I know perfectly well the principle of ayurveda that one of the worst things I can do for my health is to go to bed after 10 pm. At both mid-day and midnight, the hours between 10 and 2 are pitta time — the natural principle associated with metabolism. Pitta is strongest at noon and midnight. That’s why it’s best to have your biggest meal of the day at noon, when your digestion is strong. And you have fuel for the rest of the day’s work. Midnight pitta functions like a self-cleaning oven, burning off impurities. However, if you are awake at this time, the rise in pitta will make you hungry and if you eat, your body will have to metabolize the food and will miss its chance for housecleaning. The increase in pitta between 10 pm and 2 am also increases your energy and alertness, which is what makes many people feel they’ve gotten a second wind and convinces them that they are night owls, especially if their mind-body type is predominantly pitta.

However, knowing this has not helped me cure my night owl ways. Well, that’s not entirely how it goes. Often, I’m falling asleep around 9 pm, but I have to stay up to see my father to bed. He’s usually not sleepy until 10 pm. By the time he’s tucked in, because pitta has started to come up, I feel alert and can’t sleep. If I start to read blogs, I’m often up until 2 am (and if I start to write a post in response to something I’ve read, then I can be up until 4 am or later). Then I can get a full night’s sleep but still feel not quite awake during the day. I have not been able to break this cycle.

However, now I think I can break the cycle because now I don’t just know what to do: I know why. Recently I’ve been reading The Ageless Woman by Dr. Nancy Lonsdorf, whom I have known since she was in medical school at Johns Hopkins. She points out that one powerful ayurvedic remedy is accessible and affordable for almost everyone: a morning walk. It supports and balances prana vata, which governs the functioning of the mind. I did try a morning walk, and it was wonderful. But I didn’t realize how important a morning walk could be in helping me to break my night-owl cycle, recover my clarity and be fully alert and energetic all day until I read this at Caring.com (boldfacing mine):

7. You get a full night’s sleep but feel groggy all the time or get sleepy while driving.

What it’s a symptom of: This signals circadian rhythm problems or, more simply, getting out of sync with night and day. Irregular sleep patterns, staying up late under bright lights, working a shift schedule, using computers and other devices in bed, and having too much light in the room while you sleep can disrupt your body’s natural sleep-wake cycle.

Why it interrupts sleep: The onset of darkness triggers production of the hormone melatonin, which tells the brain it’s time to sleep. Conversely, when your eyes register light, it shuts off melatonin production and tells you it’s time to wake up. Even a small amount of ambient light in the room can keep your body from falling into and remaining in a deep sleep. The use of devices with lighted screens is especially problematic in terms of melatonin production because the light shines directly into your eyes. This light is also at the blue end of the spectrum, which scientists believe is particularly disruptive to circadian rhythms.

What to do: Try to get on a regular sleep schedule that’s not too far off from the natural cycle of night and day — and preferably the same schedule all week. (Experts recommend 10 p.m. to 6 a.m. or 11 p.m. to 7 a.m. every night, but that’s just a general outline.) If you struggle with not feeling alert in the morning, go outside and take a brisk walk in daylight to feel more awake; you’ll find that it’s much easier to fall asleep the following night. This is also a trick experts recommend to help night owls reset their internal clocks. Force yourself to get up and get into bright light one or two mornings in a row and you’ll be less likely to get that “second wind” and burn the midnight oil or experience nighttime sleeplessness.

As much as possible, banish all screens (TVs, computers, and iPads) for at least an hour before bed. Reading is much more sleep-inducing than looking at a lighted screen, but make sure your reading light isn’t too bright and turn it so it doesn’t shine in your eyes. Remove night-lights; if you need to get up in the middle of the night, keep a small flashlight next to your bed, being careful to turn it away from you. Check your bedroom for all sources of light, however small. Does your smoke alarm have a light in it? Put tape over it. Use an alarm clock without a lighted dial, or cover it. If your windows allow moonlight and light from streetlights to shine in, install blackout curtains or shades tightly fitted to the window frames. Don’t charge laptops, phones, cameras, and other devices in your bedroom unless you cover the light they give off.

