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Obstructive Sleep Apnea And Hearing Loss

I’ve always suspected that nerve deafness may be one of the consequences of obstructive sleep apnea, but there’s been little research in this area. However, a new study out of Korea shows that in the elderly, having obstructive sleep apnea significantly increases your chances of have nerve deafness, particularly due to a problem in the central nervous system.

This finding is not surprising, since sleep apnea causes a hyper-coagulable state, with blood being more stagnant and tending to clot, in addition to additional inflammatory factors that can cause damage. It’s also been shown that blood is thicker and more viscous in people with sleep apnea. In fact, a recent study showed that people with obstructive sleep apnea had thicker blood than normal, and by diluting the blood concentration with saline, auditory brainstem reflexes improved to the point of being normal. Placing these people on CPAP also normalized hearing reflexes.

Recent brain imaging studies have shown that hypoxia in the brain from sleep apnea can cause major vascular and tissue damage, affecting critical areas of the brain, including the brainstem. The risk of stroke is also increased by more than 3 times if you have sleep apnea. Knowing all this, it’s not surprising that you can have either brainstem damage or peripheral inner ear vascular damage from untreated obstructive sleep apnea. One study showed that people with sudden one sided hearing loss from nerve damage have a higher risk of having sleep apnea.

I think that nerve deafness is part of the cardiovascular-metabolic process, going along with hypertension, diabetes, hypertension, high cholesterol, and heart disease. What you you think? If you have sleep apnea, do you have any hearing loss?

New Year’s Day Heart Attack Rates Soar

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.

Did My Father Die From Sleep Apnea?

My father died a few months ago from metastatic prostate cancer. Looking back on the series of events that occurred before his death, I’m wondering if it was really from Alzheimer’s Disease aggravated by sleep apnea. Let me explain…

About 4 weeks before his death, my father was a vibrant and young 78. He took classes with undergraduates at Hunter College, performed in a musical theater group, sang in his church choir, played tennis, swam, and and went hiking up a mountain every week. He was originally diagnosed with prostate cancer over 10 years ago, but was in remission until recently, when it finally surfaced in his lower spine. He underwent radiation therapy, which was an ordeal for him, but he managed to fight through it.

One day, we got a call from the hospital ER saying that my father was admitted after begin found unconscious on the sidewalk. A CT of the brain was reported as being normal. Before this, he was completely coherent, and mentally very sharp. After this hospital admission, he kept going in and out, not being able to express himself, and not even remembering who his children were. Over the next 2 weeks, his condition deteriorated even further, and eventually passed away in a wonderful hospice, Calvary Hospital.

During his last few days, he would sometimes talk as if he were a 5 or 6 year old. He even stopped recognizing his family members. During these last two weeks, although not official, he had classic symptoms of Alzheimer’s-like dementia.

I’ve also always suspected that he had an undiagnosed sleep-breathing problem, with very loud breathing and an open mouth during sleep. We know that untreated obstructive sleep apnea can thicken your blood, making it much more viscous, and more likely to stagnate and clot. Sleep apnea patients have increased inflammatory markers such as TNF, IL-2, IL-6, and many others. Cancer is also thought to cause a hypercoagulable state. He also has two other risk factors for sleep apnea: older age and having an Asian facial structure.

Something must have happened that day when my father was walking down the street. He must have clotted or damaged a critical part of his brain that’s responsible for short term memory and face recognition. Whatever happened, it wasn’t large enough to show up on his head CT.

It’s been shown that untreated obstructive sleep apnea can cause brain damage in many different ways. This includes multiple mini-strokes throughout the brain, and lowered gray matter density in parts of the brain that includes memory, executive function, and autonomic nervous system control.

I’m convinced that all modern human’s inability to breathe properly as we get older is a major factor in how quickly we age or develop illnesses. Many of the chronic medical complications or conditions that we die from can be shown to be directly or indirectly related to sleep-breathing problems.

Ask Dr. Park: Neurologic Complications of Sleep Apnea

We already know that obstructive sleep apnea can cause stroke, but can it can also cause central sleep apnea, MS, or even Alzheimer’s? How can it lead to various other unexpected conditions such as ADHD, migraines, headaches, dizziness, lightheadedness, various stomach ailments, and even ringing, hearing loss, or vertigo?

Heavy Smoking Found to Increase Dementia Risk—Through Sleep Apnea?

