SLEEP Meeting 2008 Summary

I spent all day yesterday at the SLEEP 2008 national meeting in Baltimore. I  went to qualify various home testing options (I have three to choose from), but I wanted to mention in this blog a few interesting companies and products that I  saw.

Cure for Insomnia?

For people with severe insomnia, I've mentioned cognitive behavioral therapy or CBT. It's been found work better than sleeping pills, and many people can stop taking these pills as well. The problem has been that it's very labor and time intensive. I was pleasantly

surprised to see an online version of CBT, developed by a Harvard insomnia researcher. Check it out here.

Elephant CPAP Mask

I was walking by a booth and I did a double take, as I thought I saw an elephant's nose. I turned around and saw this device in the picture below. It's made of a soft fabric and it allows you to sleep on your side with no rigid tubing or plastic mask to get in the way. You can find out more information or order it here. 

Football Helmet for Sleep Apnea?

Many people hate CPAP because they can't sleep on their stomach, face down. The mask and the tubing comes off when this is attempted. A device that I saw looks almost like a football helmet but on closer inspection is a light plastic helmet with  thick rounded bars (like a face mask) in front of the face to accommodate for the CPAP mask and tubing. It's patent is pending and may take another 1-2 years to become available. You can see the design at http://www.sleepmedicinesolutions.com.

After many hours of walking, my tired feet took me to a company called "Happy Feet." Not the penguin movie, but a shoe insert that's filled with glycerin that massages your feet when walking. I bought a pair and so far so good. You can check them out here.

When You Hear Ringing, and It's Not the Phone

Temporomandibular joint disease, or TMJD, is a very common disorder that affects millions of people in this country. The most common symptoms are ear pain and headaches. Other less common symptoms that are described are ringing, buzzing, ear fullness, sound sensitivity, popping and clicking. A paper published in April, 2008 issue of Archives of Otolaryngology - Head & Neck Surgery described a relatively high incidence of theses "aural" symptom in patients seen in an academic TMJ clinic. They reiterate and agree with other authors' hypothesis that local inflammation of the jaw joint, due to it's proximity to the ear structures, can aggravate all these problems. In the end, no one really knows why these symptoms occur. As in all scientific papers, they can only show association, but never prove cause and effect.

Let me propose one possible cause for these effects: People with sleep-breathing disorders (obstructive sleep apnea and upper airway resistance syndrome) all have various degrees of nasal inflammation with ear and sinus pressure problems, TMJD, and headaches. If you have nasal inflammation with partial blockage of the tube that connects the back of the nose to the middle ear (Eustachian tube), then you can imagine that you may feel ear fullness, hearing loss, popping or clicking. If your senses are heightened due to a physiologic stress response due to inefficient breathing during sleep, then you can hear noises in your ear or be sensitive to certain sounds or voices. Neurologic stimulation of the various structures can aggravate jaw muscle stimulation and spasm, or even ear or sinus fullness. This is similar to what occurs in a migraine attack. Various papers have suggested that a migraine attack can occur in any part of the body that has nerve endings, so in theory you can have a "migraine" attack anywhere in your body.

This is one of many papers that describe observations between one specific condition and it's symptoms. Their findings and observations are accurate, but when viewed from the more holistic perspective of the sleep-breathing paradigm, you may be able to make sense of all of these various interpretations all that much more. After all, there's really no point in looking at all this research without having an overall perspective to interpret it from.

Insomnia and the Blues

A new study published in the journal Sleep reveals that people with insomnia are more likely to develop depression later in life. The traditional thinking is that insomnia is a symptom of depression, but the authors argue that insomnia may come before depression.

My take on this is: "So what,this is old news". However, if you were to look at insomnia from a sleep-breathing paradigm which I describe in my forthcoming book, Sleep, Interrupted the issue becomes a lot more complex and all that more meaningful.

In the book I propose that both insomnia and depression are manifestations of interrupted breathing while sleeping that deprives you of deep, restful, restorative sleep. This process begins in early childhood, and is affected by multiple factors, including anatomic issues, diet, infections or stressful situations.

The beauty of my sleep-breathing paradigm is that it doesn't contradict what's out there in insomnia knowledge and research. Instead, it suggests a revolutionary approach on thinking about medical concepts that we take for granted. For the most part, it even agrees with and supports the evidence in insomnia research. My theory is that it's not important which comes first (insomnia or depression), but that both can coexist together. If this is so, what can cause both to occur?

This is another example of the peculiarities of medical research when you try to isolate and correlate one variable against another. Yes, you'll get some interesting results, but more often than not, you'll end up asking more questions as a result, or end up with multiple conflicting results. Once you look at humans as a complex interaction of innumerable processes, by looking at the "big picture," things just make more sense. This is one of my overriding themes in my book.