This Just In: Feeling Lackadaisical? Sleep Apnea Could Be to Blame

From HealthDay News.

"Millions of Americans plod through each day exhausted. Not because they're working too hard, over-exercising or not taking enough vitamins.  The real reason, experts say, is because they unknowingly have a sleep disorder.

As many as 18 million Americans have obstructive sleep apnea, according to the National Sleep Foundation. But researchers estimate that as many as 90 percent of them don't know they have it.  Sleep apnea causes people's airways to become blocked while they sleep, depriving them of the oxygen the body needs. 

Many people with sleep apnea are chronic snorers. Their partners probably complain of loud snoring during the night, which may or may not be accompanied by gasping or choking sounds. People with sleep apnea are often startled awake many times during the night as the body becomes starved of oxygen. Often, though, people don't even realize that they've briefly woken up. 

However, it's these numerous interruptions in sleep, though brief, that can cause severe daytime sleepiness. "It's such a slow process that it can go on for years," said Dr. Joyce Walsleben, an associate professor of medicine at the New York University School of Medicine in New York City. "People think, 'Oh, I'm older, it's normal not to be as peppy,' and they blow off their symptoms."

Sleep apnea can be particularly difficult to uncover in women, she said. "Unfortunately, women don't snore as much," Walsleben said. "They tend to report vague symptoms of not feeling well or having a sense of depression or anxiety."

The effects of too little sleep, however, can go beyond feeling tired during the day.

"Besides a lack of energy and the byproducts of too little sleep, sleep apnea can increase your risk of a car accident by as much as 15 times the normal risk," said Dr. Steven Park, an integrative sleep surgeon at Montefiore Medical Center in New York City. "It also puts you at greater risk of industrial accidents." 

In addition, he said, sleep apnea increases people's risk for a host of other ailments, including type 2 diabetes, high blood pressure, heart disease, heart attack, stroke and early death.  "I've seen estimates that life expectancy is lowered by 20 years if you have untreated sleep apnea," Park said. 


What causes an airway to close during sleep can vary from person to person. Obesity is a major risk factor because it narrows the airway. A tongue that's too large for the jaw can fall back and block the airway. And, in some people, Park said, a narrow passage through the nasal cavity or chronic allergies also can cause sleep apnea.

The standard way to diagnose obstructive sleep apnea has been to have an individual spend a night in a sleep lab, where the quality of the person's sleep is monitored along with the number of episodes of apnea, when breathing stops for 10 seconds or longer, or of hypopnea, when breathing nearly stops. A sleep apnea diagnosis requires more than five episodes of apnea or hypopnea an hour while asleep, Park said.

Today, though, at-home studies can be done, too, though Walsleben said that home tests don't give as much information as an in-lab sleep study. 

But "for the vast majority of people," Park said, at-home studies are sufficient. "You have many less leads, and it's much simpler and much more conducive to sleep when you're at home," he said. People who have other medical conditions, such as heart disease or nighttime leg movements, that could mimic sleep apnea symptoms still should have a study done in a sleep lab, he said. 

Once diagnosed, doctors generally prescribe continuous positive airway pressure, or CPAP, to treat sleep apnea. "A machine blows general positive air pressure and keeps the throat open," Park said, adding that the flow of air can be adjusted so that it's not too weak or too forceful. The person usually wears a mask connected by a tube to the machine.

"CPAP is the gold standard in sleep apnea treatment, and people should be encouraged to try it," Walsleben said. "If one mask isn't comfortable, there are others you can try." She said the machines have more options these days, and options such as a heated humidifier can make the device more comfortable to use. "It can take trial and error, but don't give up," she advised. "Talk to your physician." 

 Park agreed, saying that five to 10 common problems with CPAP can usually be solved with just a little effort. "Some people love CPAP," he said, but noted that some others just never get used to it.
Other treatment options include dental devices that push the lower jaw and tongue forward, and surgery if there are obvious airway issues, such as a nasal blockage from a deviated septum. In children with sleep apnea, Park said, removal of the tonsils often helps.

The bottom line, according to both experts, is that sleep apnea is underdiagnosed and undertreated.
"Sleep apnea is more common than you suspect," said Walsleben. "Snoring isn't something to just laugh about. You need to pay attention if your spouse tells you you're snoring." 

 And if anyone has doubts, remember that the disorder can have far-reaching effects, Park noted.
"A lack of quality sleep affects every part of your body and mind," he said. "People often get treated for other conditions caused by a lack of sleep from apnea, like depression or high blood pressure, but you have to treat the root of the problem."

