The Reason For Asking My 3 Questions

[Steven Y Park, MD]

I asked everyone on this forum the following 3 questions:

1. do you prefer to sleep on your back, side or stomach?
2. did you or do you have cold hands or feet?
3. did or do either of your parents snore and do they have any medical problems?

Overwhelmingly, the answers were: mainly side and stomach only, the vast majority have cold hands or feet, and almost everyone has one or two parents that snore heavily with various degrees of heart disease. Many of you also complain of intense fatigue.

This sounds amazingly like what I see in patients with upper airway resistance syndrome. UARS is a mild variation or precursor to sleep apnea, but it's different in that it's typically seen in young thin women (and men) who don't snore, can't sleep on their backs, have cold hands or feet, have normal or low BP with lightheadedness or dizziness, chronic fatigue and unrefreshing sleep no matter how long one sleeps, various unexplained gastrointestinal problems, hypothyroidism, depression, and many others. Later on, as they gain weight many of these symptoms improve (especially the cold hand and dizziness), but begin to develop high blood pressure, diabetes, heart disease, heart attack or stroke.

Anatomically, they all have relatively narrowed jaws with very narrowed breathing passageways when on their backs. Due to gravity, the tongue (which takes up too much space within a smaller jaw cavity) falls, back partially, and then when in deep sleep, can obstruct completely due to muscle relaxation. If you stop breathing and wake up after 10 seconds, then that's called an apnea. If you stop breathing and wake up anywhere from 1-9 seconds, then you'll wake up to light sleep or be awake, but it won't get counted as an apnea. The minimum number of apneas you need every hour on average to receive a diagnosis of sleep apnea is 5. But if you stop breathing 25 times every hour and wake up after 2-9 seconds, then you're told you don't have any sleep apnea.

There is a significant group of people who stay in UARS, and with the chronic extra stress response due to the inefficient sleep with repeated arousals, their nervous systems and immune systems are heightened. Having a hypersensitive nervous system or immune system can have certain consequences. UARS patients have normal or heightened nervous systems, whereas OSA patients have diminished nervous systems.

Your anatomy is hereditary, so you got your smaller jaws from one or both of your parents. As people with UARS get older and gain more weight, they'll have the classic signs and symptoms of obstructive sleep apnea: severe snoring, breathing pauses, and medical complications such as heart disease, depression, heart attack or stroke.

I can't say if one definitely causes the other but I can say that there's a definitely link between MS and sleep-breathing problems. Some of you already have sleep apnea. I know it's impractical, but it would be interesting if everyone could get formal sleep studies to see how many people with MS have OSA or UARS. One is not exclusive of the other, so if you have a family history of snoring and heart disease, it's important to get checked for sleep apnea.

Snoring is a sign of major breathing problems at night, and is nothing to be laughed at. A heavy snorer should definitely be checked for sleep apnea, since untreated, it raises your heart attack and stroke rate by 3 and 5 times, respectively. Not to mention high blood pressure, obesity, depression, anxiety, heart disease, and Alzheimers (this one's controversial, but there's plenty of convincing evidence). Also, you don't have to snore to have significant sleep-breathing problems.

[ChunkyMonkeysMommy]

Wow, very interesting! Thanks for sharing with us! I can't remember the last time i woke and actually felt rested. I'm sure it has been well over six months ago. (My son is 6 months old, lol.) Even before that, I still felt groggy quite often, to the point that I would drive to or from work (1/2 an hour) and fall asleep driving! And if I didn't fall asleep, there were many times that I would be so 'out of it', for lack of a better term, and especially if I had a migraine, that I wouldn't even remember the drive, or would completely miss my turns, after driving the same route for four years.

[PastorDan]

Fascinating information.

As I mentioned somewhere in one of these threads (I think), I am undx for MS, but very frequently seeing what are possibly new signs of it, and working toward SOME dx, preferably NOT MS, of course.  However, I do have OSA, and have been on CPAP for the better part of the past year.  I think our oldest brother might be, also.  (Memory's one of my symptoms lately).  Also, our parents' snoring was often loud enough to wake us up when we were kids.  I have five living siblings and two we lost as infants (in 1962 and 1967) due to breathing problems.  No idea if this information tells you anything, but if it helps, use it.

[opie74]

You are definately on to something!  Even when I sleep for 8 hours, I am not rested.  I have TMJ problems.  When I sleep on my back, my jaw falls and hurts.  I am sure that it causes breathing problems.  When I sleep on my side, my jaw moves to the side and aches.  I did have my toncils out, my turbinates reduced, and my septom straightend last april.  That had made a HUGE difference in the way that I sleep.  I noticed afterward that I would wake up almost hungover from sleep.  As if Ihad not slept in years.  Maybe I had not!  I do have tightly fitting teeth, especally on the top, and I do not usually snore.

[Steven Y Park, MD]

Sorry, I pressed post by mistake before I was finished.

Even at 50%, do you think that all MS patients should get at least screened for sleep-breathing problems? Also, just because you don't have it when younger doesn't mean you can't get sleep apnea later on. hbananas' story could be a great example.

[Steven Y Park, MD]

Thanks for your comments, especially your MS specialist's reporting that 50% of MS patients have OSA or other sleep issues. If you add UARS, I'm sure that number will go much higher.

Even at 50%, do you think that all MS patients should get at least screened for sleep-breathing problems? Also, just because you don't have it when younger doesn't mean you can't get it

[hbananas]

Hi.  I haven't answered anything yet because I'm not diagnosed with MS, just a CIS of Transverse Myelitis.  However, now that you have spilled the beans, here's my response, because it fits so well:

1.  Side exclusively.  Used to like stomach as a kid, but not so much now because it makes my back hurt.
2.  Had cold hands as a teenager.  Now that I'm an overweight 50+ age, they are warm.
3.  Father snored like a chainsaw, was very obese, had type 2 diabetes, hypertension, and died of heart disease.  Mom was petite, but she died of heart disease when she was 49.

I've had a sleep study and am on CPAP, which has helped my fatigue tons.  I have high blood pressure and all that wonderful insulin resistance stuff.  I was having some sort of arousal to my sleep about 40 times per hour during my study, don't remember if that's the AHI index or not--will check later at home.  I had mostly hypopneas, a couple of apneas, and one mixed central/obstructive one.  My MS specialist neurologist is also my sleep doctor, and he sees OSA or other sleep disorders in something around 50% of his MS patients.