Sleep Apnea Does not Just Happen to Fat People. Sleep disorders are everywhere!
Despite what has been written about Obstructive Sleep Apnea, most people who have this disorder are not obese and there is nothing abnormal about the way their neck is formed. They do not necessarily snore and are not always witnessed to stop breathing. Most of my patients with daily headache did not have apnea, they just didn’t sleep, or didn’t have REM sleep. I was puzzled by why all of my patients had abnormal sleep. What would affect every age group, all over the world. By accident I stumbled on vitamin D deficiency. There are scientific articles showing that the sleep switches have vitamin D receptors. If vitamin D plays a role in how we sleep could that mean that we could fix these problems instead of just patching them with a sleep apnea mask or a sleeping pill?
Why do we Sleep?
We sleep to repair and replenish our supplies. Every night we make chemicals like thyroid hormone, insulin, serotonin, dopamine, interferon. We make enough to last 16 hours then we run out, and we have to go to sleep to make more. We don’t grow a third arm during the night but we do actually re-make ourselves to look the same, every night. That means if we are not able to get into and stay in deep, paralyzed sleep every night our organs begin to fail. We get heart disease or liver disease, or kidney disease, or high blood pressure. Most authors attribute our widespread sleep problems to “not doing it right”; we “stay up too late”, we’re “too busy”. I disagree, I believe that sleep is completely involuntary, you can’t “do it wrong” if you don’t sleep normally there’s something wrong with you! This site exists to explain what happened to you and how to fix it! First, some basics about how doctors talk about sleep:
Light Sleep and Deep Sleep
The first stage of sleep is Light Sleep, a “waiting phase” to be sure we “are in a safe place to get paralyzed”. Light sleep is still sleep but we are still moving about and wake easily. Light sleep is recorded on the hypnogram below as a horizontal line. REM sleep is in black, recorded at the top. Light sleep is drawn below REM but above Slow Wave sleep. There are two phases that we consider Deep Sleep; Slow Wave sleep depicted below as “Deep slow sleep”, and Rapid Eye Movement (REM) sleep. The major difference between light sleep and deep sleep is that in deep sleep we are paralyzed and performing the “work” of sleep. Children grow in slow wave sleep and probably, adults repair during slow wave sleep. Memory work is thought to happen in both REM sleep and slow wave sleep.
Repair in Slow Wave Sleep
In slow wave sleep the brain wave pattern becomes slow, steady and regular. As we enter this phase there begins to be a pulsatile release of Growth Hormone. This is the same hormone we use to grow as children. In kids the growth hormone is a steady flow and they grow, while paralyzed, in deep sleep. In adults this same hormone is released in pulses. I believe that this growth hormone acts as the “boss hormone” calling all the specific repair hormones; bone, muscle, tendon, joint, vein, hormones to come out as a “repair crew” to repair any injury that occurred during the day. If we move inappropriately during deep sleep the repair crew has to stop and wait, and they don’t finish. If your repair phases never get completed the parts that are moving hurt the next day. And when it happens night after night they get “worn out”. Then the doctor tells you that they’re “bone on bone” and you get them replaced. Your knees were supposed to last you your whole life, if the repair phase is happening correctly they don’t just wear out! That also implies that our body can actually re-build those joints. If we can mend a broken bone we can also re-make a joint, given the right circumstances and enough time perfectly paralyzed in the healing phases of sleep.
Why Do We Get Paralyzed?
There is a small switch in the posterior brain stem that paralyzes us when we enter deep sleep ( Nucleus reticularis pontis oralis, caudalis) . This switch has wires that run to every muscle in our body including our throat, face and diaphragm. It allows us to be running and screaming in our dream without actually moving and hurting ourselves or our family. This paralysis protected us from being found and eaten while we were sleeping under a bush thousands of years ago. Obviously, if we paralyze the chest and diaphragms we stop breathing and die, and if we don’t swallow our own spit from time to time we drown, so the paralysis “switch” has to do this just right. To be able to fine tune this complicated process the paralysis cells are broken up into three groups; mouth and throat, chest and diaphragm, and “all the rest”. In some phases of sleep we paralyze just the arms and legs, in other phases we paralyze the mouth and throat along with the arms and legs. We get the most paralyzed of all while we’re dreaming in REM sleep.
Posterior brainstem viewed from the back
What Happens When we Don’t get Paralyzed Correctly?
