language development was ultimately detrimental to humans. This is why only humans have various breathing and swallowing problems that other animals, for the most part, don't suffer from. 

 

In humans, the voice box continues to descend throughout life, but there are two major stages of laryngeal descent that are important. The first one occurs around 4-6 months, when the voice box drops down from behind the tongue (at vertebral levels C3-C4) to a position below the tongue. This process also create a space called the oropharynx between the soft palate and voice box, where the tongue can fall back more easily. Before this happens, human infants can suckle and breathe at the same time, but during this transition they have to relearn how to swallow and breathe. Interestingly, this is also the time when the rate of SIDS (sudden infant death syndrome) is at its' highest.

 

The second stage occurs during adolescence. The voice box begins to drop even further, reaching its' final relative position in the late teens (vertebral level C7). In fact, the voice box continues to drop another 1/2 vertebral height well into your 80s (see figure 2.1 in this link). In boys, this happens to a greater degree than in girls, leading to a deeper voice in men. As the voice box drops lower and lower, the more your tongue is susceptible to collapse while sleeping supine (on your backs), and when in deep sleep, since your muscles are most relaxed during this time. If you add to this additional dental crowding and jaw narrowing, you'll see that it can explain many of the health problems that all modern humans suffer from.

 

This leads to less efficient sleep, leading the teen to be attracted to stimulating activities that compensate for this fact. No wonder many teens are so incredibly productive, engaging in sports, clubs, academics, and social activities. Because of this mental, emotional and physical overload, they can't shut down their minds at night, leading to delayed sleep times. But then they are forced to wake up long before they achieve the necessary hours of restorative sleep.

 

Add to this all the distractions of modern society, including cell phones, texting, chats, light bulbs, computers and TV. Also notice how bright the LED lights are in all the bedroom electronic devices. One modern LED is now 10 times brighter than a traditional night light. 

 

Do your teenaged children have trouble getting up in the morning? What kind of activities are they engaged in during the day? What's their nighttime routine before going to bed? Please enter your response to this blog in the comments box below.

Do All Pregnant Women Have Sleep Apnea?

We know that significant weight gain is a common aggravator of obstructive sleep apnea. If you already have narrowed jaws and gain some weight, then you'll move up the sleep-breathing continuum that I describe in my book, Sleep, Interrupted. But why is it that when women become pregnant, sleep apnea is the last thing that's considered whenever they develop depression, high blood pressure or extreme fatigue? 

 

Two recent published studies perpetuate this myth amongst doctors that sleep apnea can't happen in pregnant women. One study showed that about 2/3 of pregnant women responded to depression using acupuncture. Another study showed that antidepressant use during pregnancy led to small, but measurable developmental delays at 19 months. Depression (during pregnancy or post-partum) is a major problem with many women. But rather than saying that it's pregnancy-related depression, it should be looked at as a sleep-breathing problem, since one major reason for depession is lack of deep, quality sleep that's common with all pregnant women. Pharmaceutical companies promoting anti-depression medications to replace deficiencies in brain biochemistries doesn't help either.

 

One reason why not every woman that's pregnant goes into depression during or after pregnancy is due to the effects of progesterone, which has been called the "feel good" hormone. One of the interesting properties of progesterone is that it's an upper airway muscle stimulant. It increases tongue muscle tone and tension. During pregnancy, progesterone goes through the roof, since it's needed for maintaining the uterus and development of the baby. But if the weight gain is too much, or if your jaw is too narrow, then the effects of progesterone won't be as helpful. Once you deliver, progesterone drops, but you're still left with all that weight. This is one major revelation that I had when my wife experienced severe post-partum depression after the birth of our first son, Jonas.

 

We also know that many women who develop pre-eclampsia (dangerous high blood pressure) during pregnancy have various degrees of sleep-breathing problems, which can be treated effectively with standard sleep apnea treatment options.

 

For the women that's reading this blog, did you have any significant depression during or after pregnancy? How did you deal with it, and if your saw a doctor about it, what did they recommend? Please enter your answer in the comments section below.

Sleep Apnea, Migraines and Multiple Sclerosis: Is There a Link?

It seems like study after study is published that links two previously unlinked conditions to one another. In this study, the presence of migraines was associated with a 47% increased risk of developing multiple sclerosis (MS) later in life. Researchers again point to a genetic wastebasket explanation, with no practical implications. In a previous post, I noted that MS was linked to heart disease. Since we know that Alzheimer's is linked to heart disease, why can't migraines be linked to heart disease or even Alzheimer's? Ultimately, if you connect all the dots of all the associations between various medical conditions, then almost every medical condition can be linked in one way or another. 

