Recurrent sinus infections, throat pain, ear fullness and chronic cough are some of the most common conditions that I see every day. You may think that I typically diagnose and treat for routine bacterial infections in these situations, but in most cases, they’re not really infections at all. What I do find, however, is that if you probe and look back at the patients’ history, there’s always some major life change or recent event that acted as a trigger for their symptoms, especially if their upper airway anatomy is already narrowed or predisposed. Here are 5 common examples:

 Sleepless nights from a newborn child

 The birth of a child is always a joyous event, but everyone knows that your life will change drastically all of a sudden. Your normal routines, eating habits, exercise regimens, and especially the timing for all these events will change. The sleep deprivation, lack of exercise, and bad eating habits can promote weight gain, which can narrow your throat even further. This leads to more problems breathing at night, leading to less efficient sleep, leading to more weight gain. This applies to both the mother and the father.

 It’s also a common phenomenon where a woman is never able to lose her pregnancy weight, despite extreme dieting or exercise. This leads to less effective sleep, increased fatigue, and various other health-related conditions. 

 Newfound independence, more depression

 The freshman 15 is more than just an observation—there’s a good reason why college students gain weight all of a sudden during their freshman year. Dorm meals and cafeteria food tends to be starchy and very high in calories, and because of the buffet-style format, there can be problems with portion control. Home-cooked meals by parents, eaten at relatively normal times (5 to 7 PM), turns into eating later in the night: more episodes of pizza, take out food, and late night snacks while pulling all-nighters for exams. 

 Having stomach juices when you go to sleep will allow more acid and other stomach materials to regurgitate into your throat, leading to more frequent arousals and less efficient sleep. This leads to a cascade of metabolic, hormonal, and cardiovascular consequences that promotes weight gain. Drinking alcohol at night relaxes the throat even further, leading to more frequent breathing pauses.

 This relative sudden change in your eating and sleep routines can definitely affect your mood and mental health. It’s not surprising that depression and anxiety peaks during the college years. This is also the time when the larynx (voice box) descends in the neck to its’ lowest position during maturation into adulthood. The lower your voice-box, the more the tongue can fall back, leading to more frequent breathing problems.

 A new job or a promotion

 It’s great to start a new job, or get that promotion that you’ve wanted. But just like any other major change in your life, your routines will change. You’ll stay later to impress your boss, skip meals, come home later and go to bed later. As a result, you’ll gain a few pounds. Some people can eventually adjust their schedules to accommodate a healthy sleep schedule, diet and exercise regimen, but others can’t. This is when things begin to go downhill.

 Injury or surgery

 Most people with sleep-breathing problems prefer to sleep on their sides or stomach. Any kind of injury or undergoing surgery can force you to sleep on your back, which causes more tongue collapse (due to gravity) and more obstructions and arousals (due to muscle relaxation in deep sleep). In fact, many patients have told me that their lack of sleep, physical activity and subsequent weight gain is what triggered a vicious cycle. 

 Menopause

 This applies mainly to women, but hormonal changes can affect men too. Loss of estrogen and progesterone can diminish their protective effects on the upper airway. In particular, progesterone is an upper airway muscle stimulant/dilator. As it begins to diminish in the early 40s, the tongue begins to relax more and more over the years, leading to less efficient sleep, and the typical vasomotor symptoms begin which includes hot flashes, night sweats, weight gain, mood swings, and irritability. Believe it or not, these symptoms can happen in young men, too. These are your body’s nervous system reaction to the changes with your sleep-breathing status.

As you can see, all of us will go through some or all of these events at some point in our lives. It’s natural as modern humans to be susceptible to these sleep-breathing related conditions. It may sound a bit depressing, but the good news is that now you’re aware of it, you can take preventive measures once it starts. 

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.

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.

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.

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.

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.

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?