How I Remember 9/11

 

“This must be a joke,” I muttered.

My alarm clock has gone off at 6:30 a.m. virtually every morning for years now.  I follow my own clinical advice and do everything I can to keep my sleep schedules regular, including on weekends.  The morning of September 11, 2001 was no exception.

The alarm provoked my arousal at its usual appointed time.  As my waking cortex struggled to climb out of its sleepy haze, I listened lazily for a few moments to the muffled words on the NPR station to which I kept my clock radio dialed.  I could tell immediately something was different this morning, even prior to my comprehension of the words.  There was an urgency to the voices, staccato, quick and breathless, unscripted and frightened.  Whatever was the topic at hand, this clearly was not a normal news day.  Then the words started to register in my brain:  “planes,” “World Trade Center,” “attacks,” “explosions.”

My first coherent thought was that what I was hearing was a hoax, a modern-day War of the Worlds.  A couple minutes of listening and then the first images on television terminated any hopes I had that it was so.  I jostled my wife awake and the two of us stared at the TV in mute, open-mouthed horror.  At that moment, I knew our country would never be the same.

My brief drive to work–under beautiful cloudless blue Seattle skies eerily similar to those above Manhattan that same morning–was a blur.  I walked into my clinic.  Not a single person said a thing.  We all just looked at each other in disbelief, our eyes all saying to each other, what is happening to our world?  

Not surprisingly, few of my patients chose to show up to clinic that morning, so I had some extra time on my hands.  I and my co-worker, Lamont, found our old little rabbit-eared lab TV, and we spent most of the morning staring at the fuzzy images, still trying to comprehend it all.  Needless to say, I didn’t sleep very well that night and for several nights thereafter.  Neither did my patients.  In the months to follow, I was bombarded by insomniacs filling my clinic.  The entire country suffered from collective insomnia as well as collective grief.

During my life there have been several events that I remember with clarity, defining moments in our country’s history.  I remember lying on the front bench of our family’s big ol’ sedan, watching my father stare at the AM car radio as Nixon’s resignation was announced.  I remember being in class hearing about John Lennon’s assassination and Ronald Reagan’s near-assassination.  In college I stood in a crowd in our student lounge after morning classes, watching images of Challenger exploding on television.  9/11 was one such moment, of course, and probably the most notable single historical event of my working adult life.  Twelve years later, it remains difficult for me to believe that such a thing even happened.

I must admit I grumble about some things from time to time:  the miserable state of our country’s health care administration and reform; traffic; the interminable meanness and passive aggression of some people; all the hassles and noise of modern life.  Each 9/11 brings me back to center, reminding me of how privileged I am to be alive now in this time and place, enjoying the family, friends, and prosperity with which I somehow, undeservingly, have been blessed.

As it is for millions of other Americans, 9/11 is and always will be a day of reflection for me.  As horrific as 9/11 was, it did crystallize in my mind some of my life’s most basic philosophies:  love fiercely, live boldly, and protect yourself and those you love from those who seek to harm you, whether they be silent or loud in their intent.

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Sleep Well This Summer, Part 2: Keep Your Bedroom Dark

Hi, all!  This is the continuation of my short series how to sleep well during the warmer and longer days of summer.  As mentioned in Part 1, people generally find a dark, cool, quiet environment most conducive to sleep.  Today’s entry is devoted to improving your sleep by keeping your sleeping environment dark.

 

By way of background, light is an extremely potent outside influence on your “body clock,” which regulates the timing of certain biological functions of your body.  Exposure of your retinas to light stimulates a neurologic pathway through your brain, essentially telling your body clock it’s time to be awake.  As such, exposure to light shortly upon arising in the morning can cause you to feel more awake and alert, and bright light exposure late at night can cause insomnia.  Even relatively modest light can have a stimulatory effect.  It makes sense, then, that shielding your bedroom from bright light is important during the summer, when the sun often shines relatively late into the evening, carrying both light and heat into your room.

Here’s a couple of considerations to darken your room.

1.  Sleep in a room without windows.  If you can.  Basements are great for that, for example, and some of my patients simply migrate to a basement bedroom each summer to sleep better.

2.  Sleep in a room which has windows that don’t face westward.  The sun sets in the west.

3.  Cover your windows.  I recognize this seems obvious, but it’s amazing how many people sleep in bedrooms with bare windows.

