• Home
• About Dr. Park
  • Dr. Park’s Bio
  • My Mission
• Testimonials
• Articles
• Sleep Apnea Basics
  • Obstructive Sleep Apnea – A Primer
  • Upper Airway Resistance Syndrome
  • Surgery For Snoring & Sleep Apnea
  • Usual and Unusual Ways to Stop Snoring
• Expert Interviews
• Blog
• Press Room
• Resources
• Contact Us

Colds, Viruses, and Sleep Apnea

Have you ever wondered by some people never get colds? Why do other people get colds at the drop of a sneeze? An opinion piece recently published in the New York Times explains away a common myth—that you have to strengthen your immune system to fight a cold. His argument is that your symptoms of a cold are actually your immune system over-reacting to harmless viruses. This is similar to your immune system over-reacting to typical typical allergens like dust or pollens. So if you make your immune system even stronger, your cold will get worse.

In this article, the author also points out that most cold viruses are harmless, causing mild inflammation and swelling in the nose. Only some people end up going on to full-blown sinus, ear or throat infections.

This is where my sleep-breathing paradigm fits in nicely. If you assume that all modern humans stop breathing once in a while due to narrowed upper breathing passageways, then any degree of inflammation (from a cold, an allergy, weather changes, or even acid reflux) can narrow any part of your nose, and this can aggravate a vicious cycle where more frequent obstructions can occur behind your tongue, suctioning up more stomach juices back up into your throat and even your nose. Narrowing of your jaws also narrows your nasal and sinus structures, and even a slight degree of swelling can significantly diminish airflow through your nose.

Furthermore, most cases of sore or scratchy throat isn’t really from the viral infection—it’s from your stomach juices, which includes bile, digestive enzymes, acid, and bacteria. This is why many people have sore throats the morning after drinking or eating late. Many women have sore throats in the days before their periods. I had one woman tell me that she gets sore throat whenever she gets wet or if it rains. Hormonal changes (especially progesterone) during monthly periods causes relaxation of the tongue muscles, which can fall back more easily whenever you’re in deep sleep. Weather changes can also aggravate nasal membranes, causing additional inflammation, aggravating further tongue collapse.

By definition, if you have a sleep-breathing problem, your immune system is overly active. And so is your nervous system. This is why your body over-reacts to weather changes, certain foods, emotions, pollens, chemicals, and even certain sounds.

Is That Scratchy Throat Really A Cold? The Case Against Strep Throat (Part 1)

Here's a typical patient that I see 2-3 time every day in my practice: A young woman comes in complaining of waking up Sunday morning with a sore and scratchy throat. She thinks she may have caught her husband's cold, since she is also experiencing some sweats, low-grade fever and unrefreshing sleep. I ask repeatedly if she did something out of the ordinary a few days prior to the onset of her symptoms, and she says no. She denies any traveling, flying, eating or drinking late. She normally sleeps on her stomach, and her father snores like a train. She's worried that she has Strep throat. 

Her general exam, as expected, is normal. No throat inflammation, redness or swollen glands. Looking via a flexible endoscope, the back of her voice box is slightly inflamed and swollen, but there's absolutely no evidence of infection? What would you do?

When Your Cold Is Not A Cold

Every time you get a cold, notice how it usually starts in the throat with a tickle, a scratch, or a slight cough. It then progresses into chest congestion or travels up into the ears and the sinuses. You’ll have a low grade fever, mild chills, and a runny nose. Even if you start out with a runny nose, eventually, you’ll have throat symptoms later on. Sounds like a classic cold, right? When you see your doctor, throat redness and irritation and swollen glands are noted, confirming even further that you’re in the middle of a standard upper respiratory infection, or the common cold. Typically, it’ll last anywhere from 3-5 days. A small minority will progress into one of the classic complications of a common cold, such as a bronchitis or sinusitis.

Any time I see patients in the office that come in with any of these classic symptoms or one of the more severe complications such as sinusitis, I always ask about the few days or weeks prior to the onset of the throat symptoms. With few exceptions, most of you will have either increased stress (out of the ordinary), a history of eating later than normal, or drinking alcohol later in the evening. Sudden weather fluctuations such as pressure or humidity changes is another common trigger.

If you’re susceptible to sleep-breathing problems at all (most modern humans are to some degree), any degree of inflammation in the throat will cause further swelling, starting up a vicious cycle that brings up more stomach juices into the throat, which causes more obstructed breathing and stomach juice reflux. It’s important to realize that whatever comes up from your stomach includes not only acid, but also bile, digestive enzymes, and bacteria. Even microscopic amounts will cause irritation to your delicate voice box, giving you a scratchy throat, cough or hoarseness. This is why these symptoms are most obvious when you first wake up in the morning.

