December 31, 2010
I’m willing to bet that tonight we’ll also have the highest rate of apneas during sleep due to alcohol ingestion just before bedtime. Alcohol relaxes your throat muscles, which can aggravate, if not cause obstructive sleep apnea. Sleep apnea is a major source of stress on the heart. We also know that the days after Christmas and New Years Eve have the highest rates of heart attacks.
If you’re inebriated , you won’t have the normal reflexes to wake up and turn over every time you stop breathing. You’ll also have lots of reflux due to vacuum forces suctioning up your stomach juices into your throat. This will cause a lot of sore/dry throats and even much higher rates of pneumonia, asthma, sinusitis and ear infections.
Unfortunately, this is a sad observation and commentary, but likely to be true.
October 9, 2010
One of my most popular blog posts is the piece I did about women who have sore throats just before their periods. Take a look at the 45 comments in response to my post. To summarize, the reason why some women have sore throats along with their monthly periods is due to the relative drop in their progesterone levels. One of the positive benefits of progesterone is that it’s an upper airway muscle stimulant. It literally tenses or stiffen your tongue muscle. As progesterone drops, the tongue falls back more easily during deep sleep, causing more frequent obstructions and arousals.
I recently had a woman who told me she gets sore throats when it rains or if she gets wet. How many you have this particular condition?
August 2, 2010
You wake up one morning with a sore, scratchy throat, feeling a little run down. The next night, your throat pain gets even worse, and you experience mild fever, with sweats and chills. Your nose is a little stuffy and runny. Your muscles ache. You're feeling even more tired. After a few days, your symptoms slowly improve, and in retrospect, you conclude that it was a passing cold.
This is a description of the classic cold, where once you catch a cold virus, it invades your body, releasing toxins and chemicals which causes fever, aches, and general fatigue. But what if I told you that the same symptoms can happen due to an allergy attack, or whenever the weather changes, or even during menopause?
About once or twice every month, I see young men who complain of hot flashes, night sweats, chills, and fever. This occurs for weeks to months. But this history isn't consistent with a typical cold. What's going on?
Whenever your involuntary nervous system is upset or imbalanced, it reacts with what are called vasomotor symptoms. This particular part of your nervous system is what normally controls sweating, temperature, blood flow, digestion, and other automatic body functions. So technically, you can have fever, chills, and even sweats from this reaction.
What then can cause this type of reaction? Let me answer by giving you the story of someone I saw this past week. He was a young man who noticed a mild sore throat 4 days prior to seeing me, and by the next morning, had a horrible sore throat. That night, he felt hot, had some sweats and shaking chills. He felt much more tired than usual, and also had some muscle aches. He saw his medical doctor that same say and was given a strong antibiotic, but didn't feel any better over the next few days.
When I saw him, I was expecting to see the typical tonsillitis with pusses out tonsils, but was surprised to find only mild inflammation and swelling. An endoscopic exam revealed severe narrowing of the space behind the tongue, made much worse when on his back.
It turns out that on the night previous to the onset of his sore throat, he had been out eating and drinking later than usual. He also normally prefers to sleep on his stomach, but felt that his sore throat might improve is he slept on his back, as he's heard about the health benefits of sleeping on his back.
What happened to this patient was that by eating and drinking late, more of his stomach juices were forced up into his throat over the first night. Then, as more swelling arose in the throat, more frequent obstructions and arousals occurred, leading to more reflux of gastric contents into the throat, adding to the swelling in the throat, along with much less efficient sleep.
Lack of deep, efficient sleep causes a physiologic stress response that makes your involuntary system overly sensitive. Hypersensitivity of your involuntary nervous system can lead to vasomotor symptoms, such as fever, hot flashes or sweats. This is why as women go through this process (since progesterone, which stiffens tongue muscle tone, relaxes), symptoms can occur. The same thing can happen when young men are slowly gaining weight.
All I recommended for him to do was to go back to sleeping on his back, and avoid eating or drinking within 3-4 hours of bedtime.
Do you get sore throats in the morning, or have fever, chills or sweats at night?
January 28, 2010
Here’s an interesting observation by more than a handful of my female patients: Their throats are sore for a few days just before their monthly periods. It doesn’t go on to a cold or other more severe symptoms. Just a transient sore throat. Then it goes away.
