Research Opportunity for CPAP Users ($375 Honorarium)

A research firm is seeking obstructive sleep apnea patients who are currently using CPAP therapy for a study in the New York area. Candidates must meet ONE of the following criteria:

• Recently diagnosed and have been on CPAP therapy between 2 weeks to 3 months
• Use CPAP therapy intermittently
• Have stopped using CPAP therapy within the last 3 months.

My Quote in More Magazine About Alcohol and Sleep

Look for my quote in More Magazine about the effects of alcohol on sleep (under #3).

Listen To My Interview About Snoring With Dr. Sosenko

Dr. Lydia Sosenko, a dentist specializing in sleep-breathing disorders in Illinois, interviews me for this 34 minute segment on snoring. You can listen to it or download it here. We talk about about the many dangers of snoring, how it’s a “dealbreaker” in many relationships, why sleep tests are very important, how common undiagnosed apnea really is, and much more!

A Surprising Finding: Sleep Apnea Is Linked With Depression!

If you have sleep apnea, you’re more likely to suffer from depression. I can’t help but to be amazed that theses type of studies are still performed. I know that in the name of science, you have to show that there are statistical associations between two conditions that are thought to be related. But it’s like doing a study that shows that if you cut your hand, you’re more likely to bleed, or if you trip over an uneven sidewalk, you’re more likely to fall.

You don’t have to be a doctor to know that not sleeping well for extended periods can definitely cause you to feel depressed. The skeptics will then point out that there’s only a strong association between depression and sleep apnea, and that it doesn’t show that sleep apnea actually causes depression. Knowing how prevalent sleep apnea is in our society (most of it undiagnosed), it makes sense to at least think about obstructive sleep apnea before you make a diagnosis of depression and prescribe antidepressants. Unfortunately, even if a randomized placebo-controlled prospective study of thousands of patents showed that having untreated sleep apnea leads to higher rates of clinical depression, it’s unlikely that physicians will change the way they diagnose and treat depression.

Interestingly, most antidepressants suppress REM sleep. Coincidentally, REM sleep is when you’re most likely to have obstructions and apneas, due to complete muscle relaxation in your throat. So anything that lowers REM sleep will by definition lower your rate of apneas. In fact, there are published studies showing that REM sleep deprivation can be helpful for depression. Not having as many apneas could make you feel better during the day. I realize this may be an overly simplistic explanation, but it’s definitely something that the scientific community should think more about.

Come to think of it, there are no prospective randomized double-blinded placebo-controlled trials showing that drinking water cures dehydration. Millions of mothers are giving their children water every day to treat dehydration without FDA approval. 

Early Puberty For Girls: A Sleep-Breathing Problem?

You may have seen reports about the epidemic of public hair and early breast development in 6 to 7 year old girls. A recent study published in Pediatrics revealed that by age 7, 10% of white girls, 23% of black girls, 15% of Hispanic girls, and 2% of Asian girls had started developing breasts. In this week’s New York Times Magazine, a writer profiles a young girl that developed pubic hair, tall stature, big feet, and a curvaceous body at age 6.

There’s a general consensus amongst pediatricians that early puberty is a growing problem and a number of factors are blamed. The obesity epidemic is thought to play a role, since excess fat is known to produce higher levels of endogenous estrogen. The most probable suspect is thought to be due to the presence of xenoestrogens, which are artificial chemicals in our food and water supply that has estrogen-like properties. The most well-known of these is bisphenol-A (BPA). Recently, the FDA rejected a motion by environmental groups to ban BPA, which is widely found in food containers. Most baby bottle manufacturers have voluntarily stopped using BPA in their products.

Xenoestrogens and other endocrine disruptors like PBA not only act to induce early puberty, but can also alter the optimal balance of reproductive hormones in a woman’s (and man’s) body. The idea have having too much estrogen (endogenous or exogenous) in your body has been coined estrogen dominance by Dr. John Lee. An important concept to emphasize is that too much estrogen (or estrogen-like molecules) can suppress progesterone, which can have significant detrimental effects on breathing, especially in post-pubertal women. Progesterone is an upper airway muscle stimulant, and increases tongue muscle tone. Post-menopausal women have lower levels of progesterone, and lower tongue muscle tone (genioglossus muscle), but when given progesterone, muscle tone increased significantly.

This is why many women sleep better when given hormone replacement therapy after menopause. In one study, the average apnea hypopnea index (AHI, or measure of obstructive sleep apnea severity) was over 50% lower in postmenopausal women taking hormones. I sometimes wonder if the incidence of sleep apnea in women shot up after women were advised to stop taking hormones many years ago due to increased cardiovascular risks. If more women have sleep apnea, then that in itself will significantly increase rates of cardiovascular disease, including heart attacks and strokes.

If these environmental effects are happening in adult women, think about what can occur in young children. There’s even suspicion that these chemicals can cause neuro-developmental delays in infants. If you already have a sleep-breathing problem, adding xenoestrogens can only make things worse. As far as I know, I’m not sure of any studies showing that xenoestrogens can cause sleep apnea, but it can be argued that anything that prevents proper facial growth and development can increase your risk for developing obstructive sleep apnea.

What do you think about this issue? Is it a real problem that’s not being addressed by the government, or is it an an overblown concern?

 

 

New Innovations in Sleep Apnea Therapy: Live Presentation at the Manhattan AWAKE Group

Please join me for a live presentation on the newest innovations in sleep apnea therapy. I’ll be talking about hypoglossal nerve stimulation, Provent, and functional dental appliances at the Manhattan AWAKE group meeting on Wednesday, April 2nd at 6:15 PM. It takes place at 134 West 26th Street, 2nd Floor, New York, NY.

