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Bad News For Alzheimer’s Disease

Here’s an article in the New York Times that describes why scientists are baffled as to why we’ve made essentially no progress in preventing or treating Alzheimer’s disease, despite all the recent advances in understanding this all-too-common condition. Could it be because our fundamental explanation for Alzheimer’s is wrong to begin with? Researchers are convinced that buildup and accumulation of plaques in the brain is what causes this condition and that by preventing its’ buildup, we can better control this disease. So far, nothing has worked. No surprises.

This general paradigm of Western medicine is that if you can lower your numbers (cholesterol or blood pressure), or prevent buildup of plaques in your blood vessels or brain, then you can supposedly “cure” the disease. But this is the fundamental problem with Western medicine. Every medicine that we use for chronic medical conditions only covers up the end result, rather than treating what’s actually causing the problem: our stress-filled modern lives, poor diet, lack of exercise, and poor breathing at night. Yes, lowering your cholesterol may lower your risk of heart disease by 10%, but at what cost? Side effects such as liver toxicity are routine in various cholesterol medications. In the same way, side effects from the various Alzheimer’s drugs are also very common.

Knowing what we know about the effects of untreated obstructive sleep apnea on the brain, and with the HUGE number of untreated sleep apnea patients, it’s time that sleep apnea researchers and Alzheimer’s researchers begin talking to each other.

Should scientists continue to go figure out ways to block amyloid plaque production, or should they be looking for an alternative explanation, such as obstructive sleep apnea? I’d like to hear your opinion. Please enter your comments in the box blow.

Ask Dr. Park: Minimally Invasive Options for Snoring & Sleep Apnea

Please join me for my next Ask Dr. Park program when I’ll be talking about all the different minimally invasive treatment options for snoring and obstructive sleep apnea. I’ll talk about Somnoplasty, Pillar, Repose, Snoreplasty, and many others.

Date: September 14

Time 8 PM Eastern

Registration details to follow…..

Should Asymptomatic Sleep Apnea Patients Be Treated?

Once in a while, I’ll come across someone with moderate or severe obstructive sleep apnea who feel fine. They deny any sleep problems or any daytime fatigue. In this situation, it’s hard to convince the patient that he or she should use CPAP or oral appliances. Here’s another study that shows why it’s important to treat obstructive sleep apnea, even if you’re not tired: Researchers from Spain showed that treating asymptomatic sleep apnea patients significant lowered their cardiovascular risks by 28%. Furthermore, sleep apnea patients with hypertension had a 50% reduction in cardiovascular events if they used CPAP for at least 4 hours every night.

If the patient is still resistant, I give the following example: If you had high blood pressure or diabetes, you’ll feel fine, right? But if your doctor told you that despite dieting and exercise, your numbers (blood pressure or glucose levels) are still on the high side and medications were recommended, would you consider it?

Do you have obstructive sleep apnea and are completely symptom free? If you’re on some sort of treatment, what motivated you to start treatment? I’d like to know. Please enter your reasons in the text area below.

Migraines, Heart Disease, & Sleep Apnea

One of the most common conditions that I see in my ENT practice is migraines. Not your typical classic migraine with the auras, light sensitivity and nausea, but the variations of migraine that involve the ears and sinuses. In fact, the vast majority of people who suffer from sinus pain and headaches are found to have migraines—if you perform CT scans, the sinuses will be completely normal. However, patients usually won’t believe me until they see the CT images, and after they respond to anti-migraine treatments.

In an often repeated study on migraines, researchers showed again that having migraines is linked with an increased risk of cardiovascular disease and even death.

These results are not surprising, since obstructive sleep apnea is strongly linked to cardiovascular disease and increased risk of death (46% in people with severe sleep apnea). Poor sleep quality that results leads to hypersensitivity of various nerve endings. If it happens in your sinuses, you’ll feel pain, pressure, headaches, nasal congestion and post-nasal drip. If in your ears, hearing loss, ringing, dizziness, fullness and sensitivity.

Having a migraine is not normal. If you suffer from migraines, it’s you’re body’s way of telling you that something is wrong, that you’re not getting quality deep sleep.

