Friday, January 25, 2008

Sleep Position Matters

I just saw a young man who complains of many months history of right-sided throat pain and swollen glands. Past medical history is significant for anxiety issues. He noted that he usually sleeps on his back. He also mentioned that he's had a nagging right chest, and shoulder discomfort, which started around the same time as his throat problems. When asked how he slept prior to his problems began, he stated that he normally slept on his sides. He also complains of chronic post-nasal drip, throat clearing, and coughing. He also has a relatively small lower jaw. He eats late and complains of being tired all the time, no matter how long he sleeps. 

His exam reveals severe tongue collapse when on his back with swelling and inflammation of the back of his voice box, consistent with a sleep-breathing, throat acid reflux problem aggravated by suddenly sleeping on his back. I recommended sleeping on his left side, not eating late, and practicing relaxing breathing exercises. 

Thursday, January 24, 2008

Bad Advice from the American Academy of Dermatology

About once per week, I see mostly female patients who come in for recurrent sinus or throat problems who also have severe and chronic fatigue. When asked if they sleep on their backs, they'll say yes. But when I question them further, they'll tell me that when they were younger, they always slept on their stomachs, with their face on one side of the other. Then I asked about when they began to sleep on their backs, and not too surprisingly, it's about the same time that they began to feel more tired and started to have various illness such as sinus infections, throat pain, etc.

When asked why they began to sleep on their backs, the most common answer usually is, "my dermatologist said sleeping on my face could aggravate wrinkles" (read the article from the American Academy of Dermatology here). What the dermatologist does not appreciate, however, is that these people MUST sleep on their stomachs so they can breathe well when sleeping at night. The reason for this is that many people (to various degrees) have a tendency for their tongues to fall back slightly when lying on their backs due to gravity. When you add deep sleep, all the muscles begin to relax, and the tongue may collapse completely, which causes a temporary obstruction and arousal. This prevents people from getting deep sleep. This is what I talk about in my book, Sleep, Interrupted.

If you have this condition, you probably realized this subconsciously when much younger and slept on your side or stomach to compensate pretty well. But when you start to sleep on your back, then you can't compensate very well anymore and you will have multiple micro-obstructions and arousals, preventing you from achieving restorative, deep sleep. So in a sense, this will age you more in the following manner: inefficient sleep causes a low grade stress response, constricting blood vessels to nonessential organs such as your gastrointestinal or reproductive organs, skin and hands or feet. If you don't get enough blood flow. your skin cannot heal and repair itself properly, this "aging" faster. Plus you also feel tired and lousy.

This situation can also apply to people who are admitted to the hospital after operations or after an accident, but in these situations, the consequences can be much more severe. Others have to sleep on their backs due to an shoulder injury or neck pain, which prevents stomach sided sleeping. Some people ABSOLUTELY cannot sleep on their backs. Something to think about.

My First Post

I just got back from the annual Integrative Healthcare Symposium, and I thought what I learned would be a good subject for the inaugural entry in my blog. As you may or may not be aware, my passion is to help people live more fulfilling lives by allowing them to breathe better while sleeping. This is why I wrote my forthcoming book, Sleep, Interrupted. It’s about a new way of looking at health and disease in general from a sleep-breathing perspective—based on the premise that all humans are susceptible to breathing problems while sleeping, to various degrees.

During the one-year process of writing this book, I’ve traveled a great journey. What I discovered is that to treat isolated conditions such as sinusitis or middle ear infections, you must treat the whole person, including their overall medical status, diet, lifestyle, stresses, and emotional state of mind. Going to the Integrative Healthcare Symposium only solidified my suspicions that you must treat the entire person first, before treating a symptom or medical condition.

In a sense, this journey has been a healing process for me as well, as I’ve learned to take the time to re-examine the way I value my own health, my relationships with others, and my goals and priorities in life. I have to admit that when I first started writing my book, I was somewhat overwhelmed with the added time commitments, financial burdens, and strains on my relationships with my family and friends. Slowly but unexpectedly, as I researched and read through the material needed for my book, I saw a small but significant change in myself for the better. I seem to be less stressed or worried, I’m eating healthier, I’m running competitively again for the first time in 20 years, and my relationship with my wife and children has improved. All this from simply writing a book. Most of it was through great guidance and coaching from my book authoring mentoring program. Through goals-setting exercises, time blocking, and transformational mind-shifts, I found that I had more time to accomplish more activities more effectively.

