The Relationship between Seasonal Affective Disorder and Sleep Problems

One of the most common questions I get in the office during the winter months has to do with seasonal affective disorder: What is it? Do I have it? And what can I do about it? Seasonal affective disorder is a very real form of depression that may affect six out of every 100 people in the United States, according to the American Academy of Family Physicians.

Symptoms of SAD generally manifest in late fall, when the days become shorter and colder, and people enjoy less natural sunlight. Symptoms include, but are not limited to, feelings of sadness, hopelessness and helplessness, lack of energy, loss of sexual interest and usual pleasurable activities, irritability and restlessness, cravings for carbohydrates and overeating (which can lead to weight gain and compound negative and depressive feelings), trouble concentrating, difficulty sleeping and/or insomnia and at the extreme end—thoughts of death or suicide. Symptoms of SAD are usually most intense during the darkest months of the year, so it stands to reason that the farther a person lives from the equator, the higher the incidence of SAD occurs.

These sleep-related symptoms are of particular interest to me, and are usually the catalyst for a person with SAD to come see me for a consultation and treatment. A person with SAD who suffers from sleep problems may go to sleep early and stay in bed for nine or ten hours, but not experience refreshing sleep.  Because of a lack of restful sleep, people with SAD are often drowsy and have trouble concentrating and working during the day.

The relationship between sleep and depression is a bit of a “chicken or the egg” relationship. Which came first? SAD-related depression, or the sleeping problems? It depends. For some, symptoms of SAD occur first—for others, sleep problems appear first. Depression may cause the sleep problems, and sleep problems may cause or worsen the other SAD symptoms.

There is a common link between people with depression and insomnia. Studies have shown that people with insomnia have a ten-fold risk of developing depression compared with people who sleep well. Further, developing depression is highest among those with both sleep onset and sleep maintenance insomnia.

People with depression may also experience insomnia symptoms, including difficulty falling asleep, difficulty staying asleep, experiencing restful sleep and daytime sleepiness. People who suffer from depression are also five times more likely to have a breathing-related sleep disorder than non-depressed people, according to a study at the Stanford University School of Medicine. The 2003 study by Stanford researcher Maurice Ohayon, MD, PhD, found that people with depression were found to be five times more likely to suffer from obstructive sleep apnea (OSA), the most common form of sleep disordered breathing. This was one of the first studies to make the connection between depression and sleep disorders.  More current research has confirmed the connection.

So, if you believe you are experiencing SAD-related depression and/or sleep disorders, please see a psychiatrist or sleep specialist about it. There are treatments such as morning light therapy that can offer some relief, so you don’t have to suffer unnecessarily through the winter blues. Call me—I’m happy to help.

Who’s Suffering More from Lack of Sleep—Men or Women?

This week, I was interviewed by WCBS-TV New York for a news segment called, “Sleep: the Battle of the Sexes.” The topic was one I am very familiar with: People suffering from lack of sleep, and how it can affect daytime mood, mental acuity, job performance and relationship intimacy.

The show drilled down a bit farther and asked: who is more likely to suffer from a sleep disorder, men or women? And of the two genders, which performs better despite a lack of sleep?

What we know is that men and women have different circadian rhythms. According to an article by the Proceedings of the National Academy of Sciences of the United States of America,  “The circadian rhythms of melatonin and body temperature are set to an earlier hour in women than in men, even when the women and men maintain nearly identical and consistent bedtimes and wake times. Moreover, women tend to wake up earlier than men and exhibit a greater preference for morning activities than men.”

In other words, women tend to go to sleep and wake up earlier than men. We also know thanks to a Penn State study that women need 6.8 hours of sleep per night, while men require just 6.2 hours. While scientific studies are interesting, there is a discrepancy between these numbers and what I am seeing in my office at the Manhattan Snoring and Sleep Center.

Based on the facts, one would think women are getting to sleep earlier and sleeping longer than their male counterparts. But are women getting the sleep they need? In my anecdotal opinion, they are not, and they are suffering quietly for it. In our society, men are stressed out, but women are really stressed out. The physical demands of balancing career and family, along with the mental strain of worrying about finances and future is taking its toll on the women in our society. 

Don’t get me wrong, men worry and suffer from sleep disorders too. But they seem more willing to speak up and seek treatment. Women, on the other hand, being the selfless caregivers they are, stay focused on others and what needs to be done and power through their day. Which explains another Penn State study that found sleep deprived women made fewer mistakes compared to men in a series of computer tasks. It seems that, although women need more sleep, they do better without it because, for better or worse, they’re just more used to it.

Whether a man or woman is suffering from a lack of sleep, the fact is that a sleep disorder can lead to negative health issues, including an increased chance of hypertension, heart disease, osteoporosis and inflammatory disease.

In addition to personal health issues, a sleep disorder can wreak havoc on a relationship. The partner of a patient once shared with me how his snoring and sleep apnea had impacted their relationship. It led to weeks without quality REM sleep, and she said it left her feeling groggy with low energy, cranky, unable to concentrate for long and she was more prone to getting sick. His constant snoring caused her to start sleeping on the couch, which led to resentment, lack of intimacy and loss of connection.

I have made it clear in previous blogs that I am not a marriage counselor or relationship expert. But I can tell you unequivocally that, if you or your partner snores or suffers from a lack of sleep on a consistent basis, it will negatively affect your relationship.

In the end, circadian rhythms and who performs better and the sex of the person with the sleep disorder doesn’t matter. What matters is getting it treated and keeping the relationship healthy.

This also bears repeating: Turn off the TV when you go to sleep. Falling asleep with the TV or computer on interrupts deep REM sleep because the light from the screens interfere with the production of melatonin, a hormone that tells our bodies when it’s time to go to sleep. Do yourself a favor and turn off the TV, computer and lights at night. Your brain and body will thank you for it the next day.

