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Sleep Apnea, Migraines and Multiple Sclerosis: Is There a Link?

It seems like study after study is published that links two previously unlinked conditions to one another. In this study, the presence of migraines was associated with a 47% increased risk of developing multiple sclerosis (MS) later in life. Researchers again point to a genetic wastebasket explanation, with no practical implications. In a previous post, I noted that MS was linked to heart disease. Since we know that Alzheimer's is linked to heart disease, why can't migraines be linked to heart disease or even Alzheimer's? Ultimately, if you connect all the dots of all the associations between various medical conditions, then almost every medical condition can be linked in one way or another. 

 

My sleep-breathing paradigm easily explains the link between migraines and MS via the following mechanism: Migraines are a common symptom of poor quality sleep due to an inability to breathe properly at night. By definition, all modern humans are susceptible to these events, where only the extreme end of the spectrum is called obstructive sleep apnea. If you're not able to sleep deeply, then your entire nervous system is hypersensitive, causing an over-reaction to your senses, leading to symptoms such as headaches, TMJ, sinus pain and pressure. 

 

MS is thought to be an autoimmune condition with flareups of inflammation and "plaques" in any part of the brain that are seen on MRI. Sleep apnea is known to cause not only chronic sympathetic nervous system overload, but also thickening of the blood with patients being prone to either diminished blood flow or small microscopic clots in the brain. Studies have shown that sleep apnea patients have multiple areas of decreased gray matter density in various parts of the brain. This could in theory lead to either "lesions" in the brain, neurotransmitter abnormalities, or hormonal dysfunction.

 

It makes sense that in people who have sleep-breathing problems long before they go into sleep apnea, their nervous systems are overly active (waking up too quickly), whereas sleep apnea patients' nervous systems are underactive (not waking up quickly enough). Chronic low-grade stress is also known to upregulate your immune system, leading to the classic autoimmune conditions that are often seen in people with upper airway resistance syndrome (cold hands, anxiety, fatigue, etc.). 

 

Rather then reducing human illnesses down to genetic factors or biochemical deficiencies, it makes more sense to treat the patient as a whole person. But with modern medicine, that's not allowed. Yes, there has to be progress in medical research, but as a whole, are we going in the wrong direction? I'd like to know your opinion on this issue. Please enter your opinion in the comments box below.

Sleep Apnea Causes Brain Damage

A new study in the journal Sleep revealed that using special MRI imaging techniques, untreated sleep apnea patients have significantly decreased concentrations of gray matter in certain predictable areas of the brain. This means that the density of neurons is much lower than normal. The average AHI was 52, and on initial inspection of the MRI, there were no obvious structural abnormalities, with no differences in the total volume. However, gray matter density was significantly lower for sleep apnea patients in various areas of the brain that serves important functions such as memory, breathing, cardiovascular function, and autonomic function.

This study complements a prior study that showed that OSA patients have multiple dysfunctional areas of the brain.

I think the implications of this study along with various other similar studies are profound. What this means is that if you have obstructive sleep apnea, you can literally kill off certain parts of  your brain, that preferentially control your memory, executive function, your breathing patterns, and even your your heart rate. Could this be an alternate explanation for central sleep apnea? Maybe this is also why not all patients that use CPAP feel significantly better—perhaps the damage is irreversible. What's frightening is that you can suffer permanent brain damage long before your sleep apnea is even picked up and treated. 

Take a look at the abstract and read the paper if possible. What do you think about these findings? Please enter your opinions in the text box below.

The Gingivitis–Heart Disease–Sleep Apnea Connection

There have been numerous studies on your increased risk of heart disease if you have gum disease or cavities. The most common explanation is based on the antiquated germ-theory that Louis Pasteur developed over 100 years ago—that bacteria or other pathogens in the gums and the teeth can travel into the bloodstream and lodge in the heart, causing heart disease. The explanations that were given during medical school were never too satisfying. To this day, I still wonder how bacteria in your mouth can spread and reach your heart. We have hundreds, if not thousands of stains of bacteria living naturally in our bodies. Why do some preferentially reach the heart, whereas others can’t?

 

If you look at this connection through the perspective of my sleep-breathing paradigm, there’s a much better explanation. Studies have shown that acid reflux is linked to gingivitis and cavities. What’s acid reflux linked to? Right! Obstructive sleep apnea. I also mentioned in a past post that these same juices also contain bile, digestive enzymes, as well as bacteria. Imagine bathing your gums and teeth in acid, bile, digestive enzymes and bacteria all night. What do you get? Gingivitis and cavities.

 

In his book Nutrition and Physical Degeneration, Dr. Weston Price showed that in certain cultures with wide and spacious jaws, the presence of cavities was almost nonexistent. However, in cultures with narrow jaws dental crowding, cavities were rampant.

