A Tongue Pacemaker for Sleep Apnea: Hope or Hype?

Originally at: https://doctorstevenpark.com/inspire?utm_source=rss&utm_medium=rss&utm_campaign=inspire

One of the most common questions I get asked by patients and my online community is, “What’s the newest or cutting edge option for treating obstructive sleep apnea?” Internally, I cringe at this question, since it’s like asking what’s the best way to get from your home to work? The answer is…it depends. You can walk, use a skateboard, cycle, drive a car, or even fly there by helicopter. Even the car answer can range from a basic Toyota subcompact to a Lamborghini. All these options have their pros and cons. Some are not very practical, such as flying by helicopter.

It’s understandable that people with obstructive sleep apnea are always looking for better ways of treating OSA, not having to use a pressurized mask (CPAP) for the rest of their lives. Others are reluctant to consider surgery, even when they are good candidates. There are also too many good dental options to choose from. All these mainstream treatment options work to various degrees with various pros and cons.

One recent option that’s been available to sleep apnea patients in the past few years is the tongue nerve pacemaker. The official term is called hypoglossal nerve stimulation, where a pacemaker-like device is implanted in the right upper chest wall, and an electrical cuff is placed around the nerve that protrudes your tongue (the hypoglossal nerve). A sensor lead is placed below the pacemaker device to detect breathing efforts. The device senses when you are making an effort to breathe, and creates an electrical signal to push your tongue forward, opening up your airway being the tongue and soft palate. Click here to see a graphic.

This sounds like a novel idea, but it was first described many years ago by Johns Hopkins researchers in the 1990s. It didn’t take hold for mass sleep apnea treatment until 3 start-up companies were created in the United States in 2006 years of 2007. ImThera is being used in Europe and is currently in clinical trials in the United States. Inspire and Apnex performed clinical studies in the early 2010s. I had the privilege of being involved in the early studies with Apnex. 

Inspire received FDA approval in 2014. In their landmark New England Journal of Medicine publication, they found that in the 126 patient study, the average AHI at 12 months dropped from 29.3 to 9.0, a 68% difference. The overall response rate (> 50% drop in AHI and final AHI < 20) was 66%. The Epworth Sleepiness Score dropped from 11.6 to 7 (< 10 is considered normal). Functional Outcome of Sleep Questionnaire (FOSQ) scores increased from 14.3 …

The Connection Between Cancer and Sleep Apnea [Podcast 87]

Originally at: https://doctorstevenpark.com/cancer?utm_source=rss&utm_medium=rss&utm_campaign=cancer

It’s unavoidable that all of us will experience cancer at one time or another. If you have not experienced cancer, it’s likely that you know someone that has suffered or even died from cancer. 

In this episode, Kathy and I discuss the importance of good sleep as it relates to cancer. This is an important topic that everyone needs to hear if you want to significantly lower your risk of cancer.

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Show Notes:

Cancer statistics

OSA and cancer review article

Two cancer and OSA studies: Wisconsin cohort and Spanish Study

Intermittent hypoxia and cancer review article

Cancer VEGF

Hypoxia Induceable factor (HIF)

Tumor necrosis factor (TNF)

IL6 and OSA

Endothelial dysfunction and OSA 

Taiwanese study on cancer and parasomnias, OSA, insomnia

Shift work breast cancer, colon cancer

Estrogens podcast

Vitamin D podcast

Beta blocker and lower cancer

Love Medicine and Miracles book

Why Zebras Don’t Get Ulcers book

Pillar Implants for snoring and OSA

Environmental Working Group (EWG)

Dirty Dozen foods on EWG

Relaxing breath video by Dr. Weil

5 steps to lower your risk of cancer:

  • Eat clean healthy organic foods
  • Don’t smoke and minimize toxin exposure
  • Optimal, regular sleep
  • Stress control
  • Optimize upper airway and jaw size, starting from pregnancy and childhood.

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The Estrogen Goldilocks Principle: Confusion and Controversy [Podcast 86]

Originally at: https://doctorstevenpark.com/estrogen?utm_source=rss&utm_medium=rss&utm_campaign=estrogen

Estrogen imbalance is a problem not only for women. Men and children can be affected as well, leading to various health conditions including thyroid problems, early puberty in girls, the feminization of boys, poor sleep, weight gain, and higher cancer risk.

