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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?

Q: Severe OSA or UARS?

Q:
Hello Dr. Park,
 
I am a 24 year old male and have been suffering from moderate-severe sleep problems for at least 7 years now.  For as long as I can remember, I have had issues waking up in the morning.  No matter how hard I try or what methods are used, I couldn’t get up when desired.  In the past 2 years I have noticed a big decrease in my level of energy.  Oftentimes I feel fatigued to the point where my day is compromised. 
 
In early April I had a sleep study performed which found that I had severe OSA.  Apparently I stopped breathing up to 85 times an hour when I was on my back, which was slightly worse than when I was on my side or stomach.  I have been using the CPAP for almost 2 months now and honestly don’t feel that much better.  I would say that it is a little easier to wake-up in the morning, but that’s about it.  I still suffer from fatigue and lack of energy throughout the day.  My doctor is saying that the CPAP has returned my AHI to normal levels, but I am not noticing the difference.
 
In my attempt to locate more information, I came across your journal entry “Tired of Being Tired” to learn more about UARS.  My main question, is how possible is it that I have a moderate-severe OSA as well as UARS?
 
I greatly appreciate your assistance and service and wish you the best!

JPBESpoke

A:  Sorry to hear about all that you’re going through. It must be frustrating. If you’re using CPAP regularly and have data from the machine that confirms it (good compliance and no leaks with minimal AHIs), then the best thing to do is to be patient. You’ve had this condition for years, and sometimes it can take months (sometimes 6-12) to begin to feel better.

It does sound like you do have upper airway resistance syndrome, but you also have severe obstructive sleep apnea. What I see is that some people with UARS go on to develop what may look like chronic fatigue syndrome. Your involuntary nervous system is severely unbalanced, and you have to give it time to come back into alignment. Your situation is complicated and and endoscopic exam will only confirm what you already know. But it’s probably a good idea to take one look to make sure there’s nothing else that’s going on.  By definition, you’re susceptible to any of the somatic syndromes, since these are intimately linked to sleep-breathing problems.

There are also many studies that show that people with untreated obstructive sleep apnea have significant brain abnormalities with various degrees of injury. Years of hypoxia can cause temporary or permanent injury. You can imagine how multiple areas of damage throughout the brain can give various signs or symptoms such as chronic fatigue, numbness, hormonal imbalances, etc. This is not proven as of yet, but if you look at all the research in this area, it’s a reasonable explanation. This is why sometimes it can take months or over a year to begin to feel better.

Manhattan AWAKE Group Re-awakens After 5 Years

When Exercise Becomes Hazardous To Your Health

As the obesity numbers keep climbing, everyone wants to eat less and to exercise more. This is great if you’re able to exercise moderation and common sense. But if you’re already sick and your frame of reference is unhealthy to begin with, it’s difficult to know when enough is enough. 

Just as those with anorexia diet excessively to cover up their faulty body image, some people with sleep breathing problems like upper airway resistance syndrome (UARS), or obstructive sleep apnea (OSA), abuse exercise as a means to cope with the lethargy created by their chronic sleep deprivation.

Addicted to Exercise

A lot of patients I see with UARS and OSA become exercise junkies in the same way that people who don’t sleep enough become coffee addicts. Rather than consume substances to give them a "high", these exercise addicts crave the endorphin fix they get while working out to overcome the constant fatigue they feel from not getting the quality sleep they need. Many of them admit that If they miss even one day of working out, they’ll get agitated, moody, and sometimes downright catatonic. 

For these people, exercise or any physical activity is a coping mechanism for the constant energy drain they feel. The problem is, like any drug, too much exercise, if it’s used to deter them from taking care of their underlying sleep breathing problem, will manifest later into health complications that no amount of exercise may be able to cure. 

What’s Your Sleep Position?

Obviously, not everyone who exercise excessively do so to compensate for an underlying sleep breathing problem. One quick and simple way I use to discern who is and who is not susceptible to having a sleep breathing problem is to ask whether or not they can or like to sleep on their backs. You see, those with sleep breathing problems can only sleep on their sides or more commonly their stomachs. The reason being, that they’ll have difficulty breathing when they’re sleeping otherwise. 

