• 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 

CPAP Can Help With Metabolic Syndrome

We already know that treating obstructive sleep apnea can help you to sleep better, but there’s been conflicting studies showing the benefits of CPAP on high blood pressure, diabetes, or risk of heart disease. However, for the most part, CPAP has been found to be helpful with hypertension, diabetes and cardiovascular risk factors.

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?

Lack of Deep Sleep Can Cause High Blood Pressure

Here’s another article which confirms what we already know: That lack of deep sleep can cause high blood pressure. We’ve known for years that sleep fragmentation can increase your adrenaline response at night during sleep, preventing the normal lowering of your blood pressure during sleep. Not having this “dipping” phenomenon is tied to having hypertension during the day.

If you look at this study in light of statistics from the CDC, the implications are frightening: Almost 1/3 of Americans have high blood pressure, and about 70% of these people are on medications, but less than 50% are being adequately controlled. Another 25% have pre-hypertension. Over 70% of people over 65 have hypertension. Take into consideration how sleep deprived we are as a society, and that 90% of people with obstructive sleep apnea are not diagnosed, this should be wake-up call for everyone.

 

Lack of Deep Sleep (From Sleep Apnea) Can Cause High Blood Pressure

If you don’t sleep well or are sleep deprived, you know what that feels like: you’re more likely to be unenergetic, unfocused, unproductive, and unmotivated. Lack of sleep in general is already an epidemic in this country, and there are studies that show that lack of specific stages of sleep can contribute to certain types of symptoms. Sleep deprivation is also tied to an increased risk of hypertension, heart disease, diabetes and early death. Researchers from Harvard have now confirmed that lack of non-REM deep sleep is associated with an increased risk of high blood pressure. Furthermore, people who lacked deep sleep were more likely to have obstructive sleep apnea.

We’ve known for years that people who lack the normal blood pressure “dipping” phenomenon at night are at increased risk for high blood pressure during the day. People with sleep apnea are known to lack this blood pressure dip at night. It’s thought that increased physiologic stress responses from activation of of your sympathetic nervous system may the the cause. As your throat muscles begin to relax in deeper levels sleep, apneas are more likely to occur. 

This study emphasis that point that despite sleeping 8 to 9 hours, if you’re not getting quality (deep) sleep, it can can still be detrimental to hour health.

 

Sleep Apnea Causes High Blood Pressure In Children

A new study out of Australia showed that in children with obstructive sleep apnea, their blood pressure levels were higher while awake just before sleep onset and during sleep. Overall, their blood pressure was 10-15 mm Hg higher compared with controls. Blood pressure was elevated, regardless of the severity of sleep apnea. The authors argue that thresholds for mild forms of sleep-disordered breathing needs to be reassessed, and that benign snoring should not be considered benign anymore.

I totally agree with the study authors. Sleep apnea doesn’t begin in middle age—it begins during the early childhood years. Having smaller jaws and more narrow airways predisposes to additional inflammation, causing lymphoid tissues (tonsils and adenoids) to become larger, which causes even more breathing problems. Taking out tonsils and adenoids are usually the first line therapy for most children with sleep apnea, but a significant number of children will have persistent sleep apnea, despite surgery. Since most children undergoing adenotonsillectomy don’t have sleep studies before and after their procedures, we’re probably missing a large number of children with persistent obstructive sleep apnea, despite subjective and clinical improvement in their symptoms.

Addressing these issues early on could potentially prevent many of the complications that may occur later in adulthood. A child that doesn’t sleep well due to breathing problems can manifest with a number of medical conditions, such as ADHD, asthma, developmental delay, bedwetting, ear infections, or even mood disorders. The public health implications are potentially huge.

 

 

 

 

 

 

 

 

 

 

Should Asymptomatic Sleep Apnea Patients Be Treated?

Once in a while, I’ll come across someone with moderate or severe obstructive sleep apnea who feel fine. They deny any sleep problems or any daytime fatigue. In this situation, it’s hard to convince the patient that he or she should use CPAP or oral appliances. Here’s another study that shows why it’s important to treat obstructive sleep apnea, even if you’re not tired: Researchers from Spain showed that treating asymptomatic sleep apnea patients significant lowered their cardiovascular risks by 28%. Furthermore, sleep apnea patients with hypertension had a 50% reduction in cardiovascular events if they used CPAP for at least 4 hours every night.

If the patient is still resistant, I give the following example: If you had high blood pressure or diabetes, you’ll feel fine, right? But if your doctor told you that despite dieting and exercise, your numbers (blood pressure or glucose levels) are still on the high side and medications were recommended, would you consider it?

Do you have obstructive sleep apnea and are completely symptom free? If you’re on some sort of treatment, what motivated you to start treatment? I’d like to know. Please enter your reasons in the text area below.