 

There are also  tons of studies strongly linking obstructive sleep apnea with heart disease, hypertension, diabetes, stroke, and heart attack. 

 

So is obstructive sleep apnea the common link? What’s you opinion on this theory? Please enter your comments in the text box below.

Are You Depressed? Check Your Heart First

Can Snoring Cause Stroke?

Snoring is so common these days that no one takes it seriously anymore. One patient commented  that even her dog snores! Yesterday, I saw a man who uses earplugs to cover up his wife’s intense snoring. When someone is caught snoring, giggles and smiles are more common than genuine concern about the snorer’s health.

 

Not all snoring is dangerous, but a significant number of snorers will have undiagnosed obstructive sleep apnea. Recent studies highlight the seriousness untreated sleep apnea. One study showed that untreated apnea patients experience similar changes in brain biochemistry as people who are having a stroke or are dying. Even moderate degrees of oxygen deprivation was found to have profound effects. The abstract can be found here.

 

Another study showed that untreated sleep apnea patients have higher blood viscosity, meaning that their blood is literally thicker than normal. This, coupled with increased inflammation that’s seen in sleep apnea, makes small vessels in the brain more likely to clot.

 

Numerous other imaging studies report finding multiple small areas of damage in different areas of the brain in people with untreated obstructive sleep apnea.

 

Studies in young children found that even very mild degrees of obstructive sleep apnea can lead to cognitive changes and maybe even permanent neurologic injury. 

 

These type of studies go on and on. While we can’t screen everyone who snores for obstructive sleep apnea, if you have any of the potential complications of sleep apnea (such as depression, anxiety, high blood pressure, or heart disease) or if there’s a strong family history of snoring with cardiovascular diseases, there’s good reason to get checked for sleep apnea. 

 

The reason I bring up this issue at all is that once in a while, I’ll see a relatively young patient (in his or her 30s or 40s) who had a stroke. Not too surprisingly, they all snore heavily. If you know anyone that had a stroke at a relatively young age, at least consider the possibility.

A Surprising Finding About Women and Heart Attacks

Men who suffer from heart attacks typically complain of chest pain, shortness of breath, and radiating pain from the neck to the left arm. But for women, it’s completely different. A recent study financed by the NIH (and summarized in the New York Times) showed that in the weeks before their heart attacks, 70% of women complained of severe fatigue and 48% reported sleep disturbances. Less than 50% had shortness of breath, anxiety, or indigestion. 

Post-menopausal women have a much higher risk of developing heart disease compared with their pre-menopausal peers. We know that obstructive sleep apnea can cause heart disease, and menopause can aggravate sleep-breathing problems. We also know that 90% of women with sleep apnea are not diagnosed. I think it’s safe to assume that many if not most of the women in this study had some degree of a sleep-breathing problem. It’s not surprising that the initial symptoms by women who were about to have heart attacks had mainly sleep-related symptoms. Oddly, these symptoms were called "atypical."  Sadly, 90% of women with sleep apnea will continue to go undiagnosed. 

The Value of Genetic Testing in Alzheimer’s

ABC News’ Terry Moran wrote a poignant piece on why he decided to get tested for the gene that carries markers that are linked to Alzheimer’s disease. He states that he has a strong family history of Alzheimer’s and wanted to take the test not only to know more about his future health, but also to take responsibility for his own health. He does state that this test does not definitively predict whether or not he will get Alzheimer’s. It only gives statistical information based on his innate genetic risks. It ends up that he has a 19% chance of getting Alzheimer’s. It’s about 10% greater than the average population.  

Alzheimer’s is a devastating disease, not only for the patient, but also for the immediate family members. Research so far has focused on the molecular and genetic mechanisms, with progress being made day by day. However, I can’t help but to wonder if we’re going about this the wrong way. 

 

Let me explain: We know that Alzheimer’s is linked with cardiovascular conditions such as heart disease, heart attack and stroke. Untreated obstructive sleep apnea is a major risk factor for developing heart disease and significantly increasing your risk for sudden cardiac death and stroke. Sleep apnea is something that you don’t just develop when you’re older—you’ve had some degree of it all your life. 

 

Recent sophisticated imaging studies have revealed a much higher incidence of multiple areas of brain injury or damage in people with untreated sleep apnea compared with normals. MRIs in people with sleep apnea show many more areas of "lacunar infarcts," or small areas of strokes. Rats with the Alzheimer’s gene that were subjected to chronic hypoxia were found on autopsy studies to have very similar histologic findings as in humans with Alzheimer’s. We also know that chronic hypoxia and inflammatory state that results from sleep apnea can cause microscopic areas of blood vessel clotting (rather than your more typical large vessel stroke). The authors of some of these studies were very careful in only alluding to the implications of their findings: That obstructive sleep apnea can lead to Alzhiemer’s. 