4.  Cover your windows with something dark (preferably black) and thick, such as black curtains.  Venetian blinds generally don’t do a great job of shielding the room from light.

5.  Turn your bed away from your windows.

6.  Turn off all the lights and the television when you’re ready to go to sleep.  Again, I’m stating the obvious here, but many people sleep with lights and other electronics on.

7.  Turn around or turn off glowing electronics, like digital alarm clocks.  If you’re an insomniac, turning your nightstand clock around will have the added benefit of keeping you from the deadly habit of “clock-watching,” which I’ve written about in previous entries.  It would also be helpful to turn off the lights one night and simply look around the room, looking for electronic lights.  You might be surprised about how much glowing, blinking stuff coinhabits your sleeping space, from your DVR, stereo, laptop, cable box, or whatever.  Turn off or hide whatever light sources you can, even if they’re small.  Turn down brightness levels as well if possible.

8.  Reconsider your nightlight.  Some people have long slept with a nightlight without problems, but bed partners may be bothered by this.  Discuss this with your spouse or bed partner.  If a nightlight is absolutely necessary, consider getting one that can be dimmed.

9.  If necessary and if all else fails, sleep masks or even dark sunglasses can help.  Hopefully, however, you can keep your entire bedroom dark throughout the night.

Sleep well, everyone!  The third and final entry in this series:  how to keep your bedroom quiet during the summer.  Enjoy these months of warmth:  winter is coming.

Sleep Well This Summer, Part 1: Stay Cool

Hi all!  It’s getting powerful-warm out there now in most parts of the U.S., so today I’m starting a 3-part series on sleeping during the summer months.

People generally prefer sleeping in a dark, quiet, cool environment.  This can be a challenge in the summertime, when it’s sweltering at night, it’s light out late, and there’s always some loud party going on late near your home.

 

Today we’ll tackle the issue of the summer warmth.

Many of us recognize that it can be difficult to fall and stay asleep if it’s uncomfortably warm or hot in your bedroom.  The common-sense advice here is to do what you can to maintain a cool sleeping environment to the extent that you can, particularly during the first half of the night:  outside temperatures naturally continue to fall until just prior to dawn due to an increasing duration of absent direct sun exposure, and our bodies naturally cool (i.e., our core body temperatures gradually fall) the longer we sleep at night.  As such, it’s a good idea to concentrate on how comfortable you are with the room temperature at bedtime.

Some brief tips to sleep a little better in the summer:

1.  Use your air conditioner.  I understand the desire to save $ on your utility bills–I share that desire–but I suggest not skimping on the air conditioning (if you have it) if you’re miserable in bed night after night.

2.  Invest in a fan.  Large room fans can be inexpensive (particularly if purchased off-season), and the convective effect of the circulating air can make a big difference.

3.  Take a shower or bath prior to bedtime.  Using cool water may reduce your core body temperature.  For some, however, a warm shower or bath prior to bedtime makes your  bedroom temperature “feel” cooler by the time you get into bed.  Experiment to see what makes you most comfortable.

4.  Consider your bedsheets and pajamas.  This is very individually dependent, but you can obviously reduce the amount of body coverage in bed to cool things down.  The cloth materials you use can also make a difference:  you can be bothered by not only the heat, but also the degree to which you’re wet and sweaty in bed.  I suggest using materials that “breathe” and absorb or wick away moisture:  in general natural materials, like cotton, are considered better at this than synthetic.

5.  Sleep in the basement.  If you can’t do anything about the heat in your bedroom, migrating to a cool, dark underground basement may make all the difference during summer months.

6.  If you use CPAP (continuous positive airway pressure) for obstructive sleep apnea, you can turn down your heated humidity and utilize as small a mask interface as possible.

Next up:  how to keep your bedroom dark.  This is more important than you may think.

Cheers all, and stay cool this summer!

A Mother’s Day Wish For Better Sleep

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This is my mom.  Please spend a moment and look upon her beautiful face.  Perhaps you may see some of the same qualities that I do:  the hopeful happiness in her smile, the joyful but fiery intensity in her eyes, the serene youthfulness in her gaze.  She looks so young and new here, new at adulthood, parenthood, American life.  But for me, her son, I also see wisdom, awareness, a vague sense of knowing, some ill-defined proficiency in everything she does, though she was much newer at this parenting thing when the photo was taken than I am now.  A lifetime of observing my mom’s way of being and burning love for her family gives me well-informed license to perceive these special qualities:  this unique perspective creates a sensation, and feeling you cannot know unless it’s your own mother you see looking back at you from that old, black-and-white photograph.