To watch “Sleep: The Battle of the Sexes” on CBS2 New York, click here.

Stop Snoring — It Can Be the Secret to Happy Marriage

I am by no means a marriage therapist. However, I hear couples complain all the time in my practice. They come in for a snoring test appointment, and within seconds the husband makes a comment such as “my wife made me come.” Snoring is more common in men than women, but the reverse is also common.

The snoring spouse who feels “dragged” to the doctor’s office is resentful that his or her snoring problem can’t be left alone. The spouse that does the dragging-in is frustrated and tired. Ordinarily affectionate couples can have a strain in their relationship caused by snoring. Sometimes if it wasn’t for their spouse, a snorer wouldn’t even know they had a problem. As one of my patients recently told me, “I was very surprised when my lovely wife first clued me in that I was snoring at night. It was disturbing her sleep, but I didn’t realize that snoring was the cause of my own fatigue.”

The reason for resentment is understandable. Snoring can cause daytime symptoms that can cause serious problems in one’s waking life, and unfortunately, it is not just the snorer that suffers – the snorer’s spouse can suffer just as much. According to the National Sleep Foundation,  39% of American adults get less than seven hours of sleep each weeknight, and more than one in three (37%) are so sleepy during the day that it interferes with daily activities. The sleep loss associated with snoring—whether it’s the snorer or the bed partner who is awakened by the snoring, interrupts important recuperative sleep which can impair a person’s ability to perform cognitive tasks involving memory, learning, reasoning, and mathematical processes. It can impair motor skills and can cause morning headaches, irritability, burnout and depression to mention just a few symptoms.

Symptoms can be even more severe for the snorer if they have sleep apnea, a condition which causes them to stop breathing often many times a night, and wake gasping for air. Sleep apnea is linked to lung and heart disease, diabetes, obesity and stroke.

The disruption of sleep from snoring is causing couples to have a hard time sleeping together. Fifty-three percent of adults say they have relationship problems because of their or their partner's sleep disorder, the National Sleep Foundation found in a recent study. To avoid the symptoms of daytime sleepiness, many couples choose not to sleep together in the same bed.

In the book, "Two in a Bed: The Social System of Couple Bed Sharing," author Paul C. Rosenblatt interviewed 42 couples, and examined how sharing a bed affects the couple’s relationship. Many couples described the intimacy and comfort level of sleeping in the same bed is extremely important to their relationship. As he describes in the book, in their time together before drifting off to sleep, “couples catch up on what's going on with one another, plan, make decisions, deal with disagreements and solve problems.”

With their hectic schedules, many couples often only have this time to catch up. It is no wonder why it’s crucial to their relationship. Unfortunately snoring can force one spouse into another room for the sake of sleep, and this crucial together time is hard to replace in their busy lives otherwise.

If your marriage is suffering because you or your spouse snores, the key to reconciling is to understand that snoring is a symptom of a physical condition, such as sleep apnea, sinusitis, or nasal obstruction and it can be treated. There are many non-surgical, in-office and minimally invasive treatments available to snorers today. Although I would never make the claim that I’ve saved marriages, I’ve heard back many times from patients who tell me that it wasn’t until after their snoring was cured did they realize how much happier they are snuggling next to their spouse again.

Summer’s Weather Causing Severe Allergy Season this Fall

Otolaryngology Associates, with two locations of its ear, nose and throat (ENT) practice in New York City, is seeing a surge in patients who suffer from ragweed allergies, and expect an unusually severe and extended season. The practice is also experiencing an uptick in patients that are affected by the non-seasonal airborne allergens such as mold and dust mites.

This summer, and extending into the early Fall, residents along the East Coast experienced a record-breaking summer of high-heat and record rainfalls. When combined, they formed the perfect storm to growth of these allergens.

In August, it was reported that the Northeast experienced record ragweed pollen counts. Ragweed thrives in lots of water and sun. It blooms around August and can continue producing pollen through the late fall until a killing frost. Weather experts expect that it will be a long blooming season because for the last decade killing frosts have been occurring later and later.

Hurricane Irene, which caused record-breaking rainfall all along the East Coast, caused severe flooding of “epic proportions” according to NASA. High levels of rain are also ideal for the proliferation of another common allergen, mold. Although it is not a seasonal allergen, mold multiplies quickly in damp conditions. The Northeast typically has much dryer weather conditions in late summer to early fall, and is expected to have unusually high levels of mold this year. Dust-mites are also a widespread allergen that has reached unusual levels due to the high heat experienced this summer.

Allergic reactions to air-born allergens can range from mild to severe. Usual symptoms include stuffy or runny nose, sneezing and itchy eyes. Other symptoms can include coughing, fatigue, and sore throat. These symptoms can sometimes lead to more serious conditions such as sinus and ear infections. Due to blockage in the nose, snoring is also a very common result.

Treatment of your allergies varies according to severity. Prescription nasal steroid sprays decrease the allergic reaction and inflammation in the nose. Non-sedating antihistamines treat the body’s natural reaction when it comes in contact with an allergen by blocking histamine which causes swelling and congestion. Allergy injections or immunotherapy, are for patients with long-standing allergies, and may be identified through skin or blood tests. They gradually reduce symptoms and the need for medication. If you’re not sure what it is that is causing your allergic reaction, an allergist can identify your allergy. It is important to treat your symptoms because they can lead to more serious conditions, and if they are interfering with your breathing or sleeping, seek treatment with an ear, nose and throat specialist.  

Irene’s Lessons

Hurricane Irene

In the days preceding Hurricane Irene, many East-coasters, myself included, experienced some sleepless nights. Preparing for the worst, it was hard to get the thoughts out of my head as I ran through the checklists of tasks to secure the house, and provisions to buy for the days we expected to be out of power.