To summarize, my sleep-breathing paradigm proposes that all modern humans have difficulty breathing at night to various degrees due to our unique upper airway anatomy. The voice box is located underneath the tongue, as opposed to animals, where the voice box is located behind the tongue. This location of the voice box under the tongue is necessary for complex speech and language. But this is also what makes our airway vulnerable and unprotected, making us more prone to having the various breathing and swallowing problems that we, as modern humans have. 

What’s worse, it’s thought that due to a radical change in our diets (highly processed foods and refined sugars) over the past century, our jaws are getting narrower and we have more dental crowding. Furthermore, dentists have stated that introduction of bottle-feeding to infants can aggravate dental crowding and malocclusion, which makes everything much worse. All these factors aren’t the only reason for everyone’s sleep problems, but they are problematic if your anatomy is already predisposed. 

So what does breathing have to do with sleep quality? There are two components to this issue: When lying flat on your back, your tongue falls back partially, due to gravity. This narrows the breathing passageway behind your tongue to various degrees. As you fall asleep, the deeper level of sleep you enter, the more your muscles relax, and at a certain point, your tongue can fall back and obstruct your breathing. The more narrow your airway (due to smaller jaws or inflammation due to a cold or allergies), the more likely you’ll stop breathing and wake up to turn over. When you were young, you tossed and turned and eventually figured out that you can sleep much better when sleeping on your side or stomach. The problem is that even on your side or stomach, it’s never perfect, and you’re not able to get deep, efficient sleep, no matter how long you sleep.

Sleep Among Athletes

It’s also not too surprising that many personal trainers and fitness professionals have very similar features: Almost invariably they prefer to sleep only on their sides or stomachs. The same can be said about bodybuilders—a personal trainer/natural body builder friend of mine told me that almost every one in her gym snores. Snoring, incidentally, is a very common trait amongst those who have OSA or UARS. 

Professional football players also have a much higher incidence of obstructive sleep apnea. About 1/3 of all linemen were found to have mild or moderate sleep apnea. Many people assume that this is due to the abnormally thick necks that many football players have. However, it’s not only the fat in the neck—it’s also the muscle mass that impinges on the soft tissues of the upper airway. So in theory, the more muscle bulk you have in your neck, the more breathing problems you’ll have while sleeping, and therefore more fatigue to cope with. This in turn, makes you work all that much harder than let’s say, someone else who may not be sleep deprived, to get the same level of intensity.  It’s hard to say which came first, the sleep breathing problem, or the intense work outs, but once it’s started, it ends up being a self-perpetuating vicious cycle. 

Sleeplessness Can Aggravate Injuries

As a long time track and field enthusiast, I know how important it is to eat right and exercise–especially as you get older. Running helped invigorate me after being cloistered for days studying for finals during medical school, and it still helps me maintain my health while balancing the demands of my work and family. Yet, there are times when I’ve let the running take control. This often happens when I’m outpaced by someone in my age group, or when I’m coping with a stressful event. During these times, I’d often train to the point of illness or injury—at which point, I’m temporarily unable to do the one thing that keeps me healthy and sane.

In this way, if you’re an exercise junky, you’re also more prone to having injuries. It’s like that saying: "The higher you climb, the harder you fall." Unfortunately, once injured, it becomes all that much harder to gain the momentum back. What often occurs is common trap for any athlete but much worse if you have UARS or OSA. The sudden lack of activity can cause you to eat more due to increased levels of stress from increased sleep deprivation. As you gain weight, your upper airway narrows even further, leading to worse deep sleep quality. Another scenario that can happen is if you injure your neck or shoulder. This will prevent you from being able to sleep on your side or stomach, which again, aggravates the vicious cycle.

What I just described may seem a little far fetched, but if you are prone to constant fatigue, snore, or have any other chronic health problems like chronic sinusitis, nasal congestion, throat problems, then the sleep breathing paradigm can potentially explain and help you avoid the various health complications you may experience down the road. One way to see where you’re headed is to look at your parents. More often than not, one or both your parents may snore heavily, and in many cases will have one or more of the complications of untreated obstructive sleep apnea: depression, anxiety, diabetes, hypertension, heart disease, heart attack or stroke. 

