February 25, 2015 by Steven Park
- How to optimize growth hormone release
The link between slow wave sleep and the B vitamins
How this b vitamin can help REM behavior disorder
How much Vit D is made in your skin by sunlight
Vitamin D’s anti-cancer properties
The importance of quality sleep and cancer prevention
Download MP3 audio file
NY Time article on Meditation for a Good Night’s Sleep.
February 19, 2015 by Steven Park
This is Part 2 of my interview with Dr. Stasha Gominak, a neurologist practicing in Tyler, Texas. Dr. Gominak has unique views on how Vitamin D can significantly affect the quality of your sleep, independent of obstructive sleep apnea or upper airway resistance syndrome. In this intervew, she will reveal:
February 11, 2015 by Steven Park
This is Part 1 of my interview with Dr. Stasha Gominak, a neurologist practicing in Tyler, Texas. Dr. Gominak has unique views on how Vitamin D can significantly affect the quality of your sleep, independent of obstructive sleep apnea or upper airway resistance syndrome. In this intervew, she will reveal:
January 28, 2015 by Steven Park
January 21, 2015 by Steven Park
January 17, 2015 by Steven Park
Allergies are a common reason for causing a stuffy nose. One of my recommendations for patients is to purchase a good quality room air purifier. Here’s a guest post from Janet Miller, from airpurifier-review.com.
If you are looking to buy your first air purifier, the process can be daunting with the many choices available. Here are 11 tips for choosing a good air purifier that will be helpful.
1. Start by listing out what you need in your air purifier
The most important first step is to list out what you need in your air purifier. While most air purifiers will remove common air pollutants such as dust, smoke, pet dander and pollen, not all are able to remove other potential pollutants such as specific allergens, odors, volatile organic compounds (VOCs), mold and germs. When reading the manufacturer’s product description and specifications, check against your list of needs carefully.
2. Find one with the right coverage area
Do you need the air purifier to cover your entire house, just your living room, or just your bedroom? All air purifiers will list their coverage area—or the size of the room recommended for using the air purifier in. Find an air purifier with a coverage area at least no smaller than the size of your room.
3. ACH rating should be at least 4x
ACH stands for air changes per hour. The ACH rating indicates the number of times the air purifier can exchange the air in its coverage area in an hour. The higher the better—for those with allergies, look for an ACH rating higher than 4.
4. CADR ratings should be at least 100
In addition to the ACH rating, most air purifiers will also have a CADR or Clean Air Delivery Rate rating. This indicates the ability of the air purifier to filter common air pollutants such as dust, smoke and pollen. Look for CADR ratings of at least 100 across each of these categories. The best air purifiers will have CADR ratings of at least 200.
5. Warranty at least 3 years
You want maximum protection should there be any manufacturing defects. A 3-year warranty should be the the bare minimum – there are even some manufacturers (such as Alen) that offer lifetime guarantees.
6. Check the noise level
This is not usually stated clearly by the manufacturer but most air purifiers will generate some white noise. Read user reviews to get a sense of whether this is a noise level you are comfortable with (eg. Is it consistent, soft white noise that is barely noticeable, or does it get annoying?)
7. Decide if you need to remove odors as well
If you need an air purifier with odor removal capabilities, look for those with activated carbon pre-filters. A pre-filter is the first step in the air purification process, and typically used to remove larger particles such as hair. Pre-filters coated with activated carbon have the additional advantage of being able to remove odors, as the carbon pores have a large surface area that will absorb odorous gases and chemicals passing through.
8. Check the energy rating and average energy consumption
Since you will most likely be using the air purifier everyday, you want it to be as energy-efficient as possible. Pick an air purifier that has an energy-star rating, and look for estimated energy consumption no more than 100W.
9. Check how much replacement filters cost
Another important consideration is how much replacement filters cost. Some air purifiers may seem inexpensive, but their replacement filters may cost close to $100 a piece. Expect to change your filters at least once a year.
10. Check the product dimensions
Air purifier placement is an important factor to consider. For maximum effectiveness, you should place your air purifier at least one feet away from the wall. Check the product dimensions to make sure you have enough space in the house for your air purifier.
11. Handle preferred
Finally, check if the air purifier has a handle. Should you need to move the air purifier from room to room, having an handle makes things much easier.
Hope these 11 tips for choosing an air purifier were helpful. Do you have other tips you would like to share? Please leave a comment below. Janet Miller is the owner of Air Purifier Reviews, a site dedicated to providing detailed information on air purifiers, humidifiers, dehumidifiers, air conditioners and other home appliances.
