Some of the questions I get asked include:

• How did you become interested in sleep apnea surgery?
• As a busy surgeon, how do you have time to do run your website and do your programs?
• How do you decide who can benefit from surgery?
• Why do modern humans have more sleep apnea?
• How do I find the right surgeon to treat sleep apnea?
• Any advice for people who are considering surgery for sleep apnea?

 In this interview, Dr. Wickwire shares his wisdom about comprehensive approaches to managing sleep apnea, including cognitive-behavioral treatment to maximize success with CPAP .

 Some of the questions include: 

 What are cognitive-behavioral treatments (CBT)?

 Have cognitive-behavioral treatments been applied to sleep disorders?

 What is the psychology of sleep apnea?

 What factors influence PAP use?

 What are Wickwire’s Four Pillars of CPAP Success?

 What is a PAP adherence risk profile?

 What CBT interventions have been tested to improve PAP adherence?

 And much more…

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AJ Jacobs, a senior editor for Esquire Magazine, interviewed me last year while working on his latest book project, Drop Dead Healthy: One Man’s Humble Quest for Bodily Perfection. The book is now out and was favorably reviewed by the New York Times. We talked extensively about his snoring and sleep apnea, and he underwent the entire diagnosis and treatment protocol, including CPAP. I just read sections of his book (including parts with me in it) and it’s hilarious! 

If you’re not already familiar with Mr. Jacobs, he’s also the author of The Know-It-All: One Man’s Humble Quest to Become the Smartest Person in the World and The Year of Living Biblically: One Man’s Humble Quest to Follow the Bible as Literally as Possible. His current book, Drop Dead Healthy, is already #31 on Amazon’s best-seller list. 

His book was endorsed by Dr. Mehmet Oz, and Timothy Ferriss (author of The 4-Hour Body). I strongly recommend that you read Mr. Jacobs’ book. But don’t stay up too late reading it—sleep deprivation can lead to premature aging.

• Recently diagnosed and have been on CPAP therapy between 2 weeks to 3 months
• Use CPAP therapy intermittently
• Have stopped using CPAP therapy within the last 3 months.

You don’t have to be a doctor to know that not sleeping well for extended periods can definitely cause you to feel depressed. The skeptics will then point out that there’s only a strong association between depression and sleep apnea, and that it doesn’t show that sleep apnea actually causes depression. Knowing how prevalent sleep apnea is in our society (most of it undiagnosed), it makes sense to at least think about obstructive sleep apnea before you make a diagnosis of depression and prescribe antidepressants. Unfortunately, even if a randomized placebo-controlled prospective study of thousands of patents showed that having untreated sleep apnea leads to higher rates of clinical depression, it’s unlikely that physicians will change the way they diagnose and treat depression.

Interestingly, most antidepressants suppress REM sleep. Coincidentally, REM sleep is when you’re most likely to have obstructions and apneas, due to complete muscle relaxation in your throat. So anything that lowers REM sleep will by definition lower your rate of apneas. In fact, there are published studies showing that REM sleep deprivation can be helpful for depression. Not having as many apneas could make you feel better during the day. I realize this may be an overly simplistic explanation, but it’s definitely something that the scientific community should think more about.

Come to think of it, there are no prospective randomized double-blinded placebo-controlled trials showing that drinking water cures dehydration. Millions of mothers are giving their children water every day to treat dehydration without FDA approval. 

In this Ask Dr. Park Teleseminar, I answer the following questions:

- I’ve had my CPAP machine for 5 years. Should I undergo another sleep study to see if anything has changed?

- Does palatal expansion work for people over 60?

- What do you think about Provent therapy?

- Is it possible to have a dental device lose its’ effectiveness without any weight gain?

- What’s your vision in the multidisciplinary approach to OSA treatment and comorbididies?

- Will restorative breathing correct OSA cases previously recommended for surgery?

- Can sleeping on your side be OK for sleep apnea?

- A recent Chinese study reported OSA in 27% of 5 to 12 year olds. In view of the obesity epidemic here in the US, is the incidence here in the US at least as high, if not higher?

- Should a person’s stuffy nose be addressed before OSA therapy?

- Does CPAP create “dependence,” so that surgical options later on may not work as well due to a weakened diaphragm  or other muscles for breathing?

- Your opinion on the new implants (Pillar and hypoglossal nerve stimulation)

- Does sleeping on a 45 degree incline help with obstructive sleep apnea?

- What can be done to reduce the number of “getups” each night?

