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  • The Effects of Sleep Deprivation on Your Body

    Original Post | Healthline May 15 2020

    The following is a fantastic article describing the effects of sleep deprivation on your body, broken down by system. Medically reviewed by Stacy Sampson, D.O., Family Medicine — Written by Stephanie Watson and Kristeen Cherney on May 15, 2020


    If you’ve ever spent a night tossing and turning, you already know how you’ll feel the next day — tired, cranky, and out of sorts. But missing out on the recommended 7 to 9 hours of shut-eye nightly does more than make you feel groggy and grumpy.

    The long-term effects of sleep deprivation are real.

    It drains your mental abilities and puts your physical health at real risk. Science has linked poor slumber with a number of health problems, from weight gain to a weakened immune system.

    Read on to learn the causes of sleep deprivation and exactly how it affects specific body functions and systems.

    Causes of sleep deprivation

    In a nutshell, sleep deprivation is caused by consistent lack of sleep or reduced quality of sleep. Getting less than 7 hours of sleep on a regular basis can eventually lead to health consequences that affect your entire body. This may also be caused by an underlying sleep disorder.

    Your body needs sleep, just as it needs air and food to function at its best. During sleep, your body heals itself and restores its chemical balance. Your brain forges new thought connections and helps memory retention.

    Without enough sleep, your brain and body systems won’t function normally. It can also dramatically lower your quality of life.

    review of studies in 2010Trusted Source found that sleeping too little at night increases the risk of early death.

    Noticeable signs of sleep deprivation include:

    Stimulants, such as caffeine, aren’t enough to override your body’s profound need for sleep. In fact, these can make sleep deprivation worse by making it harder to fall asleep at night.

    This, in turn, may lead to a cycle of nighttime insomnia followed by daytime caffeine consumption to combat the tiredness caused by the lost hours of shut-eye.

    Behind the scenes, chronic sleep deprivation can interfere with your body’s internal systems and cause more than just the initial signs and symptoms listed above.

    Central nervous system

    Your central nervous system is the main information highway of your body. Sleep is necessary to keep it functioning properly, but chronic insomnia can disrupt how your body usually sends and processes information.

    During sleep, pathways form between nerve cells (neurons) in your brain that help you remember new information you’ve learned. Sleep deprivation leaves your brain exhausted, so it can’t perform its duties as well.

    You may also find it more difficult to concentrate or learn new things. The signals your body sends may also be delayed, decreasing your coordination and increasing your risk for accidents.

    Sleep deprivation also negatively affects your mental abilities and emotional state. You may feel more impatient or prone to mood swings. It can also compromise decision-making processes and creativity.

    If sleep deprivation continues long enough, you could start having hallucinations — seeing or hearing things that aren’t really there. A lack of sleep can also trigger mania in people who have bipolar mood disorder. Other psychological risks include:

    You may also end up experiencing microsleep during the day. During these episodes, you’ll fall asleep for a few to several seconds without realizing it.

    Microsleep is out of your control and can be extremely dangerous if you’re driving. It can also make you more prone to injury if you operate heavy machinery at work and have a microsleep episode.

    Immune system

    While you sleep, your immune system produces protective, infection-fighting substances like antibodies and cytokines. It uses these substances to combat foreign invaders such as bacteria and viruses.

    Certain cytokines also help you to sleep, giving your immune system more efficiency to defend your body against illness.

    Sleep deprivation prevents your immune system from building up its forces. If you don’t get enough sleep, your body may not be able to fend off invaders, and it may also take you longer to recover from illness.

    Long-term sleep deprivation also increases your risk for chronic conditions, such as diabetes mellitus and heart disease.powered by Rubicon Project

    Respiratory system

    The relationship between sleep and the respiratory system goes both ways. A nighttime breathing disorder called obstructive sleep apnea (OSA) can interrupt your sleep and lower sleep quality.

    As you wake up throughout the night, this can cause sleep deprivation, which leaves you more vulnerable to respiratory infections like the common cold and flu. Sleep deprivation can also make existing respiratory diseases worse, such as chronic lung illness.