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Show Notes:

Post-menopausal women and progesterone study

Dr. John Lee

Dr. Christianne Northrup Wisdom of Menopause book

Sleep Interrupted

Thyroid health podcast

The Top 7 Toxins to Avoid for Better Sleep and Health podcast

Why Zebras Don’t Get Ulcers book by Dr. Robert Sapolsky

Possible autism due to too much estrogen during pregnancy

Sicker Fatter Poorer book podcast

Estrogen enhances growth of cancer cells

Estrogen, obesity, and cancer

Increased estrogen in obese men

Estrogen and breast cancer risk 

Vitamin D Chart

Checklist:

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from Doctor Steven Y. Park, MD | New York, NY | Integrative Solutions for Obstructive Sleep Apnea, Upper Airway Resistance Syndrome, and SnoringBlog – Doctor Steven Y. Park, MD | New York, NY | Integrative Solutions for Obstructive Sleep Apnea, Upper Airway Resistance Syndrome, and Snoring https://doctorstevenpark.com/estrogen?utm_source=rss&utm_medium=rss&utm_campaign=estrogen…

A Tongue Pacemaker for Sleep Apnea: High Tech Hope or Hype?

Originally at: https://doctorstevenpark.com/a-tongue-pacemaker-for-sleep-apnea-high-tech-hope-or-hype?utm_source=rss&utm_medium=rss&utm_campaign=a-tongue-pacemaker-for-sleep-apnea-high-tech-hope-or-hype

Every few years, a revolutionary way of treating OSA comes out. Nineteen eighty (1981) was a pivotal year in sleep medicine when Dr. Colin Sullivan reported reversing a vacuum cleaner motor to provide positive pressure through a makeshift mask to treat severe obstructive sleep apnea. Dr. Shiro Fujita also described a palatal operation to treat obstructive sleep apnea in 1981. Later on, oral appliances were also introduced. Over the years, advances were made with positive air pressure as well as with multi-level soft tissue and jaw procedures.

In 2014, the Inspire hypoglossal nerve stimulation procedure received FDA approval for patients in the United States. In their pivotal trial with results published in the New England Journal of Medicine in 2014, they reported a 68% drop in the average apnea hypopnea index (AHI), 70% drop in the oxygen desaturation index (ODI), and with an overall “response” rate of 66% (more than 50% drop in the AHI and less than 20).

Having been involved years prior with similar technology through another company called Apnex, I was pleased to see that this technology had progressed to the point of being available to the general public. Due to the volatile nature of medical high-tech start-up companies, I was cautiously waiting to see how they would do and see what the results would show in the real world on a long term basis. In 2018, a  group of surgeons performing this procedure published their 5 year outcomes. One hundred and twenty six patients were followed for 5 years, and 97 were included in the study, with 71 available sleep studies. Comparing from baseline to 12, 36 and 60 months, improvements across all measurements remained stable. The pre-treatment AHI was 32, dropping to 15, 11 and 12, at 12, 36 and 60 months, respectively. The functional outcome of sleep questionnaire (FOSQ, a validated sleep quality of life tool) increased significantly from 14 to 17, 17 and 18. The Epworth Sleepiness Scale dropped from 11.6 to 7 at all follow-up periods. Now, this procedure is being performed at over 300 centers in the United States and more and more insurance carriers are covering it, usually after a preauthorization process.

Technically, the pacemaker is implanted under the skin beneath the right collarbone, as opposed to a heart pacemaker, which is implanted on the left side. It’s a similar sized container. A small incision is made under the right chin, and the nerve that supplies the tongue (hypoglossal nerve) is exposed. This technique is very similar to a common procedure we perform in our field to remove the submandibular gland for stones, infections, or cancer. …

Tripple Trouble: Sleep Problems Before, During, and After Pregnancy [Podcast 85]

Originally at: https://doctorstevenpark.com/pregnancy?utm_source=rss&utm_medium=rss&utm_campaign=pregnancy

In this episode, Kathy and I will be discussing the importance of good health during all phases of pregnancy: before, during and after. Discover the following helpful tips:

  • What to do even before you think about conceiving
  • What to look for if you’re having pregnancy complications
  • An important thing to prepare for just after your delivery
  • A major reason why you’re having trouble breastfeeding
  • What to do for post-partum depression.

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Shownotes:

50% lower sperm counts in men

Fertility problems and obstructive sleep apnea 

Gestational Diabetes and OSA 

Gestational high blood pressure and sleep apnea

Pre-eclampaia and OSA

Prematurity and risk of OSA 

Sleep Interrupted: A physician reveals the #1 reason why so many of us are sick and tired

Tongue Tied book interview with Dr. Richard Baxter

5 Best Korean Foods For Postpartum Recovery

Dr. Palmer and breast feeding podcast

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from Doctor Steven Y. Park, MD | New York, NY | Integrative Solutions for Obstructive Sleep Apnea, Upper Airway Resistance Syndrome, and SnoringBlog – Doctor Steven Y. Park, MD | New York, NY | Integrative Solutions for Obstructive Sleep Apnea, Upper Airway Resistance Syndrome, and Snoring https://doctorstevenpark.com/pregnancy?utm_source=rss&utm_medium=rss&utm_campaign=pregnancy…

5 Surprising Facts About Your Thyroid And Sleep [Podcast 84]

Originally at: https://doctorstevenpark.com/thyroid?utm_source=rss&utm_medium=rss&utm_campaign=thyroid thyroid disease

In this episode, Kathy and I will talk about thyroid diseases, a very common condition that’s not often addressed when you are seen for a sleep problem.

