Posts by: Momentum

OSA and Weight Loss

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Researchers have been studying the interrelations of OSA, weight loss and Type 2 diabetes for years. Recently there have been new developments with the Sleep AHEAD study, a supplementary study of Look Ahead (Action for Health in Diabetes), identified in this article. Study inclusion criteria were patients between the ages of 45 – 47, who have a BMI greater than 25 and have been diagnosed with Type 2 diabetes. While it has been proven that weight loss reduces the severity of OSA, investigators in this study looked to establish whether or not the patient would maintain the initial benefit of intensive lifestyle intervention for weight loss on OSA severity for 10 years. Participants of the study either had intensive lifestyle intervention for weight loss or diabetes support and education (DSE). After the 10-year mark, PSG’s were obtained in approximately half of the participants. Overall, the AHI was lower and the weight losses were higher in the intensive lifestyle intervention group compared with DSE group. Additionally, OSA remission occurred in more participants in the intensive lifestyle intervention compared with participants in DSE group (34.4% vs 22.2%, respectively) at 10 years. The investigators concluded that overall OSA severity decreased across the 10-year study period with intensive lifestyle intervention.

Please click here to read the full article.

Is Obstructive Sleep Apnea a Risk Factor for COVID-19?

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Many of the common risk factors and comorbidities associated with OSA, such as diabetes, obesity, male sex, upper airway structure anomalies and hypertension are similar to those associated with poor COVID-19 outcomes. Researchers have started to investigate whether being diagnosed with Obstructive Sleep Apnea conferred an additional risk on top of those factors.

Since OSA affects nearly 8% of the population and has a higher prevalence of over 20% in individuals above 60 years, its association with the risk of severe COVID-19 infection leading to hospitalization is worrying.  Results of recent studies are showing that OSA patients with COVID-19 were at 5 times more risk of developing complications and being hospitalized. OSA is an independent risk factor for severe COVID-19 that requires hospitalization. 

sleep apnea and covid 19

Is there a link between OSA and COVID-19?

While the mechanisms potentially linking OSA to COVID-19 have not been concretely identified, there are a number of studies being performed all over the world to gain more knowledge and allow physicians and hospitals to treat patients accordingly. Identifying risk factors for coronavirus 2019 (COVID-19) infection and severe disease course facilitates personalizing preventative measures, targeting surveillance and diagnostic testing, and managing active infections. 

One area that warrants special attention in future research is the role of the immune system in OSA. There is a need for additional investigation regarding the benefits of OSA treatment from the standpoint of respiratory infection. Separating the causes and effects are what makes this research challenging. 

Patients with previously diagnosed OSA experience a risk that is approximately 8 times higher for COVID-19 infection.  

Does having OSA increase my risk of Covid-19 hospitalization?

Among patients with COVID-19 infection, OSA was associated with increased risk of hospitalization and approximately double the risk of developing respiratory failure. 

In 2 small recent studies of individuals admitted to the ICU with confirmed COVID-19, OSA was present in approximately 25% of patients. Such findings suggest that OSA “could potentially contribute to worsening hypoxemia and the cytokine storm that occurs in COVID patients,” wrote the authors of an article published in the Journal of Clinical Sleep Medicine (JCSM).2

(References 1&2). 

Similar questions have begun to emerge in the medical literature. So, what do we know so far:

covid 19 deaths by state

  • The first confirmed case of coronavirus disease 2019 (COVID-19) in the US was reported from Washington State on January 31, 2020
  • Cases in the US have now exceeded total cases reported in both Italy and China
  • The rate of infections in New York, with its high population density, has exceeded every other state, and, as of April 20, 2020, it has more than 30% of all of the US cases
  • Common morbidities between OSA and Covid-19 include obesity, asthma, diabetes, hypertension, cardiovascular disease, and pulmonary disease
  • OSA is related to hypoxemia, which can be an aggravating factor in Covid-19 pneumonia
  • Sleep deprivation causes increased inflammatory processes and decreased immune systems

The role of physicians since the emergence of the pandemic has changed drastically.  The sleep medicine community, in particular, must collaborate with multiple other specialists, assuring what comorbidities are preexisting.

In order to have a strategy for therapies and treatments, we need research with a greater number of individuals to determine the possible effect of OSA on patients with COVID-19. Screening with simple instruments like the four question STOP-Bang Questionnaire may be helpful in guiding management decisions in COVID-19 patients.

