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Hair Loss and Sleep Apnea?

This is what I posted to the NY Times Blog for an article on hair loss in women:

 

Hair loss in women is a serious condition with lots of conventional explanations. One area that's never mentioned is the connection to poor sleep quality, especially due to breathing problems at night. A significant percentage of men and women have undiagnosed sleep-breathing problems, with the end extreme being called obstructive sleep apnea. 

 

It's estimated that about 1/4 of all men and 1/10 of all women have at lease mild sleep apnea, and 90% are not diagnosed. However, there's a variation of sleep apnea called upper airway resistance syndrome (UARS), where you'll stop breathing while sleeping, but not long enough to be called obstructive sleep apnea. 

 

Typically these people (more typically thin women) will have colds hands or feet, prefer not to sleep on their backs, feel tired all the time, no matter how long they sleep, and will usually have at least one parent that snores heavily.

 

These multiple arousals lead to a chronic low-grade physiologic stress response which heightens the nervous system (and immune system). During times of stress, blood is shunted away from low-priority organs like the GI  system, reproductive organs, the distant extremities and the skin. Chronic lack of blood flow can lead to a number detrimental effects, including hair loss.

 

It's also been shown that chronic physiologic stress also raises your cortisol levels, lowers your thyroid levels, and alters your estrogen/progesterone/testosterone balance. 

 

There are also anecdotal reports of people who report hair regrowth after starting sleep apnea treatment.

 

If you have any of the symptoms mentioned above, you should get checked for UARS. In many cases, UARS progresses into obstructive sleep apnea, especially after menopause. Even if it doesn't help your hair loss, being diagnosed may prevent complications of sleep apnea, including hypertension, diabetes, weight gain, anxiety, depression, and heart disease.

A Link Between Endometriosis and Sleep Apnea?

Endometriosis is a common condition that's estimated to occur in about 5 to 10% of all women. It's characterized by pelvic and abdominal pain, along with infertility, and not too surprisingly, hypothyroidism, chronic fatigue syndrome, fibromyalgia, autoimmune conditions, allergies and asthma. 

 

Does this list sound familiar? Right — upper airway resistance syndrome (UARS). Doing some more research, I came across a health-related website (CureTogether.com, an open source health research site) that anonymously aggregates patients' symptoms and and other conditions to give you statistical data. Here are the top symptoms and the top associated conditions for endometriosis.

 

If you look down the list of associated conditions, many are also seen in patients with UARS. Since endometriosis is more commonly seen in women during the reproductive years, you may not see obstructive sleep apnea as often. I'm willing to bet that many of these women will go on to develop obstructive sleep apnea, especially when much older and if they gain weight after menopause. If you look at their parents, one or both parents will snore heavily. In addition, Raynaud's (cold hands for feet) is also a common feature in both endometriosis and UARS.

 

Knowing that upper airway resistance syndrome can cause profound changes in women's physiology, all these findings are not surprising.

 

Do you or anyone you know have endometriosis? If so, how many of the above symptoms or conditions do you see? Please enter your observations in the comments box below.

Sleep Apnea and Breast Cancer: Is There A Connection?

There’s been a lot of press coverage recently about the new mammography screening recommendations for breast cancer. The United States Preventive Service Task Force recently recommended that women begin routine mammography screening at age 50, rather than 40. This is an important issue for me as my aunt died from metastatic breast cancer in her early 40s. 

 

One thing that I see over and over again is how obstructive sleep apnea can affect every aspect of your health, from your mood, to diabetes, to heart disease. You may think that cancer and sleep apnea are totally separate conditions, but with the human body, everything is ultimately connected in one way or another. This lead me ask the question: Do sleep apnea and cancer have a common origin?

 

In my practice, anytime I see a patient with a history of breast cancer, I almost consistently see the following: cold hands or feet, unrefreshing sleep, an inability to sleep on their backs, and a severely snoring parent, typically with cardiovascular disease. What’s remarkable is that when I examine their airways with a fiberoptic camera, the space behind the tongue is usually very narrow, especially when they lie flat on their backs. This anatomy leads to repeated obstructions and arousals, especially when sleeping on their backs and in deep sleep, when muscles relax the most. For this reason, these women prefer not to sleep on their backs.

 

In my book, Sleep, Interrupted, I describe a process where due to poor breathing and inefficient sleep, a physiologic stress state is created, which leads to lack of proper blood flow to certain parts of the body that are considered unimportant when you’re in a fight or running from a tiger. These areas include the digestive system, reproductive organs, your hands and feet, and your skin, amongst others. 