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    Digestive system

    Along with eating too much and not exercising, sleep deprivation is another risk factor for becoming overweight and obese. Sleep affects the levels of two hormones, leptin and ghrelin, which control feelings of hunger and fullness.

    Leptin tells your brain that you’ve had enough to eat. Without enough sleep, your brain reduces leptin and raises ghrelin, which is an appetite stimulant. The flux of these hormones could explain nighttime snacking or why someone may overeat later in the night.

    A lack of sleep can also make you feel too tired to exercise. Over time, reduced physical activity can make you gain weight because you’re not burning enough calories and not building muscle mass.

    Sleep deprivation also causes your body to release less insulin after you eat. Insulin helps to reduce your blood sugar (glucose) level.

    Sleep deprivation also lowers the body’s tolerance for glucose and is associated with insulin resistance. These disruptions can lead to diabetes mellitus and obesity.

    Cardiovascular system

    Sleep affects processes that keep your heart and blood vessels healthy, including those that affect your blood sugar, blood pressure, and inflammation levels. It also plays a vital role in your body’s ability to heal and repair the blood vessels and heart.

    People who don’t sleep enough are more likely to get cardiovascular disease. One analysis linked insomnia to an increased risk of heart attack and stroke.

    Endocrine system

    Hormone production is dependent on your sleep. For testosterone production, you need at least 3 hours of uninterrupted sleep, which is about the time of your first R.E.M. episode. Waking up throughout the night could affect hormone production.

    This interruption can also affect growth hormone production, especially in children and adolescents. These hormones help the body build muscle mass and repair cells and tissues, in addition to other growth functions.

    The pituitary gland releases growth hormone throughout each day, but adequate sleep and exercise also help the release of this hormone.

    Treatment for sleep deprivation

    The most basic form of sleep deprivation treatment is getting an adequate amount of sleep, typically 7 to 9 hours each night.

    This is often easier said than done, especially if you’ve been deprived of precious shut-eye for several weeks or longer. After this point, you may need help from your doctor or a sleep specialist who, if needed, can diagnose and treat a possible sleep disorder.

    Sleep disorders may make it difficult to get quality sleep at night. They may also increase your risk for the above effects of sleep deprivation on the body.

    The following are some of the most common types of sleep disorders:

    To diagnose these conditions, your doctor may order a sleep study. This is traditionally conducted at a formal sleep center, but now there are options to measure your sleep quality at home, too.

    If you’re diagnosed with a sleep disorder, you may be given medication or a device to keep your airway open at night (in the case of obstructive sleep apnea) to help combat the disorder so you can get a better night’s sleep on a regular basis.

    Prevention

    The best way to prevent sleep deprivation is to make sure you get adequate sleep. Follow the recommended guidelines for your age group, which is 7 to 9 hours for most adults ages 18 to 64.

    Other ways you can get back on track with a healthy sleep schedule include:

    • limiting daytime naps (or avoiding them altogether)
    • refraining from caffeine past noon or at least a few hours prior to bedtime
    • going to bed at the same time each night
    • waking up at the same time every morning
    • sticking to your bedtime schedule during weekends and holidays
    • spending an hour before bed doing relaxing activities, such as reading, meditating, or taking a bath
    • avoiding heavy meals within a few hours before bedtime
    • refraining from using electronic devices right before bed
    • exercising regularly, but not in the evening hours close to bedtime
    • reducing alcohol intake

    If you continue to have problems sleeping at night and are fighting daytime fatigue, talk to your doctor. They can test for underlying health conditions that might be getting in the way of your sleep schedule.

  • Addressing Sleep Could Help Women Avoid Weight Gain During Menopause

    Original Article | Posted by Sree Roy | Apr 1, 2021

    Addressing sleep symptoms during menopause may reduce susceptibility to weight gain, according to a small study presented virtually at ENDO 2021, the Endocrine Society’s annual meeting.

    “Our findings suggest that not only estrogen withdrawal but also sleep disturbances during menopause may contribute to changes in a woman’s body that could predispose midlife women to weight gain,” says lead researcher Leilah Grant, PhD, of Brigham and Women’s Hospital in Boston, Mass, in a release. “Helping women sleep better during menopause may therefore reduce the chances a woman will gain weight, which in turn will lower her risk of diabetes and other related diseases.”