If you’ve been following my blogs, articles, and especially if you read my book, Sleep, Interrupted, there’s a simple explanation. During your monthly cycles, progesterone levels increase with ovulation, but drops when there’s no egg fertilization. One relatively unknown property of progesterone is that it’s an upper airway muscle dilator. It literally tenses your tongue muscles. When in deep sleep, your muscles (as well as your tongue and other throat muscles) tend to relax to various degrees depending on your sleep stage. If you have less progesterone on board, then it’s more likely to fall back, obstructing your breathing, leading to a temporary vacuum effect in the throat, suctioning up small amounts of normal stomach juices. All this causes a temporary deep sleep deficiency. If you eat a late meal, more of these juices will come up. But once progesterone levels begin to increase again, the tongue tenses, and sleep quality improves as well.
Sometimes, the inflammation in the throat increases to the point of significant deep sleep deprivation, leading to some of the more severe symptoms as pre-menstrual headaches, fatigue, irritability, and weight gain.
For you women out there, do you experience sore throats just before your periods? Please enter your responses in the comments box below.
Are hormonal imbalances ruing your life? Dr. Richard Shames, author of the best selling book, Feeling Fat, Fuzzy, or Frazzled?: A 3-Step Program to: Restore Thyroid, Adrenal, and Reproductive Balance, Beat Hormone Havoc, and Feel Better Fast! will reveal the following:
How your hormone imbalance and your sleep-breathing problems combine to create a runaway appetite and how you and still lose weight without dieting.
- Which hormonal problems both men and women experience but must treat differently
- Why checking your potassium levels is key to your health-especially if you suffer from constant fatigue
- What is the #1 hormone deficiency that affects millions of sleep apnea sufferers yet is often ignored by even the most experienced doctors
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December 7, 2009
If you’ve ever suffered from a hangover, the pounding headache, facial pressure, sensitivity to lights and loud noises will be familiar. Most people will also have a very dry, raw throat, and this is usually blamed on dehydration that’s caused by drinking too much alcohol. As far as I know, there’s no scientific proof that drinking alcohol causes significant dehydration.
Furthermore, notice that many of the features of a hangover, which usually happen only after waking from sleep after drinking too much, resemble the same symptoms when someone suffers from a migraine headache: pounding headache, nasal and sinus pressure and congestion, light and sound sensitivity, lightheadedness and imbalance, brain fog, and nausea.
Interestingly, there’s another condition that give you headaches when you wake up in the morning: obstructive sleep apnea. Not too surprisingly, you’ll have a pounding headache, sinus pain and pressure, light and sound sensitivity, and mild nausea, and brain fog. Numerous studies clearly document that alcohol can worsen or uncover obstructive sleep apnea.
This is not too surprising, since alcohol is a strong muscle relaxant, causing your throat muscles to collapse and obstruct your breathing every time you go into deep sleep. When your throat obstructs, you’ll create a vacuum effect in your throat, which literally suctions up your normal stomach juices into your throat. This is why your throat is so dry and sore in the morning during a hangover. Not getting any deep sleep will give you pounding headaches, nausea, light and sound sensitivity, and brain fog.
This process also explains why some people are less susceptible to hangovers, no matter how much thy drink. If your throat anatomy is wide to begin with, muscle relaxation and collapse won’t progress to the point of obstruction and arousals as often.
What’s your take on hangovers? Please enter your opinion below in the comments box.
September 16, 2009
Tonsils are one of the most misunderstood structures in the throat, not only by patients, but by many doctors as well. Traditional teaching states that tonsils are glands in the throat that help to fight infection. Because they are blamed for most cases of repeated throat infections, tonsillectomy is one of the most commonly performed operations in the United States. As I’ll reveal in the remainder of this article, many tonsillectomies today are being performed unnecessarily. Simultaneously, there are too many tonsils still left in place when in fact they should be removed. Here’s the reason why.
What Are Tonsils?
Before I can clear up the contradictory statement above, I must first explain what tonsils are and what they do to merit removal, if at all.
Tonsils are lymphoid tissue, like glands in your neck, armpits or groins. They are part of the immune system and are involved in learning what’s foreign and helping to make antibodies to help fight off infections. In young children, lymphoid tissues are very sensitive and can become greatly enlarged even after a simple cold or infection. If you have young children, I’m sure you’re familiar with their complaints of sore throats whenever they have colds.
