Do Sleeping Pills Increase Your Risk Of Dying?

February 28, 2012

Here’s a stunning statistic: A prescription for just a few sleeping pills per year was associated with a 3.6 times increased risk of dying (from any cause) compared to those who didn’t have any prescriptions for these medications. It jumped to 5.32 if more than 152 doses per year were prescribed. The authors of this British Medical Journal article estimate that in 2010, hypnotics may have been associated with 320,000 to 507,000 excess deaths in the US alone. They came to this conclusion by combing through more than 10,000 records of people who were prescribed at least one prescription for a hypnotic and looked at mortality over 4 years compared to matched controls who didn’t have a hypnotic prescription.

They were careful to note that association does not imply causality. While it’s temping to interpret this study implying that sleeping pills can kill people, it’s important to realize that there are numerous studies showing that people with sleep problems are known to have a higher risk of dying from various reasons. For example, people with insomnia have higher rates of depression, suicide, and cancer. In addition, a significant number of insomniacs on sleeping pills will have obstructive sleep apnea, and untreated obstructive sleep apnea can increase your risk of car accidents, heart attack and stroke.

It’s likely that increased risk of dying is already elevated in people with sleep problems, and those that are given sleeping pills are found to have increased rates of death. This may be the classic case of being true, true, but unrelated. To really determine what causes what, you’ll have to look at mortality in a large prospective study in people with insomnia and randomize to be given sleeping pills versus a placebo.

Written by Steven Park · Filed Under Blog | 2 Comments

Increased Cancer Rates, Alcohol, And Sleep Apnea?

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?

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How Alcohol Is Linked To Psoriasis In Women

December 26, 2010

Women who drink 2 or more times per week, particularly nonlight beer, are found to have a higher risk of developing psoriasis. This study out of Harvard University showed that the risk increased by 1.72 times normal. One hypothesis that was proposed was that non-light beer is made from wheat products, and that wheat contains gluten, which is a common component that provokes an autoimmune response in Celiac disease.

I’ve written before about how sleep apnea could cause psoriasis in men, and this situation can apply to women as well. Sleep-breathing problems at night, whether or not they’re apneas, can cause a low-grade physiologic stress response which heightens your immune system. When your body’s immune system is in a constant state of stress, it can easily attack normal tissues or proteins. Furthermore, when your body is under stress, certain parts of your body (like your skin, digestive or reproductive organs) will be deprived of blood flow and nervous innervation. Hypoxic states can cause oxidative stress, which has been shown to be linked to autoimmunity, atherosclerosis and even cancer.

Knowing how prevalent obstructive sleep apnea is in our population, this connection is not surprising. Is there anyone reading this blog that had their psoriasis go away completely after your sleep apnea was treated?

Written by Steven Park · Filed Under Blog | 1 Comment

When Your Cold is Not a Cold

June 12, 2009

In our current age of economic recession and flu epidemics, experiencing hoarseness or a sore throat can conjure up worst-case scenarios. What I’ve noticed in more recent months is that more and more people with these two symptoms are coming in concerned about throat or lung cancer. If you feel a lump in your throat, the word lump itself can cause feelings of stress or anxiety. If you’re a smoker or a past smoker, the situation is even worse.

The other day a man came in complaining of an itchy, scratchy throat 4 days prior, with loss of his voice the next day. He didn’t have any other viral symptoms such as fever, chills, or muscle aches. Upon further questioning, he normally eats dinner early, but the night before all this happened, he went out to eat dinner late and also had some drinks.

Here’s the explanation to the sequence: Because of his upper airway anatomy, he was predisposed to acid reflux at night due to occasional obstructions and arousals. I talk about who may be predisposed and why this occurs in my book, Sleep, Interrupted. During an obstruction, vacuum forces can suction up small amounts of stomach juices into the throat, leading to various throat symptoms such as scratchiness, pain, hoarseness, post-nasal drip, lump sensation, and chronic cough. More often than not, doctors will give oral antibiotics in this situation, "just in case."

Many typical "colds" start of with a scratchy or sore throat, with no other viral symptoms. Later, it can "travel" up into the nose and sinuses, leading to nasal congestion and sinusitis. What’s happening here is that there was an initial episode of acid reflux, which first irritates the throat, leading to more swelling and congestion, aggravating the vicious cycle. It’s also been shown that your normal stomach contents (acid, bile, digestive enzymes, bacteria) can travel up into your nose and ears. Chronic inflammation can predispose any part of the body to true viral or bacterial infections.

The typical fevers, chills and sweats that are seen in this situation may suggest a viral infection, but you can also have all these symptoms from an involuntary nervous system reaction, which is called vasomotor symptoms. This happens when your involuntary nervous system becomes imbalanced due to a sudden change in your sleep-breathing status.

Even if you start off with allergies or a runny nose from a cold, eventually, the tongue will collapse more and perpetuate this vicious cycle.

So the next time you have a sore throat and are convinced that you have an infection, think again. In many cases, you’ll find that either you must have eaten late or drank alcohol the previous night. If not, then you may have a true cold. But since it’s been shown that having colored nasal mucous of throat phlegm does not necessarily mean you have a bacterial infection, things are not always what it seems.

How do your typical "colds" begin? I’d like to know.

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