It is difficult to estimate whether OSA may be overrepresented or underrepresented in COVID-19 cases due to selection bias for testing and healthcare avoidance behaviors during the pandemic.  Not to mention that OSA is underdiagnosed in the first place. 

Can I still use my CPAP machine if I have Covid-19?

In terms of treatment for OSA, keep in mind that there are different treatment options available depending on the type, cause and severity of your sleep apnea.  For patients who are currently under treatment for OSA with a CPAP, cleaning methods should be taken with the utmost seriousness. 

Poor maintenance not only lessens the effectiveness of your CPAP, but it can damage the actual equipment.  If you have been sick, it is imperative to wash your mask, tube, and humidifier (if applicable) daily.  

Even when not feeling sick, during this pandemic it is recommended that you increase the cleaning of the machine to weekly, instead of biweekly as previously recommended.  Masks should be replaced every 90 days.

using a cpap machine with covid

*Courtesy Sleep Health Foundation

For those who choose an alternative method of treatment, such as an oral appliance, there are multiple options. At Michigan Head & Neck Institute, we exclusively offer treatment for obstructive sleep apnea that consists of creating a custom-fit oral appliance (mouthpiece) which is comfortable and can be adjusted to meet the requirements of each patient. Each patient that chooses an oral appliance (OA) as their treatment, will receive follow up sleep studies (either at-home or in a sleep lab) which will ensure the OA is positioned accordingly. There are over 100 different types of oral appliances that are made for OSA. Dr. Klein works with each patient to provide the best options for their specific treatment.

oral appliances

Please visit our website at for further information. 


  1. Tufik S, Gozal D, Ishikura IA, Pires GN, Andersen ML. Does obstructive sleep apnea lead to increased risk of COVID-19 infection and severity? J Clin Sleep Med. Published online May 22, 2020. doi:10.5664/jcsm.8596
  2. McSharry D, Malhotra A. Potential influences of obstructive sleep apnea and obesity on COVID-19 severityJ Clin Sleep Med. Published online May 1, 2020. doi:10.5664/jcsm.8538
  3. Bhatraju PK, Ghassemieh BJ, Nichols M, et al. COVID-19 in critically ill patients in the Seattle region – case series. N Engl J Med. 2020;382(21):2012-2022.
  4. Arentz M, Yim E, Klaff L, et al. Characteristics and outcomes of 21 critically ill patients with COVID-19 in Washington StateJAMA. 2020;323(16):1612-1614.
  5. Taylor DJ, Kelly K, Kohut ML, Song KS. Is insomnia a risk factor for decreased influenza vaccine response? Behav Sleep Med. 2017;15(4):270-287.
  6. Salles C, Barbosa HM. COVID-19 and obstructive sleep apneaJ Clin Sleep Med. Published online June 2, 2020. doi:10.5664/jcsm.8606
  7. Maas MB, Kim M, Malkani RG, Abbott SM, Zee PC. Obstructive Sleep Apnea and Risk of COVID-19 Infection, Hospitalization and Respiratory Failure [published online ahead of print, 2020 Sep 29]. Sleep Breath. 2020;1-3. doi:10.1007/s11325-020-02203-0
  8. Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, and the Northwell COVID-19 Research Consortium. Barnaby DP, Becker LB, Chelico JD, Cohen SL, Cookingham J, Coppa K, Diefenbach MA, Dominello AJ, Duer-Hefele J, Falzon L, Gitlin J, Hajizadeh N, Harvin TG, Hirschwerk DA, Kim EJ, Kozel ZM, Marrast LM, Mogavero JN, Osorio GA, Qiu M, Zanos TP. Presenting Characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area. JAMA. 2020;323:2052–2059. doi: 10.1001/jama.2020.6775
  9. University of Warwick. (2020, September 14). COVID-19 patients with sleep apnea could be at additional risk. ScienceDaily. Retrieved November 23, 2020 from

Sleep Pattern Alterations Due to Covid-19

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According to a recent study published in the Journal of Sleep Research, the pandemic and home confinement has resulted in varied sleep patterns among both children and their parents.  The subjects were mothers of 264 children who participated in the web-based study, identifying their child’s sleep patterns, and noting their Insomnia Severity Index (ISI) levels prior to the pandemic and during home confinement.  The ages of the children ranged from 6 months – 6 years old, the mothers were 33 years of age on average, and the families had an average of 2 children per household.  60% of mothers reported insomnia and anxiety, which in turn affects their child’s sleep quality.

