Pregnant Women More Likely To Stop Breathing At Night
August 3, 2011
As a follow-up to my post last week on why pregnant women may have an increased risk of stroke, here’s a study published this month in the journal Sleep. Researchers compared 34 women with gestational hypertension vs. 26 healthy women with uncomplicated pregnancies. Significant sleep-disordered breathing was defined as a respiratory disturbance index (RDI) of 5. Pregnant women with high blood pressure had significant sleep-disordered breathing in 53%, whereas 12% of healthy pregnant women had sleep-disordered breathing. Hypertension is a known risk factor for preeclampsia and stroke.
This study is in line with my suspicion that pregnant women, while at risk for obstructive sleep apnea, probably have shorter obstructions and RERAs (respiratory-effort related arousals), rather than frank apneas. Increased progesterone and various other physiologic changes seen in pregnancy can increase your respiratory drive and lower arousal thresholds, leading to more frequent arousals from deep sleep.
Notice how commonly pregnant women snore, and they’re extremely tired. If they weren’t pregnant, doctors would suspect obstructive sleep apnea. Then why do we have this double standard? Why can’t women who suddenly gain weight and snore be routinely screened for obstructive sleep apnea?
Why Pregnant Women Have More Strokes
July 28, 2011
Rates of stroke went up 47% for expectant mothers and climbed to 83% in the first three months after delivery. This was the finding that was published in the journal Stroke: Journal of the American Heart Association. They cite rising rates of additional risk factors such as high blood pressure, obesity, and gestational diabetes, but didn’t give a plausible explanation. Here’s a story about this study published in the Wall Street Journal.
Here’s a simple explanation: Sleep-breathing problems. Whether it’s obstructive sleep apnea or more likely upper airway resistance syndrome, pregnant women tend to have more frequent breathing pauses, especially as they gain weight. One protective mechanism is through progesterone, which acts as a tongue muscle stimulant, but the forces of upper airway collapse is likely to overwhelm these protective effects. What’s even more striking is that the rate almost doubles immediately postpartum. Remember that progesterone drops soon after delivery, but you’re still left with all that additional weight. We know that obstructive sleep apnea can significantly increase your chances of stroke and heart attacks. There are even reports that suggest that preeclampsia can be successfully treated with CPAP.
Overall, the numbers are still very low, but the sudden rise in the rate of stroke in new mothers leaves researchers scratching their heads.
Interrupted Sleep And Memory Loss
July 26, 2011
Remember the last time you forgot something? Did you forget about the last time this happened? Chances are, you were probably sleep deprived.
There are tons of studies showing that even mild sleep deprivation can have detrimental effects on memory and executive functioning. Now there’s new research from Stanford University showing that sleep fragmentation can be just as detrimental as sleep deprivation. The researchers figured out a way of fragmenting sleep in mice without causing any stress, using special lights to control genetically engineered brain neurons that control sleep and wake. By pulsing these cells with 10 second bursts of light, they could fragment sleep without significantly altering the quality and the composition of sleep, or the total sleep time.
Their conclusion was that “regardless of the total amount of sleep, a minimal unit of uninterrupted sleep is crucial for memory consolidation.”
Another research tool that’s used to measure deep sleep instability is what’s called cyclic alternating pattern (CAP) analysis. Cyclic patterns of brief brain wave arousals were found to be more common in people with upper airway resistance syndrome (UARS) and fibromyalgia.
These studies support the general observation that people with people with UARS, fibromyalgia, or idiopathic hypersomnias have increased levels of subtle arousals that don’t get scored on a routine sleep studies.
The Connection Between Migraines & Sleep-Breathing Problems
July 22, 2011
Michelle Bachmann’s recent revelation that she suffers from migraines brings up an important point that most doctors and the lay public don’t appreciate: the importance of proper breathing at night. It’s commonly known that sleep deprivation can cause or aggravate migraines, but what’s usually assumed is that migraine sufferers are breathing well at night. If you’ve read my articles or listened to my teleseminars, I can make a convincing argument that migraine sufferers all have some variation of a sleep-breathing disorder, of which only a small fraction have obstructive sleep apnea.