The symposium was truly eye-opening. In contrast to the typical medical conferences that I usually attend, there was so much more hope, excitement, and enthusiasm than I’m used to seeing. There was much less statistical analysis and academic pontification, and much more practical and empowering information that I could implement immediately in my practice. For the first time ever after a meeting or conference, I was excited about what I learned and was confident about making significant positive changes in the fundamental way that I practice medicine: not focusing on better medicines or surgical techniques, but to focus on significantly improving doctor-patient relationships, and improving the overall health and wellness of the patient as a human-being, not just a person with sinusitis.

I have to admit that the very first keynote talk that I heard was very nerve-racking. One example had to do with known toxins and carcinogens that are required to be applied in all mattresses in the US as a flame retardant due to fires from unextinguished cigarettes, but was never rescinded even after self-extinguishing cigarettes came out. This material was banned in Europe, and is still found in certain mattresses, even infant crib mattresses. Another example is the effect of environmental toxins that mimic estrogens that are causing an epidemic of early puberty, with one study citing 27% of African-American girls in the US developing pubic hair and breasts by age 7, and 48% by age 8, and in White girls, the numbers were 6% and 14%, respectively. The shocking number was that 3% of African-Americans and 1% of White girls had pubic hair and/or breast development by age 3. Obviously, I was somewhat paranoid by the end of this talk.

I then got into the meat of the sessions, with a number of great lectures on nutrition and the concept of nutrigenomics, which is the ability of foods to modify to various degrees the amount of our innate gene expression. After these talks, I was pretty convinced that our country’s SAD diet (Standard American Diet) is a major part of what’s making us one of the sickest countries in the developed world.

I could go on and on about the other talks, but I do want to mention some of the vendors that I came across in the exhibition area. I’m normally not into vitamins and nutritional supplements, but I happened to come across a new type of grain called Salba which had some wild claims: ounce per ounce, Salba had 8x more omega-3s than salmon, 15x more magnesium than broccoli, 3x more iron than spinach, 1.1x more fiber than bran, 3x more antioxidants than blueberries, and 6x more calcium than whole milk. The reps claimed that it was the choice of the ancient Aztec runners for energy and stamina. With these incredible claims, and having just signed up for the Bronx ½ marathon in 4 weeks, I ordered a one month supply to test it out. Stay tuned for my results.

I also underwent acupuncture for the first time. I got 5 needles in each ear for stress reduction and relaxation. I have to admit, after the first few minutes of mild irritation, I was soooooo relaxed, I lost total track of time. My arms and legs were so heavy, and I felt like I was in a trance in the middle of a very busy and noisy convention floor. Despite that fact that acupuncture’s theories are completely different from that of Western medicine, it’s been shown in multiple studies that the needles affect your nervous system, realigning the imbalances in your body. So if you have too much of the stress response (sympathetic nervous system), then acupuncture can lower this part and raise the relaxation portion (parasympathetic) of your nervous system.

Not surprisingly, many western physicians are somewhat skeptical of the validity of many of these complementary and alternative medicine (CAM) methods. Our model or definition of the usefulness of any intervention has to be shown in a large randomized, double-blinded, placebo-controlled, prospective studies that shows statistical significance. So if you have enough numbers to show that the “drug” is 10% better than a placebo with statistical significance, then it can get FDA approval.

One of the major criticisms of CAM medical models is that there are no convincing large-scale studies proving that they work. Although there are a number of smaller often conflicting studies out there, there are no “landmark” studies that are convincing enough for the traditional allopathic community.

However, people in the CAM fields would argue that that’s not the point. Statistics and studies are important, but what’s more important is to look at the person as a whole, not just a number in a large-scale study. They would argue that if you used CAM’s definition of “success”, Western medications and interventions would fail miserably for certain chronic conditions such as heart disease, diabetes, cancer or obesity. Yes, for acute conditions such as certain bacterial infections or major trauma, Western medicine is great. CAM practitioners define wellness very differently from Western practitioners. A Western doctor thinks you’re well if she cured your sinus infection with an antibiotic. A CAM practitioner thinks you’re well, once your entire mind, body and spirit are in balance, and that what predisposed you to getting the bacterial infection is addressed, as well as how your body responds to infections is optimized, with minimal to no side effects. Unfortunately, in Western medicine, complications and side effects are more the rule than the exception.

Don’t get me wrong—I’m not crossing over completely into CAM. What I’ve found over the course of the last year writing my book is that all the journal reading, conference attending and test ordering has not made significant improvements in my practice. What has made a big difference is when I got to know the patient by taking time to really know the patient en toto, as a whole person, that’s when great things started to happen. I still believe firmly in the original goals of Western medicine; it’s just that we’ve lost our focus and clarity in light of the obstacles and hurdles that we doctors have to face dealing with administrative hassles and overwhelming paperwork. But that’s no excuse.