Overall, studies are showing that teens and young adults are reporting the worst sleep patterns.  This is attributed to isolation, depression, an excess of technology and adjusting to the transition of remote learning.  Females are showing a 50% higher rate of difficulty in falling asleep as opposed to males.  Throughout the course of this pandemic, not only are people worried about their families, their finances, their health and their jobs, but watching the news and seeing what is happening to the economy is causing an enormous amount of anxiety and uncertainty.  When your body reacts to this kind of information, it produces an excess of the stress hormone cortisol, keeping your mind going like a hamster wheel.  Losing your routine and disrupting your daily schedule throws off your sleep-wake cycle, not to mention the lack of natural daylight due to quarantine.

To read more about this study, please click here.

The Connection Between OSA & Hypothyroidism

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Sometimes your body confuses healthy cells for invading cells, more commonly known as an autoimmune response.  If the autoimmune response isn’t treated, your immune system can attack healthy tissues. This can cause a plethora of certain medical conditions, including hypothyroidism.

The two major thyroid gland disorders include hypothyroidism and hyperthyroidism.  Hypothyroidism refers to the inadequate secretion of thyroid hormones, which is more commonly known as having an underactive thyroid.  As a result of this, there may be changes within the upper airway that lead to difficulties breathing during sleep.

how thyroid conditions affect sleep

Did you know that individuals diagnosed with hypothyroidism are almost twice as likely to have a diagnosis of Obstructive Sleep Apnea?  According to studies, the prevalence of hypothyroidism in the United States is about 9.47%.  While men are more likely to be at risk for OSA, women are more likely to have an underactive thyroid.  About 1 in 6 women will develop hypothyroidism by age 60.

Symptoms of hypothyroidism which coincide with OSA symptoms are as follows:

  • Difficulty concentrating
  • Weight gain
  • Fatigue
  • Depressed mood
  • Reduced desire
  • Sleep difficulties

If you have some of the above listed symptoms, it may be time to speak with your doctor about getting a blood test to evaluate the function of your thyroid if this is abnormally elevated, suggesting that the thyroid is not working properly. It is important to tell your physician if any family members have had this same diagnosis – you may be at a higher risk because of it.

Hypothyroidism can lead to increased upper airway dysfunction and collapsibility, due to soft tissue swelling in tongue, neck, and pharynx.  When severe, it can also result in blunted ventilatory drive and impaired chemosensory response to hypoxia/hypercapnia.  It has also been known to weaken the diaphragm, resulting in decreased lung volumes, which in turn contributes to more severe OSA.

obstructive sleep apnea and hypothyroidism

If your thyroid gland is not functioning properly, then your metabolic rate will most likely be low. For that reason, an underactive thyroid is commonly associated with weight gain. The more severe the condition, the more weight you are likely to gain.

Hypothyroidism is relatively easy to diagnose and treat.  Most treatments rely on supplementing low hormone levels with artificial varieties. These hormones will replace what your body isn’t producing on its own and help return your body’s functions to normal.  Determining if you have OSA at the same time can be a little tricky, since many of the symptoms present the same.  With the right testing/evaluation, your physician can ensure that you are receiving the proper treatment for both disorders.

For those already diagnosed with hypothyroidism, who also have symptoms of sleep apnea, a PSG (overnight sleep test) can help determine whether sleep apnea is present.  Fortunately, if hypothyroidism is causing sleep apnea or other sleep disordered breathing, it will most likely improve with thyroid hormone replacement. This is typically taken as a pharmaceutical pill called Synthroid (levothyroxine).  Natural alternatives are available as well, such as Armour thyroid.

In patients with hypothyroidism, disordered breathing appears to be very common; yet in patients with OSA, hypothyroidism is very uncommon.  One potential advantage of diagnosis of hypothyroidism prior to polysomnography is that polysomnography, an expensive and time-consuming test, might be avoided if the hypothyroid patient’s subjective complaints are ameliorated by levothyroxine replacement.

