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Steven Y Park, MD  
Male, 47
New York, NY

Specialties: Sleep-breathing disorders

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Can Sleep Apnea Cause Alzheimer's?

Jan 05, 2009 - 24 comments
Tags:

alzheimer's

,

dementia

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Sleep Apnea

,

snoring

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Memory loss

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Stroke

,

Lacunar Infarcts



Researchers found that when people with Alzheimer’s and OSA are treated with CPAP, cognition and memory improves. This study was published in the November edition of the Journal of the American Geriatrics Society. They estimated that about 70-80% of Alzheimer’s patients have at least 5 apneas every hour. The authors concluded that CPAP may be an effective tool to improve cognitive skills if someone with Alzheimer’s also has OSA. They pointed out, however, that it’s unlikely that OSA causes dementia, and that the lowered oxygen levels and sleep fragmentation is what can aggravate poor cognition and memory loss.

I disagree with the last statement. The fact that 70-80% of Alzheimer’s patients have OSA is a very high figure. The minimum criteria for a sleep apnea diagnosis is 5 apneas or hypopneas per hour, and each episode has to last longer than 10 seconds. But what if someone stops breathing 25 times every hours, but wakes up only after 2 or 9 seconds? It doesn’t get counted at all! These are the people who are tried all the time and never get deep refreshing sleep, and it’s called upper airway resistance syndrome.

Also, sleep apnea doesn’t just occur all of a sudden when you’re older or gain weight. All modern humans are all susceptible to various degrees, so it’s plausible that these same Alzheimer’s patients in the study already had at least some degree of a sleep-breathing problem years, or even decades before the onset of Alzheimer’s.

If you take a look at the research literature, there are tomes of studies that link sleep apnea (and even snoring alone) with a much higher incidence of stroke (as well as heart disease). One recent study looked a MRI’s of people with sleep apnea and found a significant increase in the number of small silent strokes (or lacunar infarcts). Another study showed that people with sleep apnea had significantly reduced blood flow rates to certain critical areas of the brain. Other studies have shown that the acoustic trauma from snoring can worsen carotid artery plaque formation. This is just a small sampling of studies that all suggests that the process of Alzheimer’s begins long before you develop symptoms. Add to this the fact that Alzheimer’s patients also have a higher incidence of depression and heart disease. And lastly, there’s a general consensus amongst Alzheimer’s researchers that this condition is a small vessel disease. Autopsy studies have revealed neurofibrilary tangles (NFTs) and senile plaques (SPs) in Alzheimer’s patients, but no one has figured out why or how these events occur. NFTs and SPs are also seen in other non-Alzheimer’s conditions as well.

All this goes back to my theory that all humans are on a continuum with regards to sleep-breathing problems. Of course, if OSA causes lots of mini-strokes over decades and once you become demented at age 80, treating your underlying sleep apnea will help you think better, but the damage has already been done.

Steven Y. Park, M.D.
http***www.doctorstevenpark.com

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by dude_o_rama, Jan 06, 2009
Thank you for your fascinating post Dr Park. My 70 year old father was recently diagnosed with early dementia. His mother (my grandmother) suffered a series of microstrokes when she was in her 60's onward until she descended into complete senility by the time she passed away at 83. My dad always was a big snorer, he has suffered from sleep apnea nearly his entire adult life. After reading what you've said here, I can't help but wonder if what is happening to him now has been caused or at least exacerbated by his longstanding sleep apnea. It makes sense - snoring deprives the brain of oxygen, and all of those accumulated "hypoxic episodes" over the decades are bound to take a toll. Is it possible the plaques and tangles seen in brain tissue samples from those with dementia were caused by a form of gradual brain cell death scarring? Similar to cirrhosis of the liver, except instead of damaged hepatocytes, it's being caused by brain cell death due to a long term oxygen deficit? (from sleep apnea and/or vascular obstructions due to arterial cholesterol/plaque etc?)

I'm now in my early 40's and of course the thoughts of how I might prevent dementia are on my mind. I'm a snorer too. Probably not as bad as my father, but I definitely experience sleep apnea from time to time (and the fatigue that comes with it). I'm thin and not overweight, I do not have a thick neck. I take good care of myself and exercise and eat reasonably well (including green tea, salmon, blueberries etc). I do have a strongly deviated septum which completely obstructs my left nostril. I also seem to experience some kind of low level allergy syndrome. My sinuses are almost always at least partially clogged and I often have red eyes (I do not regularly take allergy meds). This forces me to breathe through my mouth and I suppose cause my snoring. If I had my septum surgically fixed, and perhaps started taking allergy meds to reduce my sinus congestion, do you think this would help me? And do you think having my uvula surgically removed will help? Your words "All this goes back to my theory that all humans are on a continuum with regards to sleep-breathing problems" haunt me. I know what you're saying is true, it has to be. And I want to take corrective action sooner rather than later. Thank you for sharing your thoughts - god bless!

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by Steven Y Park, MDBlank, Jan 06, 2009
dude-o-rama,

There are many pathways where sleep apnea can cause stroke. Carotid artery plaque formation, or a heart arrhythmia can throw a large clot into the brain, leading to a major stroke. Another way is when blood flow is diminished, blood tends to clot—this will happen in the smaller end-vessels. The senile plaques and tangles could the be scar tissue formations. Your liver analogy is a good one.

