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A Surprising Finding: Sleep Apnea Is Linked With Depression!

If you have sleep apnea, you’re more likely to suffer from depression. I can’t help but to be amazed that theses type of studies are still performed. I know that in the name of science, you have to show that there are statistical associations between two conditions that are thought to be related. But it’s like doing a study that shows that if you cut your hand, you’re more likely to bleed, or if you trip over an uneven sidewalk, you’re more likely to fall.

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. 

Another Link Between Heart Disease, Depression, & Sleep Apnea

Here’s a study showing that having both heart disease and depression can significantly increase your chances of cognitive decline later in life.  This makes absolute sense if you have obstructive sleep apnea to begin with, since this is what can aggravate or cause both heart disease and depression. There are also many studies showing how damaging untreated obstructive sleep apnea is on the brain.

Do Sleeping Pills Increase Your Risk Of Dying?

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. 

Teens & Sleep Deprivation: An Epidemic

Everyone knows that teens are under intense pressure to not only produce stellar grades, but also excel in numerous extracurricular activities as well. The problem is that there’s only 24 hours in a day. Add to this 4-6 hours of homework in the most competitive private and public high schools, and the first thing to get sacrificed is sleep. 

In this New York Times article on the stresses of too much homework in independent schools, one student newspaper at a prestigious private school published an article last year showing that upper school students slept an average of 6.5 hours per night. I was shocked to see this.  You may think that this is not too bad, but consider this: A teenager should be sleeping 9 to 10 hours per night. 

There are tomes of research showing what chronic long-term sleep deprivation does for people in general, but these negative effects are even more magnified in developing teens’ brains and bodies. It’s not surprising that rate of anxiety and depression are are at already too high levels, and a lot of students are just burning out (mentally and physically). Many of these problems will ultimately manifest when they get to college, where sleep deprivation and poor eating and sleep habits become even worse. This is why the incidence of depression peaks in the college years. 

I realize there’s no easy solution to this problem, but someone has to take a stand and say enough is enough. What do you think about this issue?

Depression Ups Your Stroke Risk

A recent study revealed that having depression was found to increase the risk of having a stroke by 45% in people who were followed from 2 to 29 years. Your risk of dying from a stroke also increases by 55%. The article talks about people with depression being more overweight. What else can being overweight cause?

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? 

Expert Interview: Psychology of Sleep Apnea

In this Expert Interview program, Ms. Lisa Brateman will talk to us about the psychology of obstructive sleep apnea. This is an important topic that affects not only those of you with sleep apnea, but also your loved ones, your friends, and family members.

 

 

 

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Freshman 15, or Obstructive Sleep Apnea?

With the start to the new school year, millions of college freshmen will begin their academic endeavors, gaining knowledge, newfound independence and new life skills. But there’s one more thing that many students will gain this year: 10 to 15 pounds. Weather or not the Freshman 15 actually exists (on average they gain about 5 pounds), this commonly seen phenomenon is thought to be due to a lack of exercise, eating buffet style cafeteria food, late meals and snacks, unhealthy diets, and excessive alcohol.

However, there’s one more important, but under-appreciated condition that is expected to occur when you gain even a small amount of weight: Fat cells take up space in your throat, leading to a gradual progression into obstructive sleep apnea. As I’ve mentioned before on numerous occasions, eating late promotes more obstructions and arousals, as well as increased gastric contents reaching the throat. This causes more swelling and damage to the protective upper airway receptors in the throat, leading to more frequent and prolonged breathing pauses. Poor quality sleep promotes weight gain, through hormonal, metabolic, and neurologic mechanisms. Drinking alcohol close to bedtime an also relax your throat muscles, leading to more frequent apneas. There’s no need to remind you about sleep deprivation and poor sleep hygiene in college students.

It’s also no coincidence that anxiety and depression peaks in college-aged men and women. Poor sleep quality can not only cause neuro-biochemical changes, but also promotes poor sleep habits and hygiene. It’s no wonder college students are at higher risk of delayed sleep phase syndrome, where one’s sleep clock cycle is shifted many hours later. I suspect that students who are most prone to weigh gain have narrowed jaws and dental crowding to begin with, prefer to sleep on their sides or stomach, and one or both parents probably have undiagnosed obstructive sleep apnea.

Have you or any of your children experienced the Freshman 15?

 

 

Why Having Depression Can Raise Stroke Risk in Postmenopausal Women

Here’s another study that shows an interesting observation, but an explanation using my sleep-breathing paradigm is much more satisfying. Researchers found that postmenopausal women who have a current history of depression, past history of depression, or use of antidepressant medications had a significantly higher overall risk of stroke (29% over 6 years). Having a current history of depression alone increased your risk to 41%. The authors speculated that this increased risk may be due to medication use, weight gain, or increased cardiovascular complications that’s seen in people with depression. It’s been already shown in a past study that depression increases your risk of sudden death and fatal coronary heart disease.

It you accept the fact that postmenopausal women will have a higher likelihood of developing obstructive sleep apnea, then it’s likely that they will also be at higher risk of having depression, anxiety, hypertension, heart disease, etc. The researchers have done a great job in linking two of the end consequences of untreated obstructive sleep apnea, but failed to look at the common root of both conditions. 

