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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.

Is Your Computer Screen Ruining Your Sleep?

As I’m writing this post at 9:30 PM, using my computer is likely to keep me up later into the night. It’s not so much the activity or the content that’s overly stimulating, but the type of computer screen that might prevent me from falling asleep. The newer, brighter backlit LED screens that are almost commonplace with computers these days (especially laptops and tablets) have a much higher level of blue light (460 nm), which is known to have stimulating properties on the circadian system. A study published in the Journal of Applied Physiology showed that subjects who used backlit LED screens had higher rates of attention, wakefulness, and declarative memory compared to subjects who used conventional computer screens. On the flip side, melatonin levels were significantly supressed. As you may know, melatonin levels go up as you’re falling asleep.

This has huge implications since many people (including me) use these type of screens while working later in the evening. It may be great during the day so that you can be productive and get more work done, but it’s counterproductive in the evening hours, especially just before bedtime.

Notice also that most of the newer appliances, traffic lights, cars, toys, and even medical equipment, have LED lights, which are significantly more intense than standard lightbulbs. If you have a few electronic appliances in your bedroom, it’s likely that once you turn the lights out, three or four LED lights can light up your entire room, shining much brighter than many night-lights. I cover my LED lights with black electrical tape.

For some reason, driving has been a bit more annoying for me lately, especially in local traffic, and I realized that it may be due to the fact that I have to look at the very bright LED brake lights on the car in front of me, which makes me squint. It just barely seems to give me a headache, sort of like a very mild migraine. I find myself squinting, and I know that my iris is closing down to shut out the light, kind of like clamping down on the aperture on a camera. This would likely stimulate your sympathetic nervous system (your fight or flight response).

The traffic lights bother me a bit too. If all these little things bother me, I’m sure they’re bothering many other people subconsciously, and it will manifest in different ways. It’s also likely to significantly disturb sleep for millions of Americans.

Do you work with backlit LED computers just before bedtime? Do the brighter LED light bother you too?

 

The Fountain of Youth, Revealed

Ponce de Leon is well known as the Spanish explorer that searched for the fountain of youth in the early 1500s. Even today, that search continues through the multi-billion dollar cosmetics industry, plastic surgery procedures, and nutritional products. Anti-aging medicine even has a certifying organization for doctors. Some experts are even claiming that they can reverse the aging process.

Knowing what we know about the importance of sleep and the havoc it can cause on your body, I can confidently say that the best way to slow down aging is to optimize your sleep quality. Sleep is known to be vital in tissue healing and regeneration, hormone regulation, as well as in helping to consolidate memories and thought processes. For example, non-REM deep sleep is important for tissue repair, growth hormone release, and other regenerative processes. REM sleep is needed for memory consolidation and creativity.

When most people read or hear about better sleep, they think about going to bed earlier or sleeping longer. People with insomnia are also inundated with “warm milk” recommendations, such as valerian, green tea, turkey, melatonin, meditation, and probably dozens of other vitamins, supplements, or relaxation techniques that help to calm or numb the mind to allow for faster sleep onset. Many of these options can work to various degrees, but won’t be helpful at all if you stop breathing at night. Once your breathing passageways obstruct while sleeping, you have to wake up. You can either wake up violently in a state of panic with sweating and your heart racing, or just get taken out of deep sleep into a lighter stage of sleep.

About 1-2 times per month, I see women who complain of various ear, nose or throat symptoms, let’s say for about 6 weeks. They also usually complains of increased fatigue, headaches, and poor sleep. They usually see their medical doctors and have tried multiple courses of antibiotics or allergy medications. They will typically say that they sleep on their backs when questioned about their preferred sleep position. Looking at their oral cavity exam, I don’t believe them. When questioned further, they all admit that they used to be stomach sleepers, but changed to back sleeping after reading an articles on various magazines, usually by a dermatologist (or sometimes a chiropractor) that recommends avoiding stomach sleeping since it can cause facial wrinkles. Almost every time, their health problems began just after they made the switch in their sleep position. Once they go back to their normal sleep position, their health problems usually resolve.

The cosmetics industry’s fight against facial wrinkles is a classic example our quest to delay aging. In the above example, the reason why some people have to sleep on their stomachs is so that they can breathe properly. Being on their backs causes the tongue to fall back due to gravity, and when in deep sleep, it relaxes completely, leading to obstruction and arousal. Having smaller jaws and dental crowding can aggravate this problem even more. Not getting sufficient amounts of deep sleep causes a generalized state of physiologic stress and adrenaline production, which tends to constrict blood vessels that supply certain parts of the body that are considered “unessential” when you’re under stress. This includes your digestive system, your reproductive organs, as well as your skin. Not receiving proper circulation deprives the tissues of oxygen, preventing proper nutrition and not allowing for healing, regeneration, and waste removal. Hypoxia also creates an environment that’s toxic to the local tissues, leading to further damage and accelerated aging. The bottom line is that not getting good sleep accelerates your aging process.

Another important concept that has profound implications is the fact that underdevelopment of the bony midface and jaw structures leads to wrinkles earlier in life. Having smaller facial bony structures does not stretch the facial skin over the bones as much compared to larger facial structures. Since elastic properties of facial skin tend to degrade over time, having smaller facial bones allows wrinkles to show up earlier, with the same degree of environmental, dietary, or genetic factors.

Two common habits that are thought to accelerate aging and even wrinkles are sun tanning and smoking. Sun tanning may make you look “healthy” temporarily, but sun damage takes a toll on your skin, especially if you’re susceptible to the sleep-breathing problems that I describe. Imagine if you already have diminished circulation to the skin,  with diminished levels of oxygen. By definition, you’ll have more levels of oxidative stress, where free-radical oxygen molecules are formed, which can damage DNA. Add ionizing radiation, and it’s a double whammy.

Nicotine is a known stimulant which also has been proven to constrict blood vessels, especially in the skin. It also has a calming effect the way Ritalin helps to calm children with ADHD: Stimulants help to counteract the effects of sleep deprivation from not breathing well at night. It’s also been shown that it takes nicotine about 45 seconds to reach the brain once you inhale smoke into your lungs. This doesn’t make any sense, since most smokers will tell you that they feel more relaxed after the first one or two breaths. What’s making smokes relaxed is the relaxing properties of deep breathing, along with the stimulating effects of nicotine. But by relaxing more using deep breathing techniques to inhale a stimulant, you’re cutting off blood flow to your skin, which if already sun damaged, is more likely to suffer from wrinkles.

The basic thesis of my sleep-breathing paradigm states that all modern humans stop breathing once is a while. But as we get older, not only do we sag on the outside, but also on the inside. If you think about it, the rate at which we age is directly proportional to how narrow your upper airway gets. Add to this additional gravity and the typical weight gain that tends to occur during middle age, it’s no wonder so many people have sleep-breathing problems as we all get older. We’ll never run out of more pills, gadgets, devices and diets that tout their anti-aging properties, but without addressing how well you breathe while sleeping, you’ll continue to suffer from accelerated aging.

 

Struggling with an addiction? Check into a Long term drug rehab facility and get the help you deserve!

 

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