Regarding the advice about blacking out all the lights in your bedroom while you sleep — this is real. Research shows even a pinpoint of light disturbs your sleep. My sleep improved dramatically about four years ago when I began to sleep with eyeshades, so if you can’t get your room completely dark, I suggest they’re worth a try.

P.S.

I’ve been trying to get Dad out in the sunlight, especially to go swimming, but mostly I can only get him to sit on the front porch and listen to “Prairie Home Companion.”

Note: Another version of this piece is posted at RightNetwork. My agreement with them is that I can cross-post the pieces I write for them here after four or five days. However, it was so significantly re-written that I am posting my original piece tonight. It is NOT about de-cluttering — it is about exactly what it says: if you find that you clutter and can’t keep your environment orderly and clean, it could be a symptom of a health problem and your life may be at risk.

Here is what I originally wrote:

If your environment is cluttered, whether at home or work or both, the worse your problem is, the more you need to look at your health as its cause. The good news is that when you feel better, you will have the energy and organizing power you need to clear your clutter and make your environment glow with orderliness and well-being.

The first things to look at are your exercise and sleep habits. Aerobic exercise – even brisk walking – for at least 20 minutes helps your body clean house at the cellular level because it increases your circulation. It’s like the cells are better able to throw out their garbage when the blood is circulating more rapidly, probably for the same reason that a quick-moving stream of water washes things away, while water that is slow-moving, or stagnant, does not. Somehow that seems to translate from the micro level to the macro level. My own experience is that 20 minutes of aerobic exercise gives me two or three days of being able to tackle clutter more effectively. However, it took three or four months of exercising regularly for me to notice this benefit because I was so out of shape when I started. So don’t be discouraged if it takes awhile before you really experience the de-cluttering benefits of exercising.

Another part of your daily routine to look at if you are a clutterer is how much sleep you are getting. If you aren’t sleeping as much as you need to in order to wake up feeling refreshed, you won’t have the clarity to make all the decisions necessary for keeping your environment in order. You won’t have all the energy you need, either. Plus, you might see pounds pile on as you eat more calories than you need to get the energy you should have gotten from a good night’s sleep. To learn how to pay off your sleep debt and establish good sleep habits – called “sleep hygiene” – try the “Three-Week Sleep Camp” program, which you can do in your own home, in The Promise of Sleep, by Dr. William Dement, one of the pioneers of sleep medicine.

In addition to improving your exercise and sleep habits – or if you find you can’t because you just don’t feel well enough – three signs that you may have health problems you need to address to stop cluttering are as follows: waking up still feeling tired, daytime sleepiness and feeling sluggish mentally and physically. While sleep deprivation alone can make you feel sluggish, it doesn’t hurt to see your doctor to rule out a thyroid disorder. The blood test to check whether your thyroid is not producing enough thyroid hormones is called the “TSH” test. It actually measures the hormone from the pituitary gland that regulates the thyroid gland. If you need to start taking thyroid medication, it may take a few months to find the right dose, but you’ll be amazed at how much better you feel. You’ll regain the energy and mental clarity you need to clear your clutter.

However, if you still feel lethargic and sleepy even if your thyroid is fine or your thyroid medication is at the correct dose, you may have a sleep disorder. Don’t expect your primary care physician to understand sleep disorders – sleep medicine is so new that you really need to see a sleep specialist to determine if your symptoms are due to a sleep disorder, and if so, ensure it is correctly diagnosed and treated.

One of the common sleep disorders that can be associated with cluttering is obstructive sleep apnea (OSA). In OSA, the airway collapses when you are sleeping so little or no air gets to your lungs. However, your brain still tells your body to breathe – breathing against a sealed airway puts enormous strain on your heart and lungs, which is exhausting. Then, when your blood oxygen falls to a certain point, your brain sends a signal to wake up – at least enough to open your airway. What OSA sounds like is at least 10 seconds to a couple of minutes of silence, followed by an explosive snore as the airway opens. OSA is a potentially deadly condition because severe exhaustion, a normal dose of a painkiller or normal consumption of an alcoholic beverage can dull the brain so much it can’t send the signal to wake up.

