Tag: and SnoringBlog – Doctor Steven Y. Park

Originally at: https://doctorstevenpark.com/the-mouth-taping-controversy-for-better-sleep?utm_source=rss&utm_medium=rss&utm_campaign=the-mouth-taping-controversy-for-better-sleep

Does It Work And Is It Safe?

My wife Kathy keeps making fun of me for using tape to fix all of life’s problems. For example, I take black electrical tape with me while traveling to cover up all electronic LED lights at night to sleep better. I have to admit that I’ve used duct tape on a number of occasions for temporary home repairs. More recently, I have been taping my lips closed at night for better sleep. I have to admit that overall, I do seem to be sleeping better.

Mouth taping has been promoted by dentists, myofunctional therapists and various holistic health practitioners for a number of years. During a cursory search for its origins, I could not see anything mentioned before the past 5 or 6 years, except for lip taping in children with a cleft lip.

Several societies and prominent physicians have cautioned against it. This myofunctional therapy website recommends avoiding lip taping. Dr. Kasey Li, a world-renown ENT and maxillofacial surgeon advises against it in this Forbes article. My specialties (ENT and sleep medicine) are generally against it. Up until recently, I was against it too, until I heard countless patients telling me that they sleep better with mouth taping.

My Personal Journey

About 3 months ago, I decided to take the plunge and try mouth taping for myself. I tried different types of tape and different ways of placing the tape. The most commonly recommended type of tape is the 1 inch 3M micropore paper tape, but I had no problems using other types of tape. It’s a personal preference. The other issue that I played with was tape placement. Most experts recommend a single horizontal position across your lips. There are several commercially available mouth tape options to keep your mouth closed. I’ve even seen some photos of people using nasal dilator devices (Breathe Right strips®) or a Band-Aid.® Remember to use lip balm if your lips get dry. 

One way of tape placement ended up working best for me: vertically from the upper lip (base of the nose) to under my chin. What I found was that if you stop just under your lower lip in front of your chin, your mouth can still open significantly. I see this happening all the time in the operating room during drug-induced sleep endoscopy. With the mouth closed, the space behind the tongue is relatively open (Photo 1), but if your mouth opens about 1/2 inch distance between your teeth, the tongue moves back severely with almost total obstruction (Photo 2). Try it yourself. While keeping …

Originally at: https://doctorstevenpark.com/can-cpap-make-you-gain-weight?utm_source=rss&utm_medium=rss&utm_campaign=can-cpap-make-you-gain-weight

Scanning through my daily schedule of patients, I noticed Mr. Johnson was on the schedule. I have been following him for over 10 years since diagnosing and prescribing CPAP for his severe obstructive sleep apnea. I last saw him 3 years ago. He was faithful in using his CPAP 100% of the time, and his adherence numbers were perfect, with an average AHI of 1, minimal leaks, and being used 8-9 hours every night. As I entered the exam room and greeted him, I was shocked to see how much weight he had gained (30 pounds) over the past few years.

One of the basic tenants of sleep medicine is that poor sleep leads to weight gain. It naturally follows that sleeping better with CPAP will lead to weight loss. It’s not uncommon to see patients losing weight after sleeping better with CPAP, dental appliances or even after surgery. However, I had seen a few studies over the years showing that a small proportion of people using CPAP may gain some weight, but what I discovered over the past few weeks studying basal metabolic rates and weight loss in relation to CPAP was surprising.

It turns out that overall, CPAP use has been found to increase weight significantly, in proportion to how long you use CPAP. The more hours you use CPAP every night and the more number of years, the higher the amount of cumulative weight gain.

• Researchers from Harvard and Stanford Universities found that patients randomized to receive CPAP for 6 months gained 0.77 pounds, whereas people on sham CPAP lost 1.5 pounds. Of note, people who more highly compliant (using more than 4 hours/night, at least 4/7 days/week) had higher degrees of weight gain.

• In another study, overall BMI did not increase in CPAP compliant patients after one year, but women and non-obese subjects did gain significant weight.

• A Finnish study in 2016 found that CPAP compliant, more obese patients had higher levels of weight gain after 5 years.

• However, this one retrospective study did not find and significant weight gain in complaint CPAP users.

• Lastly, a meta-analysis of randomized only studies analyzed over 3181 patients from 25 studies, finding significant weight increase in compliant CPAP users.

