February 27, 2013
There are probably millions of people in the US every year who drink a glass of wine or other alcoholic beverage just before bedtime. Reasons can include being able to sleep faster, or for red wine’s health benefits. Here’s a recent study that only repeats what’s already known about in sleep medicine for years: That alcohol can make you go into deep sleep faster, but later on, it cuts into your REM sleep, increasing the chances that you’ll have apneas or sleepwalk. The reason for this is that alcohol relaxes your throat muscles, so it’ll make you more prone to obstruction and arousals.
I disagree with the authors to moderate alcohol just before bedtime. I think everyone should stop any sort of alcohol (and food) within 3-4 hours of bedtime. Even if you don’t have sleep apnea, do you want to begin having apneas at night?
April 7, 2012
Look for my quote in More Magazine about the effects of alcohol on sleep (under #3).
April 12, 2011
Here’s an interesting study which showed that drinking more than recommended amounts of alcohol can significantly increase your risk of certain types of cancer. Eight European countries enrolled over 250,000 people prospectively over 13 years and found that drinking too much alcohol could account for nearly 45 of cancers of the mouth, voice box and throat in men and 25% of those cancers in women. The rates for liver cancer were 33% and 18%, respectively for men and women. The researchers don’t have a good explanation for why alcohol can increase your chances of cancer. One proposed mechanism is the possibility that alcohol somehow damages DNA, preventing cells from repairing itself.
I’ve written in the past about how chronic reflux in the throat due to untreated obstructive sleep apnea can lead to an increased risk for pre-cancerous changes in the throat, as well as increasing inflammation in the nose and lungs. Chronic low-grade irritation and inflammation is a known risk factor for malignant degeneration. Other studies have shown that obesity is also an independent risk factor for cancer, particularly with breast and prostate cancers. It’s a given that if you’re overweight, you’ll have a higher chance of having obstructive sleep apnea. Multiple breathing pauses while sleeping can cause vacuum forces that literally suction up your stomach juices into your throat. Stomach juices not only include acid, but also bile, digestive enzymes, and even bacteria.
Not sleeping effectively due to breathing pauses can prevent adequate blood supply to the reproductive and digestive organs, as well the the peripheral organs such as the skin. Chronic hypoxia is a known aggravator of oxidative stress, which is one of the proposed mechanisms cancer generation. Chronic hypoxia and chronic inflammation are double whammies in cancer research.
I realize that this is not your typical, genetics-molecular biology explanation for cancer development, but if you look at it from a broader perspective, it does have some merit which deserves further investigation. Maybe cancer researchers should place sleep apnea as an additional risk factor for cancer.
What do you think about my hypothesis?
January 5, 2011
Believe it or not, your skin is considered an end organ, meaning that it’s at the outermost reaches of your blood supply. It’s also a part of your body which can be deprived of blood flow if you’re under stress, similar to what happens to your digestive or reproductive systems.
Psoriasis is a common skin condition that affects about 34 million Americans, or about 3% of the population. It’s characterized by red, scaly patches of skin covered by white flakes. It’s thought to be a chronic autoimmune condition, where your body’s immune system can attack or damage your own tissues.
I’ve written before about strong links between psoriasis and obstructive sleep apnea, but here are a series of studies that further solidifies this connection. Some of the studies I’ve cited before. Others are new:
Metabolic syndrome (Syndrome X) is a combination of high blood pressure, insulin resistance, and high cholesterol levels. Having all three conditions has been shown to significantly increase your risk of heart disease, heart attack, or stroke. Numerous studies show that people with metabolic syndrome can also have obstructive sleep apnea. In fact, syndrome Z has been described as all the features of Syndrome X plus obstructive sleep apnea.
A study published in Archives of Dermatology showed that patients with psoriasis had a higher chance of having metabolic syndrome compared to people who didn’t (40% vs. 23). I’ve written in the past about how chronic physiologic stress due to sleep apnea causes diversion of blood flow and nutrients to the bowels, reproductive organs, and the skin, since they’re considered “low priority” organs. Low blood flow causes a relative hypoxia, creating oxidative stress, and along with a heightened immune system, so it’s not surprising that the skin can show psoriatic plaques.
