Sleep apnea causes systemic inflammation: CPAP can help

By Dr. David O. Volpi

If you, or someone you know, have been diagnosed with obstructive sleep apnea (OSA), you’re probably familiar with a treatment called CPAP, or Continuous Positive Airway Pressure.

While some people find the mask worn for CPAP treatment uncomfortable—more on that later—it has been proven to be a highly effective way to keep the airways open that become obstructed in sleep apnea patients, and reduce or prevent snoring and paused breathing.

There’s a new study that found that CPAP treatment also reduces the systemic inflammation caused by sleep apnea, usually in the bronchial and nasal passages.

Systemic inflammation is the chronic biological response, or inflammation, of blood vessel tissues due to dangerous or foreign elements, such as pathogens or damaged cells. It is increasingly being recognized that systemic inflammation is a risk factor for a number of health complications, including atherosclerosis, and is a well-established factor in the development of cardiovascular disease.

The new study published March 22 in the Journal of Inflammation found that treating OSA with a CPAP machine helps to lower systemic inflammation, which might prevent some of the other problems associated with OSA. The source of the research was the PubMed, Embase and Cochrane library.

Here’s a refresher on how CPAP machines help OSA patients: When you fall asleep, your muscles relax, and the soft palate at the back of the throat may sag. When this happens, the upper airway can become obstructed, causing the soft palate and uvula to vibrate, causing snoring.

When the airway is completely obstructed, breathing stops for a period of time, until the body is jerked awake in reaction. This is known as obstructive sleep apnea. OSA can cause interrupted breathing hundreds of times a night, usually around 20 seconds per pause. This paused breathing causes waking through the night, preventing deep, restorative sleep. This often leads to a host of problems, from daytime sleepiness and reduced job performance to hypertension, heart disease, mood, and memory problems.

A CPAP machine helps this condition by pumping a continuous flow of air into the nasal passages—via a mask worn at night—keeping the airway open—and preventing or greatly reducing snoring and paused breathing.

To find out if CPAP treatment reduces inflammatory symptoms or “markers” in OSA patients, the researchers pooled data from 24 trials involving more than 1,000 patients. The resulting data suggested that treating OSA with CPAP significantly reduces levels of two proteins associated with systemic inflammation: tumor necrosis factor and C-reactive protein (CRP).

While more study is needed, the researchers believe that reducing systemic inflammation in OSA patients with CPAP treatment may be one way to reverse some of the long-term health disorders associated with OSA.

If you or someone you know is considering Continuous Positive Airway Pressure (CPAP) treatment, you'll need a sleep study to diagnosis whether or not you have sleep apnea, and a sleep specialist will recommend the correct CPAP machine, or treatment, for you.

A Good Night’s Sleep Can Be a Matter of Life and Death

Over the past three years, I have been writing the Wake Up! You’re Snoring blog with two main objectives: first, to educate you, the public, about sleep disorders, and second, to provide compelling reasons—preferably scientific evidence—why a person who may have a sleep disorder should get diagnosed and, if necessary, properly treated.

There is no shortage of scientific studies being released on a regular basis showing links between obstructive sleep apnea (OSA), insomnia, and other sleep disorders, and myriad negative health conditions, from daytime sleepiness to increased depression.

I wasn’t surprised to see a new study showing a link between insomnia, the loss of hope, and an increased risk of suicide. In a study led by Dr. W. Vaughn McCall, chair of the Medical College of Georgia at Georgia Regents University, researchers studied the mental state of 50 depressed patients between the ages of 20 and 80. More than half of the patients had attempted suicide, and most were taking an antidepressant.

It is established that insomnia and nightmares often go hand-in-hand, and are both known risk factors for suicide. The new study reaffirms that link, but researchers also wanted to find out what effect feelings of hopelessness about sleep had on suicide risk.

In the study, the researchers specifically focused on the relationship between insomnia and suicide risk by asking questions about dysfunctional beliefs about sleep, such as, “Do you think you will ever sleep again?” The scientists used psychometric testing to objectively measure the mental states and personalities of the 50 depressed patients.

Dr. McCall published the results of the study in the Journal of Clinical Sleep Medicine, the journal of the American Academy of Sleep Medicine. In the report, Dr. McCall stated, “It turns out insomnia can lead to a very specific type of hopelessness, and hopelessness by itself is a powerful predictor of suicide.” Dr. McCall also said, “The likelihood of being suicidal at least doubles when insomnia is a symptom.”