While the daytime sleepiness associated with untreated obstructive sleep apnea will rob you of the energy and clarity you need to enjoy life and keep your home clutter-free, sleep deprivation isn’t the only problem caused by OSA that can lead to cluttering. OSA also causes oxygen deprivation during the periods that the airway is collapsed. A person with OSA may not be getting air for up to 40 percent of the time he or she is asleep. This can cause damage to the part of your brain responsible for executive function – see here and here – which you need to have in good shape to be able to keep everything in your life in order. Since current research suggests executive function damage due to sleep apnea is resistant to treatment, it seems better to be safe than sorry and consult a sleep doctor if you really just can’t seem to keep your environment in order.

This clip includes the intro music for all five seasons of “Get Smart” and the 1989 reunion movie:

Fun fact: “Get Smart” is my father’s favorite comedy.

I have learned the hard way that I have to exercise to think clearly and function well, and these rewards are so obvious to me that I dread missing my exercise classes and time on the cross-trainer.

So I was delighted to come across a piece in the New York Times about what kind of exercise to do to, well, get smart — here are the highlights, but I recommend reading the whole piece (boldfacing mine):

For some time, researchers have known that exercise changes the structure of the brain and affects thinking. Ten years ago scientists at the Salk Institute in California published the groundbreaking finding that exercise stimulates the creation of new brain cells. But fundamental questions remain, like whether exercise must be strenuous to be beneficial. Should it be aerobic? What about weight lifting? And are the cognitive improvements permanent or fleeting?

Other recent studies provide some preliminary answers. In an experiment published in the journal of the American College of Sports Medicine, 21 students at the University of Illinois were asked to memorize a string of letters and then pick them out from a list flashed at them. Then they were asked to do one of three things for 30 minutes — sit quietly, run on a treadmill or lift weights — before performing the letter test again. After an additional 30-minute cool down, they were tested once more. On subsequent days, the students returned to try the other two options. The students were noticeably quicker and more accurate on the retest after they ran compared with the other two options, and they continued to perform better when tested after the cool down. “There seems to be something different about aerobic exercise,” Charles Hillman, an associate professor in the department of kinesiology at the University of Illinois and an author of the study, says.

Similarly, in other work by scientists at the University of Illinois, elderly people were assigned a six-month program of either stretching exercises or brisk walking. The stretchers increased their flexibility but did not improve on tests of cognition. The brisk walkers did.

Why should exercise need to be aerobic to affect the brain? “It appears that various growth factors must be carried from the periphery of the body into the brain to start a molecular cascade there,” creating new neurons and brain connections, says Henriette van Praag, an investigator in the Laboratory of Neurosciences at the National Institute on Aging. For that to happen, “you need a fairly dramatic change in blood flow,” like the one that occurs when you run or cycle or swim. Weight lifting, on the other hand, stimulates the production of “growth factors in the muscles that stay in the muscles and aren’t transported to the brain,” van Praag says.

What then of the Taiwanese mice, all of which ran? According to the investigators, mice on a running wheel “usually show little improvements in the conventionally defined” measurements of fitness, like elevated muscle strength and improved aerobic capacity. They enjoy themselves; they don’t strain. Those on the treadmill, meanwhile, are forced to pant and puff. Jen says researchers suspect that treadmill running is more intense and leads to improvements in “muscle aerobic capacity,” and this increased aerobic capacity, in turn, affects the brain more than the wheel jogging.

Does this mean we should relinquish control of our workouts to a demanding coach? Jen cautions against assuming human bodies work exactly like those of rats. But there are lessons from his work. “It would be fair to say that any form of regular exercise,” he says, if it is aerobic, “should be able to maintain or even increase our brain functions.”

Thanks to Little Miss Attila, I just read the New York Times story from 8/24/09 based on information obtained in Texas from court documents regarding the investigation into the death of Michael Jackson on June 25. The documents name the cause of death as the anesthetic propofol, which should never be used outside of a hospital because of the degree to which it suppresses breathing.

So why do I say Michael Jackson died of a sleep disorder? Because he would not have demanded, manipulated, bribed and coerced doctors and nurse practitioners to give him the propofol and other drugs to make him sleep if he did not have a sleep disorder, which was probably undiagnosed, and definitely was not being treated appropriately. Even so, Jackson was so willful that it appears he disregarded the advice of any health professional that disagreed with the treatment and drugs that Jackson desired. So Jackson also died of his own willfulness.