Hormone problems can wreak havoc on health, especially when it comes to sleep. In addition to symptoms mentioned above, there are additional sleep-related issues such as insomnia and night sweats.  Night sweats can also be associated with the onset of menopause, but that only pertains to a specific age range of women.  There may be frequent awakenings during the night, especially during REM sleep.  Due to the poor-quality sleep, the time in bed may be extended, even though you’re not actually sleeping but just lying there trying to rest.  If the time in bed exceeds the amount of sleep that is needed to feel rested, chronic insomnia may occur.

insomnia and hypothyroidism

To understand the potential link between hypothyroidism and sleep apnea, a team from Texas Tech University Health Sciences Center (TTUHSC) embarked upon new research using data mined from the National Health and Nutrition Examination Survey (NHANES). Their study, “Hypothyroidism and its Association with Sleep Apnea Among Adults in the United States: NHANES 2007-2008,” was published in July by the Journal of Clinical Endocrinology & Metabolism.  A brief summary of the study can be found online here.

For additional information on OSA and/or sleep disorders, please visit our website at

Associations Between Sleep and Alzheimer’s Disease

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Studies have shown that insufficient or decreased sleep quality is associated with poor cognitive function.  In addition, sleep disturbances are associated with a 1.5-fold increased risk in developing Alzheimer’s disease (AD).

This article suggests a relationship between sleep and Amyloid B, which is a key molecule involved in Alzheimer’s pathogenesis.  Until recently, amyloid formation was considered to be a slow process of deposition of an abnormal protein due to genetic abnormalities, however recent data suggests that the process of amyloidogenesis may be much more rapid than previously thought.  Amyloid deposition is one of the central neuropathological abnormalities in Alzheimer disease (AD).

Symptoms of AD develop slowly, often making it harder to detect.  Keep in mind that the pathological changes underlying AD can begin 10-20 years before any cognitive symptoms appear.  AD affects an estimated 4.5 million Americans, according to NIH.  Alzheimer’s disease is not a normal part of aging, but the risk of developing it increases with age. It usually begins after age 60 and the risk nearly doubles with every 5 years of age after age 60.  AD begins with short-term memory problems.  As time goes on, patients gradually lose more of their mental faculties.  We all tend to forget names from time to time, or we cannot always remember specific dates, but we need to be on alert when things get more serious.  AD patients typically cannot think or speak clearly, they forget to do routine things like bathing or cleaning, and they may not recognize family and friends.   Many people with Alzheimer’s start experiencing changes in their sleep patterns.  Scientists are not totally clear why this happens.  As with changes in memory and behavior, sleep changes somehow result from the impact of Alzheimer’s on the brain.  Those who cannot sleep may develop other comorbidities such as restless leg syndrome, sleepwalking, or they may yell out in their sleep.  This leads to daytime sleepiness, fatigue, agitation, memory loss, and inability to focus.  “Sundowning” is a common term you may hear associated with this.  Because of this, napping often occurs once a day to several times per day, which also creates difficulty falling asleep again at night when their body is supposed to be resting.

Experts estimate that in late stages of Alzheimer’s, individuals spend about 40 percent of their time in bed at night awake and a significant part of their daytime sleeping.  In extreme cases, people may have a complete reversal of the usual daytime wakefulness-nighttime sleep pattern.

Please click here to read the full article.

Does Covid Stress Lead to Headaches?

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2020 has certainly proven to be a stressful year for everyone due to the pandemic.  For some, their business will not survive.  Others are still able to work, but have been faced with a huge shift in the dynamic of the previous work environment.  Similar to the economic collapse that we faced during the recession in 2008-2009, financial strain is playing a huge role in the physical and mental health of people everywhere.  As we know, stress can cause excessive clenching or grinding of the dentition (bruxism) and tightening of the cervical masticatory muscles, both of which can lead to Cephalgia.

Does Covid Stress Lead to Headaches







Numerous studies have shown that there is a definitive association between anxiety/depression and bruxism.  In addition to self-reported clenching and grinding, there is also dentist-assessed physical evidence of damage found during routine cleanings and procedures. Occlusal wear, gum recession and tongue indentations are common indicators associated with bruxism.

When patients are clenching/grinding their teeth, they may not even be aware of it.  Some have nocturnal bruxism, but many are daytime clenchers.

