• 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

Subscribe: Email RSS 

Expert Interview: Dr. Avram Gold on UARS, Chronic Fatigue & Functional Somatic Syndromes

In this month’s Expert Interview, I interview Dr. Avram Gold, a pioneer in researching the link between upper airway resistance syndrome, chronic fatigue, and the functional somatic syndromes. Some of the topics will include:

- What are the functional somatic syndromes and how are they related to sleep-breathing disorders?

- What’s the relationship between central sensitivity syndrome and stress?

- How is sleep-disordered breathing related to stress?

- How is anxiety or depression related to functional somatic syndromes?

- How is chronic fatigue syndrome connected to the this condition?

 

Please enter your information below to gain access to the free recording:

 

Person Information
First Name *
Last Name
Email *
How did you find out about this recording? *	Please select a referral source Patient (received an email) Dr. Park’s newsletter On-line article Book: Sleep Interrupted SleepGuide.com Facebook Twitter Referred by a Friend Other/Not Sure
*By clicking ‘submit’ above, you are agreeing to receive ongoing communications from Dr. Park including monthly newsletters, events alerts, and other such written correspondences. Your e-mail will remain strictly confidential and will not be disclosed to any third parties without your prior written consent. You may unsubscribe to any or all portions of our e-mail correspondences at any time. Thank you for your cooperation.

 

 

 

Multiple Links Between Psoriasis & Obstructive Sleep Apnea

Believe it or not, your skin is considered an end organ, meaning that it’s at the outermost reaches of your blood supply. It’s also a part of your body which can be deprived of blood flow if you’re under stress, similar to what happens to your digestive or reproductive systems.

Psoriasis is a common skin condition that affects about 34 million Americans, or about 3% of the population. It’s characterized by red, scaly patches of skin covered by white flakes. It’s thought to be a chronic autoimmune condition, where your body’s immune system can attack or damage your own tissues.

I’ve written before about strong links between psoriasis and obstructive sleep apnea, but here are a series of studies that further solidifies this connection. Some of the studies I’ve cited before. Others are new:

Metabolic syndrome (Syndrome X) is a combination of high blood pressure, insulin resistance, and high cholesterol levels. Having all three conditions has been shown to significantly increase your risk of heart disease, heart attack, or stroke. Numerous studies show that people with metabolic syndrome can also have obstructive sleep apnea. In fact, syndrome Z has been described as all the features of Syndrome X plus obstructive sleep apnea.

A study published in Archives of Dermatology showed that patients with psoriasis had a higher chance of having metabolic syndrome compared to people who didn’t (40% vs. 23). I’ve written in the past about how chronic physiologic stress due to sleep apnea causes diversion of blood flow and nutrients to the bowels, reproductive organs, and the skin, since they’re considered “low priority” organs. Low blood flow causes a relative hypoxia, creating oxidative stress, and along with a heightened immune system, so it’s not surprising that the skin can show psoriatic plaques.

Here’s a study showed that women who drank more than two alcoholic beverages per week had a significantly higher risk of psoriasis. Alcohol relaxes your throat muscles, aggravating sleep apnea.

Researchers from harvard showed that comorbid conditions such as cardiovascular disease, depression, diabetes, obesity, and hyperlipidemia all increased over time. Not too surprising if you already have sleep apnea.

Pregnant women with psoriasis were found by Harvard and Mass General researchers to have higher risk of pregnancy-related complications, including spontaneous abortion, preterm birth, preeclampsia, placenta previa, and ectopic pregnancy. Gaining weight can aggravate sleep apnea. Studies show that CPAP can help with preeclampsia.

People with psoriasis were found to have increased risk of depression (39%), anxiety (31%) and suicidal thoughts (44%). Sleep apnea can cause structural, metabolic, and biochemical changes in your brain due to hypoxia.

And lastly, young adults who are obese were found to have a higher risk of developing psoriatic arthritis later in life. Obesity is a major risk factor for obstructive sleep apnea.

