Ask Dr. Park About Sleep About Sleep Apnea (11/8/11)

November 6, 2011

For this month’s Ask Dr. Park teleseminar, I answer the following questions:

1. Does sleeping with your head propped up help with sleep apnea?

2. Why is UARS so hard to define?

3. What do you think about all the latest publicity about thyroidectomy in helping with sleep apnea?

4. Can using tape over the mouth help with sleep apnea?

5. As we age how can we gauge whether we have sleep-related breathing issues, or circadian rhythm problems?

6. What if you are using a cpap machine and STILL wake up about every 2-3 hours?

7. How low should one seek to lower the AHI and the AI?

8. Is there a place for hyperbaric oxygen in the treatment of OSA?

9. Does a dental positioning device work for mild sleep apnea?

10. How does the future look for sleep apnea patients£ Will something replace CPAP as the gold standard?

11. Is there a clear distinction between central and obstructive sleep apnea? What are the alternatives if your apnea is primarily classified central?

12. If patient’s airway is examined with camera inserted through nose while patient is sitting upright and airway is found to be clear, is this enough to indicate airway would also be clear if patient was lying down? Should patients be checked in both positions?

And many more questions from the live audience.

Click here to purchase the MP3 recording ($17).

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Ask Dr. Park: Any Question About Sleep Apnea or UARS

August 4, 2011

In this Ask Dr. Park Teleseminar, I answer the following questions:

- Why don’t I feel better on CPAP?

- How long do I have to wait before feeling better on CPAP?

- What’s the best PAP machine for sleep apnea or UARS?

- What’s the difference between flow limitations and RERAs?

- What is the best surgical option for sleep apnea?

- Can nasal surgery cure sleep apnea?

- Is waking up early in the morning everyday around the same time an indication of sleep apnea?

- I was diagnosed with obstructive sleep apnea (AHI 36-40) but do not snore. Might this mean there is some other cause?

- Plus much more….

Click here to purchase and download your 60 minute MP3 file ($17)

Written by Steven Park · Filed Under Expert Interviews | 4 Comments

Expert Interview: Dr. Christian Guilleminault on UARS

July 21, 2011

This month, I interview Dr. Christian Guilleminault of Stanford University, who is one of the pioneers in sleep apnea diagnosis and treatment. We’re going to focus on Upper Airway Resistance Syndrome (UARS), which he discovered.

Here are some of the questions we covered:

- Describe to us what UARS is and how it’s different from OSA?

- Why is the AHI limited when it comes to picking up UARS.

- How to diagnose UARS: Esophageal manometry vs. nasal cannula.

- How UARS patients have intact nervous systems, whereas sleep apnea (OSA) patients have diminished nervous systems, and what may cause progression from UARS to OSA?

- How do you treat patients with UARS? How is it different from treating sleep apnea?

- What are the dental options for UARS?

- How common is UARS in children and how can they be treated?

- And much more…

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Ask Dr. Park Teleseminar (7/12/11)

June 28, 2011

In this month’s Ask Dr. Park Teleseminar (7/12/11), I answer the following questions:

• Can having a stuffy nose prevent CPAP use?

• What kind of surgical procedures for the nose can help me breathe better?

• Can Viagra make me sleep better if I have sleep apnea?

• What’s the best non-CPAP treatment for severe sleep apnea?

• Is the laser procedure for snoring or sleep apnea effective?

• How does the TAP oral appliance compare with CPAP?

• Can oral appliances be used to treat UARS?

• Is CPAP a commitment for life? Is it ever reversible without surgery?

• What’s the success rate for tongue reduction surgery?

• What can I do about my dry mouth when using CPAP?

• Can wearing a cervical collar help sleep apnea?

• How can air in the stomach due to CPAP be prevented?

• What’s the Pillar procedure?

• Plus many more questions….

Download the 60 minute MP3 recording ($17).

Written by Steven Park · Filed Under Expert Interviews | 2 Comments

The Connection Between MS And Fatigue

June 8, 2011

It’s a given that if you have multiple sclerosis (MS), you’ll be tired all the time. It’s thought to be a normal part of having this condition, just like many other chronic medical conditions. But here’s an interesting study that suggests that fatigue can precede MS by up to 3 years. The researchers found that many MS patients complained of fatigue to their doctors months or even years before the first clinical signs of MS.