One thing that's been proven is that you don't have to be overweight, male, or have a big neck to have sleep apnea. I have many young, thin, women in my practice that don't snore that have significant obstructive sleep apnea. You should see a sleep doctor and get tested and treated. Chances are, fixing your deviated septum will not cure your sleep apnea. Your sleep-breathing condition can also aggravate your nasal/sinus conditions and can sometimes present as allergy symptoms. Although having a stuffy nose can aggravate sleep apnea, the main source of your obstruction is typically your tongue (and less likely your soft palate/uvula). Only a thorough evaluation by an ENT that can look with a camera can tell where exactly these obstructions may be happening.

However, if you can't improve your nasal breathing through medications, I would recommend the nasal surgery. Breathing better through your nose is a good thing in general, and also will help you with your sleep apnea treatment (using a CPAP machine or a dental device). Take a look at my older articles on sleep apnea on this site. I talk about these issues more extensively in my book, Sleep, Interrupted.

Steven Y. Park. MD
www.doctorstevenpark.com

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by dude_o_rama, Jan 06, 2009
Thank you for your informative response Dr Park. Yes I strongly believe many thin people who do not fit the stereotypical overweight male with a thick neck profile can and do have sleep apnea. I actually went to a sleep doctor about 3 years ago and came in one evening for a sleep study (which was very expensive). They wired me up and I couldn't fall asleep almost during the entire evening! I only fell asleep about 20 minutes before the nurse had to wake me up in the mornining. So unfortunately no real data was collected on my sleep habits. But I know I have sleep apnea already, there is no doubt.

So clearing my sinuses and correcting my septum is unlikely to be largely curative? I guess I'll have to go see an experienced ENT as you suggest. I was really hoping to avoid being strapped to what appears to be a mechanical elephant every night (i.e. the CPAP machine). How often (statistically speaking) do simple dental devices work in alleviating sleep apnea? I'm not familiar with them, although I did see a tv commercial recently for them. Presumably they keep the tongue/jaw in the right place to keep the airway from collapsing in on itself?

I will take a look at your book. Sounds like it's right up my alley, thanks for the suggestion and the helpful advice. God bless...

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by Steven Y Park, MDBlank, Jan 07, 2009
dude_o_rama,

Sorry to hear about your sleep study experience. Although a formal study is ideal, another option for you is a home based study. They are much less expensive and less complicated. There's also a small chance that you could have a decent study and still not officially have obstructive sleep apnea. This is due to how we define an apnea. You have to stop breathing for 10 seconds or longer to say you had an apnea. The same goes for a hypopneas, where your airflow is significantly limited. You need 5 apneas or hypopneas every hour to say that you have obstructive sleep apnea. But if you stop breathing 25 times every hour and wake up after 1-9 seconds, then you're told you don't have sleep apnea.

It's understandable how you feel about using CPAP, but once you feel the benefits, you'll be hooked. But I have to warn you that it will be a process. Don't count on your sleep doctor and DME vendor (equipment company) alone to help you adjust to CPAP—you need to take responsibility for making sure that it works. For certain individuals that are candidates, a dental device is a good option. The over-the counter boil-and-bite models can help, but they are not adjustable. They are also bulky and uncomfortable. The custom-made devices (by dentists) are much more comfortable and adjustable (and more expensive). Success with these devices depends on the experience of the dentist and your willingness to give it an honest try. Surgery is also a reasonable option, but only as a last resort. With all three options, the rate of success ranges widely from 20-30% all the way to over 90%. It all depends. I talk about all these options briefly in my articles on this site and in more detail in my book. Good luck.




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by Irishtwo, Jan 08, 2009
Hi there,
My husband was diagnosed with sleep apnea approximately 15 years ago.   He tried having laser surgery and had a dental appliance made - neither of them worked for him until he tried the machine.    The CPAP machine did take a little while to get used to but now he won't be without it.   He adds water to it every night and some nights the water tank is empty and other times only half empty.   His sleep pattern is much better however just about 3-4 weeks ago I have noticed him twitching in his sleep just before he actually falls asleep.    I have read all the comments about stress related factors and don't think this is his problem as he is fairly easy going and I know when he is under stress.   I'm wondering if it is because he has been diagnosed with a bleeding ulcer lately that this could also be the cause for the twitching.

This is a great forum and thank you.

Irishtwo



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by alagirl, Feb 20, 2009
Dr. Park,

I would think that any method of increasing oxygenation to the blood is going to improve memory and performance.  To make a causal link, instead of an association or correlation, between sleep deprivation due to apnea and other sleep disorders, and diseases like Alzheimer's and MS, is, I think, taking quite a huge leap.  

To me it seems that in the case of MS and other auto-immune issues the cause OF sleep problems is the same mechanism that causes the MS, not the other way around, and that it is hematological and auto-immune in nature (and possibly genetic as well).  Treating the sleep and thus adding oxygenation helps in that it treats a symptom that then gives you better quality of life and may also slow the deterioration in the heart/blood vessels of any damage having to do with chronic insufficient oxygenation.

