Monday, November 24, 2014

Sleep Apnea - What is it? What can help? The Didgeridoo?

Each time you breath in, muscles in your throat, chest and diaphragm help you inhale; air flows from your nose and mouth into your lungs  - the breath of life.  During your waking hours your breathing is usually regular and automatic, unless you suffer from asthma or other lung diseases.  Throat muscles are important, although we are generally not aware of their action, by keeping the  airway open and stiff so inhalation is easy. When you sleep, these throat muscles may relax, narrowing your airway.  Normally, this narrowing doesn’t prevent air flow in and out of your lungs.  But if you have sleep apnea, your airway can become partially or fully blocked because of factors like these: 
*Your throat muscles and tongue relax more than normal.  Aging may play a role here.
*Your tongue and tonsils may be large compared to the opening into your windpipe.
*Overweight may cause extra fat tissue to thicken the wall of the windpipe, narrowing it and making it harder to keep open.
*The shape of your head and neck may result in a smaller airway size. 

Apnea is a word that means the suspension of breathing.  During sleep apnea, when the opening to the windpipe is narrowed or closed, people snore loudly and/or stop breathing for a time. Breathing may stop for up to a minute. Blood oxygen levels drop, triggering the brain to disturb sleep.  This helps to tighten airway muscles and open the windpipe.  Normal breathing starts again, often with a snorting sound.  When this happens repeatedly during the night, drops in oxygen levels and constant waking can result in the release of stress hormones.  A risk of high blood pressure, heart attack, stroke and irregular heartbeat is increased.  People with this condition often have excessive daytime fatigue because of sleep disturbance.  They often do not experience REM sleep and do not have dreams. 

Sleep apnea can be greatly helped by  a device called CPAP – continuous positive airway pressure, as well as by certain dental devices.  Many people with sleep apnea have used these treatments, which are important and helpful.  However, it is not easy for everyone to get used to these treatments and use them regularly. Weight loss is also helpful for some people with sleep apnea.

Since the human mind is infinitely inventive, new treatments that involve breathing techniques were bound to emerge. Instructors teaching the didgeridoo noted that their students reported reduced daytime sleepiness and less snoring after practicing the instrument for several months.  In Zurich, a group of doctors, respiratory therapists and sleep therapists decided to test the proposition that training the upper airway by digeridoo playing would reduce daytime sleepiness, due to training the muscles of the upper airways that control airway dilation and wall stiffening.  The recruited 25 patients, average age 50, who had moderate sleep apnea and were willing to learn the didgeridoo.  Half the patients became a control group, who had to wait for 4 months before taking the didg training.  The patients had weekly lessons, and were told to practice for 20 minutes 5 times a week.  They were instructed in circular breathing.  Apparently the practice was enjoyable, as compliance was excellent – the subjects practiced 6 days a week, and there were no dropouts.  The same was true of the control group, who started didg playing 4 months later.  The study found that patients had reduced daytime sleepiness and snoring – the effectiveness of didg playing was slightly less than that of regular CPAP use, but still notable.  The study was published in the British Medical Journal in 2006.

A study in Australia looked at the effectiveness of didgeridoo playing on boys with asthma.  The comparison group was singing lessons for girls.  Asthma is a problem for 15% of Austrian Aborigines, probably because of poverty and poor living conditions.  Girls are not supposed to play the didgeridoo in public for cultural reasons.  Asthma relief was more pronounced for the didg players than the singers. Playing the didg has a pronounced effect on lung capacity, relaxation and the ease of controlled breathing.  The study was published in Music and Medicine in 2013.

I have been taking classes in didgeridoo playing in Petaluma, and have found playing the instrument to be calming, mesmerizing, and helpful for my lungs. I love the sound of the low vibrations. Other people in the classes have found improvement with their sleep apnea.  The teacher, Elise Peeples, will be giving an introductory class in January as well as continuing lessons.  The classes will take place on Saturday morning in Petaluma.  I plan to post fliers about the classes and also give them to local doctors who may want to refer their patients.  Feel free to contact me if you are interested.  Full disclosure – I am crazy about wind instruments. 
Sadja Greenwood, MD, MPH  Back issues on this blog!

Tuesday, November 4, 2014

The Color Purple

I ‘m not referring to the amazing novel by Alice Walker, which won the 1983 Pulitzer Prize and the National Book Award for fiction.  I’m not writing about the movie with Whoopi Goldberg, Danny Glover and Oprah Winfrey, directed by Steven Spielberg, although I am planning to see it again.  I’m writing about (you guessed it) the benefits of purple foods, such as, purple cabbage, the skin of eggplant, purple corn, black rice, raspberries, cherries, blueberries, blackberries, cranberries, blood oranges, dark grapes and red wines. The dark red and purple color in these foods contain a pigment known as anthocyanin, which may appear red, purple or blue depending on the pH. 

Anthocyanins occur in the leaves, stems, flowers, fruits and roots of many plants.  Their colors attracts pollinators and other animals, enhances the scattering of seeds, and also protect plants from sun damage. 

Researchers at Ohio State University have done studies on human colon cancer cells and in rats, to determine what gives anthocyanins cancer –protective properties.  Extracts derived from purple corn were the most potent, with chokeberry and bilberry extracts also effective in reducing colon cancer cell growth in laboratory dishes. The researchers said that only small amounts of anthocyanin is absorbed by the blood stream in animals, but a large portion travels through the gastro-intestinal tract, where tissues absorb the compound. Anthocyanins may also help with esophageal cancers.   The researchers also noted that plant pigments such as anthocyanins could be used instead of synthetic dyes to color foods and enhance their health-promoting properties.

A comprehensive review of anthocyanin consumption and human health was published by an Italian research center in 2013.  They cited papers showing that anthocyanins  can protect against heart disease, obesity and diabetes, and gave rodent pancreatic cells increased insulin secretion.  Anticancer activity was found in leukemia cells, colon cancer cells, oral cancer cells, and other forms of cancer.  Laboratory studies have shown that anthocyanins can inhibit malignant cell growth, and stimulate apoptosis (tumor cell death).  The authors cited studies showing potent anti-oxidant activity of anthocyanins, which is enhanced by the other phytonutrients and vitamins in fruits.  Studies have shown neuroprotective  activity in animals with brain injuries, memory problems and visual decline with aging.  Recent studies also indicate that anthocyanins can inhibit the growth of some pathogenic bacteria, and may enhance the growth of healthy bacteria in the intestinal tract. 

What inspired me to write this column were the purple yams now on sale at the Bolinas People’s Store.  They are deep in color and amazingly good.  I also recall that Dr. Donald Abrams, an integrative oncologist at UCSF’s Osher Center, has said that he eats a yam every day of the year.   My advice:  Try those yams and also purple potatoes.  Once you plant the little Peruvian potatoes in your yard (gopher proof area) they will keep on giving, I have some ready to plant – call me if you want a few.  They are hardy in the winter. Include berries in your diet as often as possible, including frozen berries during the winter months.  Stock up on the cranberries now in season, and freeze some for later.  Eat prunes – they are purple plums and are high in anthocyanins.  Get purple popcorn and black rice at a natural food store.  Just think of the color purple; it’s powerful. 
Sadja Greenwood, MD, MPH – back issues on this blog