Thankfully no one I know had any major damage to their homes. In fact, it seemed that almost immediately after the winds died down, there was an upside to the calm after the storm. As our workplace got back to normal, a business acquaintance of mine was still without power. She told me an interesting anecdote of her experience after the hurricane. She has realized, even though power hasn’t been restored yet in her home, there was a  benefit to the storm after all—she’s feeling more rested than she has in years.

She was surprised by this considering the anxiety and frustration she’s been going through learning to live with no electricity. However with a few questions about her normal sleep routine, I realized she had gotten into some bad habits and they had been getting progressively worse. For example, her bedroom contains her computer and television. She had been in the habit of before bedtime getting on the computer, checking email and instant messaging or surfing. This was causing her to go to bed later and later. With the need to conserve her cell phone battery, she put that down as well. Without the electronics to distract her for hours, she began going to bed at a decent hour. The result has been a bedtime of a reasonable hour, as opposed to her average time of 3 a.m.

When I asked if she usually fell asleep with the TV on, she admitted she felt she couldn’t go to bed without it. This is one of the worst habits one can have since not only does the TV interrupt deep REM sleep with noise throughout the night, but it is now understood from recent research that the light from the screen can interfere in the production of the hormone, melatonin, which is the natural sleep aid the body creates to tell us it’s time to go to sleep. As a result of the dark and quiet, she’s receiving a deeper, more regenerative sleep.

The dryer, cooler nights we’ve been experiencing in the New York area has also aided her in sleeping more deeply. Falling asleep in a dark, quiet, and cool room is ideal for the most regenerative sleep possible. Over the past few days, she has reset her internal sleep clock. Falling asleep when she feels sleepy and sleeping deeply throughout the night has allowed her to wake up on her own without the aid of an alarm clock, feeling rested and alert throughout the day—the very definition of restorative sleep. Learning the how good she feels after just a few night’s rest, she’s determined not to fall back on bad habits.

She cites some other important benefits as well. For example, the neighborhood children are playing together outside instead of through their gaming headsets. Irene has given her hours of one-on-one time with her son. Instead of computer, TV and video games, they’ve played board games and talked. Her son was set to start high school this week, and since that is delayed, she feels she’s been grateful for a few more summer days together before the hustle of the school year begins.  

Unobstructed by light pollution, the other night they watched the clear night sky together, and talked about constellations they could never see before. Many of us on in the tri-state region were very lucky that we had no damage. Some lost everything. Some of us simply lost power for a few days. As frustrating as that can be, as some still wait for the lights to come back on, maybe we can thank Irene for some gifts.

Mending Your Relationship When Snoring Rips You Apart

Snoring is a major cause of couple's unhappiness.

Although in this blog I generally discuss the health consequences of snoring, I’d like to bring to light another serious side effect, which is the devastation snoring can wreak on marriage. Often I meet with married couples in my practice who are at their wits end. Both partners are exhausted…the snorer because of the toll snoring takes on their body, and the spouse whose health is impacted dramatically from their partner’s snoring because of the daytime fatigue brought on by their inability to get a healthy full night’s sleep.

According to a new study by the British Lung Foundation (BLF)¹, loud snoring forces more than a third of couples to sleep in separate beds at night. The foundation polled more than 2,500 adults through an online survey in the United Kingdom this past Spring. Even more drastic for these couples is the fact of the 39% who admit they sleep apart, a full third (33%) claim it has become a permanent sleeping arrangement. Certainly sleeping apart from your significant other all the time can’t be healthy for the relationship. In addition to the noise of snoring creating distance between couples, snoring can also be a factor that leads to sexual dysfunction in men, according to a study² that was reported in The Journal of Sexual Medicine.

When couples feel that snoring is ripping their marriages apart, it is often because they are both tired, irritable and tense. If they have been sleeping separately, most likely their relationship has eroded, and their communication has faltered. Certainly the lack of intimacy—not just physically, but the relaxing interactions between companions such as pillow talk—has worn them down.

How intrusive is snoring in a marriage? In 2006, a study from the Rush University Medical Center in Illinois3 determined that couples have a high divorce rate when the husband snores due to sleep apnea. Sleep apnea is the most serious of the many causes of snoring because it causes the snorer to stop breathing multiple times throughout the night, which can lead to heart and lung issues, high blood pressure and stroke. For years many snorers were reluctant to seek treatment because some of the most common treatments involved cumbersome sleep masks or surgery. Thankfully, today there are a number non-invasive in-office techniques that successfully treat the varied types of snoring such as the Pillar® Procedure, Balloon Sinuplasty™, and more based on the individual cause of your snoring.

Although I’m not a marriage counselor or sex therapist, patients who come to the Manhattan Snoring and Sleep Center are taking a positive step to mend their relationship and hopefully will not become one of the statistics of divorce due to snoring. They are not only mending their relationship, but they are taking control of their health, leading to a more fulfilling life.

My marital advice to snorers? Seek treatment and enjoy getting close to your partner again.

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1. The British Lung Foundation, 14 June 2011, Survey of over UK 2,500 adults aged 16 and over through TNS between 28 April – 3 May 2011, completed online through an OnlineBus.
2. Hanak, V., Jacobson, D. J., McGree, M. E., Sauver, J. S., Lieber, M. M., Olson, E. J., Somers, V. K., Gades, N. M. and Jacobsen, S. J. (2008), ORIGINAL RESEARCH—MEN’S SEXUAL HEALTH: Snoring as a Risk Factor for Sexual Dysfunction in Community Men. The Journal of Sexual Medicine, 5: 898–908. doi: 10.1111/j.1743-6109.2007.00706.x
3. The Sleep Disorders Center at Rush University Medical Center, Illinois: The Married Couples Sleep Study, January 2006

A Snorer’s Guide to Summer Travel

Summer Vacation

School is out and summer travel plans are getting underway. Whether you’re planning a camping trip, renting a house on the shore for a week, or visiting relatives on the other side of the country, summer is a way for us to relax and reconnect with family.