The best way for you to stay healthy and fit is to eat well, exercise, and most importantly, to sleep better.
 
 

Ask Dr. Park – A Live Teleconference

Join me on the next "Ask Dr. Park" call.  We’ll talk about lots of things, but the focus of this teleseminar will be sleep apnea. Everything about the quality of your sleep will be discussed: from tips on improving your sleep quality to a discussion on the best treatments for OSA. And, you get to set the actual agenda! I would like to hear from YOU about what your biggest questions and topic areas of concern are. The aim is to arm you with lots of information about sleep apnea that you want to know. This is a rare treat for any of you or your loved ones who suffer from sleep apnea.

This event will be held live on 5/12 at 8PM Eastern. You’ll be able to either call in using your telephone line, or listen in on your computer’s browser. You can ask your question during registration or during the call. 

Click here to register and receive the call-in information.

 

Can A Sleep Problem Give You Alzheimer’s?

There’s been a lot of press recently about the side affects that poor sleep quality has on our cognitive functioning not to mention what it means for those who suffer from neurological problems like Alzheimers.

This month, our expert article is contributed by noted neurologist and author of Deadly Sleep, Dr. Mack Jones, who explains the reason why he thinks everyone who has Alzheimers or is at risk for this problem should get tested for a sleep breathing problem like OSA.

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 Is it possible that Obstructive Sleep Apnea (OSA) causes Alzheimer’s Disease (AD)? I believe so. As a retired clinical neurologist and former patient with Obstructive Sleep Apnea, I have a special interest in sleep disorders medicine. I am thoroughly convinced of the connection between OSA and AD and will remain so until credible studies prove otherwise. Numerous short term studies have been done on cognition (mental processes) and sleep or the lack thereof, but there are few or no long term studies to determine OSA’s relationship to Alzheimer’s Disease (AD) and/or the other dementias.

Many polysomnograms (PSGs) or in lab sleep tests have been done on patients with AD revealing an incidence of OSA of up to seventy to ninety percent.  The assumption has been that AD causes OSA, or they just happened to coincide, but I contend that OSA is the cause of AD.

There are no studies that either prove or disprove my hypothesis that long standing undiagnosed OSA is a cause of AD, but evidence is accumulating. For example, OSA is a recognized risk for Type 2 Diabetes. In the April 2008 issue of The Archives of Neurology, type 2 Diabetics had an increased risk or developing Mild Cognitive Impairment (MCI)(1) which is the earliest stage of dementia.  Fifty to sixty percent of patients with MCI progress to AD at rate of twelve percent per year.
 
Additionally, OSA is a known risk for the development of high blood pressure.  Like patients with Type 2 diabetes, those with high blood pressure were also found to have an increased risk of developing MCI.(2)  Since the majority of patients with MCI eventually progress to Alzheimer’s Disease at a rate of approximately twelve percent per year, then it’s not a stretch to conclude that OSA is a cause of Alzheimer’s Disease.
 
In 2006 a study in the Proceedings of the National Academy of Sciences showed low brain oxygen (hypoxia) raises Alzheimer’s risk in the mouse brain with a genetic susceptibility.(3) A group of mice with an Alzheimer’s gene were given a maze test in which they all performed normally. They were separated into two groups, one exposed to 16 hours of a reduced oxygen environment (hypoxia) daily for several weeks; the other group in a normal environment.

The maze test was repeated and revealed the hypoxic mice performed poorly, whereas the control groups performance remained normal as before. All the mice were sacrificed and their brains examined under the microscope. Plaques and neurofibrillary tangles typical of Alzheimer’s Disease were present in the hypoxic mouse brain specimens, whereas the controls were normal. According to investigators, the study suggests that preventing brain hypoxia (as occurs in OSA) may reduce the risk of developing Alzheimer’s Disease.
 