Here’s a study showed that women who drank more than two alcoholic beverages per week had a significantly higher risk of psoriasis. Alcohol relaxes your throat muscles, aggravating sleep apnea.
Researchers from harvard showed that comorbid conditions such as cardiovascular disease, depression, diabetes, obesity, and hyperlipidemia all increased over time. Not too surprising if you already have sleep apnea.
Pregnant women with psoriasis were found by Harvard and Mass General researchers to have higher risk of pregnancy-related complications, including spontaneous abortion, preterm birth, preeclampsia, placenta previa, and ectopic pregnancy. Gaining weight can aggravate sleep apnea. Studies show that CPAP can help with preeclampsia.
People with psoriasis were found to have increased risk of depression (39%), anxiety (31%) and suicidal thoughts (44%). Sleep apnea can cause structural, metabolic, and biochemical changes in your brain due to hypoxia.
And lastly, young adults who are obese were found to have a higher risk of developing psoriatic arthritis later in life. Obesity is a major risk factor for obstructive sleep apnea.
Perhaps psoriasis should be placed on the ever-growing list of complications of obstructive sleep apnea. What do you think?
June 2, 2010
Former news anchor Ted Koppel's son, Andrew, was found dead after after a night of heavy drinking with friends. It's a sad occasion whenever anyone's son dies for any reason, but there were a few points in the Associated Press news article that's worth mentioning. After a night of heavy drinking, he ended up at a third friend's apartment, where they lay him down to sleep it off since he was clearly drunk. When they checked on him a few hours later, he was noted to be snoring, but had a pulse. A few hours later, he was found dead.
December 14, 2009
I’ve been accused in the past of of trying to link everything to sleep apnea. While not everything is caused by sleep apnea (taxes, the weather, etc.), I can make a good argument that not breathing properly during the day and while sleeping can directly or indirectly affect every aspect of our state of health and well-being. Obstructive sleep apnea is only a small fraction of what I describe in my sleep-breathing continuum. Due to the way we define sleep apnea, you can have major sleep-breathing problems and not have any sleep apnea.
Along these lines, here’s something interesting to think about: Can a sleep-breathing problem cause or aggravate breast cancer?
Drinking alcohol was found to increase a woman’s risk of not only developing breast cancer, but also increase the risk of developing recurrence in breast cancer survivors. In a recent study from Kaiser Permanente, women who drank 3-4 glasses of wine per week were 34% more likely to develop a recurrence compared with women who drank little to no alcohol.
The researchers speculated that alcohol can increase levels of estrogen, which increases metabolism. However, they didn’t have a clear explanation for these findings. What’s more relevant to this discussion is the fact that post-menopausal women and overweight women who drank were at higher risk for recurrence.
Like many other studies, researchers never commit themselves to state that one thing causes another—they can only state statistical likelihood of an association, but not causation.
Similar finding are being reported with prostate cancer—that heavy alcohol consumption and being overweight increases your risk of recurrence.
Here’s my interpretation of these findings: Alcohol is a strong muscle relaxant that’s usually taken with dinner or later in the evening. Muscle relaxation during deep sleep causes more frequent obstructions in your breathing, which can cause or aggravate existing sleep apnea. The resulting activation of the sympathetic nervous system leads to a relative hypoxic environment in preferential body parts and organs, such as the gastrointestinal system, the reproductive system, the skin, and the hands and feet.
Since the breast is a combination skin and reproductive structure, it’s more susceptible to various levels of hypoxia. Physiologic stress that develops in sleep apnea constricts blood vessels that feed blood into the breasts. This is also why many women with breast cancer also have cold hands and feet.
