Monthly Archives: January 2013

Sleep Song #1: “When You Dream” by Barenaked Ladies

There are countless songs containing sleep as a theme. From time to time I will showcase some of my more favorite sleep-related or sleep-flavored songs for your enjoyment!

I’ve been a Barenaked Ladies fan for the past twenty years or so. I love their clever lyrics, hook-filled melodies, and frenetic, spontaneous, audience-centric live shows. Plus, their bassist, Jim Creeggan, is an absolute badass on standup bass. I highly recommend their live performances.  I’ve seen them numerous times.  The show that stands out in my memory most was one held in a teeny club in Northampton, Massachusetts, circa 1996. In between songs Ed Robertson called a couple up to the front, and the guy proposed to his girlfriend on stage. While she stood there silent and mortified, the guys in the band all leaned in to hear her response, and they came up with a song in which they chanted something like, “Will she say yes?” Finally she accepted the proposal, and the band busted into a speed-metal vamp, screaming their on-the-spot chorus, “She said yes!” over and over while the crowd went nuts.

So this song, “When You Dream,” is a great tune near the end of their 1999 album Stunt. The singer imagines what his infant boy is thinking about while he dreams peacefully. It’s a wonderfully crafted piece, conjuring many of those fuzzy, fanciful images we think of when we try to recall our dreams.

There is much we do not understand about rapid eye movement (REM) sleep, but REM sleep and dreaming are the focus of very intense sleep medicine research at the moment. I will write more about dreaming in a future post. We know REM sleep has restorative effects and has some role to play in things such as memory consolidation. However, there are still many mysteries yet to be unlocked.

Enjoy!  I can’t find an official video, but click above to hear the song.

Here are the Barenaked Ladies song lyrics (written by Ed Robertson and Steven Page, copyright Warner/Chappell Music):

With life just begun
My sleeping new son
Has eyes that roll back in his head
They flutter and dart
He slows down his heart
And pictures a world past his bed
Its hard to believe
As I watch you breathe
Your mind drifts and weaves
When you dream
What do you dream about
When you dream
What do you dream about
Do you dream about music
Or mathematics
Or planets too far for the eye?
Do you dream about Jesus
Or quantum mechanics
Or angels who sing lullabyes?
His fontanelle pulses
With lives that he’s lived
With memories he’ll learn to ignore
And when it is closed
He already knows
Hes forgotten all he knew before
But when sleep sets in
History begins
But the future will win
When you dream
What do you dream about?
When you dream
What do you dream about?
Are they colored or black and white
Yiddish or English or languages not yet conceived?
Are they silent or boisterous?
Do you hear noises
Just loud enough to be perceived?
Do you hear Del Shannon’s “Runaway”
Playing on transistor radio waves?
With so little experience
You might not get cognizant
Are you wise beyond your few days?
When you dream
What do you dream about?

Sleepy Teen? Read On

You have a teenager in the house. He’s 15. Great kid, popular, happy, fun to be around. Problem is, recently, with several months of school under his belt, he is sleepy too, all the time, falling asleep in front of you at the dinner table.

 

Excessive daytime sleepiness is increasingly prevalent in our society. Certainly social and academic pressures represent a potential cause. I’m constantly astounded with what so many parents now expect of their children: all the activities, sports, school projects, social outings . . . it is all just so different compared to when I was young:  everything is more, crazier, faster, more wired (or wireless), more complicated. My wife and I get caught up in that as well, I’m afraid, and though we do our best to maintain a reasonable balance to our children’s lives, their after-school hours remain dominated by what feels like an endless cascade of commitments: tae kwon do, basketball, skiing, adventure guides, student council, math olympiad, latin root class, on and on. For the most part our boys enjoy these activities and participate with relish, but I really do wonder how they’re going to find the time for additional activities or expanding interests as they get closer to high school, not to mention that all-important, precious time that should be spent with family.  Back in the day, we kids had time and space to relax, even laze from time to time. Time is just such a precious commodity now for us all.