    Woman Battling Weight Issues from Lack Of Sleep

    Rates of obesity increase in women around the age of menopause. Menopause-related weight gain is often thought to be caused by the withdrawal of the female hormone estrogen. Estrogen is unlikely to be the only contributing factor, however, since all women stop producing estrogen in menopause while only about half of women gain weight, Grant says. Another common symptom, also affecting around half of women during menopause, is sleep disturbance, which has independently been linked to changes in metabolism that might increase the risk of weight gain.

    [RELATED: Insomnia Symptoms Worsen Throughout Menopause Transition]

    To better understand the role of sleep disturbances and hormonal changes in menopausal weight gain, the researchers studied 21 healthy premenopausal women.

    They used an experimental model simulating the sleep disturbance experienced in menopause to examine the effects of poor sleep on the body’s use of fat.

    Participants had two nights of uninterrupted sleep followed by three nights of interrupted sleep, where they were woken by an alarm every 15 minutes for 2 minutes each time. The researchers then restudied a subset of nine participants in the same sleep interruption protocol after they were given a drug called leuprolide, which temporarily suppressed estrogen to levels similar to menopause.

    Compared to a normal night of sleep, after three nights of disturbed sleep there was a significant reduction in the rate at which the women’s bodies used fat. A similar reduction in fat utilization was also seen when estrogen was suppressed, even during normal sleep. The combination of low estrogen and sleep disturbance also reduced fat utilization, but the effect was not larger than either exposure on their own.

    “In addition to estrogen withdrawal, sleep disturbances decrease fat utilization,” Grant says. “This may increase the likelihood of fat storage and subsequent weight gain during menopause.”

    If you are struggling with any sleep issues as a result of a diagnosis of sleep apnea, please contact us today for a consultation. We can help ensure better nights for better days!

  • Beta-blockers May Contribute to Sleep Disturbances

    We do not wish to infer that anyone should stop beta blocker use, but just explain why the use of beta blockers may interrupt with the treatment of insomnia.

    Posted by Sleep Review Staff | Mar 16, 2021 

    Beta Blocker and Sleep Disturbance

    Unusual dreams, insomnia and sleep disorders may be linked to beta-blockers, according to new research published in Hypertension, an American Heart Association journal.

    Beta-blockers are a class of medications that reduce the heart rate, the heart’s workload and the heart’s output of blood, which, together, lower blood pressure. They are a common treatment for cardiovascular diseases, including heart failure, arrhythmias, chest pains and high blood pressure. Researchers have suspected beta-blockers of having negative psychological side effects, including depression, anxiety, drowsiness, insomnia, hallucinations and nightmares.

    “The possible mental health side effects of beta-blockers have been the subject of discussion in the scientific community for many decades,” Reinhold Kreutz, MD, PhD, a professor at the Berlin Institute of Health, Institute of Clinical Pharmacology and Toxicology and the study’s supervising and corresponding author, says in a statement.

    The researchers analyzed data for more than 50,000 individuals from 258 studies including beta-blockers in double-blind, randomized controlled trials. Nearly 70% of the studies were clinical trials focused on high blood pressure treatment, and 31 assessed depression in placebo-controlled trials.

    Results from the comprehensive analysis also revealed that despite being the most frequently reported mental health side effect, depression did not occur more frequently during beta-blocker treatment compared to placebo treatment. And the rate of discontinuing medication use due to depression was not any different for those taking beta-blockers compared to those on other treatments.

    “Our results indicate that concerns about adverse mental health events, especially depression, should not affect the decision about beta blockers. Beta-blockers are mostly safe regarding psychological health,” said Kreutz. “We found no indication of an association between beta-blocker use and depression. The same was true for most of the other mental health symptoms, as reported in the studies that were included in our analyses. However, sleep-related symptoms such as unusual dreams or insomnia did emerge during beta-blocker therapy for some patients.”

  • The Sleep-Gut Connection

    Original Article | Posted Jan 08, 2016, Authored by Michael J Breus, MD

    What is Sleep Gut?

