Brain Damage in Chronic Fatigue Syndrome and Sleep Apnea

March 5, 2011

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?

Written by Steven Park · Filed Under Blog | 6 Comments

How to Go From Fatigued To Fantastic

November 25, 2009

Learn how to get rid of your fatigue once and for all…

Another Expert Interview where Dr. Park interviews world renown expert, Dr. Jacob Teitelbaum on what you can do to treat chronic fatigue syndrome and fibromyalgia.

Learn:

If you have chronic fatigue syndrome and what you can do to get it treated
How to avoid many of the common mistakes chronic fatigue sufferers make when choosing the right treatment options or healthcare provider
Which on-line resource can help you overcome CFS and fibromyalgia
What safe, affordable treatment options Dr. Teitelbaum uses to treat his own private patients and how you can access the same type of care from your own physicians to start feeling good right away
What specialized treatment options obstructive sleep apnea or upper airway resistance syndrome patients should opt for if they also suffer from CFS and fibromyalgia

Buy your copy of this audio recording today, available in two easy-to-access formats:

MP3 audio recording, $17

PDF digital transcript, $7

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MP3 recording + PDF transcript, $20

Start Breathing, Sleeping, and Living Better with Dr. Park’s Expert Interview Series!

Written by Steven Park · Filed Under Expert Interviews, General Health, Premium Products, Products | Leave a Comment

Can H1N1 Cause Sleep Apnea?

November 24, 2009

You may be thinking that I’m stretching things a bit by making the suggestion that H1N1 can cause sleep apnea, but in my mind, there’s no doubt that whether it’s H1N1, the common cold, allergies, or strep throat, any degree of inflammation and swelling in the nose and the throat can aggravate sleep-breathing problems. If you didn’t have sleep apnea to begin with, then you may go into sleep apnea territory temporarily, and come back to normal once the infection is gone. This is why you’ll toss and turn when you have a simple cold. If you already have some degree of sleep apnea, then any infection or inflammation will only make things worse. Some people will recover, whereas others will be stuck in a continuous vicious cycle, leading to various other medical complications.

As I detail in my book, Sleep, Interrupted, most modern humans have narrowed jaws that lead to dental crowding and a predisposition to breathing problems while sleeping at night. My sleep-breathing paradigm proposes that all modern humans are on a continuum, where the upper extreme is formally called obstructive sleep apnea. But even if you don’t have sleep apnea, you can still stop breathing multiple times every hour. This disrupts your sleep and causes more inflammation and swelling due to suctioning up of your stomach juices into your throat. More swelling causes more upper airway narrowing, leading to more obstruction, which leads to more swelling.

The most dramatic example is what happens with mononucleosis. The Epstein-Barr virus which is thought to cause mono preferentially attacks lymphoid tissues. Your tonsils are made of lymphoid tissues, like the glands in your neck, armpits and groins. When your tonsils swell up for whatever reason (infection, irritation, inflammation), it narrows the throat, aggravating more frequent collapse, perpetuating the vicious cycle described above. This is why it takes a long time for mono to go away. In some people, the cycle never stops, leading to chronic fatigue syndrome. The physiologic consequences of this process can lead to hormonal, biochemical, and neurologic changes which may or may not show up on blood tests.

In this situation, it’s not that the tonsils are too big, but the jaws are too small, causing chronic inflammation and swelling, which keeps the tonsils larger than normal. This leads to further narrowing of the upper airways. It’s also been shown that you can have persistently enlarged lingual tonsils, which are lymphoid tissue at the base of the tongue in the midline. The size of lingual tonsils has been correlated to the level of reflux material in the throat. Your adenoids, which are lymphoid tissue in the back of your nose, can also become inflamed from colds or allergies, aggravating nasal congestion, which creates a vacuum effect downstream in the throat.

Ultimately, what’s more important than what’s infecting you is the size of your upper airway and how well your body is able to handle these infections. An underlying sleep-breathing problem can definitely aggravate your symptoms. This is why living by the principles that incorporate my sleep-breathing paradigm will help you to minimize or even prevent serious complications from any infection this winter season. My wife and I live by these principles and so far (knock on wood), so good.

Do simple colds lead to prolonged symptoms or repeated infections for you? If so, please explain in the comments box below.

Written by Steven Park · Filed Under Blog | 1 Comment

Is the XMRV the True Cause Of Chronic Fatigue Syndrome?

November 4, 2009

Written by neha · Filed Under obstructive sleep apnea, Videos | Leave a Comment

Is the XMRV the True Cause Of Chronic Fatigue Syndrome?

October 28, 2009

Researchers and the media are buzzing with the recent finding that a retrovirus called XMRV is found in 95% of chronic fatigue syndrome (CFS) sufferers, compared with only 3.7% in controls. For CFS sufferers, this further legitimizes the condition, whereas skeptics state that there’s no proof that the virus causes the symptoms, and that more studies must be done.

