9/12/08
Are You Addicted to Exercise?
It's generally accepted that regular moderate exercise is good for your health, but what if you exercise too much? Do you HAVE to exercise every day? What happens when you don't exercise for a few days? Do you feel more tired and irritable if you skip a few workouts? Does intense vigorous exercise make you feel good? Does skipping a workout make you feel stressed?
Despite all the known benefits of exercise, if you overdo it, this can be a sign that you may be compensating for something else that may be going on. For example, one of the most common conditions that I see in my practice is when people are unable to get a good night's sleep, they compensate in various ways, such as regular exercise, increased caffeine consumption, relaxation or breathing techniques. You'll automatically take part in activities or habits that make you feel more energetic or relaxed. Eating is another form of relaxation, since it stimulates your parasympathetic nervous system (the relaxation half of your involuntary nervous system).
I know a lot of endurance distance runners in my running club, and almost invariably, no one can or likes to sleep on their backs. They can only sleep on their sides or more commonly their stomachs. What does their sleep position have to do with why their addicted to exercise? It all comes down to my sleep-breathing paradigm.
To summarize, my sleep-breathing paradigm proposes that all modern humans have difficulty breathing at night to various degrees due to our unique upper airway anatomy. The voice box is located underneath the tongue, as opposed to animals, where the voice box is located behind the tongue. This location of the voice box under the tongue is necessary for complex speech and language. But this is also what unprotected our airway, leading to all the various breathing and swallowing problems that modern humans have. Comparative anatomists and evolutionary biologists have said that speech and language development was ultimately detrimental to humans.
What's worse, it's thought that due to a radical change in our diets (highly processed foods and refined sugars) over the past century, our jaws are getting more narrow with increased dental crowding. Furthermore, dentists have stated that introduction of bottle-feeding to infants can aggravate dental crowding and malocclusion, which makes everything much worse. All these factors aren't the only reason for everyone's sleep problems, but everyone, by definition, is along a continuum. Your ability to breathe properly while sleeping is ultimately determined by your genes (the anatomy that you're given by your parents), your diet, and how you were fed as an infant.
So why is breathing a problem only when we're sleeping? There are two components to this issue: When lying flat on your back, your tongue falls back partially, due to gravity. This narrows the breathing passageway behind your tongue to various degrees. As you fall asleep, the deeper level of sleep you enter, the more your muscles relax, and at at a certain point, your tongue can fall back and obstruct your breathing. The more narrow your airway (due to smaller jaws or inflammation due to a cold or allergies), the more likely you'll stop breathing and wake up to turn over. When you were young, you tossed and turned and eventually figured out that you can sleep much better when sleeping on your side or stomach. The problem is that even on your side or stomach, it's never perfect, and you're not able to get deep, efficient sleep, no matter how long you sleep.
It's also not too surprising that many personal trainers and fitness professionals have very similar features: Almost invariably they prefer to sleep only on their sides or stomachs. The same can be said about bodybuilders-a personal trainer/natural body builder friend of mine told me that almost every one in her gym snores. Working out intensely for 2-3 hours is invigorating and energizing, but maybe for some people, this is a way to overcome the expected fatigue and lethargy that would result from inefficient sleep.
We know that professional football players have a much higher incidence of obstructive sleep apnea. About 1/3 of all linemen were found to have mild or moderate sleep apnea. It's not only the fat in the neck-it's also the muscle mass that impinges on the soft tissues of the upper airway. So in theory, the more muscle bulk you have in your neck, the more breathing problems while sleeping, which can promote more intense workouts. It's hard to say which came first, but once it's started, it ends up being a self-perpetuating vicious cycle.
The worst case scenario is when you fit the profile above, and you suddenly get injured. Let's say you either can't run anymore. You become more lethargic, and you may end up eating more due to increased levels of stress from increased sleep deprivation. As you gain weight, your upper airway narrows even further, leading to worse deep sleep quality. Another scenario is if you injure your neck or shoulder. This will prevent you from being able to sleep on your side or stomach, which again, aggravates the vicious cycle.