A number of explanations are given as to why CPAP can promote weight gain. The one most reasonable proposal that I saw is that when you have obstructive sleep apnea, your basal metabolic rate (BMR) in higher.  Due to the extra energy demands of having sleep apnea, you burn up more calories. It’s been shown that using CPAP reduces your BMR.  Since dietary intake and …

Originally at: https://doctorstevenpark.com/5-unexpected-causes-of-autoimmunity?utm_source=rss&utm_medium=rss&utm_campaign=5-unexpected-causes-of-autoimmunity

Jennifer had tried everything to get rid of her psoriasis. She made major changes tp her diet and lifestyle with only modest improvements in the red, scaly patches on her hands and elbows. A 45 year old woman with 2 school-aged children, she always wore long-sleeved shirts, even in the summer. Powerful prescriptions medications did help, but only temporarily. She stopped taking these medications due to their side effects. Three months after using CPAP for her moderately severe obstructive sleep apnea, she was ecstatic to let me know that her psoriasis was finally gone. Even her joint pains were mostly gone. 

Autoimmune disease is a condition when the body attacks its own tissues mistakenly, unlike a reaction to viruses, bacteria or toxins. As a result, inflammation occurs. This can happen in any part of the body.  Symptoms are too numerous to list, but can can range from fatigue and lack of energy to rashes, to poor digestion, or memory loss. Various autoimmune conditions include psoriasis, rheumatoid arthritis, lupus, celiac disease, thyroiditis, multiple sclerosis, inflammatory bowel disease, and even Ménière’s disease. 

The most commonly blamed reasons for autoimmune disease are genetics, toxins, certain foods, and infections. I distinctly remember learning about autoimmune diseases during medical school, and even now, the explanations by doctors for the causes and treatment for autoimmune conditions are not very satisfying. Back then, in the early 1990s, autoimmunity was relatively rare, but now it’s more common than not. 

If you look up information about this on your typical medical website, you’ll see that there’s no specific pattern, explanation, diagnostic test or standard way of treatment. It’s all over the place. Notice that nowhere in the treatment section does it mention removal of potentially offending food, toxins, or irritants, but only lists various medications. 

Why Traditional Explanations Fail

In our textbooks, the most common reason for autoimmune disease is stated to be from your genes. There are a myriad of genetic predispositions to various conditions, such as genes for Sjogren’s disease or HLA-DRB1 for Meniere’s disease. But notice that for most studies that link certain genes to classic autoimmune conditions, there’s a wide range of different genes, with no one certain gene. Since emphasis is placed more on your genes (rather than your environment), medical and biochemical treatment tends to be favored over environmental modifications.  If most autoimmune conditions are due to our genes, then why was autoimmunity so rare even 50 years ago? This observation supports the suspicion that what’s in our environment may be a better explanation. Epigenetics is a concept that supports this idea, that your environment can modify how your …

Originally at: https://doctorstevenpark.com/interview-with-james-nestor-author-of-ny-times-best-seller-breath-the-new-science-of-a-lost-art-podcast-92?utm_source=rss&utm_medium=rss&utm_campaign=interview-with-james-nestor-author-of-ny-times-best-seller-breath-the-new-science-of-a-lost-art-podcast-92

Please join me as I welcome James Nestor, author of the New York Times, Wall Street Journal,  and LA Times best-selling book, Breath: The New Science of a Lost Art.

He will reveal the following:

• How and why did you write this book?
• How did you end up volunteering for a Stanford experiment to plug your nose for a few days?
• How do you deal with doctors and other patients that don’t see poor breathing as a serious problem, especially if you’re younger or thin?
• What’s the one thing that you’ve implemented after writing this book?
• What are some tips for our listeners to improve their breathing and well-being?
• And much, much more.

Download mp3  |  Subscribe

The post Interview with James Nestor, Author of NY Times Best-Seller, Breath: The New Science of a Lost Art [Podcast #92] appeared first on Doctor Steven Y. Park, MD | New York, NY | Integrative Solutions for Obstructive Sleep Apnea, Upper Airway Resistance Syndrome, and Snoring.

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Originally at: https://doctorstevenpark.com/how-to-stop-mouth-breathing-and-get-better-sleep?utm_source=rss&utm_medium=rss&utm_campaign=how-to-stop-mouth-breathing-and-get-better-sleep

My Comments on CNN

Here’s a great article on CNN, with an interview with James Nestor, author of the New York Times best-seller, Breath: The New Science of a Lost Art. 

 

The post How to Stop Mouth Breathing and Get Better Sleep appeared first on Doctor Steven Y. Park, MD | New York, NY | Integrative Solutions for Obstructive Sleep Apnea, Upper Airway Resistance Syndrome, and Snoring.

