As a first time author who has worked for a year and a half to get my book published, I feel a combination of excitement and pure terror now that the book is out and available to the public. On the one hand, I’m excited to be able to share my revelations about health and wellness to as many people on this planet as possible. But at the same time, I’m scared to death that the book will flop and that no one would have been helped by my message.
Still, I’m sure that my stress is nothing compared to the stress that many of you probably feel when you come see me. I see many patients coming in these days thinking the worst case scenario—thinking that their chronic throat pain is a sign of throat cancer, or that their ear pain is the beginnings of a brain tumor. It’s not surprising during hard economic times, that the stress and uncertainty about our financial future manifests physically as one type of illness or another. However, there is one intrinsic stressor that I see all the time that many people overlook. And without addressing this one problem first, it’s virtually impossible to eliminate all the other stress in our lives no matter what the circumstance.
As I state in my book, Sleep, Interrupted, all modern humans are susceptible to various degrees to breathing stoppages due to our tongues falling back and occluding our upper airways. This problem is thought to be due to our unique ability to talk. In humans, the voice box sits below the tongue, whereas in human infants and other animals, the voice box sits behind the tongue. You could even say that the overdevelopment of complex speech and language may be detrimental to breathing and swallowing. This is evidenced by the fact that only humans regularly choke on food and die.
Up until recently, this airway "problem" was not really a problem for those who were relatively young and healthy. Unless you were an obese, middle aged male who snored like a freight train, sleep breathing problems like obstructive sleep apnea or OSA, would not have been an issue.
However, in the last 10 to 20 years a lot has changed. Not only are we living longer, thanks to advancements in science, but we’re also getting heavier, less active and working longer hours thanks to technological innovations like the internet and the mobile phone. Add to that, our poor diets and frenetic lifestyles, and what we have is a serious problem for anyone who needs to sleep and breathe. Ironically, during this last century we seemed to have devolved in an effort to evolve.
That Was Then, This Is Now
In my book, Sleep Interrupted, I reference a dentist named Weston Price who traveled the world in the first half of the 1900s and discovered that indigenous, isolated cultures that ate completely off the land (or mountains or the oceans) had wide jaws and perfectly aligned teeth. But once their children began to eat Western diets,namely more processed foods with highly refined sugars, their jaws became more narrow and dental crowding became rampant.
Similarly, another dentist, Dr. Brian Palmer, noticed that there has been an exponential increase of malocclussions, or dental crowding and jaw malformation in children over the last 10-20 years. He proposes that bottle-feeding may have attributed to this process and that we’re seeing more and more sleep breathing problems like obstructive sleep apnea as a result. Dr. David Page, another dentist who specializes in Functional Jaw Orthopedics, suggests in his book, Your Jaws, Your Life, that this type of jaw degeneration can have detrimental consequences to our health and longevity. He states that due to our: "Diet, infant feeding practices…most people today have jaws about 1/4 inch too small to fit all the wisdom teeth into place. Sadly, small jaws and airways can bring about premature death."
All of these findings support what I continue to see in my medical practice as well—especially in those patients suffering from chronic ear, nose and throat problems along with unexplained fatigue, anxiety and an assortment of digestive problems. What I see is a preponderance of jaw narrowing along with airway narrowing. It appears that both of these traits go hand in hand.
What’s more significant however, is that I’m seeing this in patients who are young, thin, and relatively healthy—three physical characteristics that would have precluded them in earlier generations from being diagnosed with a sleep breathing problem, like OSA. Yet now there seems to be a preponderance of this airway narrowing across all ages and genders and along with it a host of sleep breathing problems. Many of them profess to feeling sick and tired all the time no matter how long they sleep. Consequently, they’re more stressed than ever before.
More Reasons to Stress When you have any type of airway narrowing you’re bound to have some major physiological stressors compounding your health problems.