Our planet’s population continues to grow, and subsequently so do the challenges for our children, who now must compete with a huge army of peers for a limited number of scholarships, college placements, internships, jobs, and resources. It thus seems natural–crucial, even–to push your kids to do more, accomplish more, dig deeper, become exposed to more things to give them a leg up in an increasingly competitive world. However, there’s still only 24 hours in a day. So what time is often easiest to sacrifice? You guessed . . . the time usually allocated for sleep.

Adults typically need 7.5-8 hours of sleep per night to feel fully rested during the day. Teens often need more sleep than adults, such as 9 hours per night. Teenagers need proper amounts of sleep like adults do, obviously, and in fact in many ways they need their sleep even more than adults do, considering they are still growing and developing. The effects of chronic sleep deprivation for a teenager can completely wreck one’s quality of life: daytime sleepiness, tendencies to fall asleep in class, lethargy, headaches, poor academic performance, depression, social withdrawal.

There’s another important cause of daytime sleepiness in teenagers, and it’s related to their sleep schedules. Here’s a scenario many of you will know well: Sunday night your teen has terrible difficulties falling asleep, and then finds it bloody impossible to awaken early the following morning for school. There is sleepiness all day long Monday at school, and for one or two additional nights there are residual difficulties falling asleep early, compounding the sleep deprivation. You pull your hair out as you cajole and shove your teen out of bed to get to school on time. Finally Friday night comes ’round, but your teen stays up until 1 a.m., and sleeps in like the dead until noon. This happens again Saturday into Sunday, and the cycle repeats itself, with another sleepless Sunday evening. Sound familiar?

Leaving the biochemistry out of it for now, here’s the reason why this occurs. We as humans are generally creatures of habit when it comes to sleep. Our internal body clocks are designed for us to do and feel things at certain times to coincide roughly with the 24-hour period. Our circadian rhythms dictate and regulate the timing of various inner biological processes, such as when we become sleepy or when we feel awake and alert.  When it comes to sleep, many of us have a natural tendency to become drowsy just slightly longer than every 24 hours (which can help explain why many prefer to go to bed later at night as opposed to earlier).  We are usually able to stay on the 24-hour clock because of the environmental cues (like daylight) and social cues (such as work) that “entrain” us to running our sleep every 24 hours. However, adolescents are particularly susceptible to this tendency for a delay in their bedtimes, leaving them prone to feeling awake at night and making it very difficult for them to get out of bed early for school. Things then are made worse when they allow themselves to go to bed very late on weekends and sleep in on weekends, because when Sunday night rolls around it becomes very difficult to fall asleep early. This is called delayed sleep phase syndrome.

 

So, parents, though this routine of trying to get your kid to bed at night and then fighting with them to wake up in the morning gets old quickly and can drive you bats**t crazy, in many ways what you’re seeing is the manifestation of normal adolescent brain biology, essentially a clash between teen physiology and our fast and furious society’s modern expectations.  I mean, if teens didn’t have to awaken at 6 a.m. to get ready for school, but instead could awaken whenever they please, this wouldn’t be nearly as big of a deal, right?  In this real world of ours’, though, it’s still a problem that needs to be addressed:  countless report cards, interpersonal relationships, and family dynamics have been affected negatively by delayed sleep phase syndrome particularly in recent decades.  And if there is pre-existing sleep deprivation due to all the other stuff your teen does after school, this only compounds the problem, worsening daytime sleepiness and all of the sequelae from it.

There are a couple of recommendations that can help.  One is something your kid is guaranteed not to like:  wake up around the same time every morning, including on weekends.  This is generally much easier for adults than it is for teens, but if you don’t sleep in by 3-5 hours on weekends any longer, you will naturally become drowsier sooner at night (including Sundays), making it easier to achieve more sleep and awaken in time for school; you’re essentially then forcing your body clock into regularity, which can then improve the insomnia and total sleep time at night.  The key, however, is persistence, which sometimes can be lacking in some kids.  When I am counseling my teenage patients with delayed sleep phase, I basically become their coach, working to help them understand that they can do it, that they will do it, for the sanity of everyone around them, including themselves.  The other helpful management tool is bright light therapy, such as with a light box (2000-2500 lux) early in the morning, and the avoidance of bright light in the late afternoon to evening.  Certain medications may be useful in severe cases, like melatonin or modafinil, but these are teenagers we’re talking about, and my clinical practice has generally been to try to do things as naturally as possible in this setting.