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Originally at: https://doctorstevenpark.com/is-there-a-gene-for-crooked-teeth?utm_source=rss&utm_medium=rss&utm_campaign=is-there-a-gene-for-crooked-teeth

It’s commonly accepted that your face will look like your parent’s faces. The same goes for your teeth. So if you have crooked teeth, then it’s assumed that your parents must have given you their genes for crooked teeth. However, In this blog post, I’m going to argue that there’s is no gene for crooked teeth.

Numerous sources and research papers have shown that even a few hundred years ago, most Americans did not need their wisdom teeth removed.  If you look at Native American skulls from these times, you’ll see that they had wide jaws and perfectly straight 32 teeth, and essentially no cavities. Dr. Weston Price found the same thing in the early to mid-1900s in all 5 continents, if people ate naturally, with no Western influences. George Catlin the American painter in his book, Shut Your Mouth and Save Your Life, observed that Native Americans who had wide jaws and perfect teeth were healthier, stronger, and more resilient.

Both observed that as we start to adopt Western diets (soft/processed foods, refined sugars, canned foods, etc.), people’s teeth came in more crooked and crowded, with more narrow jaws. Bee Wilson, in her book, Consider the Fork, A History of How We Cook and Eat, cites anthropologic studies showing that only the rich in old England could afford newly invented metal cutlery. As a result, the aristocracy was found to have overbites (upper front teeth in front of the lower teeth) long before the poor peasants. The same was found in Chinese culture as well.

Yes, genes give you a blueprint for a range of possible genetic expressions, but it’s your environment while developing inside the womb, and what you’re exposed to after birth that determines how your mouth and teeth develop. This process is called epigenetics. So far, the known risk factors for crooked teeth (malocclusion) are prematurity, soft foods, bottle-feeding, thumb sucking, pacifier use, toxins, and nasal congestion. I’ve also speculated that perhaps even fluoride may have an influence as well.

Here are two examples of how your environment can be a significant factor in how crooked your teeth become. One of the residents that work with me recounts that her grandmother was born in Vietnam and immigrated to the United States at the age of 5. She was the firstborn and had 9 subsequent siblings, all born in the US.  She is the only one with straight teeth, as well as being the healthiest of all her siblings, even the youngest one. 

One of my operating room nurses grew up in St. Kitts, a small island in the Caribbean Sea.…

Originally at: https://doctorstevenpark.com/un-stuff-your-stuffy-nose-for-better-sleep-2?utm_source=rss&utm_medium=rss&utm_campaign=un-stuff-your-stuffy-nose-for-better-sleep-2

Whether or Not You Use CPAP

In this video I’m going to reveal why it’s so vitally important for you to breathe well through your nose if CPAP is going to work for you. Whether or not you have obstructive sleep apnea, good nasal breathing is vital for optimal health. 

In this 8 minute video, I will discuss:

• How good nasal breathing can increase oxygen uptake by up to 20%
• 5 ways to breathe better through your nose
• How nasal surgery can increase CPAP use by up to 5 hours.

The post Un-stuff Your Stuffy Nose For Better Sleep appeared first on Doctor Steven Y. Park, MD | New York, NY | Integrative Solutions for Obstructive Sleep Apnea, Upper Airway Resistance Syndrome, and Snoring.

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Originally at: https://doctorstevenpark.com/natural-and-unnatural-ways-to-decongest-your-nose?utm_source=rss&utm_medium=rss&utm_campaign=natural-and-unnatural-ways-to-decongest-your-nose

If you search the Internet, there are literally hundreds of different suggestions on how to get rid of a stuffy nose. Some of the commonly seen options include natural, home remedies such as steam, garlic, onion, essential oils, saline, and ginger.

However, in this article, I’d like to focus on ways to decongest your stuffy nose by describing natural and unnatural ways of changing the status of your nasal autonomic nervous system. Nasal breathing is controlled by the two parts of the autonomic nervous system: sympathetic and parasympathetic.

The sympathetic nervous system controls your “fight or flight” response, causing constriction of your blood vessels. The parasympathetic nervous system activates your relaxation state, such as sleep, digestion, and sex. This is also what explains the nasal cycle, where one side opens up, alternating from side to side every few hours. This article will go over 5 unnatural and 7 natural ways of activating your nose’s sympathetic nervous system to improve your nasal breathing.

