Brain Damage and Sleep Apnea: Dr. Ronald Harper

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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RogerSC
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Re: Brain Damage and Sleep Apnea: Dr. Ronald Harper

Post by RogerSC » Thu Feb 04, 2016 8:53 pm

Mopheus wrote: I've played didgeridoo for 20 years, long before the apnea.
I've been to OZ three times to learn in the bush from the best players in the world.
I can safely say didj playing is not going to affect your apnea.
I think that you can safely say that it didn't affect your apnea.

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Re: Brain Damage and Sleep Apnea: Dr. Ronald Harper

Post by Mopheus » Thu Feb 04, 2016 9:16 pm

oh no the grammer police

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RogerSC
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Re: Brain Damage and Sleep Apnea: Dr. Ronald Harper

Post by RogerSC » Fri Feb 05, 2016 2:27 am

Mopheus wrote:oh no the grammer police :roll:
You mean "grammar"?

Might as go all the way, as long as my cover's blown *smile*.

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ChicagoGranny
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Re: Brain Damage and Sleep Apnea: Dr. Ronald Harper

Post by ChicagoGranny » Fri Feb 05, 2016 7:52 am

Mopheus wrote:oh no the grammer police
His post wasn't about grammar. It was about critical thinking skills.

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RogerSC
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Re: Brain Damage and Sleep Apnea: Dr. Ronald Harper

Post by RogerSC » Fri Feb 05, 2016 9:07 pm

ChicagoGranny wrote:
Mopheus wrote:oh no the grammer police :roll:
His post wasn't about grammar. It was about critical thinking skills.
Thank you.

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Re: Brain Damage and Sleep Apnea: Dr. Ronald Harper

Post by story1267 » Thu Feb 11, 2016 8:46 pm

70sSanO wrote:
So I go in to see the "specialist" and showed him my twenty-seven pages of Rescan data with the circles and arrows and a paragraph on the back of each one, and he looked at them and said... kid, I want you to go over and sit down on that bench that says Group W.

John
I had to come on and thank you for this....I needed a laugh today. You can get anything you want.....

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Re: Brain Damage and Sleep Apnea: Dr. Ronald Harper

Post by thecpapguy! » Thu Feb 11, 2016 9:16 pm

ChicagoGranny wrote:
davep700 wrote:I would ask about who needs a cervical collar, but that would send the thread off topic.
It's an easy answer: You don't know until you try.

1)If you try one and your AHI and/or pressure needs are significantly lower over a couple of weeks, it's helping!

2)If you use a FFM because you mouthbreathe and you try a cervical collar and find that mouthbreathing and/or dry mouth is reduced significantly, it's helping!

Only you will know. Cheap experiment - less than ten bucks.
ChicagoGranny, should the normal expected results of the collar being within a couple weeks? I've worked with a couple of users that stated they saw results within a few days. I didn't discredit them at all, I just wondering if seeing an apnea index decreae from 4-7 to 1-3 while using the collar would be expected within a few short days based off of your experience?
I'm sorry if this is an ignorant question and thanks for any information.

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Re: Brain Damage and Sleep Apnea: Dr. Ronald Harper

Post by Julie » Thu Feb 11, 2016 9:24 pm

Hi, not CG here, but... the collar is something that can work overnight if it's going to work at all...

but not having seen your previous stuff (sorry, in a rush here) I wonder why your settings are so low? I couldn't breathe at those and not anyone else I know could... 4?

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Re: Brain Damage and Sleep Apnea: Dr. Ronald Harper

Post by chunkyfrog » Thu Feb 11, 2016 9:28 pm

I notice the cervical collar, and the "sniff" position both touted as remedies for aerophagia.
TheLankyLefty has promoted tucking the chin towards the chest for the same reason.
I can only conclude that either the same results have come from opposite measures,
or improvement would have happened in the fullness of time, regardless of where ones chin is pointed.
Maybe we need a poll? OH, NO! Please, no!