Take-home message today:  help your teen get proper amounts of sleep by examining his or her bedtime schedules and discussing openly what could be modified to make everybody happier in the house.  As with everything else within the realm of parenting, love, communication, and the constant quest to understand are cornerstones in helping your adolescent achieve good sleep.

There will be more to say regarding circadian rhythm disorders in future posts.  It’s time for dinner now, though, so ’til next time . . . sleep well!

 

May the PAP Be With You

Good evening!  My final act of the night before taking off for REM City:  to share a couple of great photos sent to me this afternoon by my good ol’ college friend and former bandmate, Ken, a Kansas Citian, bassist, fellow Jayhawk hoops fan, and Star Wars obsessive.

My last post featured photos of a bunch of bad guys in masks.  Here now are some good guys.

Where do you think all of Han Solo’s energy came from?

 

And why do you think the Force is so strong with Princess Leia?

 

Again, keep in mind, most people don’t need full face masks and can get away with small nasal masks or nasal pillow systems.  And you don’t need to use the CPAP device until you’re in bed and ready to sleep.

More serious posts will resume shortly.  Enjoy your dreams tonight, y’all!

Darth Vader: Really? Popular Misconceptions About CPAP

Obstructive sleep apnea is a common breathing disorder, in which the airway in the throat and neck collapses during sleep.  It’s very important to diagnose and treat this problem properly, not only because treating it can make you feel much more awake and alert during the day and stop your terrible snoring at night, but also because untreated sleep apnea increases the risk for substantial medical problems, including hypertension, heart failure, cardiac rhythm abnormalities, and early heart attack and stroke.

Problem is, it’s estimated that out of the millions of people in the U.S. with sleep apnea, about 85% of them have not yet been diagnosed.  Why is that?  There are probably several reasons.  First, symptoms can be insidious.  You’re not awake to hear your own snoring or witness your own pauses in breathing; if you’ve felt tired for years, the fatigue can just feel “normal,” to the point in which falling asleep while driving or during conversations at parties becomes your “normal.”  Secondly, medical care in general is expensive, particularly with the increased deductibles many now have to pay, and in today’s economy some people elect to put off non-emergency medical care. Thirdly, and importantly, there are a lot of presumptions regarding testing for and treatment of sleep apnea which are inaccurate or simply untrue.

When I see someone in my clinic for the first time for possible sleep apnea, I make it a point to discuss thoroughly the nature of the disorder, the procedure of diagnostic testing, and all standard accepted treatment options.  A primary and common form of treatment for sleep apnea is continuous positive airway pressure (CPAP), a device that takes room air, pressurizes it at a pressure prescribed by the physician, and delivers it via a small mask into the nose and into the airway.  CPAP is not designed to push or force air into the lungs.  The air from the device acts as a splint for the upper airway, keeping it patent (open) all night and thus allowing air to travel into the lungs, where it’s supposed to go.  This then dramatically deepens sleep, because the brain no longer arouses constantly due to low oxygen levels, thereby making the patient much more awake and alert during the day.  The success rates in resolving the sleep apnea with CPAP are incredibly high, provided that 1) the device is utilized properly, and 2) the patient is willing to utilize the device.

Most of my patients come to me very open-minded regarding how to fix their breathing problems during sleep.  There are times, however, in which my first mentioning of CPAP in clinic is met with reluctance, or a flat-out refusal.  In some ways, it’s perfectly natural to have initial reservations.  We are designed biologically always to protect our airways, so it seems counterintuitive to cover your nose or nostrils with something that it meant to make you breathe better.  This can be a source of an initial sensation of claustrophobia for some.  In addition, there is not only a mask involved, which may seem daunting to the uninitiated, but also a change in night-time habits, and we, the humans that we are, are naturally inclined to hate lifestyle changes thrust upon us by someone else.  But I’m struck by the responses I get when I ask why there is such immediate pushback to the consideration for CPAP use, when the patient hasn’t even seen or touched the device.  Among the most common of these is, . . . “I don’t want to look like Darth Vader.”

