IS MY SLEEP APNEA CAUSED BY NASAL CONGESTION?

QUESTION: Hi. I'm 18 years old and I've had moderate sleep apnea (45-50 apnea episodes per night) for almost 2 years now. It seems to be caused by nightly congestion and I was wondering if other patients have had this same specific issue. Thanks.

ANSWER: THERE IS A PROCESS CALLED THE NASAL CYCLE WHERE ONE SIDE OF THE NOSE CLOSES DURING SLEEP AND YOU BREATHE THRU THE OTHER SIDE . IT CHANGES SIDES EVERY 60-90 MINUTES. WHEN WE WAKE FROM AN APNEA EPISODE WE MAY FEEL THAT THIS IS DUE TO NASAL CONGESTION WHERE IT IS ACTUALLYA NORMAL PART OF THIS CYCLE.

IF THERE IS A LARGER NASAL AIRWAY ON ONE SIDE THAN THE OTHER THAN WHEN THE SMALL SIDE CLOSES WE DO WELL BECAUSE THE LARGER AIRWAY SIDE IS OPEN. WHEN THE LARGER AIRWAY SIDE SWELLS UP WE NOW NEED TO BREATHE THRU THE MORE CONSTRICTED AIRWAY.

IT IS POSTULATED THAT THE NASAL AIRWAY CYCLE IS HEALTH BECAUSE IT PROMOTES THE MOVEMENT OF OUR BODY FROM SIDE TO SIDE DURING SLEEP.

BELOW IS FROM WIKIPEDIA:
"The nasal cycle is the alternating obstruction of the nostrils in humans. It is a physiological congestion of the nasal concha due to selective activation of one half of the autonomic nervous system by the hypothalamus. It should not be confused with pathological nasal congestion. The nasal cycle was first described by the German physician Richard Kayser in 1895."
"Later on in 1927 Heetderks[2] speaks about alternating turgescence of the inferior turbinates in 80% of a normal population. The turbinates in one fossa filled up while the opposite turbinates decongested. This cycle, which is controlled by the autonomic nervous system as described above, had a mean duration of two and a half hours. He further observed and documented that the turbinates in the dependent nasal fossa filled when the patient was in the lateral decubitus position. Some postulate that this alternating positional obstruction has the purpose of causing a person to turn from one side to the other while sleeping. The nasal cycle is an alternating one, with the total resistance in the nose remaining constant. In patients with a fixed septal deviation and intermittent nasal obstruction, the interplay of the nasal cycle becomes evident; the sensation of obstruction frequently mirrors the congestion phase."

AN ARTICLE IN CNS Spectr. 2007;12(8):625-634 by David S. Shannahoff-Khalsa, BA discusses how this autonomic phenomenon can have psychiatric implications if only one side is stimulated. The abstract and link to this interesting topic is below: http://www.cnsspectrums.com/aspx/articledetail.aspx?articleid=1163

Research advances have led to three methods for selectively activating one half of the autonomic nervous system in humans. The first method is an ancient yogic technique called unilateral forced nostril breathing (UFNB) that employs forced breathing through only one nostril while closing off the other. The second method works by stimulation of an autonomic reflex point on the fifth intercostal space near the axilla. The most recent method employs unilateral vagus nerve stimulation (VNS) via the mid-inferior cervical branch and requires surgical implantation of a wire and pacemaker. UFNB is non-invasive and seems to selectively activate the ipsilateral branch of the sympathetic nervous system with a possible compensation effect leading to contralateral VNS. UFNB and VNS have been employed to treat psychiatric disorders. While UFNB has been studied for its potential effects on the endogenous ultradian rhythms of the autonomic and central nervous system, and their tightly coupled correlates, VNS has yet to be studied in this regard. This article reviews these three methods and discusses their similarities, putative mechanisms, their studied effects on the endogenous autonomic nervous system and central nervous system rhythms, and their implications for the treatment of psychiatric disorders.

WHY IS THIS IMPORTANT IN REGARDS TO SLEEP APNEA: THE CYCLE CAN BE DISRUPTED BY APNEA AND IF THE NASAL CYCLE TENDS TO ALWAYS AWAKEN THE BODY WHEN THE SAME SYMPATHETIC AND PARASYMPATHTIC INNERVATIONS IT COULD CREAT A HOST OF PROBLEMS INCLUDING HORMONE REGULATION.

An interesting section of this article deals with an ancient Yogi technique that can effect the nasal cycle and other autonomic phenomenon.

Sleep Apnea on the Rise

With the rise of sleep medicines in the United States, more and more people are discovering they are suffering from sleep apnea. When people come into the doctor and describe why they need sleep medicines, doctors often discover either they or their sleeping partner is suffering from obstructive sleep apnea (OSA).

