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Expert Interview: Dr. Ted Belfor on “Developing the Face and The Airway with a Removable Dental Appliance: The Homeoblock”

Please join me on Tuesday, May 29th, at 8PM Eastern for my next Expert Interview. This month, Dr. Ted Belfor will give a presentation on “Developing the Face and The Airway with a Removable Dental Appliance: The Homeoblock”.

 

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Did Adam Yauch of the Beastie Boys Have UARS?

The hip-hop and pop music world was saddened to hear that Adam Yauch of the Beastie Boys died at at the age of 47. He had been battling parotid gland cancer. As you may know, one of my hobbies is to analyze facial features, particularly jaw configurations in relation to one’s ability to breathe and sleep properly at night. I came across this picture on MSNBC, showing Mr. Yauch’s narrow and recessed mandible, along with a very narrow and pinched in nose. Having small jaws leads to airway crowding, predisposing to breathing problems while in deep sleep during muscle relaxation. 

There’s nothing more public about his health status besides his cancer, but one of his hallmark features was his raspy voice. If  he had upper airway resistance syndrome, it’s likely he also had laryngopharyngeal reflux disease. Besides aggravating hoarseness, reflux can also cause chronic oral cavity, nasal and lung inflammation, potentially leading to a multitude of health problems. It’s also very likely that he didn’t like to sleep on his back, and had unrefreshing sleep. Studies are beginning to show that lack of good sleep may also be a risk factor for cancer. 

All this is speculation, but celebrities are also modern humans, being susceptible to craniofacial features that can lead to sleep-related breathing disorders. Do you know of other celebrities that have small jaws or facial features?

 

 

 

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.

 

Browse several inpatient drug rehab centers!

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

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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?

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