Podcast #5: Interview With Dr. Stasha Gominak on How Low Vitamin D Can Ruin Your Sleep (Part 3)

February 25, 2015 by  

This is part 3 and the final segment of my conversation with Dr. Stasha Gominck, a neurologist with some very insightful information about vitamin d and how it’s vitally related not only to sleep, but to every aspect of your health. As mentioned previously, Vitamin D is actually a hormone that’s needed by every area of your body, including your brain. 
In this segment, Gominak is going to tell us
  • 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

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NY Time article on Meditation for a Good Night’s Sleep.

Mindfulness meditation sites: calm.com, headspace.com, and saagara.com

CBT-i sites: cbtreferee, CBT-i coach and cbtforinsomnia

Visit Dr. Gominak at drgominak.com
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Podcast #004: Interview With Dr. Stasha Gominak on How Low Vitamin D Can Ruin Your Sleep (Part 2)

February 19, 2015 by  

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:

How B vitamins interact with Vitamin D
How B vitamins are related to fibromyalgia
The link between irritable bowel syndrome and headaches
How Vit D is linked with weight gain
What’s the right dose of B vitamins? And for how long?
Which vitamins are made in your gut?
Visit Dr. Gominak at drgominak.com
Subscribe in iTunes. I would appreciate it if you can rate my podcast and provide feedback within iTunes.
Please leave your feedback or any comments about this episode in the space below.

Podcast #003: Interview With Dr. Stasha Gominak on How Low Vitamin D Can Ruin Your Sleep (Part 1)

February 11, 2015 by  

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:

1. How Vitamin D is related to sleep
2. Why Vitamin D3 is better than D2
3. How Mice and Pigs Confused Doctors About Vitamin D
4. Why Sleep became much worse in the 1980s
5. How much Vitamin D do we need?
Download audio file
Visit Dr. Gominak at drgominak.com
Vitamin D Council
Dr. Walter E. Stumpf
Subscribe in iTunes. I would appreciate it if you can rate my podcast and provide feedback within iTunes.
Please leave your feedback or any comments about this episode in the space below.

How Anemia Can Be Caused By Upper Airway Resistance Syndrome

January 28, 2015 by  

I just saw Kim (name changed for privacy), who is a 24 year old graduate student for her recurrent sinus infections. She tried multiple antibiotics which helped only temporarily. She also mentioned that she was chronically tired, which she blamed on her anemia. As I see in many women (and men) with upper airway resistance syndrome, she also had frequent headaches, cold hands and feet, low blood pressure, and cannot sleep on her back.
One of the most common explanations by doctors for fatigue in younger women is said to be from anemia. It’s thought that losing regular amounts of blood during the normal menstrual cycle can lower blood count levels. There are a number of other explanations for anemia, including Vitamin B12 and folate deficiency.
One of my guest bloggers, Dr. Deborah Wardly, recently published a review article a few years back on the effects of atrial natriuretic peptide (ANP) on various aspects of your body. ANP is created in your heart muscles every time it’s subjected to obstructed breathing. The heart thinks that the body has too much fluid, and creates ANP which goes to the kidneys to create more urine, lowering blood volume. She also points out that ANP has been shown to lower your blood pressure, keep you thin, make your nervous system more excitable, make you chronically tired, and makes you pee more than usual. In particular, ANP is also known to lower the angiotensin-aldosterone pathway in the kidneys.
So how does lowering angiotensin-aldosterone cause anemia? A quick review of the renin-angiotensin-aldosterone system (RAAS) is in order. I know it sounds a bit complicated, but take a look at the referenced figures, and you’ll see how everything in the body is so well interconnected.
The RAAS is a hormone system that regulates blood pressure and fluid balance. If the kidneys sense that you’re dehydrated (lower blood flow through the kidneys), the cells in your kidneys convert an already circulating protein (prorenin) into renin, which converts angiotensinogen (made by the liver) into angiotensin I. Angiotensin I is then converted into angiotensin II by angiotensin converting enzyme (ACE) in the lungs. Angiotensin II constricts your blood vessels, raising your blood pressure. It also stimulates the hormone aldosterone, which is made in the adrenal cortex (which also makes epinephrine). Aldosterone causes the kidneys to reabsorb sodium and water, causing you to hold onto sodium, raising your blood pressure. 
As you can see in this diagram, there are a number of steps that can be blocked by certain prescription medications.
ANP has the opposite effect of angiotensin II, lowering renin and aldosterone in the kidneys. One review article states that angiotensin II acts to stimulate erythropoietin, which is made in the kidneys to stimulate red blood cell production in your bone marrow. So by lowering the salt and fluid conserving properties of angiotensin II, you can in theory lower erythropoietin levels. This supports the observation that you can have mild anemia if you’re taking ACE inhibitors for high blood pressure or in certain people with chronic kidney disease. Now you can add upper airway resistance syndrome to the list (via ANP production).
If you have been diagnosed with anemia, do you also have cold hands, low blood pressure, headaches or chronic fatigue? Do you also prefer to sleep on your side or stomach? Please tell us your story in the box below.