It’s also important to note, however, that tonsils can swell up not only after viral or bacterial infections, but also from allergies and acid reflux. Any degree of irritation or inflammation can cause the tissues to swell up. This is normal, and will happen to various degrees in people after any type of infection, irritation or inflammation. As such, not all complaints of a sore throat are viral or bacterial in origin. There are many factors for an enflamed tonsil—this is the reason why antibiotics are not as effective in curing sore throats.
What Do Tonsils Do?
Tonsils are part of Waldeyer’s ring, which is a complete circle of lymphoid tissue that is made up of both tonsils in the side walls of your throat, the adenoids, which are in the midline back of your nose, and your lingual tonsil, which is located at the base of your tongue in the midline. In some cases, you’ll see small connections between all four glands, forming a complete circle. Anything that you breathe in or swallow has to go through this “ring”, so that the body can learn what’s coming into the body. This process is most active around ages 3 to 6.
It’s common knowledge what happens when your tonsils become infected: your throat hurts, you have a fever, your neck glands hurt (lymphoid glands that drain your tonsils), and you don’t sleep well. Anything from simple cold viruses to bacteria, and even allergies can cause your tonsils to swell. Streptococcal bacteria are very common, but there’s one particular strain called Group A beta-Hemolytic Streptococcus (GABHS) that tested for and treated, since toxins produced by this strain can potentially damage the heart or the kidneys. In theory, non-GABHS bacteria can also give you similar miserable symptoms, but if severe, doctors will typically give you oral antibiotics, which will make you feel better in most cases.
When Tonsils Mean More Than Sore Throats
But there’s one more variable that occurs during a tonsil infection that’s usually not appreciated—the fact that the tonsil can swell significantly. As I’ve mentioned in my book, Sleep, Interrupted, and in other related articles, humans have relatively narrowed upper airway breathing passageways to begin with, and even mild inflammation and swelling in the throat can narrow this airway even further, almost always leading to various degrees of obstruction and arousal from sleep.
What this means is that, your enlarged tonsils not only affect how sore your throat feels, they can also cause you to sleep poorly. Here’s the reason why.
If the inflammation and swelling caused by an infected tonsil causes your airway to narrow or obstruct entirely and this in turn, causes you to stop breathing, you’ll either wake up to light sleep immediately, or stop breathing for 10 seconds or longer and then wake up. In this latter situation, you would have experienced what’s called an “apnea” or “loss of breath." Most people will have lots of short obstructions and arousals—this is why if you have a simple cold, you won’t sleep as well, since you’ll toss and turn more often than normal. Luckily, in most situations, once the infection goes away, you’ll return to normal.
However, there’s one more piece to the puzzle that can prevent you from feeling better: This is the piece that many patients and even many doctors overlook as well. If you stop breathing, even temporarily, you’ll create a vacuum effect in your throat, where your stomach juices literally get suctioned up into your throat. Small amounts of acid, bile, digestive enzymes, and bacteria can cause your tonsils to stay swollen, aggravating this vicious process. Even worse, your stomach juices can then travel up into your nose or down into your lungs, wreaking more havoc. Add to this a stuffy nose, then another vacuum effect is created downstream, and the tongue can fall back even further.
Certain viruses such as the Epstein-Barr virus (that causes mononucleosis) attack lymphoid tissues specifically, and as a result, keeps the tonsils abnormally large.
This is one reason why patients with this condition have prolonged bouts of chronic fatigue.
Misleading Throat Pain
Most people (and doctors) naturally assume that if your throat hurts, it means that you have a throat infection. If the antibiotics that you’re given works, then it means that it was an infection after all, right? Not necessarily. One of the most commonly prescribed oral antibiotics is called azithromycin (brand name is Z-Pak), which is a convenient 5 day course. One of the lesser known beneficial side effects from this medications is that it empties your stomach faster. So by keeping your stomach juices from coming up, your throat will feel better relatively quickly, sometimes working faster than what you’d expect from typical antibiotics. The problem with this medication is that it only works sometimes in some people, and the effect begins to wear off after a few doses.
