Thursday, June 19, 2008

Lyme and sleep

Most discussions about late Lyme mention "sleep disorder" as one of the symptoms. Certainly patients can have a wide variety of psychiatric symptoms including depression, anxiety and mood swings which are typically associated with disturbances in sleep. The use of sleep medicines or hypnotics may be helpful. Good quality sleep is important.
What I am most concerned about is a disorder called sleep apnea. Sleep apnea is more common in Lyme patients in my experience. It is classically associated with obesity, snoring and fatigue. But these signs may be absent. Many Lyme patients have neurologic dysfunction of the palate and uvula which may contribute to this disorder. In addition, brain abnormalities of Lyme may be a contributing factor. Sleep apnea is mostly peripheral, due to floppiness of the soft tissues in the back of the throat; but it may also be central, due to brain dysfunction. Patients with sleep apnea have severe fatigue, a symptom commonly reported in Lyme disease. These patients also have cognitive difficulties which may be similar to those seen in Lyme. Patients with sleep apnea have been shown to have abnormal SPECT scans with decreased blood flow to the frontal lobes of the brain. This is associated with poor executive function. This creates a syndrome which mimics attention deficit disorder, a finding which is also common in Lyme patients. Patients who are chronically deprived of deep sleep called stage 4 sleep, associated with delta waves on the EEG, electroencephalograph, have been shown to develop diffuse muscle pain which resembles fibromyalgia, another common Lyme syndrome. Many researches have described fibromyalgia as a syndrome related to a sleep disorder.Obstructive sleep apnea occurs when patients enter deep sleep, stage 4 and the airway closes off. The individual is unable to exhale. This may causes a decrease in respiration (hypopnea) or complete apnea, a cessation of breathing. The person has an arousal, of which he is unaware, which puts him in a more superficial stage of sleep and allows the closed airway to open again. The condition is frequently associated with low blood oxygen levels. It puts tremendous stress on the heart and is associated with hypertension and heart failure. The fatigue is profound and may cause day time drowsiness which includes falling asleep while driving. Sleep apnea is also associated with activation of the immune system. Markers of inflammation, including cytokines are elevated in these patients.
Patients with fatigue, day time drowsiness, snoring, hypertension and possibly ADD should have sleep studies. If narcolepsy is suspected another test called a multiple sleep latency test is also necessary. A full discussion of this and other related sleep disorders is outside the scope of this Blog. But I recommend that all patients with these symptoms have sleep disorders excluded as part of their evaluation.


girl Mark said...

Could you elaborate just a bit about the uvula and soft palate neurological stuff? I've seen this reference here and there.

What makes me interested is that I'm trying to learn more about air hunger, and the nausea that some babesia patients get. I have these un-fun symptoms and they feel very connected- yawning/trying to take a deep breath when having an attack of air hunger would bring on gagging or nausea when this symptom was really bad. It's clearing up with therapy for babesia.

Rumor on the Lyme patient end of the internet says that air hunger has something to do with the vagus nerve, as does nausea. Is this true, and does it have anything to do with the soft palate issues you're describing?

Lyme report: Montgomery County, MD said...

The movements of the uvula and soft palate are controlled by two cranial nerves the 9th and 10th: glossopharyngeal and vagus.

If these structures are compromised it would exacerbate sleep apnea. These cranial nerves are frequently diseased due to Lyme disease. I don't think this has anything to do with air hunger. The cause of air hunger in Babesia might be an asthma like reaction. When the lungs are hyper-expanded due to air trapping, one gets the sensation of not being able to take a breath. The inspired column of air meets pressure from residual trapped air in the lungs. I would guess that Babesia triggers an inflammatory response in airways which sets up this response.

girl mark said...

Do you ever see the damage to those tissues improve in your patients with treatment? I now have that classic 'deviated' uvula issue (soft palate in back of the throat is drooping on one side too), and I'm wondering whether it's going to get back to normal with treatment.

Are there any sleep drugs that help with sleep apnea symptoms, without having to go to the CPAP and similar devices?

Prosperity-Coach said...

My husband had Sleep apnea and also Lyme disease. When he took MMS (water purifier)for two years, and got over the Lyme disease. The MMS killed the Lyme spirochete and the Sleep Apnea also went away. He wrote a simple Kindle book that is on Amazon for 99 cents.

It is a short read but is full of alternative health information about Lyme disease.

Keep up the good work. This subject is under reported and need exposure. People are suffering.

Yowwwwie said...

After 14 years and 2 Kaiser short treatments for Lyme I was diagnosed with Obstructive Sleep Apnea. The last 3 years I have been so weak I was mostly in bed. Recently I went to Dr Eric Gordon (LLMD) and started on Rifampin, Biaxin and Omnicef. My very severe (88 apneic episodes/night) OSA is now moderate (29/nite). Have you experienced reversals of OSA/Lyme with treatment?

Elisha Battle said...
This comment has been removed by the author.
Sleep Apnea Clinic said...

This is a great blog and it's important to share this information with the public. Sleep disorders are a highly common medical issue that affects millions.

Sleep Disorders Clinic Poulsbo
Sleep Apnea Clinic Poulsbo

Worried and Sad said...

Hello. Have a bf, tested positive for Lyme and has now developed Sleep Apnea (Severe at 509 episodes of "stopping breathing" per night (at least when the machine test was done on him) Doc he's seeing has diagnosed Sleep Apnea of course but in no correlation to the Lyme. This doc is not an LLMD by any means and stated that it's questionable whether he even has Lyme, while looking at a Positive Western Blot with 10 reactive bands, many of which are B. Bergdorferi specific markers. Bad symptoms of Lyme and the Apnea came on about 10 months ago, test was just confirmed less than two months ago. He's in denial of the connection of the two and is in bad shape. They say a CPAP will help although I question this due to having both conditions. He's irritable, nasty, judgemental, exhausted etc. Didn't used to be before having a surgery about 10 months ago that had to have set off the Lyme back into action. Became very exhausted in the days after and conditions progressed on from there. He's had several cysts, one in the knee which ruptured, a terrible poison like rash and the exhaustion and personality changes (which he swears is Bc of our arguing, and I say the arguing is due to the changes in him to this degree, although I do take repsponsibilty for my participation). I have stressed for many months that something is very wrong. Please advise on any thoughts you may have. Thanks!!!

Steve Berke said...

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Nathan Dennis said...

The above comment should be removed. Its utter quackery. You had me for a minute... I have Kindle unlimited and I read that poorly written book that repeats itself every 3 pages.. this isn't science.. the clinical trials on malaria were faked and illegal. This is utter rubbish and they are preying on weak people to generate a business model. This book tells you partial truth so you believe it. I've had this disease since 2001. I was diagnosed in 2003.. I did 3.5 years of heavy antibiotics.. they don't cure this. I was in remission after making lifestyle changes and other factors for 7 years. We are all out here looking for answers and we dont need this. Im optimistic hyperbaric holds the answers But I don't know either. I can tell you I not a chemist or a doctor... but i have a better shot at getting the molecular structure of ClO2 right than the original author. There are studies where clearly this compound supressed CD4+ markers in monkeys after 6 months of expose. Now with lyme we are more concerned about CD57+ But wrecking your immune system is a bad treatment plan. Quack science with an Amazon book to back it up.. shame on you people.