 

During periods of stress (whether internal/physiologic or external/emotional), there can be severe blood flow restriction to any of these body areas. As an example of how dramatic this can be, there’s a description of a man who was severely injured during battle, and most of his abdominal wall was missing, with his bowels clearly visible. While he was recovering in bed, his doctors noticed that whenever he was angry or in pain, his bowels were dark and dusky, whereas when he was happy, his bowels looked pink and healthy. Similarly, there can be dramatic fluctuations in blood flow to the breasts depending on the woman’s mood and stress-inducing states.

 

One common finding in both cancer and sleep apnea research fields is that hypoxia (lack or oxygen) in tissues can lead to production of signals that tell the body to bring in more blood and nutrients. As a result, a number of inflammatory mediators are released, including the well-known vascular endothelial growth factor (VEGF). VEGF promotes local growth of blood vessels in oxygen-poor areas. Imagine if this process happened all the time, with slow but gradual growth of local tissues, with activation of genes and proteins that promote more inflammation and more cell reproduction. 

 

We know that chronic overstimulation of any tissue can lead to cell replication that can go out of control. Chronic overstimulation of breast tissue can initially lead to localized benign growths or cysts, and some of these can end up transforming into malignancies. Perhaps some women with certain genes may be more susceptible to this transformation. This same process can also be described for prostate cancer.

 

Most younger breast cancer survivors probably won’t have obstructive sleep apnea if tested. But what they most likely will have is upper airway resistance syndrome, which results in multiple microscopic obstructions and arousals that prevents deep, efficient sleep. This can cause the nervous system to become hypersensitive, with increased physiologic states of stress. As they gain weight later on in life, many will progress into formal sleep apnea. 

 

Studies show that breast cancer survival is poorer in obese patients. Similar findings are also found with prostate cancer. This is possibly explained by the fact that the more obese you are, the more likely you’ll have obstructive sleep apnea. Having obstructive sleep apnea significantly increases your risk of dying in general.

 

Granted, what I’m describing here is a very different perspective in explaining breast cancer, and is sure to be controversial in some people’s minds. However, rather than trying to explain breast cancer from a molecular, genetic, or organ level, wouldn’t you agree that it’s much more satisfying when you can explain this illness from a whole-person perspective? As much as Western medicine tries to deny it by fragmenting care to different specialties, we know intuitively that whether it’s the breast, the heart, the mind or the prostate gland, everything is ultimately connected.

 

What’s your opinion on this important issue? Please enter your comments in the box below.

Is the XMRV the True Cause Of Chronic Fatigue Syndrome?

Q: Severe OSA or UARS?

Q:
Hello Dr. Park,
 
I am a 24 year old male and have been suffering from moderate-severe sleep problems for at least 7 years now.  For as long as I can remember, I have had issues waking up in the morning.  No matter how hard I try or what methods are used, I couldn’t get up when desired.  In the past 2 years I have noticed a big decrease in my level of energy.  Oftentimes I feel fatigued to the point where my day is compromised. 
 
In early April I had a sleep study performed which found that I had severe OSA.  Apparently I stopped breathing up to 85 times an hour when I was on my back, which was slightly worse than when I was on my side or stomach.  I have been using the CPAP for almost 2 months now and honestly don’t feel that much better.  I would say that it is a little easier to wake-up in the morning, but that’s about it.  I still suffer from fatigue and lack of energy throughout the day.  My doctor is saying that the CPAP has returned my AHI to normal levels, but I am not noticing the difference.
 
In my attempt to locate more information, I came across your journal entry “Tired of Being Tired” to learn more about UARS.  My main question, is how possible is it that I have a moderate-severe OSA as well as UARS?
 
I greatly appreciate your assistance and service and wish you the best!

JPBESpoke

A:  Sorry to hear about all that you’re going through. It must be frustrating. If you’re using CPAP regularly and have data from the machine that confirms it (good compliance and no leaks with minimal AHIs), then the best thing to do is to be patient. You’ve had this condition for years, and sometimes it can take months (sometimes 6-12) to begin to feel better.

It does sound like you do have upper airway resistance syndrome, but you also have severe obstructive sleep apnea. What I see is that some people with UARS go on to develop what may look like chronic fatigue syndrome. Your involuntary nervous system is severely unbalanced, and you have to give it time to come back into alignment. Your situation is complicated and and endoscopic exam will only confirm what you already know. But it’s probably a good idea to take one look to make sure there’s nothing else that’s going on.  By definition, you’re susceptible to any of the somatic syndromes, since these are intimately linked to sleep-breathing problems.