Perhaps psoriasis should be placed on the ever-growing list of complications of obstructive sleep apnea. What do you think?

Can Antidepressants Cause Obstructive Sleep Apnea?

I do believe that untreated obstructive sleep apnea (OSA) is a major cause, if not the most common cause of depression.  We know from numerous studies that OSA, via massive hypoxia and inflammation, causes brain biochemical and structural changes that can alter almost every aspect of your physiology and psychology.

Almost weekly, I see patients that suddenly gained significant weight after starting an antidepressant medication. We know that certain antidepressants are more likely to cause weight gain. Weight gain can aggravate obstructive sleep apnea, and obstructive sleep apnea can worsen depression. We also know that depression is linked with a higher incidence of insomnia, cardiovascular disease, and even death.

Did you gain weight after starting an antidepressant medication? If so, which one did you take?

Do All Pregnant Women Have Sleep Apnea?

We know that significant weight gain is a common aggravator of obstructive sleep apnea. If you already have narrowed jaws and gain some weight, then you'll move up the sleep-breathing continuum that I describe in my book, Sleep, Interrupted. But why is it that when women become pregnant, sleep apnea is the last thing that's considered whenever they develop depression, high blood pressure or extreme fatigue? 

 

Two recent published studies perpetuate this myth amongst doctors that sleep apnea can't happen in pregnant women. One study showed that about 2/3 of pregnant women responded to depression using acupuncture. Another study showed that antidepressant use during pregnancy led to small, but measurable developmental delays at 19 months. Depression (during pregnancy or post-partum) is a major problem with many women. But rather than saying that it's pregnancy-related depression, it should be looked at as a sleep-breathing problem, since one major reason for depession is lack of deep, quality sleep that's common with all pregnant women. Pharmaceutical companies promoting anti-depression medications to replace deficiencies in brain biochemistries doesn't help either.

 

One reason why not every woman that's pregnant goes into depression during or after pregnancy is due to the effects of progesterone, which has been called the "feel good" hormone. One of the interesting properties of progesterone is that it's an upper airway muscle stimulant. It increases tongue muscle tone and tension. During pregnancy, progesterone goes through the roof, since it's needed for maintaining the uterus and development of the baby. But if the weight gain is too much, or if your jaw is too narrow, then the effects of progesterone won't be as helpful. Once you deliver, progesterone drops, but you're still left with all that weight. This is one major revelation that I had when my wife experienced severe post-partum depression after the birth of our first son, Jonas.

 

We also know that many women who develop pre-eclampsia (dangerous high blood pressure) during pregnancy have various degrees of sleep-breathing problems, which can be treated effectively with standard sleep apnea treatment options.

 

For the women that's reading this blog, did you have any significant depression during or after pregnancy? How did you deal with it, and if your saw a doctor about it, what did they recommend? Please enter your answer in the comments section below.

Sleep Apnea, Restless Legs and Erectile Dysfunction

There are studies linking sleep apnea with restless leg syndrome (RLS) and sleep apnea with erectile dysfunction, but now there's a study linking restless leg syndrome with erectile dysfunction. Not too surprising, since sleep apnea seems to be the common denominator for almost every imaginable disease, known or unknown. You may think that this statement is over the top, but you'll have to admit that not breathing well during the day, and especially not breathing well at night while sleeping can potentially lead to or aggravate almost every disease known to man. 

 

In this particular study, researchers found that men with RLS  had significantly increased risk for having erectile dysfunction (ED) compared with men who did not have RLS. The lead researcher, Dr. Gao, commented that the findings indirectly support the role of dopamine as a common pathway, in light of another study of his in the past that showed an association between ED and Parkinson's disease. He also points out that these same people with ED were more overweight, more prone to depression and anxiety, and had a greater chance of having hypertension or a history of stroke (sound familiar?)