With sleeping pills and other medicines increasing in popularity, patients have been coming to doctors describing a few different reasons as to why they need to get better rest at night. Some people want to sleep through a sleeping partner’s loud snoring; other people feel like they wake up throughout the night for no reason. Both of these are common sleep apnea symptoms.

Sleep apnea occurs very often in older and obese people when the muscles in the throat become weak and are unable to keep the airways open. The result of this obstruction is loud snoring that can be a true nightmare for sleeping partners. In addition to snoring, the body can also force you awake because it is in need of air. When you wake up multiple times a night simply for your body to get oxygen, it can have a serious effect on other aspects of your life.

Sleep apnea dangers include an increased risk of heart attack and stroke, obesity, and high blood pressure. If you’re feeling tired during the day, or if you’re hearing from your sleep partner that you snore all night, it may be time to discover if you have sleep apnea.

The best way to determine if you have sleep apnea is to schedule a full sleep apnea evaluation with Dr. Ira Shapira, Gurnee, Illinois dentist.

ARM AND HAND NUMBNESS AND PAIN IN SLEEP APNEA PATIENTS RELATED TO SCALENE MUSCLE NERVE ENTRAPMENT

The Russian article (see abstract below) discusses the entrapment of the neuromuscular bundle in fibruous bands in the scalene muscles. These muscles are very important in sleep apnea patients. They are normally accessory breathing muscles but are overused when patients with obstructive apnea try to breathe past an obstruction. Long term overuse can lead to taut bands and trigger points as described by Dr Janet Travell. These trigger points can lead to upper quarter pain including the entire arm and hand as well as anterior and posterior shouler regions.

In addition the nerve roots of the brachial plexus can be compressed between the anterior and medial scalene muscles. The authors call this scalenus anticus syndrome a subtype of thoracic outlet syndrome. These problems can be adressed by body work such as massage or myotherapy but correcting the underlying sleep apnea will often result in self correction of this problem. This will result in many patients utilizing CPAP or oral appliances.

In patients where the condition does not self correct a neuromuscular orthotic may give amazing relief. See http://www.ihateheadaches.org

Georgian Med News. 2005 Sep;(126):18-23.

[Fibrous-muscular and vessels anomalies revealing during surgery of the scalenus anticus syndrome]

[Article in Russian]

Tsitsuashvili G, Dzhavakhishvili G, Buddzhiashvili V, Gogeliani A, Rcheulishvili I.

National Center of Surgery, Tbilisi, Georgia.

One hundred and twenty five operations on 100 patients were performed due to the symptoms suggesting presence of the pressure on the neurovascular supraclavicular structures, although X-ray showed no evidence of cervical rib. In 15 cases of patients with so-called scalenus anticus syndrome as one of the forms of thoracic outlet syndrome (TOS) seemed to be compressing the neurovascular bundle. Scalenus mediums muscle appeared to be producing more compression of the nerve roots than did the scalenus anterior in 5 patients. Pressure from Rudimentary First Rib--in 2 cases in our series malformation of the first rib was the cause of the patient's distress. Anomalous Bands--in 4 cases anomalous bands of fibrous tissue in the supraclavicular area were the cause of compression of the neurovascular bundle Anomaleus Arteries Compressing Nerve Roots- large arteries compressed roots of trunks of the brachial plexus in four patients in our series to such an extent that it seemed these structures were the cause of the patient's symptoms. All anomalous structures were removed, good results after such surgical tactics were kept for long time in all cases. Therefore the surgeons, performing scalenotomy have to pay particular attention to the fibrous bands and anomalies in the scalene group of muscles.

PMID: 16234586 [PubMed - indexed for MEDLINE]

What is Sleep Apnea?

Sleep apnea is a very serious, life-threatening condition in which one repeatedly stops breathing during sleep. The periods of not breathing can last several seconds, leaving you gasping for air, and sleep apneaics may have hundreds of these episodes during one night.

There are three types of sleep apnea: obstructive sleep apnea (OSA), central sleep apnea, and a combination of the two. OSA is caused by a blockage of your airway; excess tissue may be the cause of this blockage. The blockage could be in the nasal passages, or something related to the structure of the jaw and airway may also cause the sleep apnea.

Central sleep apnea is not as common as obstructive sleep apnea. In CSA, the brain does not send the appropriate signals to the breathing muscles to produce respiration.

The causes of sleep apnea are numerous and may include:

Structural problems in the airway that cause interrupted breathing during sleep
Throat muscles and tongue relax during sleep blocking the airway
Narrowing of the airway often occurs in obese individuals due to the excess tissue in the throat and neck areas

Some people are more prone to suffer from sleep apnea than others. A staggering 15 million people are estimated to suffer from this condition with more men than women having the condition. People who are overweight, have hypertension (high blood pressure) or snore loudly are at a greater risk of developing sleep apnea. Some studies indicate that the disorder may be hereditary.