Unfortunately, if you’re one of the 50 million Americans who snore, sharing close quarters can not only be embarrassing, but put a damper on the entire vacation if you’re a guest in someone’s home or as a housemate in a vacation home. While your spouse may have learned to adjust to the noise of your snoring, it’s important to understand that your snoring can also interfere with the sleep patterns of family and friends in close proximity.

When someone is prevented from receiving their requisite hours of recuperative sleep, it can lead them to be irritable, experience daytime drowsiness, affect their ability to concentrate, and interfere with their response time when they drive.  Absolutely nothing can ruin a vacation faster than cranky, over-tired children, and/or their parents.

However, realizing that your snoring is a problem that can be avoided, and by taking some steps ahead of time, you can prevent the issue altogether and ensure that your vacation will be full of energy and fun.

In-Office Procedures:

There are a few relatively new procedures that cure or drastically eliminate snoring that can be performed in just a few minutes in a snoring specialist’s office:

ThePillar® Procedure can be performed in a doctor’s office in about 20 minutes using only local anesthetic. It is effective to treat snoring that is caused by the fluttering of the soft palate, which occurs when the muscles in the back of the throat relax while asleep. The procedure involves three small polyester implants that are placed into the soft palate and over time, the implants, together with the body’s natural fibrotic response, provide support and stiffen the soft palate. This minimally invasive, simple and safe treatment for snoring and mild to moderate snoring including snoring caused by Obstructive Sleep Apnea, is a relatively painless procedure that is giving hope to snorers everywhere.  

Balloon Sinuplasty™ is another relatively new procedure to treat blocked sinus passages for snoring that is caused by chronic sinusitis. It can also be performed in a doctor’s office on an out-patient basis. It uses a small, flexible, sinus balloon catheter to open up blocked sinus passageways. When the balloon inflates, it widens the walls of the passageway while maintaining the integrity of the sinus lining, and restores normal sinus drainage.

When the sinus balloon is inflated, it gently while maintaining the integrity of the sinus lining.

Over the counter treatments: There are additional treatments a snoring specialist can recommend that can aid you while on your vacation that don’t necessarily include other types of surgery. For example if obstruction in the nose or sinus cavity is the cause of your snoring, many patients get relief from using nasal strips. Antihistamines, decongestants as well as topical and systemic corticosteroids can also be of assistance.

Lifestyle Adjustments: Your snoring specialist may ask you for some lifestyle modifications before any of the above treatments are recommended. That is because there are a variety of influences that could cause you to snore.

•  Lose 5-10 pounds. Excess weight is the most common contributing factor to snoring. If there is time before your vacation, try losing weight,
  because even those that are mildly overweight find that weight loss can significantly reduce their snoring with even a modest weight loss of five to ten pounds.   
• Quit smoking. Since snoring leads to irritation and dryness of mucous membranes, quitting cigars or cigarettes is a lifestyle change that can have a dramatic impact on snoring. 
• Reduce consumption of alcohol and sedatives. Alcohol, sedatives, and sedating antihistamines lower muscle tone in the upper airways, causing an increased airway resistance and snoring. Many people who reduce these substances report improvements in their snoring. 
• Change your sleep position. For some people, an increased amount of obstruction occurs when they sleep on their backs. Described as positional snoring, this type of snoring can have a simple solution. Sew a ball into the pocket of a t-shirt and wear it backwards. This will keep you off your back during sleep.
• Get an extra pillow. Some positional snorers also improve when the head of the bed is elevated.
• Pack some earplugs. If you’re worried that the loudness of your snoring still won’t be under control, do your fellow vacationers a favor, and pack some earplugs for them. They’ll thank you for it.

With a little forethought, your snoring doesn’t need to interfere with you or your fellow
vacationer’s sleep. Contact a snoring specialist near you today to get the treatment you need, to relax and enjoy your summer travels.

#          #          #

David Volpi, M.D., P.C., F.A.C.S. is a board-certified otolaryngology surgeon with Ear, Nose and Throat practices, Otolaryngology Associates, on the Upper West Side and Upper East Side and is a staff member of the best teaching hospitals New York City. Realizing that there is a lack of information on the part of the public about the potential severity of snoring, he founded The Manhattan Snoring and Sleep Center to be a place where snoring patients can go for expert information, diagnosis and treatment. As a recognized authority throughout the country for his work in snoring disorders, he is also the author of the definitive guide book on the diagnosis and treatment of snoring: Wake Up! You’re Snoring…

He is a Fellow of the American Academy of Sleep Medicine (AASM), the American Medical Association (AMA), the American College of Surgeons, the Medical Society of the State of New York, the New York County Medical Society, the American Academy of Otolaryngology—Head and Neck Surgery, the American Academy of Facial Plastic and Reconstructive Surgeons and the American Rhinologic Society.

For more information, contact the Manhattan Snoring and Sleep Center: (866) 835-2361 or visit www.drvolpi.com.

Could a Simple Procedure Be the Key to Treating Snoring?

A relatively new in-office medical technique is being touted among snoring specialists as a successful treatment for snoring in many patients.

A relatively painless procedure that can be performed in a doctor's office in about 20 minutes, using only local anesthetic, is giving hope to snorers everywhere. More than 40,000 snorers have been treated with the Pillar® Procedure worldwide, and lasting, positive results are being realized.

The Pillar Procedure is a minimally invasive, simple and safe treatment for snoring and mild to moderate snoring, including snoring caused by Obstructive Sleep Apnea (OSA) in many patients. Snoring is caused by the fluttering of the soft palate when the muscles in the back of the throat relax while asleep. The relaxed muscles obstruct airflow, which causes vibration as the air flows out while breathing, and creates the snoring sound.