Reported in the June 27th issue of Neuroscience Letters, sleep apnea patients have shrunken brain structures called “mammillary bodies” involved in memory according to Rajesh Kumar, PhD and colleagues from the University of California at Los Angles (UCLA).  High resolution MRI brain scans revealed mammillary bodies to be twenty percent smaller in patients with sleep apnea than in normals.  “These findings are important because patients suffering from memory loss from other symptoms, such as alcoholism or Alzheimer’s Disease, also show shrunken mammillary bodies,” Dr. Kumar said in a press release.
 
A recent study form San Diego showed that Sleep Disordered Breathing, including OSA, is and important risk factor for cognitive impairment in older women. (4)

Neuroimaging studies have been performed on patients with OSA including CT, MRI. PET and SPECT scans, revealing a variety of defects, but none has displayed anything quiet as dramatic as in a study published in SLEEP July7, 2008, by Dr. Paul M. Macey et al. (5)  The report reveals results of a new MRI technology called DTI (Diffusion Tensor Imaging). It is an extremely sensitive method of determining damaged nerve fibers (axons). This new imaging technique reveals multiple areas of brain damage in OSA patients not known to exist until now. DTI revealed various sized color-coded yellow-orange patches of brain damage scattered throughout the brains of a group of forty-one men and women subjects with OSA. Their ages ranged from thirty-eight to fifty two years old and they had not yet been treated. The areas of nerve fiber injury were wide-spread, located in critical regions of brain including prefrontal, temporal and parietal lobes. The cerebellum and brainstem were equally involved. This is the first report of DTI imaging of a group with OSA to my knowledge. The findings have far-reaching implications.

One can anticipate finding even more areas of damage in an older population as studies are done. What problems result from each one of these areas of brain damage?  It is possible that they are responsible for difficulties with cognition, mood, behavior, memory, heart regulation, high blood pressure, breathing control, fear, anxiety and other emotional disorders including depression? Those findings are yet to be reported. Could this brain damage eventually accumulate enough to cause Alzheimer’s Disease and/or the other dementias? 

The structural changes likely represent accumulated damage over sustained periods of time.  Are they permanent or do they improve or disappear with treatment?  No one knows yet, but my guess is they may improve to some degree or even resolve with treatment, but we will have to wait and see.
 
The implications of these findings are profound. Early treatment of OSA could potentially prevent the development of Alzheimer’s Disease. Now is the time to wake up the public and our snoozing medical community and put an end to this disease.

References:

1. José A. Luchsinger, M.D. et al, Relation of Diabetes to Mild Cognitive Impairment, Arch Neurol. 2007; 64 (4):570-575.
2. Christine Reitz, M.D. PhD, et.al. Hypertension and the Risk of Mild Cognitive Impairment:, Arch Neurol. 2007; 64(12):1734-1740.
3. Xiulian Sun, et al, Hypoxia Facilitates Alzheimer’s Disease Pathogenesis By Up Regulating BACE1 Gene Expression. PNAS (Proceedings of the National Academy of
Sciences) 2006 | vol.103 | no. 49 |18727-18732
4. Adam P. Spira, et al, Disordered Breathing and Cognition in Older Women: Journal of the American Geriatrics Society. Volume 56, issue 1, January 2008, 45-50.
5. Paul M. Macey, et al, “Brain Structural Changes in Obstructive Sleep Apnea," SLEEP vol.32, Number July 7, 2008, 913-1056.

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After surviving his four year ordeal in search for a cure of his own sleep apnea, Dr. Mack Jones, a clinical neurologist, felt a need to pass on to others what he learned first-hand as a patient, so that you might avoid the pitfalls he encountered and possibly save your own life or the lives of your loved ones. Dr. Jones in his book, Deadly Sleep, expected publication date, June of 2009, discusses how this common sleep disorder is a likely cause of Alzheimer’s and possibly a host of other life threatening neurological diseases that may have been plaguing us for hundreds if not thousands of years. He can be contacted via e-mail by clicking here.
 

Multiple Sclerosis And Obstructive Sleep Apnea: Is There A Link?

