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More Sleep Apnea Bites the Dust

I had a crazy day today with a packed schedule full of patients, but the one thing that made it worthwhile for me was the feedback I got from three different patients about either how well they were sleeping, or how their lives were changed as a result of sleep apnea treatment.

While rounding at the hospital early this morning to see my post op patient, she was doing remarkably well one day after her multiple soft palate and tongue procedures for obstructive sleep apnea. She was already swallowing liquids pretty well, and ready to go home. She also noted that despite the pain and the poor sleep environment of being in a hospital with all the noises and distractions, she felt more refreshed than normal when she woke up this morning.

Another patient that I hadn’t seen in 6 or 7 years came in for ear wax removal, and just happened to thank me for changing his life. I had no idea what he was talking about. He reminded me that I had sent him to a dentist for his sleep apnea and he has been successfully using his dental device all this time.

A third patient came in one month after routine nasal surgery and remarked that his breathing is not only normal, but he’s not snoring anymore, and his sleep is much more refreshing and he’s dreaming more.

These are some of the examples of patients that have found success with either CPAP, oral appliances, or with surgery. Some people find success after their first option, while others go through everything before finding a solution that works.

Admittedly, not everyone that I see has great results like that ones above, but the vast majority do, while the remainder have partial or limited success.

This is what keeps me going, knowing that I’m able to help people breathe better and sleep better, regardless of which option they choose. It’s truly a privilege for me to be able to help people in this way.

What’s your success story? Please share your story with me in the comments box below.

Listen To Dr. Park on Radio

Please join me on Thursday, September 2nd at 2 PM Eastern when Tara Marie Segundo of Tara Marie Live interviews me about my book, Sleep, Interrupted: A Physician reveals the #1 reason why so many of us are sick and tired. Click on this link to listen live or to download the interview later if you can’t make it. That link again is http://www.healthylife.net/RadioShow/archiveTM.htm.

Hope you can make it.

UARS: The Hidden Sleep Condition

You’ve gained some weight over the years and you’re just not sleeping well. Your husband says you’ve begun snoring. You know that your father has obstructive sleep apnea and is doing well with CPAP. You mention this to your doctor and she orders a sleep study. The sleep study comes back completely normal. Now what?

The Real Reason for Your Chronic Fatigue

Before you begin searching for other reasons for your chronic fatigue, don’t rule out a sleep-breathing problem too quickly, even if you don’t have obstructive sleep apnea. In fact, a sleep-breathing problem can cause if not aggravate conditions such as hypothyroidism, chronic fatigue syndrome, depression, insomnia, and even irritable bowel syndrome.

Sleep doctors have defined obstructive sleep apnea as having at least 5 apneas or hypopneas every hour on average. An apnea means you stop breathing completely for 10 seconds or longer. Hypopneas are similar 10 second or longer pauses but with restricted airflow. But what what happens if you stop breathing 25 times every hour but each episode lasts only a few seconds?

In the early 1990s, Dr. Christian Guilleminault of Stanford University looked at young, thin men and women who were tired all the time, no matter how long they slept. These people were found not to have obstructive sleep apnea after undergoing formal sleep studies. However when they placed thin pressure catheters in their chest and throat, they found the they had frequent episodes of partial obstruction which led to subtle, but significant limitation of nasal airflow, along with very negative vacuum pressures in the throat. Most of these minor episodes were not apneas or hypopneas, but still lead to an arousal—from deep to light sleep. What was happening was multiple partial obstructions and arousals that were not severe enough to be called apneas or hypopneas, but enough to wreak havoc on deep sleep quality.

It’s been shown that even very subtle levels of restricted breathing can lead to deep brain stimulation and arousals that prevents your ability to stay in deep sleep. These reflex signals to the brain can be so weak that it doesn’t even reach the outer layers of the brain where standard scalp electrodes can pick up these disturbances.

