Expert Interview: Dr. Shelby Harris on Sleep Hygiene

January 20, 2012

This month, we’re privileged to have with us Dr. Shelby Harris, who answers your most pressing questions about sleep hygiene. Dr. Harris has been quoted numerous times in the New York Times, The Wall Street Journal, The Huffington Post, and the New Yorker. She has also appeared on the Today Show, World News with Diane Sawyer, Good Morning America Health, ABC7-NY’s Eyewittness News and ABC’s Primetime: Live.

Some of the topics and questions she covers are:

“If I sleep in on the weekend, does it make up for the lost sleep over the week?”
“I’m so tired when I’m on the couch at night, but when I hit the pillow, my mind starts racing and I can’t fall asleep. Why?”
The importance of scheduling in time for sleep as well as wind-down time beforehand
Proper timing of exercise to help with better sleep
Misuse of alcohol as a sleep aid
Smoking – effects on sleep
Caffeine – how/when to use it and when not to
And lots more

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Written by Steven Park · Filed Under Expert Interviews | 1 Comment

Hypothyroidism in Pregnancy Goes Largely Undiagnosed

January 16, 2012

Researchers combed through 117,892 Quest Diagnsotics records and found that about 15% of women tested positive for gestational diabetes. Based on this finding, they estimate that as many as 483,000 women with gestational diabetes may go undiagnosed every year. Asian women had the highest rates of being tested and being positive for this condition, and older women and overweight women were much more likely to be tested during pregnancy.

Hypothyroidism during pregnancy can lead to lower IQ scores in children after birth.

I’ve written extensively before that pregnancy increases your chances of sleep-breathing problems, especially in light of significant weight gain that occurs. Gaining weight is a major risk factor for obstructive sleep apnea, which has been shown to significantly increase your risk or diabetes and hypertension. Any form of physiologic stress can has been shown to lower your thyroid levels as well. You don’t have to have obstructive sleep apnea to have significant breathing problems at night.

Having low thyroid levels can also promote weight gain. Poor sleep quality also promotes weight gain. Weight gain narrows your throat, causing more breathing problems. It’s a vicious cycle. Regardless of which comes first (sleep apnea or hypothyroidism), it’s a two-way street.

If you consider that our population as a whole is now heavier, and women are having babies at much later ages, then hypothyroidism is one of many conditions related to sleep-breathing problems and pregnancy that is expected to increase in numbers.

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Shortage Of ADHD Medications Creates An Uproar

January 4, 2012

A recent New York Times article reports on the shortage of medications for people with ADHD, or attention deficit hyperactivity disorder. There’s a lot of speculation about why this is happening. One explanation that was put forth was that the FDA (Food and Drug Administration) is limiting the available supply, due to the high rates of possible abuse of these stimulant medications. My response was a little off-topic, but I just had to comment. Here’s a reprint of what I wrote:

“There’s no doubt that ADHD medications can be lifesaving for millions of Americans, but there’s another dimension to this issue that’s being ignored by the mainstream media and the general public, despite growing evidence in published studies.

It’s a general consensus in sleep medicine that sleep deprived adults get drowsy, whereas children become fidgety and hyperactive. Not only are todays’ children sleep deprived (homework, TV, etc.), many are not able to breathe properly at night, due to narrowed airways.

In a study published in Pediatrics in 2006, 28% of children scheduled for tonsillectomy were found to have undiagnosed ADHD, compared to 7% in controls. After tonsillectomy, 50% of the ADHD group were cured. Another study showed that children with ADHD are more likely to snore, and that about 25% of children with ADHD could be treated effectively by treating their sleep apnea.

Notice all the typical findings in a child with sleep-breathing problems that are also found with ADHD: inability to sleep supine, snoring, nasal congestion, mouth breathing, snoring parents, unrefreshing sleep, frequent urination, inability to focus or concentrate, history of needing braces, and bottle-feeding. You don’t have to be obese or snore to have sleep apnea.

It’s clear that in some children with ADHD, stimulants like Ritalin or Adderall work because they’re sleepy. My feeling is that all children with ADHD should be screened for obstructive sleep apnea.“

Let me make it clear that I’m NOT saying that all children with ADHD have obstructive sleep apnea. But even if it’s only 25% (a very conservative number), the implications are huge. If you look at the CDC’s website on ADHD statistics, it’s frightening.

9.5% or 5.4 million children 4-17 years of age have ever been diagnosed with ADHD, as of 2007
Rates of ADHD diagnosis increased an average of 3% per year from 1997 to 2006 [Read article ] and an average of 5.5% per year from 2003 to 2007
Prevalence of parent-reported ADHD diagnosis varied substantially by state, from a low of 5.6% in Nevada to a high of 15.6% in North Carolina
As of 2007, 2.7 million youth ages 4-17 years (66.3% of those with a current diagnosis) were receiving medication treatment for the disorder
Rates of medication treatment for ADHD varied by age and sex; children aged 11-17 years of age were more likely than those 4-10 years of age to take medication, and boys are 2.8 times more likely to take medication than girls.