Masticatory muscles can also tighten as a result of bruxism.  Hypertrophy can present, and the masseter and temporalis muscles become tense.  A physician will become aware of this during a head and neck exam, as the patient will express pain as a result of the facial muscles being palpated.  Areas of pain can include the head, neck, back, shoulders, temples, masseters and pterygoids.  In medicine there often are multiple causalities of a diagnosis.

In 2020 I have seen two categories of patients with TMD. 1) Clergy, they love helping their parishioners but those in their flock are stressed, anxious and frustrated causing the Bishop, Minister, Rabbi or Pastor to now also clench or grind more than usual and 2) People who had clenched or ground their teeth for years without pain are now clenching or grinding more causing pain to occur & TMD symptoms.

All of the above-described symptoms can lead to none other than a headache.  Approximately 50% of the general population has headaches.  Migraine and Tension headaches are the most common types.

The effects of repeated stress may lead to alteration in brain networks both functionally and structurally. As a result the brain responds abnormally to environmental conditions (psychological or physiological).  High levels of stress are reported in migraine patients, particularly in those suffering from chronic daily migraine.

Stress-related headaches are also known as Tension headaches.  They typically involve both sides of the head, and tightness in the forehead can present itself.  Tension headaches are not usually debilitating, and those who experience them will most likely have a few per month at most.  Again, during the course of this pandemic, it is very probable that the frequency is much higher.

Does Covid Stress Lead to Headaches








Chronic stress is one of the most destructive factors for human organisms.  There are many ways that we can manage stress.  Common recommendations include getting adequate sleep, make sure you are exercising, maintain a healthy diet, eliminate bad habits like smoking, reduce alcohol intake, practice deep breathing and meditation, and if you feel that you are unable to control your stress levels, make sure to talk to your doctor for help.

For any questions on managing stress, and to learn more about stress/tension headaches or bruxism, please visit our website at


Sutin AR, Terracciano A, Ferrucci L, Costa PT Jr. Teeth Grinding: Is Emotional Stability related to Bruxism?. J Res Pers. 2010;44(3):402-405. doi:10.1016/j.jrp.2010.03.006

Gungormus Z, Erciyas K. Evaluation of the relationship between anxiety and depression and bruxism. Journal of International Medical Research. 2009;37:547–550.

Maleki N, Becerra L, Borsook D. Migraine: maladaptive brain responses to stress. Headache. 2012;52 Suppl 2(Suppl 2):102-106. doi:10.1111/j.1526-4610.2012.02241

Shetty S, Pitti V, Satish Babu CL, Surendra Kumar GP, Deepthi BC. Bruxism: a literature review. J Indian Prosthodont Soc. 2010;10(3):141-148. doi:10.1007/s13191-011-0041-5

Sauro KM, Becker WJ. The stress and migraine interaction. Headache. 2009;49(9):1378-1386. doi:10.1111/j.1526-4610.2009.01486

Aguilera SB, Brown L, Perico VA. Aesthetic Treatment of Bruxism. J Clin Aesthet Dermatol. 2017;10(5):49-55.

Ahlberg J, Lobbezoo F, Ahlberg K,et al. Self-reported bruxism mirrors anxiety and stress in adults. Med Oral Patol Oral Cir Bucal. 2013;18(1):e7-e11. Published 2013 Jan 1. doi:10.4317/medoral.18232


TMJ: How Do You Find Relief?

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The temporomandibular joint (TMJ) is responsible for connecting your jawbone to your skull. When functioning properly, the TMJ allows for smooth movement of the jaw when chewing and speaking. Should the TMJ become inflamed, pain, stiffness, eye, neck, ear problems and general discomfort are sure to follow. This illustrates the importance of finding proper TMJ pain relief when bothersome symptoms arise.

TMJ Pain

TMJ pain can be severe in some cases, sometimes disrupting your daily life or making it difficult to perform simple tasks. It can also spread to other areas of your body, such as your eyes, neck or ears and may even cause headaches on a regular basis. Understanding TMJ disorder and how it can be treated is the first step to finding relief.