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Show Notes:

Hypothyroidism

Hyperthyroidism

Hashimotos thyroiditis

Graves disease

Autoimmune thyroiditis

The Thyroid Diet Revolution: Manage Your Master Gland of Metabolism for Lasting Weight Loss by Mary Shomon

Sleep Interrupted: A physician reveals the #1 reason why so many of us are sick and tired

Thyroid and interaction with sleep

Ideal thyroid labs

TSH less than 2

Free T4 top 25%

Free T3 top 25%

Reverse T3, low end

Anti-thyroid antibodies as low as possible

Thyroid binding globulin

Vitamin D > 50

Ferritin > 60

Thyroid friendly foods

Health organic foods

Iodine in seafood and salt, as well other various foods

Selenium to help thyroid function

Vitamin D health chart

Omega-3

Zinc

Copper

Vitamin B Complex

Magnesium

Iodine

Ashwagandha

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from Doctor Steven Y. Park, MD | New York, NY | Integrative Solutions for Obstructive Sleep Apnea, Upper Airway Resistance Syndrome, and SnoringBlog – Doctor Steven Y. Park, MD | New York, NY | Integrative Solutions for Obstructive Sleep Apnea, Upper Airway Resistance Syndrome, and Snoring https://doctorstevenpark.com/thyroid?utm_source=rss&utm_medium=rss&utm_campaign=thyroid…

How to Treat Your Sinusitis Without Medications [Podcast 83]

Originally at: https://doctorstevenpark.com/sinusitis?utm_source=rss&utm_medium=rss&utm_campaign=sinusitis

Sinus infections with pain and pressure are all-too-common this time of the year. Please join Kathy and me as we reveal:

  • Why your sinus infection may not be an infection al all
  • What many doctors (even ENTs) may miss when treating sinusitis
  • How to treat your sinus symptoms without using antibiotics
  • How sinus pain may be linked to anxiety
  • Alternative ways of treating your sinus condition.

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Shownotes:

Heal Your Headache by Dr. David Buchholz 

Sinus And Migraine Study

Sleep Interrupted: A physician reveals the #1 reason why so many of us are sick and tired 

Reflux and chronic sinusitis 

OSA and reflux

CPAP reduces reflux

Pepsin in middle ear

Pepsin and H. pylori in maxillary sinus

Pepsin and lungs

Macrolide antibiotics and anti-inflammatory properties

Biaxin and chronic sinusitis in Japanese study

DISE in AHI < 5 study

Anxiety podcast

Why Zebras Don’t Get Ulcers by Dr. Robert Sapolsky 

Unstuff your stuffy nose free report 

Acupuncture studies

Myofunctional therapy studies

Janet Bennet of ijustwanttosleep.com

 

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from Doctor Steven Y. Park, MD | New York, NY | Integrative Solutions for Obstructive Sleep Apnea, Upper Airway Resistance Syndrome, and SnoringBlog – Doctor Steven Y. Park, MD | New York, NY | Integrative Solutions for Obstructive Sleep Apnea, Upper Airway Resistance Syndrome, and Snoring https://doctorstevenpark.com/sinusitis?utm_source=rss&utm_medium=rss&utm_campaign=sinusitis…

The Gut Biome and How It Can Affect Your Sleep & Weight [Podcast 82]

Originally at: https://doctorstevenpark.com/gutbiome?utm_source=rss&utm_medium=rss&utm_campaign=gutbiome

In this age of fecal transplants, the gut biome is a popular topic that everyone is talking about. What is the gut biome and how is it related to your sleep quality? How can the bacteria in your gut prevent you from losing weight? 

Please join Kathy and me as we answer the above questions and more.

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Show Notes:

What is the gut biome?

