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Hypothyroidism in Pregnancy Goes Largely Undiagnosed

Researchers combed through 117,892 Quest Diagnsotics records and found that about 15% of women tested positive for gestational diabetes. Based on this finding, they estimate that as many as 483,000 women with gestational diabetes may go undiagnosed every year. Asian women had the highest rates of being tested and being positive for this condition, and older women and overweight women were much more likely to be tested during pregnancy. 

Hypothyroidism during pregnancy can lead to lower IQ scores in children after birth. 

I’ve written extensively before that pregnancy increases your chances of sleep-breathing problems, especially in light of significant weight gain that occurs. Gaining weight is a major risk factor for obstructive sleep apnea, which has been shown to significantly increase your risk or diabetes and hypertension. Any form of physiologic stress can has been shown to lower your thyroid levels as well. You don’t have to have obstructive sleep apnea to have significant breathing problems at night.

Having low thyroid levels can also promote weight gain. Poor sleep quality also promotes weight gain. Weight gain narrows your throat, causing more breathing problems. It’s a vicious cycle. Regardless of which comes first (sleep apnea or hypothyroidism), it’s a two-way street.

If you consider that our population as a whole is now heavier, and women are having babies at much later ages, then hypothyroidism is one of many conditions related to sleep-breathing problems and pregnancy that is expected to increase in numbers.

Ask Dr. Park: Sleep & Breathing: The 2 Keys to Optimal Health

In this teleseminar, I reveal:

• Why all modern humans stop breathing intermittently while sleeping
• 3 key anatomic concepts that makes everyone susceptible to sleep apnea
• 7 common surgical procedures that can worsen or uncover obstructive sleep apnea
• 5 simple steps to better breathing and better sleep
• 5 ways to treat obstructive sleep apnea.
• What you MUST do first before trying to lose weight.

Topic:  Ask Dr. Park: Sleep & Breathing: The 2 Keys to Optimal Health

Please enter your information below to register and access your free MP3 recording and PDF of the slides:

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Why Do Some Insomniacs Keep Waking Up At the Same Time?

One of the most common complaints that I get from patients is that they keep waking up at the same time in the middle of the night and are unable to get back to sleep, or they keep waking up every 90 to 120 minutes. This phenomenon is called sleep maintenance insomnia, when you are unable to stay asleep during the night. In contrast, sleep onset insomnia is when you’re unable to fall asleep in the beginning of the night.

A low-dose version of zolpidem (Ambien) was recently FDA approved as Intermezzo to treat these middle of the night awakenings. It’s purpose is similar to zaleplon (Sonata), which is a very short-acting sleep aid, so it can be used in the middle of the night to get back to sleep, without the “hangover” effects that people feel with typical sleep aids.

There are a number of different explanations for why some people keep waking up in the middle of the night. One theory is that people with insomnia are hyperarousable, with higher levels of brain activity and stress hormones. If it’s due to these factors, why is it that insomniacs keep waking up at the same time? One possible explanation is that it has to do with sleep stages. Humans go through 4-5 cycles of sleep, where deep sleep (slow wave) predominates in the first half of the night and REM sleep is more common in the second half. As the night progresses, the periods of REM sleep become longer and longer. Since we know that throat muscles are most relaxed during REM sleep, you’re more likely to have breathing pauses during REM, especially if you’re anatomically predisposed (narrowed upper airway anatomy).

This can explain why many people say that they keep waking up at 3AM, like clockwork. Some people wake up when REM length reaches a critical period, whereas other keep waking up with each successive REM period. Transitions into and out of REM can also predispose one to upper airway instability.

One thing I’ve noticed is that in almost all cases, severe insomniacs have very narrowed upper air passageways. On endoscopy, the space behind the tongue is very narrow, and most people can’t (or prefer not to) sleep on their backs, since the tongue is more likely to fall back then supine. Dr. Barry Krakow did a study a while back showing that the vast majority of insomniacs who were resistant to sleeping pills had sleep-breathing problems.

What I’m describing is not necessarily obstructive sleep apnea. Once you obstruct or have partial obstruction, you can either continue the breathing pause for 10 to 40 seconds (this is called an apnea or hypopnea). But if you wake up quickly within a few seconds, then it’s called an arousal. Insomniacs typically have lots of arousals.

This is why even if you have classic insomnia, you need to look for and treat any underlying sleep-breathing problems, regardless of whether or not you have apneas.

If you are an insomniac, what time do you wake up in the middle of the night?

Ask Dr. Park About Sleep About Sleep Apnea (11/8/11)

For this month’s Ask Dr. Park teleseminar, I answer the following questions:

1. Does sleeping with your head propped up help with sleep apnea?

2. Why is UARS so hard to define?

3. What do you think about all the latest publicity about thyroidectomy in helping with sleep apnea?

4. Can using tape over the mouth help with sleep apnea?

5. As we age how can we gauge whether we have sleep-related breathing issues, or circadian rhythm problems?

6. What if you are using a cpap machine and STILL wake up about every 2-3 hours?

7. How low should one seek to lower the AHI and the AI?

8. Is there a place for hyperbaric oxygen in the treatment of OSA?

9. Does a dental positioning device work for mild sleep apnea?

10. How does the future look for sleep apnea patients£ Will something replace CPAP as the gold standard?

11. Is there a clear distinction between central and obstructive sleep apnea? What are the alternatives if your apnea is primarily classified central?

12. If patient’s airway is examined with camera inserted through nose while patient is sitting upright and airway is found to be clear, is this enough to indicate airway would also be clear if patient was lying down? Should patients be checked in both positions?

And many more questions from the live audience.

Click here to purchase the MP3 recording ($17).

 

 

Expert Interview: Psychology of Sleep Apnea

In this Expert Interview program, Ms. Lisa Brateman will talk to us about the psychology of obstructive sleep apnea. This is an important topic that affects not only those of you with sleep apnea, but also your loved ones, your friends, and family members.

 

 

 

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UARS Article In Forbes.com

Here’s a good summary of upper airway resistance syndrome (UARS) in the Forbes.com health blog, where I get interviewed about this all-too-common condition.

Ask Dr. Park: Any Question About Sleep Apnea or UARS

In this Ask Dr. Park Teleseminar, I answer the following questions:

- Why don’t I feel better on CPAP? 

- How long do I have to wait before feeling better on CPAP?

- What’s the best PAP machine for sleep apnea or UARS?

- What’s the difference between flow limitations and RERAs?

- What is the best surgical option for sleep apnea?

- Can nasal surgery cure sleep apnea?

- Is waking up early in the morning everyday around the same time an indication of sleep apnea?

- I was diagnosed with obstructive sleep apnea (AHI 36-40) but do not snore. Might this mean there is some other cause?

- Plus much more….

 

Click here to purchase and download  your 60 minute MP3 file ($17)

Pregnant Women More Likely To Stop Breathing At Night

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?

Expert Interview: Dr. Christian Guilleminault on UARS

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:

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*By clicking ‘submit’ above, you are agreeing to receive ongoing communications from Dr. Park including monthly newsletters, events alerts, and other such written correspondences. Your e-mail will remain strictly confidential and will not be disclosed to any third parties without your prior written consent. You may unsubscribe to any or all portions of our e-mail correspondences at any time. Thank you for your cooperation.

Chronic Pain & Sleep Apnea: Is There A Link?

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.

 

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