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33% of All Cops May Have Sleep Apnea

I’ve always wondered about police officers—just like the rest of the population, many are generally overweight.  A new study published in the Journal of the American Medical Association revealed that about 40% of police officers screened positive for at least one major sleep disorder. Sleep apnea was the most commonly found condition, at 34%. Insomnia and shift word disorder were the two other conditions seen. About 80% were overweight or obese. And 26% reported falling asleep while driving at least once or twice per month.

These findings are not too surprising, since police officers frequently work odd hours that include night shift and weekends. Their poor eating habits can contribute as well. We also know that poor sleep can promote weight gain. The irony is that police officers probably need to be outdoors, walking or driving around, since an indoor desk job will not be stimulating enough. The question is which comes first: poor sleep habits and lifestyles that lead to weight gain and sleep apnea, or anatomic predisposition to sleep apnea that leads to choosing these type of occupations that promote weight gain, which leads to sleep apnea? I’m sure that if you studied fire fighters, you’ll find similar results, and that you’ll agree with me that this is a potentially major public health issue.

Based on these findings, do you think mandatory screening for obstructive sleep apnea should be required on a periodic basis for all police officers?

Why Most Doctors Know Almost Nothing About Sleep

Studies in the past have shown that when someone complains about not being able to sleep to a doctor, more often than not, a sleeping pill is prescribed. The reason is that young doctors are taught in training that pharmaceuticals like Zolpidem (Ambien) stimulates GABA receptors in the brain, promoting sleep. There’s essentially no mention that cognitive behavioral therapy for insomnia works just as well for insomnia in the short term, but is superior to drugs in the long term.

You’d think that medical students would get at least some education about a part of patient’s lives that they spend 1/3 of their lives doing, which is sleep. Well, not really. 

I remember getting only about 2-3 hours of lectures on sleep during medical school. I’m told by a medical school professor that due to stiff competition between various subjects such as molecular biology, anatomy, pathology and pharmacology for student’s time in classes, sleep gets squeezed out in the end. 

This problem was brought to light by a study in a major sleep journal (Sleep Medicine) which showed that the quality and quantity of sleep education varied tremendously between various international countries. For example, the average number of hours on time spent on sleep education was 2.5 hours. In 1990, a survey reported that medical students received about 2 hours of sleep education, and not much has changed recently. In fact, 27% of respondents reported no training in sleep at all. Pediatric sleep topics grabbed a mere 17 minutes on average.

Even now, despite knowing that untreated obstructive sleep apnea can significantly increase your risk of heart attacks and stroke, doctors are still prescribing blood thinning medications and high blood pressure medications, while ignoring the patient’s severe snoring problem. We also know that poor quality and quantity of sleep is strongly linked to increased rates of cancer, sudden death, and motor vehicle accidents.

I think it’s time that physicians finally wake up to the importance of a good night’s sleep. Sadly, most mainstream physicians and surgeons that I know still don’t take sleep very seriously.

How can you as the patient better educate your doctor about the importance of a good night’s sleep?

Women & Insomnia: What Else Could it Be?

Here’s a not-too-surprising finding: A 2007 study front the National Sleep Foundation found that 3 out of every 10 women admit to taking a sleeping pill at least a few nights a week. Prescription sleep aids peak amongst women aged 40 to 59. Many women also report that their sleep has never been the same ever since that last pregnancy. Even with older children, being able to either fall asleep or stay asleep can be challenging for many women. 

Beyond the obvious reasons for poor quality sleep in women (nighttime feedings, stresses of modern life, hormonal changes, etc.), there’s one important additional factor that wasn’t mentioned in a recent New York Times article on this subject: increasing problems breathing at night.

I’ve written numerous times about how pregnancy predisposes women to obstructive sleep apnea, but due to rising levels of progesterone, their airways are protected (as an upper airway muscle stimulant). But after delivery, progesterone drops, but you still have all that weight. Now you’re narrowed your upper airway, but without the protective benefits of progesterone. Add to this the initial sleep deprivation from routine awakenings at night, and the problem is compounded even further.

Notice also that sleeping pill use peaks around peri-menopause. This is also a period when progesterone levels slowly drop, leading to even more breathing pauses while sleeping. Add to this the typical few more pounds that women gain during menopause, and this can lead to worsening obstructive sleep apnea. No wonder women begin to catch up to men when it comes to rates of obstructive sleep apnea and cardiovascular disease as they go past menopause.