To start with, you might try giving up your pillow--personal experience led me to this pillow (until allergies to latex appeared), then to no pillow at all.  I thought about how the airway becomes constricted, then about the old mouth-to-mouth instruction to clear the airway by tipping the head all the way back.  Well, how does one tip the head all the way back to gain more air when pillows force your head forward?  The object is to get the back of your head a lot lower than the chin to clear your airway, and if that means sleeping with your head hanging over the side of the bed, or pulling the top of your bed away from the wall and ditching the pillows, that will save you the cost of CPAP masks and servicing (yes, you nave to buy a new face mask part every month or so to avoid inhaling bacteria).

The mouth-to-mouth airway-clearing head tip:

You can't do this with a pillow under your head, unless it's one of those wave neck pillows.

If this doesn't work, or you can't make it work, then resort to the CPAP.  There are masks that cover the nose and mouth, and some that only cover the nose.  The bed-table machine can be as big as a clock-radio or as small as a garage door remote control.

And there's even a tubeless travel CPAP.

This Just In: For Healthy Eating, Bitter is Better

From the Wall St. Journal.

"As someone who develops new food products, I've been a professional taster for 16 years. I love my job, but I'm constantly frustrated by the unwillingness of most Americans to try foods that challenge their palates.

The tongue is a unique muscle. The best way to exercise it, if you want to make the most difference to your waistline, is not to flex or fatigue it, but to stretch it. Expanding our repertoire of foods isn't just about exploration and new pleasures. It's also the first step toward eating a broader, healthier diet.

We are born loving sweetness, so we heap sugar into our lattes and drown our Chinese food in sweet sauces. But constantly indulging our craving for sweetness has an insidious effect. With each new overly sweet food that we consume, whether it is high in calories or not, we dull our palates to other tastes and flavors, especially those of nutritious fruits and vegetables.

We also may be altering our brain chemistry by eating more and more sweeter and sweeter foods. New research shows that the excessive consumption of calorically dense foods changes the way that our brain responds to future foods. The effect is akin to a drug addict's need for more and more heroin to satisfy his craving. 

Experts in food neophobia—the fear of new food—have shown that it can take five to 10 attempts at trying something before you reach the point where you don't reject it outright. That's a lot of soapy cilantro to get down the hatch. But patience pays off on the joyous day when a child realizes that she kinda, sorta doesn't hate broccoli any more. 

Here are some exercise tips…for your palate: 

1. Eat More Bitter Foods. We're all born with an aversion to bitterness, but our levels of sensitivity vary greatly. Some kids will eat broccoli from the get-go. It may taste one-third as bitter to them as it does to the child who tests your very last nerve at the dinner table. You can usually tell who is the tolerant taster (that is, the one with the less sensitive palate) and who is the hypertaster ("I only eat white foods"), but you can coach and nurture them both into being open-minded eaters. 
 

One study found that only 5% to 8% of the calories we eat are bitter. But the compounds that make foods taste bitter (carotenoids in sweet potatoes and spinach, flavonoids in cranberries and kale, polyphenols in wine) also make them good for us. Consider the initial taste shock of bitter foods such as cranberries, cocoa and kale to be positive, rather than negative. Bitter = healthful. 


2. Try Something New. At a restaurant, order something you would never cook at home. Instead of recoiling at the smell of something foreign and pungent, get to know it better. I used to abhor the very smell of canned tuna. That was before I landed a canned-tuna client and had to taste it every week for four years. These days I'm an aficionado of good (healthy) tuna.
 

3. Do a Hated Horizontal. Pick a food that you hate but know you should eat more often, and teach yourself a bit about it. By sampling across a whole category of food—beans, for instance, if they are your most hated food—you are more likely to notice and appreciate the differences in textures, colors, flavors, tastes. Wine tasters call this a horizontal tasting. Find your least-hated bean and eat them once a day for a week. At the end of the week, if you still hate them, you're free to take a pass. 

4. Eat More Ethnic Food. There's nothing more enjoyable than using the unfamiliar flavors of Vietnamese, Lebanese, Afghan and other ethnic food to exercise your taste buds and olfactory anatomy. 

5. Quiz Yourself. I keep a couple of spice jars on my counter with the labels obscured. Every now and then, I pick one up, stick my nose in it, and see if I can identify it. At first I was terrible at the task (and I'm a professional taster!). Now I've gotten fairly good at it. With skills like this, you'll be looking for ways to flex your palate.

Delicious flavor starts with good ingredients. These provide varied textures, a backbone of balanced basic tastes (sweet, sour, bitter, salty and umami) and aromatics that give it beauty. Too much sweetness and not enough bitterness make food taste flabby. And that is what we've become: a nation of flabby palates. It isn't surprising that the rest of our physiques are flabby, too."

Bitter foods help cut down on the sugar in our lives, and are especially helpful to diabetics.  Combine a flabby palate with the expensive walkable neighborhood, and you see why people pile into the car and use the drive-thru lane wherever they chose to eat.  It also explains to some degree what you find in their carts, and likely is the REAL reason behind the myth of produce being unaffordable.  A flabby palate is probably going to be more expensive to please than a cooperative one...and take the entire body with it, since digestion starts in the mouth.