Dr. Jacob Teitalbaum, world renown expert on chronic fatigue and fibromyalgia, published a response to this media blitz (click here for his response). Essentially, he acknowledges that a virus can cause or trigger CFS, but that there are many other infections (viruses, bacteria and fungal) that can cause or trigger this condition as well. In addition to infectious causes, there are 6 other areas that he addresses as part of his SHINE protocol: S is for sleep, H is for hormonal, I is for infections, N is for nutrition, E is for exercise. With this protocol, Dr. Teitelbaum found that 91% of CFS sufferers felt much better with his protocol. You can take his free symptom analysis quiz on his website at Vitality101.com.

I tend to favor Dr. Teitelbaum’s explanation for CFS. From my perspective as a sleep-breathing expert, sleep apnea and upper airway resistance syndrome can be potent triggers, but the vicious cycle that ensues affects every system in your body (hormonal, metabolic, neurologic, digestive, cardiovascular, etc.). Anything that causes temporary or permanent narrowing of your upper airways can trigger this process. Additionally, anything else that increases your stress levels (whether internal/physiologic or external (physical, emotional or psychological) can also alter your energy balance mechanisms. Dr. T. uses the analogy of blowing a fuse in your body, with an energy crisis that results.

Everyone is looking for that one bug or gene that causes certain medical conditions. For example, the cold sore virus (herpes simplex) has been blamed for Alzheimer’s Disease. The same XMRV was found at higher levels in prostate cancers. The Epstein-Barr virus has also been implicated in CFS. So far, there’s no proof that these viruses actually causes the symptoms in CFS.

One thing to take away from this post is that in general, the virus (or infection) that caused the initial illness is not what’s casing your current chronic long-term symptoms. Yes, other secondary infections can occur, with various other systemic problems, but the key point here is that you have to look at the entire person and treat all the problems simultaneously, rather than targeting just one problem.

A simple example is with the Epstein-Barr virus and mononucleosis. This virus preferentially affects your lymphoid system. The tonsils are part of your lymphoid system. The larger your tonsils, the more likely your symptoms will be severe and last a lot longer. Since by definition your tonsils will be larger when your jaws are smaller, the smaller your airways will be, and the more likely you’ll suffer from repeated breathing obstructions, causing throat inflammation and even more swelling.

With all the media buzz about these new "discoveries," how do you deal with these findings? Do you take it with a grain of salt? Or do you get excited and can’t wait to get tested or try it out? Please enter your opinions in the box below.

Written by Steven Park · Filed Under Blog, obstructive sleep apnea, UARS | 3 Comments

Q: Severe OSA or UARS?

August 17, 2009

Q:
Hello Dr. Park,

I am a 24 year old male and have been suffering from moderate-severe sleep problems for at least 7 years now. For as long as I can remember, I have had issues waking up in the morning. No matter how hard I try or what methods are used, I couldn’t get up when desired. In the past 2 years I have noticed a big decrease in my level of energy. Oftentimes I feel fatigued to the point where my day is compromised.

In early April I had a sleep study performed which found that I had severe OSA. Apparently I stopped breathing up to 85 times an hour when I was on my back, which was slightly worse than when I was on my side or stomach. I have been using the CPAP for almost 2 months now and honestly don’t feel that much better. I would say that it is a little easier to wake-up in the morning, but that’s about it. I still suffer from fatigue and lack of energy throughout the day. My doctor is saying that the CPAP has returned my AHI to normal levels, but I am not noticing the difference.

In my attempt to locate more information, I came across your journal entry “Tired of Being Tired” to learn more about UARS. My main question, is how possible is it that I have a moderate-severe OSA as well as UARS?

I greatly appreciate your assistance and service and wish you the best!

JPBESpoke

A: Sorry to hear about all that you’re going through. It must be frustrating. If you’re using CPAP regularly and have data from the machine that confirms it (good compliance and no leaks with minimal AHIs), then the best thing to do is to be patient. You’ve had this condition for years, and sometimes it can take months (sometimes 6-12) to begin to feel better.

It does sound like you do have upper airway resistance syndrome, but you also have severe obstructive sleep apnea. What I see is that some people with UARS go on to develop what may look like chronic fatigue syndrome. Your involuntary nervous system is severely unbalanced, and you have to give it time to come back into alignment. Your situation is complicated and and endoscopic exam will only confirm what you already know. But it’s probably a good idea to take one look to make sure there’s nothing else that’s going on. By definition, you’re susceptible to any of the somatic syndromes, since these are intimately linked to sleep-breathing problems.

There are also many studies that show that people with untreated obstructive sleep apnea have significant brain abnormalities with various degrees of injury. Years of hypoxia can cause temporary or permanent injury. You can imagine how multiple areas of damage throughout the brain can give various signs or symptoms such as chronic fatigue, numbness, hormonal imbalances, etc. This is not proven as of yet, but if you look at all the research in this area, it’s a reasonable explanation. This is why sometimes it can take months or over a year to begin to feel better.

