Wellness

Wellness Requires O2 at Night – Part 1:  Stop the “Epi-drip”

This powerful hormone, epinephrine, more commonly known as Adrenaline® in its synthetic form, literally keeps untreated patients’ tissues and organs “awake all night” and likely wears out their bodies and brains sooner.  

By:  Michael G. Nathans

March 5, 2016

Sleep is a well-researched subject but many questions are not yet fully understood or answered.  For example, why do we fall asleep?  Why do we dream?  Why do some sleep walk, snore, pause breathing, have insomnia, night terrors, or wet the bed?  Why don’t we wet the bed?

What we do know is that a good night’s sleep is required for good health, and that a good oxygen supply is required for healthy sleep and good rest.

We also know that sleep-disordered breathing such as loud snoring and sleep apnea deprives sufferers of a good night’s sleep and wrecks lives.  Literally.

Harvard Medical School and McKinsey & Co estimated that untreated sleep apnea costs the U. S. economy $65B – $165B each year in fatigue-related accidents, lost workplace productivity and the treatment of chronic diseases.

Drowsy drivers are estimated to cause 100,000 police-reported crashes each year, resulting in an estimated 1,550 deaths, 71,000 injuries, and $12.5 billion in monetary losses. These figures may be very conservative, since currently it is difficult to attribute crashes to sleepiness.

The Harvard and McKinsey study estimated that 40% of those diagnosed with sleep apnea cannot tolerate continuous positive airway pressure (“CPAP”, the current gold-standard treatment achieving an average of 4 hours per night use in 75% of users) and quit, and another 20% never even try. It is no wonder 84% with moderate to severe sleep apnea are not diagnosed yet.

Sadly, we know that according to a survey conducted by the Better Sleep Council, a quarter of couples (26%) suffer “sleep divorce” and sleep in separate rooms.  The main reason is because one snores loudly and probably should be using CPAP, a dental mouth piece (mandibular advancement device – “MAD”) or a hypoglossal nerve stimulation implant from Inspire (only $30K).

Patients diagnosed with sleep apnea don’t try or quit CPAP because they are weak of will.

Would anyone call Justice Scalia weak of will? Yet, reports suggest the Justice was found dead with his CPAP machine turned off. Football star Reggie White also died in his sleep with his CPAP machine turned off.

Improperly fitted and adjusted (titrated), CPAP can be really uncomfortable.  Patients know this before they even try – just by looking at it.

CPAP is difficult to adjust to because of the mask and hoses attached to the face or nose all night, every night.  Also difficult to adjust to are the occasional “whistles” that wake patients up as air leaks out the edge of the mask – sometimes blowing onto their eyelids.  Some patients even present with esophageal dilation after CPAP use that is thought to be irreversible.

Unfortunately, the choice of alternative treatments that are safe, comfortable and efficacious is…well, not nearly good enough – yet.

For those who can tolerate using CPAP, they swear it is a life-saver. And make no mistake, it is for those 50% who can tolerate it.

MADs are currently the “Plan B” for sleep apnea patients, but MADs can cause bite changes, discomfort and TMJ.  Reportedly however, MADs can achieve similar outcomes as CPAP.

Far worse than CPAP and MADs for those who should use one or the other and don’t however, is no treatment at all.

One of the many adverse consequences of untreated sleep apnea are the natural micro arousals that actually prevent death during sleep.

There are many reasons why a natural micro arousal to a sleep apnea event is harmful.  But T.H.E. one reason that should “wake-up-and-shake” sleep apnea patients to the danger of going un-diagnosed and untreated is the nightly “epinephrine drip” that results from repeated natural micro arousals that keep them from suffocating – many times each night , night after night.

This powerful hormone, epinephrine, more commonly known as adrenaline in its synthetic form, literally keeps untreated patients’ tissues and organs “awake all night” and likely wears out their bodies and brains sooner.  

While sleep apnea is linked to the triad1 of heart disease, diabetes and cancer1, 2, as well as cognitive impairment3, the pathogenesis of epinephrine in untreated sleep apnea patients plays a life-saving role.  Yet, it is a contributor to these co-morbidities. 

What do you think is the main reason loud snoring and sleep apnea patients usually don’t die when they stop breathing at night?  Bed partner or roommate lifts the pillow off at the last minute?  No.

Not really.  Well…maybe sometimes.

But it’s actually the lack of oxygen (O2) – hypoxemia – and buildup of carbon dioxide (CO2) – hypercapnia – acting on the brain’s arousal mechanism to involuntarily save the patient’s life, but not necessarily wake them up.  When a natural arousal to an apnea event doesn’t wake the patient, it’s called a “non-cortical arousal” or “micro arousal”.

Patients with untreated moderate sleep apnea may have as many as 200 natural arousals or more each night.  Most of the arousals do not wake them, nor do they remember them in the morning.

The problem for untreated patients is that natural micro arousals in response to low Oand high CO2 cause the body to release (you won’t believe this) epinephrine among a myriad of other natural “juices” that re-start breathing but interrupt sleep many times each night – night after night, impairing health.

Epinephrine is the natural form of adrenaline and this hormone produces the “rush” of energy necessary to fight or flee – or figuratively get the pillow off your face, to restart breathing and save your life.

But it’s actually the lack of oxygen (O2) – hypoxemia – and buildup of carbon dioxide (CO2) – hypercapnia – acting on the brain’s arousal mechanism to involuntarily save the patient’s life, but not necessarily wake them up.  When a natural arousal to an apnea event doesn’t wake the patient, it’s called a “non-cortical arousal” or “micro arousal”.