Heavy smokers were found to have more than twice the risk of developing dementia later in life. This study was published recently online in the Archives of Internal Medicine. Besides all the known detrimental effects of smoking in general, nicotine is known to relax the lower esophageal sphincter. This can lead to increased reflex, and what happens when your stomach juices reach your throat? It causes inflammation and swelling, promoting more frequent breathing pauses, especially if you’re on your back and in deep sleep, when your muscles are most relaxed.

Furthermore, the presence of acid in your throat can desensitize chemoreceptors, which can diminish the protective mechanisms that help you to wake up and swallow, so you don’t aspirate your stomach juices into your lungs.

More frequent obstructions as well as prolonged breathing pauses eventually lead to periods of oxygen deprivation to your brain, which leads to inflammation and ultimately brain damage. It’s actually been shown experimentally in mice that chronic hypoxia leads to beta amyloid plaques in the brain. Untreated sleep apnea patients are also found to have multiple areas of brain tissue volume and density in critical areas that control memory, executive function, motor control and involuntary functions.

Notice that heavy alcohol use is also linked with dementia (from muscle relaxation). The combination of alcohol and smoking is a deadly mix. Risks for throat cancer go up exponentially if you add significant alcohol to chronic smoking.

We also know that obesity is linked with an increased risk for cancer. Obesity is definitely linked with obstructive sleep apnea. Obstructive sleep apnea is linked with cardiovascular disease, especially stroke. Anything that increases your risk of obstructive sleep apnea can increase your risk for dementia.

Just thinking outside the box here, but what if your lungs were to be chronically irritated by stomach juices? Could it cause or aggravate asthma, coughing, COPD, or even cancer?

What are your thoughts on my hypothesis? I’d like to hear your opinion.

Bad News For Alzheimer’s Disease

Here’s an article in the New York Times that describes why scientists are baffled as to why we’ve made essentially no progress in preventing or treating Alzheimer’s disease, despite all the recent advances in understanding this all-too-common condition. Could it be because our fundamental explanation for Alzheimer’s is wrong to begin with? Researchers are convinced that buildup and accumulation of plaques in the brain is what causes this condition and that by preventing its’ buildup, we can better control this disease. So far, nothing has worked. No surprises.

This general paradigm of Western medicine is that if you can lower your numbers (cholesterol or blood pressure), or prevent buildup of plaques in your blood vessels or brain, then you can supposedly “cure” the disease. But this is the fundamental problem with Western medicine. Every medicine that we use for chronic medical conditions only covers up the end result, rather than treating what’s actually causing the problem: our stress-filled modern lives, poor diet, lack of exercise, and poor breathing at night. Yes, lowering your cholesterol may lower your risk of heart disease by 10%, but at what cost? Side effects such as liver toxicity are routine in various cholesterol medications. In the same way, side effects from the various Alzheimer’s drugs are also very common.

Knowing what we know about the effects of untreated obstructive sleep apnea on the brain, and with the HUGE number of untreated sleep apnea patients, it’s time that sleep apnea researchers and Alzheimer’s researchers begin talking to each other.

Should scientists continue to go figure out ways to block amyloid plaque production, or should they be looking for an alternative explanation, such as obstructive sleep apnea? I’d like to hear your opinion. Please enter your comments in the box blow.

Lou Gehrig, Head Trauma, & Sleep Apnea

A recent study showed that head trauma can sometimes mimic Lou Gehrg’s disease (or amyotrophic lateral sclerosis – AML). This condition was named after the famous New York Yankees baseball player that develop muscle weakness, paralysis and eventually, death. The journalist displayed a vintage photo of Gehrig just after being knocked unconscious by a runaway pitch.

Knowing what we know about the effects of untreated obstructive sleep apnea, you could say that any type of brain injury, whether due to blunt head trauma, or small to large vascular events, cannot be good for memory, breathing, executive function, and motor control. But these are the same areas that are known to be affected when someone has untreated obstructive sleep apnea.

Chronic hypoxia causes inflammation and clotting in small vessels. One study showed that sleep apnea patients have much thicker blood, and that ear-brain reflexes where diminished, but improved after treatment. Hypoxic conditions in mice have been even shown to produce amyloid plaques—the same thing that’s seen in Alzheimer’s disease.

We also know that sleep apnea patients have much higher number of lacunar infarcts than people without, as well as having anywhere from 3-5 times increased risk of stroke. I would think numerous small strokes added together over years could lead to at least some degree of brain dysfunction.

It’s also safe to assume that if you have head trauma, having obstructive sleep apnea can prevent proper healing and regeneration.