Remember that these are 2007 statistics. Ten percent of the pediatric population has ADHD, and 6-7% are on medications! As a population, we’re much heavier than we were 5 years ago, which means that these figures are probably an underestimation. The children that we’re medicating now are mostly likely the ones that we’re going to have to give even more medications to later in life after they develop the medical complications of untreated obstructive sleep apnea (diabetes, depression, anxiety, hypertension, high cholesterol, obesity, heart disease, heart attack and stroke). In my mind, all these conditions are connected. They are all one and the same disease, but with different manifestations.

Written by Steven Park · Filed Under Blog | 2 Comments

Sleep: The Missing Link in Weight Loss

January 1, 2012

Tara Parker-Pope, New York Times health columnist, wrote a great article in last week’s Times Magazine called, “The Fat Trap.” She details a poignant account of her personal struggles with obesity, and the various scientific studies that support the notion that there are a number of genetic, biochemical and environmental factors that prevent certain people from losing weight.

But one thing that was clearly missing in her article was the importance of getting a good night’s sleep. There are a number of reasons why most modern Americans are not getting enough sleep.

A National Sleep Foundation poll in 2005 showed that Americans averaged 6.9 hours of sleep per night, which is about one hour less per night compared with 50 years ago. Furthermore, our sleep duration has dropped another 20 minutes since 2001. Invasion of technology has been blamed as one major factor, as cellphones, computers, and various media options are rampant in today’s society. The bad economy is also thought to create more insomnia and diminished total sleep times.

Not only has our sleep duration dropped, but the quality of our sleep is dropping even further. Obesity is a major risk factor for having obstructive sleep apnea. As obesity has reached epidemic proportions in the United States, it’s likely that rates of obstructive sleep apnea has increased as well. Untreated obstructive sleep apnea, by causing multiple breathing interruptions, prevents continuous, quality deep sleep. It also significantly increases your future risk of developing heart disease, heart attack, stroke and motor vehicle accidents.

A healthy diet, portion control, and regular exercise are cornerstones of most diets or weight loss programs. But without good quality sleep, your chances of losing a significant amount of weight and keeping is off is relatively low. One major reason for this is that poor sleep promotes weight gain. It’s been shown that hormonally and metabolically, one tends to either gain weight, or has difficulty losing weight, no matter how much you diet or exercise.

One great example was reported by Glamour Magazine in 2009: Seven women of varying weights were told to sleep at least 7.5 hours every night. After 10 weeks, 6 of the 7 women lost anywhere from 6 to 15 pounds, without any changes in their eating or exercise habits. The one woman that didn’t lose any weight did lose 2.5 inches off her waist, bust and hips.

This just goes to show that unless you can optimize sleep, losing weight through dieting and/or exercise won’t work as well, or last.

If you’re currently dieting, have you incorporated an optimal sleep program into your weight loss regimen?

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Ask Dr. Park: Sleep & Breathing: The 2 Keys to Optimal Health

December 29, 2011

In this teleseminar, I reveal:

Why all modern humans stop breathing intermittently while sleeping
3 key anatomic concepts that makes everyone susceptible to sleep apnea
7 common surgical procedures that can worsen or uncover obstructive sleep apnea
5 simple steps to better breathing and better sleep
5 ways to treat obstructive sleep apnea.
What you MUST do first before trying to lose weight.

Topic: Ask Dr. Park: Sleep & Breathing: The 2 Keys to Optimal Health

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33% of All Cops May Have Sleep Apnea

December 21, 2011

I’ve always wondered about police officers—just like the rest of the population, many are generally overweight. A new study published in the Journal of the American Medical Association revealed that about 40% of police officers screened positive for at least one major sleep disorder. Sleep apnea was the most commonly found condition, at 34%. Insomnia and shift word disorder were the two other conditions seen. About 80% were overweight or obese. And 26% reported falling asleep while driving at least once or twice per month.

These findings are not too surprising, since police officers frequently work odd hours that include night shift and weekends. Their poor eating habits can contribute as well. We also know that poor sleep can promote weight gain. The irony is that police officers probably need to be outdoors, walking or driving around, since an indoor desk job will not be stimulating enough. The question is which comes first: poor sleep habits and lifestyles that lead to weight gain and sleep apnea, or anatomic predisposition to sleep apnea that leads to choosing these type of occupations that promote weight gain, which leads to sleep apnea? I’m sure that if you studied fire fighters, you’ll find similar results, and that you’ll agree with me that this is a potentially major public health issue.

Based on these findings, do you think mandatory screening for obstructive sleep apnea should be required on a periodic basis for all police officers?

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Expert Interview: Dr. Brian Palmer on “The Evolution of Malocclusion & Sleep Apnea”

December 10, 2011

Dr. Brian Palmer is an internationally recognized expert on dental malocclusion, infant feeding habits, and its’ relation to obstructive sleep apnea.

