March 30, 2015
If you’re a chronic mouth breather because of a stuffy nose, you’re not alone. As the weather chills and allergies and colds abound, and nasal congestion becomes a common trend, mouth breathing inevitably follows-especially when you’re sleeping. I’m sure you’ve seen many passengers asleep on the subways and trains, head and pitched back, mouth wide open, and snoring louder than a diesel engine. Mouth breathing can surely ruin your social image, but that’s nothing compared to the havoc it can wreak on your health.
5 Potent Benefits of Breathing through Your nose
One of the most important reasons to breathe through your nose is because of a gas called nitric oxide that’s made by your nose and sinus mucous membranes. This gas is produced in small amounts, but when inhaled into the lungs, it significantly enhances your lung’s capacity to absorb oxygen, increasing oxygen absorption in your lungs by 10-25%. Nitric oxide also can kill bacteria, viruses and other germs. This is why you often hear fitness and yoga instructors emphasize inhaling and exhaling through your nose during workouts.
Also, if you can’t breathe well through your nose, your sense of smell will suffer and therefore your sense of taste, since your smell and taste buds are connected. This can lead to disturbances in your appetite and satiation levels, wreaking havoc on those struggling with weight issues.
Your nose also has vital nervous system connections to your lungs and heart. Not breathing well through your nose can alter your heart rate and blood pressure, as well as increase your stress responses.
Your nose makes about 2 pints of mucous every day. If your nose isn’t working properly and mucous isn’t cleared, the stagnant mucous can lead to infections such as sinusitis or ear infections, not to mention bad breath.
Lastly, not breathing well through your nose can aggravate snoring or obstructive sleep apnea. Nasal congestion alone doesn’t cause obstructive sleep apnea, but it can definitely aggravate it. If your palate and tongue structures are predisposed to falling back easily due to sleeping on your back and muscle relaxation in deep sleep, then having a stuffy nose can aggravate further collapse downstream. Untreated obstructive sleep apnea can lead to chronic fatigue, depression, anxiety, weight gain, high blood pressure, heart disease, heart attack and stroke.
Knowing all these benefits of breathing through your nose, however, doesn’t help much if you don’t know why you’re not able to do so. To stop mouth breathing, the first thing you must do is to figure out what’s blocking up your nose.
What Can Stop Up Your Nose
Nasal congestion is something everyone experiences now and again. Yet, if you’re trying to prevent this from happening it’s important to explore the various reasons behind why and when this occurs.
Here are five of the most common reasons for a stuffy nose:
“I Have a Deviated Septum“
By definition everyone has a slightly crooked (deviated) nasal septum. There are various reasons for having a deviated septum, including trauma, but the most common reason is no reason at all. It’s just the way your nose developed. What’s more important than how deviated your septum is is what’s happening in front of an around your septum.
Wings in Your Nose
Turbinates are wing-like structures that attach to the sidewalls of the nasal cavity, opposite the midline nasal septum. They normally smooth, warm, humidify, and filter the air that you breathe, but they also become enlarged and produce mucous when inflamed. Turbinates also swell and shrink alternating from side to side, which is a normal neurologic process called the nasal cycle.
Is It An Infection or Allergies?
If you have allergies, a cold or any kind of infection, then your turbinates will swell up, clogging your nose with lots of mucous production. Contrary to popular belief, the color of the mucous has no relation to bacterial vs. viral infections.
Once you have inflammation and swelling inside your nose, for some people, depending on the configuration of your nose, your nostrils can literally cave in as you inhale. Different noses have differently shaped nostrils with various nostril thicknesses. The more narrow your nose, the more likely your nostrils can cave in. People who undergo cosmetic rhinoplasty are more at risk years later, since narrowing the nose can weaken the support structures of the nose.
A Nervous Nose?
Some people’s noses are extra sensitive, especially to weather changes, like temperature, humidity, and pressure changes. Certain chemicals, scents and odors can set off a reaction as well. Many people mistakenly think this reaction is an allergy, but it’s really your nasal nervous system over-reacting to the weather or to odors. One of the most common reasons is from poor quality sleep, which causes a low-grade stress response, which can heighten your senses.
