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33% of All Cops May Have Sleep Apnea

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?

How Bulldogs Are Similar To Humans

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?

 

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

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).

 

 

How Diabetes, Dementia and Sleep Apnea are Linked (or Associated)

Here’s a new study out of Japan showing that people with uncontrolled diabetes had about a 35% increased risk of developing dementia. The article talks about how diabetes can cause clogging and blocking of the arteries, leading to lack of oxygen and brain damage. But guess what else causes lack of oxygen? Obstructive sleep apnea. Hypoxia has been shown to cause brain damage in numerous sleep apnea as well as Alzheimer’s research studies. As always, researchers are careful to point out that association never implies causality.

Expert Interview: Psychology of Sleep Apnea

In this Expert Interview program, Ms. Lisa Brateman will talk to us about the psychology of obstructive sleep apnea. This is an important topic that affects not only those of you with sleep apnea, but also your loved ones, your friends, and family members.

 

 

 

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The Single Most Important Advice I Give To Patients

The New York Times confirmed what I’ve been telling patients for years—that eating within 3-4 hours of bedtime can promote acid reflux. What the journalist didn’t mention was the fact that acid reflux and obstructive sleep apnea go hand in hand. Here’s what I wrote in reply to his article:

Having heartburn at night also means that you’re at risk of stomach juices reaching your throat, which not only has acid, but bile, digestive enzymes, and bile. In light of the fact that about 10 to 25% of the population has at least some sleep apnea (the majority in the elderly in some studies), any pauses in breathing will literally suction up your stomach juices into your throat, causing not only arousals, but also swelling and inflammation, leading to post-nasal drip, chronic throat clearing, chronic cough, and even Eustachian tube dysfunction. 

The more often you stop breathing at night, the more you’re likely to suction up stomach juices into your throat, which can also lead to desensitization of your  pressure and sensory nerve endings. Over time, this can lead to loss of protective upper airway reflexes, predisposing one to obstructive sleep apnea. In addition, vibratory trauma from snoring is thought to not only desensitize sensory nerve endings, but also cause carotid artery wall thickening.

Not eating late will also increase your sleep efficiency, which can promote weight loss. On the contrary, any degree of sleep deprivation or sleep inefficiency will promote weight gain. Gaining weight promotes more reflux and sleep apnea.

Counseling New Yorkers to avoid eating (and drinking alcohol) within 3-4 hours of bedtime is the simple most important recommendation I make, in addition to my routine treatment options.

Is Nocturnal Asthma Really Sleep Apnea?

Having an asthma attack in the middle of the night can be a frightening and terrifying experience. Typically, these attacks happen in the early morning hours, just before awakening. 

Now there’s research showing that poorly controlled asthma during pregnancy can increase a woman’s chances of developing preeclampsia (50%) and premature births (25%). Furthermore, infants born to mothers with poorly controlled asthma delivered babies that were about 0.2 pounds less than those born to mothers without asthma.

We typically think of asthma being a separate, distinct condition from obstructive sleep apnea, and it’s treated in completely different ways. However, it’s not just coincidence that nocturnal awakenings from asthma and the most intense periods of apnea occur at the same time in the middle of the night—the early morning hours. The early morning hours are when REM sleep is most prominent, and this is the time when throat muscles are most relaxed. Having an apnea also is known to cause reflex, which is known to reach the throat as well as the nose and the lungs. In one small study in people with sleep apnea and asthma, treating sleep apnea with CPAP significantly improved nocturnal asthma symptoms. 

We know that any degree of stress on the mother’s body can lead to a higher rate of pregnancy-related complications and low birth rates. Even snoring by the mother alone was found to result in lower Apgar scores in newborn infants. Apneas are also known to raise blood pressure and promote insulin resistance. Stress hormones are also known to increase when you have apneas.

In light of all these findings, it’s not surprising that pregnant women with poorly controlled asthma have higher complications rates. This is another great example of “connecting the dots” between two seemingly unrelated conditions, which only adds to support my sleep-breathing paradigm.

 

 

Expert Interview: Eric Cohen on How to Achieve 89% CPAP Aderence Rates

In this Expert Interview, I talk with Mr. Eric Cohen and Mr. Jake McCabe of National Sleep Therapy on how their company achieves an 89% CPAP adherence rate. 

Besides revealing their secret to getting very high adherence rates, here are some other questions we covered:

 - Define compliance or adherence, and medicare criteria
- What’s the national CPAP adherence rate average?
- Being compliant or adherent doesn’t necessarily mean that you’re sleeping better, right?
- How does the patient, doctor, and DME work together to raise adherence rates?
- How long do you stay with the patient?
- Do you have any special tools to help the patient?
- What would you say are some of the top things patients can do?

Please enter your information below to access your free MP3 download link:

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*By clicking ‘submit’ above, you are agreeing to receive ongoing communications from Dr. Park including monthly newsletters, events alerts, and other such written correspondences. Your e-mail will remain strictly confidential and will not be disclosed to any third parties without your prior written consent. You may unsubscribe to any or all portions of our e-mail correspondences at any time. Thank you for your cooperation.

 

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

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)

Gout & Sleep Apnea: A Strong Connection, But Often Ignored

Every time I see a patient in my practice that has gout, almost invariably, they have signs and symptoms of untreated obstructive sleep apnea. Gout is an arthritic condition that’s caused by uric acid buildup. Allopurinol is the medication of choice, which works by reducing levels of uric acid in the body. Gout is also associated with the metabolic syndrome (obesity, hypertension, high cholesterol, and insulin resistance).

A recent study showed that gout rates in the US are climbing. About 6% of US men and 2% of women have this painful and often debilitating condition.

Despite strong evidence that sleep apnea is a major contributor to gout, little has been done to screen for sleep problems upon initial diagnosis. Chronic hypoxia promotes excess uric acid production in the bloodstream, which the kidneys try to eliminate, leading to higher concentrations in urine. This can also lead to kidney stones.

I’ve had numerous patients that report to me that their gout has improved significantly since starting sleep apnea treatment, whether through conservative lifestyle changes or more definitive options such as CPAP and surgery.

There are a number of very common medical conditions where sleep-breathing problems should be screened for (obstructive sleep apnea or upper airway resistance syndrome). Add gout to this long and growing list.

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