Come on.  Really?  I’ve heard this, or the equivalent (“Oh yeah, that Darth Vader thing,” or “That’s the Darth Vader mask, isn’t it?,” or some other such statement), so many times, I wonder who are these people out there telling everybody they’ve become Sith lords after starting CPAP and inviting others to join the Dark Side by getting treated too.

Lookit.  I was a disciple of Star Wars growing up.  I was ten years old when the first Star Wars movie (now known as Episode IV:  A New Hope) was released in 1977.  In terms of pure love and sheer personal impact, I rank it right behind The Godfather on my list of all-time favorite films.  As a kid I studied it religiously, including its philosophies and characters.  I memorized the presentation, clothing, and mannerisms of all the characters through scrutiny of books, magazines, and my precious trading cards.  So trust me when I say, there are no CPAP masks that are remotely similar to Darth Vader’s mask.

Vader’s mask isn’t even really just a mask.  It’s a full-on helmet, covering the entirety of the head, designed and utilized not only for protection but also as a contained respiratory support system required due to massive injuries sustained following Anakin Skywalker’s unfortunate battle with Obi-Wan Kenobi on Mustafar.  Take a look:

 

Uh, the typical CPAP user is not using CPAP for these reasons.  All the CPAP device does is simply allow air to pass freely through the upper airway so oxygen can get to where it needs to go:  into the lungs and thus into the bloodstream so you can, you know, live.  In most cases all that’s needed is a small nasal mask that just covers the nose, with headgear to secure it in place:

 

Or small “nasal pillows,” soft prongs which are placed gently in the entrance of the nostrils:

 

OK.  So you don’t look glamorous with these things on, and it can take a little while to get used to; that’s the reality of it.  However, your bed partner or spouse isn’t going to care much how you look while asleep; he or she presumably will care more about your health and longevity than how you appear while you’re sleeping, and will appreciate that your heroic snoring is now completely gone.  My patients generally become accustomed to CPAP use quickly, and these mask interfaces are more comfortable and tolerable than one may think.  With proper support from the sleep physician, the sleep center, the durable medical equipment service providing you with the materials, and your family, nightly use of this device can be a complete game-changer, dramatically improving the way you feel (and thus, the quality of life) and the way you sleep.

Another reason why people may relate CPAP use to Darth Vader is the presumption that the device is noisy, with some loud, pervasive inhale/exhale sound that keeps everybody awake all night.  Since the CPAP machine is at its core essentially a blower, there is some noise, but the devices now are incredibly quiet, in many cases virtually imperceptible, and the tonal differences between inhalation and exhalation can be adjusted with the new technologies built in to modern devices.

Ultimately, my sense is that some people have heard from someone–Uncle Frank, or Bill down the street–in the distant past about some negative experience with CPAP, and the resulting conjured images just get stuck.  As we all know, once an image is lodged in your brain it’s hard to unstick it.  And it’s true that ten years ago CPAP machines were loud and bulky, with limited choices of available masks.  But think of how technology in general has changed and improved over the past decade.  Look at our cell phones now, our desktop and laptop computers, our TVs.  Of course everything is better and smaller (well, the TVs are bigger, but thinner and lighter).  Same goes for CPAP use.  The devices are now very small and whisper quiet, with lots of built-in bells and whistles to make them more comfortable and easier to use.  There are dozens and dozens of different masks available now, all in different sizes, so it’s very rare now for my patients to have difficulties finding a mask that fits well.  I’d also ask that you look at this from a different perspective:  the companies that produce these machines and accessories are all competing in a race to make the best, most comfortable, most popular products.  As such, new products come out all the time.  You, the consumer, therefore have an advantage, with an ever-expanding circle of choices for products to use to optimize your treatment experience.  Ahh, capitalism at its finest!

Having said all of this, there are plenty ways for CPAP use to go sideways (literally and figuratively), limiting one’s abilities to tolerate and use the device.  Virtually all of these potential problems are fixable, however, and I will discuss these issues in future posts.

Some think that full face masks must be used when using CPAP (these masks cover both the nose and the mouth).  Though these masks are available and may be necessary or desired in some very specific circumstances (a topic for another blog entry), the substantial majority of CPAP users just need a simple small nasal mask or nasal pillows.  Full face mask or not, you will not end up looking like Bane from the Batman series:

 

. . . or another of my favorite bad guys, Hannibal Lector:

 

I also sometimes hear, “Won’t I suffocate with the mask on?”  My reply to that is, “No, quite the opposite.  You’re suffocating every night without the mask on.”