It’s All Under Your Nose
A chronically stuffy nose doesn’t happen by itself. Usually it’s part of a bigger picture, where the entire upper and lower jaws are more narrow and constricted, in addition to more narrow nasal cavities. I’ve described this process in my book, Sleep Interrupted, where due to modern human’s eating soft, mushy, processed foods, our jaws are much more narrow than normal, with dental crowding. Bottle-feeding, which is another modern, Western phenomenon, is also thought to aggravate this problem.
If you have a stuffy nose, it can also aggravate soft palate and tongue collapse when in deep sleep, due to muscle relaxation. With more obstruction, more stomach juices are suctioned up into the throat and nose, causing more swelling and more nasal congestion. All this from smaller and more narrow jaws.
March 20, 2015
A repost of an article on why your nose is stuffy this allergy season.
Although many people assume that big nosed people naturally breathe better, there’s nothing further from the truth. The shape and size of your nose is mostly cosmetic. How well you breathe actually depends on what your internal breathing passageways look like. And for many sleep apnea sufferers, a stuffy nose can make or break their treatment therapy.
Yet, opening up the nose through medical therapy or even surgery has been found to “cure” sleep apnea in only 10% of people. Patients will definitely feel and breathe better, but it’s unlikely that their sleep apnea is addressed definitively. However, I have seen many of the people in the “10%” group derive significant benefits from clearing up their nasal congestion. Besides breathing better for the first time in years, opening up the nose can allow the person to tolerate and benefit from other treatment options for OSA besides CPAP.
Why Is My Nose Stuffy?
Problem #1: Deviated Nasal Septum
One of the more common reasons for a stuffy nose is due to a deviated nasal septum. A “septum” is a term that describes a structure that acts as a wall or separator between two cavities. Your heart has one too. No one has a perfectly flat or straight septum.
All septums, by definition, have slight irregularities or curvatures. A major reason for a crooked septum, unbeknownst to many people, even other doctors, is because your jaw never developed fully. Most people with sleep apnea have narrow upper jaws, which pushes up the roof of your mouth into your nasal cavity, which causes your septum to buckle.
If medical options don’t help you to breathe better through your nose, then you may be a candidate for a septoplasty. To get a much more detailed explanation about this procedure see the accompanying article, Myth and Truths About Septoplasty.
Problem #2. Flimsy Nostrils
In some people, the space between the nasal septum and the soft part of both nostrils is either too narrow to begin with, or they collapse partially or completely during inspiration. In many cases, this can be seen years after reduction rhinoplasty, where the nose was made smaller or narrowed for cosmetic reasons. Occasionally, people can have naturally thin and floppy nostrils.
Another common reason for flimsy nostrils is due to a narrow upper jaw. The width of your nose follows the width of your jaw. If the angle between the midline septum and the nostril sidewall is more narrow than normal, then it’s more likely to collapse with any degree of internal nasal congestion. It’s not surprising that people with sleep-breathing disorders will typically have narrower jaws, and thus more susceptible to nostril collapse. Certain ethnicities are also more prone to this phenomenon than others.
One way that you can easily tell if you have this problem is to perform the Cottle maneuver: Place both index fingers on your face just beside your nostrils. While pressing firmly against your face and simultaneously pulling the skin next to the nostril apart towards the outer corners of your eyes, breathe in quickly. Then let go and breathe in again. If there is a major improvement in your quality of breathing while performing this maneuver, then you have what’s called nasal valve collapse.
The simplest way of correcting nasal valve collapse is by using nasal dilator strips, or Breathe-Rite® strips. If you do the Cottle maneuver and there is no significant difference in your breathing, don’t waste money buying these strips. If you perceive an improvement in your breathing, you can continue using the strips at night while you sleep. For some people, these “strips” are not strong enough to hold up the nostrils, or may cause irritation to the skin.
There are also many other “internal” options available over the counter, including metal springs or plastic cones that are placed inside the nostrils. People tolerate these particular devices differently, so the only way to know if you’ll like them is to try them. Three examples are Breathe With EEZ, Nozovent, and Sinus Cones.
