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Depression Ups Your Stroke Risk

A recent study revealed that having depression was found to increase the risk of having a stroke by 45% in people who were followed from 2 to 29 years. Your risk of dying from a stroke also increases by 55%. The article talks about people with depression being more overweight. What else can being overweight cause?

We know that having insomnia significantly increases your risk of developing depression later on in life. Having untreated severe obstructive sleep apnea also significantly increases your chances of having a stroke. Not sleeping well from any reason (insomnia or sleep apnea) can cause major biochemical and structural changes in your brain. Do you see the connection? 

Brain Regeneration After CPAP Use for Sleep Apnea

I’ve written numerous times in the past about how various areas of the brain can be injured from untreated obstructive sleep apnea. Studies have shown that sleep apnea patients have lowered brain density levels in areas that control memory, executive function, and autonomic control. Despite all the bad news about the effects of untreated obstructive sleep apnea on the brain, here’s some good news: A recent study showed that the brain can regenerate even after 3 months of CPAP usage. Brain volume actually increased significantly, and neuropsychological tests improved significantly as well. The only caveat was that this study was supported by the Respironics Foundation (not that there’s anything wrong with that).

Brain Damage in Chronic Fatigue Syndrome and Sleep Apnea

There are a lot of controversial theories about the origins of chronic fatigue syndrome (CFS), and even more recommendations on how it can be treated. One particular explanation is that people with CFS have some sort of brain dysfunction, which disrupts how it regulates the body’s nervous, metabolic, and hormonal systems. A recent study confirmed that white matter and grey matter volume was diminished in various parts of the brain and brainstem.

These findings are very similar to numerous studies showing that untreated obstructive sleep apnea can lead to brain volume loss or lower tissue density in various parts of the brain, including areas that control memory, executive function, and especially autonomic control. This brings up the classic chicken or the egg question: Did brain damage come first and CFS afterwards, or does CFS cause brain damage? Knowing how common sleep-breathing problems are at any age, and knowing how even mild levels of breathing difficulty during sleep can significantly affect brain functioning, perhaps brain damage from suddenly worsened sleep apnea could be a more logical reason for most (but not all) cases of CFS.

Many patients with CFS will have documented obstructive sleep apnea, but not all. However, the upper airway anatomy in most CFS patients are more like people who have upper airway resistance syndrome. Their upper airways are so narrow that their nervous system become overly sensitive to any degree of airway obstruction. As I’ve stated before, UARS patients wake up to a light stage of sleep, even with very subtle degrees of breathing obstruction. These pauses are not long enough to be called apneas. This causes a chronic low-grade physiologic state of stress, which by itself is known to be detrimental to brain health.

So it’s not surprising that most people with CFS have very small mouths and narrow jaws. Many have had excessive dental extractions for various reasons, or have various degree of jaw underdevelopment. The vast majority definitely can’t sleep on their backs.

This also explains why a simple cold or viral infection (Mono, Lyme, etc.), sudden weight gain, or physical injury that forces you to sleep on your back, can trigger the vicious cycle that leads into the classic symptoms of CFS. All these events suddenly narrow the already narrowed upper airway.

If you have CFS, what was your precipitating event?

Sleep Apnea & Menstrual Cramps

Here's a recent study that suggests that menstrual cramping may predispose to brain structure changes.

It's more likely that brain structure changes can predispose women to menstrual cramps. Interestingly, untreated obstructive sleep apnea has been shown to result in lowered brain tissue volume and density in critical areas such as memory, executive function, and autonomic control. So it's not surprising that many women with problem menstrual cramps can't sleep on their backs, and are more tired than normal, since they can't sleep efficiently. Due to smaller jaw structures, the tongue can take up relatively more space in the throat, and can obstruct during deep stages of sleep, especially when muscles begin to relax.

Snoring: Not So Benign

Here's a study that confirms that snoring should always be taken seriously: Researchers showed that snoring children had lower IQ/test scores compares with children that didn't snore. Not too surprising, knowing what we know about snoring. 

Even if you don't have obstructive sleep apnea, snoring is a sign that you're partially obstructed, and in most cases many people who snore initially go on to develop obstructive sleep apnea many years later. In young children with very actively developing brains, any disruption in sleep quality can disrupt proper brain functioning. 