Developmental Issues That Stem From Pediatric Sleep Apnea

A guest blog by Nader Ahmadni of Sleepdisorders.com.

Pediatric sleep apnea is a sleep disorder characterized by obstructed or narrowed respiration while a child sleeps. The condition affects an estimated 25 percent of children in the US and typically occurs between ages 2 and 8, though it is quite under diagnosed. Pauses in breathing during sleep in patients with pediatric sleep apnea are typically much shorter and lighter than those in adults with sleep apnea. While an adult may snore loudly and make choking noises, a child may simply stop breathing momentarily and then wake up. Both conditions can lead to sleep deprivation and a wealth of other health issues if left untreated.

Children with pediatric sleep apnea often suffer from symptoms such as restlessness and bed wetting. Parents may notice that their kids tend to snore or breathe irregularly, through their mouths. During the day, children may seem tired and inattentive as a result of poor sleep the night before. Daytime symptoms of pediatric sleep apnea can also include hyperactivity and mood swings.

The majority of pediatric sleep apnea patients have enlarged tonsils and adenoids, which physically block the child’s upper airway. Usually, a minor surgical procedure to have the tonsils and/or adenoids removed will cure the condition. However, there are other conditions that may cause sleep apnea in young children, such as physical deformities or muscle weakness. Obese children and children with thicker necks are much more prone to pediatric sleep apnea.

Finding immediate treatment for pediatric sleep apnea is perhaps even more important than for older patients. Pediatric sleep apnea that starts at such an early stage can stunt growth and lead to a number of developmental issues. Over time, if a child is not getting enough quality sleep, he or she does not acquire sufficient amounts of oxygen to aid in normal brain and body development. The child is more likely to be diagnosed later in life with health conditions like attention-deficit hyperactivity disorder (ADHD) and childhood obesity.  Patients who grow up with untreated, chronic sleep apnea are also more likely to having learning disabilities, behavioral problems and metabolic problems.

In addition to making sure your child maintains proper diet and exercise, it is crucial that parents that notice symptoms of pediatric sleep apnea in their kids go to visit a primary care physician or a sleep center for further information. A sleep doctor can perform an overnight test called a polysomnography, which allows specialists to observe behavior, breathing and vital functions while the child sleeps in a sleep lab room. Data collected overnight will lead to proper diagnosis of the child’s sleep disorder so that the child can move forward with treatment either with a CPAP machine, oral appliances or surgery. As children aren’t able to identify the problem on their own, it’s crucial for parents to pay close attention to their children’s sleep habits and daytime behavior. In the event of an irregularity in breathing, be sure to visit a sleep doctor as soon as possible.

Sleepdisorders.com is designed to link sleep disorder sufferers to local sleep doctors and sleep centers. In addition to our directory of sleep doctors, you can find informational articles related to your unique sleep disorder.

Hotels That Promote Better Sleep

There’s been a trend in recent years by hotels to cater to people who have sleep problems during their stay. One hotel in particular is the Benjamin Hotel in New York City, which employes a sleep concierge. A New York Times journalist chronicled his odyssey of trying to get some shut eye over the course of the night. After reading the entire article, I’m not sure if the journalist actually got a better night’s sleep.

Sleep problems while traveling are a major source of sleep deprivation, from time zone changes to unfamiliar surrounding, and disrupted sleep routines. Having a sleep program such as what the Benjamin offers is a step in the right direction, but seems limited in what they can offer (different pillow selections, higher quality bed sheets, eye masks, etc.). It seems that a hotel guest is the perfect opportunity to diagnose obstructive sleep apnea, using some of the simpler screening tests that are available. They could also do a better job of emphasizing better sleep hygiene, such as not eating close to bedtime or not watching TV just before going to bed.

How well do you sleep when you travel?

Sleep Apnea Surgery Not As Risky As One Thinks

One of the common perceptions about surgery for sleep apnea is that it can be risky in the per0operative period. This is why many surgeons still observe patients who undergo UPPP or tongue base procedures in the intensive care unit overnight (ICU). A new retrospective study looking at almost 1700 procedures of the nose, palate and tongue determined that it’s not as risky as one may think. Patients that underwent tongue base procedures were admitted to a type of ‘step-down” unit for over-night observation. Overall, the complication rate was 7.1%, with most of these being minor and resolving with conservative treatment (typically transient high blood pressure or a drop in oxygen levels). Swelling of the tongue after suspension suture placement also resolved with conservative treatment. Only one patient required re-intubation for tongue base swelling. Complication rates were no different when they analyzed severity of sleep apnea or oxygen desaturation levels.

My personal experience over the last 10 years mirror these findings. So far, I haven’t had the need to admit patients to the ICU after sleep apnea surgery. With good surgical technique and nursing care, most of these patients can be observed on the regular inpatient floors. Of course, there will always be exceptions to the rule, and the decision to admit to the ICU has to be made on an individualized basis. 

A Final Farewell to Dr. Brian Palmer

I was shocked and saddened to find out that my friend and colleague, Dr. Brian Palmer, recently passed away. Dr. Palmer was responsible for opening my eyes to the importance of breastfeeding and good dental hygiene when it comes to your risk of developing obstructive sleep apnea. His decades of research and teaching has educated thousands of health care professionals. I had him as a guest on my Expert Interview program  twice, the last time being December, 2011. Prophetically, I do remember him telling me that his 2 hour presentation was his gift to society. You can listen to his talk on the Evolution of Malocclusion and Sleep Apnea here. His website is a valuable resource for the lay public and professionals alike.

Rest in peace, Brian.

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