Lots of questions!

[CareerLady]

Hi Dr. Park,

Thanks again for all the great information and interviews. I recently decide to go ahead with surgery for my UARS, so I really appreciate your interview with Dr. Li. I'm having sliding genioplasty and hyoid suspension. I am going to a major university medical center, I've met a doctor who shows a lot of understanding and concern, and I 'm pretty satisfied that I'm doing the right thing. I've tried CPAP on and off for about a year and a half (on the basis of three titration studies), and never seemed to get any improvement in my sleep.

Anyway, here are two of the many things I've noticed and would love your comments on:

1) I've had sleep problems for 35 years - since I was 15. But I was always a wound-up tired person, not a sleepy tired person. I've had a lot of  insomnia. I think the reason I am a wound-up tired person is because I have daytime airway symptoms, too. I carry my head up and have a chronic stiff neck. I exercise, stretch and generally try to stay aware of my posture, but I can't avoid adjusting my posture in a way that appears to open my airway. (Of course, I frequently sleep this way, too) During the day, I find it almost impossible to relax my upper back and neck, despite doing yoga. Is it possible that daytime airway resistance could also be disruptive to my autonomic nervous system, which is why I am wound-up and tense?

2) I have always felt much better running or engaging in vigorous physical exercise. I used to think it was endorphins, but now I think it might be because of the natural dilatation effect that exercise has on the airway. You have mentioned exercise as a kind of self-treatment. Perhaps this figures into the picture?

If you have seen any research about this, can you point me in the right direction?  Thanks so much for giving this any thought, Doc!

[CareerLady]

Hi Doc,

I have been to Dr. Hang's site and learned about his ideas. Seems like it's just common sense that retracting teeth and diminishing the airway is a bad idea. Certainly was for me. When I was a preteen, my orthodontist used a headgear to force my molars back - I remember a gap of at least 5 mm. I started having disturbed sleep at that time, and I think it led to reduced growth of my lower jaw and a downward spiral into real UARS in high school. Interestingly, my sister resembles me in many ways, but she didn't have retractive orthodontic work. She has a broad smile with prominent upper and lower teeth, and nice jaws.

So why don't orthodontists, dentists and ENT doctors know this? When I told my dentist I was planning surgery, he brought up uvula, as if that is the only issue with sleep apnea. I had to point out my deficient bone structure before he had any clue that that was the major factor involved, for me anyway. I had an ENT who said the same thing, uvula, without even doing doing an endoscopic exam. And I saw another ENT who, in answer to my question, "why do I hold my head up?" responded, "maybe you're a snob."

I hope you have time to give professional presentations on this stuff, Doc. I want other people not to have to go through all the unhelpful visits and dismissive attitudes I went through.

[Steven Y Park, MD]

CareerLady,

You're absolutely right. Not sleeping efficiently causes a low-grade stress response that can cause a generalized muscular tension in your body. No breathing well during the day also changes your head/neck position so that you can breathe better. This forces muscles to be used that are not normally needed, adding to the various neck/back issues that many people with upper airway resistance syndrome have. I talk about this in much more detail in my book. Dr. Bill Hang talked about this in our last interview. Did you get a chance to listen to that one?