Blame It On Your Parents (And Your Jaws)

The fundamental problem in UARS is due to smaller upper airway anatomy, caused by having smaller jaws and dental crowding. The smaller the space behind the tongue, the more likely you’ll obstruct while breathing when on your back (due to gravity, the tongue can fall back), and when in deeper levels of sleep (when your muscles relax). This is why most people with UARS can’t, or prefer not to sleep on their backs. The problem is that you can still have breathing problems despite sleeping on your side or stomach, just not as bad as being on your back.

Lack of sleep and especially lack of deep sleep has been found to cause a whole host of physiologic changes. In general this happens due to chronic overstimulation of your sympathetic nervous system. This is the fight-or-flight half of your involuntary nervous system. Since your body thinks it’s under attack, it heightens your nervous system, making you en garde, edgy, hypersensitive or overreact to normal situations. This also leads to diversion of blood flow, energy and resources away from less essential body parts and organs, such as your digestive system, reproductive organs, skin, hands, feet, and other “end organs.”

Due to this “hypersensitivity,” the nose and sinuses can be overly sensitive, reacting to stimulants such as weather changes, chemicals, scents, and even allergies. Chronic stress that results from sleep deprivation also can heighten your immune system.

Is It Hormones or Your Breathing?

A number of other studies point out that UARS patients are more prone to have cold hands or feet, hypothyroidism, irritable bowel syndrome, depression, chronic fatigue, and various other “somatic” syndromes. I see this all the time in my practice. In fact, a recent study even showed that chronic long-term sleep deprivation caused significant lowering of the TSH and T4 levels, with women being much more susceptible to this effect compared with men.

With time, as people age, and especially as they gain weight, most people will progress into true obstructive sleep apnea. You’ll find that most younger, thinner people with UARS will have one or two parents with significant obstructive sleep apnea.

Now that you’re convinced that you may have this condition, what can you do about it? For the most part, it’s treated just like obstructive sleep apnea. You should start with all the conservative options first, such as weight loss (if you’re overweight), diet, exercise, improving your nasal breathing, and not eating late. If these options don’t work, then all the formal options for treating obstructive sleep apnea are possible including CPAP, oral appliances, and even surgery.

Unfortunately, if you don’t officially have a sleep apnea diagnosis based on a sleep study, then insurances generally won’t cover any of the treatments. The irony is that our health care system won’t treat or prevent diseases in the early stages, and would rather wait until it’s much more severe before covering for medical services.

If you think you may have upper airway resistance syndrome, you may be disappointed to find that the medical community in general will not be responsive to your queries. With a few exceptions, many sleep doctors are not convinced that UARS is even a legitimate condition, and would rather lump it into the spectrum of snoring to obstructive sleep apnea. Time after time, whenever I see patients who are told they don’t have obstructive sleep apnea and I treat the upper airway narrowing and inflammation, patients almost always feel better. Your best option is to continue to educate yourself and be persistent. Your first priority should be to be able to breathe better so that you can sleep better.

Expert Interview: Michael Goldman of SleepGuide.com

In this Expert Interview, I talk with Michael Goldman, Sleep Health Evangelist and creator of SleepGuide.com. He and I discuss important and surely controversial topics related to obstructive sleep apnea, including:

- Should patients read their own data or make pressure change adjustments on their own?

- How much say should patients have in choosing their own machine types or masks?

- Do patients really need a doctor’s prescription before undergoing a sleep apnea test?

- And much, much more..

Click here to download the mp3 file.

Can Antidepressants Cause Obstructive Sleep Apnea?

I do believe that untreated obstructive sleep apnea (OSA) is a major cause, if not the most common cause of depression.  We know from numerous studies that OSA, via massive hypoxia and inflammation, causes brain biochemical and structural changes that can alter almost every aspect of your physiology and psychology.