What I just described may seem a little far fetched, but even if a small fraction of the people I mentioned has this anatomic condition, then it can potentially explain various health issues and problems down the road. One way to see where you're headed to to look at your parents. More often than not, one or both your parents may snore heavily, and in many cases will have one or more of the complications of untreated obstructive sleep apnea: depression, anxiety, diabetes, hypertension, heart disease, heart attack or stroke.
Many people will be just fine with their regular exercise regimen, but some others will have various health issues such as chronic nasal or sinus congestion, headaches, throat clearing, hoarseness or post-nasal drip. A thorough history and physical exam is the first step towards feeling better. Educating yourself about your condition is another step-I describe my sleep-breathing paradigm in much more detail in my book Sleep, Interrupted. I also take you through the steps you need to take to finally be able to breathe better, sleep better and feel better.
Despite all the known benefits of exercise, if you overdo it, this can be a sign that you may be compensating for something else that may be going on. For example, one of the most common conditions that I see in my practice is when people are unable to get a good night's sleep, they compensate in various ways, such as regular exercise, increased caffeine consumption, relaxation or breathing techniques. You'll automatically take part in activities or habits that make you feel more energetic or relaxed. Eating is another form of relaxation, since it stimulates your parasympathetic nervous system (the relaxation half of your involuntary nervous system).
I know a lot of endurance distance runners in my running club, and almost invariably, no one can or likes to sleep on their backs. They can only sleep on their sides or more commonly their stomachs. What does their sleep position have to do with why their addicted to exercise? It all comes down to my sleep-breathing paradigm.
To summarize, my sleep-breathing paradigm proposes that all modern humans have difficulty breathing at night to various degrees due to our unique upper airway anatomy. The voice box is located underneath the tongue, as opposed to animals, where the voice box is located behind the tongue. This location of the voice box under the tongue is necessary for complex speech and language. But this is also what unprotected our airway, leading to all the various breathing and swallowing problems that modern humans have. Comparative anatomists and evolutionary biologists have said that speech and language development was ultimately detrimental to humans.
What's worse, it's thought that due to a radical change in our diets (highly processed foods and refined sugars) over the past century, our jaws are getting more narrow with increased dental crowding. Furthermore, dentists have stated that introduction of bottle-feeding to infants can aggravate dental crowding and malocclusion, which makes everything much worse. All these factors aren't the only reason for everyone's sleep problems, but everyone, by definition, is along a continuum. Your ability to breathe properly while sleeping is ultimately determined by your genes (the anatomy that you're given by your parents), your diet, and how you were fed as an infant.
So why is breathing a problem only when we're sleeping? There are two components to this issue: When lying flat on your back, your tongue falls back partially, due to gravity. This narrows the breathing passageway behind your tongue to various degrees. As you fall asleep, the deeper level of sleep you enter, the more your muscles relax, and at at a certain point, your tongue can fall back and obstruct your breathing. The more narrow your airway (due to smaller jaws or inflammation due to a cold or allergies), the more likely you'll stop breathing and wake up to turn over. When you were young, you tossed and turned and eventually figured out that you can sleep much better when sleeping on your side or stomach. The problem is that even on your side or stomach, it's never perfect, and you're not able to get deep, efficient sleep, no matter how long you sleep.
It's also not too surprising that many personal trainers and fitness professionals have very similar features: Almost invariably they prefer to sleep only on their sides or stomachs. The same can be said about bodybuilders-a personal trainer/natural body builder friend of mine told me that almost every one in her gym snores. Working out intensely for 2-3 hours is invigorating and energizing, but maybe for some people, this is a way to overcome the expected fatigue and lethargy that would result from inefficient sleep.
We know that professional football players have a much higher incidence of obstructive sleep apnea. About 1/3 of all linemen were found to have mild or moderate sleep apnea. It's not only the fat in the neck-it's also the muscle mass that impinges on the soft tissues of the upper airway. So in theory, the more muscle bulk you have in your neck, the more breathing problems while sleeping, which can promote more intense workouts. It's hard to say which came first, but once it's started, it ends up being a self-perpetuating vicious cycle.
