March 5, 2014 by Steven Park
February 26, 2014 by Steven Park
I haven’t talked a great deal about sleep deprivation, so when I came across this article on Medscape, I thought the overview of the various epidemiologic findings related to sleeping less than 6 hours was worth reviewing:
“Sleep deprivation has a profound impact on multiple disease states. For example, if you sleep less than 6 hours, epidemiologic studies show the following:
• Stroke is increased by a factor of 4 times.
• Obesity is increased by an increase in ghrelin, which is a hunger hormone.
• Diabetes is increased because sleep deprivation increases insulin resistance.
• Memory loss is accelerated. Epidemiologic studies show that there is not only permanent cognitive loss but also evidence of early brain deterioration.
• Osteoporosis is increased, at least in an animal model, with changes in bone mineral density. Even changes in bone marrow are evident within 3 months of a study in a rat model.
• Cardiac disease is increased. There is a 48% increase in early cardiac death, as well as increased cardiac-related mortality.
• A 4-fold overall increase in mortality.
As it relates to gastrointestinal disease, there is an increased risk for colon cancer, and at least 1 epidemiologic study shows an association between sleep deprivation (or lack of sleep) and an increase in the likelihood of precancerous (adenomatous) polyps.”
The author also summarized the results of this finding that sleep deprived mice had higher rates of tumor growth.
More and more studies are linking sleep deprivation and obstructive sleep apnea with numerous medical conditions, including cancer.
If you sleep less than 6 hours, something else to sleep on…
February 19, 2014 by Steven Park
It’s been a general consensus amongst physicians that chronic pain can disrupt sleep, leading to insomnia and frequent awakenings during the night. In the sleep research field, it’s been long known that poor sleep quality or quantity can lower your pain thresholds, meaning that you’ll feel pain a lot earlier. Regardless of what causes what, it’s a vicious cycle.
Here’s a study that only confirms this link: Nonrestorative sleep was found to be a strong predictor of widespread pain in adults over 50. This has enormous implications as people age and go on to develop aches and pains that are commonly found with arthritis.
Anecdotally, I’ve had a handful of patients with severe rheumatoid arthritis who stated that the pain went away completely after starting CPAP for newly diagnosed obstructive sleep apnea. One patient tried a number of different biologics that are often prescribed for severe rheumatoid arthritis, but only CPAP helped. This is not surprising, since sleep apnea causes generalized systemic inflammation, in addition to aggravating any already existing pain.
Statistically, it can be argued that the majority of people over 65 will have at least some degree of obstructive sleep apnea. If this is the case, it’s not surprising that as sleep apnea worsens, arthritis can also worsen.
If you have rheumatoid arthritis, what is the quality of your sleep?
February 12, 2014 by Steven Park
Insomnia is treated by sleep specialists as a completely different condition from obstructive sleep apnea. Similar to how sleep problem is now considered a “co-morbid” condition to depression and various other medical conditions, insomnia is now beginning to be considered a “co-morbid” condition alongside obstructive sleep apnea. I’ve interviewed Dr. Barry Krakow in the past on upper airway resistance syndrome and complex insomnia (click here for the interviews; search for Krakow). Here’s a must-read interview that was just published in Sleep Review Magazine. The magazine interviews Dr. Krakow on complex insomnia and how everyone with severe insomnia should also be considered for a possible sleep-breathing disorder.
February 6, 2014 by Steven Park
There’s been a rash of studies on the numerous health consequences of pre-term deliveries. Here’s a study showing that babies born before 37 weeks had significantly higher rates of developing asthma. The more preterm, the higher the risk. Since it was a large-scale epidemiological study combining 42 similar studies, with over 1.5 million total births, it didn’t go too much into possible mechanisms.
Underdevelopment of the lungs is a common potential explanation, but here’s another possible mechanism: Preterm delivery can raise your risk for obstructive sleep apnea. This study found that very premature delivery and maternal smoking raised the risk of developing obstructive sleep apnea by 2.2 time normal.
We know that obstructive sleep apnea can predispose your stomach juices to come up into the throat, mainly due to vacuum forces in the throat. If you accept the possibility that stomach juices can reach the throat, then it can easily reach the lungs or even the ears. Here’s one study showing that children with chronic lung diseases had much higher rates of pepsin (a stomach enzyme) in lung washings.
There’s a reason why 40 weeks is needed for full-term delivery. Not having enough time to fully develop the airway and jaw structures can lead to narrowed upper airways which can predispose to obstructive sleep apnea, asthma, reflux, and a variety of other future health problems.
If your child was delivered pre-term, does he or she have asthma?
February 3, 2014 by Steven Park
I’m willing to bet that many of you reading this blog stayed up last night watching TV or surfing the net, going to bed much later than your normal bedtime. Some of you never sleep for more than 6 hours. Life can oftentimes prevent optimal sleep times, such as having a new baby, work obligations, or staying up to watch the Grammy or Academy awards.