There are also many studies that show that people with untreated obstructive sleep apnea have significant brain abnormalities with various degrees of injury. Years of hypoxia can cause temporary or permanent injury. You can imagine how multiple areas of damage throughout the brain can give various signs or symptoms such as chronic fatigue, numbness, hormonal imbalances, etc. This is not proven as of yet, but if you look at all the research in this area, it’s a reasonable explanation. This is why sometimes it can take months or over a year to begin to feel better.

When Exercise Becomes Hazardous To Your Health

As the obesity numbers keep climbing, everyone wants to eat less and to exercise more. This is great if you’re able to exercise moderation and common sense. But if you’re already sick and your frame of reference is unhealthy to begin with, it’s difficult to know when enough is enough. 

Just as those with anorexia diet excessively to cover up their faulty body image, some people with sleep breathing problems like upper airway resistance syndrome (UARS), or obstructive sleep apnea (OSA), abuse exercise as a means to cope with the lethargy created by their chronic sleep deprivation.

Addicted to Exercise

A lot of patients I see with UARS and OSA become exercise junkies in the same way that people who don’t sleep enough become coffee addicts. Rather than consume substances to give them a "high", these exercise addicts crave the endorphin fix they get while working out to overcome the constant fatigue they feel from not getting the quality sleep they need. Many of them admit that If they miss even one day of working out, they’ll get agitated, moody, and sometimes downright catatonic. 

For these people, exercise or any physical activity is a coping mechanism for the constant energy drain they feel. The problem is, like any drug, too much exercise, if it’s used to deter them from taking care of their underlying sleep breathing problem, will manifest later into health complications that no amount of exercise may be able to cure. 

What’s Your Sleep Position?

Obviously, not everyone who exercise excessively do so to compensate for an underlying sleep breathing problem. One quick and simple way I use to discern who is and who is not susceptible to having a sleep breathing problem is to ask whether or not they can or like to sleep on their backs. You see, those with sleep breathing problems can only sleep on their sides or more commonly their stomachs. The reason being, that they’ll have difficulty breathing when they’re sleeping otherwise. 

To summarize, my sleep-breathing paradigm proposes that all modern humans have difficulty breathing at night to various degrees due to our unique upper airway anatomy. The voice box is located underneath the tongue, as opposed to animals, where the voice box is located behind the tongue. This location of the voice box under the tongue is necessary for complex speech and language. But this is also what makes our airway vulnerable and unprotected, making us more prone to having the various breathing and swallowing problems that we, as modern humans have. 

What’s worse, it’s thought that due to a radical change in our diets (highly processed foods and refined sugars) over the past century, our jaws are getting narrower and we have more dental crowding. Furthermore, dentists have stated that introduction of bottle-feeding to infants can aggravate dental crowding and malocclusion, which makes everything much worse. All these factors aren’t the only reason for everyone’s sleep problems, but they are problematic if your anatomy is already predisposed. 

So what does breathing have to do with sleep quality? There are two components to this issue: When lying flat on your back, your tongue falls back partially, due to gravity. This narrows the breathing passageway behind your tongue to various degrees. As you fall asleep, the deeper level of sleep you enter, the more your muscles relax, and at a certain point, your tongue can fall back and obstruct your breathing. The more narrow your airway (due to smaller jaws or inflammation due to a cold or allergies), the more likely you’ll stop breathing and wake up to turn over. When you were young, you tossed and turned and eventually figured out that you can sleep much better when sleeping on your side or stomach. The problem is that even on your side or stomach, it’s never perfect, and you’re not able to get deep, efficient sleep, no matter how long you sleep.

Sleep Among Athletes

It’s also not too surprising that many personal trainers and fitness professionals have very similar features: Almost invariably they prefer to sleep only on their sides or stomachs. The same can be said about bodybuilders—a personal trainer/natural body builder friend of mine told me that almost every one in her gym snores. Snoring, incidentally, is a very common trait amongst those who have OSA or UARS. 