January 15, 2015 by Steven Park
January 7, 2015 by Steven Park
Coincidentally, I saw three patients a few days ago that were told by another physician that they will outgrow their large tonsils or adenoids. One was a 9 year old girl with golf-ball sized kissing tonsils who kept getting recurrent throat infections. Since none of her throat cultures came back positive, surgery wasn’t recommended. The second patient was a 29 year old man with life-long history heavy snoring. When he was 6 years old, his ENT surgeon told his parents that he would eventually outgrow his large tonsils. The last patient was a 17 year old girl with repeated ear infections as a young child and chronic nasal congestion. Similarly, she was told that she would grow out of her large adenoids.
By the time I saw all three of these patients, their doctors were all correct: They all grew out of their large tonsils and adenoids. In fact, all of their tonsils were markedly smaller than what was described many years prior.
However, all three patients had one thing in common: severe dental crowding, a high arched hard palate, and chronic nasal congestion due to a deviated nasal septum, bilateral turbinate hypertrophy, and nasal valve (nostril) collapse. All three were found not to have any significant apneas on a sleep study.
Over the years, a number of studies revealed that for some conditions related to obstructive sleep apnea, a watchful waiting method may be an option. One such finding was reported in the recent Childhood Adenotonsillectomy (CHAT) Study, a multi-institutional, prospective, randomized study of 464 children undergoing surgery vs. watchful waiting. They looked at various outcomes after seven months, including sleep study and neurocognitive information. Not surprisingly, children with more severe cases of obstructive sleep apnea had more improved outcomes. However, about 30 to 50% of children who underwent observation only had normal sleep studies after 7 months. There were also no significant differences in cognition between the two groups. Adenotonsillectomy, however, was found to have more significant improvements in sleep duration and quality.
The CHAT study didn’t look at nasal breathing measures or any changes to craniofacial or dental measurements. Additionally, 7 months is is very short period of time to follow-up children after a surgical procedure. It would be interesting if they measured all these variables 5 or even 10 years later.
Despite the results of the CHAT study, I don’t hesitate to offer adenotonsillectomy in a child with obviously large tonsils, who snore and choke at night.
Have you or your child ever been told by a physician that you can outgrow your large tonsils or adenoids? If so please tell us your story below.
January 2, 2015 by Steven Park
Now that it’s the day after New Years, many of you likely made a resolution to lose weight. I’m not going to go into any detail about what you should eat or how you should exercise, since that’s not my area of expertise. What I can say is that poor sleep in general will promote weight gain. It’s also known that sleep deprivation will cause cravings for sugary, starchy, salty and fatty foods. Gaining weight will promote obstructive sleep apnea. Lack of energy and exercise will further enhance more weight gain, and the vicious cycle continues.
However, one important aspect of weight gain (or not being able to lose weight) is the importance of prescription medications. I wrote a post a few months ago on 7 common prescription medications that can cause weight gain. I think it’s important to take a look at it again. Check to see if any of the medications that you’re taking is on this list.
If you’ve gained significant weight since taking any of these medications, please tell me your story in the comments section below.
December 31, 2014 by Steven Park
Today, I had good news and bad news for Anna, a 28 year old patient regarding her sleep study results. The good news was that she didn’t have obstructive sleep apnea. The bad news was that she stopped breathing 15 times every hour. More bad news: She woke from deep to light sleep 25 times every hour over the course of the entire 7 hours. Lastly, some good news: She has a treatable condition called upper airway resistance syndrome.
Most sleep physicians think of upper airway resistance syndrome (UARS) as a wastebasket diagnosis when you don’t officially have OSA, despite having many of the symptoms of OSA including severe fatigue, unrefreshing sleep, and brain impairment. Snoring is also sometimes lumped into UARS. But when questioned about what can be done, most will tell you the standard sleep hygiene list of bullet points: lose weight, don’t watch TV before bedtime, don’t eat late, and various other important things that everyone must do, even if you don’t have sleep apnea or UARS. Since most people with UARS are not overweight, it’s hard for some doctors to believe that you can have a sleep-breathing problem, especially if your official score on the sleep study is 0.
The problem is that you need at least 5 apneas or hypopneas per hour (AHI) to qualify for a sleep apnea diagnosis based on a sleep study. By definition, apneas are total breathing pauses for more than 10 seconds. Hypopnea are more than 30% obstructed breathing for more than 10 seconds. The total number of apneas and hypopnea per hour is how the AHI is calculated.
