Don’t Let Poor Sleep Ruin Your Vacation

July 20, 2010

There are many resources available regarding tips for travel while on vacation, but one thing that can definitely ruin your vacation is poor sleep. You may never think that you will suffer from sleeping problem until it happens, and by then, it’s too late. Besides the various stresses of travel, including delayed flights, misplaced luggage, or traveling with children, the last thing you need is to lay down in your hotel bed, and start tossing and turning, unable to sleep.

On the other hand, you can go to sleep with no problems, but wake up feeling like you slept for only 3 hours. This can happen due to worrying about your lost luggage, persistent ear pain and hearing loss since getting off the plane, or an uncomfortable mattress or pillow. If you are a poor sleeper to begin with and especially if you normally can’t sleep on your back, then the following travel tips could prevent your vacation from turning into a disaster.

Tip #1. Keep your nose clear.

If you have a history of ear or sinus discomfort while flying, or if you have any degree of nasal congestion due to allergies or colds, then take preventive measures to open up your nasal breathing passageways to prevent ear, nose or sinus problems which can keep you up at night. Your ears and sinuses are connected to your nose through very narrow passageways. If you have any form of nasal congestion or inflammation, these passageways can become more narrow, and the rapid pressure changes during your flight (usually when descending) can aggravate more swelling and a partial blockage of your sinuses or ears. The middle ears are connected to the nose by the Eustachian tubes, which acts to equalize pressure between your nose and your ears every time you swallow. But when there’s swelling (due to colds, allergies, migraines, or acid reflux) around the Eustachian tubes in the back of the nose, this tube doesn’t work properly and your ears won’t equalize. Not breathing well through your nose can also prevent proper breathing at night, leading to poor sleep.

The simplest way of preventing ear, nose and sinus problems while flying is to decongest your nose using generous amounts of nasal saline (which is a mild decongestant), or over-the-counter decongestants, such as Sudafed tablets or Afrin nasal spray. If you have high blood pressure or are sensitive to Sudafed, it’s not a good idea to take. Afrin, on the hand, can only be used for 2-3 days if you have persistent ear fullness after the flight. For most people, taking a decongestant in the middle of the flight (before descending), should be enough. There are various ear “plugs” marketed for flying. They can be helpful for some people; if it works, keep using them.

Now that you've made it safely off the plane without any problems, you finally make it to your hotel at 9 PM and check in. You're really hungry and stop by the restaurant to grab a sandwich.

Bad move.

Tip #2: Don’t eat before bedtime.

Eating late before bedtime, while on vacation or at home, is the single most common habit that could potentially ruin a good night's sleep. On vacation, it’s tempting to eat later or binge at a great restaurant, but you’ll pay for it that night. For many people, if you have food in your stomach when you lay down, some of the stomach juices can regurgitate up into your throat, causing irritation and inflammation. This can wake you up more often, diminishing deep sleep quality. For people who snore or prefer to sleep on their sides or stomachs, they may actively suck up stomach juices into their throats while sleeping, worsening an already tenuous sleep situation. The general rule of thumb is to eat your last meal about 3-4 hours before bedtime. This also means no snacks before bedtime.

Tip #3. Avoid the Night Cap.

You've stopped your late night snacks, and so far so good. You make arrangements to meet your long-time friend at the hotel bar, but the earliest he can meet is at 10 PM. The two of you meet and decide to have a glass of wine. As you take your first sip, you remember the newspaper article that reported that red wine has an ingredient that could keep you young. Afterwards, you to back to your room to rejoin your wife, and you go to bed. The next morning, for some reason, you feel like you only slept for 3-4 hours. What happened?

There are numerous studies that tout red wines' beneficial health effects. But one aspect of red wine, and all other forms of alcohol, that could be detrimental to your health is its' relaxing effects on your throat muscles. If you already have a slightly narrowed upper airway passageways (like most people), sleeping on your back can cause mild collapse of your tongue backwards. But when you add deep sleep, since all your body's muscles relax the most, adding alcohol can tip you over the edge and cause you to stop breathing. You may wake up subconsciously, or completely awake. This is one of the main components of alcohol that promotes hangovers in some people.