You know what would be cool?  Since George Lucas recently sold the Star Wars franchise to Disney, maybe I should approach someone at Disney about creating and marketing an actual Darth Vader CPAP full face mask.  You know, paint it black, have it play John Williams’ ominous Darth Vader theme music when you put it on.  Then all of these references to Darth Vader could actually become true!  I’ll look into it.  Wish me luck on that one.

So here’s my take-home point for today:  don’t deny yourself the diagnosis and treatment of an important medical problem because of what you think the treatment might be like.  Explore, speak with your doctor, keep your mind open to trying something that can actually change your life.  Insurance companies rent the CPAP device on your behalf for the first several months of use, because they don’t want to pay for a CPAP machine you don’t end up using.  If you really hate the machine no matter what is done to try to make things better, you can return it.  In other words, you have very little to lose and a lot to gain by at least trying it, if it’s recommended by your sleep doctor.  You’ll never know how much it can help you unless you try.

“You’re disoriented.  You just woke up.  You’re in the future.  You’ve been asleep for eight hours.” — Jarod Kintz

Insomnia: To Try or Not to Try

Howdy all!  This will be the first of many posts pertaining to insomnia, a spectrum of sleep disorders from which many millions suffer in this country.  Insomnia truly can be a challenge to manage, in part because so many things can cause it and perpetuate it, and because fixing the problem properly often requires modifications in lifestyles, thought processes, and expectations on the part of the patient.  Tonight’s post will not be in any way exhaustive in its scope; it’s the end of my workday and I’m tired.  I will concentrate on an important consideration, however:  how one’s own thoughts can worsen the insomnia problem.

Insomnia simply refers to one’s perception of poor and/or insufficient sleep during the habitual sleep period, such that it is bothersome and has the potential for daytime dysfunction, like fatigue and sleepiness.  By nature the problem is subjective; what makes the sleep poor or insufficient may depend on a whole host of variables, including the absolute amount of time slept, the perceived amount of time slept, how much time was spent tossing and turning, and how much the problem is driving the insomniac crazy.  One can have difficulties falling asleep at the beginning of the night, difficulties staying asleep throughout the night, or both; one may be bothered by spending a half-hour awake at 3 a.m., or one may feel like he or she didn’t sleep all night long.

One can imagine that there are hundreds of things that can cause insomnia.  I will not list them here; that would be a topic of another post.  Virtually everybody has experienced situational insomnia, which occurs as the result of something exciting, stimulating, or traumatic in one’s life.  I’m pretty confident that over the past several months, David Petraeus, Lance Armstrong, Michael Christian, and Ronaiah Tuiasosopo have all had some sleepless nights.  Though most people don’t typically have experiences as, uh, intense as these folks, the general concept is the same:  life events or circumstances in general that are of substantial emotional value can cause temporary difficulties falling and staying asleep.  In many ways this is simply part of the human condition; we all are subject to such physical responses to the ebbs and flows of life.  Often the insomnia is self-limited, improving and resolving as the dust settles from whatever it was that sparked the problem.

However, in some cases, the insomnia can persist even though the triggering event goes away.  There are many reasons as to why this may occur, but eventually one may get in a “rut,” experiencing night after night of difficulties sleeping, to the point in which an expectation of poor sleep develops.  That’s when things really start getting nasty.  The bed then feels like the enemy; the insomniac comes to look at the bed at night with a vague combination of hope and fear, on one hand hoping that tonight will be different, but on the other fearful that tonight’s gonna suck just like last night did.

One basic tenet of insomnia management is the recognition that the more time you spent awake in bed, the harder it often gets to fall asleep.  Why is that?  Simple, really:  because it’s frustrating.  I mean, no one wants to be in bed awake when they’re trying to sleep, right?  It’s always a frustrating experience.  Frustration is a stimulating emotion.  It makes you feel more awake and alert.  So the more time you spend awake in bed, the more frustrated you get, the more awake you feel, and the worse the insomnia gets.  This is the reason why what you read in all those self-help books on sleep–that you should limit the amount of time spent awake in bed each night–is an important component in chronic insomnia management.  I promise we will delve more into that at a future date.