Mom had gone through a lot to get to where she was when my dad snapped this photo.  She had left her native country and a life of comfort and stability–a true rarity in Korea at the time–for a modest life with a young Japanese-born, American-trained professor of Korean descent, now living and teaching in Michigan.  An accomplished pianist and young scholar in her own right, she threw herself eagerly into the responsibilities of being a wife and parent, managing to earn a master’s degree in mathematics along the way.  Looking at her young, smiling face, one wonders if she had some inkling of the adventures to come:  all the soccer and baseball games, the world travel, the many times playing hostess to friends and her husband’s many colleagues and students, the maturation and graduation of her sons, the germination and success of her businesses.

She could not have known, however, about all the challenges that lay ahead.  Apart from the passing of my father–the most devastating event in the lives of everybody in my immediate family–the biggest challenge of them all was her diagnosis with Parkinson disease, which has over the past several years gradually robbed her of her agility, coordination, and ability to walk.

A neurologist by training, I have counseled many patients and families regarding the management of Parkinson disease over the years.  No clinical experience or medical training could compare, however, to the education I have received from helping a parent cope with this cruel disorder every day.  It has been a truly humbling experience, realizing the true personal effects of Parkinson’s as I have through my mother.  This knowledge now in hand and without dwelling on details, I am qualified to offer this one, non-doctorly piece of simple, universal advice:  never get Parkinson’s.  It blows.

Today’s entry pertains to sleep because Mom started having substantial insomnia–without a clear trigger–years prior to her diagnosis with Parkinson’s.  Parkinson disease is commonly associated with sleep disruption and it is not uncommon for the first symptoms of Parkinson’s to be very nonspecific, starting well prior to the onset of more specific symptoms (tremor, slowness of movements, and the like), so I wonder in retrospect if her difficulties sleeping represented the heralding problem of her particular disorder.  Her neurologist, a movement disorder specialist, is doing what she can to manage the insomnia, but Mom still struggles with her sleep from time to time.

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Last year I had the pleasure of introducing my mother to Michael J. Fox, whose public battle with early-onset Parkinson disease has been the inspiration for many public speaking events and several excellent, highly recommended books (which Mom and I have both read), including Lucky Man:  A Memoir and Always Looking Up:  The Adventures of an Incurable Optimist.  Mr. Fox told Mom, “You look great!”  It was wonderful for her to meet someone who has lived what she is living, someone who understands.  She smiled quietly in response, and in her expression I saw that same hope and determination she’s always had, qualities so relentlessly challenged in recent years by this crippling disorder.  I believe that that fight will always be there, despite the fatigue, because that’s who she is and who she will always be.  And my family and I will continue to be there for her, helping her fight.  When it comes to my mom, I took off my doctor’s hat long ago.  I’m just a son, a boy loving and trying to help his parent.  That’s all I can be now, and I think that’s what she needs most.

Today’s Mother’s Day.  Dang it, man.  Love your mom.  Remember her if she’s gone.  Squeeze her tight if she’s not.  Call her if she’s away.  Just don’t waste a second of her presence.  Moms are incredibly precious.  I know mine is.

Sleep Song #5: “Sleeping With the Television On” by Billy Joel

Recently I wrote about my early love for Billy Joel’s music:

https://sleephelpdesk.com/2013/03/29/what-a-young-billy-joel-fan-can-teach-us/

The year after my mom bought me his great album 52nd Street in 1979, Joel’s Glass Houses was released, and I managed to get my grubby musical little hands on that album as well, and as I had done with its predecessor, I played it over and over in our basement until everybody in the house was bloomin’ sick of it.

The second song on the the second side of the LP is a happy 3-minute track called “Sleeping With the Television On.”  Here it is, for your listening pleasure.

It occurs to me as I write this that younger readers may be genuinely puzzled by the prelude to the song:  years ago, before “24-hour news cycles” and hundreds of channels to choose from, network television stations “signed off” late at night, following the national anthem, and the viewer would then see snow or some focus pattern until the next morning, when the station would resume its programming.