Let me give you an analogous example of what I'm talking about using an auto-immune disorder.  I have antiphospholipid syndrome.  It has affected several different organs (pre-discovery).  It has caused adrenal insufficiency, focal nodular hyperplasia, gall bladder insufficiency (possible infarct), chronic headaches, pre-eclampsia, miscarriages, thickening of the walls of vessels in my bowel and heart, pulmonary scarring, and many other issues I won't bore you with here.  Now that I have finally been diagnosed, I am on blood thinner.  The blood thinner both relieves my worst symptoms (the headaches in particular), and it keeps other problems from recurring or becoming worse (keeps more nodules of vessels from forming in my liver, more micro-hemorrhages of the adrenals - although, they are shot anyway, lol, and of other organs from occurring, helps the blood run through my vessels more easily, keeping them in better shape (I had chronic hypertension before treatment (diastolic) - I could go on and on.  What it does NOT do of course, is cure antiphospholipid syndrome.  It treats it.

I think what you have with the sleep issues and use of mechanisms like the cpap is exactly analogous.  That "system" controlling the manner in which one breathes at night, is damaged by MS in the same manner that MS damages other organs and systems, and I'll quote here from the MS resource center:

"Muscle weakness: as the muscles which control breathing weaken, the ability to cough is impaired and the patient is at a high risk of pneumonia and other complications in the lungs. Inactivity can result in such weakness, as can poor postural alignment and trunk control, muscle imbalances, decreased bone density, and/or shallow, inefficient breathing."

So MS can cause structural changes as well as causing postural issues during sleep - not to mention the potential for infection.  The same muscular issues faced elsewhere in the body due to MS apply here, as well as other possible issues affecting structure, such as bone density issues.

The use of a mechanism to improve breathing, such as the cpap, is of course helpful, and oxygenation improves all kinds of things in terms of preventing, possibly, further physical deterioration in some blood vessels (hence - possibly -the link to stroke and heart attack with improper oxygenation).  It gives better quality of life and more energy with better oxygenation and greater amounts of net sleep time - which in turn, helps with alertness and general well-being (and possibly pleasantness, wish my father would get one).  This does not make the ability to oxygenate at night a cure though, in my mind.

Instead, it makes it a useful tool, much like the blood thinner is in my case.  Nor, in my mind, is there any basis for thinking that the breathing disorder which is actually caused BY MS, is the actual cause OF a disorder like MS.  It is a symptom of a problem (MS) that really seems to me to be more bound up in hematological and auto-immune issues.  And in that regard, it is unfortunately all too similar to the symptomology of many other auto-immune issues, which have hematological findings that differ vastly from the norm (thus, in my mind, LEADING to the auto-immune issues, and THEN leading to the systems issues, such as the breathing issues).  And possibly with some genetic component in front of it all.  To me, this seems similar in some ways to the progression of some cancers thought to have an auto-immune basis, such as Waldenstrom's, i.e., genetics>hematology/auto-immune>systems issues.  Thus, the real area of interest to me is more in the interaction between genetics, hematology, and the auto-immune process, from a research standpoint.

And of course, with Alzheimer's, (not associating this with auto-immune disorders, but because you mentioned it as the topic header here) there is still much ongoing research, and much research yet to do.  Several things known though are that there seem to be modifications or mutations of the "Tau" protein, higher levels of the plaque peptide A-beta 42 preceeding Alzheimer's, which seem to then suddenly decrease (thought to possibly settle in the brain) as the person moves into the actual disease, and there are believed to be several genes that predispose one to Alzheimer's, such as apolipoprotein E-e4 (APOE-e4) - with others yet to be defined - possibly as many as twelve.

Now, on point with what you seem to espouse, one of the risk factors of Alzheimers and age related dementia does seem to be blood vessel damage (of course we know that a plethora of things damage the blood vessels - hypertension, high cholesterol, problems managing blood sugar, heart disease, etc) - but, certainly there does seem to be some evidence (or at least positive correlation seeming to show) that chronic lack of oxygenation from any source adds to these issues which can then influence heart disease and stroke.

So in that respect I can agree with you that chronic lack of oxygenation could certainly be a contributing factor to the progression of Alzheimers or age related dementia (and that adding oxygenation in such a situation (and in many other conditions) could only be helpful), but I can't see it as being the root cause due to all of the research that implicates, again, hematology (and genetics).  Perhaps Alzheimer's/dementia is as yet not as clearly defined as it needs to be.  This continues to be a problem for many medical disorders for which are still trying to find answers in large supply.  Perhaps it is more of a syndrome.  Maybe it can involve a host of contributing factors (as all medical problems do in one way or another on some level, I suppose).  Maybe it comes down to a genetic issue causing a hematological issue, the progression of which can be influenced by other factors such as blood vessel damage, chronic insufficient oxygenation, inactivity, etc.  But I can't see that sleep apnea, in and of itself, would cause Alzheimer's, as seemed to be postulated in the header.  I just can't get there from the evidence on hand.

At any rate, I apologize for the long post, but at the basis of my virtual blog here is, I think, the feeling that we patients sometimes have that physicians look at our medical problems one organ or body system at a time (according to their specialty) and feel they can solve issues in this manner, when so many issues are systemic in their effects - particularly when it comes to diseases of an auto-immune nature, and when the bulk of existing evidence for the etiology of the disease points to an area with specialists who don't usually even handle the disease we happen to have, and who are not well versed in it.  i.e. - perhaps someone sees a neurologist for their MS, but is MS really neurological in etiology or does the process of the disease affect the nervous system.

And I don't, honestly, have a good remedy or answer for how to manage that better that would be fair to physicians and patients alike.  Each doctor does have the responsibility to know all he can about his given specialty in order for good patient care to occur in that specialty, and no one human being can truly specialize in everything, so its a bit of a conundrum.  Anyway, thank you for your time and for entertaining what I know was a small amount of opposing opinion in some areas during my lengthy little diatribe.