 

I’m not discrediting all the great research out there on Alzheimer’s, but at least consider the possibility that in some cases of Alzheimer’s, untreated obstructive sleep apnea can lead to Alzheimer’s, with the same clinical symptoms, biochemical and histological changes that are seen in classic Alzheimer’s patients. 

 

Mr. Moran is more likely to know about his future health if he screens himself for obstructive sleep apnea, rather than undergo genetic testing for Alzheimer’s. At least there’s something you can do about sleep apnea.

 

(See related article by guest columnist Dr. Mack Jones.)

 

 

Solutions for Your Bed Partner’s Worst Sleep Problem

Anthony Burgess, the novelist, once said: "Laugh and the world laughs with you. Snore and you snore alone". Suffice it to say, there’s nothing worse than trying to sleep next to someone who snores.  Snoring is also a common reason why many married couples sleep apart. Besides the whole host of health problems that snoring is associated with, like high blood pressure, heart disease, diabetes, snoring is even linked to erectile dysfunction in men (see our feature article: What the Makers of Viagra Missed). Fortunately, snoring is something you can get rid of. The problem is in knowing how.

Why Snore?

Snoring is probably one of the most frustrating conditions not only for the snorer, but for spouses and bed-partners as well. It’s also one of the least understood medical conditions by most doctors. One of the main reasons for this is that there are a lot of myths perpetuated both by the media and pop culture about snoring. It’s oftentimes seen as something of a farce. The truth is, however, snoring is a sign that the person who snores is most likely struggling to breathe at night, and therefore, is at a much higher risk of having a heart attack or stroke.

Moreover, textbooks and internet resources further mislead people to think that snoring originates at the soft palate, since that’s where most of the vibrations occur. However, the soft palate doesn’t flutter all by itself: the nose as well as the tongue can be involved. Even most doctors focus way too much attention on the soft palate.

The challenging part of eliminating snoring is in figuring out what’s actually causing the snoring. The vibrations of the soft palate is only the end result and not, as many people think, the thing that causes the snoring. Imagine your upper airway as a long, thin tube that has three main areas that can either narrow or collapse when a slight vacuum pressure is applied. Like a flimsy straw that would collapse in the middle if you pinch the tip, or would collapse at one end if you pinched the middle, your airway is also affected by how well you can breathe through your nose not to mention how tone or relaxed your muscles become as you drift off in to deep sleep. Gravity can also play a part in obstructing your airway, since your tongue, as well as the excess tissues around the back of your throat can naturally fall back partially obstructing the airway, as you lie down on your back to go to sleep.

It’s All In Your Jaw Size

Another major factor that determines how well you breathe at night, or how susceptible you are to snoring, is the size of your jaws. It’s been shown that modern human’s jaws are slightly smaller than what we had hundreds of years ago. Various reasons are proposed, but one major reason is thought to be due to a major change in our diets. (For a more complete description of this process, take a look at my book, Sleep, Interrupted: A physician reveals the #1 reason why so many of us are sick and tired.) If your jaw is slightly smaller, then your tongue which grows to its’ normal size, takes up too much space, sitting higher and more backwards in your throat.  As a result, when you lay flat on your back, due to gravity, your tongue will fall back partially, and when you breathe in, a mild vacuum effect is created upstream at the palatal level, which constricts the soft palate closed, which then causes the free edge of the soft palate to flutter and vibrate causing the snoring noise. On the other hand, if your nose is stuffy for any reason, then a vacuum effect is created downstream, which forces the palate and the tongue to slide backwards towards the airway making it narrower and therefore creating sounds we call snoring when the air seeps through the small opening. So this is how a simple cold or an allergy attack can aggravate temporary snoring.

Furthermore, if your muscles relax more than usual (like after alcohol ingestion), then you may even stop breathing altogether. In this circumstance, if these breathing pauses last longer than 10 seconds, then it’s called an apnea (or loss of breath). In those people who have 5 or more of these apneas every hour on average, then are diagnosed with a serious sleep breathing condition called obstructive sleep apnea. Untreated obstructive sleep apnea can then lead to depression, anxiety, weight gain, diabetes, sexual dysfunction, high blood pressure, heart disease, heart attack and stroke.

The really bad news for snorers is that a significant number of heavy snorers have obstructive sleep apnea (about 30-40%, and much higher as you get older or heavier). It’s true that not all snorers have sleep apnea, and not all people with sleep apnea snore. However,  if you’re not snoring, then you may also not be breathing. It’s also been shown that neither you nor your bed-partner can tell if you stop breathing—it can just be silent pauses, without any audible gasping, coking or snorting. When some people say, I used to snore a lot, and now I don’t anymore, but I’m still tired, then there’s cause for alarm since even those that state with certainty, "I know I don’t have sleep apnea" are more often than not, wrong.

