Vitamin D & B's and Sleep Quality

[membus]

Since I'm new to xPAP therapy I'm always researching for sleep quality and last week came across a video by a neurologist, Dr. Stasha Gominak. It was about Vitamin D deficiency and it's possible effects on sleep quality. It caught my attention because my latest blood test showed I had low Vitamin D.

I think it is pretty interesting.

Did anyone here came across similar articles or lectures? Would love to read or listen more about this.

The link for Dr. Gominak's videos is here: http://drgominak.com/videos.html

I watched the first and last one so far.

[membus]

I found a thread about this topic. Sorry for not having checked before. Tried to delete my post but got error. The link to the post is here:

http://www.apneaboard.com/forums/Thread-...a-patients

[I_will_never_sleep_again]

That was long but interesting. It does make a lot of sense.
Thanks for posting

[Mosquitobait]

There really isn't anything proven on this. Except for calcium absorption, most of the studies are not panning out that added Vitamin D is any kind of cure-all. However, too low of vitamin D and calcium increases risk of broken bones. That IS the only proven thing. Most of these other Vitamin D studies are on populations too low to be significant.

How you take vitamin D may also have some play. Taking it with the biggest meal of the day increases absorption in all age groups. For some, like me, the 50,000 units once a week did nothing, but works for another family member. I found taking 5,000 units of D3 daily was the only way I could get BARELY into the normal range. Vitamin D for your bones does demand that you also consume calcium.

[worn_out_in_lebanon]

In addition to D's role in bone health, especially if you are considering supplementing calcium, I'd recommend researching K2. It plays a role in directing calcium to bones (and not to arteries). Dr. Kate Rhéaume-Bleue has done a lot of research in this area and has written a very informative book on it.


In general, sufficient D directly affects 291 genes in white blood cells alone (decreases expression of 82 and increases expression of 209), with cascading effects to hundreds of other genes. One gene affected by D (EGR-1) is estimated to affect another 300 genes. (taken from a pdf on plosone, also linked from "291 genes improved expression by 2000 IU of vitamin D – RCT March 2013" on vitamindwiki)

So in any case, it would seem to be a good idea to address any D deficiency.


Bodyecology has an article indicating a tie to apnea. I haven't researched the studies referenced by it though. Here's a quote from the article:
"Vitamin D curbs the expression of the RelB gene, which plays a pivotal role in the development of inflammation. What's more, some pro-inflammatory chemicals also regulate sleep. The ReIB gene (and inflammation) has been linked to sleep apnea—a common sleep disorder."

[tmoody]

I also have been interested in Dr. Gominak's work on vitamin D and sleep disorders (not just apnea). By way of introduction, since this is my first post, I'm 62, male, and was diagnosed with OSA ten years ago. I used a regular CPAP for nine years. It was the old kind, with no information display or telemetry. I never bothered to check in with my pulmonologist and just assumed everything was fine. Eventually, I started to feel a little less rested and called in about getting a new machine. I got an APAP and the digital readout showed that my OSA had progressed to complex apnea. I had a cardio check, echocardiogram, etc, that turned up nothing unusual. I've been treated for hypertension for a few years now.

ANYWAY...I stumbled on Dr. Gominak's videos and was struck by her assertion that ALL sleep apnea, including obstructive, is an "autonomic disorder", not simply a mechanical one. And she said she often sees patients going from obstructive to complex over time, with CPAP/APAP treatment. Interestingly, my cardiologist said the same thing. When I got an opportunity to ask the pulmonologist, he too said it's not uncommon, and nobody really knows why.

I have a BPAP/ASV machine coming next week. I also had my vitamin D tested two days ago, and I expect the results today or tomorrow. I started supplementing with D a few weeks ago, after seeing Dr. Gominak's videos and exchanging a few emails with her. I'm currently taking 10,400 IU a day. 10,000 of that is from a single supplement. The other 400 is from cod liver oil, which I take for its vitamin A content. I've also started with vitamin K2 and magnesium, and a B50 supplement.

I'd like to point out that the so-called "normal" range for D is 30-100 ng/ml. Dr. Gominak and others believe that 30 is really only about half of "true" normal, and the level should be 60-80. John Whitcomb also argues for 60 or so. Their argument is that this is the level seen in dark-skinned people who live in equatorial regions, who don't wear a lot of clothing. This is meant to be understood as our ancestral/evolutionary adaptation. As human beings migrated away from the equator, they also tended to lose melanin, allowing them to produce more D with less exposure, but of course that didn't allow for sunscreen, cosmetics, and indoor living.