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by Steven Y Park, MDBlank, Feb 20, 2009
alagirl,

I had to read through your post twice, as my own brain's a little foggy due to the multiple newborn baby feedings last night.

The point of all my articles is not to repeat the same old repetitive medical dogma, but to stimulate discussion and to encourage people to think outside their own medical "boxes." I'm not discounting any of the research and known facts about Alzheimers and MS. Rather, I'm describing the big elephant from a different perspective, which is from an airway/breathing perspective. One thing that I learned early on as a medical professional is that you can only state facts based on published studies, just like lawyers have to cite precedence. However, one of the problems with modern science is that you can never say that A causes B. You can only say A is strongly associated with B. Furthermore, by trying to reduce the millions of different components of a medical condition down to one single chemical or gene, it's like trying to describe a good cake as strongly associated with eggs. It's a lot more complicated than eggs. This is why you need non-study related discussions about the big picture, and constantly question conventional wisdom. Scientists and physicians often get lazy and assume that everything published recently is a scientific fact, but we all know that in 50 years, most of what we know will be turned upside-down.

Here's an exaggerated example: In medicine, you can't actually say that water cures dehydration. There are no published randomized prospective double-blinded placebo-controlled studies that prove a strong correlation between water intake and resolution of thirst and dehydration. Doctors can't officially prescribe water for dehydration. Mothers can't give water to their children for dehydration, since water is not officially FDA approved for dehydration, which is a medical diagnosis. What happens when you fall on the sidewalk? Most likely, you'll scrape your knee, but do you need to do a study to prove it? What I'm proposing here is that we're allowed to use common sense to come up with plausible connections between two seemingly unrelated medical conditions.

One point of clarification that I have with your arguments is when you talk about oxygen deprivation leading to or aggravating various medical conditions. Yes, in sleep apnea that's the extreme end of the spectrum, but what I'm talking about is breathing pauses that lead to subtle arousals that lead to deep sleep disruptions that don't usually get counted or even picked up on standard sleep studies. This leads to a physiologic stress response that sets off a cascade of hormonal, biochemical, neurologic, metabolic and immunolgic changes. Of the thousands or millions of events that occur, of course you'll find that one protein that's elevated, or that one gene that makes you susceptible to this condition. These new findings will be endless. But when was the last time the discovery of a new gene actually cured someone?

Regarding genetics, it's currently acknowledged that in many cases gene expression is markedly determined by your environment, in terms of what you eat, how you live your life, your prenatal status, and many other countless factors. With the exception of certain clearly genetic factors, many of the modern chronic conditions that we see are not determined by genetics alone.

I do agree that doctors are guilty of compartmentalizing medical conditions into their own areas or systems. I'm guilty of it too. But one thing that I've learned over the years is that to properly treat your own area of the body, you have to look at the whole person, not only in terms of physiology and anatomy, but also any stresses, family and life situation, and the entire environment that surrounds the patient. This along with the fact that doctors and the public naturally assume that all humans have this rigid tube that passes air from our noses to our lungs, but this can't be further from the truth. The human upper airway, due to a variety of factors that I describe in my book, Sleep, Interrupted, is susceptible to collapse and obstruction in everyone to various degrees. This condition has actually gotten worse over the past 100 years due to modernization.

Breathing is so fundamental to life that I think it's a safe argument to make that poor breathing can make you sick. I'm not talking about suffocation—then you'll be dead. What I describe is a chronic low-grade physiologic stress response that hypersensitizes or hyperactivates both your immune and nervous systems. The stresses of modern society only makes this physiologic stress even worse. Certain areas of the human body are also prone to lack of blood flow when under stress, namely, the hands or the feet, the bowels, the reproductive organs, the skin, or any other "end-organ" area of the body. You can imagine all the systemic inflammation and elevated markers, neurologic and hormonal changes that can occur and be measured.

You also bring up the classic chicken or the egg question. My general answer would be that a sleep-breathing problem can explain a variety of disparate medical conditions, but ultimately, it doesn't matter since it ends up being a vicious cycle. Your description of antiphospholipid syndrome sounds remarkably like the UARS condition that I describe. Every one of the symptoms and conditions that you describe can be explained via a sleep-breathing mechanism. But I think you'll agree that the elevated phopholipids alone are not causing all your medical problems. It's just a byproduct of whatever else is causing all these problems.

There's a dichotomy occurring in medicine today. There's the hardcore evidence-based medical system, which places their hopes on genetics, technology, and scientific progress. These people try to find answers within the human body down to the molecular level. Then there's the other half, who take a more holistic approach, looking at the big picture, striving for generalized balance rather than laser-focused targeting. Functional medicine is just one such example. In a very general sense, Chinese medical philosophy, for example, is much more attractive in dealing with these type of issues since they don't really have descriptions of medical conditions like we do in Western medicine. Everything is about balance of the opposing forces, and different people will need different treatment for the same condition, depending on their constitution.

To conclude, I'm not disagreeing with you at all. In fact, I actually agree with you on most of your points. Two people can describe the same elephant from two different perspectives and both can still be right. Thanks for bringing up some important issues.

