Brain structural changes in obstructive sleep apnea.

[roster]

........Do you know if the alterations are reversible once we stop the oxygen deprivation? OR We know we only use a small percentage of our brains, and I've read amazing descriptions of how a healthy area of a person's brain has taken over work that no longer can be performed by a damaged area of his/her brain. Do you know if this sort of thing might happen?

........

1. The scarring in the brain is not reversible.
2. The brain can find ways to partially compensate for some of the damage.
3. We will never reach our previous potential.

Do the best with what we have left.

I can live with that. (Good thing, eh?) Knowing is better than wondering.
What Abe said (see below).

Marsha

Marsha,

Here is something encouraging that applies to stroke but maybe damage from apnea can be seen in the same light.

Treadmill Walking Can Retrain Brain and Body Even Years After Stroke
By Judith Groch, Contributing Writer, MedPage Today
Published: August 28, 2008
Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston. Earn CME/CE credit
for reading medical news


TUBINGEN, Germany, Aug. 28 -- Six months of repetitive gait training on a treadmill not only improved walking speed and fitness, but appeared to rewire brain circuits in patients who'd had a hemiparetic stroke years earlier, researchers reported.


Stroke patients are typically told to learn to live with their disabilities, and most rehabilitation programs focus on short-term improvement, ending just a few months after the stroke, the researchers said.


Consequently, over time, patients' functional improvement plateaus and fitness often wanes.


However, this study suggests that it's never too late for the brain and body to recover, the researchers said, noting that patients in the study had significant improvement even nine years after a stroke.


From 2003 to 2006, Dr. Luft and researchers at Johns Hopkins, the University of Maryland, and the Maryland VA Medical Center recruited 71 individuals (mean age 63) who'd had an ischemic stroke at least six months earlier. There was an average time lapse of nearly four years.


At the study's start, half of the individuals could walk without assistance; the rest used a cane, a walker, or a wheelchair.


The patients were randomized to two groups, regardless of disability, and walking velocity and VO2 were measured for all participants during a symptom-limited maximal effort treadmill exercise test.


Thirty-seven patients participated in an exercise program that involved walking on a treadmill three times a week for up to 40 minutes. Patients were assisted by a supporting sling and tether if needed.


Physical therapists increased the intensity of the workout over time without taxing patients beyond a moderate level of 60% VO2.


Therapists assisted the 34 controls in doing stretching exercises for the same period of time.


Thirty-two patients drawn equally from both groups underwent functional MRI to assess brain activity linked to single joint movements of the leg and knee, given that walking could not be studied directly during functional MRI. Investigators handling the scans were blind to patients' treatment.


The treadmill walkers' speed increased 51% versus 11% for the stretchers, and VO2 peak increased about 18%, versus a slight 3% decrease for the controls.


The average walking speed during a six-minute over-ground walk increased by 19% for the treadmill walkers versus 8% for the stretchers.


In the treadmill walkers, there was a positive correlation between change in treadmill velocity and increased activation in the contralesional posterior cerebellum, but this was not so for the stretchers.


Treadmill walking improved walking, fitness, and recruited cerebellum-midbrain circuits, likely reflecting neural network plasticity, the researchers said.


Whether the enhanced recruitment of these networks reflects structural reorganization of cortico-subcortico circuitry remains to be tested by studying the long-term retention of the neuroplastic changes or by studies of brain morphology, they said.


Patients with the most improvement in walking showed the greatest changes in brain activity, the researchers said, but added that it was not clear whether these changes were caused by more walking or whether participants walked better because brain activity in these key areas increased.


The investigators noted that the study had some limitations involving methodology and design. Functional MRI measures brain activation indirectly through changes in blood oxygenation and flow. Thus other factors such as pathology related to generalized vascular disease may have confounded the results. However involvement of a similar control group minimized this potential difficulty, they said.


Locomotor disability diminishes physical activity, placing the stroke patient in a vicious cycle in which immobility promotes deconditioning, sarcopenia, and metabolic dysfunction that can increase cerebrovascular risk and worsen disability, the researchers said.


It is promising therefore, they said, that treadmill walking can stimulate new or underused brain circuits and improve ambulation in stroke survivors even after completion of conventional rehabilitation therapy.



The research was organized by the University of Maryland Veterans Medical Center and the MRIs were done at the Kirby Research Center, affiliated with Johns Hopkins.
The study was supported by a grant from the National Institutes of Health; the University of Maryland; the Claude D. Pepper Older Americans Independence Center; the Department of Veterans Affairs; Baltimore Veterans Affairs Medical Center Geriatrics Research, Education and Clinical Center; Rehabilitation Research & Development Exercise and Robotics Center of Excellence; VA Advanced Career Development Award and Stroke; France-Merrick Foundation, Johns Hopkins University, the Eleanor Naylor Dana Charitable Trust, and the Deutsche Forschungsgemeinschaft.

