Avatar dr m
Steven Y Park, MD  
Male, 53
New York, NY

Specialties: Sleep-breathing disorders

Interests: Running, Baking, origami
Private Practice
New York, NY
All Journal Entries Journals

Surgery For Insomnia?

Nov 03, 2008 - 5 comments



Sleep Apnea




cognitive behavioral therapy


sleep apnea surgery

I've been holding off saying this until now, but now I'm going to say, "I told you so." In my recently published, book, Sleep, Interrupted, I proposed that many people with insomnia may actually have a mild sleep-breathing disorder due to very narrow breathing passageways which worsen in deep sleep. Inefficient sleep sets off a low-grade stress response which stimulates the nervous system, preventing the insomniac's mind from calming down before going to bed. In this month's issue of Sleep, Dr. Guilleminault and colleagues reported on a study where they took patients who have both insomnia and mild sleep breathing problems, and randomized them into either a surgical arm (to treat the sleep-breathing problem) or to cognitive behavioral therapy (CBT). Based on subjective questionnaires, people who underwent surgical management rated much better in their insomnia scores than people who underwent CBT, although the CBP scores did improve to what was considered "normal.". The researchers went further and crossed over each group into the other, and the effects were additive.

I realize that they didn't choose purely insomniacs, but their premise in designing the study was to determine how to approach someone with both insomnia and a mild sleep-breathing disorder. They also noted that most patients who have mild sleep-breathing problems also have insomnia, are women, and are thin and don't fit the typical sleep apnea profile.

This study is one more in the daily to weekly studies that are published that only serves to strengthen the sleep-breathing paradigm that I describe in my book. I realize it's controversial to say that most of insomnia is actually a breathing issue, but take a look at all the studies that show that having insomnia places you at a higher risk for developing depression, diabetes, and heart disease later in lifeā€”all complications of obstructive sleep apnea. Of course CBT is still very useful and should be recommended much more often than offered currently. In addition, good sleep hygiene is still the gold standard and must be tried first. Unfortunately, our medical establishment's obsession to search for the magic bullet to insomniacs to sleep better without all the side effects will dominate treatment recommendations for years to come.

Steven Y. Park, M.D., author of Sleep, Interrupted: A physician reveals the #1 reason why so many of us are sick and tired. Endorsed by New York Times best-selling authors Dr. Christiane Northrup, Dr. Dean Ornish, Dr. Mark Liponis, and Mary Shomon.


Post a Comment
Avatar universal
by 1nana, Nov 09, 2008
I found this to be interesting.

I've suffered with insomnia for years. I was told that it goes along with my fibromyalgia diagnosis. I've always questioned that, though.

I doubt that I have a mild sleep-breathing disorder, although, I've never been to a sleep clinic.

Thanks for the article.

Avatar universal
by Steven Y Park, MDBlank, Nov 09, 2008
Wannabenana, If you've had insomnia for years, and you have possible fibromyalgia, then it's even more likely that you may have a sleep-breathing problem. You don't have to be overweight or snore to have it. I'm guessing that you probably don't (or can't) sleep on your back, and are tired no matter how long you sleep. Inefficient sleep can lower your pain thresholds, meaning that you sense pain a lot earlier and a lot more magnified than others. Although there are many good explanations and proposed treatments for fibromyalgia, there are some experts that suggests that it's mainly a sleep disorder.

Avatar universal
by 1nana, Nov 11, 2008
You're right, I don't (can't) sleep on my back, and according to my hubby, I don't snore.

I guess my next step is to check out a sleep clinic.

Thank you so much for your reply.

Avatar universal
by neilfe, Jan 29, 2009

I find your articles quite interesting..I have had chronic insomnia for over 10 years and in the past, the only thing that has worked has been sleep restriction therapy...I have been to a sleep lab and dont have sleep apnea, so I doubt the surgery described above is pertinent to me..Believe it or not, I have so much anxiety that I cant even get tired most night -  there are times I can go 4 or 5 days with just an hour or 2 of sleep..I am kind of at wits end -  I would appreciate if you could drop me an email at ***@**** and we can hopefully talk..i am located in NYC as well

Thank you in advance

1565420 tn?1304572548
by leopard19, Feb 05, 2011
Excellent article, Dr. Park!  I thank you.  

I too have fibromyalgia and insomnia.  I've noticed in the last year or so that when I don't sleep well...my pain worsens. It like someone turned the volume up on my pain.
I've recently been diagnosed with sleep apnea although I never knew I had it.  Apparently both of my parents have it too.
The first night I used the cpap machine I noticed a major difference in my sleep.  I slept like a baby! Something I never do esp. not in a foreign place to me.  I've only tried it once since I'm waiting for my insurance to approve it.  I never thought I'd be happy to be wearing a mask at night but I am looking forward to it to see if it makes a difference in my over all health.  I have an especially hard time with the fatigue that comes along with the fibromyalgia.

Is the breathing disorder similar to sleep apnea? And, is it posssible that these breathing problems also cause other health problems i.e. all those troublesome fibro symtoms?  Thanks!!

Post a Comment