I participate on a medical forum called Medhelp.org, where I’m the sleep-breathing expert. I answer people’s questions on various topics related to sleep and breathing. Somehow, I stumbled onto the multiple sclerosis (MS) community and was surprised to see that many people have severe fatigue issues, cold hands and various sleep issues. Their symptoms sounded surprisingly like upper airway resistance syndrome, which I’ve described before. So I decided to take a poll: I asked three questions: 1. How many MS patients have cold hands or feet? 2. How many MS patients have one or both parents that snore heavily, and if so, what kind of medical problems do they have? And 3. What’s your favorite sleep position (back, side, or stomach)?

The answers to this informal and unscientific poll was surprisingly lopsided. Out of 36 responses, 31 people said that they had either cold hands or feet. Many had to wear socks before going to bed, but some had to kick them off later. Fifteen out of sixteen stated that a parent (usually their father) snored heavily, and many also had major heart disease. Lastly, 26/30 responded that they prefer to sleep on their sides or stomachs. Many complained of intense fatigue.

This is the exact pattern that I see in patients with upper airway resistance syndrome, where they also have cold hands or feet, has a parent that snores, and wears mittens and socks to bed. Typically one or both parents snore, and have various degrees of heart disease. As many people with UARS slowly gain weight over the years, their cold hands may get better, but they’ll slowly develop into obstructive sleep apnea.

It’s a given that both UARS and MS will have a physiologic stress response, for different reasons. This can lead to various autonomic nervous system dysfunctions, such as cold hands or feet. It’s also known that chronic low-grade physiologic stress can stimulate the immune as well as the nervous system, heightening both these systems, leading to various pain issues or autoimmune conditions. I can’t say if there’s a definite cause and effect relationship between UARS and MS, but one thing for sure is that both have problems staying in deep sleep. The only definitive way to find out is is examine these MS patients with a flexible fiberoptic camera to examine the airway.

Am I going too far with my sleep-breathing hypothesis, or could I be onto something big?

 

 

 

Is Insomnia Really A Sleep-Breathing Problem?

Sleep doctors have always thought of insomnia as a behavioral or stress aggravated issue, and the standard ways of treating this all-too-common condition is to either give sleeping pills or have the patient undergo cognitive behavioral therapy. However, a recent study directed by Dr. Barry Krakow at the Sleep and Human Health Institute is looking at the possibility that insomnia may actually be caused by a sleep-breathing problem, such as obstructive sleep apnea. 

 

If you’ve read my book, Sleep, Interrupted: A physician reveals the #1 reason why so many of us are sick and tired, I stated my opinion that in my experience, almost all people with insomnia have narrowed upper air passageways, especially behind the tongue. Some will have undiagnosed sleep apnea, but many will have instead something called upper airway resistance syndrome. This is a variation or precursor to sleep apnea where the length of time of each breathing pause is not long enough to be called an apnea. Because of the multiple pauses in breathing in deep sleep, a low-grade stress response is created which causes the insomniac’s mind to race or think about stress-related issues before going to bed. Their nervous systems are edgy and en garde all the time. No wonder it’s hard to fall asleep, especially if you’ve had a stressful day.

 

I’ve also experienced multiple instances where treating an underlying sleep-breathing problem also significantly improves insomnia symptoms as well.

 

You may be asking by now, "why do sleeping pills or cognitive behavioral therapy work?" The older type sleep aids were generally tranquilizers and only helped to numb the nervous system so that you can fall asleep faster. But these medications did nothing to prevent the sleep-breathing pauses. The newer medications don’t have as much of the sedating properties, but it’s very controversial that they even make any significant difference. Although industry supported studies find significant  improvements in sleep scores using sleeping pills, non-industry supported studies show that these same sleeping pills only increase total sleep time by only 5-10 minutes. 

 

Cognitive behavioral therapy (CBT) is another underused option that has been shown to work much better than sleeping pills in general. CBT works by re-programming your thinking and behavior about sleep to promote good sleep hygiene and habits. 

 

CBT will work to some degree even if you have an underlying sleep-breathing problem because you’re addressing the physiologic stress-aggravting end result of the breathing problems that occur during sleep. Multiple micro-arousals from deep sleep to light sleep due to tongue muscle relaxation can definitely aggravate stress and anxiety problems.