The bottom line is that you should avoid drinking alcohol 3-4 hours before bedtime.

Tip #4. Take Your Own Pillow.

You've stopped your late night eating and drinking alcohol, and you are ready to go to sleep. You lie down to sleep, but something doesn't feel right. After a few minutes of tossing and turning and fluffing the pillow, you realize what the problem is: you miss your own pillow. Yours is much firmer, and the hotel's pillow is too soft. Thinking about your pillow is not something that most people consider before taking trips. You can't bring your own mattress, but you can bring your own pillow, if space allows. On car trips, I always bring my own memory foam, contoured pillow. A soft down pillow could easily fit into a decent sized suitcase.

Don't wait until you are ready to go to bed to find that the hotel's pillow isn't "just right." When you first arrive in your room, after you unpack, test drive your pillow. If it doesn't feel right, ask the concierge for a different type of pillow. Some may even have the memory foam contoured pillow that I like, and some Asian travelers may prefer a roll-like buckwheat-filled pillow.

If you like to sleep on your back, and feel less than refreshed in the morning, try sleeping on your side. If that's not possible, experiment with the roll-like pillow that I mentioned previously, or roll up a towel to just the right thickness. The reason this may help you sleep is that when your head is cocked back slightly when sleeping (unlike softer, down pillows that end up bending your head forward), the space behind the tongue opens up significantly, preventing frequent awakenings at night.

Tip #5. Don't Sleep In.

When you're on vacation, it's tempting to stay up late and sleep in in the morning. RESIST THE URGE. I've already covered in the past few lessons why it's important not to eat late, and why you must go to bed at a reasonable time to allot for your normal sleep duration. If you go to bed late and wake up later in the morning, you've shifted your sleep clock, which will make you want to go to bed later. Once you're back home, along with the clock shift from changing time zones, you'll be doubly affected: time zone shift and a sleep clock shift. This is why it's so hard to get anything done when you get back to work.

To make the most of your vacation, plan your sleep times accordingly so that you can maximize your fun during your waking hours. Spend time outside in the sun, walk, jog, cycle, swim, and relax! If possible, remember to give yourself a day or two to wind down after you come back before you go back to work.

Even if you don't suffer from any problems during your trip, many ear and sinus problems occur AFTER your return trip, usually aggravated by the return flight. You've had a great vacation, but now you're paying for it when you come home. If you had followed my advice during your vacation, you wouldn't have to see a doctor about your ear problem.

Written by Steven Park · Filed Under Articles, Sleep Health | 2 Comments

The Biggest Ear Problems for Sleep Apnea Sufferers

June 10, 2010

If you have obstructive sleep apnea, chances are, you’re likely to have some sort of an ear problem. There are a number of reasons why you’re going to be prone to various ear problems, but in many cases, the problem is not actually coming from the ear. To better manage your ear issues, you first have to understand your ear anatomy, and the different types of inflammation caused by sleep apnea. In the last part of this article, I’ll go over some tips to help you solve many of your ear-related issues.

What You Must Know About Ear Anatomy

The ear drum is a thin membrane that separates the middle ear cavity from the outer ear canal. Sounds waves vibrate the ear drum, which connects via a sophisticated lever and piston amplifier system that transmits sound waves to the inner ear. Normally, the middle ear cavity should have the same pressure as the outer ear canal. This is made possible by the function of the eustachian tube, which connects your middle ear cavity to the back of your nose. Whenever you swallow or yawn, your palatal and throat muscles open up the eustachian tube temporarily, equalizing pressure between the middle ear and the nose. You can think of the middle ear as a sinus—an out-pouching from the nose into an adjacent pocket of bone or soft tissue.

Whenever you go up an elevator or descend during a flight, the atmospheric pressure either goes up or down, and this creates either positive or negative pressure in your middle ear. With very slight pressure changes, you’ll feels a bit of fullness and hearing loss, but with severe pressure changes, you may even have pain and discomfort. If you keep swallowing, then you’ll keep popping open your ears. As a result, you’ll feel anything from fullness, hearing loss, popping, clicking, buzzing, or even ringing. This is why it’s recommended that you chew gum during descents in flights, or give the baby a bottle to feed.