The New York Times piece gives the most complete timeline I’ve read to date of the events surrounding Jackson’s death, but I think they have one thing wrong. Jackson was probably dead as a doornail by the time his personal physician, cardiologist Dr. Conrad Murray, returned to his side after leaving him to go to the bathroom. And waiting 82 minutes from discovering Jackson not breathing until calling 911? In the movies that time would be spent on getting rid of evidence.

Also, Cherilyn Lee has been identified in other news stories as a nurse practitioner. Nurse practitioners are allowed to prescribe medications when they are practicing under a doctor’s supervision. That is why Jackson approached her begging for a prescription for propofol. Ms. Lee refused and cautioned Jackson.

So — Michael Jackson may not have died of obstructive sleep apnea, but the root cause of his death is still a sleep disorder because he told the medical professionals appeasing him — you can’t say “treating” — that he just wanted to sleep.

Billy Mays

I know the coroner’s report says that Billy Mays died on June 28 of a heart attack just shy of his fifty-first birthday. I know that the toxicology report released August 7 says that he had used cocaine a few days before his death and that cocaine use exacerbated his hypertensive heart disease and contributed to his death. I know statistics on heart disease from the American Heart Association show that the first sign of heart disease for one-third to half of people who have it is suddenly dropping dead. I know Mays went to bed the night he died saying he didn’t feel well.

However, I think the real cause of death for Billy Mays was obstructive sleep apnea.

Let me explain by starting with some background from the Miami Herald, which summarizes the coroner’s report released Aug. 7 as follows — I boldfaced the most important sentence:

While heart disease was the primary cause of his death, the medical examiner listed cocaine as a “contributory cause of death.”

The medical examiner “concluded that cocaine use caused or contributed to the development of his heart disease, and thereby contributed to his death,” the office said in a press release.

The office said Mays last used cocaine in the few days before his death but was not under the influence of the drug when he died. Hillsborough County spokeswoman Lori Hudson said nothing in the toxicology report indicated the frequency of Mays’ cocaine use.

Cocaine can raise the arterial blood pressure, directly cause thickening of the left wall of the ventricle and accelerate the formation of atherosclerosis in the coronary arteries, the release said.

The toxicology tests also showed therapeutic amounts of painkillers hydrocodone, oxycodone and tramadol, as well as anti-anxiety drugs alprazolam and diazepam. Mays had suffered hip problems and was scheduled for hip-replacement surgery the day after he was found dead.

Pill counts also showed Mays was using his prescription pain and anxiety medications as prescribed.

I am unaware of any autopsy test for death by obstructive sleep apnea, so I expect coroners do not look for it or consider it as a cause of death.

Here’s the thing: research shows obstructive sleep apnea contributes to heart disease even more than cocaine use. Specifically, it has been found to be a cause of intractable high blood pressure (= hypertension), atrial fibrillation and idiopathic congestive heart failure. OSA is not what made Mays’ heart atherosclerotic, but it could have contributed to its enlargement related to hypertension. The reason that obstructive sleep apnea affects the heart is that during an obstructive apnea, your body still goes through the motions of breathing, even though the airway has collapsed and is sealed shut — trying to breathe against this vacuum causes an enormous strain on the heart. (I started playing the bassoon again in 2003 three months after I was diagnosed with OSA. The pressure of playing long notes is comparable to trying to breathe against a sealed airway — it took five years from my diagnosis before I could play long notes without my heart going crazy the way it did during long apneas.)

Obstructive sleep apnea results in sleep deprivation, because it jars you slightly awake hundreds of times a night, usually without your being aware of it. But it also results in oxygen deprivation because the amount of time your airway is shut and you are not getting air can add up to almost half of every hour you are asleep. Oh, and by the way, the reason it doesn’t add up to a half hour OR MORE of every hour you are asleep is that once you reach that amount of time without air, you are circling the drain and could die any time. That’s because there’s a feedback system in the body between the level of oxygen and carbon dioxide and when the carbon dioxide level gets too high, the brain stops sending the signals to breathe.