Not Your Normal Migraines
The classic migraine headache is described as a one-sided, debilitating, pounding, intense headaches that’s associated with nausea, vomiting, light or sound sensitivity. Notice that classically, migraines get better with sleep. Recently, neurologists have expanded the definition of a migraine attack. Any time the nerves in any part of your body becomes oversensitive or overly excitable, then you’ll experience symptoms that are specific to that part of the body.
For example, if the nerve endings in your sinuses are suddenly extra sensitive, then you’ll feel pain, pressure, nasal congestion, and post-nasal drip. In fact, it’s been shown that the vast majority of chronic sinus headache and pain sufferers actually have a variation of a migraine, with normal CAT scans. Many people are placed on oral antibiotics empirically, when there’s no bacterial infection.
You can also have migraines in your stomach. This can present as nausea, vomiting, diarrhea, constipation, or bloating. It’s been suggested that children who suffer from chronic abdominal pain actually suffer from migraines.
If you have a migraine attack in your inner ears, you’ll feel dizzy, lightheaded, feel fullness, or have hearing loss or ringing. This is called vestibular variant of migraine.
Problems Due to Your Tongue?
One anatomic feature that I see all migraineurs have in common is the very small nature of their upper airways, especially in the space behind the tongue and in the nose. I talk about how most modern humans have smaller jaws and facial skeletons due to a radical change in our diets and lifestyles. This leads to dental crowding, which narrows the space behind your tongue, especially if you lay flat on your back. When you go into deep sleep, since your muscles will relax, you’ll stop breathing and wake up to turn over to your side or stomach. This is why most people with this type of anatomy can’t sleep on their backs.
You Are A What?
These breathing pauses usually aren’t long enough to be called apneas (at least 10 second pauses), and usually don’t lead to lowered oxygen levels. However, it does lead to more frequent arousals and sleep fragmentation. Essentially, you can’t stay in deep sleep. In most cases, you won’t even realize that you’re waking up. What you will feel is not feeling refreshed when you wake up in the morning, or feeling like you only slept for 2-3 hours.
In the early 1990s, a new type of sleep-breathing problem called upper airway resistance syndrome (UARS) was described. Young women and men who didn’t meet the official criteria for obstructive sleep apnea were recruited and underwent esophageal pressure monitoring. What they showed was gradually increasing negative inspiratory pressures leading to an arousal, but not severe or long enough to be called apneas or hypopneas. Officially, apneas require at least 10 second breathing pauses, whereas hypopneas require 30 to 50% drop in airflow, along with arousals or oxygen level drops. However, if you don’t reach the 10 second threshold for apneas or hypopneas, then they’re not scored at all. So in theory, you can stop breathing 20 to 30 times every hour and not officially have obstructive sleep apnea.
En garde
Not being able to get deep, refreshing sleep can lead to a physiologic state of stress, where your entire nervous system can become heightened and hypersensitive, even carrying over into the daytime. Poor sleep quality also cause muscle tension and tightening, which can predispose to headaches, TMJ, neck spasms or backaches. Even your senses can become overly sensitive, especially to weather changes, chemical, scents or odors. In this particular situation, even your creativity or intuition can be heightened.
Notice how many of the features of a migraine attack are very similar to suffering from a hangover: nausea, vomiting, brain fog, and sensitivity to bright lights and loud noises. This is your involuntary nervous system over-reacting to something that’s not normally bothersome.
Simple Steps to Take
So if you suffer from any of these migraine types, what can you do besides take prescription medications? Here are 5 basic steps for better sleep and less headaches:
1. Don’t eat anything within 3-4 hours of bedtime. Having juices in your stomach can promote reflex into your throat, causing more arousals and less efficient sleep.
2. Don’t drink any alcohol within 3-4 hours of bedtime. Alcohol relaxes your throat muscles, causing more frequent obstructions and arousals.
3. Keep your nose clear. If your nose is stuffy for whatever reason, do everything possible to keep it open. Having a stuffy nose creates a vacuum effect downstream in the throat which causes your tongue to fall back more often. Use nasal saline irrigation systems, nasal dilator strips, allergy medications, decongestants and even surgery if the former options don’t work that well.