Symptoms of TMJ Disorder

Diagnosing TMJ pain is difficult since symptoms mimic so many other ailments and conditions. Persistent jaw pain is the most obvious symptom, and pain can occur on its own or it can be caused by chewing or speaking. TMJ pain may also be felt in your neck and shoulders, and sometimes it can feel like you’re experiencing a toothache simultaneously. Headaches, ear pain, hearing loss, dizziness and ear congestion are also common when the TMJ is swollen or inflamed.

TMJ disorder is linked to other strange sensations that aren’t specifically painful. Some people complain of a clicking sensation when opening and closing their mouths. Should the swelling become severe, it may also be seen or felt on the outside of the face. In severe cases, some people develop lockjaw, which is when your jaw becomes stuck in one position.

How to Relieve TMJ Pain

Some people who experience TMJ pain and associated symptoms feel very mild effects. In this case, home relief for TMJ disorder is usually sufficient at reducing symptoms. Nonsteroidal anti-inflammatory drugs (NSAIDs), which include medications like ibuprofen, reduce swelling in joints to relieve stiffness. Ice packs are another effective remedy for facial swelling and pain. Ice packs can be used throughout the day, just make sure you’re not leaving the pack on your skin for more than ten minutes at a time.  Hot packs can help reduce muscle pain.

TMJ pain also increases tension in the head and neck. Massage may be effective for relieving this tension and inducing a relaxing effect, which can sometimes prevent future TMJ pain. When discomfort occurs, gently rub the muscles in your head and neck until you feel more at ease. Taking steps to boost relaxation in your life is also recommended, whether that’s through yoga, meditation, reading your favorite book, or listening to your favorite band or singer.

When TMJ symptoms are more severe, medical treatment will be needed. Stronger prescription pain medications may be administered, including muscle relaxers to ease jaw pain. If improper jaw positioning is believed to be a factor in the disorder, a custom-fitted mouthpiece or oral splint can help. These devices correct jaw positioning to reduce stiffness and discomfort.

When other methods fail, physical therapy may be recommended. A physical therapist can help build muscle strength and jaw flexibility by using safe, targeted exercise tailored to your specific needs. Local anesthetic injections sometimes with corticosteroids are also beneficial, as they reduce swelling in the muscles surrounding the jaw to promote optimum flexibility. If it’s determined that surgery is the best course of action, arthrocentesis may be performed. This is a minimally invasive procedure that uses small needles to irrigate the TMJ, which removes debris that may contribute to irritation.

At Michigan Head & Neck Institute, we understand how challenging TMJ pain is to treat. We also know that it can negatively affect the lives of our patients in a number of ways, which is why we’re so diligent about using safe, effective treatment methods. Dr. Richard Klein and the rest of our team utilize a conservative approach to treating TMJ disorder, as we believe this is the best course of action for our patients. If you’d like to learn more about our treatment methods and how they provide relief, contact us today. You can also schedule a consultation by calling (586) 588-9444.

A Woman’s Worst Nightmare – Advanced Aging from Sleep Disorders

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Having Obstructive Sleep Apnea (OSA) or other sleep-disordered breathing (SDB) conditions may speed up aging, especially among women.  As we know, OSA occurs when a person’s airway is obstructed by the collapse of soft tissue in the throat, leading to the gasping and/or snoring sound.   OSA is the most common form of SDB, which is characterized by abnormal breathing during sleep that commonly results in repeated nightly reductions in blood oxygen saturation.

Dr. Kleins model






Both BMI (body mass index) and age are significant risk factors of sleep apnea.  Other variables associated with aging must be taken into consideration, including health behaviors and sociodemographic factors.  The relationship between age and BMI closely resembles the relationship between age and sleep apnea, demonstrating that BMI can confuse the age/sleep apnea relationship.

Sleep disorders are also found to be associated with accelerated epigenetic aging.  Epigenetic age is an estimate of biological age, based on changes in DNA at various locations throughout the genetic material.  Recent research suggests that like chronological age and environmental and physiologic risk factors such as smoking and heart disease, epigenetic age can predict life expectancy.  Prolonged disruptions in blood oxygen levels and sleep fragmentation can generate stem cell exhaustion, epigenetic changes, increased inflammation, and other hallmarks of aging.

Studies have shown that the higher the AHI (apnea-hypopnea index), the greater the age acceleration that will occur.


  • Each standard deviation increase in the sleep disruption arousal index was associated with an estimated 321 days of age acceleration.

