I hope you are enjoying this hot and crazy summer!
As you know, we in clinical sleep medicine are here for you. Without patients in need of help for their sleeping problems, there would be no physician sleep specialists, no sleep centers, no sleep medicine.
Sleep medicine is an independent medial subspecialty, just like cardiology, pulmonology, and neurology. Though sleep medicine remains focused on the clinical evaluation and management of sleep disorders, it also must continue to move forward in innovation and search for answers to unknowns in our field. These essential aspects of our work can only be accomplished through research.
An organization called SAPCON (Sleep Apnea Patient Centered Outcomes Network) is dedicated to promoting sleep apnea research around the country. Organized in conjunction with the American Sleep Apnea Association, it is one of the largest networks to advance sleep apnea research. My friend and mentor, Dr. Vishesh Kapur (Professor of Medicine, University of Washington; Steering Committee Member, SAPCON), asked me recently to spread the word about SAPCON, which has created a website designed to develop a sleep apnea patient community that will learn about and contribute to sleep apnea research. Sleep apnea apnea patients may now easily connect with health care providers and researchers to share ideas and needs. As Dr. Kapur puts it, through the website “patients will be able to learn what is new in sleep apnea research, suggest new areas of focus for sleep apnea research, and participate in research if they choose to.” The website also contains valuable online tools to help you manage your sleep apnea.
The website: www.myapnea.org
I encourage sleep apnea patients and their loved ones to visit the site and see all that it has to offer.
Here’s hoping you’ve recovered from Thursdays’ turkey debauchery!
November is National Diabetes Month, and as we wrap up the month I want to bring to your attention an article recently published in the Huffington Post regarding diabetes and obstructive sleep apnea. Recent published literature demonstrates that up to 7 out of 10 diabetic people have sleep apnea. Those are astounding numbers considering how many people are diabetic in the United States.
Rather than repeat the contents of the article (written by my academy’s president, Tim Morgenthaler), I’m providing the link to it here:
There are many reasons to be concerned about this connection. First, obstructive sleep apnea is still a very under-recognized, under-diagnosed problem. Epidemiologic studies show that out of the millions of Americans with sleep apnea, only about 15% have been diagnosed! Second, there is increasing evidence that sleep apnea affects metabolism and weight more deeply and in more ways than originally thought. Finally, both sleep apnea and diabetes are risk factors for the development of heart disease, such as heart failure, early heart attack, atherosclerotic disease, and rhythm abnormalities.
Diagnosing and treating sleep apnea early have the potential of making the sleep apnea patient feel MUCH BETTER and more awake and alert during the day, but among the fringe benefits are that the SNORING STOPS and hopefully there may be a REDUCTION IN RISK for cardiac disease. I can’t underscore enough how important it is to seek medical help if you’re chronically sleepy during the day, snoring substantially at night, and having breathing pauses or choking or gasping events during your sleep.
Some of my readers may know that I’m back in school, which is why I’ve not been writing as much recently. However, winter break will soon be here, and I will write more on the topic of sleep deprivation in the near future. I wish you and yours’ a most peaceful (and snore-free) holiday season!
Many of us have experienced this problem at one point or another during our lives: awakening with that nasty sensation of uncomfortable dryness in the morning. Your saliva–or what’s left of it–feels like paste; there’s that funky, faintly cheesy taste in your mouth that you’re sure doesn’t smell good either.
Dry mouth, or xerostomia, can be a particular problem at night. Saliva is necessary to protect and lubricate the structures of the mouth and throat, as well as their fragile mucosal linings, from friction, foreign particles (food), and virulent organisms (viruses and bateria). While sleeping, your salivary glands naturally and normally slow down production of this saliva, and so in some respects it may be natural to awaken feeling like your mouth is a little dry. In some, however, dry mouth at night or in the early morning can be a substantial problem and a source of genuine discomfort; the words “Sahara desert” and “bone dry” are often used by my patients, for example, to describe this unpleasant sensation.
There are a number of potential causes for substantial dry mouth. Aging into your 70’s and 80’s, for example, often further slows down saliva production. Dehydration and metabolic imbalances may cause dry mouth as well. Certain medical disorders, such as Sjögren’s Syndrome and lupus, often are associated with dry mouth, as are a variety of different medications, such as antihistamines, certain blood pressure lowering drugs, diuretics (“water pills”), and anti-depressants.