4. Don’t sleep on your back. Back sleeping promotes tongue collapse due to gravity.
5. Do more yoga, tai chi, or deep breathing exercises to calm your nervous system. Take 4-5 slow deep breaths anytime you have 15 to 30 seconds, such as while standing in line, in-between major activities, on hold one the phone, or walking to another room. This helps to activate your parasympathetic nervous system, which helps to calm and relax your body. Acupuncture can also help.
Other Steps to Take
Once you’ve tried these conservative options, and you wish to take it to the next level, consider undergoing a thorough ear, nose and throat evaluation to see of you have any narrowing in your breathing passageways. In particular, your doctor should focus on your nasal septum and turbinates, your nostrils (to see if they collapse), tonsils, adenoids, lingual tonsils, soft palate and tongue base areas.
Many people with migraines will have either UARS or sleep apnea. Standard treatment options can help to alleviate migraines significantly. Dental appliances and specialized orthodontics are also an excellent option—these options are more important if you have any significant dental crowding, bite issues, or if you have a very small mouth. Dentists can also help with TMJ, which can overlap significantly with migraines and various other facial pain syndromes.
Botox can also be used for migraines, but just like using prescription migraine medications, are only covering up the causes, rather than treating it.
To a certain extent, OTC medications, and natural herbs or supplement (like feverfew), while they do work to various degrees, doesn’t help everyone. But it’s worth trying, if you’re interested.
Avoiding migraine triggering foods: red wine, aged cheeses, chocolate, and MSG.
I don’t usually recommend surgery, but it can be a viable option if the more conservative options don’t help. There are a number of different options, depending on where the narrowing occurs in your breathing passageways.
Hope for Migraine Sufferers
One of the most gratifying experiences is to have patients tell me that their migraines (or even cluster headaches) went away after various forms of surgery. It even happens sometimes with some of the non-surgical, conservative options.
It’s a given in our culture that migraines must be treated with a pill, and I want to dispel that stereotype. I believe that trying to achieve the best possible sleep (by breathing better) is a better way of improving migraines. It’s important to combine the various conservative steps along with techniques to help you breathe better and sleep better. Rather than focusing on the migraine only, it’s more important to re-evaluate your entire life situation, and be willing to make the lifestyle changes that can not only improve your migraines, but also significantly improve your overall quality of life.
Expert Interview: Dr. Christian Guilleminault on UARS
July 21, 2011
This month, I interview Dr. Christian Guilleminault of Stanford University, who is one of the pioneers in sleep apnea diagnosis and treatment. We’re going to focus on Upper Airway Resistance Syndrome (UARS), which he discovered.
Here are some of the questions we covered:
- Describe to us what UARS is and how it’s different from OSA?
- Why is the AHI limited when it comes to picking up UARS.
- How to diagnose UARS: Esophageal manometry vs. nasal cannula.
- How UARS patients have intact nervous systems, whereas sleep apnea (OSA) patients have diminished nervous systems, and what may cause progression from UARS to OSA?
- How do you treat patients with UARS? How is it different from treating sleep apnea?
- What are the dental options for UARS?
- How common is UARS in children and how can they be treated?
- And much more…
Please enter your information below to access your free MP3 download:
Chronic Pain & Sleep Apnea: Is There A Link?
July 18, 2011
Here’s a shocking statistic put out by the National Academy of Sciences—that 116 million Americans (37%) suffer from chronic pain. That’s more than diabetes, heart disease, and cancer combined. The article in the New York Times emphasizes the importance of more recognition of this condition by doctors. However, I doubt we’re ever going to make a significant dent in treating chronic pain unless we deal with their sleep issues.
It’s easy to argue that chronic pain can negatively affect your sleep quality. However, you can also argue that poor sleep can predispose you to chronic pain, once you experience a trigger (such as an accident, trauma, weight gain, or an operation). It’s been shown that poor sleep can lower your pain thresholds: Sleep deprived people were found to pull their fingers from a hot environment much quicker than people who had normal sleep. What this means is that the less quality or quantity of sleep you have, the more likely you’ll sense pain at very low levels.
If you think about the total number of people with obstructive sleep apnea (and even UARS), it’s probably about 1/4 to 1/3 of the population. Coincidence?