Causes Of Inflammation

However, if you have any degree of inflammation in your nose, then additional swelling can prevent proper equilibration of air between your middle ear and nose. A number of different causes can aggravate swelling, including viral colds, allergies, weather changes, and even acid reflux.

You’re probably very familiar with the effects that a simple cold or allergy can have on your nose and ears. In most cases, you’ll have a few days of discomfort. But in certain situations, your cold or allergy may go away, but your ears will continue to be stuffed for days or weeks. Sometimes, the vacuum pressures that are created can cause fluid to accumulate, giving you what’s called serous otitis media. Rarely, this fluid can get infected and turn into the classic bacterial infection or otitis media. Fortunately, not too many people have true bacterial infections—most never make it past the vacuum pressure or clear fluid stages.

A Vicious Cycle

If you don’t have obstructive sleep apnea, the entire process can come and go within a few days to weeks. However, if you have sleep apnea, due to the additional inflammation that’s created, a simple ear or sinus problems can linger for weeks, and sometimes even months for the following reason: Any additional inflammation in the nose or throat causes swelling which can aggravate more frequent obstructions, leading to stomach juices to come up into the throat and nose, including in the area of the eustachian tubes. Furthermore, frequent obstructions and arousals leads to an imbalance of your involuntary nervous system, where your nose is going to be overly sensitive, especially to weather changes (pressure, temperature, and humidity changes). This is called chronic or non-allergic rhinitis.

For some people using a CPAP machine can blow air into the middle ears, through positive pressure. This can be a frustrating issue that’s difficult to cure completely.

Solutions For Your Ear Problems

So if you have obstructive sleep apnea and are prone to ear problems, what can you do? The first thing to make sure of is that you’re treating your sleep apnea condition optimally. If your CPAP pressure is too low, or your dental device is undercalibrated, or your UPPP procedure was only partially effective, then you’ll still have residual obstructive sleep apnea and are still feeling the effects of intermittent obstructions and arousals.

Second, make sure that your nasal breathing is optimal. By definition, your nasal passageways will be either narrowed, inflamed, or both. Having a chronically stuffy nose can create more of a vacuum effect downstream, which allows the tongue to fall back more often when in deep sleep, due to muscle relaxation. If you’re using CPAP, then it’s likely that your pressures may be too high, which can make it uncomfortable, and even blow air into your ears. Whether through vigorous saline irrigation, allergy avoidance, medications, or surgery, it’s important to make sure you’re able to breathe well through your nose.

Lastly, it’s important to lower inflammation in your throat by making sure you’re not eating within 3-4 hours of bedtime. Having even 2-3 apnea or hypopnea episodes per hour, although acceptable, can still suction up juices into your throat. Since you’re going to suction up normal stomach juices anyway, it’s important to keep the acidity and juice volume as low as possible. The same rule applies to alcohol, since not only does it produce more stomach acid, it also relaxes your tongue and throat muscles, causing you to stop breathing more often.

Ear problems are an inevitable part of having obstructive sleep apnea. By knowing what can cause ear problems and how you can deal with it, you can minimize the discomfort to a point where it’s tolerable or minimal.

Written by Steven Park · Filed Under Articles, obstructive sleep apnea, Sleep Apnea Surgery | 6 Comments

Top Ten Do’s and Don’ts of Ear Remedies

June 10, 2010

Patients always ask what they can do on their own to prevent chronic ear problems. Here’s a Top Ten List of my Do’s and Don’ts for your ears. It’s a condensed version of what I tell my patients all the time. Hope they help you to avoid ear problems from plaguing you.