The Most Misunderstood And Often Overlooked Treatment For Sleep Apnea (HINT: It’s NOT CPAP)

January 21, 2015 by  

John Wooten, UCLA’s legendary basketball coach was a stickler for fundamentals. He looked down on trick plays, fancy footwork, or high-tech strategies. Similarly, before looking for state-of-the-art treatment options for obstructive sleep apnea, you should always first consider the fundamentals. 
If you’ve been newly diagnosed with obstructive sleep apnea, you’re likely to be told to lose weight, diet and exercise. Everyone know this already. Avoiding alcohol is another big no-no, since it relaxes your throat muscles. 
One option that is mentioned only casually is to avoid sleeping on your back. This is because being on your back allows your tongue and soft tissues of your throat to fall back more severely. When you add muscle relaxation during deeper levels of sleep, then you’ll either snore, or stop breathing altogether (called an apnea). 
In sleep studies, you’ll routinely see that in most cases, being on your back can lead to double, or even triple the number of apneas on your back compared to sleeping on your side or tummy. One study showed that sleep positioning was almost as good as CPAP.
Many people know not to sleep on their backs. The problem is that in most cases, you can’t control your sleep position all night long. 
If you are one of these people, then there’s an opportunity to use gravity to your advantage. 
One of the oldest recommendation is to sew a tennis ball inside a sock to the back of your pajamas. This may work sometimes, but more often than not, you’ll just sleep on top of it, or it’ll keep annoying you causing you to wake up. One of my patients misunderstood me and filled an entire backpack with tennis balls during sleep, and it worked well for him.
There are now multiple options for keeping you off your back during sleep. One popular option is the Rematee Anti-snore shirt. It’s a vest that you wear at night with pockets in the back that’s filled with inflatable bumpers. 
Another variation is the isidesleep mattress, which is an inclined wedge with a cutout at the top that allow you to drop your arm below the mattress, which cradling your head on a pillow that sits above the cutout. 
If you have shoulder or back problems and you can’t sleep on your side, then sleeping on your back on a incline is another option. There are a number of different options that you can find including this wedge pillow. This can be also be good for acid reflux. It’s also why some people can only sleep on recliners.
If you must sleep on your back, then it’s important to use a pillow that will tilt your head back somewhat, which will open up your airway. This is similar to what you do as the first step in CPR, but not as far back. There are many of these “contour memory foam” pillows that are promoted to reduce snoring. It’s not going to cure your sleep apnea, but used in conjunction with various other methods, it can help to various degrees.
Two of my patients wore neck braces (one soft and one hard) with some success. This may work by preventing your chin from dropping forward, while keeping your neck extended.
If you must sleep on your back, there aren’t too may options. One desperate patient actually bought a massage table and slept tummy down with his face inside the hole. 
As a last resort, you can always fly into space, where there’s no gravity. In fact, it’s been shown that astronauts have less snoring and apneas while in space compared to levels found back on earth.
If none of these options work for you, then it’s time to see a sleep physician. If you’re already using CPAP or an oral appliance, you can supplement positional therapy to your current regimen. Oftentimes, you’ll have to combine multiple options for better results.
I’m sure that many of you have tried other creative ways to get rid of snoring using positioning devices or contractions. If so, please share what worked for you in the comments area below.

11 Tips for Choosing a Good Air Purifier

January 17, 2015 by  

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.

How Breathing Exercises Can Help Your Headaches

January 15, 2015 by  

Suzy is a 49 year old woman who saw me for daily headaches, ear pain, and fatigue. Her routine blood tests all came back normal. I helped her breathe better though her nose with allergy control, nasal saline irrigation, and nasal dilator strips. But the one thing she said helped the most was the deep-breathing exercises that I taught her.
In yogic breathing, the relaxing breath is performed by taking a slow, deep breath in through your nose on a count of 4, holding for a few seconds, and then breathing out slowly through your mouth on a count of 7. Then the cycle is repeated 4 to 5 times. I had her do this exercise multiple times per day: upon awakening, in-between major tasks or activities, and for 5 minutes just before bedtime. 
Noted integrative physician Andrew Weil has pointed out the breathing in (inhalation) stimulates the sympathetic nervous system (the fight-or-flight response), whereas breathing out (exhalation) stimulates the parasympathetic nervous system (the relaxing response). So by spending more time breathing out, the more relaxed you’ll be.
Another key concept to consider in Buteyko breathing is that by slowing down your breathing, you’re able to raise carbon dioxide (CO2) levels, which can make you calmer and feel more relaxed. During my neurosurgery rotation in my surgical internship year, I distinctly remember that we gave acetazolamide to lower intracranial pressures. Acetazolamide raises CO2, which is known to lower pressure inside your brain cavity.
In the sleep apnea research literature, obstructive sleep apnea has been strongly associated with elevated pressures within the brain cavity. One study found increased pressure, worse during sleep and highest in REM sleep, when apneas are most common. Pressures were also higher in the morning compared with evening pressures. This may explain morning headaches which are commonly seen in people with sleep apnea. Another small study reported on six adult patients with idiopathic intracranial hypertension (IIH) who all had various degrees of vision loss, and swelling of the optic nerve. One patient received acetazolamide alone, four received both acetazolamide and CPAP, and one got CPAP alone. Four had complete return of their vision loss and three had no more swelling of the optic nerve after treatment. 
This is one example of how many natural healing options may work to various degrees, with scientific explanations. 
How many of you practice deep-breathing exercises on a regular basis? How has your life improved as a result of doing these exercises? Please enter your responses in the box below.

Can Your Child Outgrow Tonsils or Adenoids?

January 7, 2015 by  

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.

How Doctors Are Making You Fat

January 2, 2015 by  

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.

Taking the Mystery Out of UARS: A Must Read

December 31, 2014 by  

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.


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The material on this website is for educational and informational purposes only and is not and should not be relied upon or construed as medical, surgical, psychological, or nutritional advice. Please consult your doctor before making any changes to your medical regimen, exercise or diet program.

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