Here’s my take on this: I’ve written in the past about how the vast majority of people with MS that I see in my office have small jaws and narrowed upper airway anatomy. In an informal poll I conducted on Medhelp.com’s MS forum, a very high number of people had an excessive number of dental extractions, couldn’t sleep on their backs, and many of their parents snored heavily. Having excessive dental extractions causes the oral cavity to become much smaller, making the tongue take up too much space.

I’m not discounting current thinking about the origins of MS, but it’s extremely interesting that most patients with MS have very narrowed upper airway breathing anatomy which prevents achieving deep sleep. Lack of quality deep sleep can lead to various neurologic, hormonal, metabolic and digestive problems. Many patients with MS also have obstructive sleep apnea, but most will most likely have upper airway resistance syndrome, which I’ve described extensively here and in my book.

For those of you who happen to have MS:

What’s your favorite sleep position (back, side or stomach)?
Did you have any teeth removed besides your wisdom teeth, and if so, which ones and how many?
Do either of your parents snore heavily?

Written by Steven Park · Filed Under Blog | 1 Comment

Ask Dr. Park Teleseminar on Obstructive Sleep Apnea (4/12/11)

March 23, 2011

In this month’s (April 12, 2011) Ask Dr. Park Teleseminar I answer your questions on anything related to obstructive sleep apnea:

1. Do UARS patients progress into obstructive sleep apnea?

2. Given how common sleep apnea is, why hasn’t universal screening been implemented?

3. Despite using CPAP 5 to 8 hours every night, why am I still tired?

4. What do you think about the Pillar implants for snoring and sleep apnea?

5. How do I know when I can come off my CPAP machine as my sleep apnea improves?

6. What comes first, depression or sleep apnea?

7. How do you know if your sleep apnea machine is set for you correctly for you?

8. What surgery is recommended for nasal congestion?

9. Is it possible to underdiagnose sleep apnea in a sleep study?

10. What tips do you have for us dentists regarding UARS?

11. Can nasal congestion alter other areas of the upper airway?

12. Do you do turbinate reduction with the microdebrider?

13. What is UARS?

14. How much does lack of understanding of OSA and its’ consequences play in poor compliance? Are sleep doctors to blame?

15. Where are the best doctors or medical centers to go to on the West coast for fibromyalgia and UARS?

16. Why not add a hyoid procedure to the UPPP?

17. Can white matter lesions on DTI scans be responsible for sleep apnea patients’ symptoms?

18. Can hyperbaric oxygen therapy have a role in treating complications of sleep apnea?

19. What is expiatory sleep apnea?

20. Is bi-level use becoming more common?

21. Does high altitude make sleep apnea worse?

22. Is it worth trying the oral appliance for sleep apnea?

23. Is there any connection between cervical stenosis and sleep apnea?

24. What’s an SV Unit?

Click here to order the MP3 recording ($17).

Click here to order the PDF transcript ($7).

Written by Steven Park · Filed Under Expert Interviews | 6 Comments

Tim Ferris, Michael Phelps, ADHD, & Sleep Apnea

March 21, 2011

I wrote in my last post about how creativity can be linked to ADHD, mainly due to inefficient sleep from breathing problems at night. ADHD can also be linked to tremendous achievements in sports or physical activities. People who don’t sleep efficiently will take measures during the day to compensate for their inability to stay focused or stay awake. Some people drink lots of coffee. Others exercise like crazy. Some even become olympic swimming or ballroom dancing champions.

I’ve written before about how Michael Phelps, the olympic swimming champion, has a major malocclusion, and seems to be a mouth breather. It’s well documented in the papers that he had ADHD as a child. Swimming is a great way to not only stay active, but also has a calming, relaxing property that’s almost like doing deep-breathing meditation exercises. Swimming forces you to take slow, rhythmic breaths. His mother has known hypertension, and being clearly overweight, it’s likely that she has obstructive sleep apnea. Many long distance runners feel alive only when they’re running. It’s shocking how often people who are addicted to endurance sports can’t or prefer not to sleep on their backs.

Even with Tim Ferris, best-selling author of The 4-Hour Work-Week, in his new book, The 4-Hour Body, he describes how he and his entire family have major insomnia. He even recommends sleeping on your stomach, which is what he most likely prefers due to his jaw anatomy. He’s excelled in almost every physical activity, from running to swimming, to body-buiding, and even ballroom dancing. I do enjoy reading his books, but I have to admit that his writing style is definitely scattered, in the stereotypical style that’s typical for ADHD.