We already know that untreated OSA leads to memory loss, concentration issues, daytime fatigue, and headaches, among multiple other medical problems.  New evidence also suggests that untreated sleep disorders can be related to Alzheimer’s, Parkinson’s, dementia and type 2 diabetes.  Patients with OSA also have a higher prevalence of cardiovascular disease.

Depending on our anatomy, our risk of sleep disorders can increase due to situations like the structure of our jaw, nose and throat.  Loss of muscle tone also plays a role in this.  With menopause, women become automatically more susceptible to developing a sleep disorder.  Estrogen levels decline, therefore the muscle tone of the airway declines.  Estrogen deficiency after menopause also causes other physiologic changes in a woman’s body which can have severe consequences on quality of life, the most serious being increased risk for cardiovascular disease (the #1 cause of death in the menopausal age group).

Also, the majority of postmenopausal women experience a reduction in blood pressure.  SDB is a risk factor for hypertension, so it is possible that the reduction of cardiovascular mortality rates in postmenopausal women could be related to the reduction of SDB in this demographic.








As we age, it is extremely important to make sure we get enough sleep.  Even one night of sleep deprivation causes cells to age faster than usual (especially in older adults).  Sleep is restorative for your body and your brain, and there are health consequences in both he short and long term.  During the deeper phases of sleep, chemicals like insulin and glucose are regulated within your body.  Depriving your body of sleep and access to those deep phases prohibits your body from distributing what it needs to.  As a result, cells and organs miss out on replenishment, renewal, and redistribution.

Consistent nights of healthy sleep are very important. A lot happens during this vital time of growth and renewal:


  • Thanks to growth hormones, your body’s cells are repaired
  • Your brain has a chance to remove waste products that accumulate during the day
  • Healthy new cells appear in your tissues and organs
  • Your brain also gets a chance to rest while still maintaining key functions

Structural changes in the brain and memory function are fairly normal for the older age demographic, as are some sleep disorders.  However, changes in brain structure are accelerated at a higher rate for every hour of sleep that is lost on a nightly basis.

Many of the symptoms we may associate with someone who is getting older may be linked to sleep apnea.  Consider the following examples:

-Waking to urinate(nocturia)
-Daytime sleepiness
-Naps or dozing
-Fragmented sleep
-Early morning awakenings
-Heartburn at night
-Teeth grinding (bruxism)
-Mood problems (anxiety, depression, and irritability)
-Cognitive complaints (short-term memory, concentration, and attention)








As human life expectancy increases, further research on age-related diseases are critical to our society, especially healthcare professionals.  Dr. Klein and his staff strive to increase patients’ quality of life and are constantly making improvements through treatment for OSA and SDB.  Please visit our website for further information at


Yim-Yeh S, Rahangdale S, Nguyen AT, et al. Obstructive sleep apnea and aging effects on macrovascular and microcirculatory function. Sleep. 2010;33(9):1177–1183. doi:10.1093/sleep/33.9.1177

Xiaoyu Li, Yongmei Liu, Stephen S Rich, Jerome I Rotter, Susan Redline, Tamar Sofer. 0291 Sleep Disordered Breathing Associated with Epigenetic Age Acceleration: Evidence from the Multi-Ethnic Study of Atherosclerosis. Sleep, 2019; 42 (Supplement_1): A118 DOI: 10.1093/sleep/zsz067.290

Bixler EO et al. “Prevalence of sleep-disordered breathing in women: effects of gender.” Am J Respir Crit Care Med. 2001;163:608-613.

Guilleminault C, Quera-Salva MA, Partinen M, Jamieson AWomen and the obstructive sleep apnea syndrome. Chest931988104109

Carroll JE, Cole SW, Seeman TE, et al. Partial sleep deprivation activates the DNA damage response (DDR) and the senescence-associated secretory phenotype (SASP) in aged adult humans. Brain Behav Immun. 2016;51:223–229. doi:10.1016/j.bbi.2015.08.024

Vitlic A, Lord JM, Phillips AC. Stress, ageing and their influence on functional, cellular and molecular aspects of the immune system. Age (Dordr). 2014;36(3):9631. doi:10.1007/s11357-014-9631-6

New Daily Persistent Headache

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Over the last several years there have been new developments in the research for NDPH (new daily persistent headache).   This headache is located in the frontal and temporal regions, and peaks maximum intensity over several seconds, lasting up to several minutes, at which point the pain level starts decreasing.  This is recognized (ICD) as a primary headache disorder.  Symptoms are not isolated to one specific demographic, and patients that experience this do not necessarily have any comorbidities or other chronic pain.  Most patients that report this have not had any history of headaches in the past.  Many of these cases are triggered by an illness, infection, or surgical procedure involving intubation.  Other contributing factors could be cervical injury or hyperextension.