    There’s a lot of discussion these days about sleep gut health—how a healthy gut can support overall health, and the ways a compromised gut may contribute to illness and disease. We’re learning more about the complexity of the vast, dense, microbial world of the human gut and its influence over immune health, hormone balance, brain function, and mental and physical equilibrium. What relationship exists between sleep and this microbial ecosystem within the body? Emerging science demonstrates that there is a very real and dynamic connection between the microbiome and sleep itself.

    Sleep Gut
    Sleep Gut from over eating.

    What is the Microbiome?

    The term microbiome can mean a couple of different things. It is sometimes used to describe the collection of all microbes in a particular community. In scientific terms, the microbiome can also refer to the genes belonging to all the microbes living in a community. The microbiome is often seen as a genetic counterpart to the human genome.  

    The genes that make up a person’s microbiome are far more numerous than human genes themselves—there are roughly 100 times more genes in the human microbiome than in the human genome. This makes sense when you consider that there are somewhere in the neighborhood of 100 trillion microbes living in (and on) each of us—a combination of many different types, including bacteria, fungi, viruses, and other tiny organisms.

    This vast array of microbial life lives on our skin and throughout the body. The largest single collection of microbes resides in the intestine—hence the attention to “gut” health. Here, trillions of microscopic organisms live and die—and appear to exert a profound effect on human health.

    The Microbiome and Sleep

    The human microbiota is a complicated, dynamic ecosystem within the body. It appears to interact in some important ways with another fundamental aspect of living—sleep. As with much about the microbiome, there is a tremendous amount we don’t know about this interaction. That said, there are some fascinating possible connections and shared influences. Scientists investigating the relationship between sleep and the microbiome are finding that this ecosystem may affect sleep and sleep-related physiological functions in a number of ways—shifting circadian rhythms, altering the body’s sleep-wake cycle, and affecting hormones that regulate sleep and wakefulness. Our sleep, in turn, may affect the health and diversity of the human microbiome.

    The microbial life within our bodies is in perpetual flux, with microbes constantly being generated and dying. Some of this decay and renewal naturally occurs during sleep. There’s no answer yet, however, to the important question: What role does sleep itself play in maintaining the health of the microbial world inside us, and which appears to contribute so significantly to our health?

    There are some important signs of a significant connection: We’ve seen research demonstrating that circadian rhythm disruptions can have negative effects on gut microbiota. (More on this shortly.) There’s also evidence that the disordered breathing associated with obstructive sleep apnea (OSA), a common sleep disorder, may disrupt the health of the microbiome. Scientists put mice through a pattern of disrupted breathing that mimicked the effects of OSA, and found that the mice that lived with periods of OSA-like breathing for six weeks showed significant changes to the diversity and makeup of their microbiota.article continues after advertisement

    Sleep and the Gut-Brain Connection

    A significant, fast-growing body of research illustrates the far-reaching effects of the microbiome over brain function and brain health—as well as the influence of the brain over gut health and the microbiome. This “gut-brain axis” appears likely to have a profound influence over nearly every aspect of human health and physiological function, including sleep.

    The constant communication and interplay between the gut and the brain has the potential to influence and intersect with sleep directly and indirectly. Let’s take a closer look at the ways that might occur:

    Mood. Studies indicate that the health and balance of the gut microbiota has a significant influence over our mood and emotional equilibrium. Disruptions and an imbalance of gut microbes have been strongly connected to anxiety and depression. This has potentially significant implications for sleep, as both anxiety and depression can trigger or exacerbate sleep disruptions.

    Stress. Research is also revealing a complicated, two-way relationship between stress and gut health that also may exert influence over sleep and sleep architecture. Stress is an extremely common obstacle to healthy, sufficient sleep.

    Pain. Studies link gut health to pain perception, specifically for visceral pain. An unhealthy microbiome appears to increase sensitivity to this form of pain. Like so many others, this connection travels the communication pathway between the gut and the brain. The connection between sleep and physical pain or discomfort is significant—the presence of pain can make falling asleep and staying asleep much more difficult.

    Hormones. Several hormones and neurotransmitters that play important roles in sleep also have significant influence over gut health and function. The intestinal microbiome produces and releases many of the same neurotransmittersdopamine, serotonin, and GABA among them—that help to regulate mood, and also help to promote sleep.