Problems can arise if you get injured or are forced to sleep on your back for some reason (an injury or surgery). Poor sleep quality can promote rapid weight gain, and then it’s really difficult to take off, especially since you’re not sleeping well, and you’re not able to exercise at your normal levels. Time and time again, people with these issues tell me that they get really down and depressed even if they miss a few workouts.

I know many of you reading this have this condition. Do you agree or disagree?

Written by Steven Park · Filed Under Blog | 1 Comment

Viagra, Raynaud’s & Sleep Apnea

March 16, 2011

Viagra is still a popular drug that’s used to treat erectile dysfunction (ED) in men. It works by relaxing smooth muscle in blood vessels, allowing blood to enter the penis. A recent study showed that it can also help people with Raynaud’s phenomenon, where small blood vessels in the hands or feet go into spasm and cause cold or numb extremities, sometimes to the point of infection or even gangrene. This condition is commonly seen with autoimmune conditions, especially in lupus. It makes sense that relaxing smooth muscles that constrict blood vessels may increase circulation. Unfortunately, people taking this medication had a number of side effects.

In my book, Sleep, Interrupted, I describe a young woman who had classic Raynaud’s symptoms, needing to wear socks and mittens to bed even in the summer. After undergoing multilevel upper airway surgery for her mild obstructive sleep apnea, her Raynaud’s disappeared completely! Her depression, low blood pressure, irritable bowel symptoms, and daily headaches improved significantly as well.

There are also numerous studies showing the ED is a common complication of obstructive sleep apnea. One of the more common signs that sleep apnea treatment is working (through CPAP, dental devices or surgery) is that men are having erections again upon awakening in the morning. In many cases, ED resolves completely after sleep apnea treatment.

Not getting deep, high quality sleep is known to cause a physiologic state of stress, leading to too much of an adrenaline response. This results in an inability to relax vascular smooth muscles in various parts of the body, including the hands, as well as the digestive or reproductive organs.

If you have obstructive sleep apnea or upper airway resistance syndrome, it’s a given that your body will be under a constant state of stress. This why why after properly treating these conditions, ED and Raynaud’s often improve. These common conditions are not problems specific to the respective body parts—they are the end result of a systemic problem aggravated by not breathing and not sleeping properly.

These sleep-breathing problems are often treated successfully by alternative and complementary practitioners, since they tend to focus on the whole person, including his or her surroundings, rather than the one specific neurotransmitter, hormone, or body part.

However, taking a pill, whether it’s a prescription medication, vitamin or natural herb, or breathing exercises during the day, won’t solve the problem completely if you’re not able to breathe properly at night.

How many of you have had partial or total resolution of your ED or Raynaud’s after treating your sleep-breathing condition?

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Brain Damage in Chronic Fatigue Syndrome and Sleep Apnea

March 5, 2011

There are a lot of controversial theories about the origins of chronic fatigue syndrome (CFS), and even more recommendations on how it can be treated. One particular explanation is that people with CFS have some sort of brain dysfunction, which disrupts how it regulates the body’s nervous, metabolic, and hormonal systems. A recent study confirmed that white matter and grey matter volume was diminished in various parts of the brain and brainstem.

These findings are very similar to numerous studies showing that untreated obstructive sleep apnea can lead to brain volume loss or lower tissue density in various parts of the brain, including areas that control memory, executive function, and especially autonomic control. This brings up the classic chicken or the egg question: Did brain damage come first and CFS afterwards, or does CFS cause brain damage? Knowing how common sleep-breathing problems are at any age, and knowing how even mild levels of breathing difficulty during sleep can significantly affect brain functioning, perhaps brain damage from suddenly worsened sleep apnea could be a more logical reason for most (but not all) cases of CFS.

Many patients with CFS will have documented obstructive sleep apnea, but not all. However, the upper airway anatomy in most CFS patients are more like people who have upper airway resistance syndrome. Their upper airways are so narrow that their nervous system become overly sensitive to any degree of airway obstruction. As I’ve stated before, UARS patients wake up to a light stage of sleep, even with very subtle degrees of breathing obstruction. These pauses are not long enough to be called apneas. This causes a chronic low-grade physiologic state of stress, which by itself is known to be detrimental to brain health.