McCall and his colleagues have, in effect, discovered a new predictor for suicidal thinking. But why the link between lack of sleep and suicidal thoughts? Dr. McCall explained that, “It turns out insomnia can lead to a very specific type of hopelessness, and hopelessness by itself is a powerful predictor of suicide.” He continued, “If you talk with depressed people, they really feel like they have failed at so many things. It goes something like, ‘My marriage is a mess, I hate my job, I can’t communicate with my kids, I can’t even sleep.’ There is a sense of failure and hopelessness that now runs from top to bottom, and (insomnia) is one more thing. It was this dysfunctional thinking — all these negative thoughts about sleep — that was the mediating factor that explained why insomnia was linked to suicide,” said McCall.

The significance of this study, like many others, is that it not only educates people about the risks associated with insomnia and other sleep disorders, but it challenges the medical community to look at things a little differently when diagnosing and treating.

In this case, examine lack of sleep and insomnia when treating depression and suicidal thinking.  The finding also is a reminder to physicians that depressed patients who report increased sleep problems should be asked if they are having suicidal thoughts, McCall said.

If you’re having trouble sleeping, here are some tips to increase your chances of getting a good night’s sleep.

• Use the bedroom for sleep. With so many electronic distractions in our lives, it’s important to re-claim your bedroom for its intended purpose: rest and sleep. Move the TV and computer out of the bedroom, or at the very least, do not watch TV, work on the computer or check your blackberry close to bedtime.
• Stick to a bedtime routine. Try to go to sleep before 10:00 pm at night, and wake up around the same time every day, even on weekends. Try to keep to within 20 minutes of the same time each morning and night.
• Do activities that will get you ready for bed. Before bed, do activities that will promote sleepiness, such as a taking a warm bath, or reading a book or magazine.
• Maintain a cool temperature in your bedroom. A cool but comfortable temperature is ideal for sleep. Too warm and you will be fitful, too cold however can be uncomfortable and disturb your sleep.
• Exercise regularly but not after the late afternoon. Even though exercise helps regulate sleep, rigorous exercise causes endorphins in the body to circulate which can have a stimulant effect, and keep you awake longer at night.
• Stay away from caffeine at night. The effects of caffeine are different from person to person, and may last hours after your last cup of coffee, so make your last cup of coffee, regular tea or soda earlier in the day.
• Avoid alcohol and medicines that make you drowsy. Even if you think it is helping you fall asleep initially, alcohol and medicines that makes you drowsy may affect your sleep throughout the night.

Remember, people need an average of 7-8 hours of restful sleep to fully take advantage of its restorative power and avoid daytime symptoms of fatigue. If a regular, peaceful routine incorporating the tips above doesn’t help you start sleeping peacefully throughout the night, contact your doctor. You may have a more serious cause of sleeplessness such as snoring, sleep apnea or chronic insomnia. Getting treated could prevent heart disease, hypertension and stroke.

Lack of Sleep is Stressing Us Out, New Study Says

Stress in our life is not only caused by what we do and our busy schedules—stress is also caused by what we don’t do, namely, not get enough sleep. A new study by researchers in England and the Netherlands have discovered that a severe lack of sleep creates a response in the immune system that is similar to the body’s immediate response when it experiences a stressful situation. Yes, even lack of sleep is stressing us out.

The study was a joint effort by the Department of Forensic Molecular Biology at the Erasmus MC University Medical Center in Rotterdam and the Centre for Chronobiology, Faculty of Health and Medical Sciences, University of Surrey, and the University of Surrey Clinical Research Centre in England.

So how did the researchers determine this? They compared the white blood cell counts of 15 healthy young men under both normal and severely sleep-deprived conditions.

In the first phase of the study, the men followed a strict schedule of eight hours of sleep per night every day for one week. They were also exposed to at least 15 minutes of outdoor light within the first 90 minutes of waking, and prohibited from using caffeine, alcohol or medication during the final three days of the first week.

The researchers required this in order to stabilize the participant’s circadian clocks and minimize sleep deprivation before the second phase of the study. The researchers then categorized and measured each participant’s white blood cells.

In the second phase of the study, the men stayed awake for 29 continual hours, and their white blood cells were again recorded and compared to the white blood cell numbers collected in the first phase of the study.

According to the researchers, the effect of sleep loss on the white blood cells was immediate. The white blood cells known as granulocytes showed a loss of day-night rhythmicity—the circadian rhythm of the granulocytes slowed—and their numbers also increased, particularly at night. This reaction directly mirrors the body’s white blood cell response to stress.

