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Why Mothers Are So Tired

Mother's Day has come and gone, and despite the short respite that many mothers received from their loved ones, most mothers are in a constant state of exhaustion. There are many explanations for why this is so, including the demands of modern society, family, career, and so on. But as many fathers will argue, these are the same issues and challenges they face. For women however, there are a number of internal, or physiologic factors that can not only contribute to but sometimes cause women, more so than men, in general to be tired all the time.

Blame It On Hormones…Or Your Anatomy?

We all know about hormonal issues, which has been blamed for everything from PMS and menopause to infertility issues. But one relatively unknown fact that most doctors don't know about is that progesterone is an upper airway muscle dilator. Essentially, it stimulates the tongue, giving it more muscle tone. How is this relevant to how much energy you have?

Modern humans have a number of anatomic issues that makes us predisposed to breathing pauses at night, especially when in deep sleep, due to muscle relaxation. Since our voice boxes are lower in the neck beneath the tongue, our tongues can fall back easily due to gravity, especially when on our backs. Add REM sleep (the dreaming stage) along with muscle relaxation, and the more likely you may stop breathing.

Modern humans are thought to have shrinking jaws with dental crowding due to a major shift in our diets. We went from eating completely off the land (ripping, shredding, grinding, chewing) to eating soft, mushy foods with relatively little nutritional value. Bottle-feeding (another modern, Western invention) is also thought to aggravate dental crowding and malocclusion. The smaller the jaws, the less room there is for the normal-sized tongue, which predisposes it to breathing obstruction at night.

So the less progesterone you have, the more likely your tongue will relax and obstruct your breathing, causing you to wake up and turn over. This condition prevents you from staying in deep sleep. Most people with this condition will naturally like to sleep on their sides or stomachs to compensate.

Life Changes That Aggravate Deep Sleep Deprivation

There are a number of life changes in a woman's life that promote more frequent obstructions and arousals, leading to increased fatigue and tiredness. During a woman's monthly periods, estrogen and progesterone cycles up and down. The week before she has her period, progesterone drops, leading to a temporary state of deep sleep deprivation, leading to a low-grade state of physiologic stress. This also causes a heightening of the involuntary nervous system, leading to heightened senses, irritability and moodiness.

During pregnancy, progesterone naturally increases significantly. As women gain 20 to 40 pounds during pregnancy, they would be expected to develop sleep apnea, but most don't. One major reason is that progesterone helps to protect the upper airway, by tensing the tongue, despite the added throat narrowing from weight gain. But once mom delivers, progesterone drops, and she's left with all the weight. This only adds to the chronic fatigue, depression and problems with weight loss in the post-partum period for most women.

Similarly, long before menopause begins, progesterone begins to slowly drop beginning the late 30s and early 40s. This leads to a slow and gradual lessening of the woman's sleep efficiency. Later on as the drop intensifies, the relative changes in the involuntary nervous system causes the typical symptoms of menopause such as night sweats, hot flashes, mood swings, weight gain and irritability. Once the hormonal changes stabilize, the symptoms get better.

The Effect of Estrogen Dominance

Like everything else in life, balance is key. The relative proportions between estrogen and progesterone has a huge impact on a woman's sleep quality. With the advances in science, medicine, and industrialization, this delicate balance between these two hormones has been  significantly altered.
 
One major shift comes from oral contraceptives. Despite the potential benefits of birth control pills, having excess estrogen of any type can suppress progesterone levels or functional status. Synthetic variants of estrogen are much more powerful than what the body normally makes. There are various combinations of synthetic and bio-identical estrogens and progesterones that are used, but it's safe to say that the overall relative balance is never perfect.

In addition, many of the byproducts of industrialization produces chemicals that can mimic estrogen. Up until recently, Bisphenol-A (or BPA) has been used in plastics that are found in most plastics, including baby bottles. BPA and many other chemicals are though to leech into our environment, acting as endocrine disruptors. There are various reports of earlier onset of puberty and breast development (premature thelarche) in young girls compared with even 10 years ago.

Blame It on Stress

One of the major consequences of inefficient sleep is a physiologic form of stress. Your body thinks it's under attack all the time. This causes hormonal and neurologic changes that not only increases cortisol, it also heightens your involuntary nervous system. It also makes you more hungry in general, with cravings for fatty,  sugary or high-carb foods. This can lead to weight gain, which is hard to get rid of since you're not sleeping well.

Your body also doesn't care where stress comes from. Modern life is full of stresses including family and career obligations, along with the typical financial and health considerations. Any degree of external stress whether it's physical, psychological or emotional stress, can also aggravate any internal stress that's going on.