You’ll notice that most women who have chronic insomnia prefer not to sleep on their backs, since that’s then the tongue falls back the most due to gravity. Having smaller jaws create less room for the tongue, making them more prone to sleep-breathing problems. Many of these women will have one or two parents that snore heavily. 

It’s also important to realize that you don’t have to have true apneas to have disrupted breathing during sleep. You can have very short obstructions and arousals that don’t count as being apneas if you did a formal sleep study. Younger and thinner women (and men) can have these more subtle events, which can manifest as upper airway resistance syndrome. You can also have different combinations of all these breathing pauses and arousals. The bottom line is that you just can’t sustain deep, continuous sleep. Waking up after 4-5 hours of sleep would be expected when you begin to enter longer periods of REM sleep in the later parts of the night. This is when your throat muscles are most relaxed, and most susceptible to obstructions and arousals.

I’m not discounting all the other reasons why women have so many sleep issues, but untreated sleep-breathing problems is is major source of poor sleep that can frequently masquerade as insomnia, especially in women. 

Insomnia Significantly Raises Your Heart Attack Risk

Millions of people have chronic insomnia. Billions are spent on pharmacologic and natural treatment options every year. Now a study shows that if you have chronic insomnia, you have up to a 45% increased risk of having a heart attack. 

This study followed over 52,000 Norwegians who initially complained about insomnia. After 11 years of follow-up, those that said they had trouble falling asleep daily for over one month were 45% more likely to have suffered a heart attack. Those that couldn’t stay asleep all night had  a 30% increased risk, and those that reported unrefreshing sleep had a 27% increased risk. After adjusting for age, sex, marital status, education, blood pressure, cholesterol, diabetes, weight, exercise, shift work, depression and anxiety, people with sleep troubles were found to have the highest risk of having a heart attack.

Something to sleep on.

Taking The Sleep Medicine Board Examination On 2 Hours Sleep

After months of studying, I finally took my sleep medicine board examination yesterday. I felt well-prepared for this 4-part, 8 hour test. But one thing that always seems to happen to me before every major exam is that I suffer from severe insomnia. The same thing happened to me before my SAT, MCAT, and otolaryngology board exams.

The night before this test, I went to bed at my normal 10:30 PM time, but was unable to fall asleep unto about 4AM! What made it worse was that my mind was filled with thoughts of studies showing memory loss and poor recall  in sleep-deprived individuals. Imagine a sleep doctor having major sleep problems before a major sleep test. This temporary, stress-induced insomnia is called adjustment (or acute) insomnia as defined by the International Classification of Sleep Disorders (Second Edition). Fortunately, it goes away once the stressor resolves.

I got a refreshing 8 hours of sleep last night, and now with the test over, I can get back to a normal life again. 

Dr. Park’s TV Segment On Black Enterprise

I was recently interviewed by Sonia Alleyne of Black Enterprise Business Report on the importance of a good night’s sleep. Take a look at this 3 minute video segment.

Depression Ups Your Stroke Risk

A recent study revealed that having depression was found to increase the risk of having a stroke by 45% in people who were followed from 2 to 29 years. Your risk of dying from a stroke also increases by 55%. The article talks about people with depression being more overweight. What else can being overweight cause?

We know that having insomnia significantly increases your risk of developing depression later on in life. Having untreated severe obstructive sleep apnea also significantly increases your chances of having a stroke. Not sleeping well from any reason (insomnia or sleep apnea) can cause major biochemical and structural changes in your brain. Do you see the connection? 

Update On My Blue Light Screen Filter Experiment

I commented two weeks ago on how modern computer displays (particularly LED backlit monitors) emit a very high amount of blue light, which can be very stimulating. Any kind of light in the hours just before sleep can delay the circadian clock, as well as to suppress melatonin levels, which can delay sleep onset. I installed a program on my laptop called F.lux, which removes the blue tinge on my screen only in the evening hours. 

I’m happy to report that I’m able to fall asleep much earlier now. Overall, I’m feeling more refreshed when I wake up, and generally have more energy during the day.

If you have to work on your computer late in the night, try downloading and testing out this free and simple program. In this age of overstimulation and too many distractions, we can use any help that we can get. After using it for a few weeks, please report back to me your experiences. 