As I’ve described in my book, Sleep, Interrupted, hypoxia creates chemical mediators that tell the body to send more blood. One particular substance is vascular endothelial growth factor, or VGEF, which promotes new vessel formation and more aggressive tissue growth and regeneration.
Menopause is stage in life in a woman’s life where progesterone slowly diminishes, leading to more and more frequent obstructions and arousals (since progesterone promote tongue muscle tone). Furthermore, inefficient sleep can promote weight gain. Weight gain narrows the throat, leading to more frequent obstructions. Women’s rate of cardiovascular disease also increases significantly after menopause, along with a significant increase in obstructive sleep apnea. We know that sleep apnea can cause heart disease, but so far, these conditions are treated separately. It’s not surprising that breast cancer is treated independently, rather than looking at the bigger picture.
Granted, this is an unorthodox explanation for breast cancer, but as Einstein once said, "The significant problems we face cannot be solved at the same level of thinking we were at when we we created them." In other words, we must think outside the box.
What I’m proposing doesn’t contradict traditional explanations for breast cancer. Rather, it’s a different perspective that can only complement existing treatment options.
What you do think about this explanation? Please enter your responses in the box below.
December 10, 2009
Not too surprisingly, regular use of the recreational drug ecstacy was found to significantly raise the risk of sleep apnea in young, healthy volunteers. Researchers found that this drug affects deep sleep muscle tone and brain neurotransmitters, leading to more frequent obstructions.
Ecstacy is illegal, but there’s one common and very legal drug that’s just as bad in aggravating sleep apnea: alcohol. Anything that causes muscle relaxation or depresses the nervous system will lead to obstructions. This is why people snore more after having a nightcap, or if they take a muscle relaxing sedative medication.
Worse yet, many people use alcohol as a sleep aid, since they’re too wound up or stressed to fall asleep. Yes, alcohol does make you more drowsy, but once you’re asleep, you’ll stop breathing more often. Due to poor quality sleep, you’ll feel even more stressed by the end of the day. Thinking you’ll sleep better, you have your nightcap and the vicious cycle starts all over again. Over the long term, poor quality sleep leads to weight gain, which aggravates sleep apnea even further.
This begs the question: Does regular ecstacy use cause sleep apnea, or are people with sleep apnea more likely to use psychoactive medications such as ecstacy and alcohol?
What do you think about this issue? Please enter your answer in the comments box below.
December 7, 2009
If you’ve ever suffered from a hangover, the pounding headache, facial pressure, sensitivity to lights and loud noises will be familiar. Most people will also have a very dry, raw throat, and this is usually blamed on dehydration that’s caused by drinking too much alcohol. As far as I know, there’s no scientific proof that drinking alcohol causes significant dehydration.
Furthermore, notice that many of the features of a hangover, which usually happen only after waking from sleep after drinking too much, resemble the same symptoms when someone suffers from a migraine headache: pounding headache, nasal and sinus pressure and congestion, light and sound sensitivity, lightheadedness and imbalance, brain fog, and nausea.
Interestingly, there’s another condition that give you headaches when you wake up in the morning: obstructive sleep apnea. Not too surprisingly, you’ll have a pounding headache, sinus pain and pressure, light and sound sensitivity, and mild nausea, and brain fog. Numerous studies clearly document that alcohol can worsen or uncover obstructive sleep apnea.
This is not too surprising, since alcohol is a strong muscle relaxant, causing your throat muscles to collapse and obstruct your breathing every time you go into deep sleep. When your throat obstructs, you’ll create a vacuum effect in your throat, which literally suctions up your normal stomach juices into your throat. This is why your throat is so dry and sore in the morning during a hangover. Not getting any deep sleep will give you pounding headaches, nausea, light and sound sensitivity, and brain fog.
This process also explains why some people are less susceptible to hangovers, no matter how much thy drink. If your throat anatomy is wide to begin with, muscle relaxation and collapse won’t progress to the point of obstruction and arousals as often.
What’s your take on hangovers? Please enter your opinion below in the comments box.