Idiopathic Intracranial Hypertension, or a Pseudotumor, is a condition when the whole brain becomes swollen for no obvious no reason. There are no signs of infection, no stroke, no tumor. The symptoms mimic a tumor, with the most common one being moderate to severe headaches. When left untreated, the increased pressure between the spaces in the brain can lead to swelling of the optic nerve and ultimately loss of vision.
We can detect a Pseudotumor by examining the back of the eye using an ophthalmoscope. Proper treatment consists of diuretics and medications to decrease the production of spinal fluid so the brain will shrink. The cause of the Pseudotumor believed to be a reaction to various types of medications, like tetracycline. Recently, however, we have started to note a strong association between the Pseudotumor and Obstructive Sleep Apnea.
Is Sleep Apnea Causing Your Brain to Deteriorate?
The association of sleep apnea and intracranial hypertension leaves us with the question of why? Is sleep apnea causing your pseudotumor? Is it having other negative effects on your brain?
While more research and understanding is needed to fully answer these questions, a recent article by D.E. Wardly, Intracranial hypertension associated with obstructive sleep apnea: A discussion of potential etiologic factors, begins to look at why Obstructive Sleep Apnea may lead to the increased intracranial pressure and the condition of the Pseudotumor.
His first hypothesis is that mouth breathing, which is common amongst patients with OSA, leads to vertical development which narrows the neck compartment to increase resistance in the internal jugular veins. This would then increase your risk of Idiopathic Intracranial Hypertension.
Another way OSA can lead to a pseudotumor is by possible excess neuro-excitability, or neuro-excitotoxicity. In OSA, there is excess glutamate and this over-stimulation leads to the death of cells in the memory structures of the brain, and to brain swelling. CPAP can reduce some of the resultant brain swelling seen in these patients, though careful titration must be done.
In addition, people with OSA have so-called “hypercoagulability”, where blood forms clots more easily than in normal people. This is caused by increased clotting factors, and these can be reversed by CPAP treatment. If left untreated, increased clots form in the veins and arteries, which can lead to stroke and heart attack.
Lastly, the barrier between the blood and the brain, the “blood-brain barrier,” so important in keeping unwanted chemicals out of the brain, can be broken down in OSA. This break down contributes to brain edema.
The Takeway: Treat Your OSA
Wardly’s article presents very valid hypotheses that even mild sleep-disordered breathing, as present in many patients with Hypermobility Spectrum Disorder, can have deleterious effects on the brain and the central nervous system. And while more experiments are needed to test his hypotheses, we know enough about OSA to know that proper treatment is crucial — even if it’s found that it does not increase intracranial pressure.
We know the treatment of OSA is important for the improvement of brain function and its protection against unwanted chemicals present in the blood, byproducts of the unhealthy food we eat sometimes, and the stress we all have in our lives.
We know OSA disrupts sleep, makes us tired during the day, and causes automobile accidents, stroke and heart attacks.
The risks and effects of Obstructive Sleep Apnea, even if it’s mild, even if you’re, should be treated — more than just your sleep depends on it.