The worst case scenario is when you fit the profile above, and you suddenly get injured. Let's say you either can't run anymore. You become more lethargic, and you may end up eating more due to increased levels of stress from increased sleep deprivation. As you gain weight, your upper airway narrows even further, leading to worse deep sleep quality. Another scenario is if you injure your neck or shoulder. This will prevent you from being able to sleep on your side or stomach, which again, aggravates the vicious cycle.
What I just described may seem a little far fetched, but even if a small fraction of the people I mentioned has this anatomic condition, then it can potentially explain various health issues and problems down the road. One way to see where you're headed to to look at your parents. More often than not, one or both your parents may snore heavily, and in many cases will have one or more of the complications of untreated obstructive sleep apnea: depression, anxiety, diabetes, hypertension, heart disease, heart attack or stroke.
Many people will be just fine with their regular exercise regimen, but some others will have various health issues such as chronic nasal or sinus congestion, headaches, throat clearing, hoarseness or post-nasal drip. A thorough history and physical exam is the first step towards feeling better. Educating yourself about your condition is another step-I describe my sleep-breathing paradigm in much more detail in my book Sleep, Interrupted. I also take you through the steps you need to take to finally be able to breathe better, sleep better and feel better.
Steven Y. Park, M.D.
Author of Sleep, Interrupted: A physician reveals the #1 reason why so many of us are sick and tired. Find out why you're always sick and tired here: http://www.sleepinterrupted.com
http://www.doctorstevenpark.com
Author of Sleep, Interrupted: A physician reveals the #1 reason why so many of us are sick and tired. Find out why you're always sick and tired here: http://www.sleepinterrupted.com
http://www.doctorstevenpark.com
Article Source: http://EzineArticles.com/?expert=Steven_Park
9/10/08
The 5 W's of Dental Sleep Medicine Sleep Apnea
What is Dental Sleep Medicine? Dental Sleep Medicine refers to the branch of dentistry devoted to the treatment of snoring and sleep apnea with an oral appliance similar to a retainer. When a patient is diagnosed with obstructive sleep apnea, they are usually prescribed a CPAP (continuous positive airway pressure) machine which functions like a reverse vacuum cleaner to keep the airway open.
It consists of a mask fitted over the mouth and nose which is attached to a compressor-like machine via a hose through which room air is forced. Compliance is shown to be very low due to common complaints of the machine being too noisy, the mask irritating the face, claustrophobia due to wearing the mask, inconvenience of being tethered to a machine and inability to sleep in all positions. In many cases, oral appliances are an effective alternative to CPAP therapy for sleep apnea.
Why do airway testing? A specially trained dentist utilizes airway testing with a Pharyngometer and Rhinometer to verify airway size and collapsibility as well as to predict success with an oral appliance. This technology utilizes sound waves in acoustic reflection much like a fish-finding device. The Pharyngometer measures the cross-sectional airway in the throat to determine where there is an obstruction and whether movement of the lower jaw with an oral appliance will be effective in clearing that obstruction. The Rhinometer measures the nasal airway and determines whether there is blockage in the nose. This is critical because oral appliances are unable to open the nasal airway and should not be used if the obstruction exists in the nasal passages only. Airway testing with the Pharyngometer/Rhinometer is crucial for predicting before treatment even begins whether the oral appliance will work or not.
When can we treat with Oral Appliances? Obstructive Sleep Apnea occurs when the tongue falls back into the throat and blocks the airway. Partial obstruction typically causes snoring and complete obstruction causes a cessation of breathing in addition to snoring. Oral appliances are designed to bring the lower jaw forward and thereby bring the tongue forward to open the airway. Oral Appliances were approved by the American Academy of Sleep Medicine as a first line of therapy for patients with mild to moderate sleep apnea. Patients with severe sleep apnea who cannot or will not wear a CPAP machine can also benefit from oral appliances but they are not as effective as CPAP therapy. It is still better than no treatment at all.
Where is Obstructive Sleep Apnea Diagnosed? Only a physician can make a diagnosis of obstructive sleep apnea and classify its severity. For many years, diagnosis had to be made from an overnight sleep study, Polysomnography or PSG for short. This study is conducted in a hospital or sleep laboratory.