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by alagirl, Feb 21, 2009
Yeah, I'm afraid what we're looking at here is that I'm in that group of hardcore evidenced based medical folks that wants to find the answers down to the molecular level.  And I think that this IS the big picture.  It affects every system.  And you can treat the symptoms with cpaps (or blood thinners in my case) all day long, but you won't cure the issue until you understand and are able to change things on the micro-level.  Its at the very basis of looking at those effects on the entire body and all of the organ systems, realizing that many systems are effected, and treating ALL of the affected systems in each individual - which as you suggest, varies from person to person in certain diseases.  To me, that is the very definition of the holistic approach and it is what medicine and science are all about.

When you continue to compartmentalize a macro system and list it as a causal instead of a contributing factor in so many different illnesses, I think you have it backwards.  My biggest issue is that I don't want the blind man describing the elephant in different parts and calling each part the entire elephant.

I had a sleep doctor tell me that my chronic headaches were due to UARS and I could be cured by using a cpap.  I had another doctor tell me they were caused by constipation.  I can't agree with you about the elevated anticardiolipid antibodies not causing the medical problems I listed.  These issue are THE PRIMARY issues associated with antiphospholipid syndrome and blood thinner has caused them to discontinue.

And I did understand earlier that you think that the more subtle breathing disorders cause stress that changes blood chemistry.  I just chose not to address it because I think the role of stress is so overplayed lately by homeopaths that I don't even like to get into that argument.

Yes, all of the medical factors do work on each other in the vicious circle you described as an illness or medical issue progresses, such that the diagnostic waters are muddied.  But, that does still not negate the fact that there is an absolute etiology or etiological syndrome for the medical problem or disease in question.  And there should be a manner in which to study and quantify that or you might as well not even call it a hard science any longer.  

You have used your OWN anecdotal evidence here recently to suggest a causal link between sleep issues of different types and both MS and Alzheimer's.  And I just feel that this is not backed by the research at this time - that I can find - and I'm surprised to see it here.  That type of speculation.  We have patients here suffering from diseases who are taking your word for this when I can't find the studies to back it, and frankly, I'm sorry, but it troubles me that a physician is postulating in this manner publicly on this type of forum, with patients.  Patients on this site are GREATLY influenced by what physicians on this site say, and I feel it may be irresponsible.  As long as I'm being honest.  Particularly when your role here is to help people with sleep disorders.  If you are a homeopath or naturopath, that should be listed so that patients understand how to evaluate the data.

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by rooobosmith, Mar 02, 2009
Dr. Park,

I have recently realized that night-time sinus congestion (I don't snore) is triggering my atrial flutter.

Due to 4 catheter ablation treatments and Sotalol, my AF is no longer persistent, but I fear it may be causing damage of some sort.

Nightly sinus congestion seems to be a recently developed symptom, and I'm not sure why it's become so prevalent.

What are the possible treatments that might eliminate these hypoxic episodes?

Thanks.

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by Steven Y Park, MDBlank, Mar 02, 2009
rooobosmith,

It's hard to say exactly without more information, but from what you've relayed, your nasal congestion could be aggravating an already existing sleep-breathing problem. If you have multiple obstructions at night, it can cause a stress response that activates your sympathetic nervous system, which can aggravate heart rhythm problems. You don't have to snore to have this condition.

I'm not clear if you already had a formal sleep study, since you mentioned having hypoxia. If not, then you may want to consider a formal overnight sleep study.

Simultaneously, you should get your nasal congestion taken care of definitively. If medical treatment doesn't work, then surgery may be required.

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by rooobosmith, Mar 02, 2009
Dr. Park,

Thank you for your timely response. Frankly I am amazed.

I have not had a formal sleep study, and am only assuming hypoxia based on this and the other things which trigger my AF. They all seem to involve activities which (probably) reduce blood oxygen levels such as heavy anarobic exercise like skiing.

I will speak with my doctor tomorrow about medical treatment of my congestion.

Thanks again.

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by Poisrcu, May 16, 2009
Dr. Park,

I am 19 and was diagnosed with OSA 4 years ago.  I am not over weight and never have been I am 5' 6" and weight 130 pounds.  We have found no cause for it but it is a severe case, the study showed 30-40 apneas an hour.  As a result I have been on the CPAP for the past 4 years.  Doctors are stumped as to the cause, and I have been actively pursuing the cause for 3 years (at least 12 sleep related doctors appointments per calendar year).  My cognitive abilities improved but have not fully returned.  Recently it has come to light that my grandfather, who has always been suspiciously forgetful (he has used a pocket notebook to remember things since his 20's) has Alzheimer's.  Is it possible that I, at the age of 19, have Alzheimer's?  Could Alzheimer's have caused my sleep apnea?

-Brian

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by Steven Y Park, MDBlank, May 17, 2009
Brian, thanks for posting. Your sleep apnea is because of your small jaw anatomy. Even if you're using your CPAP 100% of the time while sleeping, some people never feel completely well. There are no simple explanations for this. One can't say that you have Alzheimer's at this point, since you're very young. But if you accept my theory about one way that Alzheimer's develops, then your situation is not surprising. You should talk to your doctor to make sure that there isn't anything else (besides sleep apnea) that could be causing you to feel this way. Without doing specialized and investigational imaging tests, it's hard to "prove" any of this. Even if you see a neurologist about this, he or she probably won't even consider Alzheimer's because of your age.