This is why you should do whatever you can do to help your mother feel loved and more relaxed. Mothers have lots of reasons to feel stressed, sleep deprived, and just plain tired all the time. Now you know the reason why.

Breathing Lessons for Sleep Apnea Sufferers

Proper breathing is fundamental to good health and vitality. It's also the most basic physiologic function that we must do to survive. Improper breathing can lead to illness, disease, and ultimately, death. Ancient Hindu cultures recognized this basic principle and developed very sophisticated breathing techniques that we now realize are scientifically sound when it comes to promoting optimal health, energy and life balance. These breathing concepts have spread across various continents to different cultures, but the basic fundamental principles remain the same. What Most Holistic Doctors Already Know Breathing means spirit in many languages (Hebrew, Latin, Greek, and Sanscrit), but not in English. In Latin, the word for breath and the word for soul are the masculine and feminine roots of the same root. In Greek, the two words are the same. Breathing is a natural physiologic function which continues, regardless of whether or not you notice it. It's controlled by two parts of the autonomic nervous system: the sympathetic and parasympathetic nervous systems. The sympathetic nervous system is the classic fight-or-flight half that's needed if you're in a fight or running from a tiger. The parasympathetic nervous system is the relaxation half, promoting sleep, digestion and reproduction. Inhalation is activated by the sympathetic nervous system and exhalation is activated by the parasympathetic part. When you slow down your breathing, your heart rate slows down. If you take a little longer exhaling relative to inhaling, then you're spending more time activating your parasympathetic nervous system. This is the physiologic reason why breathing techniques such as the relaxing breath is literally relaxing. These same concepts also apply to singing, humming or whistling. Notice that when you sing, you're spending up to 10 to 20 times longer exhaling relative to inhaling. By activating your vagus (parasympathetic) nerve, this is why you feel good when you sing. What Some Doctors Don't Know We all take it for granted that the physical air passageways that we breathe through is more than sufficient as conduits for air to travel into and out of our lungs. However, our upper air passageways are dynamically changing all the time, depending on your head position, weather status, allergies, emotions, moods, stress levels and even what you just had for lunch. Your nose is exquisitely sensitive to pressure or humidity changes, swelling or shrinking your internal nasal turbinates to significant degrees. Air passing through the nasal cavity is being filtered, humidified, and warmed before passing into the lungs. Any temporary or permanent blockage to proper breathing in this area can prevent optimal airflow into the lungs. In addition, the nose and sinus cavities make a gas called nitric oxide, which has two important beneficial properties. The first property is that nitric oxide is antimicrobial, both in the nose as well as in the lungs. This gas, when inhaled even in small amounts into the lungs, can increase oxygen absorption up to 20%. Not breathing through your nose for whatever reason has potentially detrimental effects on your health. What Most Doctors Don't Know Everyone in the Western, alternative and complementary fields of healing naturally assume that we are able to breathe properly at night. We now know that there are certain medical conditions such as sleep apnea where you have complete obstruction and repeated bouts of oxygen deprivation. Most practitioners still think that this typically occurs in some people who are overweight, snore, and have big necks. But now we know that even young, thin women who don't snore can have significant obstructive sleep apnea. Even more, many people who don't officially meet the criteria for obstructive sleep apnea still can have significant breathing pauses but wake up too quickly to be classified as an apnea. These are the patients that are commonly diagnosed with idiopathic hypersomnia. However, the bigger issue is that by definition, all modern humans are susceptible to breathing problems at night for the following reason: Due to jaw narrowing and dental crowding from a radical change in our diets, our tongues take up relatively too much space, and as a result, we're more susceptible to obstructing the airway when sleeping on our backs (supine) and in deep sleep due to muscle relaxation. In his classic nutritional text, Nutrition and Physical Degeneration, Dr. Weston Price documented these physical changes. Our ability to talk also positioned our voice boxes below the tongue, which can aggravate this process. Many modern humans can't sleep on our backs anymore since the tongue and voice box falls back the most in the back position. As a result, we compensate by sleeping only on our sides or stomachs. The problem is that it's not good enough. A simple cold or an allergy attack, or with even 5 to 10 pounds of weight gain, can cause more frequent obstructions occur, leading to less efficient sleep. Less efficient sleep leads to a physiologic stress response that can cause or aggravate a number of various medical conditions such as anxiety, depression, insomnia, cold hands, digestive problems, high blood pressure, etc. What I describe in my sleep-breathing paradigm is that all modern humans are on a continuum, where the one extreme end is called obstructive sleep apnea. The rest of us are lower down, but we creep up during various life stages, such as puberty, pregnancy, and menopause. A simple cold, by causing nasal congestion in a young, healthy woman, can cause her to toss and turn at night, due to repeated tongue collapse. Once the cold improves, sleep improves as well. What We All Must Know Breathing should never be taken for granted. We must do everything to make sure that proper breathing occurs not only during the day, but also at night. Many younger, thinner patients who complain of being tired all the time will also be found to have hypothyroidism, anemia, cold hands and feet, low blood pressure, anxiety, depression, or other various disorders. Later in life, as they slowly gain weight, they move up the continuum, and eventually will go into obstructive sleep apnea. Almost invariably, one or both parents will snore and have known or unknown cardiovascular disease. If you see a high-arched hard palate, an extra small mouth or a recessed jaw, or scalloping on the side of the tongue, ask about sleep position, fatigue issues, and sleep. You'll be surprised how often all these features come together to explain your chronic fatigue and various health problems.