But if you stop breathing 25 times every hour, and each episode is anywhere from 1 to 9 seconds, then your AHI will be 0. This was the case for Anna, the woman I saw today. Not having a sleep apnea diagnosis means that you won’t be covered for sleep apnea treatment options by your insurance company—even if you stop breathing 25 times every hour.
Anna’s main complaints were blamed on anemia by her doctors. However, anemia alone can’t explain her daily headaches, anxiety, lightheadedness and dizziness, lower blood pressure, and intense fatigue, no matter how long she sleeps.
Interestingly, she told me that her symptoms got much worse 3 weeks ago when she began to sleep on her back, when she used to sleep on her tummy. When asked what prompted her to make the change, she commented that her dermatologist recommended staying off her tummy since it can cause facial wrinkles. Not too surprisingly, having her switch back to her tummy improved her symptoms back to baseline again.
Most people with UARS have very narrowed jaws and upper airways, rather than being overweight. Due to severe dental crowding, gravity, and muscle relaxation in deep levels of sleep, the tongue, soft palate, or even the epiglottis will fall back and cause you to wake up suddenly, long before the 10 second apnea threshold. In a nutshell, once you obstruct, sleep apnea patients take too long to wake up, whereas UARS patients wake up too quickly. Because the pauses are so short, you won’t have any significant levels of oxygen deprivation.
The problem with so many frequent obstructions and arousals is that your sleep is severely fragmented. You may get the normal amount of deep sleep, but if it’s fragmented, it’s like not getting any deep sleep at all. Not getting deep sleep will cause you to have problems with memory, executive function, and no energy to do anything at all.
One interesting consequence of UARS is how your heart responds to repeated obstructions. Every time you obstruct, tremendous vacuum forces are created in your chest cavity. This causes your heart muscle to becomes stretched, and your body thinks that there’s too much fluid. The heart then makes a hormone called atrial natriuretic peptide (ANP), which goes to your kidneys to make you produce more urine than usual. This is one of many factors that can cause people with sleep-related breathing disorders to go to the bathroom at night. Usually, you’ll wake up a the same time intervals, about 90 to 120 minutes apart, which happens to be one sleep cycle. Every time you go into deeper levels of sleep, due to muscle relaxation in your throat, you’ll have a more severe obstruction and arousal, and you’ll think you have to go to the bathroom. But oftentimes, it’s not a lot of urine.
Other interesting properties of ANP include low blood pressure, weight loss, digestive problems, low magnesium levels, anemia, and neuro-excitability. Essentially, your entire nervous system is overactive, especially to emotions, weather changes, smoke, chemical, and odors. It’s estimated that about 5 to 10% of people with UARS progress to OSA every year, especially if you gain weight. I often see overweight, snoring women in their 50 and 60s who have high blood pressure, with classic OSA, but when in their 20s, were stick thin and with low blood pressure. Even the cold hands and feet that they had when younger tends to go away after menopause.
Now that you’re more familiar with UARS, you may be asking what you can do about it. In general, you have to treat it just like for obstructive sleep apnea. The challenge is that since insurance won’t pay for treatment, you’ll have to pay for a CPAP machine or dental appliance. I’ve covered OSA treatment options in great detail in other articles, teleseminars and my book, starting with conservative options to standard devices and gadgets, dental appliances, and lastly, surgical options. However, for nasal congestion, it’s generally covered, since that’s a different diagnosis.
Most people with undiagnosed UARS can’t be helped by traditional medical options. Oftentimes, you may be diagnosed with anemia, hypothyroidism, anxiety, depression, headaches, irritable bowel syndrome, nutritional or vitamin deficiencies, allergies, for even food sensitivities. I have had every one of these conditions resolve partially or completely when UARS is addressed fully. Some do well with only lifestyle adjustments like not eating late and using Breathe Right Strips. Others do well with CPAP or a mandibular advancement device. Some need aggressive surgery to feel relief. Unfortunately, not too many people ever end up going up the ladder for UARS treatment, since it takes time, resources and having access to the right health care practitioners that are even aware that this exists.
By now, you’re probably more knowledgeable about UARS than most physicians in this country. Hopefully, you can use this information to search out the root cause of many of your symptoms, which is an extremely narrowed airway preventing you from getting deep sleep.
If you have some, or even all of the symptoms of UARS, which options have worked for you? How did your doctor respond to your concerns? Please enter your responses in the text area below.
I interviewed two of the foremost sleep physicians on UARS in my past teleseminars: Drs. Barry Krakow and Avram Gold. Click here to go to iTunes podcast page. Search for Episodes 27 and 31. After listening, please subscribe and rate my podcast. The more feedback you give me and topics that you want to hear about, the more programs I can develop to address your particular needs.