No financial disclosures were reported.




Primary source: Stroke
Source reference:
&searchidLuft AR, et al "Treadmill exercise activates subcortical neural networks and improves walking after stroke: a randomized controlled trial" Stroke 2008; DOI: 10.1161/STROKEAHA.108.527531.

Source: http://www.medpagetoday.com/Cardiology/Strokes/tb/10710

[Snoredog]

I take an additional 500mg of niacin. Niacin attacks that Atherosclerosis better than anything and Niacin is OTC and cheap. But if you have insurance you can ask your doctor about Niaspan (http://www.niaspan.com) it is prescription only same strength but it is time-released coated so it doesn't cause as much flushing, but once you get used to the flushing and I take it at bed time along with the aspirin so by the time it dissolves I'm asleep before the flushing ever takes place.

My understanding is that you can take Niacinamide instead of strait Niacin and avoid the flush?

Both are Niacin ingredients, but "Niacinamide" to my understanding doesn't cause as much flushing as that part has been removed or changed as not to cause the flushing to be as strong.

However, the flushing is what you want in my opinion, flushing means it is effectively dilating the blood vessels, for us with strokes that is what we want. while it may feel uncomfortable on your skin for 15 minutes or so, you get used to taking it (plain generic 500mg OTC type from like Costco). My cardiologist suggested taking my daily aspirin right before I take it to reduce the flushing, he reported his other patients indicated that helped, said Tylenol also helped.

Here is a site that discusses the flushing effect, it explains it where you can understand it:
http://www.healingdaily.com/detoxificat ... niacin.htm

I guess if you want to research the research, a good google search term might be: "Niacin role in cardiovascular disease"

I've taken a multi-vitamin before that had higher amounts of niacin, I got a mild niacin buzz from it as well. If you get that flushing, which kind of feels like a mild sun burn, just know it goes away after a few minutes and not to panic, you can tell how long after you take it before it starts working that is for sure.

[roster]

........I asked a pharmacist about niacinamide. He said it is nearly worthless because it is not well absorbed by your body. The reason it doesn't cause flushing is because it is not absorbed. There are some comments about the lack of effectiveness of niacinamide here: http://www.mayoclinic.com/health/niacin ... ent-niacin

I noticed WalMart has an OTC time-release niacin quite cheap.

The link SnoreDog just provided tends to substantiate what the pharmacist said. In the link it states, "The other form of niacin (nicotinamide or niacinamide) does not open blood vessels wider nor provide a cholesterol-lowering effect." This is consistent with the Mayo Clinic link above.

Now at WalMart I saw three different types of niacin that stated "No Flushing" and one time released straight niacin that warned of flushing in the small print. My doc is pushing me to start statins but I am considering self-treatment with OTC time-release niacin. I will stay away from the "No Flushing" type as they seem to be poorly absorbed and therefore ineffective.

Wednesday I took my 86-year old mother for her annual physical. She is taking Lipitor and I really challenged the doc about the value of Lipitor and asked him a lot of questions about Niaspan. He spoke very highly of Lipitor and Niaspan. He prescribes Niaspan less because people complain about the flushing. However, he believes Niaspan is very effective. Important for me he said Niaspan has excellent anti-inflammatory properties.

The doc never suspected that my line of questioning and challenges had less to do with my mother than with me. I was getting some free medical advise for myself tacked onto my mom's physical.

When we get back from a Labor Day weekend trip I may start 500 mg Niacin daily. I like that idea about taking it at bedtime. On the other hand maybe I will take it just before social events and see if the flushing can get me some sympathetic attention from any good looking unattached females.

[Snoredog]

speaking of Wal-Mart and the recent invasion by Russia:

This News Just In:

All of the Wal-Marts across Alabama sold out of ammunition as of yesterday.

A reliable source said that one of the purchasers commented that while Russia may have invaded Georgia, they sure as hell ain't doin' it to Alabama!

[roster]

I just noticed in SnoreDog's link the time release niacin is slammed as being dangerous to the liver,

but timed-release niacin is also associated with greater toxicity and safe doses are only about half of normal-release forms of niacin.

I wonder why that would be?

[roster]

No flush, no effect



"Inositol Hexanicotinate is the true 'flushless niacin.' Unlike 'sustained-release' niacin, which is just regular niacin in a pill which dissolves more slowly, Inositol Hexanicotinate is a niacin complex, formed with the B-vitamin-like inositol. When you take an IHN supplement, the central inositol ring gradually releases niacin molecules, one at a time delivering true niacin. This, like "sustained-release" niacin, allows you to take niacin at clinically-proven doses without going crazy with the itch."