A Link Between Sleep Apnea and Diabetes Confirmed Again

A Link Between Sleep Apnea and Diabetes Confirmed—Again

It’s almost a given that you’ll see headlines regarding sleep apnea every few days, about how it’s linked with heart disease, diabetes, high blood pressure, weight gain, and sudden death. Unfortunately, it’s gotten to the point where you’re likely to yawns at these findings because you’re so inundated with more interesting medical news and other celebrity media stories. Bare minimum, you might glance at the brief article and think, "that’s interesting," and then go on to the next story. 

 

Recently, there’s been news about the National Transportation and Safety Board making recommendations about mandatory screening for all commercial airline pilots, commercial truck drivers, ship pilots, and transit train operators, in light of many recent events including pilots that fall asleep and miss their destinations due to undiagnosed sleep apnea. Yawn.

 

A recent Johns Hopkins study showed that if you have severe sleep apnea, you have a 46% increased risk of dying compared with those that have mild to moderate sleep apnea. Yawn. We already know this information. Sleep apnea patients have a much higher risk of dying from heart attacks or strokes.

 

A study now shows that your risk of developing diabetes is 2-3 times higher if you have severe sleep apnea and you have daytime sleepiness. We already know that sleep apnea is independently linked to diabetes.

 

I guarantee that many more studies will be released repeating these same findings over and over again, linking or associating one variable to sleep apnea, without flat out saying that one causes the other. 

 

I wonder what will it take to significantly elevate sleep apnea awareness in this country? Celebrities with sleep apnea? We already have a few including Rosie and Regis. Politicians with sleep apnea? With the congress being mostly older men, I’m guessing about 1/3 to 1/2 of our leader have at least some degree of sleep apnea.

 

Should All Older People Be On High Blood Pressure Pills?

A recent article published in the British Medical Journal concluded that all older people should be placed routinely on blood pressure lowering pills, regardless of whether or not they have high blood pressure. You can read a summary here.

It’s one thing to conclude that lowering blood pressure even incrementally has potential health benefits, but to say that all older people should be placed routinely on a cocktail of high blood pressure medications is going too far. Also, the fact that the authors have financial interest in what they’re recommending does not support their stance.

What they should be asking is what’s actually causing hypertension. One major cause that’s been proven but virtually ignored by the medical community is the presence of obstructive sleep apnea. It’s safe to say that most seniors will have some degree of obstructed breathing. Despite all that we know about the cause and effect relationship between hypertension and sleep apnea, 90% of people who have it are not diagnosed. Instead, they get treated for their hypertension, diabetes, depression, anxiety, weight gain, heart disease, heart attack and stroke.

 

Read the summary article and let me know your thoughts on this. Has research, in the name of science, gone too far?

 

 

 

Can A Sleep Problem Give You Alzheimer’s?

There’s been a lot of press recently about the side affects that poor sleep quality has on our cognitive functioning not to mention what it means for those who suffer from neurological problems like Alzheimers.

This month, our expert article is contributed by noted neurologist and author of Deadly Sleep, Dr. Mack Jones, who explains the reason why he thinks everyone who has Alzheimers or is at risk for this problem should get tested for a sleep breathing problem like OSA.

——-

 Is it possible that Obstructive Sleep Apnea (OSA) causes Alzheimer’s Disease (AD)? I believe so. As a retired clinical neurologist and former patient with Obstructive Sleep Apnea, I have a special interest in sleep disorders medicine. I am thoroughly convinced of the connection between OSA and AD and will remain so until credible studies prove otherwise. Numerous short term studies have been done on cognition (mental processes) and sleep or the lack thereof, but there are few or no long term studies to determine OSA’s relationship to Alzheimer’s Disease (AD) and/or the other dementias.

Many polysomnograms (PSGs) or in lab sleep tests have been done on patients with AD revealing an incidence of OSA of up to seventy to ninety percent.  The assumption has been that AD causes OSA, or they just happened to coincide, but I contend that OSA is the cause of AD.

There are no studies that either prove or disprove my hypothesis that long standing undiagnosed OSA is a cause of AD, but evidence is accumulating. For example, OSA is a recognized risk for Type 2 Diabetes. In the April 2008 issue of The Archives of Neurology, type 2 Diabetics had an increased risk or developing Mild Cognitive Impairment (MCI)(1) which is the earliest stage of dementia.  Fifty to sixty percent of patients with MCI progress to AD at rate of twelve percent per year.
 
Additionally, OSA is a known risk for the development of high blood pressure.  Like patients with Type 2 diabetes, those with high blood pressure were also found to have an increased risk of developing MCI.(2)  Since the majority of patients with MCI eventually progress to Alzheimer’s Disease at a rate of approximately twelve percent per year, then it’s not a stretch to conclude that OSA is a cause of Alzheimer’s Disease.
 