Topic: The Evolution of Malocclusion & Sleep Apnea

Guest: Dr. Brian Palmer

Length: 2 hours

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Why Do Some Insomniacs Keep Waking Up At the Same Time?

December 7, 2011

One of the most common complaints that I get from patients is that they keep waking up at the same time in the middle of the night and are unable to get back to sleep, or they keep waking up every 90 to 120 minutes. This phenomenon is called sleep maintenance insomnia, when you are unable to stay asleep during the night. In contrast, sleep onset insomnia is when you’re unable to fall asleep in the beginning of the night.

A low-dose version of zolpidem (Ambien) was recently FDA approved as Intermezzo to treat these middle of the night awakenings. It’s purpose is similar to zaleplon (Sonata), which is a very short-acting sleep aid, so it can be used in the middle of the night to get back to sleep, without the “hangover” effects that people feel with typical sleep aids.

There are a number of different explanations for why some people keep waking up in the middle of the night. One theory is that people with insomnia are hyperarousable, with higher levels of brain activity and stress hormones. If it’s due to these factors, why is it that insomniacs keep waking up at the same time? One possible explanation is that it has to do with sleep stages. Humans go through 4-5 cycles of sleep, where deep sleep (slow wave) predominates in the first half of the night and REM sleep is more common in the second half. As the night progresses, the periods of REM sleep become longer and longer. Since we know that throat muscles are most relaxed during REM sleep, you’re more likely to have breathing pauses during REM, especially if you’re anatomically predisposed (narrowed upper airway anatomy).

This can explain why many people say that they keep waking up at 3AM, like clockwork. Some people wake up when REM length reaches a critical period, whereas other keep waking up with each successive REM period. Transitions into and out of REM can also predispose one to upper airway instability.

One thing I’ve noticed is that in almost all cases, severe insomniacs have very narrowed upper air passageways. On endoscopy, the space behind the tongue is very narrow, and most people can’t (or prefer not to) sleep on their backs, since the tongue is more likely to fall back then supine. Dr. Barry Krakow did a study a while back showing that the vast majority of insomniacs who were resistant to sleeping pills had sleep-breathing problems.

What I’m describing is not necessarily obstructive sleep apnea. Once you obstruct or have partial obstruction, you can either continue the breathing pause for 10 to 40 seconds (this is called an apnea or hypopnea). But if you wake up quickly within a few seconds, then it’s called an arousal. Insomniacs typically have lots of arousals.

This is why even if you have classic insomnia, you need to look for and treat any underlying sleep-breathing problems, regardless of whether or not you have apneas.

If you are an insomniac, what time do you wake up in the middle of the night?

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How Bulldogs Are Similar To Humans

November 29, 2011

I just came across an interesting article in the New York Times about the problem with bulldogs. The articles focuses on Uga VII, who would rather take naps than perform his official duties as the school mascot for Georgia. In short, the bulldog’s face is too short—just like humans. One of the sought-after features in bulldogs is a flat face, something that experts speculate may mimic humans faces, thus adding to their appeal. In fact, bulldogs are now the 6th most popular breed in America, just behind golden retrievers.

The problem with bulldogs is that they’re much more prone to medical ailments than many other breeds. They can suffer from ear and eye problems, skin infections, respiratory problems, immunological and neurological problems. They also have the highest rate of hip dysplasia of any breed. Bulldogs are also notorious for very loud snoring, and a variation of the uvulopalatopharyngoplasty procedure is commonly performed for this condition.

Having a flat face can cause major breathing problems, as evidenced by the very high rate of obstructive sleep apnea in modern humans. The ability to talk made things even worse for us. Shrinking of the jaws is known to cause crowding of the soft tissues in the upper airway, as well as facial wrinkling. Could it be possible that bulldogs have excess facial skin due to significant shrinkage of the underlying facial bones, that would normally stretch out the facial skin?

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Can Eating Canned Foods Cause Sleep Problems?

November 25, 2011

The next time you eat anything out of a can, think about this study: Researchers at Harvard found that levels of BPA (bisphenol-A) had a 1,221% increase in urine levels after eating canned soup once daily for 5 days. BPA is commonly found in the lining of bottles and cans. Recently, manufacturers have voluntarily removed this substance from baby bottles, but not from commonly used containers such those used for canned foods.

BPA is a known endocrine disruptor, as well as being linked to increased rates of cancer. These molecules mimic estrogen and stimulate estrogen receptors artificially. In the process, it can also suppress progesterone levels, which can alter one’s sleep-breathing status by lowering your upper airway muscle tone, particularly the genioglossus muscle of the tongue.

Since the combination of estrogen and progesterone have protective effects on upper airway muscle tone, any disruption of this delicate balance can affect how well you breathe at night. Having artificial levels of a synthetic estrogen can suppress natural estrogen function as well. The end result can have a subtle, but significant effect on your sleep quality.

Another good reason to eat organically.

Written by Steven Park · Filed Under Blog | 3 Comments