I overheard one sleep researcher a few years ago saying that after tonsillectomy, cognitive and behavioral scores improve dramatically, but never catch up to that of children who didn't need tonsillectomy.

So why should snoring be taken so seriously?

We know that in drivers, snoring alone without having formal obstructive sleep apnea significantly increases your risk of car accidents. Vibrations that come from snoring is thought to alter the sensory nerve endings of the soft palate, somehow damaging the protective reflexes that help to keep the upper airway open. Vibrations from snoring are also found to cause carotid artery wall thickening in rabbits. Damage to the chemical receptors from additional reflux can also aggravate this vicious cycle. These type of studies go on and on. 

What all these studies point to is the fact that snoring is on a continuum of sleep-breathing disturbances of which all humans are susceptible. While not all snorers will have obstructive sleep apnea, it's important to look for complications of snoring, as well as to prevent progression later on into true sleep apnea. 

How many of your friends or family members snore?

Brain Injury And Obstructive Sleep Apnea

 

I recently came across a study what showed that people who suffer from strokes have much more difficulty recovering brain function if they have obstructive sleep apnea. This makes total sense. Once you have brain damage of any type, having chronic hypoxia and blood stagnation can definitely prevent proper healing. This study assumed that only some people who have strokes have obstructive sleep apnea, but numerous studies show that the vast majority of stoke patients have undiagnosed obstructive sleep apnea. We also know that having obstructive sleep apnea significantly increases your chances of having a stroke by up to 300%. 

With recent increased awareness of traumatic brain injury in football players as well as in returning war veterans, it's important to at least screen for undiagnosed obstructive sleep apnea with both of these groups for people, early, rather than after the damage is done. Knowing that about 1/4 of all men will have at least mild sleep apnea, looking for and treating an underling sleep apnea condition can improve recovery after any form of brain injury, not to mention prevention of further brain injury and impairment. 

What years of do think about my theory? Is it plausible, or am I just over-hyping sleep apnea?

Sleep Apnea Causes Brain Damage

A new study in the journal Sleep revealed that using special MRI imaging techniques, untreated sleep apnea patients have significantly decreased concentrations of gray matter in certain predictable areas of the brain. This means that the density of neurons is much lower than normal. The average AHI was 52, and on initial inspection of the MRI, there were no obvious structural abnormalities, with no differences in the total volume. However, gray matter density was significantly lower for sleep apnea patients in various areas of the brain that serves important functions such as memory, breathing, cardiovascular function, and autonomic function.

This study complements a prior study that showed that OSA patients have multiple dysfunctional areas of the brain.

I think the implications of this study along with various other similar studies are profound. What this means is that if you have obstructive sleep apnea, you can literally kill off certain parts of  your brain, that preferentially control your memory, executive function, your breathing patterns, and even your your heart rate. Could this be an alternate explanation for central sleep apnea? Maybe this is also why not all patients that use CPAP feel significantly better—perhaps the damage is irreversible. What's frightening is that you can suffer permanent brain damage long before your sleep apnea is even picked up and treated. 

Take a look at the abstract and read the paper if possible. What do you think about these findings? Please enter your opinions in the text box below.

Sleep Apnea Can Cause Brain Damage

A recent review of the literature in the Journal of the American Dental Association concluded that episodes of hypoxia (low oxygen levels) due to sleep-breathing problems can lead to permanent brain damage, and can even occur in early childhood. These findings are not too surprising, with a number of studies in recent years that support this finding. What’s troubling, however, is that no one is making the possible connection between brain injury due to sleep apnea and other well known neurologic conditions such as ADHD and Alzheimer’s.

Numerous studies have shown that sleep apnea patients have more areas of injured or dead brain tissue than patients without sleep apnea. This can occur in the gray and white matter (which serve memory and cognition), and even in the lower areas that control breathing, sensation and movement. One sleep researcher at a meeting that I went to many years ago stated that in young children who undergo tonsillectomies for obstructive sleep apnea, they catch up pretty dramatically in terms of cognition, memory, reaction times and intelligence scores. But they never catch up fully with age matched control children that don’t have obstructive sleep apnea. What this implies is that there may be a slight, but permanent brain injury.

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