TOP TEN DO’s	TOP TEN DON’TS
1. DO…use a blow dryer to keep ears dry after water sports.	1. DON’T…undergo ear candling to remove ear wax—it doesn’t work.
2. DO…use nasal saline to keep nasal passageways clear during allergy season to prevent ear and sinus blockage.	2. DON’T…use a Q-tip to clean out your ears. Better yet, remove them entirely from your bathroom medicine cabinet.
3. DO…apply sunscreen to the back of your ears as the skin there is prone to sun exposure.	3. DON’T...expose your ears to continuous loud noises. Translation: turn your iPod down.
4. DO…use a 50:50 alcohol and vinegar solution as ear drops to evaporate excess water and keep your ears dry if you’re prone to swimmer’s ear.	4. DON’T…smoke
5. DO…see a physician if you experience sudden onset hearing loss	5. DON’T…ignore sudden hearing loss
6. DO… cover your ears when exposed to loud noises	6. DON’T… use ear plugs if you have wax problems
7. DO…have a qualified physician remove ear wax	7. DON’T…try to remove ear wax on your own
8. DO…use hydrogen peroxide or mineral oil to periodically loosen ear wax	8. DON’T…use anything larger than your elbow to clean inside your ears.
9. DO…use OTC decongestants while flying if prone to ear popping	9. DON’T…eat right before you go to bed—eat at least 3 hours before instead.
10. DO…use mineral or olive oil to drown live insects that get stuck in your ears (& get the dead insect removed by an ENT)	10. DON’T…scratch the inside of your ear with a pen or any sharp object.

Written by Steven Park · Filed Under Articles | 2 Comments

Planes, Trains and Ear Infections

July 21, 2008

To me, getting an earache is almost like losing your
luggage at the airport. For one thing, both events most
likely occur after a bad plane flight. For another, they
both happen at the most inopportune moments– like when
you’ve packed your $5,000 heirloom wedding dress, or when
you’re vacationing out in a remote island and the nearest
doctor is about a 5 hour plane ride away. Either way, you
want to prevent and not fall victim to these problems if at
all possible.

Although I can’t offer much in the way of lost luggage
retrieval, having suffered through this twice in my own
travels, I can give you prevention methods to many of your
worst ear problems. Most of them are simple enough to
manage on your own at home or abroad.

KNOW THE PROBLEM, FIND THE SOLUTION

Before I talk about prevention, let’s start off with a
brief description of some of the most common ear problems I
see this at time of the year. Knowing what causes certain
ear problems will aid you in understanding what you can do
to avoid these problems altogether.

Ear Problem #1: Swimmer’s Ear

The organisms that cause ear infections like swimmers ear
and others like it love dark, warm, moist places, and your
ears, unfortunately, are the perfect vacation spot for
these types of visitors. In the case of swimmers ear,
humidity and heat can aggravate swelling in the layer of
skin inside your ears. Add to that any additional water
from swimming and in some cases the irritation of pool
chemicals or even polluted water from natural swimming and
diving areas, and the outer ear canal can get even softer
and more prone to infection.

However, swimmer’s ear isn’t only for swimmers. Because
swimmer’s ear is caused by water trapped in the outer
structures of the ear, any water based activity can lead
you in that direction. Some people even get swimmer’s ear
from baths or showers.

Common symptoms of swimmer’s ear can include:
• itching
• mild to moderate pain
• fever
• ear fullness
• decreased hearing
• swollen lymph nodes
• ear drainage

Solution for Swimmer’s Ear: Blow Drying

With some severe infections, antibiotic drops may be
necessary to treat swimmer’s ear. However, mildly acidic
solutions such as white vinegar (diluted with an equal part
of water) can be highly effective for early infections. Of
course, the best treatment for swimmer’s ear is to keep
your ears free of moisture during and after water
activities. But using Q-tips even to just dry the outer ear
canal is NOT recommended. They have a tendency to pack the
ear wax deeper into the ear canal, or worse, remove the
protective layer of earwax in the ear canal. This can not
only irritate the thin skin around the ear canal, but make
the ear a more habitable place for bacteria to congregate.
As such, the safest way to dry your ears is, believe it or
not, with a hair dryer.

If you do NOT have a perforated eardrum, rubbing alcohol or
a 50:50 mixture of alcohol and white vinegar used as ear
drops will evaporate excess water and keep your ears dry.