To find out if your nasal valve collapse is from weak or flimsy cartilages or is aggravated by internal nasal congestion, you can spray nasal saline (which is a mild decongestant) into your nose. If your nostrils doesn’t collapse as much, then you need to address your internal nasal congestion first. A stronger over-the-counter medication that you can use is oxymetazoline, which is a topical spray decongestant. There are many brand name and generic versions that are sold that contain this ingredient. It’s very important that you don’t use this medication for more than two to three days—otherwise, you may get addicted to it.
If you want a permanent solution to this problem without having to use dilator strips or internal devices, the only option is surgery. The traditional way of dealing with this issue is to perform a kind of reconstructive rhinoplasty surgery, usually by taking small portions of your nasal septal cartilage or ear cartilage and placing in underneath the weakened portions of your nostril walls. A newer, simpler way of addressing this problem is by attaching a permanent suture just underneath the eye socket and tunneling the suture under the skin and looping it around the weakened area to suspend the nostril to prevent collapse.
Problem #3: Wings in Your Nose
Another common source of nasal congestion is from swelling of your nasal turbinates, which are the wing-like structures on the side-walls of the nasal cavity opposite the septum. Turbinates are comprised of bone on the inside and mucous membrane on the out- side. The area just underneath the mucous membrane is filled with blood vessels which can swell significantly. As the turbinates swell due to allergies, colds, or weather changes, the air passageways narrow further, especially if you have a mildly deviated nasal septum, and particularly if you have nasal valve collapse.
One of the most common misunderstandings that I see by both doctors and patients alike is that they think that swollen turbinates are polyps. The nasal turbinates can swell so much that you can sometimes see the reddish-pink, fleshy grape-like mass through your nostrils. Once decongested, they shrink dramatically and the air passageways open up again.
If conservative treatment including prescription allergy medications don’t work, various surgical options are available from very conservative 5 minute in-office procedures to more aggressive procedures that are performed in the operating room. These procedures are usually performed alongside a septoplasty to improve nasal breathing.
Problem #4: Sinusitis
If you suffer from sinusitis, this can cause nasal congestion and inflammation combined with post-nasal drip, sinus pressure, and pain. Put simply, pure misery. Sinus infections typically follow either a routine cold or allergy attack; they cause both swelling and blockage of the sinus passageways, leading to negative pressure initially and, if allowed to progress, can turn into a full-blown sinus infection, with yellow-green discharge, fever and severe facial pain. Your teeth can also hurt since the roots of the upper molars jut up into the floor of the maxillary sinuses. Similarly, dental pain can sometimes feel like sinus pain.
Fortunately, most cases of sinus congestion will eventually go away. The body has a remarkable ability to take care of these issues without any intervention. Sometimes bacterial infections occur, and with proper conservative treatment using saline and decongestants, the infection gradually resolves. Rarely, you may need an antibiotic to control stubborn bacterial infections.
Problem #5: Poor Sleep
As you can see from the above discussion, there are a number of various reasons for having a stuffy nose. But the most common reason for nasal congestion that I see routinely is due to inefficient breathing and poor sleep. This is why sleep apnea sufferers, more often than not, suffer relentlessly from nasal congestion.
Without a doubt, structural reasons like allergies or nasal polyps can definitely block your nose and these issues must be dealt with appropriately. But in general, it’s the inflammation that’s created by a combination of your hypersensitive nasal nervous system and possible stomach acid regurgitation into the nose from multiple obstructions and arousals, that causes nasal congestion. Without addressing this underlying source of inflammation, correcting a deviated nasal septum or treating for nasal allergies will only provide a temporary solution.
March 3, 2015
My monthly Ask Dr. Park Teleseminars in years past were very popular with many of you. It was also a way for me to understand the frustrations and pains for those of you with obstructive sleep apnea. I truly enjoyed the live Q&A format, but due to recent time constraints from my new academic position, I’ve had to transition my telesemianrs to pre-recorded podcasts. My recent 3-part podcast series on Vitamin D and sleep with Dr. Stasha Gominak was extremely well-received, with well over 2000 downloads so far.