In 2006 a study in the Proceedings of the National Academy of Sciences showed low brain oxygen (hypoxia) raises Alzheimer’s risk in the mouse brain with a genetic susceptibility.(3) A group of mice with an Alzheimer’s gene were given a maze test in which they all performed normally. They were separated into two groups, one exposed to 16 hours of a reduced oxygen environment (hypoxia) daily for several weeks; the other group in a normal environment.

The maze test was repeated and revealed the hypoxic mice performed poorly, whereas the control groups performance remained normal as before. All the mice were sacrificed and their brains examined under the microscope. Plaques and neurofibrillary tangles typical of Alzheimer’s Disease were present in the hypoxic mouse brain specimens, whereas the controls were normal. According to investigators, the study suggests that preventing brain hypoxia (as occurs in OSA) may reduce the risk of developing Alzheimer’s Disease.
 
Reported in the June 27th issue of Neuroscience Letters, sleep apnea patients have shrunken brain structures called “mammillary bodies” involved in memory according to Rajesh Kumar, PhD and colleagues from the University of California at Los Angles (UCLA).  High resolution MRI brain scans revealed mammillary bodies to be twenty percent smaller in patients with sleep apnea than in normals.  “These findings are important because patients suffering from memory loss from other symptoms, such as alcoholism or Alzheimer’s Disease, also show shrunken mammillary bodies,” Dr. Kumar said in a press release.
 
A recent study form San Diego showed that Sleep Disordered Breathing, including OSA, is and important risk factor for cognitive impairment in older women. (4)

Neuroimaging studies have been performed on patients with OSA including CT, MRI. PET and SPECT scans, revealing a variety of defects, but none has displayed anything quiet as dramatic as in a study published in SLEEP July7, 2008, by Dr. Paul M. Macey et al. (5)  The report reveals results of a new MRI technology called DTI (Diffusion Tensor Imaging). It is an extremely sensitive method of determining damaged nerve fibers (axons). This new imaging technique reveals multiple areas of brain damage in OSA patients not known to exist until now. DTI revealed various sized color-coded yellow-orange patches of brain damage scattered throughout the brains of a group of forty-one men and women subjects with OSA. Their ages ranged from thirty-eight to fifty two years old and they had not yet been treated. The areas of nerve fiber injury were wide-spread, located in critical regions of brain including prefrontal, temporal and parietal lobes. The cerebellum and brainstem were equally involved. This is the first report of DTI imaging of a group with OSA to my knowledge. The findings have far-reaching implications.

One can anticipate finding even more areas of damage in an older population as studies are done. What problems result from each one of these areas of brain damage?  It is possible that they are responsible for difficulties with cognition, mood, behavior, memory, heart regulation, high blood pressure, breathing control, fear, anxiety and other emotional disorders including depression? Those findings are yet to be reported. Could this brain damage eventually accumulate enough to cause Alzheimer’s Disease and/or the other dementias? 

The structural changes likely represent accumulated damage over sustained periods of time.  Are they permanent or do they improve or disappear with treatment?  No one knows yet, but my guess is they may improve to some degree or even resolve with treatment, but we will have to wait and see.
 
The implications of these findings are profound. Early treatment of OSA could potentially prevent the development of Alzheimer’s Disease. Now is the time to wake up the public and our snoozing medical community and put an end to this disease.

References:

1. José A. Luchsinger, M.D. et al, Relation of Diabetes to Mild Cognitive Impairment, Arch Neurol. 2007; 64 (4):570-575.
2. Christine Reitz, M.D. PhD, et.al. Hypertension and the Risk of Mild Cognitive Impairment:, Arch Neurol. 2007; 64(12):1734-1740.
3. Xiulian Sun, et al, Hypoxia Facilitates Alzheimer’s Disease Pathogenesis By Up Regulating BACE1 Gene Expression. PNAS (Proceedings of the National Academy of
Sciences) 2006 | vol.103 | no. 49 |18727-18732
4. Adam P. Spira, et al, Disordered Breathing and Cognition in Older Women: Journal of the American Geriatrics Society. Volume 56, issue 1, January 2008, 45-50.
5. Paul M. Macey, et al, “Brain Structural Changes in Obstructive Sleep Apnea," SLEEP vol.32, Number July 7, 2008, 913-1056.

——-
After surviving his four year ordeal in search for a cure of his own sleep apnea, Dr. Mack Jones, a clinical neurologist, felt a need to pass on to others what he learned first-hand as a patient, so that you might avoid the pitfalls he encountered and possibly save your own life or the lives of your loved ones. Dr. Jones in his book, Deadly Sleep, expected publication date, June of 2009, discusses how this common sleep disorder is a likely cause of Alzheimer’s and possibly a host of other life threatening neurological diseases that may have been plaguing us for hundreds if not thousands of years. He can be contacted via e-mail by clicking here.
 

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.
 

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