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Re: Brain Damage and Sleep Apnea: Dr. Ronald Harper

Post by teachcsg » Thu Feb 11, 2016 9:30 pm

Interesting. First time hearing about using a cervical collar to help with with sleep apnea. Thanks for the tip-I will pas it on to my patients!
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Re: Brain Damage and Sleep Apnea: Dr. Ronald Harper

Post by ChicagoGranny » Fri Feb 12, 2016 7:11 am

thecpapguy! wrote:ChicagoGranny, should the normal expected results of the collar being within a couple weeks? I've worked with a couple of users that stated they saw results within a few days. I didn't discredit them at all, I just wondering if seeing an apnea index decreae from 4-7 to 1-3 while using the collar would be expected within a few short days based off of your experience?
I'm sorry if this is an ignorant question and thanks for any information.
If the collar helps a person, the effects are immediate.

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Re: Brain Damage and Sleep Apnea: Dr. Ronald Harper

Post by ChicagoGranny » Fri Feb 12, 2016 7:32 am

chunkyfrog wrote:TheLankyLefty has promoted tucking the chin towards the chest for the same reason.
I think lefty is badly wrong on this one. People that follow his advice are setting themselves up for nasty spinal problems in the long run. Or maybe even in the short run.

Any CPAPer who visits an orthopedic doc, should ask him about sleeping all night with his neck jacked down like lefty recommends. The doc is going to say, "Hell no."

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Re: Brain Damage and Sleep Apnea: Dr. Ronald Harper

Post by OkyDoky » Fri Feb 12, 2016 9:32 am

ChicagoGranny wrote:
chunkyfrog wrote:TheLankyLefty has promoted tucking the chin towards the chest for the same reason.
I think lefty is badly wrong on this one. People that follow his advice are setting themselves up for nasty spinal problems in the long run. Or maybe even in the short run.

Any CPAPer who visits an orthopedic doc, should ask him about sleeping all night with his neck jacked down like lefty recommends. The doc is going to say, "Hell no."
+1 Just anatomically it does not make sense.
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Re: Brain Damage and Sleep Apnea: Dr. Ronald Harper

Post by jaw » Sat Oct 15, 2016 6:44 pm

So my 1st contribution to this forum, after consuming many time of you guys in helping me.

I copy here the text from that podcast, this is transcribed by me. It helps people in reading the info faster, helps also Google. There are some words I cannot recognize, please help me fix them. Thanks

===============================

Steven Y. Park talking with Ronald Harper at UCLA http://doctorstevenpark.com/harper