There are a variety of treatments for sleep apnea, and treatment for sleep apneaics varies from case to case. In the past, CPAP (Continuous Positive Airway Pressure) has been used but because you must actually wear a mask while you sleep. The CPAP machine uses pressure to send air flowing through the nasal passages. Other treatments for sleep apnea include:

Oral appliances
Behavioral changes
Medication
Surgery

If you think you may suffer from sleep apnea, there is help out there for you. In Gurnee, Illinois, Dr. Ira Shapira has successfully treated thousands of sleep apneaics, and he can help you, too. Please contact The Snoring & Sleep Apnea Treatment Center in Gurnee today to schedule an evaluation.

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The Palate and Obstructive Sleep Apnea

In describing obstructive sleep apnea, we often talk about the collapse of the airways during sleep. Now, the journal Archives of Otolaryngology reports that at least one of these anatomical changes has been imaged during actual apnea/hypoxia events. In a study reported in the February issue, researchers investigated changes to the soft palate experienced by sleepers to determine whether particular soft palate changes could be used to distinguish between obstructive sleep apnea sufferers and simple snorers.

The palate is the roof of the mouth. The front of the palate is the hard palate, and behind it is the soft palate, which extends back to the uvula (the fleshy, dangling protuberance at the back of the mouth. Using sleep videofluoroscopy to measure anatomical changes and polysomnography to identify apnea/hypoxia events, researchers found that the soft palate behaved very differently in sleep apnea sufferers than it did in simple snorers. Sleep apnea sufferers were more likely to see the soft palate expand backward during sleep. And this expansion was linked to instances of apnea and hypoxia.

The distinction between simple snorers and obstructive sleep apnea sufferers is a crucial part of delivering the right solution for those with sleep disordered breathing. Simple snoring is just a nuisance, but the dangers of sleep apnea make it a deadly condition that can dramatically reduce a person's life expectancy.

If you need help getting the best solution for your sleep apnea, schedule a sleep apnea consultation at the Snoring and Sleep Apnea Treatment Center in Gurnee, Illinois today.

Sleep Apnea in Children

Sleep apnea can have a huge affect on the health of adults, but when the dangers of sleep apnea are directed at children, the results can be devastating. Overweight children are still developing, and sleep apnea can stress their bodies, putting them at an even greater risk of sleep apnea symptoms.

According to a new study, children who are overweight and wet the bed may be suffering from obstructive sleep apnea. After performing sleep studies on control and sleep apnea suffering children, the study showed that both bedwetting and being overweight can be associated with sleep apnea but the two not associated with each other.

The data from the study showed that there is a significant association between overweight children, bedwetting, and obstructive sleep apnea. Scientists are unsure of why this association exists, but they suggest doctors examine the possibility of children suffering from obstructive sleep apnea if an overweight child is also suffering from bedwetting; especially if they are also suffering from other sleep apnea symptoms.

Researchers claim that a child who suffers from bedwetting is five times more likely to have sleep apnea. While unrelated, a child who suffers from being overweight is four times more likely to have obstructive sleep apnea.

If you live in the Illinois area and you suspect that your child or other family member is suffering from sleep apnea, please contact Dr. Ira Shapira, Gurnee, Illinois sleep dentist to schedule a professional sleep apnea examination.

Snoring Cure: When You are Tired of Sleeping with a SubWoofer

Oral Appliances are an excellent method, if not the best method for treating Snoring. The appliances are approved for treating sleep apnea but loud snoring is a serious problem that can destroy intimate relationships and adversly affect the health of your loved ones. According to a study at Mayo Clinic the spouses of snorers lose 15% of their sleep.

Heavy snorers have up to a six-fold increase in carotid artery atherosclerosis even when there is no sleep apnea. If you are tired of snoring ruining your life and interfering with intimacy consider an oral appliance to silence snoring.

It is amazing what a positive effect eliminating snoring can have on relationships. There is significant literature on sleep apnea and snoring that shows these problems increase the percentage of marriages ending in divorce.

Snoring should always be consided an emergency early warning system of possible sleep apnea. Do not ignore this important and life saving warning. Oral appliances are excellent for treating snoring, as well as mild to moderate sleep apnea.

Snoring is a Good Indicator of Sleep Apnea

While most people consider snoring more of an annoyance than a health issue, the truth is that snoring can lead to very serious health problems. Snoring is closely related to a health condition known as Obstructive Sleep Apnea (OSA); according to the National Heart, Lung, and Blood Institute, over 12 million Americans have OSA. This condition can lead to:

Fatigue
High blood pressure
Anxiety
Depression
Concentration and memory problems
Weight gain
Cardiac problems
Stroke

Many people wonder what causes snoring. It's quite simple, actually. When you sleep, the soft tissue and muscles in your mouth and throat relax, which causes your airway to become smaller; if it becomes too small, your soft palate and uvula will vibrate against each other when you breathe in and out. This is the sound of snoring. Sleep studies indicate that snoring is very common. In fact, 45% of the general population snores. Six percent of children snore on a regular basis, also.