Professional football players also have a much higher incidence of obstructive sleep apnea. About 1/3 of all linemen were found to have mild or moderate sleep apnea. Many people assume that this is due to the abnormally thick necks that many football players have. However, it’s not only the fat in the neck—it’s also the muscle mass that impinges on the soft tissues of the upper airway. So in theory, the more muscle bulk you have in your neck, the more breathing problems you’ll have while sleeping, and therefore more fatigue to cope with. This in turn, makes you work all that much harder than let’s say, someone else who may not be sleep deprived, to get the same level of intensity.  It’s hard to say which came first, the sleep breathing problem, or the intense work outs, but once it’s started, it ends up being a self-perpetuating vicious cycle. 

Sleeplessness Can Aggravate Injuries

As a long time track and field enthusiast, I know how important it is to eat right and exercise–especially as you get older. Running helped invigorate me after being cloistered for days studying for finals during medical school, and it still helps me maintain my health while balancing the demands of my work and family. Yet, there are times when I’ve let the running take control. This often happens when I’m outpaced by someone in my age group, or when I’m coping with a stressful event. During these times, I’d often train to the point of illness or injury—at which point, I’m temporarily unable to do the one thing that keeps me healthy and sane.

In this way, if you’re an exercise junky, you’re also more prone to having injuries. It’s like that saying: "The higher you climb, the harder you fall." Unfortunately, once injured, it becomes all that much harder to gain the momentum back. What often occurs is common trap for any athlete but much worse if you have UARS or OSA. The sudden lack of activity can cause you to eat more due to increased levels of stress from increased sleep deprivation. As you gain weight, your upper airway narrows even further, leading to worse deep sleep quality. Another scenario that can happen is if you injure your neck or shoulder. This will prevent you from being able to sleep on your side or stomach, which again, aggravates the vicious cycle.

What I just described may seem a little far fetched, but if you are prone to constant fatigue, snore, or have any other chronic health problems like chronic sinusitis, nasal congestion, throat problems, then the sleep breathing paradigm can potentially explain and help you avoid the various health complications you may experience down the road. One way to see where you’re headed is to look at your parents. More often than not, one or both your parents may snore heavily, and in many cases will have one or more of the complications of untreated obstructive sleep apnea: depression, anxiety, diabetes, hypertension, heart disease, heart attack or stroke. 

The best way for you to stay healthy and fit is to eat well, exercise, and most importantly, to sleep better.
 
 

CPAP for Upper Airway Resistance Syndrome?

I recently came across a post on a sleep apnea support forum where a member asked about upper airway resistance syndrome (UARS) and how being on CPAP took care of a variety of his medical problems:

"So many things are better on the CPAP: 

My severe peripheral neuropathy of 5 years is almost gone. 
All the aches and pains are pretty much gone. 
My peripheral edema is gone. 
The age spots on my face are going away. 
I’m not huffing and puffing just doing simple things (like walking my son to his classroom.) 
My night sweats are gone. 
No more getting up to go to the bathroom at night. 
My heat intolerance is resolving -no longer sweat when I blow dry and curl my hair. 
I can exercise again and it’s enjoyable.  I no longer come home and go straight to bed. 
I don’t get so sore after exercise. 
My calf muscles are relaxing.  They used to just stay contracted all the time and I couldn’t get them to relax. 
My morning tremors are gone. 
Haven’t lost any weight, but dropped two pant sizes."

Fortunately, this person tolerated and responded very well to CPAP, whereas most people with UARS can’t stand having anything on their faces due to their hypersensitive nervous systems. Unfortunately, he was given CPAP by mistake before it was approved and the insurance company is refusing to pay for it anymore. Since his AHI was below the cut-off line of 5 for diagnosing obstructive sleep apnea (his was 1.9), officially he didn’t have sleep apnea. But he did stop breathing 8 times every hour on average. This is the dilemma with UARS.

My point here is that if the anatomic sleep-breathing problem is fixed definitively, regardless of the method (CPAP, dental devices or surgery), the patient will feel better. I describe a similar, very dramatic story about a young woman with even worse problems in my book, Sleep, Interrupted.

 

Is Insomnia Really A Sleep-Breathing Problem?

Sleep doctors have always thought of insomnia as a behavioral or stress aggravated issue, and the standard ways of treating this all-too-common condition is to either give sleeping pills or have the patient undergo cognitive behavioral therapy. However, a recent study directed by Dr. Barry Krakow at the Sleep and Human Health Institute is looking at the possibility that insomnia may actually be caused by a sleep-breathing problem, such as obstructive sleep apnea. 