Read the full study entitled, “Diurnal Rhythms in Blood Cell Populations and the Effect of Acute Sleep Deprivation in Healthy Young Men,” published in the July 2012 issue of the journal, Sleep. 

The results of the study are in line with other previous research that shows a link between lack of sleep and a negative immune system response. In March of this year, the University of Rochester Medical Center published results that showed that the immune system of older adults who do not get enough sleep responds to stress with inflammation, increasing the risk for mental and physical health problems.

These studies and others like them reinforce the fact that more quality, restful sleep not only helps us feel better – it may also help us avoid myriad poor mental and physical health conditions. So, get some sleep out there — you’ll feel less stressed out!

Is Excessive Daytime Sleepiness the Cause of Learning and Behavior Problems in Children?

For months now, I have been writing about the studies that are being published—seemingly by the month—linking obstructive sleep apnea (OSA) to more and more medical conditions, including hypertension,heart disease, mood and memory problems.

The latest research didn’t surprise me, but it did upset me more than usual — because it concerns our children, and the negative effects that poor sleep can have on their ability to pay attention, learn and control their behavior.

On May 1, the results of a study by Penn State researchers was published showing that children who have learning, attention and/or behavior problems may be suffering from a condition known as excessive daytime sleepiness (EDS)—even if tests indicate that they are getting enough sleep at night. 

For the study, the researchers conducted sleep testing on 508 children, and asked their parents to report if their child seemed excessively sleeping during the day. Then, the children were divided into two groups: children with excessive daytime sleepiness, and those without EDS. The results, published in the May 2012 issue of SLEEP,  showed that the children in the parent-reported EDS group were more likely to have "neurobehavioral” problems, including behavior/conduct problems, attention/hyperactivity and poorer performance in learning speed and working memory than children without indications of EDS.

What surprised the researchers was that, even if a child was in the EDS group, few also showed signs of short (not enough) sleep when tested. As a result, the researchers did not associate short sleep with any of the learning, attention and behavior problems.

So, what is causing these children’s extensive daytime sleepiness if they are getting enough sleep (at least on paper)? Like in adults, perhaps it is not just the length of sleep time, but the quality of sleep that determines restorative rest, or not.

A New York Times article from April 16, 2012 entitled “Attention Problems May Be SleepRelated”  also examined the relationship between children’s sleep quality and the ability to pay attention at school. The article was on another recent study called “Sleep-Disordered Breathing in a Population-Based Cohort: Behavioral Outcomes at 4 and 7 Years,” published in the Official Journal ofthe American Academy of Pediatrics. 

What I found disturbing about this article was that it pointed out that many cases of attention deficit hyperactivity disorder (A.D.H.D.) in children may have been misdiagnosed—that the cause of behavior such as moodiness and hyperactivity might in fact be due to obstructive sleep apnea (OSA) or other sleep disorder, which is causing sleep deprivation in the child. Worse, the drugs diagnosed for the A.D.H.D. are probably making the child’s symptoms worse!

This should be a call to arms for parents, caretakers, teachers and the medical community. If you know of a child suffering from sleep deprivation and/or extensive daytime sleepiness, and the symptoms that result, such as behavioral and learning problems … speak up and suggest they get tested for a sleep disorder first.

 Impairment due to EDS in daytime cognitive and behavioral functioning can have a significant impact on children's development. This is not to say that A.D.H.D. cannot be a true cause, but misdiagnosis of anyone—especially a child prescribed drugs—should not be tolerated.

Stay aware of the child’s behavior; look for clues, such as inattentive behavior and obesity, take a child’s “sleepy” complaints seriously … and then say something. You could be the reason a child’s neurobehavioral challenges are properly diagnosed and treated, leading to better behavior, greater ability to learn and a happier child.

Read the abstract of the report, “Learning, Attention/Hyperactivity, and Conduct Problems as Sequelae of Excessive Daytime Sleepiness in a General Population Study of Young Children.”

New Study Uncovers the Beliefs Behind Behavior of Poor Sleepers

Difficulty Sleeping

I do my best to stay up (no pun intended) on the latest research and findings regarding sleep-related disorders and their treatments. New results out of Ryerson University in Toronto don’t surprise me — that taking sleeping pills or drinking alcohol is not a long-term solution for dealing with insomnia.

The study was conducted by Heather Hood, a PhD student in clinical psychology and lead author of the study, along with Dr. Colleen Carney, director of Ryerson's Sleep and Depression Laboratory, and graduate psychology student, Andrea Harris.