Although snoring may seem like just an annoyance, it keeps snorers from getting the appropriate amount of restful, recuperative sleep they need for their body to function properly. The sleep loss associated with snoring can affect a person's ability to concentrate, learn and reason. It causes memory loss and irritability, and impairs motor skills such as driving. It can even lead to depression.

Snoring doesn't just affect the one who snores. Relationships suffer when a bed partner's sleep is also disturbed because it causes the same symptoms of daytime fatigue to the body as the offending party's snoring. That means both can be suffering from irritability, lack of concentration, and drowsy driving. Depending on how loud the snoring is, one's whole family can be affected.

However, when snoring is caused by Obstructive Sleep Apnea, it's the snorer who needs to be concerned about even more serious health issues. OSA causes a person to stop breathing many times through the night because the muscles in the back of the throat relax so much that tissue actually blocks the airway passage. People who suffer from sleep apnea stop breathing dozens of times during sleep and may not breathe for as much as three quarters of the of the time that they're sleep. It can be potentially life threatening because repeated stops and starts in breathing can cause a drop in the amount of oxygen in your blood. Apnea is particularly severe when there are more than twenty or thirty events per hour. It is known to be linked to high blood pressure, heart disease, obesity, lung disease and stroke.

For many years, the CPAP unit was considered by doctors to be the "gold standard" in treating snoring. It is a machine that delivers a continuous flow of air through the upper respiratory tract and keeps the throat muscles from collapsing. The CPAP unit consists of a small air pressure generator that rests on a night stand near the bed that is connected by tubing to a snug-fitting nasal mask that is worn while sleeping. Although extremely effective, getting patients to comply with using it has been extremely difficult. Many snorers report that it is uncomfortable to sleep with the nasal mask, and they describe feeling claustrophobic and that the noise from the machine keeps them from falling asleep.

Since there is a high rate of non-compliance of the CPAP and there are some cases when it doesn't work, surgery has also been an option. Uvulopalatopharyngoplasty (UPPP) has been a common surgical procedure for obstructive sleep apnea for many years. It is performed under general anesthesia, and involves removing the uvula and a small portion of the soft palate which can have a painful recovery. Another surgical technique to treat OSA is maxillofacial surgery which reduces airway obstruction at the base of the tongue, below the level of the palate and tonsils. There are additional forms of surgery that involve moving or repositioning muscles and bones in the jaw that have been used to treat apnea, with the most drastic being a tracheotomy which involves creating a surgical opening in the windpipe, and placing a tube through the hole.

Perhaps that is why doctors and their patients are so encouraged by the success they are seeing with the Pillar Procedure. It can be done in a doctor's office in 10 to 20 minutes, there is little pain reported and there is a very high success rate. The procedure stiffens the soft palate and by offering structural support, reduces the vibration of the tissue that is causing the snoring. During the procedure, three small polyester implants are placed into the soft palate and over time, the implants, together with the body's natural fibrotic response, provide support to the soft palate.

The Pillar Procedure was approved by the FDA in 2004, and so far more than 40,000 people have been treated with it, according to Pillar manufacturer, Medtronics. Physicians have found that afterwards, most of their patients' snoring was treated completely, or reduced significantly. Once snoring stops, serious daytime sleep deprivation symptoms that their snoring was causing are also diminished. Hopefully so too are their relationship difficulties, and the whole family can enjoy peaceful, restful sleep.

For more information on the Pillar Procedure, visit the Manhattan Snoring and Sleep Center.

Driver Fatigue Brought to Light in NYC Bus Crash Investigation

Driver Fatigue

The tragic bus accident that killed 15 people after it violently crashed on I-95 just outside of the Bronx last week has raised multiple questions for federal investigators. Among the causes being investigated by the National Transportation Safety Board was whether the bus driver was so fatigued he was not capable of driving properly. To determine that, they will be checking surveillance video and room records at Mohegan Sun where the bus traveling from, carrying people back to New York City’s China Town.

Although there are numerous questions as to why the driver, a convicted felon, should have even been behind the wheel of the bus in the first place, there is no question that even if fatigue wasn’t the cause of this crash, it is a major cause of crashes--not just for buses, but for trucks, airplanes, trains and boating accidents as well.

Last fall the American Automobile Association (AAA) Foundation for Traffic Safety polled 2,000 drivers. One-third of them admitted to either nodding off or completely falling asleep while they were driving in the past year. The results were surprising, indicating the problem is much more profound than previously expected.

More than half of those polled by AAA reported they fell asleep on a high-speed highway. Although it might seem more common to doze off during long car rides, 59% said they’d been driving under an hour before they had fallen asleep and only 20% had been driving for more than three hours. Twenty-six percent reported that it happened in the middle of the day, between noon and 5pm.

The National Highway Traffic Safety Administration estimates that drowsy driving “results in 1,550 deaths, 71,000 injuries and more than 100,000 accidents each year” and that fifty-seven percent of  driving crashes caused by fatigue involved the driver drifting into other lanes or even off the road.

The cause in this growing US problem can be contributed to many factors, not the least of which is the link between daytime fatigue and snoring. Results of a Canadian study published a few years ago linked drivers with sleep apnea with more than double the risk of car and truck accidents. Sleep loss, whether it is associated with snoring, insomnia, or simply poor sleep habits, impairs a driver’s reaction time. It causes people to lose the ability to perform important tasks, impedes memory, reasoning, and the ability to learn and perform math. Prolonged sleep loss can also lead to depression and hallucinations, and can cause health problems involving the heart and immune system and be a contributing factor to obesity which leads to further health issues such as diabetes.