This Just In: Why We Pay More for Walkable Neighborhoods

From the Atlantic.  Maybe this says something about why we aren't walking much any more.

"Instinct probably tells you that you’ll pay a lot more to live in a downtown apartment, above a grocery store, next to a bar strip and within walking distance of your work place than you will to settle into a comparable home in a bedroom community outside of the city. As this model of compact urban living grows more popular – and every new housing projection reaffirms that it is – walkable places are also growing more expensive.

Just how much more expensive, though, may shock you. New research from the Brookings Institution has created a five-tiered scale of walkability for metropolitan neighborhoods, from completely non-walkable places (exurban residential communities where everyone gets around by car) to mixed-use, dense and amenity-rich neighborhoods where you may not need a car at all (think, in the Washington, D.C., region, Dupont Circle and Georgetown).

Brookings researchers Christopher Leinberger and Mariela Alfonzo wanted to put hard numbers to the difference between these places. Looking at the Washington, D.C., region, they've calculated that moving from a Level 1 to a Level 2 walkable neighborhood (from a non-walkable place to a slightly less non-walkable one), you will wind up paying $301.76 a month more in rent for a similar home. If you’re really moving up in the world – from, say, that car-dependent exurb to a Georgetown flat – that means the premium to live in a walkable urban community may run you as much as $1,500 a month.

“It is mind-boggling,” Leinberger says. "These were much more dramatic results than I would have guessed going into this. It also shows our lack of understanding and why it’s important to measure this phenomenon, because we need to better understand how do we create Dupont Circles, and also how do we mitigate the downside?”

On the other side of the equation, all of this means that truly walkable urban communities are much more economically vibrant than their drivable suburban neighbors. For each step up this walkablity ladder (which was constructed using both Walk Score and the Irvine Minnesota Inventory of urban design dimensions linked to walkability), a store is likely to boost its retail sales by 80 percent, in part thanks to all this sidewalk traffic. The value of your home is likely to go up by $81.54 per square foot. Average rent per square foot of office space, meanwhile, goes up $8.88. (These are all, by the way, correlations, not causal explanations, although Leinberger expects that urban researchers will prove that link eventually.)

If you own that office space, or a home, or a retail shop in one of these walkable neighborhoods, all of this is great news.

“I am both the bearer of good news and the bearer of bad news,” Leinberger concedes. These neighborhoods are the economic drivers of their cities, often accounting for a disproportionate share of public revenue relative to their land mass. But today, only the wealthiest among us can afford to live in them. That will remain the case until we create many more Dupont Circles – enough to finally bring the supply of walkable urban neighborhoods in line with the demand of all the people who want to live in them.

These numbers all speak to a fundamental change in demand in our cities.

 “It wasn’t that many years ago that walkable urban places had a price penalty associated with them, not a price premium,” Leinberger says. “That’s the structural shift. And when you have a structural shift, it’s important to change your public policy to take it into consideration.”

Those “walkable urban places” he’s talking about did not necessarily have people walking around in them 20 years ago (“Maybe they were running around because they were fearful of being mugged,” Leinberger says). These were the inner-city neighborhoods that middle-class city-dwellers abandoned decades ago. Over time, they deteriorated. They became the cheap places to live. And now that trend is reversing.

Today, amid all this talk about walkability, Leinberger and Alfonzo wanted to bring an almost scientific precision to one of the core beliefs of urbanism: the idea that cities will be stronger going into the future if they eschew “drivable suburban” for “walkable urban” development.

 “We urbanists have lots of opinions, but nothing that would be provable principles,” Leinberger says. He quotes the physicist Geoffrey West, who once observed that urbanists have none of the kind of underlying principles that can be tested and proven like scientists do. “He had a line that was a real slap in the face, which was that urbanists are where physicists were before Kepler.”

(Johannes Kepler is the guy who figured out in the 17^th century the laws of planetary motion.)
“So this is one attempt,” Leinberger says, “to bring that level of rigor to our field.”

He is also hoping that urban planners and business leaders will bring this hard data to their arguments with skeptics of walkability – and why we need much more of it."

May I Suggest This Recipe for Whoopie Pie Filling, or Putting Bertween Layers of Girl Gone Primal's Cake?

The recipe:  Strawberry coconut butter from And Love It Too.

• 4 c Unsweetened Shredded Coconut, divided
• 2 c Strawberries (fresh or thawed if using frozen)
• ¼ c Coconut Oil

Instructions

1. Add 3 cups shredded coconut, strawberries and coconut oil to high speed blender.
2. Blend on high until smooth, tampering as needed.
3. Add final cup of flakes and blend on high until smooth and creamy.
4. Transfer to mason jar and store in your refrigerator until ready to serve.
5. Makes approximately 3 cups.