Almost weekly, I see patients that suddenly gained significant weight after starting an antidepressant medication. We know that certain antidepressants are more likely to cause weight gain. Weight gain can aggravate obstructive sleep apnea, and obstructive sleep apnea can worsen depression. We also know that depression is linked with a higher incidence of insomnia, cardiovascular disease, and even death.

Did you gain weight after starting an antidepressant medication? If so, which one did you take?

Can Sleep Apnea Cause Psoriasis?

How is psoriasis connected to obstructive sleep apnea? You may think I'm crazy for even making the suggestion, but if you look at the studies, the results don't lie—you just have to connect the dots.

I've always wondered about this link, since almost every known medical condition is proven to be or possibly associated with obstructive sleep apnea. I was reminded about this connection when I read about golfer Phil Mickelson's psoriatic arthritis. I already commented on the association between sleep apnea and arthritis, and this time, I'm going to show you that psoriasis may be connected as well.

First of all, numerous studies have shown that people with psoriasis have a much higher chance of having cardiovascular disease. There are other reports that psoriasis is associated with an increased incidence of cancer, lymphoma, obesity, metabolic syndrome (also known as "Syndrome X"), autoimmune diseases (Crohn's disease and diabetes, etc.), psychiatric diseases (such as depression and sexual dysfunction), psoriatic arthritis, sleep apnea, personal behavior issues, chronic obstructive pulmonary disease (COPD).  If you have severe psoriasis, the likelihood that you'll have a heart attack is 3 times normal. Your chance of dying overall is almost doubled than if you didn't suffer from this condition. Average life expectancy is about 3 to 5 years shorter for someone with psoriasis.

We also know that obstructive sleep apnea can cause metabolic syndrome, hypertension, diabetes, high cholesterol, inflammation, heart disease, heart attack, and stroke. Your risk of dying early increases 45% if you have severe obstructive sleep apnea.

There's even a case report of someone with severe psoriasis who was completely cured after undergoing gastric bypass surgery for obesity.

Here's my take on the connection between obstructive sleep apnea and psoriasis: The chronic stress response and repeated episodes of hypoxia deprives the skin of vital blood flow and nutrients. Sympathetic activity overload preferentially shuts down certain parts of the body that are considered unessential, such as the digestive system, reproductive system, and the skin. In addition, chronic low-grade stress also causes your immune system to overreact and cause inflammation, inducing various self-destroying tendencies that are common with autoimmune conditions.

What do you think about this possible connection? I'd like to hear your opinion.

Phil Mickelson, Arthritis, and Obstructive Sleep Apnea

I've always wondered about a possible link between arthritis and obstructive sleep apnea. We know that people with arthritis also have a higher rate of cardiovascular disease and metabolic syndrome. I recently found out that Phil Mickelson has a debilitating condition called psoriatic arthritis. A few days before the last US Open, he could barely walk. 

More Dead End Tests For Alzheimer’s Disease

There have been a number of recent studies that report on markers to predict whether or not you'll develop Alzheimer's in the future. All these tests, whether blood tests or cerebral spinal fluid samples, measure various levels of beta-amyloid, which is the protein that makes up the plaques that are typically found in diseased brains. 

One study showed that measuring three different markers had almost a 90% rate of accuracy in predicting Alzheimer's disease. Another showed that measuring beta-amyloid in spinal fluid was found to be useful.

If you've been following my posts about Alzheimer's disease, you know how I feel about beta-amyloid plaques. I believe amyloid plaques are the end result of damage that's done to the brain from other reasons, and not the cause of Alzheimer's itself. I've also alluded to numerous studies showing that chronic hypoxia can lead to amyloid buildup in the brain, along with lowered volume and density of brain cells in critical areas of the brain (including memory, motor movements, executive function, breathing and autonomic control) and numerous small strokes (lacunar infarcts) in people with untreated obstructive sleep apnea. I believe that a significant number of people with the most common type of Alzheimer's (idiopathic, not genetic) have an untreated sleep-breathing problem that over time, can lead to various degrees of brain damage. Preventing amyloid plaques won't treat what's actually causing the problem, just like when we treat high cholesterol or high blood pressure with medications.