Another point: Dr. Gominak doesn't claim that getting your D level to 60-80 "cures" apnea, but she does believe, based on her clinical experience, that it alleviates it to some extent, and allows us to make the most of our sleep. She claims, again based on her clinical experience, that if one's level goes over 80 ng/dl, apnea gets worse again. Clinical work is not the same as double-blind placebo-controlled trials, but we have to make do with what we've got.

There is good evidence that adequate vitamins A and K2 reduce or eliminate the risk of D toxicity, and in fact documented cases of D toxicity are very rare. The real danger of D overload is calcium deposited into soft tissues, since D potentiates calcium absorption. K2 specifically opposes this, and A enables the body to excrete calcium it's not using. There is some preliminary evidence that K2 is important in brain (and presumably brain stem) function, but it's too early to say whether this will turn out to be relevant to sleep apnea. I'm betting it will. Even though there is no simple direct way to measure K2 levels, all circumstantial indicators suggest that most of us in the developed world are seriously deficient in it.

[tmoody]

Update: I got my D level results today. It was 40, after supplementing for about a month and a half at 10,000 IU per day for about half that time, 5,000 for the first several weeks. I also checked my AHI for the first time in months (I was getting a little OCD about it) . It had been over 15 four months, but in the last month it dropped to 11.3, mostly due to the past week or so being below ten. So, the improvement coincides with my D level getting close to 40.

I wonder if I should postpone switching to ASV for a while to see if this improvement continues with APAP. Any opinions?

[worn_out_in_lebanon]

[my AHI] had been over 15 four months, but in the last month it dropped to 11.3, mostly due to the past week or so being below ten. So, the improvement coincides with my D level getting close to 40.

Will be very interesting to see how this progresses.

[tmoody]

[my AHI] had been over 15 four months, but in the last month it dropped to 11.3, mostly due to the past week or so being below ten. So, the improvement coincides with my D level getting close to 40.

Will be very interesting to see how this progresses.

Well, switching to the ASV pretty much ruins the experiment by introducing another variable. But since I want to deal with the centrals, I guess it's justified.

I've had the ASV just under a week, and my AHI has been 5 or below every night, except the first night, which was 15.9.

Getting back to the vitamin D theory... Dr. Gominak has published peer-reviewed articles on the subject, which I've read, but there's been no placebo-controlled study that I'm aware of. What's interesting to me about her theory is that she thinks all sleep apnea, not just central, has an autonomic disorder as a component. In her clinical practice, she finds that vitamin B5 is also very important for sleep, and difficult to get the right dose (she doesn't favor supplementing with individual B vitamins, except for B12 if necessary).

Dr. Michael Holick, MD, PhD, is sort of the "dean" of vitamin D science. He has produced an app that can be used to estimate D levels in the body. It's called "dminder". If you don't have a lab test result, you input your age, weight, and skin tone, and typical weekly sun exposure, and it estimates your D3 level. Then as you supplement and/or sunbathe, it revises the estimate.

When I started my D regimen, the app estimated my D at 17. As I took large amounts of D, the estimate went up to 42. I got a lab test, which showed a blood level of 40 ng/ml, so the app estimate was pretty good. I then entered the lab result into the app, and it corrected the estimate. It now has me at 42 again, which is probably close to the true value.

To repeat what I wrote above, Dr. Gominak hasn't observed any therapeutic value for sleep disorders until you get to the 60-80 range. It's not a question of what is the "correct dose" except indirectly, to get you into that range.

Moving the blood level is a slow process. The older we are, the less effective our skin is at producing D in response to sunlight.

Personally, I would be thrilled if getting into the 60-80 range allowed me to drop back to APAP from ASV, taking out the centrals. I don't know if this is possible, but I'm cautiously optimistic. Dr. Gominak is a neurologist, who acquired her interest in sleep disorders via the side door, so to speak. It's not something she had a prior interest in but discovered that virtually all of her neuro patients had significant sleep disturbances, and even non-apnea patients were getting benefits from XPAP use!

[green wings]

Thanks for posting this, tmoody. I watched Dr. Gominak's YouTube videos last night. My biggest take-away from them was that she thinks adequate vitamin D3 blood levels are necessary for us to have normal sleep (if I understood correctly).

By "take-away", I suppose I mean what felt important to me personally, since I know that my levels have been low since at least 2007.

The app to estimate blood levels is interesting, thanks for mentioning it.

I see a rheumatologist for autoimmune arthritis. She checks my vitamin D3 level about yearly now, since I've given up on supplementing it. In 8 years of tests, it has ranged from 16-25 ng/ml.

The 16 ng/ml occurred at a time when I'd been spending hours each day outside and rarely wore sunscreen, so I've always felt like there are other factors involved (for me, at least.)

Anyway, I am feeling motivated to try supplementation again now that I'm using CPAP therapy. I will make sure I'm also taking K2 as well.