• How Micriobiome Manipulation Impacts Sleep: A Study on Mice Adds to a Growing Body of Research

    Original Article | Posted by Sree Roy | Dec 3, 2020 | Sleep & the Body

    Researchers in mice led by Masashi Yanagisawa, MD, PhD, a professor at the University of Tsukuba in Japan, revealed the extent to which bacteria can change the environment and contents of the intestines, which ultimately impacts behaviors like sleep. The research is published in Scientific Reports.


    The experiment itself was fairly simple. The researchers gave a group of mice a powerful cocktail of antibiotics for four weeks, which depleted them of intestinal microorganisms. Then, they compared intestinal contents between these mice and control mice who had the same diet. Digestion breaks food down into bits and pieces called metabolites. The research team found significant differences between metabolites in the microbiota-depleted mice and the control mice. “We found more than 200 metabolite differences between mouse groups,” Yanagisawa says in a release. “About 60 normal metabolites were missing in the microbiota-depleted mice, and the others differed in the amount, some more and some less than in the control mice.”

    The team next set out to determine what these metabolites normally do. Using metabolome set enrichment analysis, they found that the biological pathways most affected by the antibiotic treatment were those involved in making neurotransmitters, the molecules that cells in the brain use to communicate with each other. For example, the tryptophan-serotonin pathway was almost totally shut down; the microbiota-depleted mice had more tryptophan than controls, but almost zero serotonin. This shows that without important gut microbes, the mice could not make any serotonin from the tryptophan they were eating. The team also found that the mice were deficient in vitamin B6 metabolites, which accelerate production of the neurotransmitters serotonin and dopamine.

    [RELATED: A Fecal Transplant Gave Healthy Mice Sleep Disturbances. Could Gut Microbiome Manipulation Treat Sleep Apnea?]

    The team also analyzed how the mice slept by looking at brain activity in EEGs. They found that compared with the control mice, the microbiota-depleted mice had more REM and non-REM sleep at night—when mice are supposed to be active—and less non-REM sleep during the day—when mice should be mostly sleeping. The number of REM sleep episodes was higher both during the day and at night, whereas the number of non-REM episodes was higher during the day. In other words, the microbiota-depleted mice switched between sleep/wake stages more frequently than the controls.

    Yanagisawa speculates that the lack of serotonin was responsible for the sleep abnormalities; however, the exact mechanism still needs to be worked out. “We found that microbe depletion eliminated serotonin in the gut, and we know that serotonin levels in the brain can affect sleep/wake cycles,” he says. “Thus, changing which microbes are in the gut by altering diet has the potential to help those who have trouble sleeping.”

    Illustration 99464470 © Xsviatx – Dreamstime.com

  • Benefits of Oral Appliance Therapy for Treatment of Sleep Apnea

    Oral Appliance Therapy – Benefits & Side Effects

    For mild to moderate sleep apnea, oral appliance therapy can be quite useful. The health and mental benefits from the treatment of sleep apnea are undeniable. Several of our patients have reported some of the following benefits and side effects from the use of an oral appliance.

    Benefits reported include:

    Ease of use – Many of our patients prefer oral appliances because they are easier to wear than a CPAP machine. CPAP users have reported several difficulties with the CPAP, (getting twisted in the tubes, the loud noise, ill-fitting mask, and more).

    Small and easy to transport – Traveling with your sleep apnea device is a lot simpler with an oral appliance. Unlike CPAP, oral appliances are small enough to fit in your purse or carry-on bag.

    Since oral appliances are designed to fit inside your mouth, they do not disrupt your movement while you sleep. You can lie in any position without the fear of getting entangled in your CPAP tubes.

    Improved relationships with loved ones who are enjoying a good night’s sleep sans tossing and snoring.

    Possible side effects

    Oral appliance therapy may cause some of the following side effects:

    • Excessive salivation
    • Dry mouth
    • Tooth and jaw discomfort
    • Temporary bite changes

    Some patients experience potential complications such as:

    • Jaw or tooth pain
    • Permanent changes to your bite
    • TMJ symptoms

    When weighing in on the benefits versus the side effects of oral appliance therapy, consider seeing a dental sleep medicine specialist. A dentist trained in dental sleep medicine can provide oral appliance therapy that is right for you. Call 617.964.4028 today and one of our knowledgeable staff members will be available to assist.

  • Are You A CPAP Dropout?

    Many of our clients come to us because of their intolerance to the CPAP machine. There is a multitude of reasons that people are unable to tolerate CPAP therapy. We stumbled upon this article and thought it was worth the share. It nicely articulates many of the reasons CPAP is not always the solution for the treatment of sleep apnea.

    Original Post | By Victoria Knight, Kaiser Health News

    When doctors told Frances Faulkenburg she had sleep apnea, she was more than ready for relief from her tired-all-the-time existence. She used to fall asleep at red lights while behind the wheel. At night, she’d wake up gasping for air, heart pounding. Her husband told her she snored.

    But Faulkenburg, 47, couldn’t tolerate the CPAP machine her doctor prescribed.