If you’re feeling fatigued, it’s best to not get behind the wheel at all. Here are some tips to help stay awake while driving. If you are having trouble getting restful sleep, it is important that you speak to your doctor about it, because it is likely more serious that you think.

Originally published in The Huffington Post, for which Dr. Volpi is a regular contributor.

The Importance of Sleep

The medical community and healthy lifestyle advocates see the evidence mounting. Our spouses and children recognize the symptoms even when they don’t know the cause. They all agree: We need a good night’s sleep!

When we don’t get a full night of restful sleep, it can dramatically affect our health and impair our mental function and job performance. It can ruin our relationships with our loved ones. Research also points to a myriad of physical health issues caused by a lack of sleep including obesity, diabetes and heart disease.

How much is a “Good Night’s” Sleep?

A good night’s sleep isn’t just determined by the length of time one sleeps, but how restful, deep and uninterrupted that sleep is throughout the night. Even still, the average minimum amount of sleep required to be considered “a good night’s” sleep is between 7 and 8 hours for adults, with teenagers, children and infants needing more sleep, according to the American Sleep Association.

Lack of sleep can be caused by just not getting to bed when one should because of poor habits like watching TV until the wee hours of the night. Certain medicines, food, smoking and alcohol can all affect the ability to fall asleep, stay asleep, or the restfulness of sleep. Stress is also a big contributor. Usually a person can change their routines, and those with insomnia or stress-related causes can usually be treated by over the counter or prescription medicines. When a lack of sleep is caused by snoring, the issue becomes even more complicated, and the health consequences are much more serious.

Snoring – a Major Cause of Sleep Deprivation

Unlike a sleep disorder, snoring is a physical condition. It is caused when the throat relaxes and the tongue falls into the airway in the back of the throat causing a vibration in the soft tissue during sleep. This vibration is an interruption of airflow through the nose and throat.

It is estimated that more than 40 million Americans snore. Snoring interrupts sleep throughout the night, leaving the snorer with the same mental and physical conditions as someone who is sleep deprived.  There are numerous causes of snoring such as deviated nasal septum, nasal polyps or turbinates. Sinusitis and allergies can cause snoring as can anatomical factors such as abnormally relaxed neck muscles, a large tongue or tonsils and obesity because excessive weight can narrow the windpipe. Smoking, alcohol, sedatives or certain sedating antihistamines can lower muscle tone in the upper airways, and also cause snoring.

Sleep apnea is the most common cause of snoring and also the most dangerous. People who suffer from sleep apnea stop breathing dozens of times during sleep and it is particularly severe and life threatening when there are more than twenty or thirty events per hour. There are three types of sleep apnea, obstructive (OSA), central and mixed, with OSA being the most serious type because it effects blood pressure, the heart and lungs.

The Consequences

Without enough sleep we loose our ability to concentrate and our physical performance suffers. Sleep is necessary for the nervous system to function properly. For example the ability to do math and operate a car are compromised.  Other symptoms include daytime sleepiness, morning headaches, irritability, and poor memory. A person with sleep deprivation can burn-out easily, and it can lead to feelings of depression, mood swings and even hallucinations.

Unfortunately if lack of sleep is caused by snoring, often a person doesn’t even know they snore unless they’re told by a partner. Even when a person knows they snore, they often go untreated because they are embarrassed and hide it, or they don’t know it is a serious problem so they ignore it.

In the case of sleep apnea, there is even more of a toll on the body. Considering an apnea patient is unable to breathe many times throughout the night, their sleep is especially interrupted by episodes of waking up gasping for air. This oxygen deprivation combined with an inability to get a good night’s sleep, causes severe sleep deprivation and other health issues. Apnea can lead to high blood pressure because during apnea events, blood oxygen drops abnormally low, resulting in an increase in blood pressure which can bring about stroke. It can cause lung dysfunction because of low levels of oxygen in the blood and high concentrations of carbon dioxide in lung tissue. Since the heart is sensitive to oxygen levels in the blood, apnea is most dangerous in people who are already prone to heart disease. Arrhythmia is very common as is enlargement of the heart. An estimated 80-85% of sleep apnea patients go untreated, which is a serious health problem in the U.S. today.

Luckily, just as we have learned more about the consequences of sleep deprivation and snoring, today there is also a wide variety of surgical and non-surgical treatment available for snoring sufferers. If you suspect that you snore at night, or have been told by a loved one that you do, it is important to speak to your doctor. He or she can recommend you to an Ear, Nose and Throat Doctor or Otolaryngologist who will provide you with the correct diagnosis and start you on the path of treatment for a lifetime of healthy sleep.


For more information, contact the Manhattan Snoring and Sleep Center: (866) 835-2361 or visit www.drvolpi.com.

Chronic Sinusitis: The Cold That Won’t Go Away

Suffering from
Chronic Sinusitis

Are you suffering from a cold that’s been holding on? When it’s past Valentine’s Day and your sinuses have been stuffed up since before the Holidays or longer, you may have chronic sinusitis.

Sinusitis (sinus infection) is an inflammation of the sinuses and nasal passages. Its symptoms include a headache or pressure in the eyes, nose, cheek area, or one side of the head. You may also have a cough, a fever, bad breath, nasal congestion, nasal secretions, and you may snore at night.

Sinus infections are characterized by how long they last and the location of the affected areas. When one or more of the sinuses is infected for a short term, from a week to three months, it is considered acute sinusitis. When an infection lasts more than three months, it is considered chronic and is often caused by allergies or a physical abnormality such as a deviated septum, or malformed bone.

Chronic sinus infection symptoms may be less severe than an acute infection but it can also last for years. There are four types of sinus infections with varying symptoms and treatments which depend on the cause.

To treat chronic sinusitis due to allergies, prescription nasal steroid sprays can decrease nasal inflammation and can be safely used for a long period of time. Antihistamines that do not cause drowsiness can be used to reduce allergic nasal congestion, either alone or with nasal spray. Allergy injections gradually reduce symptoms and the need for medication and can help patients with allergies that have been identified through skin or blood tests.