5 Unnatural Ways to Breathe Better Through Your Nose

1. Nasal decongestants. Over-the-counter nasal decongestants such as phenylephrine or oxymetazoline are probably some of the most commonly used treatments for people with stuffy noses. These medications constrict blood vessels receptors inside your nose. The effects can be relatively quick and dramatic, but the effect lasts shorter and shorter the longer you use it. This is why it’s important not to use these products for more than 3-5 days. Many people become addicted to these sprays, leading to a condition called rhinitis medicamentosa. If you are addicted, you must see an ENT doctor who can help you wean you off this drug.
2. Epinephrine (adrenaline). This is a hormone/neurotransmitter that’s normally produced by your adrenal gland during periods of intense stress. It’s one of many medications that constrict blood vessels as well as to stimulate your heart. This will raise your blood pressure and heart rate. It can also reverse severe allergic reactions such as seen with bee-stings or peanut allergies. Nasal decongestants are much weaker versions of epinephrine, with some people experiencing heart racing, palpitations, or a rise in blood pressure.
3. Cocaine. This is a powerful decongestant as well as an anesthetic. Use in the nose over time an cause a hole in the septum, not to mention a bad drug addiction. Many famous people were cocaine addicts, including Sigmund Freud, Thomas Edison, Michael Jackson, Frank Sinatra, and Witney Houston.
4. Nasal dilator devices. These are devices or gadgets to spread your nostrils apart. The most well-known option is called Breathe Right strips, but there are also dozens of other options that go on the outside of

…

Originally at: https://doctorstevenpark.com/qa-about-sleep-apnea-with-james-nestor-author-of-breath?utm_source=rss&utm_medium=rss&utm_campaign=qa-about-sleep-apnea-with-james-nestor-author-of-breath

James Nestor is an award-winning journalist and author of Breath: The New Science of a Lost Art. It became an instant New York Times, Wall Street Journal, and Los Angeles Times Top 10 bestseller. I had the privilege of being interviewed for his video FAQs section for his book about obstructive sleep apnea. I strongly encourage you to read his book. 

The post Q&A About Sleep Apnea with James Nestor, Author of Breath appeared first on Doctor Steven Y. Park, MD | New York, NY | Integrative Solutions for Obstructive Sleep Apnea, Upper Airway Resistance Syndrome, and Snoring.

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Originally at: https://doctorstevenpark.com/can-acid-reflux-medications-cause-dementia?utm_source=rss&utm_medium=rss&utm_campaign=can-acid-reflux-medications-cause-dementia

An interesting article caught my attention regarding the association between long-term proton pump inhibitor use and rates of dementia. Researchers from the University of Rostock in Germany analyzed over 73,000 medical records from an insurance database from 2004 to 2011. What they found was that patients receiving proton pump inhibitors (PPIs) for acid reflux were found to have significantly higher rates of dementia (44%). 

My interest in this study comes from the fact that acid reflux and obstructive sleep apnea tend to go hand in hand. Obstructive episodes can create tremendous vacuum forces in the chest and throat cavities, literally suctioning up normal stomach juices into the esophagus and even the throat. Besides conservative recommendations, acid-reducing medications such as PPIs (various brands include Prilosec, Nexium, and Prevacid) are usually prescribed. All these medications work by blocking the proton pump in the acid-secreting cells in the stomach. Another class of medications includes the H2 blockers, with two common brand names seen is Tagamet or Zantac. These medications are sold over the counter, as well as by prescription. It’s estimated that the market value for acid reflux medications in 2016 was $5.66 billion. 

Here are some of my comments and observations about this study:

1. Mouse models have shown increased rates of beta-amyloid buildup in mice given PPIs.
2. PPI use was shown to block the neurotransmitter acetylcholine, potentially leading to dementia. 
3. Untreated obstructive sleep apnea (OSA) is also associated with higher rates of dementia. In this Taiwanese insurance database study, there was an overall 1.7x increased risk of having dementia if you also had OSA. For older males (ages 50 to 59), the risk was 6x higher, and for older females (> 70), about 3x higher.
4. In this prospective study, older women (average age 82) without dementia were found to develop higher rates of mild cognitive impairment (1.85x) if they had obstructive sleep apnea (AHI > 15).
5. Intermittent hypoxia (low oxygen levels), which is commonly seen in patients with untreated obstructive sleep apnea has been shown to increase levels of beta-amyloid plaques in mice.
6. Acid reflux medications do nothing to prevent acid reflux. Instead, they lower acid production in the stomach, rather than keeping stomach contents in the stomach. What comes up, however, still includes bile, bacteria, and digestive enzymes. Pepsin, a well-known stomach enzyme, has been found in the lung, ear and nasal/sinus areas.

It’s important to realize that all of the above-mentioned studies don’t prove cause and effect, but only associations. It’s hard to tease out if dementia and OSA have the same causes (leading to an association), or if needing to take …