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The Biggest Throat Problem for Sleep Apnea Sufferers

If you wake up every morning needing to hack up lots of thick mucous, or have throat pain, hoarseness, or a chronic cough, you’re not alone. You may think it’s the beginning of a cold, but a cold doesn’t continue for weeks to months without progressing into the full-blown viral symptoms.

Instead, these symptoms are the beginnings of the most common throat problem sleep apnea sufferers face. And as I explain below, without understanding why this occurs, it can be one of the hardest problems to treat.

Beware of the “Vacuum Effect”

People with obstructive sleep apnea are more prone to breathing problems at night due to partial or total collapse of one or more areas of the entire upper airway, from the nose to the tongue. It’s usually worse when on your back, since the tongue can fall back more in this position. During deep sleep, your muscles naturally relax and you’ll be more susceptible to breathing stoppages.

Pressure sensors placed inside sleep apnea patients reveal that every time an apnea occurs, a tremendous vacuum effect is created inside the chest and throat, which literally suctions up your normal stomach juices into your esophagus and throat. This can happen occasionally, even for normal people, but if you happen to have a late meal or a snack just before bedtime, there will be even more stomach juices lingering in your stomach to come up into the throat. If you happened to drink a nightcap, the situation is even worse since alcohol is a strong muscle relaxant.

What comes up into your throat is not only acid, but also bile, digestive enzymes, and even bacteria. Washings of lung, sinus and ear contents have shown H. pylori, a common stomach bacteria, and pepsin, a major stomach digestive enzyme. So what comes up can cause severe irritation in your throat, provoking the mucous secreting glands of your throat to try to dilute these substances.

Although people generally attribute throat mucous to post-nasal drip, in most cases there’s nothing dripping down the back of the throat. It’s actually coming from your stomach. However, in some cases, since your stomach juices can reach your nose, it can cause nasal congestion and inflammation, which can aggravate tongue and soft palate collapse by creating a vacuum effect downstream. Ultimately, it’s a vicious cycle.

Chronic acid and other irritating substances lingering in your throat can have other detrimental effects. One recent study showed that chronic acid exposure can numb or deaden the protective chemoreceptors in your throat. These are sensors that detect any acid in the throat to prevent aspiration of your stomach contents into your lungs. If these chemoreceptors sense any acid in your throat, a feedback signal is sent to the brain, causing you to wake up so that you can swallow. This is what’s called a reflux arousal.

Treating Reflux For Good

So besides not eating late and avoiding alcohol close to bedtime, what else can you do?

I’m assuming that many of you that are reading this article are already being treated for obstructive sleep apnea, via either CPAP, oral appliances, or even with surgery. The problem is that no matter which option you choose, there will always be some degree of reflux. Taking acid reflux medications can help sometimes, but for the most part, these reflux medications don’t really do anything for reflux. All they do is to lower the acid content content before it comes up into your throat.

Other options include stimulating your stomach via natural remedies or prescription medications to empty your stomach much faster. One fascinating study showed that using a combination of pseudoephedrine (Sudafed) and a pro-motility agent (domperidone) eliminated snoring in most people. Unfortunately, we don’t have the equivalent of domperidone here in the US. Other similar medications are available, but have more serious side effects.

This is why eating early at least 3-4 hours of bedtime is so important whether or not you have obstructive sleep apnea. The same also applies to alcohol. If your nose is stuffy, talk with your doctor to find a way to breathe better through your nose. Make sure you’re sleeping in your preferred or optimal sleep position. Lastly, work with your sleep physician to fully optimize your sleep apnea treatment, no matter which option you choose.

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?

Sleep Apnea And Pulmonary Embolism

Here's another link that solidifies the connections in my sleep-breathing paradigm: Researchers found that people who have pulmonary embolism (PE) have a much higher change of having undiagnosed obstructive sleep apnea. Pulmonary embolism is a condition where blood clots from your lower legs or other parts of your body travel into your lungs and get stuck, preventing you from breathing properly. In their study of hospitalized patients suspected of having pulmonary embolism, those that were found to have pulmonary embolism were more likely to snore (75% vs, 50%) and have obstructive sleep apnea (65% vs. 36%) compared with those that did not have pulmonary embolism. PE was found to be independently associated with the risk of obstructive sleep apnea (odds ratio = 2.78).