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To hear Dr. Park's interview with master Yoga teacher and Feldenkrais expert on the proper principles of breathing for better health and better sleep, click here.

Which Comes First, Sleep Apnea or Stress?

Sleep apnea is a major cause of physiologic stress. External stress of any kind (especially the holiday season) only aggravates the internal, physiologic stress that I describe in people who don’t sleep well.

To help you better manage your stress this holiday season, I’ve invited Dr. Niloo Dardashti, an integrative psychologist and holistic healer for this month’s expert interview, and I hope you’ll dial in and join us.

During this free information-packed hour, you’ll learn:

- What’s the interaction between stress, sleep problems and heart disease?

- What are some techniques for quieting "inner chatter" when stress has its’ hold on us?

- How can I stop unwanted thoughts?

- Which comes first – the chicken or the egg – does lack of sleep cause stress, or does stress cause lack of sleep?

- How can stress be handled returning to work after holidays or vacations?

- What are Dr. Dardashti’s thoughts on ADHD, Adderall and stimulants, especially for someone who has both anxiety and sleep apnea?

- How can I quit smoking if I’m very stressed and exhausted?

- What’s the best way of controlling work related stress?

- How can one reduce stress during a very stressful situation, such as being stuck in a large crowd, for example?

- How can I deal with being short on cash?

Tuesday, December 15th, at 8PM Eastern.

Register here to receive the call-in details.

Breast Cancer and the Sleep Apnea–Alcohol Link

I’ve been accused in the past of of trying to link everything to sleep apnea. While not everything is caused by sleep apnea (taxes, the weather, etc.), I can make a good argument that not breathing properly during the day and while sleeping can directly or indirectly affect every aspect of our state of health and well-being. Obstructive sleep apnea is only a small fraction of what I describe in my sleep-breathing continuum. Due to the way we define sleep apnea, you can have major sleep-breathing problems and not have any sleep apnea. 

 

Along these lines, here’s something interesting to think about: Can a sleep-breathing problem cause or aggravate breast cancer?

 

Drinking alcohol was found to increase a woman’s risk of not only developing breast cancer, but also increase the risk of developing recurrence in breast cancer survivors. In a recent study from Kaiser Permanente, women who drank 3-4 glasses of wine per week were 34% more likely to develop a recurrence compared with women who drank little to no alcohol.

 

The researchers speculated that alcohol can increase levels of estrogen, which increases metabolism. However, they didn’t have a clear explanation for these findings. What’s more relevant to this discussion is the fact that post-menopausal women and overweight women who drank were at higher risk for recurrence.

 

Like many other studies, researchers never commit themselves to state that one thing causes another—they can only state statistical likelihood of an association, but not causation. 

 

Similar finding are being reported with prostate cancer—that heavy alcohol consumption and being overweight increases your risk of recurrence.

 

Here’s my interpretation of these findings: Alcohol is a strong muscle relaxant that’s usually taken with dinner or later in the evening. Muscle relaxation during deep sleep causes more frequent obstructions in your breathing, which can cause or aggravate existing sleep apnea. The resulting activation of the sympathetic nervous system leads to a relative hypoxic environment in preferential body parts and organs, such as the gastrointestinal system, the reproductive system, the skin, and the hands and feet. 

 

Since the breast is a combination skin and reproductive structure, it’s more susceptible to various levels of hypoxia. Physiologic stress that develops in sleep apnea constricts blood vessels that feed blood into the breasts. This is also why many women with breast cancer also have cold hands and feet.