 

This process also confirms other recent findings that report increased rates of depression and heart disease later in life in people with insomnia earlier on in life.

 

The main purpose of Dr. Krakow’s study tries to determine what percent of insomniacs have undiagnosed obstructive sleep apnea. Although not part of the study, it would be interesting to perform upper airway endoscopic exams like what I describe, to confirm what I describe in this post. 

 

Here’s my question to all insomniacs: Do you prefer to sleep on your back, side or stomach? If you prefer your side or stomach, there’s your answer.

Solutions For Your Biggest Holiday Health Risk

According to a study that looked at 53 million U.S. death certificates issued from 1973 to 2001, researchers found a significant overall increase (5%) in heart related deaths during the winter holiday season, with the highest number of cardiac deaths occurring on December 25, the second highest on December 26, and the third highest on January 1st.

In the medical journal Circulation, where this study was published, researchers cited cold temperatures, along with emotional stress and holiday overindulgence as possible triggers for this sudden peak in heart attacks. This may be true, but there’s still one other major factor that this and other studies like this overlook. And that is that anyone who suffers from a sleep-breathing problem like obstructive sleep apnea, may be more at risk during this time of the year especially if they’re not aware.

The Deadly Link Between Sleep Apnea and Heart Problems 

If you look at all the medical studies out there linking sleep apnea and high blood pressure, heart disease, and heart attacks, it seems almost implausible that anyone who’s at risk for heart problems, wouldn’t also know that they may also be suffering from a sleep-breathing problem.

However, 80-90% of people with obstructive sleep apnea or OSA in this country remain undiagnosed and therefore untreated. As I often reiterate to my patients, and expound in my recently released book, Sleep, Interrupted, OSA is a massive trigger for heart problems but many, including some physicians, may miss its severe implications–especially when so many other factors come in to play during the winter holiday season. 

According to one other research done on this subject, respiratory disease, which tends to rise and therefore weaken patients with heart problems, was thought to play a role in increasing cardiac arrests.

Some doctors also cite that frigid temperatures can aggravate heart problems since cold weather constricts blood vessels which in turn raises blood pressure and makes you more susceptible to blood clots. Add to this the sudden physical exertion of shoveling snow and it seems more than plausible that deaths by heart attacks would certainly peak during during these icy, snowy, blistery months. 

Yet studies show that even in Los Angeles, where the temperature is much more temperate, deaths by cardiac arrest peak during the holiday season. Therefore, factors like over-eating and heightened stress during the holiday season were also cited as possible causes along with people putting off seeking medical treatment as to not disrupt their holiday plans. The study also pointed out that the shortage of staffs at local hospitals during major holidays may contribute to this rise in heart related deaths as well.

Even though all these seasonal triggers are problematic for those with preexisting heart problems and should be addressed appropriately (like staying warm and avoiding strenuous activities), they nonetheless mislead patients and physicians alike to attend to the symptoms rather than the cause. 

Specifically if a patient has OSA and this is what’s aggravating or even causing his heart problem, taking care of their high blood pressure, or their respiratory problems with medications is like treating a bullet wound with a band aid. Sooner or later, undiagnosed and untreated sleep breathing problems can wreak more havoc on your health than any of these other factors combined. It may just be that the holiday season with all its manifold health risks are providing the right place at the right time for heart patients to feel the full effects of OSA.

But before I can explain how you can avoid being part of this grim statistic, an explanation of what obstructive sleep apnea is is in order.  

What is Obstructive Sleep Apnea? 

Obstructive sleep apnea (OSA) is a condition where a person, due to an obstruction in the airway, stops breathing anywhere from 50-200 times a night while sleeping. These obstructions occur as a cause of several factors, one of which is that the muscular structures surrounding airway can slacken and close off the airway resulting in a cessation of breath or "apneas."

Ceasing to breathe multiple times throughout the night leads to a number of different physiologic consequences. Periods of low oxygen levels (along with elevated carbon dioxide levels) triggers a stress response by activating blood gas level sensors in the body, which constricts blood vessels. During an apnea episode, tremendous vacuum pressures are created (up to -80 cm of water pressure), which prevents proper blood flow to the heart, which ultimately results in less blood being pumped out of the heart.