When a person with undiagnosed obstructive sleep apnea takes therapeutic doses of medications for pain and/or anxiety — which means the normal dose on the correct schedule, not an overdose — they can die because those medications make it just hard enough to wake up that it is easy to cross that point of no return in the level of carbon dioxide in the blood that stops the brain from sending the signals to breathe — that is, which causes central apneas. (This situation is ditto for alcohol consumption or using recreational drugs, even in small or moderate amounts.)

In addition to his hypertensive heart disease, one of the things that convinces me that Billy Mays had obstructive sleep apnea is his use of cocaine a few days before his death. If he really had a drug problem, it would have been in his system when he died. No, the deprivation of sleep and oxygen from obstructive sleep apnea make you sleepy and foggy during activity. Billy Mays was famous for his energy and enthusiastic sales pitches. Cocaine perks you up. I think Billy Mays was self-medicating with cocaine to treat the sleepiness and fogginess resulting from his undiagnosed sleep apnea.

But the main reason that I think what really killed Billy Mays is obstructive sleep apnea is that just before I was diagnosed with obstructive sleep apnea one Percocet (acetominophen plus oxycodone) almost killed me. I took it for the worst sinus headache of my life. I woke up gasping for air, diaphoretic, with a thready pulse I could just barely detect and I vomited for several minutes — these are all signs of cardiac distress. My symptoms were bad enough that I called 911 and they took me to the hospital where my cardiologist did three days of tests, including an angiogram, before giving up on determining the cause of the problem (he doesn’t quite grasp the connection between heart disease and sleep disorders). I might have died if I hadn’t also had six cups of coffee that day.

What I hope will result from my writing this post are that more people who have daytime sleepiness will see a sleep specialist for an evaluation, and if needed, a sleep study. I also hope that more cardiologists will learn about the research connecting sleep disorders as a cause of various types of heart disease. And I hope that coroners will figure out a way to determine in an autopsy whether the cause of an unexpected death during sleep was caused or exacerbated by obstructive sleep apnea.

I also hope that the very real possibility that Mays was self-medicating due to symptoms of undiagnosed obstructive sleep apnea rather than addiction may restore some lustre to his reputation and comfort his fans and family.

P.S.

When someone is sleeping and stops making the sounds of breathing, the cause is most likely to be obstructive sleep apnea. You can see an animation here. Remember, the brain is still sending the signals to breathe, even though the airway has collapsed and no air can get through — which is why you do not hear breathe sounds — so you will see the motions of breathing. If the silence lasts longer than 10 seconds and happens more than 10 times an hour, or daytime sleepiness seems excessive, then it’s a good idea to consult a sleep specialist. Not your family doctor — sleep medicine is VERY new. A sleep SPECIALIST. Seriously.

Update, 8/10/09: The life-saving coffee was Hair Raiser, a proprietary blend from Caribbean Coffee Company in Santa Barbara, which is liquid alertness without any jitters:

Hair Raiser coffee proprietary blend from Caribbean Coffee Company; organic blend also available.

see more Funny Graphs

Today Michael Jackson’s nurse practitioner and nutritionist — she is licensed in both fields — Cherilynn Lee, told reporters that five days before his death, Michael Jackson begged her to order a drug that is ONLY for use in hospitals for anesthesia — where patients are intubated to keep their airway open and on a ventilator that breathes for them — or in intensive care — ditto on the intubation and ventilator. (Nurse practitioners are allowed to prescribe drugs.)

The generic name of the drug Jackson sought is propofol and its brand name is Diprivan. It is given intravenously and burns, so the local anesthetic Lidocaine is usually given with it. (I assume the Lidocaine is either given as a topical spray to numb the IV site, or as a sub-cutaneous or intramuscular injection near the IV site.) Lidocaine was found near Jackson’s body when his breathing stopped.

While propofol could have stopped Jackson’s breathing and killed him because those are two of its side effects, the secondary cause of his death has to be his undiagnosed and untreated sleep disorders — at the least, he had insomnia. Yet I’ve heard nothing about Jackson being referred to a sleep specialist for evaluation, diagnosis and treatment. If he couldn’t sleep, he had a sleep disorder. He went to other specialists for particular problems. But for a sleep problem, Jackson was not referred to a sleep specialist and did not consult with one on his own.