 

As I’ve described in my book, Sleep, Interrupted, hypoxia creates chemical mediators that tell the body to send more blood. One particular substance is vascular endothelial growth factor, or VGEF, which promotes new vessel formation and more aggressive tissue growth and regeneration.

 

Menopause is stage in life in a woman’s life where progesterone slowly diminishes, leading to more and more frequent obstructions and arousals (since progesterone promote tongue muscle tone). Furthermore, inefficient sleep can promote weight gain. Weight gain narrows the throat, leading to more frequent obstructions. Women’s rate of cardiovascular disease also increases significantly after menopause, along with a significant increase in obstructive sleep apnea. We know that sleep apnea can cause heart disease, but so far, these conditions are treated separately. It’s not surprising that breast cancer is treated independently, rather than looking at the bigger picture. 

 

Granted, this is an unorthodox explanation for breast cancer, but as Einstein once said, "The significant problems we face cannot be solved at the same level of thinking we were at when we we created them." In other words, we must think outside the box.

 

What I’m proposing doesn’t contradict traditional explanations for breast cancer. Rather, it’s a different perspective that can only complement existing treatment options.

 

What you do think about this explanation? Please enter your responses in the box below.

How Sleep Apnea Can Cause Anxiety And Panic Attacks

As we approach the most stressful time of the year, the one thing that we all forget to do is to remember to breathe. Literally. Tension and stress causes a nervous system reaction that causes you to take short, shallow breaths, leading to carbon dioxide (CO₂) retention. Interestingly, a recent study showed that increased levels of carbon dioxide has been shown to affect areas in the brain that triggers fear and panic attacks.

 

This makes sense since if you’re chronically oxygen deprived from not breathing at night due to sleep apnea, you’re going to build up carbon dioxide, which can increase the acidity levels in the amygdala, which is the area of the brain that processes fear and behavior. 

 

This biochemical reaction, along with generalized nervous system over-responsiveness that comes along with inefficient sleep, is a good reason for you to feel over-stressed, over-anxious, and on edge. I’ve also described a situation where your tongue suddenly collapses and obstructs your breathing, and you’ll wake up violently, in a state of panic, in a cold sweat, and with your heart racing. This happens much more commonly than you think.

 

This study makes me wonder what all the carbonated beverages are doing to us as a society.

 

What’s you’re take on this? Do you find yourself taking short, shallow breaths or even hold your breath when you’re stressed? Please enter your comments in the box below.

Why Sleep Apnea Increases During the Holidays

It’s the Saturday after Thanksgiving, and I have to admit, I’m not feeling too well today. I had my usual two servings of turkey Thursday evening. For some strange reason, I had three pieces my other sister-in-law’s coconut cake, and as usual, this Thanksgiving dinner was much later than my usual dinner time. The next morning, I slept in a little later, but still didn’t feel as refreshed as I normally would. Later that day, I spent the day with my two older boys, Jonas and Devin at the Intrepid Museum. For some odd reason, I was craving toffee that Devin had brought, I was was eating one every 30 minutes. This morning, I was feeling even more tired than normal, and during lunch, I was craving soda or some other sugary drink, which I normally don’t drink.

I finally realized that eating sugar, and over-eating later than normal on Thanksgiving lessened my sleep efficiency that night, which raised my craving for sugar the following day. This just goes to show how powerful even mild sleep deprivation can cause a rise in sugar cravings, which if chronic, can lead to unhealthy eating habits, ultimately leading to weight gain. Stress (emotional, physical or mental), is also known to increase cravings for sugary, fatty, or "comfort" foods. And weight gain is known to worsen sleep apnea. (To listen to an interview I did with Peter Lappin on how you can Beat the Sugar Habit Before It Beats You, click here.)

The holiday season is known to be the most stressful time of the year, with all the over-eating due to holiday parties and late night dinners. This is why the rate of heart attacks is also the highest during this time of the year. Knowing what I’ve described, we should all take appropriate measures to eat more sensibly (and earlier), drink alcohol in moderation (and earlier during the evening), and do everything that’s reasonably possible to reduce your stress levels. Find out how you can do this by joining me on December 15th, when I interview Dr. Niloo Dardashti, an integrative psychologist and holistic healer on 10 simple ways to reduce stress.

I’m sure if we had a collective sleep apnea meter that measures the total amount of sleep apnea in this country, it will most likely be at its’ peak level during the next month.

How are you going to address this issue, if any, this holiday season? Please enter your response in the comments box below.

 

 

Swine Flu Hullabaloo

Have You Checked Your GABA Levels Lately?

