July 8, 2013
The world was saddened to hear about James Gandolfini’s untimely death. The Soprano’s actor was found dead while traveling in Italy. An autopsy reportedly revealed that he suffered a massive heart attack. There’s also lots of speculation that he also may have had undiagnosed obstructive sleep apnea. We know that untreated obstructive sleep apnea can lower your life expectancy by 20 years (he was 51), and can raise your risk of suffering from a heart attack or stroke by 2-3 times normal.
We know that 80-90% of people with OSA are not diagnosed. Even when you fit the classic profile of someone with OSA (overweight, middle-aged, male, big neck), doctors in general don’t think about this condition. Most are told they need to lose weight. The problem is that poor sleep due to any reason prevents you from losing weight. It’s an unfair recommendation.
Every day during office hours, I see countless people with classic signs and symptoms of sleep apnea who continue taking their multiple medications for high blood pressure, diabetes, high cholesterol, and gout. Most snore like trains, but this issue goes unaddressed. In fact, a recent study showed that if you’re an obese woman with diabetes and high blood pressure, you have an 80% chance of having obstructive sleep apnea. (Doctors, since we’re humans too, also have the same risks.)
It’s time for doctors to wake up and help people sleep better, and save more lives.
July 2, 2013
Here’s a study that confirms what I already practice—that treating obstructive sleep apnea can help with migraine headaches. In this German study, using CPAP for one year significantly lowered frequency, duration, and intensity of migraines. Medication use and lost work days were also significantly lower.
Lack of oxygen and the increased stress response that results from repeated breathing pauses at night can cause your nervous system to become overly sensitive. Your muscles can tighten and go into spasm. You can become sensitive to lights, sounds, and become nauseous. If your inner ears are involved, you’ll become dizzy, light-headed, or may have ringing. So technically, you can have a migraine attack in any part of your body that has nerve endings.
If you’re a sleep apnea sufferer, do you suffer from migraines?
June 26, 2013
Here’s an interesting study showing that being breast-fed as an infant was associated with a higher social status later in life. While the article gives some very good plausible reasons for this finding, nowhere does it mention the well-known finding by dentists that bottle-feeding can aggravate dental crowding, which can potentially lead to problems breathing at night due to crowded soft tissues within smaller-than-normal jaws. We know that babies that snore have much higher rates of developmental and behavioral problems later as school-aged children. Poor sleep quality can also predispose to weight gain.
I’m not saying that all bottle-fed babies will develop sleep apnea. However, along with a number of other genetic, environmental and dietary, and behavioral factors, bottle-feeding can significantly increase your risk of developing sleep apnea. Based on what we know about narrowed jaw structures and obstructive sleep apnea, this finding is not surprising.
June 12, 2013
Mainstream Alzheimer’s research is still focused on genetics and ways of biochemically blocking amyloid plaque buildup. Clinical applications for this model have been mixed, if not disappointing. As I’ve mentioned many times in past posts, articles and interviews, The vast majority of seniors will have undiagnosed obstructive sleep apnea. We know that sleep apnea can cause major brain injury involved in various critical areas, including memory and executive function.
There are more and more studies now coming out that are linking Alzheimer’s and sleep apnea. A recent small study reported finding higher rates of positive biomarkers of Alzheimer’s in seniors for sleep apnea, especially in thinner people. Another article reviews the strong association between intermittent hypoxia (during apneas) on the brain and brain damage.
I’m glad to see that clinicians and researchers are beginning to address this important issue.
May 16, 2013
Theravent looks like another potential new option for snoring, but upon further inspection, looks like technology that’s also found in Provent. These are nasal adhesives that allow you to breathe in normally, but provides partial resistance when you breathe out through your nose. Numerous studies have been published on the effectiveness of Provent for sleep apnea, but I’ve had mixed results in my practice. However, many patients do like them, so I continue to offer these devices. The website for Theravent offers a free trial, so it’s worth looking into if you want to try something different.
Have you tried Provent or Theravent? Please comment on your experiences.
April 10, 2013
Here’s another chicken or egg question: Do poor sleep habits cause diabetes and lower melatonin levels, or does diabetes cause lower levels of melatonin? In this study out of Brigham and Women’s Hospital in Boston, having lower levels of melatonin was associated with a higher risk of diabetes. This does not prove that having lower levels of melatonin will give you diabetes, but only an association where directionality is not known.
One minor detail that’s important to remember is that when darkness stimulates brain neurons to produce melatonin, the signals goes through the cervical sympathetic ganglion, before reaching the pineal gland. A common side effect from any of the high blood pressure medications is that it lowers function of this ganglion, which is involved in the sympathetic nervous system. Blood pressure medications can lower activity of your sympathetic nervous system, which can in theory lower your melatonin levels.
So of you have high blood pressure, by taking blood pressure medications, you could be lowering your melatonin levels, which lead to poor sleep, which can result in weight gain, which can aggravate snoring and obstructive sleep apnea….and we know that obstructive sleep apnea can raise your sugar levels.
This example only shows that the human body can’t be reduced to one single molecule or chemical at a time. We need to look at multiple aspects of our physiology simultaneously.
April 3, 2013
Here’s an interesting study showing that the presence of heart disease may predict dementia better than cognitive tests. This finding is not surprising since we know that untreated obstructive sleep apnea can cause major injury to multiple areas of the brain. We also know that the older you get, the more likely you’ll develop sleep apnea. In fact, based on some recent population studies, more than half of people over 50 had some degrees of sleep apnea.
March 19, 2013
It’s long been known in sleep medicine that lack of sleep can cause you to gain weight. But it works the other way around as well: Being overweight gain aggravate obstructive sleep apnea, leading to lack of quality sleep. Here’s an article in the NY Times that summarizes a study showing that even mild degrees of sleep deprivation can cause metabolic changes that promotes weight gain. This article emphasizes sleep deprivation only, but knowing that a huge segment of the population has undiagnosed obstructive sleep apnea, it’s safe to say that lack of quality sleep can also promote weight gain.
Many of you (whether or not you have obstructive sleep apnea) don’t get enough hours of sleep in general. The ideal number of hours is 7 to 8, but everyone has different needs. This is assuming you’re able to breathe normally at night. It’s also been shown that short sleepers (less than 6) or long sleepers (longer than 9) have much higher risk of developing diabetes, depression, heart disease, and even death.
If you’re a short sleeper, I challenge you to sleep one hour longer for the next month. Just by making this one change alone, you’re more likely to lose some weight.
March 7, 2013
Here’s a study which reports that 29% of children with ADHD go on to have ADHD as adults. I’ve written extensively about how a significant portion of kids with ADHD have undiagnosed obstructive sleep apnea. In fact, in one study, taking out tonsils and adenoids cured 50% of children with ADHD. Clearly, not all ADHD is related to a sleep-breathing problem, but even if it’s due to sleep apnea in 50%, or 25%, or even 10%, wouldn’t it be worthwhile to at least screen for it?
February 28, 2013
In this teleseminar, I interview Dr. Jeff Rouse, about the relationship between TMJ disorders and sleep-breathing problems.
Please fill in your information below to access the free MP3 recording, as well as the PDF of his slides: