Post-Thanksgiving Sleep-Breathing Disturbances

November 30, 2009

Just as I predicted in my 11/28/09 post, many more people will experience various ear, nose, throat and sleep-breathing disturbances in the immediate days just following Thanksgiving. Just today, I saw a number of patients that developed sinus pain and congestion or throat pain along with ear pain. Of course, they all indulged in seconds helpings during Thanksgiving dinner, and many stayed up later than usual.

Since my sleep-breathing paradigm predicts that all modern humans are susceptible to various degrees of disturbed breathing while sleeping, any massive amounts of late-night food will by definition promote increased swelling in the throat, which aggravates more frequent obstructions and arousals.

Intense vacuum forces created in the throat can literally suction up normal stomach juices into the throat. It’s not only acid that comes up, but also includes bile, digestive enzymes, and bacteria. This can lead to the classic throat reflux symptoms, which include throat clearing, throat pain, post-nasal drip, chronic cough, hoarseness, lump sensation, or even difficulty swallowing. These materials can then migrate into the lungs, causing or aggravating asthma, bronchitis, and chronic cough. If these juices go up into the ears or the nose, then you’ll get ear fullness or pain, nasal congestion and sinus headaches.

Are you suffering from any of the above symptoms in the days following your Thanksgiving dinner? If so, are you more tired than usual? Please enter your responses in the comments box below.

Written by Steven Park · Filed Under Blog | Leave a Comment

Q: Severe OSA or UARS?

August 17, 2009

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.

Written by Steven Park · Filed Under QnA | 2 Comments

Q: Can Sleep Apnea Cause Birth Defects?

July 3, 2009

Q:
Dear Dr. Park,

I was wondering if you are aware of any link to birth defects or other issues in babies of mothers with undiagnosed sleep apnea? I have only been diagnosed lately at the age of 47, but my first child who’s 22 was born with a cleft lip, has asthma + is waiting for an operation for a deviated septum. My son, who’s 13, is waiting to see a specialist as his hearing is very bad in one ear, he has a permanent stuffy nose and also has learning problems (border-line dyslexia). When my daughter was born with the cleft lip her orthodontist asked me several times if I could think of any occasion during my pregnancy where there could have been a lack of oxygen to the placenta. At the time I couldn’t, but I didn’t know then that I had sleep apnea.

Many thanks for your time.
Kath (UK)

A: It’s interesting that you ask that question, as a recent study reported that women with OSA had a much higher incidence of children with neural tube defects. There are a number of other studies linking sleep-breathing problems with perinatal complications. One study revealed that snoring alone during pregnancy was associated with much lower Apgar scores at birth. I’m not aware of any association between sleep apnea during pregnancy and cleft lip or palate problems, but I wouldn’t be surprised if there is a link. We also know that sleep apnea is most likely a major aggravator for pre-eclampsia during pregnancy.

I think your family history is a combination of hereditary risk factors as well an pregnancy-related sleep apnea complications. Unfortunately, there’s no easy way of proving cause and effect. The various problems that your children suffer from could be related to hereditary factors, since you already know that you sleep apnea. There are also external environmental factors that may contribute as well, such as bottle-feeding and the child’s diet. Needless to say, oxygen deprivation during pregnancy is not good for the developing baby.

Written by Steven Park · Filed Under QnA | Leave a Comment