What Can I Do To Stop The Snoring?

So, once you’ve found out where the snoring is coming from, the next step to solving your snoring problem is to find the right solutions. Of course you can start by doing the most obvious like:

    • lose weight
    • don’t drink alcohol before bedtime
    • don’t take any medications that are sedating or relaxing
    • sleep on your side
    • sew a sock stuffed with a tennis ball to behind your back to prevent sleeping on your back.
    • use nasal dilator strips.

Sometimes, any of these options may work to various degrees, but for most, the problem will usually come back. The most important issue here, however, is that if you snore heavily, you have to find out if you have obstructive sleep apnea. Even if you are successful in covering up your snoring, you could still have untreated obstructive sleep apnea. And if this is the case, you’re putting yourself at serious risk for heart disease, heart attack and stroke. The best thing to do to avoid this from happening is to see a sleep doctor and undergo an overnight sleep study if you snore.

If you are found to have obstructive sleep apnea, then treating this condition definitively should take care of your snoring. Not only will your snoring improve, you’ll also feel much better in the morning, and have much more energy during the day. In addition, your increased risk for many chronic health problems mentioned above will be improved as well. You may also lose weight. (you may even feel like having sex again-see What the Makers of Viagra Missed).

So lets say that you don’t officially have sleep apnea. What can you do? Before I go into this discussion, sleep apnea is not something that you either have or don’t have. Everyone is on a continuum. As mentioned before, if your AHI is 5.1, you’re told you have it, whereas if your score is 4.9, do don’t have it, and because you don’t officially meet the formal criteria, it’s not a good enough to cause to ignore your snoring. It’s still a problem that should be addressed as it can make you lose sleep, not to mention put a damper on your love life in more ways than one. 

All Those Snoring Treatments

There are over 300 patented devices and gadgets for snoring (refer to ). Sometimes they work, but with a few exceptions, most of these devices either cover up your snoring without getting to the root cause of your condition, or keeps you awake so that you don’t snore. Three popular anti-snore aids were recently tested for effectiveness in a prospective study: a throat spray, nasal dilator strips and a pillow. None of these three were found significantly better than controls when tested prospectively. There are even devices that wake you up as you enter deeper levels of sleep to prevent muscle relaxation. Regardless of what treatment options you choose, it’s imperative that you first get a proper evaluation from a sleep specialist or a medical professional about your snoring. Doing so could not only help with the snoring, it can help you foster a healthy relationship with your loved ones.
 

Why Does Depression Increase Heart Attacks in Women?

Researchers found that women with depression were found to have an increased risk of sudden cardiac death. What other medial condition dramatically increases your chances of sudden cardiac death? If you guessed obstructive sleep apnea, you’re right. What condition is not diagnosed in 90% of women who have it? Correct again. It’s sleep apnea. What’s one of the biggest risk factors for women who go on to develop heart disease? Right again. Sleep apnea. What’s a common complication of sleep apnea? Depression. Do you see a pattern here?In modern medicine, it’s hard to see the forest from the leaves (not trees!). We’re so focused on determining statistical likelihood between two isolated variables, while trying to exclude every other variables, that it’s hard to see the big picture. It’s gotten to the point that you can’t even say A causes B anymore. You can only say that A is strongly associated with B. In the end, most end up saying that causality can’t be proven and that bigger and better studies are needed. Despite this study showing that women with clinical depression are more likely to die earlier, nothing will change to prevent these premature deaths. As long as we focus too finely on individual diseases, rather than looking at how everything is connected, women will go on dying earlier than they should.

A Link Between Psoriasis and Heart Disease?

Skin disease is one area that I haven’t covered so far, but data from three large clinical trials suggests that having psoriasis significantly raises your risk for heart disease and stroke. Looking at this issue through my sleep-breathing paradigm, it all makes sense. Not being able to achieve deep efficient sleep can cause a low-grade physiologic stress response, which does two things: It constricts blood vessels going to end organs and parts of the body that you don’t need when you’re running from a tiger. This includes the bowels, the reproductive organs, and the skin. Less blood flow in general leads to poor healing and poor functioning. Chronic low-grade stresses can also ratchet up your immune system which ends up attacking it’s own body parts. In light of these possibilities, it’s not surprising at all that people with psoriasis have increased risk of cardiovascular disease. 

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Copyright © 2008 Doctor Steven Y. Park, MD | New York, NY | Integrative Solutions for Obstructive Sleep Apnea, Upper Airway Resistance Syndrome, and Snoring · Design by Fervent