One general concept that Dr. Christian Guilleminault of Stanford describes is that sleep apnea patients have diminished nervous systems, whereas upper airway resistance syndrome (UARS) patients have intact nervous systems. In fact, I would argue that people with UARS have hypersensitive nervous systems. These are also the people who are overly sensitive to weather changes, chemicals, fumes, perfumes, odors and smoke. So perhaps people who are predisposed to chronic pain also have UARS.
Is it just coincidence that most of the patients that I see who have some sort of chronic pain also can’t sleep on their backs, have had excessive dental extractions, or have a parent that snores heavily? Most people with UARS can’t (or prefer not to) sleep on their backs, since that causes the tongue to fall back from gravity. Excessive dental extractions (usually from modern orthodontics) contracts the oral cavity space, leaving less room for the tongue, especially when in deep sleep, causing more frequent obstructions and arousals. As the person with UARS moves up the continuum, they’re more likely to progress into obstructive sleep apnea (like one or both parents).
If you’re truly committed to treating chronic pain patients, you have to simultaneously treat any underlying sleep-breathing problems. Giving sleeping pills just won’t cut it.
Can Sleep Apnea Cause Lupus?
July 15, 2011
Probably not. But I can make a strong argument that it’s possible with upper airway resistance syndrome.
I saw a patient with UARS today who underwent removal of her large lingual tonsils a few months ago. As expected, her previous poor sleep quality and headaches are much improved, but not completely normal. Opening up the space behind her tongue definitely made a significant difference in how well she breathes at night.
Interestingly, she happened to get tested again for her known lupus condition a few weeks ago, and was excited to tell me that not only that her ANA level come back negative, but many of her other autoimmune markers were significantly improved as well. ANA is a very generic marker for autoimmune disease in general, and not very specific for lupus. However, the improvements in her clinical symptoms, along with changes in her blood tests, strongly suggests that there may be a connection.
Unlike obstructive sleep apnea, patients with upper airway resistance syndrome have overactive immune and nervous systems. Chronic, low-grade physiologic stress that ensues without hypoxia can set up the perfect storm for autoimmune disease development.
Coincidentally, I just had another patient that remarked that his intractable gout improved significantly after eating earlier and using Breathe Rite strips. Another patient had her severe rheumatoid arthritis resolve almost completely after treatment for obstructive sleep apnea.
Casually looking up connections between sleep-breathing disorders and various autoimmune or unusual disorders, I did find a number of small or anecdotal studies.
Stay tuned for a future teleseminar on this topic.
Fatigue And Multiple Sclerosis, Along With UARS
July 2, 2011
There are probably a thousand different reasons for someone to be tired. Many people with neurologic conditions tend to report being overly tired. Not too surprisingly, fatigue was found to be reported as the first symptom with multiple sclerosis (MS), long before the first signs of MS show up. We know that MS is an autoimmune condition, where various parts of the brain are affected, leading to a number of different symptoms. But one thing I’ve noticed is that almost every person with MS also seems to have the upper airway anatomy of someone with upper airway resistance syndrome (UARS).
Women are more likely to suffer from both UARS and MS. They typically are thin, and won’t snore. Both groups in general tend to avoid back sleeping, and have narrow jaws with high arched hard palate. Women with (UARS) are more likely to have autoimmune conditions. Many will also have cold hands and feet, and have at least one parent that snores heavily. Whenever I look at their airways with an endoscope, the space just behind the tongue is usually only a few millimeters, especially when lying flat on their back.
My suspicions must be proven with prospective studies, but the similarities are pretty striking. Since we know that sleep-breathing problems can cause major structural and biochemical damage to the brain, I wouldn’t be surprised if someone proves that these two conditions are strongly connected. Just to be clear, I’m not talking about obstructive sleep apnea. Rather, people with UARS are unable to attain deep quality sleep due to frequent microobstructions and arousals, without frank apneas or hypopneas.
If anyone reading this has MS, do you have cold hands or feet? Can you sleep on your back at all? Do your parents snore heavily?
ADHD & Autism Rates Spike—Is Sleep Apnea Responsible?
May 25, 2011
Researchers were surprised that that rate of ADHD and autism have spiked over the last 10 years. ADHD increased 33%, whereas autism increased from 0.19% to 0.74% over the same time period. Honestly, I’m not surprised by these results. Here’s my explanation for the continued rise in these two common developmental disorders:
- There’s definitely more awareness of these two conditions (ADHD and autism), as well as more inclusive criteria for diagnosis
- Implementation of the back to sleep campaign about 20 years ago
- Worsened diet
- Bottle-feeding
- Environmental endocrine disruptors
- Less total sleep time
- increased incidence of allergies and food sensitivities.