All this makes sense, since we know that obstructive sleep apnea creates conditions in your bloodstream that promotes stagnation, inflammation, and clotting. In addition, we also know that the blood itself in sleep apnea patients are much thicker (viscous), making it easier to clot when stagnant. 

With sleep apnea, there are various levels of potential clotting, from larger vessels like the carotid artery and deep veins in the legs, to to small vessels in the gut or in the brain. 

If you know anyone who suffered from a pulmonary embolus, does that person snore?

Ask Dr. Park: An Insider’s Guide To Sleep Apnea Surgery

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Missing The Boat With Stroke and Sleep Apnea

Here's another large scale population-based research study that completely misses the boat. The INTERSTROKE study compared 3000 people with stroke with 3000 controls across 22 countries. The researchers concluded that hypertension appeared to be the strongest predictor of stroke, with a 2.64 increased odds ratio. Other factors included smoking, abdominal obesity, diet, exercise, alcohol, diabetes, depression, heart disease, and lipid problems. They note that 1/2 of these are modifiable.

We know from numerous past studies that obstructive sleep apnea increases your risk of stroke up to 3 times normal. If they had included obstructive sleep apnea in their list of risk factors, it would be at #1. Obstructive sleep apnea is a treatable condition. Unfortunately, it's estimated that 90% of sleep apnea is not diagnosed. It's likely that these people are being treated instead for their hypertension, elevated lipids, depression, heart disease, etc.

What this study implies is that more medications are needed to control hypertension. But we also know that obstructive sleep apnea is a major independent predictor or hypertension as well. Some researchers are saying that perhaps untreated obstructive sleep apnea is THE major cause of hypertension.

 

Sleep Apnea, Restless Legs and Erectile Dysfunction

There are studies linking sleep apnea with restless leg syndrome (RLS) and sleep apnea with erectile dysfunction, but now there's a study linking restless leg syndrome with erectile dysfunction. Not too surprising, since sleep apnea seems to be the common denominator for almost every imaginable disease, known or unknown. You may think that this statement is over the top, but you'll have to admit that not breathing well during the day, and especially not breathing well at night while sleeping can potentially lead to or aggravate almost every disease known to man. 

 

In this particular study, researchers found that men with RLS  had significantly increased risk for having erectile dysfunction (ED) compared with men who did not have RLS. The lead researcher, Dr. Gao, commented that the findings indirectly support the role of dopamine as a common pathway, in light of another study of his in the past that showed an association between ED and Parkinson's disease. He also points out that these same people with ED were more overweight, more prone to depression and anxiety, and had a greater chance of having hypertension or a history of stroke (sound familiar?)

 

It sounds like dopamine deficiency is a popular explanation for a number of different conditions. For both PLS and Parkinson's, giving dopamine-like agents help with the respective symptoms. The problem is that it never cures the problem completely, with a number of serious side effects. 

 

This approach to medicine is the replenish what's missing method. If you're deficient in dopamine, replace it. If you're deficient in Vitamin C, B12, or thyroid hormone, replace it. The problem is that this approach works in some people, but not in everyone. Then the next step is to increase the dosage, and then even more people respond, but not everyone (with more side effects). Ultimately, you're not addressing what's causing the deficiency. 

 

If you have a sleep-breathing problem, it's been shown that you can easily clot in certain small and large vessels of your brain very easily. If you happen to have a clot in the dopamine area of your brain, or if the brain biochemistry changes as a result of hypoxia, then you'll get various symptoms. But I think even the neurologists will tell you that a lack of dopamine itself won't lead to Parkinsons; it's just one part of a much larger picture. Could it be that obstructive sleep apnea may be that bigger picture, since by definition, all modern humans are susceptible to sleep breathing problems to various degrees?

 

What's your opinion on this? Should we continue to treat every medical condition in isolation hoping to target that one missing protein or gene, or should we step back and try to connect the dots until we see the bigger picture? Please enter your comments in the box below.

Is the XMRV the True Cause Of Chronic Fatigue Syndrome?

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