Archive for sleep apnea
Metabolic disturbances in obesity versus sleep apnea: the importance of visceral obesity and insulin resistance
I must admit this is a very interesting concept. Basically, this article opens up the idea that sleep apnea may actually be a manifestation of underlying insulin resistance and obesity. We have always known that abdominal obesity was a risk factor for sleep apnea, but the association with insulin resistance would really change the approach to treatment. I am always in support of a CPAP machine because sleep apnea can have some pretty serious long term consequences, but now we should add aggressive lifestyle changes for insulin resistance as well.
Adverse Effects of Modest Sleep Restriction on Sleepiness, Performance, and Inflammatory Cytokines
I know I’m guilty here. We all know that sleep is very important and is a stress on the body, but to increase inflammation is definitely news to me. And considering that inflammation plays a role in just about every chronic disease we know of, getting a good night’s sleep becomes even more important. I would like to see if the use of drugs for sleep, such as Ambien, would avoid the increase in inflammatory markers since is does interfere with the deepest levels of sleep.
JCEM — Abstracts: Vgontzas et al. 89 (5): 2119 -
Melatonin in Patients with Reduced REM Sleep Duration: Two Randomized Controlled Trials
I usually hesitate to use melatonin in most cases, and would prefer valerian root and/or snacks high in tryptophan (bananas, sunflower seeds) as a first line approach. I view melatonin as a powerful hormone that has the ability to impact many aspects of physiology. However, in patients on a weird sleep schedule (midnights, travel) I have found it to work very well. Considering how many patients I see that have been given Ambien or some other such drug to sleep, the fact that melatonin induces REM sleep and Ambien doesn’t this should be a no-brainer.
JCEM — Abstracts: Kunz et al. 89 (1): 128 -
While you may be exercising and eating right to manage or lose weight, I’m betting that you have lost this at least once in the past month or even past week.
No big shocker that our society has got problems. We think it’s lack of exercise so we exercise to Jane Fonda and Richard Simmons (ok…so we USED to exercise to them…). We think it’s fat so we cut out olive oil, avocados and almonds. Then we think it’s carbs so we attempt to cut out all carbs (which is impossible–even broccoli has carbs) and add artificial sweeteners to balance out the lost sugar.
Obviously, none of it is working.
The problem is that the obesity epidemic is not caused by a single food item, a single type of chemical exposure or merely by not burning enough calories. It is all of these things that create the weight problem in the larger chunk of our population. While this doesn’t fit well on a billboard or a soundbite and is not likely to make anyone billions of dollars, it is the reality of the situation.
Managing or avoiding obesity and diabetes requires a hard look at all aspects of your lifestyle. I had a new diabetic patient in today that was not exercising (due to severe pain), had almost exclusively refined carbs for breakfast, drinks out of plastic water bottles and was taking in upwards of 32 ounces of diet Coke per day on top of the Splenda in her coffee in the morning. All of these factors need to be addressed for a successful outcome as it relates to health.
Personally, I think it’s the subtle factors that blindside most of us. Things like:
- Chemical exposures such as BPA in plastic water bottles and flame retardants
- Artificial sweeteners like Splenda, acesulfame potassium and Nutrisweet
- Lack of healthy bacterial flora from use of antibiotics
These are the type of factors that many are not aware of. I would have to say that the bulk of patients I talk with are not aware that things like BPA and artificial sweeteners are bad for us. We’ve all been successfully duped by the best minds in marketing to believe that drinking lots of water and diet sodas are going to be the answer, not the problem.
Here’s another subtle one that may destroy your ideal body weight. Sleep.
Sure, we all know that sleep is important. We have seen studies where those who are sleep deprived have greater hedonistic tendencies (basically, you eat everything in sight regardless of whether you are hungry or not). We even know that kids who are sleep deprived aren’t able to focus as well.
This particular study takes a deeper look at what happens to our fat cells when a small group of participants are restricted to 4.5 hours of sleep for 4 days.
Researchers found that fat cells required a 3 times stronger signal from insulin to behave normally–a clear indication that the body was heading towards diabetes in a mere 4 days.
This helps us understand why sleep apnea is so bad for us and carries a large risk of heart disease and developing diabetes.
So..when was the last time you went at least 4 days without enough sleep?
Might the horrendous “gasping for air” sound sleep apnea sufferers make cause headaches? If this description fits your night, maybe it’s time to visit a sleep lab.
The brain is a very sensitive organ. Bombard it with toxic chemicals from the environment, deprive it of fuel or stress it out and it’s not going to be happy with you.
The same goes for oxygen. Decrease oxygen supply to the brain cells, even by the smallest amount, and you can trigger a headache.