 

If you’ve read my book, Sleep, Interrupted: A physician reveals the #1 reason why so many of us are sick and tired, I stated my opinion that in my experience, almost all people with insomnia have narrowed upper air passageways, especially behind the tongue. Some will have undiagnosed sleep apnea, but many will have instead something called upper airway resistance syndrome. This is a variation or precursor to sleep apnea where the length of time of each breathing pause is not long enough to be called an apnea. Because of the multiple pauses in breathing in deep sleep, a low-grade stress response is created which causes the insomniac’s mind to race or think about stress-related issues before going to bed. Their nervous systems are edgy and en garde all the time. No wonder it’s hard to fall asleep, especially if you’ve had a stressful day.

 

I’ve also experienced multiple instances where treating an underlying sleep-breathing problem also significantly improves insomnia symptoms as well.

 

You may be asking by now, "why do sleeping pills or cognitive behavioral therapy work?" The older type sleep aids were generally tranquilizers and only helped to numb the nervous system so that you can fall asleep faster. But these medications did nothing to prevent the sleep-breathing pauses. The newer medications don’t have as much of the sedating properties, but it’s very controversial that they even make any significant difference. Although industry supported studies find significant  improvements in sleep scores using sleeping pills, non-industry supported studies show that these same sleeping pills only increase total sleep time by only 5-10 minutes. 

 

Cognitive behavioral therapy (CBT) is another underused option that has been shown to work much better than sleeping pills in general. CBT works by re-programming your thinking and behavior about sleep to promote good sleep hygiene and habits. 

 

CBT will work to some degree even if you have an underlying sleep-breathing problem because you’re addressing the physiologic stress-aggravting end result of the breathing problems that occur during sleep. Multiple micro-arousals from deep sleep to light sleep due to tongue muscle relaxation can definitely aggravate stress and anxiety problems.

 

This process also confirms other recent findings that report increased rates of depression and heart disease later in life in people with insomnia earlier on in life.

 

The main purpose of Dr. Krakow’s study tries to determine what percent of insomniacs have undiagnosed obstructive sleep apnea. Although not part of the study, it would be interesting to perform upper airway endoscopic exams like what I describe, to confirm what I describe in this post. 

 

Here’s my question to all insomniacs: Do you prefer to sleep on your back, side or stomach? If you prefer your side or stomach, there’s your answer.

Why Your Lack Of Sleep Can Make You More Creative

 

It’s a known fact that sleep is essential for proper cognitive functioning, retention, concentration and mental acuity. Now, according to recent research, sleep may even enhance your creativity. According to the article in The New York Times which cites the study, those who slept more showed improved mental agility including the ability to make novel connections between disparate ideas by as much as 33%. As a result of findings like this, corporations that hinge on innovation such as Cisco Systems and Google have installed ergonomic sleep stations called EnergyPods in their corporate facilities.

 

But what about those people who sleep more than 9 to 10 hours and still feel exhausted and groggy? Why aren’t these sleep mongers waking up wide eyed and bushy tailed, bursting with creative energy? The answer to this seeming disparity depends on where these people lie on the sleep-breathing continuum. 

 

Why Some Need More Sleep While Others Can Do Without

 

If you are one of those people who wake up refreshed and recharged after a good night’s rest, then your sleep quality is probably the kind that the researchers are pointing to when they say that sleeping more can make you more creative.  

 

However, there are many more people who sleep longer than the usual number of hours (like 9 to 10 hours) and still wake up feeling groggy and exhausted. For them it’s a major chore to get through their day, let alone have the energy to innovate and come up with new ideas. For those of you who find yourself in this situation, it’s probably not the amount of sleep but the kind of sleep you’re getting that’s impinging on your creativity. Here’s what I mean:

 

Sleep is composed of six stages: awake, stage 1, stage 2, stage 3, stage 4, and REM (rapid eye movement). Stage 1 and 2 are known as the "light" stages of sleep, REM as the "dreaming" stage and stages 3 and 4 as the "deep" or delta stages. We need a good distribution of all the sleep stages to get the proper restorative sleep we need to be creative.

 

As I point out in my book, Sleep, Interrupted, many people who suffer from sleep breathing problems like obstructive sleep apnea (OSA), or upper airway resistance syndrome (UARS), are often unable to get past stage 1 and 2 let alone stay long enough in REM or stage 3 and 4 sleep stages to get the kind of quality sleep they need to feel truly rested. The reason why this happens is because their airway is constantly in danger of closing off or obstructing. These people’s airways are smaller than most, which is the result of various factors like having a floppy palate, larger than average tongue to jaw size ratio, or having chronic nasal congestion, just to name a few. (For more information, listen to my podcasts on OSA and UARS)

 

These are usually the people who feel tired even though they may have slept more than 10 hours. For them, the reason why they’re feeling so unproductive is not because they need more sleep but because they lack the necessary amount of deep restorative sleep they need to feel refreshed and rejuvenated.