    • Melatonin, the “darkness hormone” essential to sleep and a healthy sleep-wake cycle, also contributes to maintaining gut health. Deficiencies in melatonin have been linked to increased permeability of the gut—the so-called “leaky gut” increasingly associated with a range of diseases. Melatonin is produced in the gut as well as the brain, and evidence suggests that intestinal melatonin may operate on a different cyclical rhythm than the pineal melatonin generated in the brain.
    • Cortisol is another hormone critical to the human sleep-wake cycle. Rising levels of the hormone very early in the day help to promote alertness, focus, and energy. Cortisol levels are influenced in several ways within the gut-brain axis: The hormone is central to the stress and inflammatory response and also exerts an effect on gut permeability and microbial diversity. The changes to cortisol that occur amid the interplay of the gut and brain are likely to have an effect on sleep.

    “Circadian Rhythms” of the Gut?

    There is some pretty fascinating research connecting the gut microbiome to circadian rhythms, the 24-hour biological rhythms that regulate our sleep and wake cycles, in addition to many other important physiological processes. A growing number of studies now suggest that the vast and diverse microbial ecosystem of the gut has its own daily rhythms. These microbiome rhythms appear to be deeply entwined with circadian rhythms—research suggests that both circadian and microbial rhythms are capable of influencing and disrupting the other, with consequences for health and sleep.

    The rhythms of gut microbes are affected by diet, both the timing of our eating and the composition of the foods we consume. A recent study found that mice eating a healthy diet generated more beneficial gut microbes, and that the collective activity of microbial life in the gut followed a daily—or diurnal—rhythm. That rhythm, in turn, supported circadian rhythms in the animal. Mice fed a high-fat, stereotypically “Western” diet, on the other hand, produced less optimal microbial life. The gut microbes of these mice did not adhere to a daily rhythm themselves, and also sent signals that disrupted circadian rhythms. These mice gained weight and became obese, while the mice that ate healthfully did not.

    Scientists bred a third group of mice without any gut microbes at all. These mice had no signals to send from a gut microbiome. Circadian disruption occurred in these mice—but they did not gain weight or suffer metabolic disruption, even when fed the high-fat diet. This suggests a couple of important conclusions. First, that microbial activity is key to normal circadian function—and therefore to sleep. Second, that the microbiome is a key player along with diet in the regulation of weight and metabolism.

    Circadian Rhythms and Microbiome: A Two-Way Street

    Research in humans has returned similar results: The human microbiome appears to follow daily rhythms influenced by timing of eating and the types of foods consumed and to exert effects over circadian rhythms. Research has also found that the relationship between these different biological rhythms works both ways. Scientists have discovered that disruptions to circadian rhythms—the kind that occurs through jet lag, whether through actual travel or from “social” jet lag—disrupts microbial rhythms and the health of the microbial ecosystem. People who experience these changes to microbial rhythms as a result of circadian disruption suffer metabolic imbalance, glucose intolerance, and weight gain, according to research. And there’s preliminary evidence suggesting that gender may play some role in the relationship of gut microbial health, metabolism, and circadian function: a study using mice found that females had more pronounced microbiome rhythms than males.

    New Understanding of Circadian Role in Metabolism?

    We’ve known for some time about the relationship between sleep, circadian rhythms, and metabolic health. Disrupted sleep and misaligned circadian rhythms have been strongly tied to higher rates of obesity and to metabolic disorders including Type 2 diabetes. Our emerging knowledge of the microbiome and its relationship to circadian function may in time deliver a deeper understanding of how health is influenced by sleep and circadian activity.

    Science has really only just begun to delve into the world of the microbiome and its relationship to sleep as well as health more broadly. All the early signs suggest that this is a profoundly important area of research; it will be fascinating to see where this takes us, and what it means for sleep.

  • Why Nasal Breathing Is Best

    Posted by Sree Roy | Apr 5, 2019 | Mouth & Upper AirwayObstructive Sleep Apnea in Sleep Review Magazine

    Doctor examining nasal cavity to discover cause for mouth breathing.

    Nasal breathing is how our bodies are intended to breathe.

