Apnea and Pain

   Jul 30 , 2018


   Michael White

NO (Nitric Oxide)-Mediated Alterations in Skeletal Muscle Nutritive Blood Flow and Lactate Metabolism in Fibromyalgia.

McIver KLEvans CKraus RMIspas LSciotti VMHickner RC.

Human Performance Laboratory, Department of Exercise and Sport Science, East Carolina University, Greenville, NC, USA.

The purpose of these investigations was to determine if differences exist in skeletal muscle nutritive blood flow and lactate metabolism in women with fibromyalgia (FM) compared to healthy women (HC); furthermore, to determine if differences in nitric oxide-mediated systems account for any detected alterations in blood flow and lactate metabolism and contribute to exertional fatigue in FM. FM (n=8) and HC (n=8) underwent a cycle ergometry test of aerobic capacity, a muscle biopsy for determination of nitric oxide synthase (eNOS, nNOS, iNOS) content, and microdialysis for investigation of muscle nutritive blood flow and lactate metabolism. During prolonged (3h) resting conditions, the ethanol outflow/inflow ratio (inversely related to blood flow) increased in FM over time compared to HC (P<0.05). FM also exhibited a reduced nutritive blood flow response to aerobic exercise (P<0.05). There was an increase in dialysate lactate in response to acetylcholine in FM, and to sodium nitroprusside in both groups, with a greater rise in dialysate lactate in FM (P<0.05). The iNOS protein content was higher in FM and was negatively correlated with total exercise time (r(2)=0.462, P<0.05). In conclusion: (1) There is reduced nutritive flow response to aerobic exercise and reduced maximal exercise time in FM that might relate to higher iNOS protein content and contribute to exertional fatigue in FM; (2) The increased dialysate lactate in FM in response to stimulation of NOS or a nitric oxide donor suggest that FM may be more sensitive than HC to the suppressive effect of nitric oxide on oxidative phosphorylation.

PMID: 16376018 [PubMed - in process] 

From Mike: Nitric Oxide is a vaso dilator that is produced as part of breathing through the nose  Vaso constriction causes or worsens pain. Vaso dilation decreases or eliminates pain. For more about breathing development related pain reduction see the Article on Drugs


Is obstructive sleep apnea syndrome a neurological disorder? A continuous positive airway pressure follow-up study.
Ann Neurol. 2005 Dec;58(6):880-7.
PMID: 16240364 [PubMed - in process]

Guilleminault C, Huang YS, Kirisoglu C, Chan A.

“Over 5 years, we managed healthy, nonobese subjects compliant with nasal CPAP...... By the completion of the study, all subjects required an increase in nasal CPAP (1-7cm H(2)O) and demonstrated abnormal two-point palatal discrimination compared with control subjects. Despite initial control of clinical symptoms with regular usage of nasal CPAP in subjects without weight change, abnormal sensory palatal evaluation was present at the conclusion of the study. Obstructive sleep apnea syndrome involves abnormal upper airway sensory input, which may be responsible for the development of apneas and hypopneas. These neurological lesions are persistent despite nasal CPAP treatment. Ann Neurol 2006.” Respiration. 2005 Dec 8;

From Mike:
The above implication is that it IS neurological and therefore permanent. They say the same thing about spasmodic dysphonia (SD) but we know that SD NOT completely neurological and probably most can be restored to good voicing.  

CPAP Merely Palliative in Obstructive Sleep Apnea

"NEW YORK (Reuters Health) Dec 21 - Treating obstructive sleep apnea (OSA) with nasal continuous positive airway pressure (CPAP) "is not a solution to the problem," researchers report in the December issue of the Annals of Neurology. The real problem is the underlying neurological lesions that cause disordered breathing and the solution, they say, is prevention of progression of OSA....

Summing up, he added that it is important to know the size and extent of the underlying neurological lesion before surgery. It is also "important to realize that nasal CPAP is not a complete solution and that non-compliance is a major problem... surgery may be a better solution."

From Mike: Now the surgeons get in the act. "Surgery may be a better solution." HUGE "may" but still possible. Nevertheless may well be best to begin here.

Diaphragm strength and sleep.
If you're like most people, you know that one of the biggest dangers of snoring and untreated sleep apnea is a reduction in the body's intake of oxygen. It's a little known fact that your diaphragm muscles can be a HUGE help in reducing sleep apnea and breathing volume. 
The diaphragm muscles are responsible for breathing – weak muscles mean your breathing isn't as strong or as easily deepened as it should be.  But there is hope!
There are a few key breathing development techniques and exercises that are meant to strengthen the diaphragm and increase lung volume and oxygen intake.  
Without the right amount of oxygen, we experience fatigue and depression, and low oxygen levels can also lead to serious health conditions such as heart failure.  By following our program in our Sleep program you'll be well on your way to a stronger diaphragm, greater lung volume and more oxygen. 

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