 

It sounds like dopamine deficiency is a popular explanation for a number of different conditions. For both PLS and Parkinson's, giving dopamine-like agents help with the respective symptoms. The problem is that it never cures the problem completely, with a number of serious side effects. 

 

This approach to medicine is the replenish what's missing method. If you're deficient in dopamine, replace it. If you're deficient in Vitamin C, B12, or thyroid hormone, replace it. The problem is that this approach works in some people, but not in everyone. Then the next step is to increase the dosage, and then even more people respond, but not everyone (with more side effects). Ultimately, you're not addressing what's causing the deficiency. 

 

If you have a sleep-breathing problem, it's been shown that you can easily clot in certain small and large vessels of your brain very easily. If you happen to have a clot in the dopamine area of your brain, or if the brain biochemistry changes as a result of hypoxia, then you'll get various symptoms. But I think even the neurologists will tell you that a lack of dopamine itself won't lead to Parkinsons; it's just one part of a much larger picture. Could it be that obstructive sleep apnea may be that bigger picture, since by definition, all modern humans are susceptible to sleep breathing problems to various degrees?

 

What's your opinion on this? Should we continue to treat every medical condition in isolation hoping to target that one missing protein or gene, or should we step back and try to connect the dots until we see the bigger picture? Please enter your comments in the box below.

Sleep Apnea and the Stroke Belt

A new report on stroke mortality confirms that seven southern states continue to told the title of having this highest stroke risk in the country, up to 50% higher in some states compared to the rest of the country. These states are: Alabama, Arkansas, Georgia, Mississippi, North Carolina, South Carolina, and Tennessee. The study authors also added, "Our results cannot pinpoint a specific explanation, but they are consistent with other research suggesting that the roots of stroke risk begin in childhood or even infancy,"

 

If you’ve been following this blog or read my book, Sleep, Interrupted, you’ll remember that having obstructive sleep apnea increases your risk of stroke by 50% or more. I’ve also stated that sleep apnea is not something that suddenly develops when you’re in your 60s and 70s. The risk factors for sleep apnea begin when you’re an infant. Your upper airway anatomy determines your risk for sleep apnea later in life. This is also when cardiovascular risk factors are first established. 

 

If you look at obesity rates in the deep south, they’re some of the highest in the country. So is depression and ADHD, which all happen to be strongly linked with obstructive sleep apnea. If you were born in one of these states and eventually move to another state later in life, your stroke risk remains increased.

 

Interestingly, residency in these states had little association with conventional stroke risk factors, social resources, or access to medical care.

 

What’s your take on this interesting finding? Please enter your thoughts in the comments box below.

Are You Depressed? Check Your Heart First

My First Apnea?

Dr. Mack Jones suggested that I get tested for sleep apnea in response to my last post about feeling depressed all last week from what I thought was the gloomy weather. He may have a point here. Last week, as I was dozing off to sleep, my wife did mention that I stopped breathing suddenly and started breathing again after a short snort. I vaguely remember it happening. It was also a time when my nose was a little stuffy. Technically, this wasn’t an apnea, since it lasted only a brief second or two. On a sleep study, it would be classified as a respiratory event related arousal (RERA).

 

Having just passed my 42nd birthday, I’ve come to terms with the fact that this was bound to happen eventually. I’ve said again and again that all modern humans are susceptible to breathing problems while sleeping, and I’m no exception. The only comfort I take is the fact that I did undergo a sleep study many years ago to see what it was like, and it revealed an AHI of 1, which is considered "within normal limits."  It did show that I had some mild disruptions in my deep sleep stages. I suspect it may creep up slowly as I get older. Fortunately, my weight has not changed—if anything, it’s gone down since I began running regularly. 

 

More recently, I’ve been sleeping well, and my energy level is pretty good, despite that fact that our 5 month old has been up at night repeatedly due to teething.

 

There’s now even more reason for me to follow the advice I give to my patients: don’t eat late, exercise regularly, keep your nose clear, and don’t sleep on your back. The one thing I’ll have to work on is to try sleeping more on my side since that brief obstructive episode happened while I was on my back. I’ll keep you posted.