The prominent identifier of NPDH is that the patient typically remembers the exact date or circumstance when the headache started, and the 3 days after in which it was unrelenting.  In order to diagnose a patient with NPDH, imaging should include a brain MRI and/or CT scans, in addition to a complete head and neck exam.  In diagnosing NPDH, physicians consider other primary headache syndromes such as chronic migraine and tension headache.  The feature that distinguishes NPDH is the abrupt onset coupled with the daily persistence.  While no guidelines or set treatments exist at this point, it seems to be best treated similarly to the closest manifesting headache phenotype, whether that be migrainous or tension in nature.  There may be an aggravation of an underlying symptom free controlled Temporomandibular Disorder that occurs during intubation for surgery.  TMD can cause frontal and temporal region cephalgia.


To read the full article, please click here.

Nutrition Tips To Decrease Pain and Inflammation

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An unfortunate fact is that medications for pain contribute heavily to the opioid crisis currently gripping America. Even without the risk of addiction, hardly a day goes by when an attorney isn’t running an ad, asking for people to join class-action lawsuits against pharmaceutical companies. These and other factors compel many people to consider more natural remedies. With that in mind, here are some of the nutrition tips to decrease pain and inflammation that we believe will work wonders for you and your loved ones.

Get To Know Your Body

Everyone reacts differently to the same foods, so it’s important to pay close attention to your body before you begin. Some of our patients have great success with using journals to keep track of their diets. When you suffer pain or notice inflammation, write down what you ate that day. We also recommend using your journal to note any changes as you try other diets. If you feel pain and then it stops or the inflammation goes away, note what you ate then, too. In time, you might begin to notice some cause-and-effect relationships.

Reduce Known Problem-Causers

There are some specific foods that are known for contributing to pain and inflammation. There are three primary types of foods that you should look out for:

  • Processed Meats: Many Americans are switching to plant-based diets. These do not work best for everyone, but you should definitely reconsider how often you eat processed meats. Everyday options on many American menus include bacon, sausage, and smoked meats. Sodium tends to be the problem ingredient here.
  • White Bread and Pasta: If you love Italian cuisine, these are delicacies you might not feel prepared to give up. However, there are great alternatives to these “empty calories.” You could switch to whole-wheat bread and pasta. If the first brand doesn’t quite hit the spot for you, keep trying new ones until you find something you like.
  • Added Sugar: It’s hard to cure a sweet tooth, but getting it under control can help relieve pain and inflammation. The two main types of sugars to look out for are corn syrup and table sugar. You can find these in not just candy, ice cream, and soda, but even your favorite fruit juices.

Increase Your Intake of Healthy Foods

In contrast to the list above, some foods promote better health and might even help to decrease pain and inflammation. These are the four main additions to make to your diet:

  • Water: One of the most common causes of headaches and other aches and pains is dehydration. Try to drink at least eight glasses of water per day and always hydrate before and after a workout.
  • Beans: Beans contain fiber and proteins that help to reduce inflammation. If you love tacos and bean soups, you’re already on the right path. Experiment with different types, such as black, pinto, broad, and red.
  • Fish: If you feel ready to reduce your meats but don’t want to give up animal protein altogether, try working more seafood into your diet. The omega-three fatty acids do an excellent job of helping you control inflammation. Try salmon, tuna, salmon, and cod.
  • Garlic: The diallyl disulfide is what gives it its anti-inflammatory characteristics. This is probably one of the easiest foods to work into your diet because it is so easy to cook with. If you dislike the taste of garlic, you could try supplements.

At Michigan Head & Neck Institute, we work with patients to use both traditional and alternative methods to treat pain. We believe that this holistic approach to relief offers the best possible results. If you would like to know more about our methods, we are eager to share them with you. Give us a call or book an appointment so you can try them for yourself.