That above bit of nonsense adorns one manufacturer's sales pitch for its no-flush niacin. No-flush niacin is one of the biggest scams in the health food store.

Ordinarily, I love health food stores. There are lots of fun and interesting things available that pack real power for your health program. Unfortunately, there's also outright nonsense. No-flush niacin is smack in the category of absolute nonsense.

No-flush niacin is inositol hexaniacinate, or an inositol molecule complexed with 6 niacin molecules. So it really does contain niacin. However, although it works in rats, in my experience and that of many others who've used it, no-flush niacin exerts no effect in humans.

One typical example: A 41-year old woman came to my office for consultation because her doctor didn't know what to do with lipoprotein(a). She had seen a cardiologist who told her to take no-flush niacin. Both the cardiologist and the patient were therefore puzzled when lipoprotein(a) showed no drop and, in fact, was slightly higher while on the no-flush preparation.

The lack of any observable effect and no studies whatsoever showing a positive effect (there is one study demonstrating no effect), manufacturers continue to manufacture it and health food stores continue to push it as an alternative to niacin that causes the flush. It's also expensive, commonly costing $30-$50 for 100 tablets.

Don't fall for this gimmick. Niacin is among the most helpful of treatments for gaining control over heart disease risk. It raises HDL, corrects small LDL, reduces triglycerides (along with its friend, fish oil, of course), reduces lipoprotein(a), and dramatically contributes to reduced heart attack risk. No-flush niacin does none of this.



The same warning goes for other niacin scams like nicotinamide. Though it may look and sound like niacin, also called nicotinic acid, nicotinamide possesses none of the benefits of niacin.





Make it easy on yourself



Here are the steps I advise that really make taking niacin easy and tolerable:

1) Take niacin with dinner or other substantial meal.

2) Take with 2 extra glasses of water. If you experience the hot-flush later on, drink an additional 2 8-12 oz glasses of water, i.e., a total of 16-24 oz). Extra hydration is extremely effective for blocking the hot-flush. Conversely, people who are chronically underhydrated are most prone to bothersome hot flushes. (Of course, discuss this with your doctor if you are on any kind of fluid or salt restriction or have a problem with fluid retention.)

3) Take a 325 mg, uncoated aspirin. This is usually necessary in the beginning or with any increase in dose; it is rarely needed chronically.

This is not to say that there aren't occasional people who are truly and genuinely intolerant to niacin. It does happen. But those people are a small minority, less than 5% of people in my experience. Niacin is far more effective and safe than most physicians would have you believe.



Besides prescription Niaspan®, I've used the slow-release preparation SloNiacin® which is available without a prescription in many pharmacies. Slow-release niacin preparations like Niaspan® and SloNiacin® should only be taken once per day. Beware of the slow-release preparations sold in health food stores, since the pattern of release of niacin is often not well-controlled. Just plain niacin, also called immediate-release niacin, is widely available but is more likely to cause the hot flush; however, this form can be taken twice a day in smaller doses. Increase the dose of immediate-release niacin very gradually (e.g., start with 100 mg twice a day and increase in 100 mg quantities).



Because of a small risk of liver and other more concerning side-effects, niacin treatment should be conducted with the help of your doctor, particularly if you take more than 500 mg per day.

Source: http://www.healthcentral.com/cholestero ... hs-facts/2

[larbabe]

This explains a lot. I had a TIA 2 years ago, and the MRI showed lots of older lesions. That was before I'd been to the sleep lab and knew how bad my OSA really was. The neurologist ruled out artery and other problems, and couldn't come up with an answer. And here it is!
Thanks for posting this!

[Snoredog]

This explains a lot. I had a TIA 2 years ago, and the MRI showed lots of older lesions. That was before I'd been to the sleep lab and knew how bad my OSA really was. The neurologist ruled out artery and other problems, and couldn't come up with an answer. And here it is!
Thanks for posting this!

Never trust a Neuro, mine always told me it was all in my head when I asked about something. This site is pretty good for
TIA/stroke info:

http://www.neurologyreviews.com/main.html

Just take what you read with a grain of salt, for example there is one study that says Warfarin is more effective than Aspirin for stroke. Only problem with that finding is they gave the patients 75mg of aspirin and not your typical 325mg, I haven't even seen 75mg aspirin available to purchase only 81 mg. Then there are studies that show that is not enough aspirin and they doubled the dose to 162mg, then they found they were back to the 325mg size you regularly buy. So is that a fair comparison that Warfarin is more effective? Why didn't they compare Warfarin to 325mg dose of aspirin? You will find that in a lot of studies you read, you just need to compare apples to apples.

