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? 

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?

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.

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?

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?

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.

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.