Often antibiotics are combined with decongestants and/or nasal steroid spray as an effective way to eliminate chronic sinusitis. When that doesn’t work,  endoscopic sinus surgery is an option for those who do not respond to antibiotic therapy. Using a CAT scan of the sinuses to confirm the chronic condition, endoscopic sinus surgery may be used to drain the sinuses.

There is now a relatively new procedure called Balloon Sinuplasty™ that treats blocked sinus passages. It is a less-intrusive form of surgery that can be performed in a doctor’s office on an out-patient basis. During the procedure, an endoscopic catheter inserts a small, flexible balloon into the sinus passageways, and is then inflated. The balloon gently widens and restructures the walls of the passageways, enabling the sinuses to drain.

If you’ve been suffering from chronic sinusitis, contact your doctor today and schedule an examination, or if you’re in the New York City area, feel free to contact the Manhattan Snoring and Sleep Center for expert diagnosis.

Disclaimer:
This article is intended for general information only is in no way intended to be a substitute for receiving direct medical advice, diagnosis and treatment from a medical professional. Use and access to this website or any of the links contained within the site do not create a doctor-client relationship. If you have any questions regarding a medical condition, or if you suspect you may have a snoring disorder, contact your physician today.

Help for Couple’s this Valentine’s Day: Cupid’s Arrow or a Cure for Snoring?

Cure for Snoring?

Cupid could use some help from snoring treatment this Valentine’s Day. Snoring is a major cause of couple’s unhappiness according to the Etap Hotel Group of Europe, which recently conducted a poll of 4,000 couples. Of the three most aggravating factors that drive couples apart, noisiness is the most common complaint, together with hogging the bed covers and restlessness.

Results showed that snoring forces many of couples to sleep in separate rooms. According to the study, nearly a quarter of the couples studied feel resentment towards their partner as a result of lack of sleep, which causes arguments between almost half of couples. Those who do share a bed lose out on an average of 70 minutes sleep a night.

When a partner snores, according to the Etap study, in over a quarter of relationships the couple’s sex drive suffers and one in 20 people would consider leaving their partner because they snore.

When a partner snores, it causes the other person to lose much needed sleep. Even just mild sleep deprivation can cause serious health issues. As a study from the University of Wisconsin-Madison has found, even five consecutive nights of four hours or less of sleep per night has the same negative affects on the brain and body than total sleep deprivation. Someone else’s snoring can take a real toll on your health.

If your spouse’s snoring keeps you up at night, you’re not alone. It is an issue that affects people from all walks of life, including the most famous celebrities. It has been reported that Tom Cruise, Sid Owen and Kevin Jonas sleep separate from their partners because of their snoring. Recently Helena Bonham Carter admitted that Tim Burton, her partner has a deviated septum that causes him to snore loudly. They have two adjacent houses in London, and Carter stated that his snoring is one of the reasons she enjoys having her own house.

If you’re in the New York Tri-State area, schedule an appointment at the Manhattan Snoring & Sleep Center, New York City’s top medical practice for snoring and sleep apnea diagnosis and treatment. The center’s medical/surgical snoring specialists offer the latest techniques to treat snoring and sleep apnea including minimally invasive treatment for deviated deptum, the Pillar Procedure, Balloonplasty™ and even provide the Home Sleep Test for patients for whom an overnight sleep lab is not an option.

Disclaimer:
 This article is intended for general information only is in no way intended to be a substitute for receiving direct medical advice from a medical professional, their diagnosis or treatment. Use and access to this website or any of the links contained within the site do not create a doctor-client relationship. If you have any questions regarding a medical condition, or if you suspect you may have a snoring disorder.

A Winter Sore Throat

If you’ve ever awoken with a dry scratchy throat, you’ve likely felt that twinge of anxiety that signals something is coming – and it’s probably going to lay you out for a couple of days. Sore throat is a symptom of many different things – from viral infections such as the flu or mono, to bacterial infections like strep throat, allergic reactions more.

However, it is common for those living in the northern climates to get sore throats during the winter due to just their surroundings. During the winter months, houses and offices are locked up tight, and the dry heat is constantly running. Outdoors isn’t much better, as there is no humidity in the air, with even the most humid summertime areas mimicking the arid dryness of a desert climate. 

Dry indoor air can make your throat feel rough and scratchy, especially when you first wake up in the morning. Nasal congestion, also common in the winter can cause people to sleep with their mouths open, further aggravating the dryness and causing sore throat. Chronic nasal congestion can cause you to breathe through your mouth or snore, aggravating the throat and causing it to become sore and tender.

Here are some ideas to help keep you from getting a sore throat due this winter:

Moisten the Air. Adding much needed humidity into the air may be enough to prevent sore throat caused by dryness. Running the humidifier or vaporizer near your bed at night is especially important to help keep congestion in the sinuses from drying out and clogging, allowing you to comfortably breathe through your nose.

Blow Your Nose. To keep the congestion out of your sinuses, it is important to blow frequently so that drainage doesn’t drip down your throat, or clog your nose causing you to breathe with your mouth open.
 
Sleep with Your Head Elevated. This will help your sinuses drain properly, and keep you breathing properly through your nose and not your mouth. 

Drink Plenty of Water. In the winter we run the risk of becoming dehydrated because many of the triggers we have to drink plenty of water are related to hot weather, but it is just as important to keep the body hydrated properly in the winter as it is in the summer.

Home Treatment
Since sore throat can be a symptom of a condition that needs to be treated medically, it is important that if it is severe or prolonged, it is diagnosed by a doctor. However there are treatments that you can do at home to ease your discomfort:

Gargle with Saltwater. It is a tried and true method of numbing a sore throat. Dissolve a few teaspoons of salt in a glass of warm water, gargle and your throat will feel better almost immediately.