Written by Steven Park · Filed Under QnA | 2 Comments

The Real Reason for Chronic Fatigue in Mono?

February 2, 2009

A recent article in the New York Times reports on the widespread incidence of mononucleosis in teens and young adults. The Epstein-Barr virus is thought to be the cause, with most Americans infected by their 30s. It’s thought that up to 50% of people infected develop severe fatigue or other symptoms. The article points out the fact that "mono," or "the kissing disease" has been trivialized due to it’s widespread nature and that trials of new drugs and vaccines are lacking.

My take on this article: Most people who are infected with mono experience little more than your typical cold symptoms, but there are a small, but significant number of people who suffer a variety of potentially life-threatening complications, if not extreme fatigue that can be quite debilitating. Mononucleosis infects your body’s lymphoid system, most of which are found in your lymph nodes and spleen. These lymph glands educate your body about any infections and respond appropriately by making more immune cells. As a result, the glands can swell to various degrees—sometimes, to dangerous levels.

Besides the many lymph glands in your neck, your tonsils (and adenoids) are also made of lymphoid tissue. So if you are a teen or a young adult and still have relatively large tonsils, then being infected with mono will cause your tonsils to swell.

As I’ve stated before, anything that causes either temporary or permanent narrowing in your throat will cause your throat structures to obstruct when you are sleeping, especially when you are on your back (due to gravity), and when in deeper levels of sleep (due to muscle relaxation). Even a simple cold can aggravate temporary sleep-breathig problems, causing you to toss and turn all night long. Once your cold goes away, you’re fine again.

However, if you have larger tonsils than normal, then the enlarged tonsils will cause you to stop breathing more often, and in certain people, the vacuum effect created in the throat causes a suctioning of stomach juices into your throat, which causes more swelling. This irritates your tonsils further and the vicious cycle continues.

One little appreciated piece of information is that if you have large tonsils (or eve if you’ve had your tonsils taken out), you could still have lingual tonsils remaining. Lingual tonsils are lymphoid tissue at the base of the tongue in the midline, just above your voice box. So any degree of swelling will narrow the space behind the tongue significantly. It’s also been shown recently that persistently enlarged lingual tonsils are associated with laryngopharyngeal reflux disease.

I’ve also alluded to my sleep-breathing paradigm (in my book Sleep, Interrupted: A physician reveals the #1 reason why so many of us are sick and tired) where many people with sleep-breathing problems have relatively narrow jaws and dental crowding, which leads to chronic low-grade obstructions preventing deep sleep, and constant low-grade inflammation of the throat from microscopic stomach contents.

In my practice, every time I see someone with severe mono, their tonsils are infected and extremely large, sometimes almost touching in the midline. Antibiotics usually don’t work (because it’s a viral infection), and in fact, is not recommended due to a potential reaction to certain antibiotics. The one medication that usually helps patients feel better is a short course of oral steroids, like prednisone. It’s thought to be due to its’ anti-inflammatory effects, significantly reducing swelling.

Anytime there is inflammation in the throat, by definition, there will also be inflammation in the nose. This occurs via a combination of gastric juice regurgitation into the nose, ears and sinuses, as well as through an imbalance of the involuntary nervous system. People with narrows jaws will also have narrow nasal side-walls, since the the width of the nasal cavity follows the width of the upper jaw.

If there is any degree of nasal congestion, then vacuum forces are created downstream, aggravating even more throat or tongue narrowing and collapse.

The well-known residual symptoms of severe chronic fatigue after mono can last from weeks to months. Sometimes, the fatigue doesn’t go away at all. Eventually, some of these people will be diagnosed with chronic fatigue syndrome.

The chronic physiologic stress state that’s created can lead to metabolic and hormonal changes. For example, elevated cortisol levels due to stress can suppress thyroid function and raise glucose levels.

It can even affect reproductive hormones adversely. In women, stress can suppress progesterone, elevating the estrogen to progesterone ratio. Interestingly, progesterone is known to promote upper airway muscle tone, so the lower the level of progesterone, the more your tongue is likely to fall back and obstruct, leading to less efficient sleep.

It’s been suggested that there are many different reasons for chronic fatigue syndrome, but upper airway narrowing due to to anatomic reasons and swelling is one logical explanation that encompasses all other explanations. Ultimately, swelling of the upper airway structures can be from anything that causes inflammation, from the common cold to allergies, to acid reflux. The tonsils are one dramatic example of swelling due to infection or inflammation, but other areas of the throat can become swollen, such as the soft palate and tongue. If you look at mono from a sleep-breathing perspective, the chronic fatigue that results sometimes makes a lot more sense.

Written by Steven Park · Filed Under Blog | 17 Comments