After the apnea ends, chest pressure returns to normal, and a sudden increase in blood flow through the heart along with constricted blood vessels can lead to a severe rise in blood pressure.

In effect, frequent arousals like these over many nights, and years can cause injury to the lining of the blood vessels, which can promote or aggravate heart disease. The elevated blood pressure can also carry over into the daytime where any acute external trigger, like emotional stress can further aggravate. Add to this the excess weight gain, along with more inactive time indoors during these cold winter months, and it’s just a massive coronary waiting to happen.

Some classic symptoms of OSA include daytime fatigue and drowsiness, snoring, frequent nighttime urination, and morning headaches. Unfortunately, most doctors still are taught that you must be an older, heavy-set, snoring man with a big neck to have sleep apnea. Yes, that’s true, but that’s the extreme end of the spectrum. We now know that even young, thin women who don’t snore can have significant sleep apnea.

(To find out if a sleep breathing problem may be making you sick take our free quiz )

Practical Solutions For An Impractical Season

If you suspect that you may have OSA, then the first thing you must do to protect yourself from impending heart problems is to get a formal sleep evaluation by a sleep medicine doctor as well as undergoing a formal overnight sleep study.

However, even if you don’t have sleep apnea, there are many common sense measures you can take to avoid the risk of heart problems or any number of health problems for that matter during this special time of the year. As I explain in my book, Sleep, Interrupted, everyone is susceptible to sleep breathing problems to some degree as a result of our unique airway anatomy. Consequently, any measures taken now to reduce or to allay this problem will allow you to enjoy a much healthier winter season.

Reduce nasal congestion: Any amount of nasal congestion can aggravate airway collapse, thereby causing more breathing cessations, frequent arousals, or overall inefficient sleep. Use lots of nasal saline irrigate your nose to keep your airway clear. Saline acts as a mild nasal decongestant. Allergies can aggravate nasal congestion, so you should take steps to reduce your exposure. Some people with flimsy nostrils that cave in when they breathe in may benefit from nasal dilator strips (Breathe-rite strips). For a detailed explanation on how to breathe better through your nose, read 7 Tips to Breathe Better Through Your Nose).

Maintain your normal sleep routine: As difficult as it may be, try to maintain your typical sleep-wake schedule. Sleeping too long or too little can definitely trigger sleep breathing problems since certain hormones and stress levels can be affected due to rapid changes in our sleep patterns.

Don’t eat late: Although it’s important to avoid overindulging this holiday (for help on how to eat healthy for the holidays read, 10 Tips For Healthy Holiday Eating), it’s also more imperative to eat about 3-4 hours PRIOR to going to bed. Stomach juices have been known to aggravate sinus problems and prevent restful sleep. 

Avoid alcohol before bedtime. Rather than eliminate spirits of any kind this season, avoid drinking 3-4 hours before you go to sleep. Alcohol relaxes your throat muscles and can aggravate obstruction while you breathe at night.

Slow down and take a deep breath. During these hectic and stressful times, many of us forget to pause and take breaks regularly in between our daily routines. Every few hours, when you’re transitioning from one major activity to another, stop everything you’re doing, sit down, and take 5-6 slow, deep breaths. Focus on the air as it moves through your nostrils, down the back of your throat, into your lungs, and back out again. If you do this regularly, what you’ll find is that not only will you feel less stressed, but you’re more productive and focused for the activities that you perform.

In addition to all the above measures, try to maintain your regular exercise routine along with a modest diet. More importantly, rather than take these suggestions as a moratorium on your holiday fun this season, consider it a life long policy to ensure many more future holidays in the years to come.

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Sources:

Cardiac Mortality Is Higher Around Christmas and New Year’s Than at Any Other Time: The Holidays as a Risk Factor for Death
David P. Phillips, Jason R. Jarvinen, Ian S. Abramson, and Rosalie R. Phillips
Circulation. 2004;110:3781-3788

The "Merry Christmas Coronary" and "Happy New Year Heart Attack" Phenomenon
Robert A. Kloner
Circulation 2004 110: 3744-3745.

 

 

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