    By Brian D. Robertson, MD

    Sometimes we do not think about a disease until it becomes overwhelming. This is especially true when the symptoms are relatively mild, have an unclear origin, or a very gradual onset. Obstructive sleep apnea (OSA) is a good example of this sort of disease; people will often live with OSA symptoms for years before seeking medical attention.

    It is important to identify risk factors for diseases like OSA; some will be causal factors, and they may be crucial to effective treatments and even cures. Obesity is probably the most well-known OSA risk factor, but others clearly exist, such as hypertension and smoking.

    Sleep physicians can identify and correct mouth breathing in their patients.

    Less well recognized is how nasal obstruction is a risk factor for OSA. And unlike other contributors to OSA, nasal obstruction is often amenable to treatment. Even when not contributing to OSA, nasal congestion can worsen subjective sleep quality in our patients. What’s more, nasal obstruction can be a major challenge for the treatment of OSA, so it is important to recognize and manage it in all sleep-disordered breathing patients.

    In this article, I will discuss nasal obstruction as a risk factor for OSA, as a barrier to the treatment of OSA, and how sleep medicine specialists can best address it for OSA patients. By treating our patients’ nasal obstruction, we can improve their sleep, adherence to positive airway pressure (PAP) therapy, and improve their quality of life.

    Why Nasal Congestion Is Important

    The nose performs several functions during breathing. It humidifies and warms the air and filters out large particles—protecting the lower airway. While we are all capable of oral breathing, the oral mucosa is not capable of an adequate amount of humidification. In fact, an easy way to determine if someone is mouth breathing in their sleep is to ask if their mouth is dry in the morning or if they need water at their bedside.

    For patients with obstructive sleep apnea, especially those using positive airway pressure devices, nasal breathing is crucial. If there is complete or near-complete nasal obstruction, patients on PAP will be forced to breathe through their mouths. Because of the intentional leak design of PAP masks, the high amount of air flow around the open mouth leads to severe and uncomfortable dry mouth. Simply put, even with full face masks, most, if not all, patients will need to breathe through their noses to use PAP therapy comfortably.

    In a large cohort study done by Young et al, nasal congestion was strongly associated with snoring, restless sleep, and excessive daytime sleepiness.1 The study also found that patients who had allergic rhinitis-related nasal congestion were 1.8 times more likely to have moderate to severe OSA than those without nasal congestion due to an allergy. The Pediatric Allergies in America survey in 2009 found that snoring was 2.8 times more likely in children with chronic rhinitis. Forty percent of parents of children with allergic rhinitis reported some sleep disruption compared with 7% without allergic rhinitis.2 Clearly, nasal congestion is detrimental to sleep and is of importance to sleep medicine.

    Nasal breathing is preferred over oral breathing for several reasons. With oral breathing, as the mouth opens, the jaw moves inferiorly and posteriorly. This positions the tongue closer to the posterior pharyngeal wall and narrows the airway significantly. Also, this leads to changes in the muscle fiber length-tension relationship of the genioglossus muscle, which effectively decreases its muscle tone and makes the upper airway more prone to collapse.

    In children, chronic mouth breathing leads to changes in the patterns of muscle activation in the facial muscles and to caudal growth of the maxilla and the appearance of a high-arched palate. Chronic mouth breathing often leads to bite abnormalities including underbite and cross bite.

    Oral breathing bypasses the nasal ventilation reflex, a reflex activation of the genioglossus muscle with nasal breathing that increases respiratory rate and minute ventilation in healthy people and which can be attenuated by anesthetizing the nose.3 Whereas breathing through the nose increases the minute ventilation and tidal volume.

    What’s more, nitric oxide, produced in the nose, acts as an aero transmitter to the lower airways and causes increased airway dilation. Its role in normal breathing is still being elucidated. For all of these reasons, upper airway resistance increases with oral breathing, has adverse effects on sleep, and causes dental problems in children. This is why nasal breathing is greatly preferred.4

    Physical Exam

    Because patients and their families are sometimes unaware that chronic mouth breathing is a problem—or that it can be corrected, sleep medicine physicians can easily do their patients a great service by doing a quick physical exam of the nose and face. A penlight is the only equipment needed.