So it’s not surprising that most people with CFS have very small mouths and narrow jaws. Many have had excessive dental extractions for various reasons, or have various degree of jaw underdevelopment. The vast majority definitely can’t sleep on their backs.

This also explains why a simple cold or viral infection (Mono, Lyme, etc.), sudden weight gain, or physical injury that forces you to sleep on your back, can trigger the vicious cycle that leads into the classic symptoms of CFS. All these events suddenly narrow the already narrowed upper airway.

If you have CFS, what was your precipitating event?

Written by Steven Park · Filed Under Blog | 6 Comments

Autism, Vaccines, & Sleep Apnea: My Multi-Hit Theory

November 17, 2010

I remember during M&M (morbidity and mortality) rounds as a resident, our chairman felt strongly that an error never occurs in isolation. He insisted that a bad outcome happens from a series of mistakes, oversights and lack of communication. Even in engineering or aviation, whenever something goes wrong, there’s usually a series of events that led to the final adverse outcome. The same analogy also applies with cancer.

Although vaccines were essentially exonerated by recent large-scale studies (showing that the rate of autism was no different before and after Thimerisol was removed), there are still many proponents of the vaccine theory. I think that there’s some merit to this possible connection, but not for the reasons that you may think. Let me explain.

You may remember in one of my previous posts, I described reading about a theory that proposes that since the Back to Sleep campaign for infants in the early 90s, the incidence of autism went up significantly afterwards. This campaign led to a 40% reduction in sudden infant death syndrome (SIDS). However, one of the consequences of keeping infants on their backs is to keep them in a lighter state of sleep. This can prevent proper memory consolidation and brain development.

Although it sounds like a feasible explanation, it’s going to be difficult to prove. Medically and politically, doctors are not going to retract this recommendation, even if it is found to be plausible. However, if you add to this the fact that modern jaws are smaller due to a more bottle-feeding and poor nutrition, sleeping on your back can definitely lessen your deep sleep efficiency.

In another recent post, I alluded to allergy shots aggravating obstructive sleep apnea, by increasing nasal congestion. Anything that causes inflammation in the nose or throat, including allergies, colds, migraines, reflux or weather changes, can aggravate more frequent pauses in your breathing, especially when in deep sleep.

The human voice box is unique in that it’s located below the tongue. This migration downwards begins at birth and continues until your 60 or 70s. Around 4 to 6 months, a space is created between your soft palate and your voice box, called the oropharynx. Only humans have a true oropharynx. Descent of the larynx is needed for complex speech and language. But this also predisposes humans to breathing problems, especially when on our backs. This is when the tongue and voice box falls back the most, due to gravity. When you add muscle relaxation during deep sleep, you’re more likely to stop breathing and wake up.

Not breathing at night while sleeping, from a brief second to 30 seconds or more, can be detrimental to your brain. The end extreme of this spectrum is called obstructive sleep apnea, but even multiple short episodes of breathing pauses due to upper airway obstruction can lead to various pathways that can lead to significant neurological impairment.

If you put all these mechanisms together, then it creates a situation where you can suffer serious brain damage. In most cases, you won’t be able to see any anatomic changes using traditional imaging studies, such as with a CT scan or an MRI. These are sub-radiologic changes that occur within the brain tissues itself.

Vaccines and flu shots, just like anything else that creates a mild infection, can cause swelling and inflammation in your nose and throat. If your anatomy is already predisposed, and you add additional variables such as back sleeping and bottle-feeding, then even an allergy attack could in theory cause changes in your brain that can mimic autism. Given that the total number of child immunizations has increased tremendously only adds to my argument. Not too surprisingly, there are also known reports of children who develop autism after a simple cold or flu infection.

Ultimately, it may not be the specific type of vaccine or flu shot, or even the specific materials that they’re made with, but rather the general inflammation causing properties of these immunizations that may be the trigger that tips children over the edge to progress into any of the autism spectrum disorders. I may be going out on a limb here, but in the big scheme of things, autism may even be a childhood manifestation of the same process that causes Alzheimer’s.

What’s your opinion on my thought experiment? Will you agree with me that autism has multifactorial causes and not just one trigger?

Written by Steven Park · Filed Under Blog | 3 Comments