Another important thing to think about is whether your mouth is open while you are sleeping. For many open-mouth breathers, the lower jaw (mandible) may naturally fall a little due to a combination of gravitational effects and jaw muscle slackening while asleep; some may be predisposed to this tendency more than others, and other factors–like body weight, neck circumference, and body position(s) of sleep–may influence mouth opening during sleep as well. However, it’s important to know if there are other problems that may cause chronic mouth opening during sleep as well, in particular things that can cause nasal congestion or other decreases in airflow through the nasal passages–such as chronic allergies, a substantially deviated nasal septum, and sinus infections. It stands to reason that if you can’t breathe properly through your nose, your mouth may be more likely to open during sleep to maintain proper airflow.
Another problem is that obstructive sleep apnea (a breathing disorder in which the airway collapses during sleep) is commonly associated with open-mouth breathing and, hence, mouth dryness and throat and oral irritation at night or in the morning. People with sleep apnea often snore loudly. Now keep in mind that you can snore with your mouth or closed (try simulating snoring with your mouth open and then with your mouth closed; you’ll see what I mean), but the snoring is generally louder with your mouth open. As a result, sleep apnea can be more noticeable to a bed partner, because the snoring is more bothersome and the loudness of the snoring provides a greater sound contrast when you sound like you stop your breathing during sleep (which is what the sleep apnea does, due to blockage of the upper airway). So as a clinician, I actually look at the open-mouth breathing as, in a paradoxical way, a good thing: it makes the sleep apnea more bothersome to both the patient and the bed partner, thus making it more likely to be brought to the attention of a physician (studies demonstrate that in the United States, about 85% of sleep apnea cases are still not yet diagnosed!).
So here are my first take-home points of 2014! I recommend that you consider these possibilities if you frequently awaken with xerostomia. Bring symptoms consistent with reduced airflow through your nose to the attention of your doctor when you speak with him/her about the dry mouth. If your oral symptoms are accompanied by a history of substantial snoring, and certainly is someone is telling you that you sound like you’re also stopping your breathing during your sleep, I strongly urge you to discuss these important issues with your doctor and consider an evaluation by a person like me, a physician who specializes in sleep medicine.
I hope your holiday season has been great so far! And it’s not over yet!
I recognize I’m posting this video late–it aired originally during the Thanksgiving holiday–but it’s worth posting now anyway; we’re still in holiday mode, after all, aren’t we?, and lots of people eat turkey at Christmas time! Jimmy Fallon, Rashida Jones, and Carrie Underwood gave a hilarious musical performance about Thanksgiving traditions on Late Night With Jimmy Fallon.
Please pay particular attention to what Rashida sings 1:29 into the clip. She parodies Katy Perry’s song “Roar,” singing, “you’re gonna hear me SNORE!”
Drowsing and falling asleep in front of the television or fireplace after a big ol’ hyper-caloric meal are so common, they seem like natural components to our American holiday tradition. The degree to which L-tryptophan in the turkey triggers an after-dinner snooze is questionable, actually. However, there are so many reasons for sleep to take you over after a huge holiday meal: sleep deprivation due to wrapping things up at work; family and friends coming into town; irregular work and sleep schedules; parties keeping you up late; alcohol, particularly when combined with certain medications; underlying medical problems; and undiagnosed sleep disorders. Untreated sleep apnea, for example, may leave you both sleeping and snoring like a bear in your recliner, disturbing your house guests.
It’s always easier to say than to do, but keeping your sleep schedules as regular as possible and getting proper amounts of sleep during the holidays may well improve your levels of wakefulness and alertness during this time of year and may bring forth even more holiday cheer! Have a great holiday week, everyone!
I play alto saxophone and percussion for Show Brazil! here in Seattle. Originally from Salvador in the northeastern Brazilian state of Bahia, the band’s leader, Eduardo Mendonça, is an internationally renowned and award-winning recording and touring artist, accomplished songwriter, teacher, community leader and benefactor to the Puget Sound area Brazilian community. His music is played and appreciated worldwide. He has played for the Dalai Lama, Pope John Paul II, and Nelson Mandela, as well as audiences all around the world. I’m honored that Eduardo christened me with my Brazilian name, Maracujá, about which I will write in an upcoming entry.