Do you suffer from migraines? If so, do your parents have heart disease or died early from cardiovascular complications? Is like to hear your response in the response box below.

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.

Lou Gehrig, Head Trauma, & Sleep Apnea

A recent study showed that head trauma can sometimes mimic Lou Gehrg’s disease (or amyotrophic lateral sclerosis – AML). This condition was named after the famous New York Yankees baseball player that develop muscle weakness, paralysis and eventually, death. The journalist displayed a vintage photo of Gehrig just after being knocked unconscious by a runaway pitch.

Knowing what we know about the effects of untreated obstructive sleep apnea, you could say that any type of brain injury, whether due to blunt head trauma, or small to large vascular events, cannot be good for memory, breathing, executive function, and motor control. But these are the same areas that are known to be affected when someone has untreated obstructive sleep apnea.

Chronic hypoxia causes inflammation and clotting in small vessels. One study showed that sleep apnea patients have much thicker blood, and that ear-brain reflexes where diminished, but improved after treatment. Hypoxic conditions in mice have been even shown to produce amyloid plaques—the same thing that’s seen in Alzheimer’s disease.

We also know that sleep apnea patients have much higher number of lacunar infarcts than people without, as well as having anywhere from 3-5 times increased risk of stroke. I would think numerous small strokes added together over years could lead to at least some degree of brain dysfunction.

It’s also safe to assume that if you have head trauma, having obstructive sleep apnea can prevent proper healing and regeneration.

Given all this, isn’t it possible that when a certain part of the brain is “injured” due to obstructive sleep apnea, depending on where it occurs, you’ll get various symptoms that correspond to where it’s happening? For example, we know that in sleep apnea patients, brain density, volume and metabolism are significantly diminished in areas that control breathing, respiration and autonomic control. What if you clotted a small vessel that feeds this area? Could it lead to central sleep apnea? What if you damage areas that produce dopamine, or hypocretin? Could this process lead to symptoms that mimic Parkinson’s or even narcolepsy? What if you had fluctuating areas of diminished blood flow that returns to normal? Could this lead to symptoms that are similar to multiple sclerosis?

I realize that much of this may be a stretch, but it never ceases to amaze me how devastating obstructive sleep apnea can be to the brain, no matter how mild it may be.

What do you think about my theory? Is it plausible, or too far fetched of an idea? I’d like to hear your opinions about this.

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.

Sleep Apnea & Menstrual Cramps

Here's a recent study that suggests that menstrual cramping may predispose to brain structure changes.

It's more likely that brain structure changes can predispose women to menstrual cramps. Interestingly, untreated obstructive sleep apnea has been shown to result in lowered brain tissue volume and density in critical areas such as memory, executive function, and autonomic control. So it's not surprising that many women with problem menstrual cramps can't sleep on their backs, and are more tired than normal, since they can't sleep efficiently. Due to smaller jaw structures, the tongue can take up relatively more space in the throat, and can obstruct during deep stages of sleep, especially when muscles begin to relax.

Sleep Apnea in Asians vs. Caucasians

I've always suspected that Asians are much more susceptible to obstructive sleep apnea due to having smaller facial structures, and here's a study that supports my theory. Researchers in Hong Kong compared skeletal facial measurements between these two groups and found that although the average age and BMI were similar, Chinese subjects had much more severe obstructive sleep apnea (35% vs. 25%), and had significantly smaller facial bony measurements. However, Caucasians were significantly more overweight. For the same degree of obstructive sleep apnea, Caucasians were more overweight, and Chinese had more craniofacial bony restriction.

 

This explains why when Asian immigrants come to the US and begin eating Western foods, their rates of obesity, diabetes and heart disease goes up significantly higher than rates for the general population. I remember reading a while ago that the ethnic Chinese population in Queens, NY has an epidemic of young children being overweight with much higher degrees of diabetes as they get older.

 

For those of you from Asian descent, do your parents snore? If so, do they have high blood pressure, diabetes, or heart disease? Please enter your response in the comments box below.

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?

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