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by roadhog, Oct 12, 2009
Dr. Park,
I have sufffered from low grade MS like symptoms for several years without formally being diagnosed. I suspect that my snoring and insomnia over 15 years have brought on the tremors, cold muscle weakness and pins and needles sensation in my toes, feet and fingers. I have found that when I get shaky or weak that deep breathing exercises(like pearl divers do) stops these symptoms instantly! I also found that by taking 500mg L-Arginine before bed my sleep is deeper and the weakness and shaking don't occur the following day. It's after a poor nights sleep that the trouble starts.
Not a scientific study, but maybe your readers can try it and see for themselves if there is a correlation between respiration and MS/Parkinson's and blood pressure/heart disease.
I am convinced.

Jay

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by momgray, Apr 04, 2010
I was diagnosed at the age of 40 with very high, sudden onset hypertension. I had always had low blood pressure before. My medicines are not keeping me in the range the Dr would like, but due to the lethargy from the medicines  she is reluctant to increase the dose. ( Unless I am moving, I get extremely fatigued in the afternoons, while driving etc. .)   Interestingly, I wake up often  because of my husbands snoring and gasping for breath. I poke him, wiggle/bounce in the bed and ask him to roll over all night long.  I know he must have sleep apnea but he is stubborn about any kind of medical treatment. My question is.. could his sleep apnea be causing my hypertension due to chronic lack of sleep?  I am thinking of sleeping alone for a while to see if my blood pressure improves but worry about what will happen to my husband without me there to listen to him breathe.

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by sahilgupta27, Sep 30, 2010
Hi Dr Park,

Recently one of our family doctors suggested my father to get tested for OSA. My father is 60 and has been a consistent smoker through out. I read on the web about the symptoms of OSA such as deprived of sleep, weak nervous system, depression, sleepiness through out the day, etc etc, and my father seems to have all of those. He is also taking the medication for hypertension for the last few years almost 10 yrs. He is obese and has a large circumference at the neck. He sleeps with taking 2 pillows which I never understood but now after reading stuff about OSA it makes sense to me that may be now his tongue does not interrupts with airway passage and may allow him to breathe easily a little. My father also has been snoring since long and is obese.

Given all the above facts or my observations, do you think this could be a case of OSA? and could his slow movements and reflexes are getting slower because of lack of oxygen in the body and blood.

Please let me know you view point.

Thanks.
Sandy.


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by toto77777, Mar 26, 2011
I am surprised that there are only a very few responses to this report, after +/- 2.5 year....
Is the whole nation  already suffering from Alzheimer?
i did read on Amazom.com that even people who must use a CPAP machine, got rid of this uncomfortable machine by using a kind of NasiVent tube make them breathing through the nose again. For deeper sleep and more oxygen in the brains... (no mouth breathing anymore!)
Antonio

ps. good artikel


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by JessicaForester, Jun 28, 2011
After 6 months of offering stem cell therapy in combination with the venous angioplasty liberation procedure, patients of CCSVI Clinic have reported excellent health outcomes. Ms. Kasma Gianopoulos of Athens Greece, who was diagnosed with the Relapsing/Remitting form of MS in 1997 called the combination of treatments a “cure”. “I feel I am completely cured” says Ms. Gianopoulos, “my symptoms have disappeared and I have a recovery of many functions, notably my balance and my muscle strength is all coming (back). Even after six months, I feel like there are good changes happening almost every day. Before, my biggest fear was that the changes wouldn’t (hold). I don’t even worry about having a relapse anymore. I’m looking forward to a normal life with my family. I think I would call that a miracle.”
Other recent MS patients who have had Autologous Stem Cell Transplantation (ASCT), or stem cell therapy have posted videos and comments on YouTube. www.youtube.com/watch?v=jFQr2eqm3Cg.
Dr. Avneesh Gupte, the Neurosurgeon at Noble Hospital performing the procedure has been encouraged by results in Cerebral Palsy patients as well. “We are fortunate to be able to offer the treatment because not every hospital is able to perform these types of transplants. You must have the specialized medical equipment and specially trained doctors and nurses”.  With regard to MS patients, “We are cautious, but nevertheless excited by what patients are telling us. Suffice to say that the few patients who have had the therapy through us are noticing recovery of neuro deficits beyond what the venous angioplasty only should account for”.
Dr. Unmesh of Noble continues: “These are early days and certainly all evidence that the combination of liberation and stem cell therapies working together at this point is anecdotal. However I am not aware of other medical facilities in the world that offer the synthesis of both to MS patients on an approved basis and it is indeed a rare opportunity for MS patients to take advantage of a treatment that is quite possibly unique in the world”.
Autologous stem cell transplantation is a procedure by which blood-forming stem cells are removed, and later injected back into the patient. All stem cells are taken from the patient themselves and cultured for later injection. In the case of a bone marrow transplant, the HSC are typically removed from the Pelvis through a large needle that can reach into the bone. The technique is referred to as a bone marrow harvest and is performed under a general anesthesia. The incidence of patients experiencing rejection is rare due to the donor and recipient being the same individual.This remains the only approved method of the SCT therapy.

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by roberttaylor, Jul 21, 2011
“Unnecessary risks are being taken by patients seeking the liberation treatment.” says Dr. Avneesh Gupte of the CCSVI Clinic. “It has been our contention since we started doing minimally invasive venous angioplasties nearly 6 years ago that discharging patients who have had neck vein surgery on an outpatient basis is contra-indicated. We have been keeping patients hospitalized for a week to 10 days as a matter of safety and monitoring them for symptoms. Nobody who has the liberation therapy gets discharged earlier than that. During that time we do daily Doppler Ultrasounds, blood work and blood pressure monitoring among other testing. This has been the safe practice standard that we have adopted and this post-procedure monitoring over 10 days is the subject of our recent study as it relates to CCSVI for MS patients.”