Just recently, unattended home sleep studies such as the Watch-Pat 100 are available to physicians and dentists and approved by the FDA for diagnosing obstructive sleep apnea. Diagnosis still must be made by a physician but the advantages of being able to conduct the study in the patient's own bedroom can often provide a familiarity which lends itself to increased patient comfort and decreased anxiety.
Dentists treating sleep apnea can also use the Watch-PAT 100 to verify the effectiveness of an oral appliance. No patient should be given an oral appliance without the follow-up of an unattended sleep study or repeat PSG.
Who is practicing Dental Sleep Medicine? This field requires a commitment to education and a commitment to technology. Most dental school curriculua do not offer any training in this arena. Numerous books have been written on this subject and many continuing education courses are offered in this area.
Utilization of airway equipment and follow-up testing are imperative for the dentist to treat this properly. Guessing at severity of sleep disorder, jaw-position or effectiveness of oral appliances can be at the very least frustrating and potentially life-threatening.
It consists of a mask fitted over the mouth and nose which is attached to a compressor-like machine via a hose through which room air is forced. Compliance is shown to be very low due to common complaints of the machine being too noisy, the mask irritating the face, claustrophobia due to wearing the mask, inconvenience of being tethered to a machine and inability to sleep in all positions. In many cases, oral appliances are an effective alternative to CPAP therapy for sleep apnea.
Why do airway testing? A specially trained dentist utilizes airway testing with a Pharyngometer and Rhinometer to verify airway size and collapsibility as well as to predict success with an oral appliance. This technology utilizes sound waves in acoustic reflection much like a fish-finding device. The Pharyngometer measures the cross-sectional airway in the throat to determine where there is an obstruction and whether movement of the lower jaw with an oral appliance will be effective in clearing that obstruction. The Rhinometer measures the nasal airway and determines whether there is blockage in the nose. This is critical because oral appliances are unable to open the nasal airway and should not be used if the obstruction exists in the nasal passages only. Airway testing with the Pharyngometer/Rhinometer is crucial for predicting before treatment even begins whether the oral appliance will work or not.
When can we treat with Oral Appliances? Obstructive Sleep Apnea occurs when the tongue falls back into the throat and blocks the airway. Partial obstruction typically causes snoring and complete obstruction causes a cessation of breathing in addition to snoring. Oral appliances are designed to bring the lower jaw forward and thereby bring the tongue forward to open the airway. Oral Appliances were approved by the American Academy of Sleep Medicine as a first line of therapy for patients with mild to moderate sleep apnea. Patients with severe sleep apnea who cannot or will not wear a CPAP machine can also benefit from oral appliances but they are not as effective as CPAP therapy. It is still better than no treatment at all.
Where is Obstructive Sleep Apnea Diagnosed? Only a physician can make a diagnosis of obstructive sleep apnea and classify its severity. For many years, diagnosis had to be made from an overnight sleep study, Polysomnography or PSG for short. This study is conducted in a hospital or sleep laboratory.
Just recently, unattended home sleep studies such as the Watch-Pat 100 are available to physicians and dentists and approved by the FDA for diagnosing obstructive sleep apnea. Diagnosis still must be made by a physician but the advantages of being able to conduct the study in the patient's own bedroom can often provide a familiarity which lends itself to increased patient comfort and decreased anxiety.
Dentists treating sleep apnea can also use the Watch-PAT 100 to verify the effectiveness of an oral appliance. No patient should be given an oral appliance without the follow-up of an unattended sleep study or repeat PSG.
Who is practicing Dental Sleep Medicine? This field requires a commitment to education and a commitment to technology. Most dental school curriculua do not offer any training in this arena. Numerous books have been written on this subject and many continuing education courses are offered in this area.
Utilization of airway equipment and follow-up testing are imperative for the dentist to treat this properly. Guessing at severity of sleep disorder, jaw-position or effectiveness of oral appliances can be at the very least frustrating and potentially life-threatening.
Dr. Dawne Slabach is a General Dentist, Fellow of the American Academy of Craniofacial Pain, with a focus on the treatment of Snoring and Obstructive Sleep Apnea as well as TMJ Disorders (TMD). For more information, please visit
http://www.sleepapneacolumbus.com
http://www.sleepapneacolumbus.com
9/6/08
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