Hood is an insomnia therapy specialist and had previously researched the link between anxiety disorders and “safety behaviors” — things people do to self-treat a disorder. With the new research, Hood and her associates wanted to examine the relationship between insomnia and safety behaviors, such as taking sleep medication or drinking alcohol before bed. Specifically, they wanted to uncover the belief systems of poor sleepers: how much a person with insomnia believes that their behaviors are helping them sleep, even if those behaviors are not helping them sleep at all.

According to the National Sleep Foundation, 48 percent of Americans report occasional insomnia. And a recent Harvard Medical School study determined that insomnia costs U.S. companies about $63 billion a year due to missed days and poor work performance. Clearly, lack of sleep and insomnia are an American pandemic, and the efforts of Hood, Carney and Harris to help uncover the beliefs behind the behavior of poor sleepers was resulted in some very important information.

For the insomnia/safety behavior study, the researchers asked 397 Ryerson University undergraduate students to complete an online survey that asked about their safety behaviors. The questionnaire also asked how often they performed their nightly rituals, and how much they felt they needed to fall sleep. They were also asked how they defined insufficient sleep, and to what extent they went to in order to avoid feeling tired.

The results of the study, published in the December 2011 issue of Behavior Therapy, found that 40 percent of the students polled were poor sleepers who were likely to use safety behaviors, such as taking sleep medication or drinking alcohol, which in fact, not helping them fall sleep. They also observed that the poor sleepers felt dependent on these behaviors and believed they helped them sleep, even though the behaviors were actually compounding their sleeping problems. The students who did not experience sleep problems often didn't think of anything — they simply fell asleep.

Based on the research, Dr. Colleen Carney, director of Ryerson's Sleep and Depression Laboratory, believes that poor sleepers who engage in safety behaviors are actually disrupting their sleep in the long term. These safety behaviors are driven by unhelpful beliefs about sleep, but people suffering from insomnia or poor sleep feel they need to do these things to help them fall asleep.

Dr. Carney’s conclusion: That cognitive behavior therapy — not taking a pill or a drink of alcohol—is the best long-term treatment for insomnia and other sleep disorders.With cognitive behavior therapy, patients are taught to work with their physiology to help develop good sleeping habits and learn how to fall asleep naturally, rather than relying on chemicals. In our pharmaceutical society, that seems like a rogue idea … but I believe it’s the right one.

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.

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.

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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.

Roll Over and Stop Snoring! Truth or Wives’ Tale?

Many people think it’s an old wives’ tale—that rolling over from your back to your side when you’re sleeping will stop your snoring. Maybe it’s because wives are usually the ones poking their snoring husbands to roll over in the middle of the night! But just like many myths, there is a hint of truth to the tale.

To start, we must first understand why we snore. During sleep, our throats relax causing the tongue to fall into the airway in the back of the throat. Snoring is caused when there is an interruption to the free flow of air through the nose and throat causing a vibration that produces the sound of snoring. There are many reasons why air may block breathing so people can snore for many different reasons. There are many factors that can trigger the interruption of airflow including a person’s weight, whether they smoke, take certain medication, or have allergies. Physical causes can include if someone’s had a nose or throat injury or if they were born with narrow passages, and more.

For some people, gravity produces an increased amount of obstruction from the tongue occurs when they sleep on their backs, which is described as “positional snoring.” This type of snoring explains why snorers often complain about being "frequently assaulted" throughout the night by their spouses, and implored to roll over.

If you’re a snorer whose favorite sleeping position is on your back, a simple solution to keep you off of it is to sew a ball into the pocket of a t-shirt that is then worn backward during sleep, keeping you off of it and sleeping on your side or stomach. If you feel muscle strain in your lower back when you sleep on your side, many people feel more comfortable when they sleep with a pillow between their knees. Some positional snorers also improve when the head of the bed is elevated or they sleep on an extra pillow.

So there definitely is truth to the wives’ tale, but unfortunately, not for everyone. If you have tried keeping off your back when you snore and it’s not working, there may be other physical factors that are causing it, and it makes sense to have a snoring specialist examine you to discover the reason. Snoring can be more than an annoyance, and can negatively affect your health as well as daytime productivity.

If you’re in the New York City area, contact us today at the Manhattan Snoring and Sleep Center to set up your appointment and start your treatment.

The Stroke Connection: Heavy Snoring and Narrow Arteries

By David Volpi, M.D., P.C., F.A.C.S., The Manhattan Snoring and Sleep Center

In a study completed last year in Australia, researchers calculated that heavy snorers have an elevated risk for carotid artery stenosis, a narrowing of the arteries that supply the brain with blood. When those arteries are blocked, it can lead to stroke.