As a way of connecting with you again, I’ve decided to re-launch my Ask Dr. Park series, but in a different format. Submit your one question in the text field below, and I’ll try to answer as many as I can. I will then select a handful of questions to answer on an upcoming Ask Dr. Park podcast. If possible, please state at least your first name, where you live, and a brief question. I’ll try to choose questions that can help as many people as possible.
Please enter your question for Dr. Park below.
February 25, 2015
- How to optimize growth hormone release
The link between slow wave sleep and the B vitamins
How this b vitamin can help REM behavior disorder
How much Vit D is made in your skin by sunlight
Vitamin D’s anti-cancer properties
The importance of quality sleep and cancer prevention
Download MP3 audio file
NY Time article on Meditation for a Good Night’s Sleep.
February 19, 2015
This is Part 2 of my interview with Dr. Stasha Gominak, a neurologist practicing in Tyler, Texas. Dr. Gominak has unique views on how Vitamin D can significantly affect the quality of your sleep, independent of obstructive sleep apnea or upper airway resistance syndrome. In this intervew, she will reveal:
February 11, 2015
This is Part 1 of my interview with Dr. Stasha Gominak, a neurologist practicing in Tyler, Texas. Dr. Gominak has unique views on how Vitamin D can significantly affect the quality of your sleep, independent of obstructive sleep apnea or upper airway resistance syndrome. In this intervew, she will reveal:
January 21, 2015
January 15, 2015
January 2, 2015
Now that it’s the day after New Years, many of you likely made a resolution to lose weight. I’m not going to go into any detail about what you should eat or how you should exercise, since that’s not my area of expertise. What I can say is that poor sleep in general will promote weight gain. It’s also known that sleep deprivation will cause cravings for sugary, starchy, salty and fatty foods. Gaining weight will promote obstructive sleep apnea. Lack of energy and exercise will further enhance more weight gain, and the vicious cycle continues.
However, one important aspect of weight gain (or not being able to lose weight) is the importance of prescription medications. I wrote a post a few months ago on 7 common prescription medications that can cause weight gain. I think it’s important to take a look at it again. Check to see if any of the medications that you’re taking is on this list.
If you’ve gained significant weight since taking any of these medications, please tell me your story in the comments section below.
December 31, 2014
Today, I had good news and bad news for Anna, a 28 year old patient regarding her sleep study results. The good news was that she didn’t have obstructive sleep apnea. The bad news was that she stopped breathing 15 times every hour. More bad news: She woke from deep to light sleep 25 times every hour over the course of the entire 7 hours. Lastly, some good news: She has a treatable condition called upper airway resistance syndrome.
Most sleep physicians think of upper airway resistance syndrome (UARS) as a wastebasket diagnosis when you don’t officially have OSA, despite having many of the symptoms of OSA including severe fatigue, unrefreshing sleep, and brain impairment. Snoring is also sometimes lumped into UARS. But when questioned about what can be done, most will tell you the standard sleep hygiene list of bullet points: lose weight, don’t watch TV before bedtime, don’t eat late, and various other important things that everyone must do, even if you don’t have sleep apnea or UARS. Since most people with UARS are not overweight, it’s hard for some doctors to believe that you can have a sleep-breathing problem, especially if your official score on the sleep study is 0.
The problem is that you need at least 5 apneas or hypopneas per hour (AHI) to qualify for a sleep apnea diagnosis based on a sleep study. By definition, apneas are total breathing pauses for more than 10 seconds. Hypopnea are more than 30% obstructed breathing for more than 10 seconds. The total number of apneas and hypopnea per hour is how the AHI is calculated.
But if you stop breathing 25 times every hour, and each episode is anywhere from 1 to 9 seconds, then your AHI will be 0. This was the case for Anna, the woman I saw today. Not having a sleep apnea diagnosis means that you won’t be covered for sleep apnea treatment options by your insurance company—even if you stop breathing 25 times every hour.
Anna’s main complaints were blamed on anemia by her doctors. However, anemia alone can’t explain her daily headaches, anxiety, lightheadedness and dizziness, lower blood pressure, and intense fatigue, no matter how long she sleeps.