There’s even evidence showing that common motor-skill milestones are often coming in delayed, since infants are not spending as much time on their tummies, even during the day. As expected, skull deformities (flat head) are much more common since the back to sleep campaign.
What does this have to do with obstructive sleep apnea? Here are 3 important reasons:
- Factors 2 to 6 all significantly increase your risk for obstructive sleep apnea, through either poor jaw development or inflammation of the upper airway.
- Obstructive sleep apnea can predispose to obesity, which narrows your airway even further
- Sleep-breathing problems begin during infancy, and the lack of deep, efficient sleep, not to mention frank hypoxia from apneas, can be detrimental to the infant’s brain development and biochemical pathways.
I realize that there are a number of other possible reasons for ADHD or autism (probably a combination of many factors), but not getting deep sleep can be a major barrier to proper brain development. Studies are definitely needed in this matter. Unfortunately, the medical/pharmaceutical industry is unlikely to change the status quo.
What do you think about this study? It is from over-reporting or more awareness, or is it for real?
Is Insomnia Caused By Obstructive Sleep Apnea?
April 27, 2011
Common sleep medicine dogma states that chronic insomnia is a completely separate disorder from obstructive sleep apnea (OSA). But just like other seemingly disparate medical conditions, there’s increasing evidence that there may be a certain degree of overlap between these two conditions. It’s been shown that anywhere from 39 to 58% of patients with OSA also have insomnia. Conversely, up to 43% of older people with chronic insomnia were found to have undiagnosed sleep apnea.
It’s been stated that chronic insomnia and sleep apnea can co-exist together, but very few studies are saying the one could cause the other. To challenge this assumption, Dr. Barry Krakow and the Sleep and Human Health Institute is looking at the provocative theory that a large percentage of people with chronic insomnia have undiagnosed breathing problems during sleep.
I wrote in my book, Sleep, Interrupted, that almost every patient that I see with chronic insomnia has significantly narrow upper airways, and one or both parents snore heavily. Most chronic insomniacs prefer not to or absolutely can’t sleep on their backs, due to the tongue taking up relatively too much space within the confines of smaller jaws. When in deep sleep, especially when on their backs, the tongue can fall back due to gravity, and because of additional muscle relaxation, causes breathing pauses and an inability to stay asleep.
It’s also not surprising that most people with sleep maintenance insomnia keep waking up at various 90-120 minute intervals, usually around the same times. This makes sense since at the end of one sleep cycle, your muscles will be most relaxed. Not sleeping deeply can lead to chronic sleep deprivation, which causes adrenaline overload and a hyperactive nervous system, which you can’t shut down when you’re ready to go to sleep. This process can explain sleep onset insomnia. One recent study showed that sleep deprivation can even cause a kind of euphoria, which can lead to poor judgement and even addictive behaviors.
Maybe this is why cognitive behavioral therapy (CBT) for insomnia works very well, but not for everyone. There are numerous studies and personal experiences that confirm that treating the underlying sleep-breathing problem can fix the insomnia issues.
Granted, even if only 50% of people with chronic insomnia have obstructive sleep apnea, it’s likely that another 30 to 40% will have upper airway resistance syndrome (or UARS), which is a huge topic that has been discussed elsewhere.
What do you think about my suspicion?
Featured Videos
Latest Video
Somnoplasty for Snoring
Archives
Somnoplasty for Snoring
Somnoplasty Radiofrequency of the Tongue for Sleep Apnea
A New Snoring Cure? The Snoreplasty Procedure
Provent Nose Plugs for Sleep Apnea
The LAUP Procedure for Snoring and Sleep Apnea
Is the XMRV the True Cause Of Chronic Fatigue Syndrome?
Mandatory Sleep Apnea Screening for Everyone?
A Link Between Sleep Apnea and Diabetes Confirmed Again
Can Sleep Problems Cause Benign Positional Vertigo?
The Deviated Septum Myth
Rss
Email
Upcoming Events