It’s been long known that high cholesterol, hypertension, smoking and obesity are linked to carotid artery narrowing. This new risk as discovered after 110 volunteers – a mixture of men and women ages 45-80—were measured for the extent of plaque in the arteries and spent the night in a sleep lab monitoring the timing of their snoring. The study showed that those that were the heaviest snorers (after adjusting for sex, body mass index, hypertension and other factors) had the 10 times the risk of those who snored the least.

Associate Professor of Medicine at the University of Sydney, John R. Wheatley was the lead researcher, and believes that the vibrations of snoring may cause damage to the epithelium, the cells that line the inside of the artery, leading to inflammation and plaque buildup. He acknowledges that the results of this study do not establish a “causal relationship” between artery blockage and snoring. For that a much larger sample must be studied. However it is clear that the study reveals heavy snoring may increase the risk for stroke.

Are you a heavy snorer? Snoring may be caused by a number of factors, and can be treated. Often lifestyle changes such as losing weight, exercise, quitting smoking and stopping alcohol consumption prior to bed are enough to cause snoring to stop. However, sometimes snoring is caused by physical issues such as nasal obstruction or chronic sinus infections. Whatever the cause, there are non-surgical and surgical means that can treat snoring.

If you are a heavy snorer, we recommend you have an examination by an otolaryngologist (ear, nose and throat) physician to assess what is causing your snoring and how it should be treated. For more information on the causes of snoring, visit www.nycsnoringsleepapneacenter.com.

If you’re within the New York tri-state area, contact the Manhattan Snoring and Sleep Center today to schedule an appointment.

Losing Weight Can Reduce – Even Rid Sleep Apnea

By David Volpi, M.D., P.C., F.A.C.S., The Manhattan Snoring and Sleep Center

New research shows that obese sleep apnea patients who lose just 10 percent of their weight can significantly improve their symptoms and potentially rid themselves of the sleep apnea all together.

According to an article in Health News last September, the Center for Obesity Research and Education at Temple University in Philadelphia, and researchers at four other medical centers and universities analyzed data on 264 obese patients with type 2 diabetes and sleep apnea in varying forms. Those in weight loss treatment lost an average 10 percent of their beginning weight, and realized a significant reduction in number of sleep apnea episodes they suffered. Many moved to less severe categories, from moderate to mild, and 14 percent had complete remission of the disorder. Men with severe apnea who lost the most weight saw the greatest benefit.

It is thought that sleep apnea affects more than 18 million Americans. It is a potentially life-threatening disorder that can lead to heart disease, increase blood pressure, cause lung dysfunction and lead to stroke. A sleep apnea patient stops breathing during sleep for usually ten to twenty seconds, sometimes a minute or more, many times throughout the night. Obstructive sleep apnea is the most common type, and also the most dangerous. It is widespread in overweight and obese people because excess weight can cause the soft palate in the back of the mouth to collapse and block airway. However it should be noted that there are anatomical abnormalities such as a narrow throat or large tonsils that can also cause sleep apnea.

Unfortunately, it often goes undiagnosed because sleep apnea episodes occur only during sleep. Recognizing daytime symptoms, which include fatigue and daytime sleepiness (especially when it is thought that the patient should have received enough rest) is key to discovering this potentially life threatening disorder. If you believe you may have sleep apnea, it is important to have a physical examination by an otolaryngologist (ear, nose and throat doctor) to get started on treatment. If your weight is a factor in your sleep apnea, your doctor can lead you to a weight loss program that is right for you.

It’s long been known that overweight and obese people are at risk for numerous health problems. It’s also known that in addition to lowering or ridding sleep apnea, by losing just 10 percent of body weight, overweight patients can improve their heart function, lower blood pressure and levels of blood cholesterol and triglycerides, and decrease the risk of diabetes and cardiovascular disease – all reasons why weight management should be an important goal for a healthy lifestyle.

Those who participated in the weight loss study lost an average of 24 pounds by taking part in group behavior modification, eating a portion-controlled diet with liquid meal replacements, and exercising for 175 minutes per week for one year. “This is one of the first and certainly the largest study ever conducted,” Foster said. “It’s been clear that obesity increases the risk of sleep apnea but less clear that if obese people or people with type 2 diabetes lost weight, it would result in significant improvements in their sleep apnea—and it did.”

The study findings were published in the September 28 issue of the Archives of Internal Medicine. Read more about sleep apnea visit the Manhattan Snoring and Sleep Center.