Because of your smaller jaw size, airway narrowing is a given and this means a higher likelihood of airway obstruction especially as you lay back and go to sleep (and your muscles become completely relaxed). This means that you’ll also wake up multiple times during the night as you cycle from deep sleep to light sleep since your narrow airways tend to close off or obstruct completely as you drift off to sleep.
In OSA patients, these airway obstructions are called "apneas" or loss of breath and this can happen 35 to a 100 times a night in some extreme cases, and these obstructions oftentimes last as long as 10 seconds at a time. You can imagine what kind of toll this would have on your body over many years. It’s not surprising that a majority of OSA patients also suffer from diabetes, heart disease, clinical depression, anxiety, and obesity, not to mention that they’re at higher risk for strokes and even Alzheimer’s.
But there are many more patients who are not diagnosed with OSA that still suffer from these similar effects. These are the patients I most often see in my practice suffering from a milder form of OSA called Upper Airway Resistance Syndrome or UARS.
Similar to OSA patients, UARS patients also wake up multiple times while sleeping because they stop breathing. Although these episodes are brief and not really noticed by these patients, these breathing cessations can still be significant happening 5 to 25 times an hour and lasting anywhere from 1 to 9 seconds each time they stop breathing.
It’s true that every once in a while, patients suffering from UARS will obstruct completely and wake up gasping for air, with their heart beating and in a cold sweat. Yet, these episodes are dismissed as "panic attacks" and not really explored for symptoms of a sleep breathing problem.
Instead, multiple arousals like this eventually leads to a chronic state of stress and sympathetic nervous system overactivity (fight or flight response). This is a physiologic form of stress. Various neurologic, hormonal and biochemical changes cam occur, leading to certain predictable events like: high blood pressure, cold hands and feet, chronic nasal congestion or a runny nose, chronic gastrointestinal problems, bladder problems, weight gain, and many others. Typically these patients also exhibit many of the symptoms and signs of a "routine" ear, nose and throat problem, like chronic sinusitis, frequent ear infections, and even nasal allergies.
In this situation, any kind of external stress, whether emotional, physical, or psychological can aggravate the internal vicious cycle. Your entire nervous system is en garde all the time, with your nervous system becoming hypersensitive due to all the arousals and poor sleep quality. Your emotions and all your senses are heightened. Now place yourself in a stressful environment and you can just imagine what will happen next.
Add to this all the constant stimulation and information overload that only adds to this perceived stress. If you take it as a fact that we can’t sleep as efficiently as we used to, then no wonder why so many of us are so on edge these days. It doesn’t take much insight to figure out that we need to first address these internal stressors before we can effectively address the daily stress in our lives.
Reassess Your Stress Level
Timothy Ferris, in his New York Times best-seller, The 4 Hour Work-Week, tells this great story (loosely paraphrased): An extremely successful but stressed-out American CEO travels on vacation to a remote port village in Mexico. While walking by the town docks, he notices a local fisherman who brings in a boatload of fish, almost to the point of capsizing. He notices that he catches the same enormous amount of fish day after day. He approaches the fisherman and offers to systematize the fisherman’s unique techniques so that he can make multiple times the money in profits. The fisherman asks what he can do with all the money. “You and your family can eat anything you want, as much as you want,” said the CEO. “But I have more than I need to eat. I give the remaining fish to my neighbors,” replied the fisherman. The CEO then responded, “then you can build a larger house.” “Then what?” asked the fisherman. “Then you can move to America and open up a fish processing center with 200 employees and make a fortune!” said the CEO. “Then what?” replied the fisherman. “After you make all that money you can have the luxury of taking time off any time you want and have your own private house on the beach in a remote town and spend as much time as you want with your family.” said the CEO. With a big smile, the fisherman said, “But Señor, I’m doing that already.”
Sometimes, especially during our most stressful moments, we need to reassess what we’ve lost to gain better perspective on what we have already. By becoming more aware and taking action to regain control of our health you’ll gain momentum to tackle any stress that comes your way.
If you suspect that you may have a sleep breathing problem like OSA or UARS, take the following quiz on line here.