Female voice: If you have OSA or you know someone who has OSA, you won’t want to miss this interview. The reason why is that you will learn why OSA can cause brain damage, then how those brain damage can further perpetuate OSA. You are gonna gain the eye-opening insights about the relationship between brain damage with OSA and how they lead to memory loss, brain infarct, balance issues, hypertension, and even diabetes. Then you also learn besides traditional sleep apnea options, which simple and overlooked exercise can help reduce or resolve OSA altogether. But before I share the interview I want to remind everyone listing to keep in mind the following: the information you hear today is for general education and information purpose only, and should not be relied upon on as individualized medical advice. Please consult your doctor before following any advice.
Steven Park: We have with us doctor Ronald Harper, who is a professor in the Department of Biology at UCLA, and a member of the UCLA brain research institute. We first met a few years back doctor Mac Cuzon, he has many credentials and landmarks in researching how Sleep Apnea damages brain, and over 250 papers, articles, book chapters and interviews, and he has co-authored 2 books, and he is a major investigator on two major grants. So welcome doctor Harper, really honored to have you with us.
- STEVEN: How did you get interested in this area of research
o RONALD:----------------- It came about by accident. We were always interested in how the brain controlled breathing and heart function. We were approached by NIH in sudden death of infant, so called Sudden Death Syndrome. And that lead to whole series of studies, in which we described how infant breaths, how they might succumb, and then OSA came on the scene, and we needed to know what was going on in the brain. How brain fail at keeping breathing while sleeping
- STEVEN: And that’s legit to all your studies on how sleep apnea can injure the brain, right ?
o RONALD:----------------- What we found was unexpected, we observe that a number of brain structures were damaged in OSA, and when we looked further it’s fairly clear that each of the damage would lead to continuation of the condition: OSA damages the brain, then the brain injury in turn would further prolong the condition. So you see for example a damage parts of the cortex regulates how high blood pressure should be, and once that happens, then a number of other injuries result.
- STEVEN: When I heard you speak on the subject, it’s so enlightening to me because as a surgeon I always looked at OSA as a simple breathing problem. So I got the basics of how it happens, but the fact you mention that it could damage critical control centers of the brain that regulate blood pressure, heart rate, or all other functions. That really help on how I understood OSA.
o RONALD:----------------- The original conception of Sleep Apnea was that: there’s a small airways, then if you could fix the small airways, then people would breath better. Well it turns out that it maybe that the small airway is responsible in starting the process. But once the process is started, then the brain injury leads to the continuation of the condition. And from then it becomes much more complex: it very clear that the brain is actively not moving the muscles, not opening the airways muscles during sleep. They work reasonably OK during waking, but something is changed in the brain, to cause these muscles not to act appropriately at night, and that’s what we have to find. That why those muscles that work pretty well during the day, not completely well, but pretty well during the day don’t do their job at night, they are unable to act, and that’s an active brain process that shutting those muscles down. And we have to find out why it’s happening. And we are finding out more everyday about the nature of that process.
- STEVEN: You and your group at UCLA has pioneered many of the latest imaging methods in this field. What are some of the latest ways of testing for brain injury in people with OSA. What is the state of the arts in this area ?
o RONALD:----------------- Oh, there are a number of MRI techniques, many of those are brought to us by doctor G. Kunar, he came over from India, and really broadened our knowledge of MR procedures. But he has come on just recently with another colleague in the department of neurology, and found what we think is the basis of the idea of injury. And that iSteven: we all have a protective barrier in the brain: it’s called the blood brain barrier, and what we know is that blood brain barrier keeps up toxic substances from damaging the brain, shields the brain and cells from injury by keeping these toxic agents out. Well in OSA the blood brain barrier becomes leaky: we just described it a few weeks ago. It makes a huge difference as what brain structures could be damaged, but it’s a very useful finding because there means to address the leaky blood brain barrier. But we did not detect that before, and now that technique is available for us.
- STEVEN: Along those lines that OSA patients complain that brain fiber, memory problems, not being as sharp as they used to be. So along these lines what are the main areas of brain damages ? I remember reading a paper saying that there a number of areas that get injured. Could you just give 4 main areas and the consequences of damages in those areas ?
o RONALD:----------------- Yes, that’s very much the case. The injury target certain structures, and among those structures are a section that regulate memory, especially short-term memory and other forms of memory as well. And the frontal structure is the hippocampus. Everybody knows the hippocampus, everybody who watches the movies like “30 first dates” or has seen other kinds of movies like “Memento” or familiar with the signs are extreme large of recent memory that people will remember something or perhaps … but again it’s completely new. Hippocampus is damaged in OSA, damaged severely, and not only the hippocampus but the fiber, the brain fibers that come out of the hippocampus for next fibers, they are killed off in OSA as well, then they reach a small bodies called the mammalian body, a very small body at the base of the brain , and those structures, those mammalian bodies are hit very hard, typically one side is hit much harder than the other. But the damage is so severe that almost certainly it leads to harder memory issues. There are other structures as well, but those are 3 key structures (hippocampus, the axons or fibers that come out of the hippocampus, and the mammalian bodies).
