Inflammation, PTSD and Sleep Apnea

March 5, 2014

Post traumatic stress disorder, or PTSD, is a commonly seen condition, especially in victims of sexual abuse, or in military personnel after deployment. For the most part, it’s categorized as a mental health disorder that’s treated with medications and/or psychotherapy. Personal or family history of anxiety or depression is though to increase your risk of developing PTSD.
In this new study, the presence of inflammation was found to predict later development of PTSD. In particular, each 10 fold level of C-reactive protein (CRP) was associated with a 51% increased likelihood of showing at least one PTSD symptoms after deployment to Iraq or Afghanistan.
When I came across this study, the first thing that came to mind was the numerous previous studies showing that having obstructive sleep apnea (OSA) is strongly associated with elevated levels of CRP, and that treating OSA with CPAP can lower CRP levels. 
In addition to higher levels of CRP, OSA is also associated with elevated levels of IL-1, IL-6, and TNF-alpha. CRP is a general marker of inflammation and can even be elevated after surgery.
A good analogy is to say that having a fever increase the chances that you have a cold. Your temperature can also go up if you have pneumonia. There’s nothing special about having an elevated temperature, since it’s a general marker of inflammation. In a similar way both obstructive sleep apnea and PTSD are both associated with elevated levels of CRP. 
But what if obstructive sleep apnea increases your chances of developing PTSD? Not too coincidentally, there’s a study showing that veterans with PTSD have up to 50% rate of OSA. Treating OSA can oftentimes improve PTSD symptoms. I’ve had numerous veterans report that their PTSD was completely gone after starting CPAP.
Something to always think about when you’re dealing with PTSD.

Expert Interview: Dr. Barry Krakow on PTSD, Insomnia, and Sleep Apnea

November 14, 2012

In this Expert Interview, I interview Dr. Barry Krakow about his work on PTSD (post-traumatic stress disorder), insomnia, and obstructive sleep apnea. These are the questions I asked:

– How did you get involved with mental health patients who have sleep disorders?

– How is insomnia and sleep apnea related to post-traumatic stress disorder (PTSD)?

– What’s the hard evidence that sleep-breathing disorders and insomnia go hand-in-hand?

– Why do you use the term, complex insomnia to describe the co-existance of insomnia and sleep apnea?

– Tell us about your paper that’s coming out in SLEEP on complex insomnia.

– What comes first, insomnia or sleep apnea?


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My Two Major Panic-Anxiety Episodes

December 22, 2010

In this modern age of anxiety, it’s almost a given that you’ll have some anxiety over certain things, such as financial, health, relationship, or academic concerns. If you have a sleep-breathing disorder, it’s likely your stress and anxiety levels will be much higher. Any degree of sleep deprivation or inefficient sleep can heighten your nervous system, and make you over-react to situations that normally wouldn’t stress you out.

Looking back, I distinctly remember two episodes in my life, where I had some major panic attacks, beyond the typical life stresses or anxiety provoking states, such as death, relationship issues, or even job interviews.

I’ve always considered myself an introvert, but not shy. In high school, I was active in music (orchestra, symphonic band, and the jazz band), was captain of the track team, and was active in science research. I don’t remember having any problems giving presentations and speaking in public, but that changed once I got to medical school.

In the second year of medical school, I was sitting in a small psychiatry class, where each student had to interpret and critique an interview that was just observed. For some reason, as my turn came near, I could feel my heart pounding away, and broke out in a cold sweat. My heart was beating so fast and intensely, I though I was going to have a heart attack and die. Even my kidneys hurt. Fortunately, I said a few words about the interview, and didn’t die. This type of panic and anxiety persisted to some degree for the rest of the year. Fortunately, by my my third year clinical rotations, it problem went away completely.

The other situation that I remember was after a major highway car accident during residency. I was driving along with Henry Hudson Parkway at night in the express lane, and saw from the rear view mirror that there was a car that was zig-zagging from lane to lane. Within an instant, I saw that he was high beaming me on and off, and then he rammed into me while speeding over 100 miles per hour. My car got pushed onto the divider, turning almost 90 degrees, and I though I was going to flip over and die. Fortunately, my car slid back down and slid along the right side of the elevated highway for another few hundred feet. My car was totaled, and I was taken on a backboard to the ER at Columbia. I came away with only the shock of the experience, but for about a few months after this incident, whenever I saw a car change lanes into my lane behind me, I would have mild panic attacks.

Looking back at both incidents, I was in a period of time when I was majorly sleep deprived. During second year medical school, I was not getting enough sleep due to the various demands of all the courses. During residency, I was still taking first call, working about 100 to 120 hours per week. This is like having a short bout of PTSD, or post-traumatic stress disorder.