    Become familiar with the “adenoidal facies”; in children in particular, this appearance is due to chronic mouth breathing. The movie character Napoleon Dynamite is an excellent example of the adenoidal face. Look for a slightly hyperpigmented line—known as the nasal crease—across the nose due to chronic wiping. Dark circles under the eyes from vasocongestion of the venous pools in the face, and Dennie lines on the lower eyelid can be seen in patients with chronic rhinitis.

    Pay attention to the shape of the nose. A crooked nose often indicates nasal septal deviation; a wide nose can indicate nasal turbinate hypertrophy. Narrow slit-like nares are often seen in nasal valve collapse. Ask the patient to inhale sharply through their nose and look for collapse of the nares.

    When you examine the oropharynx, ask the patient to look up and examine the hard palate. A high-arched palate and/or triangular maxillary arch is often seen in patients with chronic nasal congestion currently or in childhood.

    Treatments for Nasal Obstruction to promote nasal breathing

    For patients with a structural abnormality like nasal septal deviation, surgical treatment is often the best approach. For nasal valve collapse, surgery is the definitive treatment, but it is also amenable to a variety of devices designed to support the nasal alar cartilage, like Breathe Right strips.

    If inflammation is the cause of the nasal obstruction, patients should be treated with one or more medications. The mainstay of treatment, and the one with the most supporting evidence, are nasal steroidsNasal steroids have been shown to decrease the apnea-hypopnea index in both adults and children and decrease mouth breathing.5-7 Leukotriene antagonists have also been shown to improve the symptoms of allergic rhinitis, and for these patients, it can be helpful. Antihistamines, both oral and nasal, may be helpful for rhinorrhea. Anticholinergic nasal sprays can also be helpful for some patients.

    Alpha-agonists are often sold without a prescription in the United States and can be very helpful for periodic nasal congestion. Oxymetazoline is a commonly used alpha-agonist spray that decreases nasal congestion in a dramatic fashion. Because frequent use can lead to increasing dependence on this medication to control nasal congestion and rhinorrhea (a condition called rhinitis medicamentosa), care should be taken with its use. Oral pseudoephedrine can also be effective and is sometimes combined with antihistamines to control rhinorrhea. Alpha-agonists are generally intended for short-term use, and clinicians should consider the possibility of worsening hypertension as a side effect of their use.

    For patients on CPAP, consider the possibility of growth of molds in the humidification chamber, which can cause nasal inflammation. Simply cleaning the chamber regularly can sometimes resolve this.

    Conclusion

    Nasal breathing is critical to a good night’s sleep for all patients. Compared with oral breathing, nasal breathing decreases snoring and excessive daytime sleepiness. For patients with OSA, correcting chronic nasal obstruction due to structural or inflammatory problems is critical to use of PAP therapy and oral appliances. Chronic mouth breathing in children changes the shape of children’s faces and can lead to dental problems. Addressing nasal obstruction will significantly improve the quality of life for your patients, and sleep medicine professionals can play a critical role in treating this problem.

    Brian Robertson MD

    Brian D. Robertson, MD, is chief of sleep medicine service at Walter Reed National Military Medical Center and a pediatrician, allergist, and sleep medicine specialist with the US Army.

    References
    1. Young T, Finn L, Kim H. Nasal obstruction as a risk factor for sleep-disordered breathing. The University of Wisconsin Sleep and Respiratory Research Group. J Allergy Clin Immunol. 1997 Feb;99(2):S757-62.
    2. Meltzer EO, Blaiss MS, Derebery MJ, et al. Burden of allergic rhinitis: results from the Pediatric Allergies in America survey. J Allergy Clin Immunol. 2009 Sep;124(3 Suppl):S43-70.
    3. White DP, Cadieux RJ, Lombard RM, et al. The effects of nasal anesthesia on breathing during sleep. Am Rev Respir Dis. 1985 Nov;132(5):972-5.
    4. Fitzpatrick MF, McLean H, Urton AM, et al. Effect of nasal or oral breathing route on upper airway resistance during sleep. Eur Respir J. 2003 Nov;22(5):827-32.
    5. Kiely JL, Nolan P, McNicholas WT. Intranasal corticosteroid therapy for obstructive sleep apnoea in patients with co-existing rhinitis. Thorax. 2004 Jan;59(1):50-5.
    6. McLean HA, Urton AM, Driver HS, et al. Effect of treating severe nasal obstruction on the severity of obstructive sleep apnoea. Eur Respir J. 2005 Mar;25(3):521-7.
    7. Brouillette RT, Manoukian JJ, Ducharme FM, et al. Efficacy of fluticasone nasal spray for pediatric obstructive sleep apnea. J Pediatr. 2001 Jun;138(6):838-44.