Drink Tea with Honey and Lemon. This threesome has qualities to numb and soothe the throat.

Take Vitamin C and Zinc Lozenges. It will not just soothe the dryness and irritation, but may help you fight a cold that’s coming on if you notice symptoms.

Rest Your Voice. Cheering, yelling or singing will just aggravate your throat. Hold off on using your voice loudly until your feeling better.
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David Volpi, M.D., P.C., F.A.C.S. is the founder and co-director of Otolaryngology Associates, Manhattan’s comprehensive diagnostic and treatment practice for conditions of the ear, nose, throat (ENT) and related conditions of the head and neck. The practice specializes in treating patients with ENT diseases and disorders through using the latest treatments and technology. He is also founder of  The Manhattan Snoring and Sleep Center, the premier treatment center for snoring and sleep apnea in New York City. He and his medical staff at Otolaryngology Associates are board-certified surgeons and members of New York’s finest teaching hospitals.
 
This article is intended for general information only is in no way intended to be a substitute for receiving direct medical advice and care from a medical professional, their diagnosis or treatment. If you have any questions regarding a medical condition, or if you suspect you may be ill, contact your physician. If you think you may have a medical emergency, call 911 immediately.

Loud Snoring Predicts Metabolic Syndrome

Add “metabolic syndrome” to the growing list of health risks and symptoms caused by or linked to snoring. In a study just released in the December issue of the journal SLEEP, it was found that adults were two times more likely to develop metabolic syndrome if they snored loudly during sleep.

Metabolic syndrome is a group of combined risk factors that indicate a person may have an increased chance of developing coronary artery disease, stroke, and type 2 diabetes. The syndrome is becoming common in the United States and is related to obesity. Two of the most common risk factors associated with the syndrome are extra weight around the middle of the body (central obesity), and insulin resistance, in which the body cannot use insulin effectively.

Led by researcher, Wendy Troxel of the University of Philadelphia, the study followed 812 adults (ages 47-74; 36% African American; 67% female) in an "ongoing, community-based prospective." This was the first prospective study to link metabolic syndrome with snoring, as well as with the sleep disorders difficulty falling asleep (DFA), unrefreshing sleep and insomnia. Those studied were free of metabolic syndrome at the start, had completed a baseline sleep questionnaire, and participated in a metabolic syndrome evaluation three years after the baseline. A subset of 290 participants were measured for their apnea-hypopnea index (AHI) using a portable monitor.

The study examined the risk of developing factors of metabolic syndrome according to participant’s individual snoring and sleep symptoms and insomnia. Sleep complaints have been highly prevalent with cardiovascular disease (CVD), and interestingly, 14 percent of the participants developed metabolic syndrome while they were participating in the study.

The results of the study indicated that those who snored loudly were twice as likely to develop metabolic syndrome, and also predicted specific metabolic abnormalities such as hyperglycemia and low high-density lipoprotein cholesterol. Even when adjusted for AHI or the number of metabolic abnormalities at baseline, loud snoring remained a significant predictor of metabolic syndrome, whereas difficulty falling asleep, unrefreshing sleep and insomnia had less significance. It is believed that evaluating sleep symptoms will help physicians identify patients at risk for developing metabolic syndrome.

To read more about the research results, visit SLEEP.

Sleep Deprivation – Your Spouse’s Snoring Takes a Toll on Your Health

On our blog here we often discuss the health consequences for a person who snores. We’ve talked in detail about the dangers of snoring, especially sleep apnea which can lead to heart disease, high blood pressure, lung dysfunction and stroke. However what also needs to be brought to light are the health implications on the spouse whose sleep is interrupted by their snoring sleep partner.

A new study from the University of Wisconsin-Madison has found that even five consecutive nights of four hours or less of sleep per night has the same negative affects on the brain and body than total sleep deprivation.

Unfortunately for those who share a bed – or even the next room with a chronic snorer, a simple change in lifestyle like making sure you go to bed early enough to get 7-8 hours of sleep need to totally restore the body’s brain and muscle function isn’t an option.

After 5 days with only 4 hours of sleep your body will show signs of exhaustion. Symptoms include:

• Lethargy, which make even the simplest tasks seem difficult
• Impaired coordination—very dangerous if you need to be behind the wheel or operating equipment
• Blurred of vision
• Wearing down of the immune system which will cause you to pick up colds and other illnesses that you would be able to fend off if you had a strong immune system
• Irritability
• Headaches
• Impairment of cognitive function, making it more difficult to make a decision, especially if quick-thinking is needed
• It can even increase the resistance of insulin in the body, which leads to a risk of diabetes

If you are sleep deprived because of your spouse’s snoring, then it is in both of your best interest to seek help from a snoring specialist. Many snorers are hesitant to seek treatment because they are concerned that the only treatment options are surgery or the CPAP mask which they are afraid may be uncomfortable. However many minimally invasive techniques are available today to help treat snoring and sleep apnea on an out-patient basis.

If you’re in the New York Tri-State area, schedule an appointment at the Manhattan Snoring & Sleep Center, New York City’s top medical practice for snoring and sleep apnea diagnosis and treatment. The center’s medical/surgical snoring specialists offer the latest techniques to treat snoring and sleep apnea including the Pillar Procedure, Balloonplasty™ and even provide the Home Sleep Test for patients for whom an overnight sleep lab is not an option.

Disclaimer:
This article is intended for general information only is in no way intended to be a substitute for receiving direct medical advice from a medical professional, their diagnosis or treatment. Use and access to this website or any of the links contained within the site do not create a doctor-client relationship. If you have any questions regarding a medical condition, or if you suspect you may have a snoring disorder.