Sleep apnea and inappropriate movements in sleep, like kicking or talking happen because the paralysis switch is “wobbling”. We get “too paralyzed”, (which results in “sleep apnea”), some of the time and “not paralyzed enough” other times. Often, both happen in the same person. If the mouth and throat are slightly too paralyzed, as we suck in air our throat collapses, preventing the flow of air. The brain senses that there is no air flowing and it wakes us up to light sleep. As soon as we get to light sleep we are no longer paralyzed, we open the airway again and then fall back into deep sleep. Even though this saved our life, every time we wake to light sleep and move a little, the repair crew stops working. If the normal repair phase is frequently interrupted the repair cannot happen normally. Every part of the body that’s still moving or “tensed up” instead of paralyzed doesn’t get fixed and those parts will hurt when you wake up. I believe that this is the origin of fibromyalgia.
Why REM-related apnea is important
During REM sleep we are the most paralyzed of all, only the diaphragms are still moving. Getting slightly “too paralyzed” may happen only in REM sleep. “REM-related apnea” means stopping breathing only in REM. Interrupted REM sleep robs us of the ability to repair our brain. Many people with REM related apnea have trouble with memory and are depressed or anxious. REM related apnea may be a milder, earlier form of the severe “sleep apnea” seen in the person who stops breathing in every stage of sleep. Frequently this abnormality is not reported on the sleep study or is inappropriately averaged into the entire night. If you have only a half hour of REM (should have 2 1/2 to 3 hours) and you stop breathing, interrupting this phase, 8 times (every four minutes) your sleep study report says: 8 apnea episodes per 8 hours of sleep, which averages out to 1/hour therefore the “Apnea Hypopnea Index”(how many times per hour did you stop breathing or breathe less deeply than normal) = one per hour which is “not significant”. You were just told that your sleep study was normal, when it is very, very abnormal. You have none of the deep sleep that allows your brain to think normally, even the half hour of REM that you do have is interrupted every four minutes! This sleep abnormality was very common in my daily headache sufferers, they frequently had very little or no REM sleep and usually that finding was not mentioned on the formal report, though it was clearly there in the sleep measurements.
Vitamin deficiencies cause Sleep Disorders
Vitamin D deficiency is probably the most common hormone deficiency in today’s modern world. Vitamin D used to be thought of as the calcium and bone vitamin, it is not a vitamin. It is a hormone that we make from cholesterol on our skin from the sun. D is not in the food, it’s a chemical we make. If you wanted to get enough from the milk supplementation you would have to drink 1,000 cups a day. D hormone is made from the sun to link the body’s metabolism to the length of the day. In the summer, more sun exposure and high D hormone signals the body to make more muscle, make stronger bones, and make the stomach work faster. High D signals the body to use all the food we eat to produce energy and build our body instead of storing it. We sleep less but more efficiently, so we’re up harvesting our crops or gathering food. In the winter the UVB light goes away and our D level goes lower. Low D signals the body to sleep longer, gain weight and hibernate. Hormone D is used by every organ in our body to do its job correctly. People who are D deficient are essentially in permanent winter; they get depressed, feel less active, sleep longer but don’t feel rested, they get sick more often and stay sick longer. The obesity does not cause the sleep disorder, they both come from vitamin D deficiency, and that means they can be fixed! See also vitamins and sleep.
How much Vitamin D Should I Take?
Over the last 30 years, as we’ve been advised to stay out of the sun, most Americans have become D hormone deficient. The FDA recommendation of 800 IU per day is way too low, but there’s a reason for their recommendation. Having a vitamin D level that is too high is just as dangerous as one that is too low. D levels above 80 ng/ml also cause sleep malfunction. Based on careful observation of over 5000 patients there’s a narrow band between 60–80 ng/ml where the sleep is best.
The FDA has been put in the unenviable position of recommending a dose of a hormone (not a vitamin) to every American. They have purposefully and wisely chosen to recommend a tiny dose. This is a hormone that fluctuates in normal humans, month to month and year to year based on where you live, how much sun exposure you have and the color of your skin (which determines how fast we make D). There is no way to recommend a single, correct dose for every person. The FDA recommended dose has nothing to do with the vitamin D dose that you should take, you must find out how much your body needs. And the dose you need will not be the same as your relatives or your neighbors and it may change as you get older.
Other Vitamins for Normal Sleep:
D deficiency is the most common cause of all of the sleep disorders but B12, B5 and iron deficiency also play a role. Most people become B12 deficient because they are D deficient. Low D makes the parietal cells of the stomach produce less intrinsic factor. Intrinsic factor is a special protein that binds to the B 12 in our food to help us absorb it. Low D leads to low intrinsic factor and then to low B 12. People with known B12 deficiency should have their D checked and replaced. If only the B12 is replaced, usually the sleep improves temporarily but worsens again. B12 shots are not better than pills. Daily oral dosing of 1000mcg of B12 per day is better. See the vitamins and sleep section for a more complete description of what you’ll need.