I'm reminded of a very funny and poignant video by Dr. Mercola, called The Town of Allopath. Its' message is very relevant when it comes to Alzheimer's disease.

What do you think about these new tests for Alzheimer's?

Snoring: Not So Benign

Here's a study that confirms that snoring should always be taken seriously: Researchers showed that snoring children had lower IQ/test scores compares with children that didn't snore. Not too surprising, knowing what we know about snoring. 

Even if you don't have obstructive sleep apnea, snoring is a sign that you're partially obstructed, and in most cases many people who snore initially go on to develop obstructive sleep apnea many years later. In young children with very actively developing brains, any disruption in sleep quality can disrupt proper brain functioning. 

I overheard one sleep researcher a few years ago saying that after tonsillectomy, cognitive and behavioral scores improve dramatically, but never catch up to that of children who didn't need tonsillectomy.

So why should snoring be taken so seriously?

We know that in drivers, snoring alone without having formal obstructive sleep apnea significantly increases your risk of car accidents. Vibrations that come from snoring is thought to alter the sensory nerve endings of the soft palate, somehow damaging the protective reflexes that help to keep the upper airway open. Vibrations from snoring are also found to cause carotid artery wall thickening in rabbits. Damage to the chemical receptors from additional reflux can also aggravate this vicious cycle. These type of studies go on and on. 

What all these studies point to is the fact that snoring is on a continuum of sleep-breathing disturbances of which all humans are susceptible. While not all snorers will have obstructive sleep apnea, it's important to look for complications of snoring, as well as to prevent progression later on into true sleep apnea. 

How many of your friends or family members snore?

Too Obsessed About Sleep?

A few days ago, I did an experiment. 

Many months ago, when I had a bad cold with severe coughing, I slept out in the living room sofa so that I didn't bother my wife. That night, I slept really well. I suspect that the reason for this is the angle that the armrest creates with my head position, similar to what a good contour pillow does—by tilting your head slightly back, it opens up your airway.

Recently, I haven't been sleeping well, and I after working late on my computer, I decided to try sleeping on the same sofa to see if I could recreate that great sleep experience. The experiment failed miserably. My sleep quality was pretty bad, especially since it was a bit hot and humid.

The next morning, I mentioned to my wife why I slept on the sofa that night. I told her that I wanted to recreate that really good nights' sleep that I had previously. She looked at me for a few seconds, and said something in passing, that really didn't hit me until now: "Honey, I know you're really passionate about sleep, but if your main goal is always to get that perfect night's sleep, you'll never get it."

I only recently realized just now how profound her statement is. She was just trying to be helpful and give me some practical advice, but I think she hit on a major life lesson: Don't focus on absolute goals when you should be focusing on bigger things in life. 

For example, running and finishing a marathon is a worthwhile goal, but what's more important is, why even run the marathon? Is it to become healthier, or develop an exercise regimen that's part of an overall healthy lifestyle?

Is your goal of eating healthier to see how healthy you can eat? Could it be that by staying healthy, you'll have the energy to spend quality time with your children, as well as to be around to see your children grow up past their teens?

Why even bother getting a good nights' sleep? Is it to boast to everyone that you're such a great sleeper? 

Rather than trying to sleep well, think about the reasons why getting a good nights' sleep is so important in your life: You can be much more refreshed tomorrow and be at your best during your presentation or 5K run. 

What I realized was that a good sleep should not be your ultimate goal. Rather, it should be a part of your overall plan for bigger, grander life goals, such as enhancing and enjoying your relationships, succeeding and advancing with your career goals, and living the life of your dreams. 

Numerous successful people have stated that once you have a grand vision or life goal, the steps that you need to take will come naturally. Once you know they why, the intermediate steps and the how will become obvious. 

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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