    “I just could not get used to the face mask covering both my nose and mouth,” said Faulkenburg, who lives in Oviedo, Fla.

    It was claustrophobic. I felt more like I was suffocating than getting breathing relief.

    Frances Faulkenburg

    CPAP, or continuous positive airway pressure, is often one of the first solutions doctors suggest for sleep apnea. With this disorder, a person’s breathing stops and starts so frequently during the night that it can lead to or exacerbate health problems. The National Sleep Foundation estimates that more than 18 million American adults have sleep apnea.

    A CPAP machine blows a stream of air into the back of the throat to let people breathe easier. It prevents muscles in the back of the throat from narrowing, which can constrict the airway, causing snoring or disturbed sleep.

    Yet Faulkenburg quit using her CPAP and went back to feeling sleepy and tired all the time.

    Many people have a negative reaction to the machines and are tempted to do the same. The big whoosh of air in your throat. The restrictive mask on your face. It can be a lot to adjust to. Studies suggest that from one-third to more than 50% of patients either stop using their CPAP machine or never bother to fill their prescription. They quit for a variety of reasons, but mostly because the device can be cumbersome and uncomfortable. Sometimes, they quit because of confusing or stringent health insurance restrictions.

    But the health effects of untreated sleep apnea can be serious. People struggle with anxiety, tiredness, and low productivity. There’s even an increased risk of high blood pressure, heart attack, and stroke.

    Mary Mertens, a respiratory therapist at the Cleveland Clinic, helps patients work through problems with their CPAP machine. Patients often complain that the volume of air the machine puts out feels too intense.

    “Think about it as sticking your head out of a car window with your mouth open at 60 mph versus 25 mph,” said Mertens. “The high pressure can be very overwhelming.”

    So Mertens’ team goes to people’s homes to help troubleshoot problems. That includes explaining sleep apnea and how a CPAP can help.

    “Picture the air passage at the back of their throat like a garden hose with no water in it. The hose collapses down,” said Mertens. That’s what happens when a person with sleep apnea is sleeping.

    “When we put a CPAP on somebody, it’s like turning the water on for the garden hose,” she said. “The hose then pops open and stays open.”

    At the Cleveland Clinic, about 70% of patients in the Respiratory Home Care program keep using their CPAP, Mertens said.

    Follow-up is key. Mertens’ team checks in with patients during the first three to five days, again between 30 and 45 days and again between 60 and 90 days.

    Faulkenburg, the patient in Florida, first tried a CPAP 15 years ago but never checked back with her pulmonologist when she was struggling. And, she said, the physician never contacted her. Then several people in her social circle died in their sleep—all of them right around her age. Those stories shook Faulkenburg, and she decided to try her CPAP again.

    “I got a mask that covered just my nose, which let my mouth stay closed. That ended up being the whole issue,” she said. “I sleep so well, I can’t sleep without my CPAP now.”

    Dr. Indira Gurubhagavatula, a sleep medicine physician at the University of Pennsylvania Health System, said the look of the device alone can be alarming.

    “One of the first things that I hear is that the thing itself is intimidating—they see the tubing and mask and it’s blowing air in their face—they have real concerns: ‘Am I actually going to sleep better with that thing?’

    It is a big ask to go to bed with this thing strapped to their faces.

    Gurubhagavatula said people who feel claustrophobic should wear their CPAP mask during the day while reading or watching TV. That can help the nerve endings in the face get used to the mask.

    “It’s just like breaking in new shoes or new jeans,” said Gurubhagavatula. “Once it’s broken in, it’s less of an issue.”

    Pulmonologist James Rowley, a sleep medicine physician at Detroit Medical Center, said the air pressure from the CPAP can cause a runny nose, nasal congestion or dry mouth. He said he can help by adjusting humidity settings on the machine or prescribing an antihistamine.

    Medicare and private insurance companies require patients to use their CPAP very consistently—often at least four hours every night and for 70% of nights each month. Sometimes the usage is monitored.

    Patients who don’t comply may end up paying out-of-pocket. That’s the topic of this week’s episode of the podcast “An Arm and a Leg.” Kaiser Health News co-produces the podcast.

    Prices vary, but a fully equipped machine typically costs from $500 to $3,000, with the national average around $850. After that initial investment, masks, hoses and filters need to be replaced two or three times a year. And users have the ongoing cost of maintenance supplies—wipes and brushes to keep the machine parts clean.

    Patients whose machines have been taken away because they couldn’t follow the insurance company rules.

    “They may have child care or elder responsibilities that make their sleep disrupted. Or they sleep in chunks of time because they work certain shifts,” she said. “The rule is arbitrary because using the machine, even if part-time, is beneficial.”

    Nate Wymer, 44, said his machine is lying around his home somewhere in Holly Springs, N.C., but he hasn’t seen it in years.

    “When I had the mask on I had to think about breathing out of my nose,” said Wymer. “That’s not something I normally do. After a couple of nights, I just couldn’t do it.”

    “My doctor never really followed up from what I can remember, so I back-burnered it,” said Wymer. “But, if you get in front of somebody, actually talk to them and make sure everything is going OK, that would have been nice.”

    Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.