OK.  There is an additional, very natural tendency hardcore insomniacs have, which is the proclivity to try to fall asleep.  I want you to think about this.  Under normal circumstances you become sleepy prior to falling asleep.  How, then, are you going to try to become sleepy successfully?  Becoming sleepy is a natural biological function, and trying to become sleepy is no easier to make yourself achieve than trying to become hungry, for example, or becoming thirsty.  It just doesn’t work that way, so of course you’re going to be frustrated by trying.  However, all of this mental action can happen in such a buried, subconscious way that it may not occur to the insomniac how problematic it is, and how little it actually helps.

In fact, trying to sleep works against you.  Why?  Because now you’re adding an element of performance anxiety to your problem.  Imagine engaging in that classic routine, counting sheep, in your attempt to fall asleep.  You now count to 100 . . . 200 . . . 300 . . . and sure enough, you haven’t achieved sleep by the time you’ve reached whatever mark you’ve set for yourself, and you aren’t sleepy yet.  That just compounds the anxiety and frustration, doesn’t it?  Now you’re more upset, even angry at yourself, for not achieving what you’re trying so desperately to achieve.

Let me give you another scenario.  Have you ever had a tough night in bed, tossing and turning, trying to sleep, and finally you “gave up” and left the bedroom, went the couch in the living room, turned on the TV, and then fell asleep immediately?  Why do you think that happened after having suffered so much in bed, where you’re supposed to be sleeping?  It’s because you stopped trying.

So . . . take-away point of tonight’s entry:  stop trying to sleep.  It doesn’t work, and it often works against you and makes things worse.  The idea is to allow your body’s natural tendencies to become drowsy to fall into place so that you can fall asleep without your help.  That’s the way we were built to be.  Just let it happen.  It doesn’t need your help.

Hey man, this blogging thing is fun.  Will write another entry soon.  Sleep well!

“Never go to bed mad.  Stay up and fight.” — Phyllis Diller

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Morris Chang, M.D.: Welcome to My Sleep Medicine Blog Site

Hello everyone!  Dr. Morris here writing my inaugural blog post on this site.  Thank you for starting this great new journey with me!

I’d like to start by telling you why I started this blog site.  There aren’t a lot of things that every single human being has to do.  Everyone needs to eat.  Everyone needs to breathe.  And everyone needs to SLEEP.  Sleep is a biological requirement, plain and simple, something we all must do regularly to remain alive, functional, and healthy.  Yet, as you are probably aware, problems with sleep are incredibly prevalent.  In the United States, one-third of adults have at least occasional but clinically significant insomnia, for example.  6-10% of American adults have obstructive sleep apnea.  10% of American adults have restless leg syndrome.  There are 94 sleep disorders recognized by the International Classification of Sleep Disorders.  Sleep problems compromise the lives of millions and millions of people every night, resulting in a multitude of problems as dire and far-reaching as marital discord, chronic daytime sleepiness, sexual and social dysfunction, fall-asleep car crashes, depression, impaired work productivity, heart disease, and sudden death during sleep.  Within the realm of medicine exists a small but very important subspecialty–known as somnology or sleep medicine–which is devoted to the evaluation, diagnosis, and management of problems with sleep.  This is what I practice:  I am a physician sleep specialist.  And I love what I do.

I pledge to commit the vast majority of future blog posts to you and/or your loved ones, who may have sleeping problems.  However, as I believe it important for readers to understand and get to know the person producing the words they’re reading, I would like to devote the remainder of this initial post to my history and how I came to do what I do today.  I appreciate your allowing me the opportunity to tell you briefly my story.

I was born in DeKalb, Illinois.  When I was two, my parents moved me and my younger brother to Whitewater, Wisconsin, where we lived until I was seven.  We then moved to Wichita, Kansas, where I spent the remainder of my childhood.  I went to college at the University of Kansas, where intense studying as a chemistry major and pre-med student was punctuated by, well, quite a bit of fun, including many nights at Allen Fieldhouse cheering on our perennially great basketball team.  I also graduated from medical school at KU, making me an eight-year Jayhawk, something of which I am very proud.

