• 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 

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.

 

Tim Ferris, Michael Phelps, ADHD, & Sleep Apnea

I wrote in my last post about how creativity can be linked to ADHD, mainly due to inefficient sleep from breathing problems at night. ADHD can also be linked to tremendous achievements in sports or physical activities. People who don’t sleep efficiently will take measures during the day to compensate for their inability to stay focused or stay awake. Some people drink lots of coffee. Others exercise like crazy. Some even become olympic swimming or ballroom dancing champions.

I’ve written before about how Michael Phelps, the olympic swimming champion, has a major malocclusion, and seems to be a mouth breather. It’s well documented in the papers that he had ADHD as a child. Swimming is a great way to not only stay active, but also has a calming, relaxing property that’s almost like doing deep-breathing meditation exercises. Swimming forces you to take slow, rhythmic breaths. His mother has known hypertension, and being clearly overweight, it’s likely that she has obstructive sleep apnea. Many long distance runners feel alive only when they’re running. It’s shocking how often people who are addicted to endurance sports can’t or prefer not to sleep on their backs.

Even with Tim Ferris, best-selling author of The 4-Hour Work-Week, in his new book, The 4-Hour Body, he describes how he and his entire family have major insomnia. He even recommends sleeping on your stomach, which is what he most likely prefers due to his jaw anatomy. He’s excelled in almost every physical activity, from running to swimming, to body-buiding, and even ballroom dancing. I do enjoy reading his books, but I have to admit that his writing style is definitely scattered, in the stereotypical style that’s typical for ADHD.

Problems can arise if you get injured or are forced to sleep on your back for some reason (an injury or surgery). Poor sleep quality can promote rapid weight gain, and then it’s really difficult to take off, especially since you’re not sleeping well, and you’re not able to exercise at your normal levels. Time and time again, people with these issues tell me that they get really down and depressed even if they miss a few workouts.

I know many of you reading this have this condition. Do you agree or disagree?

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.

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?

 

 

 

Another Important (Boring) Finding

A study published in the Oct. 30 edition of the the New England Journal of Medicine reported that CRP, a marker of inflammation and heart disease, does not cause heart disease. Rather, it’s just an innocent bystander (Surprise!). The same can be said for almost every medication out there that targets specific biochemical markers, such as for high cholesterol, high blood pressure and depression. Researchers are so caught up linking biochemical markers for various disorders, that somehow, the words "linking" or "associated with" slowly morphs into "causes." So then the search goes on to lower or eradicate this particular marker, thinking that this will somehow get rid of the disease. 

Imagine if you were allergic to dust and the dust particle sets off an allergic reaction in your nose that turns into an inflammatory cascade, almost like a tree trunk that branches into hundred or thousands of smaller branches and so forth. If one biochemical process is the equivalent of one particular branch, of course you’ll see the same branch with the same tree trunk. But cutting off this particular branch, although it may make you feel better, won’t get rid of the tree. The same analogy holds for most of modern medicine, including allergies. Shutting down histamine production may help your allergies feel better, but you have to keep using the medication to stay that way. You’re also not addressing the other hundreds or thousands of other known and unknown inflammatory markers that wreak havoc in other ways.

I predict there will be a proliferation of other biochemical markers that are found to be linked or associated with a medical condition, with researchers and drug companies jumping on the bandwagon to block this chemical, only to find later that it doesn’t work in the long term. 

Do you have other examples of not seeing the forest from the trees?

 

The Male Menopause Myth

It’s commonly known that women going through menopause experience hot flashes, night sweats, moods swings, irritability, insomnia and weight gain, but these same symptoms are known to occur in men as well. They generally occur in men in their 40s to 50s, thought to be due to slowly decreasing testosterone levels, along with other symptoms such as loss of sexual desire or functioning, depression, memory loss, or chronic fatigue.

But what if I told you that I see young men in their 20s coming in to see me with the same exact problems? What I’ve discovered is that it’s really not mainly a hormonal issue, but a problem with their breathing. Let me explain.

What I’ve noticed in all these young men is that they all have in common a relatively narrow upper airway. When examined with a thin flexible camera, the space behind their tongues is very narrow, about 2-3 mm wide. This is mainly due to smaller jaw structures and dental crowding. Whenever someone with this anatomy starts to fall asleep, his tongue muscle starts to relax, and in deeper levels of sleep, it relaxes almost completely, leading to partial obstruction, and awakening. Once awakened, the man turns over. In most cases, they usually don’t like to sleep on their backs for this reason.

Most people compensate very well by sleeping only on their sides or stomachs. However, if there’s anything that narrows the upper airway, either due to inflammation (allergies or a cold), or structurally (fat), the tongue collapses much easier and the person gets less efficient sleep due to multiple arousals.

Inefficient sleep leads to an imbalance of the involuntary nervous system, leading to what are called "vasomotor" conditions, such as sweating, heart palpitations, and temperature fluctuations. So is a young man with a predisposed anatomy is slowly gaining weight, he may experience all the above "male menopause" symptoms.  If these obstructions last for more than 10 seconds, they are called apneas.

If you have more than 10 to 15 apneas every hour, then you may be diagnosed with obstructive sleep apnea. Untreated obstructive sleep apnea can lead to depression, anxiety, weight gain, erectile dysfunction, memory problems, hypertension, glucose intolerance, going to the bathroom often, heart disease, heart attack and stroke. The physiologic stress state that’s created also can lower one’s thyroid and testosterone levels, making it seem like he may have either hypothyroidism or low testosterone. 

So in a sense, the "male menopause" phenomenon does happen, but not for the reasons that you may think. The word menopause literally means cessation of menses. Since men don’t have periods, this is not an appropriate word. Instead, it should be renamed something alluding to the progression of a sleep-breathing disorder. Do you have any of these symptoms or know anyone who’s going through "male menopause"?

58% of Diabetics Have Obstructive Sleep Apnea

I came across this blog that mentioned that the International Diabetes Federation did a study which showed that 58% of type 2 diabetics have obstructive sleep apnea. Not too surprising, since we’ve known for years that the stress response created by sleep-breathing problems can cause glucose intolerance. This number may be much higher if you take into consideration all diabetics that obstruct 5 to 25 times every hour who wake up after 1-9 seconds each. Since they didn’t reach to 10 second threshold to count as an apnea, their apnea score (AHI) is officially 0. Rest assured, there will be many more of these “links” between obstructive sleep apnea an a myriad of other conditions such as hypertension (many studies already published), stroke (many studies), depression (many published), anxiety (many published), heart disease (many published), headaches (many published), obesity (many published), ADHD (too many to mention), and many other various conditions such as chronic fatigue, IBS, migraines, TMJ, chronic sinusitis, etc. So many associations between all these conditions and obstructive sleep apnea…hmmmmmm….is there a common link?

Knowing about the results of this study, do you think it will sway doctors to at least start screening for obstructive sleep apnea in their diabetic patients?
photo credit: Yogma

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