Ear Problem #2: Otitis Media

Otitis Media, or middle ear infections are common in
children under the age of seven, and some children seem to
have chronic ear infections throughout their early years.
Symptoms can include fever, pain, crying, nausea, vomiting,
diarrhea, and crankiness. Most middle ear infections are
caused by blockage of the Eustachian tube openings in the
back of the nose by a virus or allergies. Although few are
caused by bacteria, the rate of antibiotic use for ear
infections have become commonplace.

It is possible to have the symptoms without having an
actual infection. This occurs when the tissues in the
middle ear become inflamed and in turn causes a build up of
pressure or fluid—with pain and hearing loss as the result.

SOLUTION FOR OTITIS MEDIA: LET IT BE

Again antibiotics are often used for treatment, but
oftentimes an approach of “watchful waiting” is better.
This entails a few days of, as you most likely guessed,
waiting and watching to see if symptoms will begin to
subside on their own. Several studies, along with my many
years of observation have found this non-antibiotic
approach has merit and can help reduce the occurrence of
antibiotic resistant strains of bacteria from developing in
the future.

Sometimes tympanostomy tubes, or the surgical insertion of
tiny tubes into the ear, may be used for children with
chronic otitis media that lasts months or more.

Ear Problem #3: Allergies & TMJ

Allergies can affect your ears by blocking the tube that
connects the nose with the middle ear. Ear stuffiness,
echoing, fullness and a sense of pressure are common
complaints.

Some other conditions that can cause ear pain are dental
pain, TMJ and other *
0.throat conditions. Sometimes when you have an infection
or other medical problem with these areas of your head and
neck, the pain can show up as ear pain. Often there are
other symptoms in these specific areas too. For example
dental and jaw pain can spread both upwards and downwards
causing headaches, jaw stiffness and throbbing, face and
neck pain, and pressure, as well as inner and outer ear
pain and a sensation of fullness.

Solutions For Allergies and TMJ: Open Up

As you’ve most likely guessed, the best way to prevent ear
problems generated by allergies or dental pain is to treat
the source of the pain itself.

For instance, if you suffer from seasonal allergies, the
best way for you to keep them from affecting your ears is
by using generous amounts of nasal saline or over the
counter decongestants like Claritin-D®, Sudafed® or Afrin®
(use this only for 2 or 3 days). For chronic sufferers,
using prescription nasal sprays like Nasonex®, or Flonase®
prior to an allergy attack can also help keep your
Eustachian tubes open and therefore less prone to problems.

For ear pain that’s generated by TMJ or other dental
problems can be alleviated at home with warm compresses,
eating a soft diet and taking an anti-inflammatory
medication like ibuprofen. Chronic TMJ sufferers may need
to see a dentist about being fitted with a TMJ night guard.

The Ultimate Prevention Solution

Of course, keeping your ears dry while swimming and washing
your hands frequently to reduce your exposure to upper
respiratory infections are all typical ways of preventing
ear infections. However, one thing that you might add to
this regimen if you haven’t already done so, is to change
your dietary and lifestyle habits. Although it’s not
stressed nearly enough, quitting smoking (Copy the
following link to your browser
http://www.audioacrobat.com/play/W3pxsBVQ to listen to an
in depth interview with a smoking cessation specialist and
author of Stop Smoking for the Last Time by George Wissing
on how you can quit struggle free), and avoiding late night
meals and getting quality restful sleep can all help to
reduce your chances of suffering from ear pain.

Besides the fact that all of these habits are unhealthy for
you anyway, they can also aggravate acid reflux—the worst
aggravator for many common ear, nose and throat problems.

When you eat late and go to sleep right away, gastric
juices can get sucked up into your throat, and you can end
up with LPRD or laryngo-pharyngeal reflux disease. Research
indicates that gastro-esophageal reflux disease as well as
its counterpart, LPRD can cause swelling of the eustachian
tubes (For more information on how you can prevent LPRD click here.

As you can see, many common ear problems can be avoided
simply and easily. As such, a good prevention plan should
always accompany you on your travels. As for lost luggage,
the best advice I have is to pack lite and to take the
train. Come Aboard!

Written by Steven Park · Filed Under Articles | Leave a Comment