 

The one exception to this rule are those people who are often categorized as the creative class.  For these type of people, sleep deprivation is not only a requisite component of their lifestyle but a vital by product of their creativity.  Many sculptors or painters will say that a 4 hour session can seem only like one hour. For them, a bout of inspiration can help them forgo all sorts of physical constraints, even sleep. In fact, more than one painter or sculptor have even told me that when they are unproductive, they intentionally sleep deprive themselves mildly to rev up their creativity.

 

So, you may be asking why is there such a wide discrepancy between those whom the sleep experts say need more sleep to be creative, and those who need less sleep to maintain their creativity? Again the answer to this mystery lies in how well you’re breathing at night while you sleep and how well your body can adjust to the constantly fluctuating sleep deficit.

 

Sleep Less, Get More Creative

 

Whenever I see patients who work in traditionally creative occupations, I find, more often than not, that many of them have narrowed upper airways, leading to easier collapse of either the throat or tongue structures while in deep sleep, leading to multiple arousals and inefficient sleep. Many of them also keep erratic sleep schedules, working without sleep one night, and sleeping in all day the next. Yet, many creatives will tell me that they thrive under these kinds of stress and pressure. They say that this is when their senses are most heightened and when they’re the most productive. 

 

This is very similar to what happens when people undergo a mild to moderate form of sleep deprivation. What happens in these situations is that a low-grade physiologic stress response occurs. In fact, the lack of sleep can actually induce hyperactivity of the sympathetic nervous system therefore enhancing not only their sense of smell, hearing or intuition, but also heightening emotions and creativity. It’s not all that surprising then that many creative types tend to either consciously or subconsciously shift back and forth from getting too much sleep to no sleep at all to maintain their creative drive.

 

This may be also why those who tend to be creative are often attracted to work that’s not constrained by the typical  9-5 work schedule. According to Richard Florida, in his fascinating book Rise of the Creative Class, this is the reason why so many creative types congregate in metropolitan areas like New York (the city that never sleeps). He suggests that creatives work independent of traditional work conventions, and why innovations like telecommuting, mobile work stations, and global networking, have become so popular in this modern day economy. Florida further argues that this new "creative class" is any person or group of people that uses their intellect and creativity to enhance their work, which includes both the traditional creative types, like actors, writers, and musicians, and even the non-traditional creatives like doctors, lawyers, accountants, engineers, techies, architects, and interior designers. They are at their best when their time for work, rest and play is shaped by no other standard than their own. Not surprisingly, these creative types won’t or can’t adhere to the good old fashioned 8 hour sleep paradigm. This may be another reason why some people get more creative when they sleep,  and some get less creative when they sleep too much.

 

The Final Word On Sleep

 

Of course, prolonged sleep deprivation, for anyone can have detrimental effects on your health and physical well being. It’s imperative that if you have a sleep breathing problem to have it treated so that you are getting the requisite amount of deep sleep needed to maintain proper cognitive functioning. 

 

Yet, if you consider the way that the human airway anatomy developed, you’ll see that we are the only mammals that are susceptible to the kind of sleep-breathing problems I describe. This makes me wonder if this isn’t the very reason why sleep makes us more productive and at the same time, be more creative than any other mammal alive. Just something to ponder the next time you have to pull an all-nighter. 

 

 

 

 

 

An ENT with ESP?

Three times this week, people have asked me if I have ESP. If they are in front of me, their eyes open wide and with a scary look and they asked me, “Do you have ESP?” I assured them that I do not. In all three situations, I had just asked these people questions from a list of common symptoms that people with airway resistance syndrome have. Some of these symptoms include: sleeping on their side or stomachs, never waking up refreshed, cold hands or feet, occasional dizziness or lightheadedness, frequent headaches, and a parent that snores heavily. More often than not, the parent that snores also has a complication of untreated obstructive sleep apnea such as hypertension or heart disease.

These list of symptoms are so consistent that I stopped asking if either of their parents snore, or which position they sleep in—their back, side or stomach. Instead, I now ask, which parent snores, or do you sleep on your side or stomach? Sure enough, about 99 % of the time, they’ll answer one or the other. 

Do you have any of the symptoms that I described above?

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