[DreamDiver]

This is your brain without xPAP... Any questions?

[deerslayer]

This is your brain without xPAP... Any questions?

that is one bad sinus infection

[feeling_better]

Thanks for the info jskinner

I just want to add to your post about the importance of white matter of the brain and XPAP.


The white matter of the brain contains nerve fibers. Many of these nerve fibers (axons) are surrounded by substance called myelin. The myelin gives the whitish appearance to the white matter. Myelin acts as an insulator, and it increases the speed of transmission of all nerve signals.

"Treating obstructive sleep apnea with continuous positive airway pressure appears to reduce the incidence of clinically obvious stroke. This study provides a novel potential mechanism for this finding. In particular, those patients with silent infarcts and sleep apnea had elevated markers of platelet activation.

Furthermore, continuous positive airway pressure therapy for 3 months can lower such markers in this population, thereby providing a link between the white matter lesions and their pathogenesis.

Treatment with continuous positive airway pressure may therefore lead to a reduced incidence of subsequent ischemic brain lesions."

You can read the whole article at:
http://www.medicalnewstoday.com/articles/65322.php

Sleepydoll, Thank you very much for posting the url to that excellent study article!

[ww]

I take an additional 500mg of niacin. Niacin attacks that Atherosclerosis better than anything and Niacin is OTC and cheap. But if you have insurance you can ask your doctor about Niaspan (http://www.niaspan.com) it is prescription only same strength but it is time-released coated so it doesn't cause as much flushing, but once you get used to the flushing and I take it at bed time along with the aspirin so by the time it dissolves I'm asleep before the flushing ever takes place.

My understanding is that you can take Niacinamide instead of strait Niacin and avoid the flush?

Both are Niacin ingredients, but "Niacinamide" to my understanding doesn't cause as much flushing as that part has been removed or changed as not to cause the flushing to be as strong.

However, the flushing is what you want in my opinion, flushing means it is effectively dilating the blood vessels, for us with strokes that is what we want. while it may feel uncomfortable on your skin for 15 minutes or so, you get used to taking it (plain generic 500mg OTC type from like Costco). My cardiologist suggested taking my daily aspirin right before I take it to reduce the flushing, he reported his other patients indicated that helped, said Tylenol also helped.

Here is a site that discusses the flushing effect, it explains it where you can understand it:
http://www.healingdaily.com/detoxificat ... niacin.htm

I guess if you want to research the research, a good google search term might be: "Niacin role in cardiovascular disease"

I've taken a multi-vitamin before that had higher amounts of niacin, I got a mild niacin buzz from it as well. If you get that flushing, which kind of feels like a mild sun burn, just know it goes away after a few minutes and not to panic, you can tell how long after you take it before it starts working that is for sure.

Just curious why people take Niacin when 80 mg Simvastatin ($18/100)is available as the low cost generic for 80 mg ($484/100) brand name Zocor. This has been proven effective and with low side effects in most people and is quite affordable as most people will take only 1/2 per day or less. That is less than $3/month for an effective dosage for most people.

[deerslayer]

500mg NIASPAN just arrived in the mail from the VA. the doc wants me to supplement my already 40mg Simvastatin & 81 mg aspirin for the purpose of elevating HDL ,along with heading off any future TIA's. instructed to take the Simvastatin & aspirin 30 to 60 min. before taking niaspan at bedtime to avoid flushing. man i hope i tolerate this stuff

[Julie]

Hi, for what it's worth, niacin (and/or it's spin-offs) and/or selenium, and/or lots of other nonprescription meds may work for some people's cholesterol, but some is 'familial' (genetic) and none of those will do the job. Mine was high, and I tried all the recommended stuff, and none of it made more than a slight change, but when I went on statins, my cholesterol dropped like a stone immediately. Trouble is, I can't take it now because my stomach complains loudly (gastritis), so I just do nothing, so everyone needs to find their own fix.

[roster]

...........Just curious why people take Niacin when 80 mg Simvastatin ($18/100)is available as the low cost generic for 80 mg ($484/100) brand name Zocor. This has been proven effective and with low side effects in most people and is quite affordable as most people will take only 1/2 per day or less. That is less than $3/month for an effective dosage for most people.

Simvastatin is effective at lowering ldl but it has no effect on hdl (the so-called "good" cholesterol). Niacin is effective at increasing hdl. That is the reason for Deerslayer's doc prescribing a combination approach.