 

My sleep-breathing paradigm easily explains the link between migraines and MS via the following mechanism: Migraines are a common symptom of poor quality sleep due to an inability to breathe properly at night. By definition, all modern humans are susceptible to these events, where only the extreme end of the spectrum is called obstructive sleep apnea. If you're not able to sleep deeply, then your entire nervous system is hypersensitive, causing an over-reaction to your senses, leading to symptoms such as headaches, TMJ, sinus pain and pressure. 

 

MS is thought to be an autoimmune condition with flareups of inflammation and "plaques" in any part of the brain that are seen on MRI. Sleep apnea is known to cause not only chronic sympathetic nervous system overload, but also thickening of the blood with patients being prone to either diminished blood flow or small microscopic clots in the brain. Studies have shown that sleep apnea patients have multiple areas of decreased gray matter density in various parts of the brain. This could in theory lead to either "lesions" in the brain, neurotransmitter abnormalities, or hormonal dysfunction.

 

It makes sense that in people who have sleep-breathing problems long before they go into sleep apnea, their nervous systems are overly active (waking up too quickly), whereas sleep apnea patients' nervous systems are underactive (not waking up quickly enough). Chronic low-grade stress is also known to upregulate your immune system, leading to the classic autoimmune conditions that are often seen in people with upper airway resistance syndrome (cold hands, anxiety, fatigue, etc.). 

 

Rather then reducing human illnesses down to genetic factors or biochemical deficiencies, it makes more sense to treat the patient as a whole person. But with modern medicine, that's not allowed. Yes, there has to be progress in medical research, but as a whole, are we going in the wrong direction? I'd like to know your opinion on this issue. Please enter your opinion in the comments box below.

New Discovery Makes Sleep Apnea Sexier?

New research has found that people with severe sleep apnea have significantly less nightmares (21%) compared with over 2/3 of healthy people. The lead author of the study was quoted as saying that after years having a bad reputation, the results of this study makes the condition "a little sexier."

I don't get it. How is not dreaming related to being "sexy"? It's clear that when you have severe apneas, you can't stay in REM sleep (the dreaming stage) since your muscles are most relaxed. REM sleep is essential for memory consolidation and proper brain function. 

What do you think about the author's remarks? Please enter your comments in the text box below.

Why Do Men Snore More Than Women?

For all of us, snoring is a fact of life. Either you snore, your bedpartner snores, or you've been rudely awakened by a loud snore at some time or another. Most of the time, the snorer is a man, but sometimes, it can be the woman. So why is it that men snore more than women?

 

Ultimately, it has to do with your upper airway anatomy. One of the main reasons why humans are susceptible to snoring and obstructive sleep apnea is because of the fact that we can talk. For complex speech and language, the voice box has to drop down from behind the tongue to below the tongue. This opens up a space behind the tongue called the oropharynx, which only humans have. As a result of this "laryngeal descent," the tongue can fall back relatively easily, especially when on our backs, and during deep sleep when our muscles relax. Men's voice boxes also drop lower in the neck, thus the lower pitched voices. 

 

I remember hearing during a plastic surgery lecture during residency the fact that aesthetically, the ideal woman's lower jaw has to be slightly recessed, whereas with men, the jaw should be more prominent, and more defined. What this means is that the smaller the jaw, the less room there is for the normal sized tongue, and the more susceptible for the tongue to fall back and obstruct your breathing while in deep sleep.

 

If you start off with a larger space behind the tongue (in men), then some degree of muscle relaxation during deep sleep will cause a partial obstruction behind the tongue. With the same inspiratory forces created by the lungs, air is forced by the soft palate at a much faster rate, and with additional muscle relaxation, the free edge of the soft palate begins to flutter. 

 

With women, since the space behind the tongue is smaller to begin with, the same degree of tongue muscle relaxation causes you to stop breathing, leading to an arousal from deep sleep. This is why in general, the man snores, and the woman, being a "light" sleeper, is bothered by the man's snoring. 

 

This may be an overgeneralization, but I see it happening over and over. Does your spouse or bedpartner snore? If so, does it keep you from getting a good night's rest? 

Everything You Ever Wanted to Know About CPAP Masks

Are you having problems with your CPAP mask? Are you newly diagnosed with sleep apnea, and want to find out which options you have? If so, hear me interview Chip Smith and Brian Werther of Restoration Medical on "Everything You Ever Wanted to Know About CPAP Masks." 

During this information packed hour, you'll learn:

 

  • The key to getting the right fit

  • What's the right mask for you

  • How to overcome the most common mask problems.

 

Title: Everything You Ever Wanted to Know About CPAP Masks

Format: MP3 download

Price: $17

 

Click here to order.

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