Patients with untreated moderate sleep apnea may have as many as 200 natural arousals or more each night that they do not remember in the morning.

The problem for untreated patients is that natural micro-arousals in response to low Oand high CO2 cause the body to release (you won’t believe this) epinephrine among a myriad of other natural “juices” that re-start breathing but interrupt sleep many times each night – night after night, impairing health.

Epinephrine is the natural form of Adrenaline®.  This hormone produces the “rush” of energy necessary to fight or flee – or figuratively push the pillow off your face, to restart breathing and save your life.

In untreated sleep apnea patients, epinephrine is released when the body senses a lack of O2 and buildup of CO2.  This release of epinephrine and all of the other stresses on the patient’s cardiovascular system necessary to restart breathing while asleep, is about the worst way to try to get any rest. The body’s cells just can’t slow their metabolic rate, relax and restore themselves with the “epi-drip” necessary to sustain life in untreated sleep apnea patients.

Instead, every time epinephrine is released in response to the sympathetic (involuntary) nervous system to restart breathing, it causes a patient’s system to involuntarily manufacture glucose, proteins and enzymes to feed the muscles necessary to fight or flee.  In fact, this natural arousal is so involuntary, patients don’t really wake up or remember it in the morning.  But about half of untreated sleep apnea patients report excessive day time fatigue  – similar (but not the same) to those who sleep nearby someone who snores loudly.

While this life saving release of epinephrine acts to increase a patient’s blood pressure and heart rate to restart breathing, all of the body’s cells, tissues and organs get a “splash” of this powerful natural stimulant – the “epi-drip” – as many as 200 times per night, night after night – when they are supposed to be at rest.

Think about this for a minute.  The commercial synthetic form of epinephrine is commonly referred to as Adrenaline®.  This is the powerful stimulant that is loaded in an EpiPen for terminating anaphylactic shock and it is used to stop heart attacks.  Remember this infamous Pulp Fiction scene?

The natural release of epinephrine to restart breathing just one time, may be a much lower dose equivalent than an EpiPen, but an almost constant “drip” occurs during the night in untreated sleep apnea patients, night after night and year after year.

It is no wonder many are tired during the day and suffer heart conditions, diabetes and chronic diseases that diminish the quality of their lives and impact loved ones.

Imagine trying to sleep after an EpiPen injection or with a constant natural release of adrenaline every time you stop breathing – 200 or so times a night, which is common for untreated moderate-severe sleep apnea sufferers?

(So if you’ve read this far, be sure to

read  at least one more paragraph.)

Untreated sleep apnea is known to damage the left atrial wall of the heart.  This heart damage is caused by repeated constriction of blood vessels and spikes in blood pressure to fight or flee – or re-start breathing and continue life.

The problem is that this “natural” re-start is slowly but surely killing untreated patients – over and over every night without waking them – and they don’t remember it in the morning.

If you’re in the estimated 92% with un-diagnosed mild, moderate, or severe sleep apnea, this could be you.

If you are among the 52% of those diagnosed with sleep apnea, but who quit CPAP or a MAD, or never even tried, this likely is you.

Get diagnosed and treated if you snore loudly or have excessive day time sleepiness.  These are the warning signs you may be getting hundreds of small adrenaline shots each night, or an “epi-drip”, while you think you are asleep.

Two tests you can take yourself to determine if you should seek diagnosis and treatment for sleep apnea  are the Berlin Questionnaire and the Epworth Sleepiness Scale.  Remember, however that only about half of those with sleep apnea have day time fatigue.

 

References:

1 Susan Redline and Stuart F. Quan “Sleep Apnea: A Common Mechanism for the Deadly Triad—Cardiovascular Disease, Diabetes, and Cancer?” American Journal of Respiratory and Critical Care Medicine, Vol. 186, No. 2 (2012), pp. 123-124.
doi: 10.1164/rccm.201204-0657ED

2 Nieto FJ, Peppard PE, Young T, Finn L, Hla KM, Farré R. “Sleep-disordered Breathing and Cancer Mortality.  Results from the Wisconsin Sleep Cohort Study.”  Am J Respir Crit Care Med. 2012 Jul 15;186(2):190-4. doi: 10.1164/rccm.201201-0130OC. Epub 2012 May 20.

3 Lal C , Strange C, Bachman D. “Neurocognitive impairment in obstructive sleep apnea.”  Chest. 2012 Jun;141(6):1601-10. doi: 10.1378/chest.11-2214.

Dr. James Metz, DDS  themetzcenter.com video discusses OSA and epinephrine.  If you can’t tolerate your CPAP, get a mouth piece from a dentist near you like Dr. Metz.

 

What is epinephrine?  Professor Fink explains.

 

Epinephrine Signal Transduction Pathway lecture – *watch at 12:20*  Shows how untreated sleep apnea sufferers make glucose and other proteins and enzymes  in their sleep, that go unused. Metabolic pathways for this excess “fuel” and  these “combustibles” suspected of leading to diabetes and cancer.

Epinephrine release during sleep apnea episodes could be linked to:

*Diabetes* because epinephrine triggers cells to release glucose that goes largely unused while at rest, while suppressing insulin.

*Cancer* because epinephrine causes a cell’s nucleus to express enzymes and proteins that must be used by the cell to carry out some physiological function.  If the body is at rest or attempting to sleep when this is happening, the cell could build up “combustibles” i.e. production of proteins and enzymes in search of a metabolic pathway, that are harmful to normal cell structure and reproduction.

Tales from two drinking towns with a sailing problem.