The point I wish to make here is that if you don’t sleep long enough, or if your sleep is inefficient (like with sleep apnea), then you’re more likely to suffer from anxiety or pain attacks. My examples are the more extreme conditions that can arise, but most people just get upset a bit quicker or over-react inappropriately in certain situations. This is why good, quality sleep should always be a top priority in your life.

Do you have any experiences where major sleep deprivation caused you to have increased anxiety or pain attacks?

Expert Interview: Dr. Barry Krakow on Complex Insomnia, UARS, & PTSD

November 14, 2010

For this Expert Interview, I’m honored to have Dr. Barry Krakow as my guest. Dr. Krakow is a world-renown sleep researcher, and author of numerous books, including Sound Sleep, Sound Mind, and Insomnia Cures. We’re going to have a fascinating discussion about:

– complex insomnia (insomnia and sleep apnea)

– upper airway resistance syndrome

– post-traumatic stress disorder

– and much, much more…

If you or your loved one has either insomnia, obstructive sleep apnea or upper airway resistance syndrome, you don’t want to miss this.

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Another Strong Link Between PTSD and Sleep Apnea

November 5, 2010

Here’s a not too surprising study about post-traumatic stress syndrome (PTSD) in veterans: 54% of PTSD patients who underwent formal sleep studies were found to have obstructive sleep apnea. This is much higher than what’s normally expected (about 20%). There are numerous reports of veterans with severe PTSD that are eventually found to have obstructive sleep apnea later in life, and once treated, the PTSD goes away.

It’s likely that they always had some degree of obstructive sleep apnea to begin with, and once the emotional or physical trauma took place, memories or thoughts of that event can trigger a hyperintense reaction, since your nervous system is going to be hypersensitive in general.

I’m also guessing that there will be a significant number of veterans that don’t meet the official criteria for obstructive sleep apnea, but still suffer from significant breathing pauses and arousals.

Based on these findings, do you think everyone with a formal diagnosis of PTSD should be screened for obstructive sleep apnea? Please enter your comments in the text box below.

9/11 And Obstructive Sleep Apnea

September 20, 2010

As I was riding the subway, I noticed an ad by the New York City Health & Hospitals Corporation promoting services for victims of the World Trade Enter disaster on  9/11. It asked about common symptoms that are seen after this tragedy, including chronic upper respiratory or breathing problems, poor sleep, depression, anxiety, and post-traumatic stress syndrome (PTSD).

This add reminded me of a conversation I had with a patient a few years ago that worked as an official for the city in helping people with these illnesses. She did agree with me that many people were affected, but there were others that didn’t suffer the same degree of physical or emotional problems, despite being in the same environment.

My suspicion is that if you have undiagnosed obstructive sleep apnea, you’ll be much more susceptible to these medical issues. Massive amounts of inflammation caused by inhaling dust, fumes, toxic chemicals and smoke can be a major irritant to the upper airways. The emotional trauma of going through such an event can lead to PTSD.

I’ve written in the past about how a sleep-breathng problem can heighten your nervous and immune systems, making you over-react to any form of stimulation or irritation. Additional inflammation in the nose or throat causes more swelling, aggravating more breathing stoppages, leading to more stomach juice reflex, leading to more frequent obstructions. The hypersensitivity that results in the nose leads to increased nasal congestion, aggravating even more obstructions downstream. Poor sleep can then lead to weight gain, leading to even worse sleep apnea.

Notice how many of the symptoms of people suffering from 9/11 trauma are very similar to some war veterans returning from battle. In many cases treating veterans with PTSD by addressing any underlying sleep apnea can help PTSD dramatically. The same concept can and should be applied to 9/11 victims as well.

Do you suffer  from these medical conditions since 9/11? If so, do you snore, and are tired all the time no matter how long you sleep? Are you not able to sleep on your back?

PTSD, Sleep Apnea, & Dementia

September 10, 2010

Post Traumatic Stress Disorder (PTSD) has gained a lot of attention recently, especially in light of so many war veterans coming home with this debilitating disorder. In a recent study involving over 10,000 subjects, researchers found that the risk of dementia later in life for soldiers with PTSD was twice that of people who didn’t have it, even if they weren’t wounded in battle.

Not too surprising, since both are linked to obstructive sleep apnea. In fact, it’s more likely that untreated obstructive sleep apnea is responsible for PTSD and dementia (and cardiovascular disease). Sleep apnea is known to cause brain damage via various mechanisms, including vascular insufficiency, micro-strokes and diminished brain metabolism, leading to lower brain tissue density and volume in critical areas of the brain. Obstructive sleep apnea also causes generalized over-reactivity of your involuntary nervous system. There are numerous reports of PTSD being cured years later after obstructive sleep apnea is found and treated. Since obstructive sleep apnea is so common, at least look for it before starting medications or psychotherapy. Dr. Barry Krakow is doing some cutting edge research in this area.

Did your symptoms of anxiety or panic attacks go away after treating your sleep apnea?

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