It’s also been shown that these same stomach juices can then travel down into the lungs or up into the ears of the sinuses. Pepsin, a digestive enzyme, and H. pylori, a common stomach bacteria, have been found in lung and sinus washings. This is also why the ears are usually affected before the sinuses—it’s a direct line from your throat to the eustachian tubes, whereas you have to take right angled turn to reach the sinus passageways in the nose.

You may now be asking, "but what about the fever and the chills?" Any sudden, or abrupt change in your sleep-breathing status can cause an autonomic nervous system imbalance that can bring about these same fevers, hot flashes, chills and sweating.

How does your typical cold start? Please enter your experiences below in the comments box.

Sleep Apnea and Rat Sperm Flow Dynamics

Some of my patients have asked me how I got interested in sleep apnea. I’ve always thought that it was a gradual process that began early in private practice, culminating in my eureka moment that I describe in my book after our first two children were born. But recently, I finally realized what gave me the background to be able to appreciate the complexities of sleep apnea: my training in biophysics. 

I majored in biophysics during my undergrad years at Johns Hopkins. Essentially, I was a physics major with an interest in solving biological problems. For my undergraduate research experience, I spent some time in a research lab that studied shear stress on rat sperm during ejaculation. Air or fluid with various densities or viscosities have very different flow characteristics depending on the nature of the channel. There tends to be more turbulence at the periphery of the tube, which can shear and damage sperm bodies, making them immobile. Soft or malleable passageways can collapse depending on the structural characteristics of the wall, as well as the material that flows through this channel.

These basic science principles have given me an appreciation for how our upper airways work. Our breathing passageways are not just channels that funnel air into the lungs. The air is filtered, moisturized, heated and smoothed before it even reaches the lungs for oxygen extraction. The entire upper airway is dynamically changing constantly in multiple areas, affected by your anatomy, any allergies, the weather, what you just ate, or even your emotions. Even slightly narrowing one part can significantly affect another part, either upstream or downstream.

This is why simple colds or an allergy attack can wreck havoc on your sleep quality. Additional narrowing due to inflammation of an already narrowed passageway (due to smaller jaws) can aggravate further collapse in other areas. At first glance it may seem a little complicated, but if you look at the big picture, it’s a beautiful and simple explanation for what happens when our nasal and throat air passageways become inflamed or narrowed for any reason.

When Your Cold is Not a Cold

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.

Swine Flu Hullabaloo

New Study Reveals That Drinking Water Cures Dehydration

You may have thought after reading this post’s title, “I know that already.” But in science, you can’t say A causes B without double blinded prospective randomized placebo-controlled studies. Even then you can’t say definitively that A causes B—all you can say is that there is a very high likelihood that A is associated with B.

In the fields of sleep medicine and ENT, I see occasional studies that are similar to the water curing dehydration title. For example, in one article, “The nasal decongestant effect of xylometazoline in the common cold,” the authors show that applying an over the counter topical decongestant spray can help you breathe better. Here, a double-blinded placebo-controlled study was performed, where the placebo was nasal saline. Other common titles that I see frequently go something like this: “CPAP improves quality of life in patients with obstructive sleep apnea,” or “Lack of sleep is associated with drowsiness and poor concentration.” 

There are many well-intentioned investigators that publish good papers, but sometimes you have to question the value of some of these studies. How does it help you and me, now? Of course, for three reasons, no one will ever do a large, expensive prospective study on the merits of giving water for dehydration. First, it’s just common sense that it’s true, and two, there’s no profit in marketing water for dehydration. Third, you can’t say that something cures or helps a medical condition without FDA approval. Essentially, mothers are practicing medicine without a license by giving water, an unapproved “supplement,” to their young children whenever they get dehydrated from diarrhea. 

If you scan the health news headlines, it’s the same old stuff – exercise can reduce your weight, or lowering stress can prolong your life. Yes, there’s been tremendous advances with technology, but why is it that as a whole, our country is sicker than ever?

I think this is one of the major reasons why there’s not too much progress in medicine. We continue to perform  studies to confirm previous confirmed studies which confirm previous confirmed studies, and so on. For this reason it’s rare to ever see a radically new approach to treatment.

Do  you think our current scientific method is adequate for our health care needs, or de we need to revamp the entire system?