One of Eduardo’s many great songs is “Vingança,” a live version of which is shown here (from a Carnaval gig we played in 2011).
“Vingança” features both Portuguese and English lyrics. Here are the English lyrics, which served the basis for a casual over-coffee discussion I recently had with Eduardo pertaining to sleep and snoring.
She left me just because I snore
It is so bad, I sing when I dream
To me it is nothing, it is nothing to me
Boy, I am crazy, please come back to me
Always back, come back to me
Baby, it is hard, come back to me
Yeah, I made my revenge
I scratched up all her pans
She got that stuff from my mother-in-law
Yeah, it was really nice
I broke her porcelain
It is my revenge because she’s gone away
I am so bad
So, here is my interview with my friend Eduardo, who I asked to provide the song’s backstory.
EM: The wife’s left this guy and he’s really mad. He reacts with non-violence. He wouldn’t hit this woman or anything, but he’s mad, and he starts to destroy the things that she likes, like the porcelain given by her mother-in-law, and he feels really compelled to do this. It’s funny; it’s humor. It’s nothing like asking anyone to be violent to solve the problem. I didn’t compose the Portuguese and English together.
MC: So you wrote the Portuguese portion first and later you added the English?
EM: Right, many years later. After I moved to the United States, I was willing to have Americans understand a little bit more about what I was saying. I was reflecting about how snoring and sleeping problems really can damage any marriage, right? Any relationship. Snoring is in my family. My mother always complained a lot about how much my father was snoring and sometimes talking in the night, and they stayed married for many years until she passed away. She was a hero to keep living with this problem. They slept in the same room and everything, but she complained, I remember she complained. Later I found out I snore as well, though not all the time.
MC: Your wife complains about your snoring?
EM: When I’m really tired, she starts to complain about the snoring, and she reports it to me, like my mother complained, and I saw that it can cause a problem in the relationship. You sleep when you sleep. You don’t have a clue that you’re interfering with somebody else’s sleep!
MC: It’s no fault of your own, but it’s causing distress to your spouse.
EM: That’s where “Vingança” came from. From my family’s experience, from my experience, and just to alert people: who has the problem? When I wrote this song, “to me it’s nothing, it’s nothing to me.” Of course not, right? Because you don’t know that you’re causing somebody else’s problem. And that’s the humorous part: when you say it’s not a problem, but it is a problem for somebody else. That’s what’s the music is about: just to make people aware that it’s something that needs to be reviewed, something that needs to be treated and talked about, because it does interfere in any kind of relationship.
MC: So he acknowledges that he is doing something that his wife is not liking, and that is a component in what eventually ends up being a dysfunctional relationship that gets worse and worse.
EM: Yes. She left because of that, right?
MC: But did she really leave only because of the snoring?
EM: Only because of the snoring! [we both laugh]
MC: Now, I will tell you that I have had patients that have gotten divorced in large part because of the snoring.
EM: I can believe that.
MC: And it’s not really because of the loudness and the obnoxiousness of the snoring, but because the person doing the snoring didn’t believe it, or didn’t do anything about it. It’s like, “I don’t care that you’re bothered by it; I don’t care.” So I’ve actually had patients that have been in that situation, when they refuse to do anything about it, knowing that it’s bothering the spouse, and then they get divorced. That’s happened!
EM: Yep, that’s my song.
MC: So what that song is then is basically a communication to people that you shouldn’t be ignoring those things, problems that you may not necessarily help, but don’t ignore it, or else your spouse isn’t going to be happy. And it’s humorous on one hand, but on the other hand, it’s deadly serious.
EM: Yes, it’s serious. The song treats a serious problem in a light way, because sometimes we can address some problem–and can make people reflect–not in a drastic way, but with humor. It’s a way to reflect on some cause, that the action that makes that cause can be changed, can be treated, and can be rethought.
MC: You can do something about it.
EM: Right. And this guy didn’t do anything about it.
MC: And he paid a price, because she left.
Obrigado to my old friend Eduardo for bringing some awareness to sleep problems such as snoring! His music may be found on Amazon, iTunes, and Spotify; Show Brazil! is constantly touring, throughout the Pacific Northwest and beyond. I highly encourage you to explore Eduardo Mendonça’s wonderful songs.
Dr. Morris' Sleep Help Desk 