Under The Weather Or Depressed?

For whatever reason, until today, I’ve been feeling really run down with no energy or motivation to do anything. My sleep’s been OK, but I felt more tired than usual. My ability to focus and concentrate was definitely affected, and my wife even called my mood "morose." Ouch. I hope my bad mood didn’t rub off on my three boys.

The reason for bringing this up is that today, I feel great all of a sudden. The only difference that I can think of is that the sun shined in New York City for the first time in days, maybe even over one week. We’ve had either rain or overcast weather most of June. 

I realize now that I was probably suffering from a mild case of seasonal affective disorder (SAD), which affects susceptible people who either don’t get enough sunlight or during the winter season, when there’s much less sunlight. I didn’t think I could have this, but I guess things change as you get older.

For prolonged cases of SAD, bright light therapy is one way to treating this condition. Another way is to spend more time outdoors, even with the overcast skies. 

How many of you were also under the weather this past week?

 

Have You Checked Your GABA Levels Lately?

GABA is a neurotransmitter that shows up once in a while that’s linked to a number of various medical and psychiatric disorders. One of the more recent studies was published in the 11/08 issue of Sleep (a summary can be seen here). Chronic insomniacs were found to have 30% less GABA activity in their brains. This finding could be misinterpreted to imply that because of low GABA levels, people can have insomnia. Let me explain.

GABA is one of numerous neurotransmitters in the brain that sends messages from one part of the brain to another. High GABA levels are associated with a calming, relaxing effect, whereas low levels are associated with anxiety and stress. Conventional wisdom says that if this is true, let’s increase GABA levels with supplements. The same can be said for various other neurotransmitters, hormones or vitamins that we use as supplements. In many cases, replacing what’s missing can certainly help, but you’re still not addressing what’s actually causing the lowering of these substances. 

If you look in the research literature (and on the internet), you’ll see many studies linking stress and low GABA levels. Another study showed that practicing yoga increases GABA. This is why any method or discipline that is calming or relaxing can raise your GABA levels. So it’s not a lack of GABA that gives you insomnia, per se, but there’s something else that is causing insomnia and low GABA levels.

This is a problem that we see with almost every area of modern medicine, where we’re great at finding associations, but not very good at solving the root of the problem. 

The common thread with all these studies goes back to stress. Yes, we have many different types of stress in our lives that can lead to insomnia (financial, work, family, poor diets, toxins, etc.), but what I’m suggesting is the possibility that due to our unique upper airway anatomy, all of us are somewhat susceptible to physiologic stress due to an inability to breathe properly at night. External stresses (psychologic, emotional and physical) can also aggravate this internal, physiologic stress.

The extreme end of this spectrum that I describe is called obstructive sleep apnea. But even if you’re "normal," having a narrowed upper airway anatomy can predispose you to microbstructions and arousals, leading to a physiologic state of hyperarousal. These people won’t officially meet the criteria for sleep apnea. Many of these people will also not be able to sleep on their backs, since that’s when the tongue falls back the most, due to gravity.

If you measure neurotransmitter levels in these patients, of course they’ll have abnormalities. This is why chronic insomnia is linked later in life to so many other medical conditions such as depression, diabetes, hypertension, and heart disease. Notice that these are all complications of obstructive sleep apnea. 

This is not to say that we should stop everything we do to treat insomnia. Cognitive Behavioral Therapy (CBT) is a great way to calm the mind and develop good sleep habits. It’s even been found to work better than sleeping pills. My only concern is what happens to these people many decades later, even if their insomnia is initially cured.

« Previous Page — Next Page »

Copyright © 2012 Doctor Steven Y. Park, MD | New York, NY | Integrative Solutions for Obstructive Sleep Apnea, Upper Airway Resistance Syndrome, and Snoring · Design by Fervent