Given all this, isn’t it possible that when a certain part of the brain is “injured” due to obstructive sleep apnea, depending on where it occurs, you’ll get various symptoms that correspond to where it’s happening? For example, we know that in sleep apnea patients, brain density, volume and metabolism are significantly diminished in areas that control breathing, respiration and autonomic control. What if you clotted a small vessel that feeds this area? Could it lead to central sleep apnea? What if you damage areas that produce dopamine, or hypocretin? Could this process lead to symptoms that mimic Parkinson’s or even narcolepsy? What if you had fluctuating areas of diminished blood flow that returns to normal? Could this lead to symptoms that are similar to multiple sclerosis?

I realize that much of this may be a stretch, but it never ceases to amaze me how devastating obstructive sleep apnea can be to the brain, no matter how mild it may be.

What do you think about my theory? Is it plausible, or too far fetched of an idea? I’d like to hear your opinions about this.

Can Sleep Apnea Cause Psoriasis?

How is psoriasis connected to obstructive sleep apnea? You may think I'm crazy for even making the suggestion, but if you look at the studies, the results don't lie—you just have to connect the dots.

I've always wondered about this link, since almost every known medical condition is proven to be or possibly associated with obstructive sleep apnea. I was reminded about this connection when I read about golfer Phil Mickelson's psoriatic arthritis. I already commented on the association between sleep apnea and arthritis, and this time, I'm going to show you that psoriasis may be connected as well.

First of all, numerous studies have shown that people with psoriasis have a much higher chance of having cardiovascular disease. There are other reports that psoriasis is associated with an increased incidence of cancer, lymphoma, obesity, metabolic syndrome (also known as "Syndrome X"), autoimmune diseases (Crohn's disease and diabetes, etc.), psychiatric diseases (such as depression and sexual dysfunction), psoriatic arthritis, sleep apnea, personal behavior issues, chronic obstructive pulmonary disease (COPD).  If you have severe psoriasis, the likelihood that you'll have a heart attack is 3 times normal. Your chance of dying overall is almost doubled than if you didn't suffer from this condition. Average life expectancy is about 3 to 5 years shorter for someone with psoriasis.

We also know that obstructive sleep apnea can cause metabolic syndrome, hypertension, diabetes, high cholesterol, inflammation, heart disease, heart attack, and stroke. Your risk of dying early increases 45% if you have severe obstructive sleep apnea.

There's even a case report of someone with severe psoriasis who was completely cured after undergoing gastric bypass surgery for obesity.

Here's my take on the connection between obstructive sleep apnea and psoriasis: The chronic stress response and repeated episodes of hypoxia deprives the skin of vital blood flow and nutrients. Sympathetic activity overload preferentially shuts down certain parts of the body that are considered unessential, such as the digestive system, reproductive system, and the skin. In addition, chronic low-grade stress also causes your immune system to overreact and cause inflammation, inducing various self-destroying tendencies that are common with autoimmune conditions.

What do you think about this possible connection? I'd like to hear your opinion.

Migraines, Heart Disease & Sleep Apnea

I was going through the NY Time's excellent Patient Voices blog and multimedia piece on migraine (see my comments #30, and #584), and was reminded that people who have migraines are at a higher risk of cardiovascular disease later in life. In this 2006 study from JAMA, women who have classic migraines had significantly higher risks for major cardiovascular disease, ischemic stroke, heart attack, coronary revascularization, angina, and ischemic cardiovascular disease death. 

This is not too surprising since most migraineurs have upper airway resistance syndrome or obstructive sleep apnea, and we know that obstructive sleep apnea can significantly increase your chances of suffering from heart disease, heart attack, or stroke.

If you have migraines, does your mother or father snore or have cardiovascular disease?

Brain Injury And Obstructive Sleep Apnea

 

I recently came across a study what showed that people who suffer from strokes have much more difficulty recovering brain function if they have obstructive sleep apnea. This makes total sense. Once you have brain damage of any type, having chronic hypoxia and blood stagnation can definitely prevent proper healing. This study assumed that only some people who have strokes have obstructive sleep apnea, but numerous studies show that the vast majority of stoke patients have undiagnosed obstructive sleep apnea. We also know that having obstructive sleep apnea significantly increases your chances of having a stroke by up to 300%. 

With recent increased awareness of traumatic brain injury in football players as well as in returning war veterans, it's important to at least screen for undiagnosed obstructive sleep apnea with both of these groups for people, early, rather than after the damage is done. Knowing that about 1/4 of all men will have at least mild sleep apnea, looking for and treating an underling sleep apnea condition can improve recovery after any form of brain injury, not to mention prevention of further brain injury and impairment. 

What years of do think about my theory? Is it plausible, or am I just over-hyping sleep apnea?

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