Mouth Exercises Significantly Reduce OSAS

Tongue and throat exercises have been found to reduce neck circumference and improve the symptoms of obstructive sleep apnea, according to an article in the May 15 2009 Am J Respir Crit Care Med entitled "Effects of oropharyngeal exercises on patients with moderate obstructive sleep apnea syndrome."

BMI and ABD circumference did not change significantly, but neck circumference did in the tongue exercise group (n=16, 39.6 +/- 3.6cm) vs the null group (n=15, 38.5 +/- 4.0 cm) with a p value <0.05. Sleep apnea measures like snoring frequency/intensity, daytime sleepiness/sleep quality score and apnea-hyponea index were also decreased.

This is an exciting alternative to CPAP, which many patients dislike because they have to wear a mask that blasts air down their throats to sleep. If they are willing to be compliant with exercises that strengthen their throat muscles and reduce their neck size, then I would certainly refer them to the following video below for some example exercises:

Exercises include: brushing the tongue with a toothbrush, putting the tip of the tongue on the soft palate and sliding the tongue backward, pronouncing vowels quickly or continuously, and keeping the tongue in a certain position when eating.

Download the Video of Oropharyngeal exercises

References:
Am J Respir Crit Care Med. 2009 May 15;179(10):962-6. Epub 2009 Feb 20.
WebMD: Tongue Exercises May Ease Sleep Apnea

hat tip to Clinical Cases and Images

Author's Note:
I am not trying to infringe on copyright by posting the video to my blog... I am just trying to eliminate one extra step for the viewing of something that I find very interesting and want to share with others. If it proves to be a legal problem in spite of the fact that I posted the public links to the article as well as the link to download the video for personal use, then I will remove the video from my site.

Sleep Hygiene: a self-critique

I recently prepared a presentation on sleep apnea and sleep hygiene. I tacked on the bit about sleep hygiene because it's a concept that's quite foreign to me and I wanted to learn more about it. Quite frankly, I suck. I routinely go to sleep around 3 or 4am and I take a nap in the afternoons to try to catch up on my sleep deficits. On days when I can't take a nap, my mind wanders, I yawn a lot, I feel on the edge of nodding off around 3 or 4pm.

Here's some of the basics about it:

• Areas important to sleep hygiene:
• Circadian rhythm
• Aging
• Stress
• Common social or recreational drugs like nicotine, caffeine, and alcohol

1. Adapt your habits
   o Set a bedtime and waking time (no sleeping in more than 2-3 hours on weekends)
   o Avoid napping (if you do, make it short and before 3 pm)
   o Avoid EtOH, caffeine, heavy/spicy/sugary foods 4-6 hours before bedtime
   o Exercise! (but not right before bed)


2. Adapt your environment
   o Comfortable bed, comfortable temperature, dark room
   o Block distractions (NO TV, NO computer for at least an hour or more before, but radio is OK)
   o Only two S’s for bed
   o Proper positioning


3. Prepare yourself nightly
   o Light snack (warm milk)
   o Relaxation techniques
   o No worries in bed!
   o Pre-sleep ritual


4. Problems?
   o If you don’t fall asleep in 20 min, go do something else (like reading) until sleepy (~20 min later)

And here's my self-critique.

My waking time varies every day. Basically, I set it as late as possible so I can sleep in because it's just so hard for me to get up in the morning. I nap around 4-5pm whenever I can, which is usually 2 or 3 times a week. My naps are about 1-2 hours long, depending on what finally rouses me (usually hunger). On the plus side for me, I hardly ever snack late at night (but it's not really a problem for me to go to bed once I'm there. It's more an issue of studying when I feel most mentally alert... it's just unfortunate that it happens to be 10pm onward.


My environment for sleeping is pretty good. I actually sleep on a bed now, which different from the ~20 years of sleeping on a futon at home (the parents' place) One of my S's is lacking... I've pretty much replaced it with another S: studying.


My pre-sleep ritual usually involves brushing my teeth for close to half an hour while I browse blogs on the internet (or on especially good days, I decide to blog!) Perhaps an unwise decision, since the lights from the computer screen and the content of the blogs stimulate me and I decide "oooh, another 15 min wouldn't hurt..." and before I know it, it's 3am and I've got class at 830 tomorrow.

So my sleep hygiene is about as bad as it could be. If I want to start sleeping earlier and reset my circadian rhythm to a more decent hour, I've got to exercise more, stop my midnight blog browsing, and stop studying in bed. I should have a warm glass of soy milk, settle in with a book and read for about 15 minutes before turning in at midnight.

Ha! I wonder if that's even possible to manage, med school and beyond.

References:
http://www.umm.edu/sleep/sleep_hyg.htm
http://www.webmd.com/sleep-disorders/guide/sleep-hygiene
http://www.cdc.gov/sleep/hygiene.htm

Munchausen by proxy

I first learned about Munchausen syndrome by proxy through the movie Sixth Sense, where young Cole conquers his fears and learns why he is being haunted. A young girl shows him a videotape revealing that her mother intentionally poisoned her to keep her sick! WTF?!? People really do that?!? I felt ill. It was totally outside of my realm of comprehension. In our last Unit on Neurology and the Musculoskeletal system, one tutorial group had a running gag when they hypothesized about the diagnoses for the cases: ascending paralysis? Munchausens. bouts of mania and depression? Munchausens. kids having trouble walking? Munchausens by proxy. headache? I think you get the point.

Browsing through my blog reader today, I came across this:

A Redlands mother of four was accused of Munchausen syndrome by proxy, fabricating or inducing illnesses in her own children
-LA Times, via the Lone Coyote @ Medical Student Musings

It certainly must be frustrating to deal with hypochondriacs... even more so with hypervigilant parents! Every little cough or sniffle becomes a sign of some impending disaster to the point where the doctors become desensitized to the Truth. Just because someone is seeking attention for a medical illness that they read about on the internet doesn't mean that they are Attention-Seeking and worthy of only a cursory exam and subsequent dismissal.

Perhaps this is just my naivete and inexperience speaking, but the patients with the irritatingly vague and persistent complaints may just BE the ones who deserve the most attention and cognition. Maybe, just maybe, they have a genetic condition like Ehlers-Danlos Plus (though I couldn't find it definitively on OMIM) with a chiari malformations that could explain the seizures, centralized sleep apnea and joint dislocations.