"To sleep, perchance to dream..."
Therein truly lies the rub, as Hamlet continues to muse in his famous 'To be or not to be' soliloquy.
What does that have to do with all maladies? It might sound more than a bit far-fetched, but in my opinion, every chronic condition that develops in priorly healthy people - diabetes, cancer, auto-immune diseases, Alzheimers (regrettably not HIV/AIDS) have a common starting point in that they have been preceded by sleep disturbances and circadian rhythm disruptions of some kind. Some studies investigate whether Sleep Disordered Breathing(SDB) is a symptom of those conditions, but there is increasing evidence that it is a precursor.
(Full disclosure, I work in a medical device company that makes ventilators and sleep therapy devices. My musings are a result of much reading on the subject, not a substitute for actual medical advice.)
Let's take an example.
Bob is born a healthy 8 lb baby. He grows into a healthy young man who is quite active and athletic well into his late 20's. He becomes a successful employee, working his way up the ladder, paying the penalty of less exercise on the way, even as he continues to eat like the average American, a relatively well-balanced-if-heavy-on-meat diet. His hours of work start to stretch into the wee hours of the morning, and his sleep is no longer restorative. He becomes mildly irritable and consults a doctor to account for this loss of energy and tiredness. The doctor does all the requisite tests, which show insulin resistance building up, increased cholesterol levels and high blood pressure. He is prescribed a regimen of pills to help with lowering these, and a dietary regimen to match, with recommendations of increased exercise. He starts off with the best of intentions, but falls by the wayside a few weeks later. It is just too stressful, along with the miscellaneous side effects of the medications, to try and revert to the previous state of unconscious 'wellness' . A few years later, one of his doctors has the presence of mind to ask about whether he snores - he is at least 50 lbs overweight at this point, with medication not adequately controlling his other health issues. His wife affirms that he is a champion snorer. Out comes the prescription pad, with a recommendation for a sleep study, where he is diagnosed with severe Obstructive Sleep Apnea (OSA). He is prescribed a CPAP (abbreviation for Continuous Positive Airway Pressure) machine, which is basically a blower that maintains a near steady pressure to prevent pauses in breathing (apneas) that occur when he sleeps, due to collapse of soft tissues in his throat. It's cumbersome, inconvenient, having to wear a mask and be tethered to a machine while one sleeps. But it currently presents Bob with his surest bet at starting to get restorative sleep,and regaining energy and brain power to reverse the slide of his overall health.
If this sounds too infomercial-like, consider the alternative, which happens more frequently than not. Bob tries and fails to use the CPAP. He goes back to his medications and snoring, develops a heart condition a few years down the line and dies of a massive heart attack by age 55. Or, he develops an aggressive cancer that rapidly worsens (the deoxygenation of blood that occurs during apneas is conducive to feeding tumors) and dies after much chemotherapy/relapse of a secondary cancer.
Substitute Bob with Mary, gynecologic conditions/ breast cancer as one of the health bugbears, breathing problems during sleep not necessarily because of OSA, but issues with small upper airway anatomy, called Upper Airway Resistance Syndrome. A very similar scenario to the above could play out, in her case, even if she is of normal weight.
The more I read, the more I am convinced that it has all to do with a good night's sleep, or the lack therof. Once diagnosed, the treatment options are few and inconvenient with poor patient compliance (CPAP) or effectiveness ( about 50% at best, with oral appliances and/or surgery). So let's look at prevention. Is it possible to nip this in the bud?
As it turns out, there are doctors and dentists who are convinced it is possible to do so, based on the perfect dental arches they have seen in ancient skeletons vs. modern. They theorize that proper jaw alignment and dental occlusions are a major contributor in maintaining what is called 'patent airways' i.e. being able to breathe without any obstruction or restriction in air flow. Our modern lifestyles of artificial feeding for babies leads to poor craniofacial and jaw development which may be worsened by dental/orthodontic treatments to align teeth into 'perfect smiles'.
As a net result, we end up with airways that are prone to complete collapse, worsened by accumulating fat around the throat and/or loss of muscle tone with age.
So it is perhaps part of the human condition, with preventive measures that must be applied before the kid is out of the cradle.
Either way, if you suspect a sleep problem with excessive drowsiness and/or snoring, it is well worth of checking to see if sleep apnea or UARS is a possible cause, treating it with CPAP (optimal) or dental devices or surgery, before taking the route of medication to control the conditions that are aggravated by the breathing problems. Many a patient has found that treating the apnea has mitigated the need for other medications to control blood pressure, blood sugar, heart conditions, etc.
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