- STEVEN: I think you’ve already mentioned that there are two areas that regulates pain and the cerebellum fibers that regulate the balance and dia… function . Can you comment on that a little bit ?
o RONALD:----------------- That’s very much the case. Let’s take the pain issue first. One of the structure that is hit very hard, and again it’s hit on one side of the brain more often than the other, and that structure is called the insular cortex. There’s insular cortex on the left side of the brain and the right. It’s fairly large area of cortex that it barried. It’s called insular because it looks like an iron …. tissue, kind of … under the other areas of cortex. It’s damaged very heavily, but it does a couple of critical things. One is it mediates pain, it is the cortical structure that is very important for pain regulation. There are others, but partly insular is key. Not only it regulates pain, but it regulates how high blood pressure is or how low it is. It’s kind of the game control on blood pressure. And the problem with OSA is that it’s damaged very heavily on the right side, then it cannot do its normal job to …..stop …. from elevating blood pressure. And it can’t do that if it’s damaged. So that’s the cause of the hypertension (high blood pressure).
- STEVEN: Well there’s a small hope that hippocampus can be generated by treatment of OSA, so can you comment on that and how well does that work ?
o RONALD:----------------- That’s the fortunate that mother nature helps us with: hippocampus can generate neurons. All things you can imagine, it’s helped by exercise. Why that helps is not very clear. Now the speed of generation depends on how much it was damaged before, and that’s an open question of how good memory can come back. It may not be so good because we know from other diseases where memory bodies are injured of alcoholism is such a case. But there’s thing we can do to stop injury even all you have, even untreated OSA, and the reason why damage occurs is because the low oxygen when people stop breathing hyper excites the cells, they become too active and they have to defend. We need 2 things to feed the cells, we need thiamine B1 and we need magnesium. And it is the case that when the insular is damaged it does something else in addition to … that causes hypertension, it makes us sweat a lot. So during OSA people sweat a lot. Thiamine and magnesium are very common nutrient you need to … to feed the cells. If you don’t have them adequately you get exactly what I have described: damage to the hippocampus, damage to the mammalian body, damage to the … . They won’t be able to recover unless you have those nutrients. We just did a study, in which we found that all OSA patients have low magnesium, and most of them have low thiamine. If you don’t have those nutrients to feed the brain cells, they won’t be able to recover regardless of what you do. And that’s the basic problem. There is another major problem if you, most of OSA patients have acid reflux ….. don’t do it because it stops you from making thiamine, it stops you from making magnesium, but most of OSA patients take the agents for acid reflux and they are hurting themselves hardly. ….. Now about the cerebellum, …. Very important for thinking. We’ve only thought that cerebellum is only used for motion control, we often test a patient to point to his/her nose, and if he/she can do it it is fine. But in fact the cerebellum does lots of other things, it puts thoughts in sequence, it also helps blood pressure from going too high or too low. The cerebellum is very intensively heavily damaged in OSA through processes like nutrient deficiency I just described.
- STEVEN: One common theme I often heard iSteven: parts of the brain don’t work in isolation, they kind of help each other along while being connected, so if one area Is damaged, it cause damage in other areas, right ?
o RONALD:----------------- Absolutely. We will lost blood pressure control, with the insular damage in OSA, but we depend on another part of the brain, the cerebellum which controls also the blood pressure. So there are 2 structures that are both hurt, and we have to do something that repair that injury. Fortunately the cerebellum is big, it has as many neurons as the rest of the brain, so even if you have OSA, you can’t kill them all. Another nice thing the cerebellum has is that it is drastic: that one part can learn and take over when another part has failed. And that we think is going to be the major benefit that will be introduced in recovery from OSA: is retraining the cerebellum and all other structure to do what was lost. And I think with the case of the cerebellum is very possible.
- STEVEN: Let me excuse you a bit, I think we are aware of the Upper Airway Resistance Syndrom where people have multiple obstructive breathing episodes but not long enough to be called apnea (10 seconds), so they don’t really have oxygen deprivation. Do you think those also cause a damage to the brain.