Interestingly, she told me that her symptoms got much worse 3 weeks ago when she began to sleep on her back, when she used to sleep on her tummy. When asked what prompted her to make the change, she commented that her dermatologist recommended staying off her tummy since it can cause facial wrinkles. Not too surprisingly, having her switch back to her tummy improved her symptoms back to baseline again.
Most people with UARS have very narrowed jaws and upper airways, rather than being overweight. Due to severe dental crowding, gravity, and muscle relaxation in deep levels of sleep, the tongue, soft palate, or even the epiglottis will fall back and cause you to wake up suddenly, long before the 10 second apnea threshold. In a nutshell, once you obstruct, sleep apnea patients take too long to wake up, whereas UARS patients wake up too quickly. Because the pauses are so short, you won’t have any significant levels of oxygen deprivation.
The problem with so many frequent obstructions and arousals is that your sleep is severely fragmented. You may get the normal amount of deep sleep, but if it’s fragmented, it’s like not getting any deep sleep at all. Not getting deep sleep will cause you to have problems with memory, executive function, and no energy to do anything at all.
One interesting consequence of UARS is how your heart responds to repeated obstructions. Every time you obstruct, tremendous vacuum forces are created in your chest cavity. This causes your heart muscle to becomes stretched, and your body thinks that there’s too much fluid. The heart then makes a hormone called atrial natriuretic peptide (ANP), which goes to your kidneys to make you produce more urine than usual. This is one of many factors that can cause people with sleep-related breathing disorders to go to the bathroom at night. Usually, you’ll wake up a the same time intervals, about 90 to 120 minutes apart, which happens to be one sleep cycle. Every time you go into deeper levels of sleep, due to muscle relaxation in your throat, you’ll have a more severe obstruction and arousal, and you’ll think you have to go to the bathroom. But oftentimes, it’s not a lot of urine.
Other interesting properties of ANP include low blood pressure, weight loss, digestive problems, low magnesium levels, anemia, and neuro-excitability. Essentially, your entire nervous system is overactive, especially to emotions, weather changes, smoke, chemical, and odors. It’s estimated that about 5 to 10% of people with UARS progress to OSA every year, especially if you gain weight. I often see overweight, snoring women in their 50 and 60s who have high blood pressure, with classic OSA, but when in their 20s, were stick thin and with low blood pressure. Even the cold hands and feet that they had when younger tends to go away after menopause.
Now that you’re more familiar with UARS, you may be asking what you can do about it. In general, you have to treat it just like for obstructive sleep apnea. The challenge is that since insurance won’t pay for treatment, you’ll have to pay for a CPAP machine or dental appliance. I’ve covered OSA treatment options in great detail in other articles, teleseminars and my book, starting with conservative options to standard devices and gadgets, dental appliances, and lastly, surgical options. However, for nasal congestion, it’s generally covered, since that’s a different diagnosis.
Most people with undiagnosed UARS can’t be helped by traditional medical options. Oftentimes, you may be diagnosed with anemia, hypothyroidism, anxiety, depression, headaches, irritable bowel syndrome, nutritional or vitamin deficiencies, allergies, for even food sensitivities. I have had every one of these conditions resolve partially or completely when UARS is addressed fully. Some do well with only lifestyle adjustments like not eating late and using Breathe Right Strips. Others do well with CPAP or a mandibular advancement device. Some need aggressive surgery to feel relief. Unfortunately, not too many people ever end up going up the ladder for UARS treatment, since it takes time, resources and having access to the right health care practitioners that are even aware that this exists.
By now, you’re probably more knowledgeable about UARS than most physicians in this country. Hopefully, you can use this information to search out the root cause of many of your symptoms, which is an extremely narrowed airway preventing you from getting deep sleep.
If you have some, or even all of the symptoms of UARS, which options have worked for you? How did your doctor respond to your concerns? Please enter your responses in the text area below.
I interviewed two of the foremost sleep physicians on UARS in my past teleseminars: Drs. Barry Krakow and Avram Gold. Click here to go to iTunes podcast page. Search for Episodes 27 and 31. After listening, please subscribe and rate my podcast. The more feedback you give me and topics that you want to hear about, the more programs I can develop to address your particular needs.