I’ve written in the past about the enormous medical consequences of poor sleep quality or quantity. But here’s another good reason to regularly get at least 7 hours of sleep: Our country’s gross domestic product. The New York Times printed a revealing article about the negative impact of sleep deprivation on our country’s economy. One telling statistic mentioned is that the number or people who sleep less than 6 hours rose 22% from 1975 to 2006.
If you listen to the topic of conversations during work or amongst friends, being tired or having problems with sleep are very common. Not getting the 7 to 8 hours of sleep is almost normal in this day and age. This is not including people who have medical sleep conditions such as obstructive sleep apnea. In one month in 2008, 29% of workers had fallen asleep or felt sleepy at work. One Australian study estimated the cost of sleepiness on the country’s gross domestic product at 0.8%. If you include medical complications of poor sleep, car accidents and industrial accidents, this figure is sure to be much higher.
This is why companies that values quality sleep can be much more productive and fosters more creativity (think Google’s sleep pods).
What’s your reason for not getting enough sleep? Is it under your control, or do your personal or work situations prevent you from getting a good night’s sleep?
January 27, 2014 by Steven Park
January 16, 2014 by Steven Park
There are a number of studies on the benefits of natural or herbal remedies for various health conditions. Nonalcoholic fatty liver disease (NAFLD) is a relatively common condition, with excessive buildup of fat in the liver. Excessive alcohol can also do this, but NAGLD is diagnosed when there’s no history of alcohol. Typically, there’s an increased risk of metabolic syndrome (obesity, high cholesterol, diabetes, and hypertension).
This new study found that ingesting cinnamon led to a significant drop in LDL levels in patients with NAFLD. There were other significant drops in inflammatory makers, such as levels of the HOMA (Homeostatic Model Assessment) index, fasting blood glucose, triglyceride, total cholesterol, alanine aminotransferase and aspartate aminotransferase. Gamma glutamine transpeptidase and high-sensitivity C-reactive protein (hs-CRP) also were significantly lower.
Notice how NAFLD seems to be related to cardiovascular risk factors, including the metabolic syndrome, heart disease, heart attack, and stroke. It’s not too coincidental that there are a number of studies showing a high rate of NAFLD in patients with obstructive sleep apnea. Numerous studies have shown a strong association between OSA and NAFLD. Here’s a good review article on this association. It’s thought that repeated episodes of low oxygen levels cause damage to the liver cells.
Another connection to two more links in my sleep-breathing paradigm.
January 13, 2014 by Steven Park
Of the various known heart rhythm disorders, atrial fibrillation is one of the most common types. The New York Times just reviewed this condition in great detail. The biggest risk from untreated A-fib is stroke. However, one thing it didn’t mention was the strong association between A-fib and obstructive sleep apnea (OSA). OSA is also known to independently raise your risk of stroke.
Studies have found very high rates of OSA in patients with A-fib. One study reported that 81.6% of A-fib patients had obstructive sleep apnea. It works the other way as well: Having OSA quadruples your risk of having A-fib. One year after cardioversion for A-fib, the rate of recurrence in patients with untreated OSA was almost double those without OSA (82% vs. 42%).
Given the high rate of OSA in patients with A-fib, it’s puzzling why cardiologists don’t routinely screen for OSA.
If you were ever diagnosed with A-fib, were you also screened for obstructive sleep apnea?
January 6, 2014 by Steven Park
About one in 12 people in the US (about 25 million, or 8% of the population) had asthma in 2009. More than 1/2 of all adults and children with asthma had an attack in 2008. 185 children and 3,262 adults died from an asthma attack in 2007. These numbers are likely to be higher in 2014 (source: CDC).
Asthma is thought to be a chronic inflammatory disorder of the lungs. Symptoms include chronic cough, wheezing, chest tightness and shortness of breath.
A recent study out of Taiwan reported that teenagers with asthma had a significantly higher chance of developing depression or bipolar disease 10 years later. After adjusting for other conditions such as allergic rhinitis, atopic dermatitis, and other confounders, patients with asthma were 1.81 times more likely to develop major depression, 1.74 times more likely to develop any depressive disorder, and 2.27 times more likely to develop bipolar disorder than patients without asthma. This was the first prospective study linking asthma with mood disorders.
Not too coincidentally, another study came out that showed that pepsin, a stomach enzyme, was found in 71% of bronchial washings in children with chronic lung diseases. In contrast, healthy children had no cases of pepsin in bronchial washings.
Obstructive sleep apnea is found in up to 10% of chidden and about 25% of adults. During an apnea, tremendous vacuum forces are created in the chest cavity, leading to a suctioning effect of normal stomach juices into the throat. These juices can then go into the lungs or the nose and ears. Stomach juices not only contain acid, but also bile, digestive enzymes, and bacteria. Even microscopic amounts of these materials can wreak havoc inside your lungs or nose.
Here’s a review of the link between asthma and obstructive sleep apnea. Not too surprisingly, the peak time for the highest levels of restricted breathing in asthmatics is during 3 to 5 AM. This is also the same time that REM sleep peaks, when apneas are most common. There are countless studies showing strong associations between obstructive sleep apnea and mood disorders.
This is another great example of how everything comes together when you start to connect the dots.