According to the medical journal, JAMA, people who snore are three times more likely to be involved in a car accident than non-snorers, and snoring is worse in those who are overweight.

There are treatments for snoring and sleep apnea. While CPAP has been the gold standard for many decades, it is uncomfortable and has a very low success rate in patient compliance. Oral appliances that are worn at night have proven to be hugely successful because the mouth pieces are custom-fitted to each patient.

If you live in Illinois and are tired of feeling tired because you were up most of the night, please contact sleep apnea dentist, Dr. Ira Shapira in Gurnee, Illinois today to schedule a thorough consultation.

Yawning is so contagious chimps can catch it from animation.

A great post om yawning can be found on the following link.

http://us.mc1106.mail.yahoo.com/mc/welcome?.gx=1&.tm=1267535822&.rand=b7gm7ekgv24r6#_pg=showMessage;_ylc=X3oDMTBucmhobGR0BF9TAzM5ODMwMTAyNwRhYwNkZWxNc2dz&mid=1_4402434_AMUNw0MAATx3S4y4YQvdHQ1Q6xw&fid=Inbox&sort=date&order=down&startMid=0&filterBy=&.rand=1957524273&hash=3dddfe78128c2f9985dad085a457d286&.jsrand=9573558

There is an international conference on yawning in June.

WHEN CPAP DOESN'T WORK: WHAT DO YOU DO NEXT? WHY DO ORAL APPLIANCES MAKE PATIENTS FEEL BETTER?

MANY PATIENTS COMPLAIN THAT THEIR CPAP DOESN'T WORK BUT THAT IS USUALLY NOT THE CASE. THE CPAP DOES USUALLY FIX THE SLEEP APNEA BUT IT OFTEN LEAVES THE PATIENT STILL TIRED. THERE ARE TIMES THERE MAY BE A PROBLEM WITH RESTLESS LEGS OR OTHER PROBLEMS DISTURBING SLEEP. IF A PATIENT IS STILL TIRED EVEN WITH CPAP AN MSLT OR A MWT TEST CAN BE GIVEN TO DETERMINE HOW MUCH OF A PROBLEM THE TIREDNESS IS BASED ON OBJECTIVE FINDINGS.

AN INTERESTING PHENOMENA IS THAT PATIENTS OFTEN FEEL BETTER WITH ORAL APPLIANCE THERAPY EVEN THOUGH OBJECTIVELY IT APPEARS LESS EFFECTIVE THAN CPAP. POSSIBLE EXPLANATIONS ARE THAT THE CPAP DISRUPTS THE SLEEP OR THAT IT HAS BEEN OVERTITRATED AND IS CAUSING CENTRAL SLEEP APNEA OR THERE MAY BE BREAKTHRU CENTRAL APNEA.

THESE EXPLANATIONS STILL DO NOT EXPLAIN WHY SOME PATIENTS FEEL SO MUCH BETTER WITH APPLIANCE THERAP THAN WITH CPAP. A POSSIBLE EXPLANATION IS THAT THE SLEEP APNEA APPLIANCE IS ACTUALLY NOT JUST MAINTAINING AN OPEN AIRWAY BUT ALSO TREATING AN UNDERLYING TMJ DISORDER. CHRONIC TIREDNESS IS ASSOCIATED WITH TMD DISORDERS AND THE NHLBI CONSIDERS SLEEP APNEA TO BE A TMJ DISORDER. THE NHLBI REPORT http://www.nhlbi.nih.gov/meetings/workshops/tmj_wksp.pdf IS A MUST READ FOR ANYONE HAVING PROBLEMS WITH RESIDUAL TIREDNESS WHILE USING CPAP.

ANOTHER REASON PATIENTS FEEL TIRED WITH CPAP USE IS THAT THEY JUST DO NOT WEAR IT ENOUGH HOURS A NIGHT. CPAP USERS AVERAGE ONLY 4-5 HOURS A NIGHT OF CPAP USE. THE MAJORITY OF PATIENTS DO NOT USE CPAP AT ALL AFTER TIME. THERE IS A GROUP OF PATIENTS WHO WEAR THEIR CPAP ALL NIGHT EVERY NIGHT SO THE 4-5 HOURS AVERAGE MEAN MANY PATIENTS USE IT SIGNIFICANTLY LESS THAN 4 HOURS.

ANOTHER PROBLEM IS SIMPLE SLEEP RESTRICTION. MANY PATIENTS ONLY SET ASIDE 5-6 HOURS A NIGHT FOR SLEEP, NOT NEARLY ENOUGH AND THEREFORE THEY ARE STILL TIRED.