  • Tom Brady: Sleeping his way to the top

    His success demonstrates the power of a good night’s sleep. 

    By Michael Howell | JANUARY 31, 2021 — 6:00PM

    KAMIL KRZACZYNSKI • ASSOCIATED PRESS

    Tampa Bay Buccaneers quarterback Tom Brady has attributed his success to proper sleep.

    When the Tampa Bay Buccaneers take on the Kansas City Chiefs in Sunday’s Super Bowl, most fans will mistakenly equate great athletic ability with physical strength. Of course, a toned body is necessary for professional or Olympic athletes. But catching a football with one hand or landing a triple axel in figure skating are only the final, most visible, results of activity along a vast number of brain pathways.

    Walk into any fitness center and you will see the superficial appearances of fitness. But those neighborhood titans are not standing on an Olympic podium or making $20 million a year, because the defining trait of elite athletes is an elegant mind.

    A player like Minnesota’s own Antoine Winfield Jr. is unique because his visual and motor cortex processes information faster than his competitors’.

    Nearly all fans as well as countless coaches succumb to the bias that muscle mass can differentiate the great from the good. The annals of sports history are replete with examples of talent scouts who failed to recognize an athletic brain.

    In the spring of 2000, all 32 NFL teams passed at least five times on the quarterback who would become the GOAT (greatest of all time). Despite his high score on the Wonderlic test, an imperfect 12-minute examination of personality and cognition skills, scouts and general managers passed on Tom Brady until the New England Patriots picked him up in the sixth round of the draft, behind 198 other players.

    But over the ensuing two decades the Brady brain has powered a relentlessly successful career. His records, if they are ever broken, will not fall for at least a generation: most games won, six-time Super Bowl champion and four-time Super Bowl MVP. On Sunday, Brady will appear in his record 10th Super Bowl (second for QBs is John Elway with five).

    What has powered his success? Like other elite athletes such as LeBron James, Brady attributes his edge to sleeping better than the competition. “Proper sleep has helped me get to where I am today as an athlete and it is something I continue to rely on every day,” he says.

    The world’s fastest human, Usain Bolt, describes sleep as the most important part of his daily training regime and targets 8-10 hours a day with naps before races.

    Sleep refines our 100 billion neurons and prunes trillions of synaptic connections, helping us master complicated motor skills.

    Sarah Hughes was a struggling 16-year-old figure skater before she met Jim Maas, a sleep specialist at Cornell University. Following Maas’s advice, she began skipping morning practice and slept in, thus permitting her brain to solidify the motor pathways laid down in practice the day before.

    In 2002 at the Winter Olympics Hughes won the gold medal in figure skating, landing a record seven consecutive triple jumps.

    Despite these high-profile examples and reams of scientific studies demonstrating the role of sleep in athletic performance, young athletes are told to wake up early and train. Coaches send groggy players to the field and have them play through sleep deprivation as a futile demonstration of toughness. They might as well pick starters by seeing who can play the longest without drinking water.

    It would be better to consider restful sleep as an all-natural performance-enhancing drug. Growth hormone injections are not allowed by the World Anti-Doping Administration. No worries, your own growth hormone is naturally secreted during sleep; all you have to do is get more than your competition. Sleep doping!

    Not to mention that sleep boosts the immune system, promotes recovery from concussions and helps young and old minds alike manage stress, balance mood and keep anxiety at bay.

    So, if you are dreaming of athletic success, sleep in as long as you can tomorrow.

    Michael Howell is vice chair for education in the Department of Neurology at the University of Minnesota and co-founder of the Sleep Performance Institute.