After obtaining my medical degree, I left the midwest to explore living and undergoing my postgraduate education in a totally different environment.  I completed my internship in internal medicine at the University of Vermont College of Medicine in Burlington, and then my residency and chief residency in neurology at Dartmouth Medical School in Lebanon, New Hampshire.  What an incredible, mind-expanding experience that was, coming to know a completely different part of our country and making so many new acquaintances and friends from backgrounds and places very different from mine.  In every way imaginable, it was an education of a lifetime.  Following completion of my residency, I moved to Seattle, where I completed fellowships in clinical neurophysiology, epilepsy, and sleep medicine at the University of Washington School of Medicine.  Additional graduate and post-graduate education over the years took place at the Mayo Clinic in Rochester, Minnesota, Washington University School of Medicine in St. Louis, Missouri, and the University of Minnesota School of Medicine in Minneapolis.  I’m proud to say I was mentored by great professors through the years, including Maurice Victor, Peter Williamson, Mark Mahowald, Carlos Schenck, and Vishesh Kapur.  From kindergarten to the end of my fellowships, I spent 27 years being schooled!

I am now in my thirteenth year of clinical practice in the Seattle area, primarily in south Puget Sound.  I am board-certified in both neurology and sleep medicine, but I practice sleep medicine full-time.  Why sleep medicine?  Simply speaking, it’s a blast.  I can help the vast majority of my patients sleep better and feel better during the day.  I can actually cure sleep problems.  I spend most of my time evaluating patients face-to-face, interpreting diagnostic testing if appropriate, treating sleep problems, and managing patients longterm.  It’s incredibly gratifying to help people, from hardcore insomniacs to lifetime “heroic” snorers, improve their health and quality of life.  I have additional duties:  I am the medical director for two American Academy of Sleep Medicine accredited sleep centers; I have sat on various hospital-based, regional, and national committees over the years; I have published articles in New England Journal of Medicine and Neurology; I thoroughly enjoy public speaking as well, and I deliver talks regularly to various groups and organizations on matters pertaining to sleep.  My favorite part of the workday, however, remains seeing my patients through their diagnosis and treatment for sleep problems and helping lives improve.

My path to sleep medicine was also informed by more personal experiences.  Though I generally sleep very well, I’ve had the occasional night of poor sleep, as many of us have.  My mother, a retired businesswoman, has had fluctuating insomnia for many years.  My late father, a professor and criminologist, had REM behavior disorder (RBD), a disorder in which one physically enacts one’s dreams.  Having trained with Mark Mahowald and Carlos Schenck, who were instrumental in the discovery and initial characterization of RBD, I have now been involved in the care of a great many patients with RBD, and in every case I think back to my dad, who I miss dearly every day.

I’m happily married to Melissa, a pharmacist.  We have two wonderful boys, Nathan and Colin, who keep our lives boisterous and exciting, and a super-cute Maltese named Molly.  I love to read–I’m in the middle of 2-3 books at all times–and to write.  I’ve now lived on both coasts, but the midwest will always be my true home; I continue to root for my Jayhawks, particularly around March Madness time!  I got my private pilot license when I was seventeen, having mowed yards and washed dishes to pay for my lessons.  I ski, scuba dive, and play sports with my boys.  We travel as much as possible, and embrace new experiences in different places.  I belong to several service organizations, and I am a proud Rotarian.  A primary passion in my life, outside of my family, friends, and work, is music.  It’s one of those things that makes life great for me.  I play drums, percussion, keyboards, and alto saxophone.  I’ve been in numerous rock-n-roll and blues bands for many years; these days, I have been exploring and performing primarily Brazilian music with two area bands.  I love many musical genres, but my iPod songs that get the most play are classic country, classic rock, cool-period jazz, early alternative, new country, and samba/raggae.

Thank you for indulging me.  Future posts will now be all about YOU:  what sleep problems you may have, how to identify them, how to fix them.  I welcome input and questions, and will do my very best to respond to inquiries and comments as I get them.  I look forward to helping you sleep like a champ.

“I love sleep.  My life has the tendency to fall apart when I’m awake, you know?” — Ernest Hemingway

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