Notice how for many people, cold and sinus “infections” always start in the throat, with a tickling, sore throat, mucous accumulation, hoarseness, cough and post-nasal drip, all of which are symptoms of throat acid reflux. Then as swelling in the throat worsens, more and more juices are brought up into the throat, causing more swelling. If you have larger than normal tonsils, then the narrowing in your throat will be more severe and you’ll stop breathing more and more often. If this process continues, the end result will be the classic bronchitis or sinusitis.
Normally, tonsils shrink down to very small glands by the time you’re an adult, but for some people, they stay enlarged. One possible explanation is that they are subjected to repeated bouts of inflammation from stomach juices, and the large tonsils can bring up more stomach juices.
A Rite of Passage?
In the 50s to 70s, it was a given that if you had tonsils, they were removed. The number of tonsillectomies has dropped significantly since then, but more recently, it’s climbing back up. The main reason for tonsillectomy back then was for recurrent infections, but now obstructed breathing is the most common indication.
We now know that even mild degrees of sleep-breathing problems in children can cause a wide range of problems, from bed-wetting and ADHD to behavioral issues and asthma.
A recent study published in the journal Pediatrics showed that about 50% of children with ADHD could be cured with adenotonsillectomy (this is when you remove both the adenoids and tonsils). Countless studies report significant improvement in children’s cognitive, behavioral, memory and sustained attention scores, after tonsillectomy. Even my son Jonas had dramatic improvements after his tonsillectomy.
Not all children with ADHD have a sleep-breathing disorder, but since it’s such a common condition that can be treated, it’s worthwhile to at least consider it if your child has ADHD. People are always asking why a stimulant medication such as Ritalin helps children focus and remain calmer. The answer is that they’re sleepy.
Poor quality of sleep can also heighten a child’s senses and cause abnormalities in their involuntary nervous system, making him or her have balance problems or become hypersensitive to certain sensory forms of input, such as touch, sounds or odors.
The Truth About Tonsillectomy
Unfortunately, not all children who undergo tonsillectomy improve. A recent meta-analysis combining multiple tonsillectomy studies showed that overall, about 2/3 had significant benefit. Some children do somewhat well, but not as well as some others. The explanation here is that the tonsils are not the only part of the equation. By definition, if your tonsils are large, then your jaws will be smaller. I’ve mentioned in my book, Sleep, Interrupted that modern humans have smaller jaws than our ancestors even a few hundred years back, mainly due to a change in our diets (from organic foods off the land or oceans to processed foods with refined sugars). Bottle-feeding is another modern Western phenomenon that has been shown to aggravate this process. If you have smaller jaws to begin with, you’ll have more inflammation in your throat via the mechanism that I described earlier, which will predispose your tonsils to become enlarged. Having large tonsils will cause more obstructions, causing a vacuum effect, which can also narrow your jaws, especially since a young child’s jaws are relatively soft and malleable.
A recent study showed that compared with tonsillectomy alone, orthodontic palatal expansion was equally effective. When both procedures were performed, the results were additive. This study goes to show that dental and orthodontic issues may be important considerations long before parents consider braces for their teens.
Outgrowing Your Tonsils
Some of you may be asking, if the tonsils are an important part of the immune system, why take them out? Most of the early education of your immune system occurs before age 6. Either during this time, or even long afterwards, if your tonsils are so large that they literally obstruct your breathing at night, then wouldn’t you think that this is a more important issue that needs to be dealt with? Doctors will also say that children will “grow out of it.” Yes, in most cases, they will, but based on all the recent studies, there’s plenty of evidence that before they “grow out of it,” there can be potential long-term consequences, including your risk for developing obstructive sleep apnea, heart disease, heart attack and stroke later in life.
I once heard a presentation at a national sleep meeting, where they showed children who underwent tonsillectomies all improved dramatically. The disturbing finding from this study was the fact that compared with children who did not have sleep-breathing issues, the children who underwent tonsillectomies never fully caught up to the control children in terms of cognitive and behavioral measures. What this implies is that there’s some degree of permanent brain damage. Fortunately, children’s brains are highly adaptable, and can compensate very well.
By no means am I advocating routine tonsillectomies for all children. But if your child has any of the issues that I talked about in this article, or if you’re on the fence about whether or not your child should undergo some type of treatment, these issues are definitely worth thinking about.