When one of my Heart Sisters posts was picked up by MedPageToday’s popular blog Kevin MD.com in December, I was thrilled by the response that this article attracted. But one of the most intriguing reactions came from Dr. Steven Park of New York City.
Dr. Park is a sleep specialist and author of the book Sleep Interrupted.
In the 20+ stories from the women I interviewed for my original article (How Does It Really Feel To Have A Heart Attack? Women Survivors Answer That Question), he spotted many whose early cardiac symptoms matched those typical of undiagnosed sleep disorders.
His comments on KevinMD.com were so compelling that I’m rerunning them here for you:
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From: Dr. Steven Park, published on KevinMD.com, December 31, 2010:
“Wow! I was riveted while I read through the entire post. We know that younger women can have heart attacks, and it’s acknowledged that doctors are not good at picking up heart attack symptoms in younger women.
“Here are a few observations that I had:
1. Many of the women had heart attacks from 3-5 a.m. One study has shown that people with obstructive sleep apnea have heart attacks during this timeframe, as compared to earlier in the morning in people who don’t have sleep apnea and have heart attacks.
2. Many women also described severe heartburn as a major symptom. If these women were having a sudden increase in the number and severity of apneas, then it’s expected to have more severe reflux, due to the negative pressures in the chest. One woman, Lidia, had too much to eat and drink for her birthday. Alcohol relaxes your throat muscles, and additional reflux from stomach juices can cause more obstructions and arousals.
3. One woman described recent 10 pounds weight gain—an additional risk for obstructive sleep apnea.
4. I also noticed how many women either were pregnant or post-partum. Weight gain during pregnancy is a major risk for obstructive sleep apnea, which can lead to pre-eclampsia and gestational diabetes. That’s also why pregnancy complications are linked to a higher rate of heart disease – because you’re at risk for having obstructive sleep apnea. Post-partum, the protective effect of progesterone is gone (progesterone tenses your upper airway dilators), and more frequent breathing pauses can tip you over the edge.
5. I’m willing to bet that many of these women snored, but it’s also been shown that you can be young, thin and not snore to have significant obstructive sleep apnea. What I’m sure of is that one or both parents of these women snores heavily, with major cardiovascular disease. Typically, these women won’t be able to sleep on their backs, due to smaller oral cavity jaw structures, which narrows the posterior airway space. Deep sleep will relax the muscles, making them more prone to breathing pauses.
6. Some of the women also mentioned casually that they were sleep deprived. Not sleeping enough can be a major trigger to cause major sympathetic stimulation when normally, you’re not ever able to get efficient sleep at all.
7. I bet that most of these women, even when younger, never felt refreshed, no matter how long they slept. Typically, these women will attribute their fatigue to anemia, stress, TMJ, sinus infections, migraines, hypothyroidism, insomnia or chronic fatigue. Many will also have cold hands or feet, and oftentimes, blood pressure will be on the low side, especially when younger (later on, the BP normalizes, and then goes high). This is called upper airway resistance syndrome, a variation of obstructive sleep apnea, where you can stop breathing 10 to 20 times per hour and not have official sleep apnea on a sleep study.
“It’s important to pick up the atypical symptoms of heart attack in women, but what’s just as important is to treat what’s actually aggravating if not causing the heart disease. If this had been done months or years prior to their heart attacks, many of these cardiac events could have been prevented.
“In these women, there was usually some trigger that tipped them over the edge, whether it’s weight gain, eating late, severe stress, drinking alcohol, pregnancy, or even weather changes. There’s so much proven evidence showing that most people with heart disease have (or will have) significant obstructive sleep apnea.
“Physicians have to erase the image of the traditional sleep apnea patient as being overweight, snoring, male, with a big neck. Sleep apnea is a craniofacial, anatomic problem due to smaller jaws. Obesity comes later, which only makes the problem worse.”
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In a later email to me, he observed:
“There are so many variables involved when it comes to heart disease, and unfortunately, modern medicine tries to reduce it down to one variable. I have to admit, I’m guilty of it myself. However, the way I justify emphasizing sleep as a major culprit that’s not addressed is because breathing is THE MOST fundamental process you have to do to not only survive, but to thrive.”
According to Dr. Park, all modern humans are susceptible to breathing problems at night to various degrees, and only the end extreme of this spectrum is called obstructive sleep apnea. Interrupted breathing leads to interrupted deep sleep, which causes a massive physiologic stress response, which can heighten your nervous and immune systems.
The root cause, he explains, is under-developed jaws, with narrowing of the upper airway from nose to voice box area. The additional inflammation that arises within your airways and your body narrows the upper airway even further, causing more obstructions. Over time, poor sleep causes hormonal and metabolic changes that can promote weight gain (which narrows the throat even more).
Dr. Park claims that doctors still believe that most people are able to breathe properly while sleeping, and that sleep breathing disorders like obstructive sleep apnea is something that only older, heavy-set, snoring men with big necks have. But he explains:
“This couldn’t be further from the truth. We know that young, thin women can have not only numerous apneas, but just as many non-apneic breathing pauses. These shorter obstructions will still keep waking you up from deep sleep to light sleep, without it showing up as an apnea.”
He recommends routine screening for sleep-breathing problems with simple patient questionnaires, and believes that if this were possible, the rates of heart attacks would go down significantly. He cites many studies showing that untreated sleep apnea is a major risk factor for heart attack, stroke, and sudden death.
There’s also a known link between regular physical exercise and sleep quality. Sleep specialist Dr. Qanta Ahmed of New York’s Winthrop University reminds us that exercise promotes the most rejuvenating component of sleep. She explains:
“Slow-wave sleep, also called Stage 3 sleep or delta sleep is the deepest stage of sleep from which it’s hard to rouse an individual. We also call this sleep slow-wave sleep because when we measure the brainwaves, quite literally the frequency of the waves is very slow, and the waves are very tall and deep. This slow-wave sleep is what gives us a sense of feeling restored in the morning and when we miss this sleep, we feel this in our joints and muscles – that familiar flu-like feeling of just not having had enough sleep.”
She adds that another benefit of physical exercise concerns its ability to speed up our metabolism and in the process elevate the body temperature deep in our core.
“We burn a lot of energy while engaged in exercise, even if we are just walking briskly, and this energy generates heat. It takes the body hours to cool down by tiny degrees in order to return to our resting baseline. This cooling of our body temperature invites better sleep.”
Find out more about sleep disorders from Dr. Steven Park.
♥ NEWS UPDATE, January 12, 2012:
Women with Severe Sleep Apnea at Increased Cardiovascular Risk
Women with severe sleep apnea are at increased risk for cardiovascular death, according to a study in the Annals of Internal Medicine. However, treatment with continuous positive airway pressure (CPAP) may reduce this risk.
Researchers followed over 1,100 women who were referred to sleep clinics in Spain for suspected obstructive sleep apnea. Over a median follow-up of 72 months, women with severe sleep apnea were at greater risk for cardiovascular death than women who didn’t have apnea. This increased risk was not observed in women who received CPAP treatment or who only had mild-to-moderate apnea.
The authors write:
“Our results suggest that, similar to that reported in men, severe [obstructive sleep apnea] may be an independent risk factor for cardiovascular death in women, and that adequate CPAP therapy may protect against this outcome.”.
Q: Have you experienced a link between sleep breathing disorders and your heart disease?