Major Life Changes That Can Trigger Sleep Apnea

Recurrent sinus infections, throat pain, ear fullness and chronic cough are some of the most common conditions that I see every day. You may think that I typically diagnose and treat for routine bacterial infections in these situations, but in most cases, they’re not really infections at all. What I do find, however, is that if you probe and look back at the patients’ history, there’s always some major life change or recent event that acted as a trigger for their symptoms, especially if their upper airway anatomy is already narrowed or predisposed. Here are 5 common examples:

 Sleepless nights from a newborn child

 The birth of a child is always a joyous event, but everyone knows that your life will change drastically all of a sudden. Your normal routines, eating habits, exercise regimens, and especially the timing for all these events will change. The sleep deprivation, lack of exercise, and bad eating habits can promote weight gain, which can narrow your throat even further. This leads to more problems breathing at night, leading to less efficient sleep, leading to more weight gain. This applies to both the mother and the father.

 It’s also a common phenomenon where a woman is never able to lose her pregnancy weight, despite extreme dieting or exercise. This leads to less effective sleep, increased fatigue, and various other health-related conditions. 

 Newfound independence, more depression

 The freshman 15 is more than just an observation—there’s a good reason why college students gain weight all of a sudden during their freshman year. Dorm meals and cafeteria food tends to be starchy and very high in calories, and because of the buffet-style format, there can be problems with portion control. Home-cooked meals by parents, eaten at relatively normal times (5 to 7 PM), turns into eating later in the night: more episodes of pizza, take out food, and late night snacks while pulling all-nighters for exams. 

 Having stomach juices when you go to sleep will allow more acid and other stomach materials to regurgitate into your throat, leading to more frequent arousals and less efficient sleep. This leads to a cascade of metabolic, hormonal, and cardiovascular consequences that promotes weight gain. Drinking alcohol at night relaxes the throat even further, leading to more frequent breathing pauses.

 This relative sudden change in your eating and sleep routines can definitely affect your mood and mental health. It’s not surprising that depression and anxiety peaks during the college years. This is also the time when the larynx (voice box) descends in the neck to its’ lowest position during maturation into adulthood. The lower your voice-box, the more the tongue can fall back, leading to more frequent breathing problems.

 A new job or a promotion

 It’s great to start a new job, or get that promotion that you’ve wanted. But just like any other major change in your life, your routines will change. You’ll stay later to impress your boss, skip meals, come home later and go to bed later. As a result, you’ll gain a few pounds. Some people can eventually adjust their schedules to accommodate a healthy sleep schedule, diet and exercise regimen, but others can’t. This is when things begin to go downhill.

 Injury or surgery

 Most people with sleep-breathing problems prefer to sleep on their sides or stomach. Any kind of injury or undergoing surgery can force you to sleep on your back, which causes more tongue collapse (due to gravity) and more obstructions and arousals (due to muscle relaxation in deep sleep). In fact, many patients have told me that their lack of sleep, physical activity and subsequent weight gain is what triggered a vicious cycle. 

 Menopause

 This applies mainly to women, but hormonal changes can affect men too. Loss of estrogen and progesterone can diminish their protective effects on the upper airway. In particular, progesterone is an upper airway muscle stimulant/dilator. As it begins to diminish in the early 40s, the tongue begins to relax more and more over the years, leading to less efficient sleep, and the typical vasomotor symptoms begin which includes hot flashes, night sweats, weight gain, mood swings, and irritability. Believe it or not, these symptoms can happen in young men, too. These are your body’s nervous system reaction to the changes with your sleep-breathing status.

 

As you can see, all of us will go through some or all of these events at some point in our lives. It’s natural as modern humans to be susceptible to these sleep-breathing related conditions. It may sound a bit depressing, but the good news is that now you’re aware of it, you can take preventive measures once it starts. 

25% of Children In The United States With Sleep Apnea?

Here’s some heartbreaking news that was recently published in the Wall Street Journal and commented on at KevinMD: That 25% of all children in the United States is on regular prescription medications. According to the report, 45 million children are on asthma medications, 24 million on ADHD medications, another 10 million on antidepressants and 6.5 million on antipsychotics. You also have the antihypertensives, sleeping pills, diabetes medications, and high cholesterol medications. This list doesn’t include prescriptions used in acute situations or over-the-counter medications.

You might be asking by now, “What does all this have to do with sleep apnea?”

My answer is, everything. If you happen to follow my blog, I’ve shown studies linking obstructive sleep apnea to almost every chronic health condition out there. This is based on published, peer-reviewed studies. What I did was only to connect all the dots, so to speak, to conceive of my sleep-breathing paradigm: That all modern humans, due to jaw underdevelopment, have various degrees of sleep-breathing problems, where only the end result is called obstructive sleep apnea. This problem begins while you’re an infant, and is aggravated by dietary and behavioral factors such as bottle-feeding, thumb-sucking, and eating the Standard American Diet (SAD). It’s also possible that the back to sleep campaign (although it lowered the SIDS rate by 40%), by forcing infants to sleep on their backs, may inadvertently prevent quality deep sleep in infants. Babies need good amounts of deep sleep for memory consolidation and brain development.

We also know that multiple breathing pauses can cause your stomach juices to reflux into your throat, and then into your lungs (or nose). This can cause various degrees of inflammation. Neurologically, your lungs will tend to over-react to weather changes, such as cold air, or even temperature or humidity changes. Breathing problems can also cause poor quality sleep, leading to major alterations in your brain biochemistry.

Poor sleep can also aggravate or promote the onset of depression. Faulty neurotransmitters or even structural damage from poor sleep can also cause your brain signals to misfire, or activate disinhibition of certain behaviors.

It’s no wonder that in one way or another there are studies (or will be studies) that connect all the various medical conditions already mentioned to one another. So it’s not too far fetched to argue that a large proportion of these children on chronic long-term medications may also have some kind of a sleep-breathing problem.

What do you think about my arguments? A realistic, but scary possibility, or too far fetched?

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