Although the venous angioplasty therapy on neck veins has been done for MS patients at CCSVI Clinic only for the last 18 months it has been performed on narrow or occluded neck veins for other reasons for many years. “Where we encounter blocked neck veins resulting in a reflux of blood to the brain, we treat it as a disease,” says Gupte. “It’s not normal pathology and we have seen improved health outcomes for patients where we have relieved the condition with minimal occurrences of re-stenosis long-term. We believe that our record of safety and success is due to our post-procedure protocol because we have had to take patients back to the OR to re-treat them in that 10-day period. Otherwise some people could have run into trouble, no question.”

Calgary MS patient Maralyn Clarke died recently after being treated for CCSVI at Synergy Health Concepts of Newport Beach, California on an outpatient basis. Synergy Health Concepts discharges patients as a rule without in-clinic provisions for follow up and aftercare. Post-procedure, Mrs. Clarke was discharged, checked into a hotel, and suffered a massive bleed in the brain only hours after the procedure. Dr. Joseph Hewett of Synergy Health recently made a cross-Canada tour promoting his clinic for safe, effective treatment of CCSVI for MS patients at public forums in major Canadian cities including Calgary.

“That just couldn’t happen here, but the sooner we develop written standards and best practices for the liberation procedure and observe them in practice, the safer the MS community will be”, says Dr. Gupte. “The way it is now is just madness. Everyone seems to be taking shortcuts. We know that it is expensive to keep patients in a clinical setting over a single night much less 10 days, but it’s quite absurd to release them the same day they have the procedure. We have always believed it to be unsafe and now it has proven to be unsafe. The thing is, are Synergy Health Concepts and other clinics doing the Liberation Treatment going to be changing their aftercare methods even though they know it is unsafe to release a patient on the same day? The answer is no, even after Mrs. Clarke’s unfortunate and unnecessary death. Therefore, they are not focused on patient safety…it’s become about money only and lives are being put at risk as a result.”

Joanne Warkentin of Morden Manitoba, an MS patient who recently had both the liberation therapy and stem cell therapy at CCSVI Clinic agrees with Dr. Gupte. “Discharging patients on the same day as the procedure is ridiculous. I was in the hospital being monitored for 12 days before we flew back. People looking for a place to have the therapy must do their homework to find better options. We found CCSVI Clinic and there’s no place on earth that’s better to go for Liberation Therapy at the moment. I have given my complete medical file from CCSVI Clinic over to my Canadian physician for review.” For more information Log on to http://ccsviclinic.ca/?p=866 OR Call on: +1 (404) 461-9560.

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by bostrom, Sep 17, 2012
While some MS patients who have had the liberation therapy are reporting long-term benefits from having the procedure, there are just as many for whom the ‘liberation therapy’ has failed as an effective therapeutic intervention. This doesn’t mean that these patients didn’t have some immediate benefits once the neck veins were opened; most did, but over time the veins restenosed again and their MS symptoms returned. In fact, having seen their MS symptoms almost totally disappear however briefly once their veins were cleared, patients who have restenosed want it done over again, as many times as necessary in some cases. However, there is now a new and growing subset of MS patients who have had vein widening venoplasty multiple times, usually to less beneficial effect each time, leading to the later discovery of so much intraluminal scar tissue by the second, third, or fourth attempt at re-opening the veins that the procedure cannot be performed again.For more information on the combination therapy protocol and study email to ***@**** or call 888-468-1554. http://www.ccsviclinic.ca/?p=1071
http://www.youtube.com/watch?v=ysFiW26MHfQ&feature=player_embedded

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by bostrom, Sep 17, 2012
Topical amongst this group are: vascular grafts, bioprosthetics with autologous source endothelialization, pig’s veins, etc. The need to remove jugular veins and implant new vessels because they are so occluded, indicates the possibility that there was ‘overtreatment’ of the veins during the initial venoplasty procedure that eventually led to the formation of scar tissue (that is, if they didn’t occlude with thrombin build-up (clots) immediately post-procedure). It’s well-known that once balloons are expanded in those narrowed areas of the diseased neck veins, tearing and abrasion (desquamation) occurs intraluminally causing inflammation and bleeding. And healing within venous lumen damaged due to venoplasty typically takes many months and leaves lasting, lumen-choking scars. Lumen diameters are permanently decreased. The recent self-reporting of an alarming number of permanently blocked neck veins certainly begs the question to be asked as to what additional medical interventions need to be developed to avoid this kind of catastrophic damage.
Because the definite risk exists that veins will become blocked as a result of the liberation therapy, this further indicates that there may not be recognition by the surgeons of the fragility of the neck vein structure, especially in patients that already have diagnosed venous disease (CCSVI), even though the procedure is considered to be ‘minimally invasive’. No additional steps in the current liberation therapy protocol have either been taken or proposed by Interventional Radiologists performing the vein dilation to eliminate the risk of restenosis. To date the approach amongst the Interventional Radiologists who are performing this therapy on an outpatient basis has been: ‘whatever happens, happens’, post-procedure. It is incorrectly assumed that restenosis will always be ‘correctable’ in subsequent therapies if necessary. This is now clearly proving to be the wrong assumption.For more information on the combination therapy protocol and study email to ***@**** or call 888-468-1554. http://www.ccsviclinic.ca/?p=1071
http://www.youtube.com/watch?v=ysFiW26MHfQ&feature=player_embedded