Dr. Sanjay Gupta blathered on CNN about how he’d consulted anesthesiologists to get them to explain to him the use of propofol. Yet Dr. Gupta said nothing about how Jackson was desperately seeking medical help for a sleep problem AND YET NO ONE SENT HIM TO A SLEEP SPECIALIST. The thought that Jackson should have been under the care of a sleep specialist was not a cloud on Dr. Gupta’s horizon.

Instead, because Jackson has had so many surgeries and therefore had anesthesia so often — which put him to sleep — when he could not sleep he sought treatment with an anesthetic and an anesthesiologist. That is, he went after the drug and medical specialty he associated with SLEEP. He was not trying to get high. He just wanted to sleep, according to the statement of Ms. Lee, who strikes me as ethical and on-the-ball. But she only knew enough to refuse to order propofol for Jackson, or find him an anesthesiologist. But she did NOT know enough to round up a sleep specialist for Jackson and get a sleep study done on him stat.

Let me say this again. Jackson clearly had a sleep disorder that was tormenting him out of his mind — as sleep disorders do. YET NO ONE INSISTED HE CONSULT A SLEEP SPECIALIST — the doctor who has the expertise that could have helped him get the good night’s sleep he craved.

Really, gentle readers, sometimes I think it’s like the journals that print sleep research are published with ink and pixels visible only to other sleep researchers.

Here are a few of the specialties that should know enough about sleep research to refer patients to a sleep specialist:

Cardiologist: because sleep disorders can cause atrial fibrillation, intractable high blood pressure and idiopathic congestive heart failure. The cardiologist can treat those conditions, but will have greater success when the underlying sleep disorder causing all the trouble is treated, too.

Endocrinologist: because half of people who have hypothyroidism have obstructive sleep apnea, too, but blame their fatigue on the titration of their thyroid dose or the thyroid hormones prescribed. Also because endocrinologists treate people with diabetes — the sleep disorder frequently precedes the weight gain.

Psychiatrist: because they diagnose depression without ruling out hypothyroidism and obstructive sleep apnea and bipolar disorder without ruling out restless leg syndrome.

Neurologist: because people with multiple sclerosis very often have insomnia. (Note to regular gentle readers: my late life partner, Margaret, had MS and insomnia and for our first few years together felt so delicate about her sleep that we slept in separate bedrooms. Then an abusive member of her family visited and I gave up my room and had to sleep in the same room with Margaret. She felt so safe and slept so well that she insisted we sleep in the same room after that. So we did. She never had insomnia again.)

Rheumatologist: OK, on this one the only research I know about is that alpha waves during deep sleep are associated with fibromyalgia. Plus, my personal experience that I had agonizing joint and muscle pain that almost completely vanished after I began CPAP therapy.

Oh, and family practioners and internists should be referring people to sleep doctors, too, when patients complain of poor sleep or daytime sleepiness.

Whatcha wanna bet that NONE of the cable news channels or major networks or major newspapers or blogs have the slightest glimmer of awareness that Jackson is dead because he had a SLEEP disorder and did not seek care from a SLEEP SPECIALIST.  And yet I expect they will go over again and again that he had sleep problems.

Make the connection, people! Make the connection!

Because it takes six-to-eight weeks for toxicology reports to be completed, it may be that long before we have a definitive answer on the cause of Michael Jackson’s death. But there is one likely cause that I believe cannot be detected by autopsy: obstructive sleep apnea. And I think the combination of sedating drugs and obstructive sleep apnea (OSA) may turn out to be the cause of Jackson’s death — although I doubt that the complicating factor of undiagnosed OSA will even be considered by the coroner.

This is a shame because I think the combination of sedating drugs and OSA is what really caused the deaths of Heath Ledger, Anna Nicole Smith, John Belushi,  Judy Garland and Marilyn Monroe.