Other Neurological Disorders:
Each one of us has a genetic deck we’re dealt the day we are born. Each night we “shore up” each of these genetic weaknesses. Many neurological disorders such as headache, tremor, vertigo, epilepsy, tics, (every genetic disorder where a nerve cell is “switching on inappropriately” instead of quietly doing its job) can also be affected by bad sleep. That means a genetic disorder that’s been there since the day you were born can present now because your sleep is disordered. Fix your sleep and your headaches will go away. Many neurological disorders have been reported to be related to vitamin D deficiency: Parkinson’s disease, dementia, psychosis, depression, epilepsy, autism, ADD, gait disorders, vertigo. I believe they are related to D’s connection to sleep.
Could my Kids have Sleep Problems too?
Sleep disorders are not isolated to adults. Kids can be tired, listless or restless because they don’t sleep well. It is not normal for a child to have a hard time falling asleep. “Normal” teenagers who “can’t” fall asleep until 1:00 am have vitamin D deficiency. Before puberty the most common problem is an inability to get out of bed in the morning for school. After puberty most teens can’t fall asleep or stay asleep and they’re inappropriately fatigued or need more sleep than other people just to operate normally.
Sleep and Psychosis:
We all know that you can make someone “crazy” by sleep depriving them, we’ve seen it used as a form of torture on TV. People who try to sleep but can’t can develop severe sleep deprivation over time. The sleep switches are designed so that we can never, ever be awake and asleep at the same time. What would it be like to dream while we’re awake? Distracting at the very least, frightening at worst. Dreaming while we’re awake, produces what we call “crazy”; hearing or seeing things that aren’t really there. That means that many people who “go crazy” do so because of a sleep disorder. Sometimes it’s called “bipolar” or “depression”. What ever the name, that person is no longer able to make the brain chemicals that make us happy, content and reasonable. They never get to the phase of sleep where those chemicals are made. “Psychosis” or seeing or hearing things that aren’t really there, has also been linked to both B12 and D deficiency. Post partum depression may be linked to the D deficiency produced by pregnancy. That means we could potentially fix this!!
Other B Vitamins and Sleep
B 12 is not the only B vitamin that affects sleep. Pantothenic Acid (B5) is absolutely necessary for normal sleep. And just like with vitamin D there’s a narrow band of dosing that works for each person. Overdosing with B5 can cause agitation and insomnia, so it’s important to understand how to use the B vitamins correctly.
It’s a little known fact that 7/8 of the B vitamins are made by our intestinal bacteria. This means that we have always carried around B vitamin generator bacteria in our bodies. Because our normal intestinal bacteria need our vitamin D, passed down to them in the bile, when our D goes low the normal bacteria die off and are replaced by the “bad bacteria” that don’t make vitamins for us. We want those B generator guys back again! Unfortunately no one has measured how much of each B vitamin the normal bacteria produce daily or hourly, but I think it makes the most sense to try to get the intestinal bacteria back, they were always the natural supply and they play a huge role in our health, and our sleep. Correcting the intestinal bacteria is part of what you will accomplish with the RightSleep® regimen.
I realize that it’s pretty hard to know the state of your poop bacteria but, if you have irritable bowel symptoms, chronic body pain, burning in the hands and feet, balance difficulties, foot swelling, or bad sleep, it is likely that your poop bacteria are not normal. Antibiotics were in common use thirty years before the the term irritable bowel syndrome came into common use so I do not think that the antibiotics are to blame for the change in the intestinal bacteria. My patients were able to improve their bowel complaints with a regimen of vitamin D and B50 that you will use to help your sleep and your gut both, come back to normal.
What do those little guys want in order to grow back?
Current suggested treatments for the “wrong” intestinal bacteria are probiotics and fecal transplants (poop from one person given as an enema to another person to implant the “right” bacteria). Neither of these work for very long. I think the problem is not the supply of the bacteria it is the intestinal environment. We have to supply the happy, helpful bacteria what they need to thrive and they’ll replace the bad guys. My experience has been that the “happy, helpful” bacteria need the proper amount of vitamin D (enough so we aren’t sucking up every bit of it for our own use, this is usually a D25OH blood level of greater than 40 ng/ml. ) plus larger doses of B vitamins for about 3 months. See also the FAQ section and sleep and vitamins section.