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by bostrom, Sep 17, 2012
Therefore performing additional effective therapeutic modalities that will avoid the normal cascade of healing events and consequential scarring in support the liberation therapy is vitally important to restore and maintain optimal central nervous system (CNS) drainage once the abnormal veins have been widened. Preliminary evidence from CCSVI Clinic patient case reports indicates that stromal cells injected through the catheter at the time of the venoplasty and applied directly to the damaged vein avoid the formation of both thrombin and scar tissue intraluminally, and that the veins heal very quickly with no evidence of scar tissue. After over a year of treating patients’ veins with stem cells at the time of the liberation therapy, it may be hypothesized that the stem cells work to create more stable, stronger and more enduring veins resulting in long-term patency (optimal blood flow) and the subsequent avoidance of additional venoplasty procedures. Case studies on each patient treated with the combination therapy are now underway.
David Summers of Murfreesboro, TN is one such MS patient now being case studied. David came to the CCSVI Clinic as a paraplegic MS patient evaluated at 8.0 on the Kurtzke EDSS scale. His MS had become secondary progressive and his rate of deterioration had increased dramatically by late 2011. In April of 2012, David was treated at CCSVI Clinic with the combination liberation/autologous stem cell therapy protocol developed by researchers at Regenetek Cellular Technologies. Liberation therapy was first performed and adult autologous stem cells were implanted into David’s jugular veins at the time of his vein expansion. Four days later, a clinical dose of mesenchymal stem cells (MSCs), enhanced in vitro from the original autologous marrow source was implanted back into David’s CNS via lumbar puncture. (Stem cells multiplied from an autologous source not only ensures that patients are receiving their own DNA, but studies have shown there is no risk of cell mutation resulting in the formation of cancerous cells).For more information on the combination therapy protocol and study email to ***@**** or call 888-468-1554. http://www.ccsviclinic.ca/?p=1071
http://www.youtube.com/watch?v=ysFiW26MHfQ&feature=player_embedded

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by bostrom, Sep 17, 2012
David’s MS symptoms not only began to improve immediately, but within four hours of his implantation, he began to feel sensation below the waist. This did not happen the first time he had his liberation therapy in 2010, nor in the 90 days following that procedure, the length of time that he said he had received some benefit as a result.
Following the combination of stem cell implants at CCSVI Clinic, disappearance of his MS symptoms could possibly be explained by the liberation therapy, but his subsequent nerve and muscle regeneration over the last several months can only be accounted for by the rebuilding of  the myelin and axonal fibers within the CNS. Only the implantation of pluripotent MSCs that can differentiate into neuroprogenitor cells can do this. Furthermore following his therapy, his frequent attacks of MS completely stopped, another known benefit of MSCs which express chemicals that ‘turn off’ the proteins expressed by the over-aggressive immune system attacking the CNS.
In the six months following his combination therapy at CCSVI Clinic, David began to walk and workout more frequently. At 108 days post-procedure he entered a formal physiotherapy program to improve his walking ability, balance and physical endurance. He has not had an MS attack since his therapies in April of 2012 and most of his MS symptoms have disappeared or reduced dramatically. His EDSS score has moved from an 8.0 to approximately 3.0 and he continues to improve.
Other MS patients not nearly as disabled as David was, having been treated at CCSVI Clinic, are now reporting dramatic improvement and many are now asymptomatic. This combination therapy protocol, meticulously researched and based on various clinical studies on autologous stem cell transplantation, has now been taken from the bench to the bedside for the first time. So far David Summers is one of dozens for whom the outcomes are producing therapeutically what the clinical studies have confirmed. More case study data is being produced and will make up the Prospective Cohort Study to be published later next year.
For more information on the combination therapy protocol and study email to ***@**** or call 888-468-1554.
http://www.ccsviclinic.ca/?p=1071
http://www.youtube.com/watch?v=ysFiW26MHfQ&feature=player_embedded

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by bostrom, Oct 03, 2012
http://www.youtube.com/watch?v=ysFiW26MHfQ&feature=player_embedded#t=0s
http://www.youtube.com/watch?v=BfSOmij8tfk&feature=youtu.be
While some MS patients who have had the liberation therapy are reporting long-term benefits from having the procedure, there are just as many for whom the ‘liberation therapy’ has failed as an effective therapeutic intervention. This doesn’t mean that these patients didn’t have some immediate benefits once the neck veins were opened; most did, but over time the veins restenosed again and their MS symptoms returned. In fact, having seen their MS symptoms almost totally disappear however briefly once their veins were cleared, patients who have restenosed want it done over again, as many times as necessary in some cases. However, there is now a new and growing subset of MS patients who have had vein widening venoplasty multiple times, usually to less beneficial effect each time, leading to the later discovery of so much intraluminal scar tissue by the second, third, or fourth attempt at re-opening the veins that the procedure cannot be performed again.For more information on the combination therapy protocol and study email to ***@**** or call 888-468-1554. http://www.ccsviclinic.ca/?p=1071
http://www.youtube.com/watch?v=ysFiW26MHfQ&feature=player_embedded#t=0s
http://www.youtube.com/watch?v=BfSOmij8tfk&feature=youtu.be

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