- What percentage of OSA is due to tongue collapse (vs. soft palate)?

And much, much more.

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Pediatric sleep apnea is a sleep disorder characterized by obstructed or narrowed respiration while a child sleeps. The condition affects an estimated 25 percent of children in the US and typically occurs between ages 2 and 8, though it is quite under diagnosed. Pauses in breathing during sleep in patients with pediatric sleep apnea are typically much shorter and lighter than those in adults with sleep apnea. While an adult may snore loudly and make choking noises, a child may simply stop breathing momentarily and then wake up. Both conditions can lead to sleep deprivation and a wealth of other health issues if left untreated.

Children with pediatric sleep apnea often suffer from symptoms such as restlessness and bed wetting. Parents may notice that their kids tend to snore or breathe irregularly, through their mouths. During the day, children may seem tired and inattentive as a result of poor sleep the night before. Daytime symptoms of pediatric sleep apnea can also include hyperactivity and mood swings.

The majority of pediatric sleep apnea patients have enlarged tonsils and adenoids, which physically block the child’s upper airway. Usually, a minor surgical procedure to have the tonsils and/or adenoids removed will cure the condition. However, there are other conditions that may cause sleep apnea in young children, such as physical deformities or muscle weakness. Obese children and children with thicker necks are much more prone to pediatric sleep apnea.

Finding immediate treatment for pediatric sleep apnea is perhaps even more important than for older patients. Pediatric sleep apnea that starts at such an early stage can stunt growth and lead to a number of developmental issues. Over time, if a child is not getting enough quality sleep, he or she does not acquire sufficient amounts of oxygen to aid in normal brain and body development. The child is more likely to be diagnosed later in life with health conditions like attention-deficit hyperactivity disorder (ADHD) and childhood obesity.  Patients who grow up with untreated, chronic sleep apnea are also more likely to having learning disabilities, behavioral problems and metabolic problems.

In addition to making sure your child maintains proper diet and exercise, it is crucial that parents that notice symptoms of pediatric sleep apnea in their kids go to visit a primary care physician or a sleep center for further information. A sleep doctor can perform an overnight test called a polysomnography, which allows specialists to observe behavior, breathing and vital functions while the child sleeps in a sleep lab room. Data collected overnight will lead to proper diagnosis of the child’s sleep disorder so that the child can move forward with treatment either with a CPAP machine, oral appliances or surgery. As children aren’t able to identify the problem on their own, it’s crucial for parents to pay close attention to their children’s sleep habits and daytime behavior. In the event of an irregularity in breathing, be sure to visit a sleep doctor as soon as possible.

Sleepdisorders.com is designed to link sleep disorder sufferers to local sleep doctors and sleep centers. In addition to our directory of sleep doctors, you can find informational articles related to your unique sleep disorder.

This month, I interview Ms. Nicole Garrison, Clinical Specialist for Philips Respironics, to answer your questions about your most common CPAP problems. She answers the following questions:

#1.  What can I do about skin irritation/breakdown on my nose/face?

#2. How can I stop the pressure leaks, & are there options for mask discomfort?

#3.  I feel like I cannot exhale against the pressure, what can I do?

#4. Do I have any options if I cannot tolerate the pressure during inhalation and exhalation?

#5.  Why am I waking up with my mask off next to me?

#6.  What can I do about dryness/dry mouth?

#7. What if I do not feel better, even with wearing CPAP every night?

And many more…

Topic: Expert Help For Your CPAP Problems with Nicole Garrison of Philips Respironics

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Here’s a small study out of India showing that CPAP significantly lowered various markers for metabolic syndrome (high blood pressure, high cholesterol, and insulin resistance). Eighty-six volunteers (87% had metabolic syndrome) with were randomized to be given CPAP or sham CPAP therapy for 3 months. After 3 months, the two group were reversed. People treated with CPAP had an overall drop of 3.9 mm Hg systolic (top number) blood pressure, and 2.5 mm Hg in the diastolic (bottom) number. Total cholesterol went down 13.1 points, and  LDL dropped 9.6 points. Triglycerides also dropped, by 18.7 points. Thirteen percent no longer had metabolic syndrome.

On a side note, this study was funded by Pfizer, which makes many of the popular medications for high cholesterol and high blood pressure. It’s interesting that they would fund a study that would make it less necessary to use their prescription medications. We know that they don’t manufacture CPAP machines, so I wonder why they funded this study. Could they be interested in entering the sleep apnea market?