GABA is a neurotransmitter that shows up once in a while that’s linked to a number of various medical and psychiatric disorders. One of the more recent studies was published in the 11/08 issue of Sleep (a summary can be seen here). Chronic insomniacs were found to have 30% less GABA activity in their brains. This finding could be misinterpreted to imply that because of low GABA levels, people can have insomnia. Let me explain.

GABA is one of numerous neurotransmitters in the brain that sends messages from one part of the brain to another. High GABA levels are associated with a calming, relaxing effect, whereas low levels are associated with anxiety and stress. Conventional wisdom says that if this is true, let’s increase GABA levels with supplements. The same can be said for various other neurotransmitters, hormones or vitamins that we use as supplements. In many cases, replacing what’s missing can certainly help, but you’re still not addressing what’s actually causing the lowering of these substances. 

If you look in the research literature (and on the internet), you’ll see many studies linking stress and low GABA levels. Another study showed that practicing yoga increases GABA. This is why any method or discipline that is calming or relaxing can raise your GABA levels. So it’s not a lack of GABA that gives you insomnia, per se, but there’s something else that is causing insomnia and low GABA levels.

This is a problem that we see with almost every area of modern medicine, where we’re great at finding associations, but not very good at solving the root of the problem. 

The common thread with all these studies goes back to stress. Yes, we have many different types of stress in our lives that can lead to insomnia (financial, work, family, poor diets, toxins, etc.), but what I’m suggesting is the possibility that due to our unique upper airway anatomy, all of us are somewhat susceptible to physiologic stress due to an inability to breathe properly at night. External stresses (psychologic, emotional and physical) can also aggravate this internal, physiologic stress.

The extreme end of this spectrum that I describe is called obstructive sleep apnea. But even if you’re "normal," having a narrowed upper airway anatomy can predispose you to microbstructions and arousals, leading to a physiologic state of hyperarousal. These people won’t officially meet the criteria for sleep apnea. Many of these people will also not be able to sleep on their backs, since that’s when the tongue falls back the most, due to gravity.

If you measure neurotransmitter levels in these patients, of course they’ll have abnormalities. This is why chronic insomnia is linked later in life to so many other medical conditions such as depression, diabetes, hypertension, and heart disease. Notice that these are all complications of obstructive sleep apnea. 

This is not to say that we should stop everything we do to treat insomnia. Cognitive Behavioral Therapy (CBT) is a great way to calm the mind and develop good sleep habits. It’s even been found to work better than sleeping pills. My only concern is what happens to these people many decades later, even if their insomnia is initially cured.

Can The Recession Make You Fat?

There’s been a lot of press recently about how the current economic situation is causing people to lose sleep. According to a recent National Sleep Foundation poll, 16% of Americans report losing sleep at least a few days in the past month due to the current financial situation. Another 15% are worried about the economy, and 10% are anxious about losing their jobs.

Lack of sleep for any reason and stress go hand in hand. One aggravates the other. Physiologic stress that develops as a result of inefficient sleep causes hormonal changes that can cause you to gain weight. Any external stresses such as psychological, emotional, or physical stress can also aggravate internal physiological stress.

When cortisol is increased due to stress, your appetite is increased for fatty and sugary foods, or "comfort" foods. This sets off a hormonal chain reaction where as you gain more weight, the fat cells in your throat can narrow slightly, aggravating any underlying breathing problems that I describe in my sleep-breathing paradigm. This perpetuates more sleep disruption and the vicious cycle continues.

Have you gained any weight recently since the recession began?

Can Smoking Be Good For You?

Despite all the really bad known consequences of smoking, there’s one aspect of the act of smoking that may actually be beneficial. It’s been shown that it takes about 1-2 minutes for nicotine to go through the bloodstream and reach your brain which gives you that "relaxed" feeling. But what most smokers will tell you is that they feel better after the first 1-2 deep inhalations. Plus, since nicotine is a stimulant, how can it make you feel more relaxed?

 

I sometimes joke with my patients that in the typical workplace, the only people that get regular breaks are the smokers. Modern society has gotten rid of all the natural,  built-in breaks. So smokers, by going out of their stressful environments every few hours, are taking grown-up time-outs. Not only are they taking these "breaks," as they puff in the cigarette smoke, they are actually performing deep breathing exercises. They’ve associated the good feeling that they get with the physical act of smoking, which also happens to make you take some slow deep breaths. This is the concept that George Wissing describes in his fascinating book, Quit Struggle Free. 

 

By no means am I recommending that everyone who’s stressed go out and start smoking. But by using these concepts, you can get the same benefits of smoking without inhaling the toxic chemicals from cigarets. There are various resources for learning deep-breathing exercises, or take a yoga class.

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