Sleep Dynamic Therapy

Archive for August, 2007

Once again, another major report on obesity and barely a word about the role of sleep and sleep disorders in this epidemic.

In this Washington Post article covering recent research on longevity in patients undergoing weight loss surgery, the emphasis seems to favor bariatric procedures. That is, it appears that those who undergo weight loss surgery and lose weight increase their lifespan. I’ve not read the research articles yet, but the question raised would be why would these patients live longer. Obesity is a risk for many diseases, but the one least likely to get a mention would be obstructive sleep apnea. I’d bet the research articles mention SDB as one explanation for why patients might live longer, even though the Post didn’t make a comment on it. However, I doubt the research conducted pre and post weight loss sleep tests to find out what happened to the severity of SDB in these cases. That information might prove quite illuminating.

On this prostate quiz at www.healthcentral.com, question #7 asks about visits to the bathroom at night (nocturia). The assumption that pervades the medical community and the mainstream media is that this finding must signal prostate problems. Rarely do we find a story describing how nocturia was eliminated when the patient was evaluated and treated for sleep-disordered breathing. Yet, if you examine the science behind this incredibly common symptom, you’ll learn that sleep breathing causes an unnatural increase of blood flow to the right atrium of the heart, which then responds to relieve this “false fluid overload state” by secreting ANP, a natural diuretic in the body that signals the kidneys to make more urine. Even though nocturia is much more likely to be caused by sleep breathing problems, we still get outdated quizzes published on the web that continue to mislead patients to imagine that prostatism is the only explanation for visiting the bathroom at night. Those who use Positive Airway Pressure (PAP) therapy to treat sleep apnea have a much different and successful story to tell, and you can guess the happy ending: fewer or no trips to the bathroom, once sleep breathing problems are corrected.

In this short video on WebMD, the explicit discussion revolves around one man’s desire for a better night’s sleep, which will somehow be achieved by eliminating his snoring. The treatment he receives is polyester implants into the soft palate for the expressed purpose of stopping the vibrations of these tissues to reduce snoring. What’s the problem here? Actually a very serious one. At no point in the video do we learn whether the patient has been tested with an overnight sleep study (polysomnography) before the surgery or after to evaluate its effects. What would the sleep study show? In all likelihood, the patient has something far more medically significant than snoring; namely, sleep-disordered breathing (SDB), for example, obstructive sleep apnea or upper airway resistance syndrome. The standard of care in the field of sleep medicine requires the patient to undergo a sleep test before and after such treatments to determine to what extent the procedure has improved his condition. Many of these site-specific snoring surgeries provide scant relief of SDB. Some actually worsen SDB. We do not know the patient involved in this video and cannot comment on what he may or may not be suffering from. However, we can state categorically that patients who share some of his features, apparently a long history of snoring, a thick neck, dark circles under his eyes, and most importantly a recessed chin (often covered up by a beard or goatee) frequently test positive on a polysomnogram for obstructive sleep apnea or upper airway resistance syndrome. Was this patient informed of the need for testing before and after surgery? Did the patient receive a full explanation of the risks snoring carries for an SDB diagnosis. Was the patient evaluated by a sleep specialist for a possible SDB diagnosis? If not, then the standard of care established by the field of sleep disorders medicine was not met prior to the surgical intervention.

This article describes the use of the imagery technique we pioneered for the treatment of chronic nightmares, but in this study it was used for insomnia. Although a strong proponent of imagery work for the treatment of insomnia, in my forthcoming book Sound Sleep, Sound Mind I detail how imagery actually represents that natural way in which an individual falls asleep. It’s not some special new miracle treatment. Rather, imagery is a natural part of the human mind’s capacity to function while awake and serves as a gateway to sleep. Thus, imagery is not needed for breathing and relaxation as cited in the article. Instead, just by tapping into the natural process of observing images in your mind, you are more likely to fall asleep. Why? Because you are jump starting the little dreamlets that emerge in your mind’s eye at bedtime, which are the very last stage of consciousness before you nod off. Nearly all insomniacs possess the ability to work on imagery, but the most important first step for them is to realize that imagery skills are something they already possess; they just need to reacquaint themselves with their use.