o RONALD:----------------- We have not done adequate studies. The problem is we do have to get our studies published, and UARS was not really recognized as a syndrome until recently. So we have to choose 1st thing first: get OSA studied. Se we haven’t yet stretched enough time examining the brain with this UARS. It really clearly exist, it is clearly a condition that would show some kinds of brain injury. It may not be the same as what happen in a pure OSA, but it’s going to add an effect. And one of the reasons why OSA …. ISteven: females don’t show OSA until after …., but probably they do show signs of UARS before. The problem is if you look at the brain of females while sleeping without breathing the parts of the brain that are injured appear to differ from males. And that is the work of …. So it’s interesting here: maybe females have more UARS than males or maybe some aspects of UARS or some aspects of breathing controls are different. So it is becoming clear that OSA is not the unitary phenomenon, but there are other various kinds of sleep breathing disorders, so one extreme case is perhaps OSA, another extreme is limited air movement from other variations and they may have very different outcomes to the brain. And the key may be to look at females and how they differ in brain injury. It is a terribly interesting problem, and we should add more hours in a day to look at it.
- STEVEN: me too. So let’s switch off this discussion, and talk about some proactive way to prevent brain injury in OSA. So what can OSA patients beside normal treatment (CPAP) can do to maximize brain function to prevent injury.
o RONALD:----------------- The major issue obviously is to shut up conditions that cause injury and the most major problem is water loss from profuse sweating which is going to drain the full body nutrient. You have to make sure that there is no thiamine or magnesium loss because that would be number one in treating memory issues. Then the other issues, for some reasons, exercise help OSA patients by neurogenesiSteven: generation of new neurons in the hippocampus, and also perhaps other structures, but we don’t know any other structure at this moment. The sheer exercise of the muscles, the upper airway muscles, we think it’s going to help because we can intervene for OSA ... native Australian … we need to have the upper airway muscles be trained by the cerebellum to respond and not … to the kind of the conditions that are creating OSA. I think how we speak as native English speaking people … for 30 years then don’t move the muscles very much you get weak muscles, and I think speaking English as oppose to singing opera or exercising the upper airway muscles, just speaking English your upper airway muscles get soft. The key to treat OSA is to retrain the upper airway muscles, for that you need adequate sensory input airflow ….. that’s another whole hour discussion on how you can do that, but I can tell you that retrain the brain using enhanced sensory input that comes … that’s possible, then you can get rid of OSA, it’s not necessary to have OSA, you can retrain your brain to handle it.
- STEVEN: Is there also some tongue exercises or facial miology.
o RONALD:----------------- yeah, partial tongue exercise, more to the soft palate that used to be at least more important for the digili-doo studies, but there maybe the whole seven muscles. It’s really unexplored, and some people have done the digili-doo works, that mean we can really go in and find out what kind of exercises work, it’s retreaining the brain but the tongue muscles are probably the huge part of that. A large number of upper airway muscles that have to be controlled, where the cerebellum plays a major role in that learning process.
- STEVEN: So maybe you should recruit a patient with OSA and have the use the digili-doo or exercises and do the imaging of the brain before and after.
o RONALD:----------------- That’s a very real scenario: try some functional test, do the MRI between the vocal learning areas, including the cerebellum, and then follow the tests after training. That’s a very good thing to do. And I will take you for lunch if the outcome is very predictable
- STEVEN: I really appreciate your spending time with us. Today I am so honored that you join us to talk with us about this important issue. Do you have a final comment before you finish ?
o RONALD:----------------- I think in the next few years the future of research on OSA will depend on activating the sensor processes that’s telling the brain: hey you don’t activate those muscles when you breath, and something is going wrong in those sensor processes are doing that, and you have to retrain those processes. And I think the future of overcoming OSA lies in that direction.
- STEVEN: So how can people find out more on your research ? Is there some website that you recommend ?
o RONALD:----------------- For those who have access to PubMed, all our studies are there. But I realize that many people don’t have access to PubMed. We have review chapters that would generally cover the issues. It’s a terribly interesting area that’s rather complex , but we have …. Out there of people want to find them.
- STEVEN: So we will put a link to your UCLA website. And you know what you also have a very interesting colored photograph of the areas of brain damage and I think that could be interesting to access somebody’s photos, right ?
o RONALD:----------------- The image of the brain injury are for anybody who looks at the brain images a little scary, because the damages are so extensive, particularly if the patient also has diabetes, and you know what, diabetes and OSA go hand in hand. Anybody who manages OSA has to ask the patient whether or not he/she has diabetes, and if they say no just run a simple glucose level test. Yes, somebody who is not convinced of what OSA does should look at some of the images.
- STEVEN: I tell you that you are absolutely right: it’s scary to look at these photographs, they are eye opening.

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Re: Brain Damage and Sleep Apnea: Dr. Ronald Harper

Post by Jay Aitchsee » Sun Oct 16, 2016 11:21 am

story1267 wrote:
70sSanO wrote:
So I go in to see the "specialist" and showed him my twenty-seven pages of Rescan data with the circles and arrows and a paragraph on the back of each one, and he looked at them and said... kid, I want you to go over and sit down on that bench that says Group W.

John
I had to come on and thank you for this....I needed a laugh today. You can get anything you want.....
Hah! Fortunately John, it sounds as if you did "rehabilitate yourself"

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