How sleep affects the gut biome (good review article on Huffington Post)

Another article on sleep loss and gut bacteria

How stress affects the gut biome

Sleep Interrupted: A physician reveals the #1 reason why so many of us are sick and tired 

Melatonin/circadian rhythm and gut biome

How excessive exercise negatively affects the gut

Gut biome and insomnia and circadian disorders

Gut dysbiosis and Vitamin D

Glyphosate as an antibiotic

Glyphosate graph

Glyphosate affects Vitamin D conversion in liver by p450 enzyme

Antibiotics in young children linked with higher rate of obesity

Vaginal delivery vs. C-section gut bacteria

Breast fed vs. bottle gut biome

14 Steps

Reduce stress

Cut out children’s activities

Animal proteins are important 

7 hours of sleep

Eat high fiber foods – pre-biotics 

Timing of meals: Eat every 4 hours or intermittent fasting

Avoid fad diets

5 Korean foods to help you quit sugar

Avoid MSG

Minimize antibiotics

Eat healthy 

Probiotics / Fermented foods

Sweat every day

Eat dirt

Avoid processed foods

Dr. Mark Hyman:

Eat whole unrefined foods

Majority vegetable/plant based foods

Good fats

Supplement smartly

Add more coconut to diet

Remove inflammatory fat

Add fiber rich foods

Eat fermented foods

Call to action: Focus on your poop.

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7 Unexpected Reasons for Your Anxiety [Podcast 81]

Originally at: https://doctorstevenpark.com/anxiety-2?utm_source=rss&utm_medium=rss&utm_campaign=anxiety-2 Stressed anxious woman

During this holiday season, are you anxious or stressed? Please join Kathy and me as we reveal 7 Unexpected Reasons for Your Anxiety.

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  1. Sleep deprivation for any reason (quantity or quality)
  2. Food as stimulants (artificial sweeteners, caffeine, aspartame, MSG, etc.)
  3. Weather changes
  4. Lack of sunlight
  5. Normal hormonal fluctuations
  6. Media overconsumption/addiction, and over-scheduling
  7. Poor nasal breathing.

Shownotes:

Sleep Interrupted: A physician reveals the #1 reason why so many of us are sick and tired 

Aspartame and sugar cravings in mice

Artificial sweeteners and weight gain

5 Ways to Sleep Better and Lose Weight Using Light podcast

Pro-gest bio-identical progesterone cream

Nitric oxide and increased oxygen uptake in lungs

Relaxing breath: Dr. Andrew Weil

How to unstuff your stuffy nose ebook

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How to Get Your Whole Family Sleeping Better – Part 2 [Podcast 80]

Originally at: https://doctorstevenpark.com/sleepingfamily2?utm_source=rss&utm_medium=rss&utm_campaign=sleepingfamily2

Please join me as we continue our important discussion on how you can get your entire family sleeping better. Whether you have young children or are single, young or old, the concepts presented will significantly increase your chances of feeling better, thinking clearer, and have a much calmer and controlled household.

Listen to this podcast to find out how you have a chance to receive for free the audio version of my book, Sleep Interrupted (worth $15).

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Show Notes:

7 year olds with lack of sleep   more problems with reasoning, emotional control and behavior problems.

Peak: Secrets from the New Science of Expertise. Original 10,000 hours study

Solve Your Child’s Sleep Problems by Dr. Richard Ferber

12 Rules for Life by Jordan Peterson

Essential Oils link (Kathy gets a small commission)

Grain Brain: The Surprising Truth about Wheat, Carbs, and Sugar—Your Brain’s Silent Killers

Sleep Interrupted: A physician reveals the #1 reason why so many of us are sick and tired

Branch Basics natural cleaning formula blog post with discount code (Kathy gets a small commission).

Appliance therapy options podcasts (Homeoblock, ALF, DNA, Mandibular Advancement Devices

Outline:

  1. Limit screen time
  2. Do inventory of light exposure
  3. Address possible sleep apnea
  4. Uncluttered, pleasing, calming bedroom
  5. Dust/allergy-free bedroom
  6. Consider essential oils
  7. Regular scheduled rest
  8. Don’t over-schedule your activities
  9. Schedule free time regularly
  10. Eat healthy meals and snacks
  11. Eat meals together as a family
  12. Consider vitamins and supplements
  13. Toxin-free living (chlorine filter, fluoride filter, cleaning supplies, personal care products, natural materials, etc.)
  14. See a professional (ENT, sleep, dentist, allergist, acupuncturist, myofunctional therapist, naturopath)
  15. Weight loss

The post How to Get Your Whole Family Sleeping Better – Part 2 [Podcast 80] appeared first on Doctor Steven Y. Park, MD | New York, NY | Integrative Solutions for Obstructive Sleep Apnea, Upper Airway Resistance Syndrome, and Snoring.

from Doctor Steven Y. Park, MD | New York, NY | Integrative Solutions for Obstructive Sleep Apnea, Upper Airway Resistance Syndrome, and SnoringBlog – Doctor Steven Y. Park, MD | New York, NY | Integrative Solutions for Obstructive Sleep Apnea, Upper Airway Resistance Syndrome, and Snoring https://doctorstevenpark.com/sleepingfamily2?utm_source=rss&utm_medium=rss&utm_campaign=sleepingfamily2…