7 Ways to Speed Up Aging

Not getting enough sleep can definitely cause more facial wrinkles, but here are 7 more ways to make sure that you get even more wrinkles, have more aches and pains, feel old, or even die sooner.

1. Eat or snack close to bedtime.

Going to bed on a full stomach may help you fall asleep faster, but once you’re asleep, you’re more likely to have reflux into the throat, leading to more frequent breathing obstructions and arousals, leading to inefficient sleep. 

Most modern humans have dental crowding and smaller jaws. Since soft tissues such as the tongue and nasal septum grow to their genetically predetermined size, the airway gets crowded. This leads to more frequent obstructions when on your back (due to gravity) and especially when in deep sleep (due to muscle relaxation). The more juices you have in your stomach when you go to bed, the more likely it’ll come up when you stop breathing.

Your stomach juices include not only acid, but also bile, digestive enzymes, and even bacteria. These substances can cause even more inflammation and swelling in your throat, leading more more obstructions and arousals. 

If you want to gain weight, continue eating late. Lack of sleep quantity or sleep quality has been shown to promote weight gain, which leads to more narrowing in your throat. 

2. Drink a night cap before bedtime

Alcohol may help you to fall asleep better and faster, but it causes your throat muscles to relax and you’ll stop breathing much more often, preventing you from achieving continuous deep and REM sleep. Not sleeping deeply can increase stress levels, making it difficult to shut down your brain when you’re trying to fall asleep. Drinking alcohol before bedtime can help you to go to sleep, but you end up aggravating this vicious cycle. Alcohol also irritate the stomach, creating more acid production.

3. Sleep on your back

Modern humans, due to smaller than normal jaws, are unable to breathe well during sleep when supine due to the tongue falling back (due to gravity) and especially in deep sleep (muscles relax). The more crowded your mouth is (if you needed braces), the more likely you’re going to be a natural side or stomach sleeper. Anything that prevents you from your normal preferred position will increase the number of obstructions and arousals, leading to less efficient sleep. One way to make sure that you sleep on your back is to get injured or undergo surgery—this will definitely lower your sleep quality.

4. Undergo rhinoplasty

Whenever the surgeon narrows the tip, cartilage in your nostrils are weakened, and years later, are more likely to cave in whenever your inhale. If you have a deviated nasal septum, or allergies, the weakened nostrils are more likely to collapse inwards, leading to a vacuum effect in the throat, with more frequent tongue collapses (especially if you have small jaws, eat late or drink late). Look for a surgeon that doesn’t take the steps needed to prevent this from happening if you want to have more breathing problems later in life. 

5. Bottle-feed as an Infant

Dentists have shown that the physical act of bottle-feeding changes your bite and dental structures, leading to a higher incidence of malocclusion. This leads to crowded teeth and narrow dental arches, which can increase your chances of developing obstructive sleep apnea later in life. If you want to make things worse, use pacifiers whenever possible and encourage thumb-sucking for as long as possible.

6. Undergo jaw surgery

Jaw operations are commonly performed to correct bite or occlusion problems, but one thing that surgeons frequently don’t address is the fact that any time the upper or lower jaw is pushed back, the airway can become more compromised. As a result, your smile and your bite can improve, but your ability to breathe properly at night will go downhill. Not sleeping efficiently can significantly increase your rate of aging.

7. Don’t treat your sleep apnea

Obstructive sleep apnea is a common condition that becomes more common as we all get older. People with sleep apnea stop breathing repeatedly at night, without even realizing it. This causes a major physiologic stress response that wreaks havoc on your body. Even growth hormone levels are diminished. In fact, about 1/4 of men and 1/10 of women are thought to have unrelated obstructive sleep apnea. After age 60 to 70, some studies show that the vast majority have obstructive sleep apnea, especially if you have chronic medical conditions or are institutionalized. 

 

Efficient sleep (quantity and quality) is essential for healing, regeneration, and rejuvenation. Ignoring your breathing problems while sleeping is a surefire way to age faster. If you really want to have more facial wrinkles, wait until you’re much older to address any underlying sleep-breathing issues you may have. 

UARS Article In Forbes.com

Here’s a good summary of upper airway resistance syndrome (UARS) in the Forbes.com health blog, where I get interviewed about this all-too-common condition.

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