In obstructive sleep apnea, the throat collapses totally and seals the airway so that no air gets through to the lungs. People who witness this hear silence instead of the sound of breathing, then usually look to see if the sleeper has motions of breathing. When they see motions of breathing, they assume the sleeper is OK. Actually, they are watching the sleeper beginning to die. However, usually as the oxygen level in the blood falls, the brain sends a sharp signal to wake up, which causes the sleeper’s body to jerk and the airway to open. The opening of the airway is usually accompanied by the sound of a snore.

What happens when the sleeper with OSA is in very advanced stages of the illness, or has taken sedating drugs or alcohol, is that the apneas become so long or so frequent that the body’s feedback system based on the balance between the levels of oxygen and carbon dioxide in the blood causes the brain NOT to send signals to breathe. In effect, the brain has a procedure for shutting down the body in a sequence that ends in death. Apneas caused by the failure of the brain to send the signal to breathe are called central apneas. (BiPAP ST respirators can detect central apneas and prompt breathing, but there is no other treatment for central apneas.)

I would source everything I’m saying, but I’m late for an appointment and I know all of this because I have OSA and it nearly killed me and also my father. It’s been a long road back.

Obstructive sleep apnea is one of the top under-diagnosed conditions because it was only discovered in the late 1970′s in the course of research on sudden infant death syndrome. The treatment of a CPAP respirator was not developed until the 1980′s. And sleep research in general is still a very young field and the specialists whose fields treat conditions that may have their source in OSA or another sleep disorder do not read sleep medicine journals.

This is particularly a problem when it comes to the relationship between cardiology and sleep medicine. For example, the first research connecting OSA as the cause of idiopathic congestive heart failure was published in 1996. My father has this condition and I’ve gotten him an extra six years of productive life by getting his OSA treated with a CPAP, and later, BiPAP, respirator, plus a pacemaker in December 2008 at the age of 92.

Other heart conditions that research shows are caused by OSA are atrial fibrillation and intractable high blood pressure. If you’re wondering about the connection, imagine the strain on your heart when you continue to go through the motions of breathing when your airway has collapsed and is sealed shut. (I was going to ask you to try to breathe while holding your hand over your mouth, but it is possible that some people could die trying that experiment, so just use your imagination.)

Other conditions that go along with untreated OSA are migraines and a ferocious amount of joint and generalized body pain. (I don’t have research for the second one, just my personal experience. However, fibromyalgia may be caused by a sleep disorder associated with alpha waves occurring during deep sleep when they shouldn’t.)

The bottom line is that OSA can cause depression and a lot of pain, and doctors may treat those symptoms with drugs that depress the breathing center. In Michael Jackson’s case, he is reported to have had the painful condition of lupus and a variety of other aches and pains that required Demerol. If Jackson had undiagnosed OSA, then it is far more likely that ordinary doses of pain medications could have led to his death, especially if he was exceptionally tired for any reason, such as rehearsing for his comeback tour. (By the way, if Jackson slept alone that was another factor dooming him, because there was no one to notice his symptoms or complain about his snoring and haul him to a sleep specialist.)

The foundation for my speculation is that just before my own diagnosis of OSA, I was in some of the worst pain of my life. I took one Percocet and woke up after such a long apneic episode with so many symptoms of cardiac distress that I had to call 911. I spent three days in the hospital getting heart tests and an angiogram before heart disease was ruled out. The cardiologist was stumped. The answer came two weeks later during my sleep study when my symptoms of OSA were so severe the tech got permission to switch to titrating the pressure for my respirator the first minute he could.

I hope my readers with symptoms like heart arrhythmias, chronic migraines, atrial fibrillation, intractable high blood pressure, idiopathic congestive heart failure, depression and hypothyroidism (yes! research suggests half of people with hypothyroidism also have OSA) will consider discussing their symptoms with a sleep specialist, especially if they also have trouble sleeping and/or daytime sleepiness.

Update, 6/29/09: The British tabloid The Sun has published a story based on leaked info about Michael Jackson’s autopsy results. He was 5’10″ tall but weighed only 112 lbs., 1 oz., at death. His stomach contained only half-digested pills. His body was covered with needle marks from being injected with pain medication three times a day for many years. It is reported he  had been barely eating for months. I now think the most likely cause of his death was failure to thrive, or inanition, due to his use of painkillers and assorted health problems.