“But how?” you ask.
When it comes to keeping our brain cells happy and healthy one of the factors that plays a critical role is the ability to carry oxygen to our brains. If the brain doesn’t have enough oxygen, our mitochondria won’t be able to produce the energy (in the form of ATP) that we need, and the brain is not able to function the way it is supposed to.
So, any drop in the ability to deliver oxygen to the brain can create problems. This is exactly the state that many women experience in the second half of their menstrual cycles as the lining of the endometrium begins to build, removing red blood cells from circulation and reducing the ability of the blood to bring oxygen to the brain.
This can be a very subtle drop in red blood cell level, but given how sensitive the brain is to changes in oxygen levels, that can be enough to trigger a menstrual migraine in women who are already sensitive.
While we’re on the subject of reducing oxygen delivery to the brain, what about sleep apnea?
Ask anyone who’s slept next to someone with sleep apnea and they will tell you that it can be a scary experience. The person can stop breathing many times per hour, leaving the other person in the bed unable to sleep, constantly ready to dial 911 if the breathing doesn’t resume this time…
This is a monumentally bad situation for our health. And this is on top of the fact that most cases of central sleep apnea are caused by being prediabetic, which carries its own risk to our health.
Clearly this sleep apnea will both stress the body out as well as deprive the brain of oxygen. As mentioned, this drop in oxygen is not received nicely by the neurons, as we can see from this particular study.
Researchers looked at a group of chronic head sufferers (chronic migraine without aura, episodic migraine without aura, migraine with aura, tension-type headache, chronic post-traumatic headache, medication overuse headache) and identified how many of these experienced sleep apnea. Here are the findings:
All patients were receiving standard treatment for their headaches by their neurologist.
63% of the chronic headache sufferers had obstructive sleep apnea (OSA).
Of the patients with OSA, 63% used CPAP and 82% of these used the CPAP as prescribed.
49% of this group of patients had a positive response to therapy (meds or CPAP)
Patients with OSA who using the CPAP were more likely to have improvement in headaches
Of the 33 patients who used CPAP, 13 reported improvement in headaches specifically due to CPAP therapy.
Overall, this is some pretty strong stuff and would suggest that every chronic headache sufferer should be evaluated at a sleep lab for sleep apnea. This is, of course, in addition to lifestyle changes designed to improve brain health.
If you use a CPAP and have suffered with chronic headaches, did using the CPAP help your headaches?
Melatonin in walnuts: Influence on levels of melatonin and total antioxidant capacity of blood
Okay, so I was a little surprised to hear that melatonin is found in walnuts. I guess I just always viewed it as one of those mammal-only substances. I guess this means we can add walnuts to the list of compounds that may have an ability to sedate and/or help people sleep when taken late at night.
Melatonin is effective for some sleep disorders
Well…I have to say that this article is probably right on for how I use melatonin in my office. Two interesting notes–this study found melatonin effective in children and also used dosages up to 10 mg, which is far in excess of the higher levels of recommendations at 3 mg. Also of notes was that the authors compared melatonin with Ambien and found it similarly effective–and, though not mentioned, a heck of alot cheaper (melatonin is very inexpensive).
Keep in mind as well that melatonin has some heavy research behind it for acting as a high powered antioxidant in the nervous system, which is an added benefit that I would bet Ambien can’t claim.
Circadian tempo: A paradigm for genome stability?
Wow!! What a concept. Our body’s ability to repair damaged DNA does not occur evenly throughout the day, but seems to be at its peak at the time of day when the DNA is most likely to be exposed to higher levels of DNA damage.
So, if this holds true, then what about patients that have problems sleeping, work night shifts or are stressed? Might this be another mechanism by which these conditions lead to cancer?
Valerian for Sleep: A Systematic Review and Meta-Analysis
Our entire approach to sleep disorders is just a little dsyfunctional. If someone has a problem sleeping, there is something really wrong to be avoiding this absolutely essential process. This can come from several sources, but adding a medication to force a body into an unnatural sleep just can’t be good in the long term (of course, we don’t really know because few, if any, sleep drugs have had long term studies done on them…). Altered cortisol rhythms from stress, neurotransmitter dysfunction, melatonin production mis-timing can all cause sleep problems. These need to be fixed, NOT medicated.
I remember a patient who worked midnights asking me what he could take for energy. Knowing his sleep cycle, I asked how he was sleeping. Poorly of course–so he tried a little melatonin to help regulate his sleep cycle. One week later he came in and had all the energy he needed. It’s not that some high dose sugar and caffeine carbonated beverage wouldn’t have done the trick.