Anyhow, though this song actually has little to do with sleep, I am nonetheless using it as an opportunity to bring up one point:  many people do sleep with the television on, specifically because of their insomnia.

When you’re tossing and turning in bed for hours at a time, frustration inevitably develops, paradoxically making you feel more stimulated and awake.  This problem is compounded by a natural tendency to try to fall asleep, which rarely works, because you can’t force a biological function to occur just because you want it to, so the more you try to sleep, the more frustrated you get, and the worse the insomnia becomes.

At some point this can drive you completely nuts, and finally you arise from bed in disgust and go to the living room.  You turn on the TV and you lay down on the couch.  You’re now asleep instantly.

Why is that?  Because you’re no longer trying to sleep.  The TV also serves to distract you from the frustration, allowing your body’s natural impulses to become drowsy and fall asleep to take over unimpeded.

Sometimes this phenomenon leads people to believe that they need the TV to sleep, and that they are unable to sleep without it.  Trust me when I say that your body and brain do not biologically require a television set in front of you to generate sleep.  It can feel like they do, however, because, as I’ve mentioned in previous entries, we humans are creatures of habit.  We’re simply used to what we’re used to, and so over time sleeping without the television on after spending years sleeping in front of the TV seems foreign and abnormal.  To me, it’s reasonable to expect that if you managed to learn how to sleep well with the television on, you can learn how to sleep well without it as well.

Below you will see Joel’s lyrics for this great song.  Enjoy your weekend, everyone!

Sleeping With the Television On

(written by Billy Joel)

I’ve been watching you waltz all night Diane
Nobody’s found a way behind your defenses
They never notice the zap gun in your hand
Until you’re pointing it and stunning their senses
 
All night long, all night long
You’ll shoot ’em down because you’re waiting for somebody good to come on
But you’ll be sleeping with the television on
 
You say you’re looking for someone solid here
You can’t be bothered with those “just for the night” boys
Tonight unless you take some kind of chances dear
Tomorrow morning you’ll wake up with the white noise
 
All night long, all night long
You’re only standing there ’cause somebody once did somebody wrong
But you’ll be sleeping with the television on
 
Your eyes are saying talk to me, talk to me
But your attitude is “don’t waste my time”
Your eyes are saying talk to me, talk to me
But you won’t hear a word ’cause it just might be the same old line
 
This isn’t easy for me to say Diane
I know you don’t need anybody’s protection
I really wish I was less of a thinking man
And more a fool who’s not afraid of rejection
 
All night long, all night long
I’ll just be standing here ’cause I know I don’t have the guts to come on
And I’ll be sleeping with the television on
 
Your eyes are saying talk to me, talk to me
But my attitude is “boy, don’t waste your time”
Your eyes are saying talk to me, talk to me
But I won’t say a word ’cause it just might be somebody else’s same old line
 
All night long, all night long
We’ll just be standing here ’cause somebody might do somebody wrong
And we’ll be sleeping with the television on
Sleeping with the television on
Sleeping with the television on
Sleeping with the television on
Oh, sleeping with the television on

Does Your iPad Lead to Insomnia?

 

Our old, well-worn first-gen iPad has gotten a LOT of use over the years, and admittedly much of the use has been in bed at night.  I read quite a bit, and though I still prefer good old-fashioned paper print books (I’m always in the middle of 2 or 3), our iPad has also become a regular staple in my routine prior to turning off the lights for the night, primarily for e-mails and this blogsite adventure I started several months ago.  My wife and I have never had problems falling asleep as a result of iPad use, but many of my patients have found their insomnia improves with modifications in their habit of using electronic devices involving bright backlit screens in bed.

We’ve all experienced activities that cause us to end up going to sleep later than what we intended.  However, backlit electronic pads can contribute to difficulties falling asleep if used shortly prior to bedtime, and there are a couple reasons why.  First, the content of what you’re doing or reading can obviously play a role.  Whether it’s an exciting video or the discovery of the latest shoe sale on Zappos, anything that you’re exposed to that is visually or emotionally stimulating or is of emotional importance to you can create an alerting effect that delays the onset of drowsiness.  Second, and importantly, the light exposure from the backlit screen (particularly when full-color) can also have a stimulating effect.

 

Light tends to inhibit the release of melatonin in your brain.  There is a thin band of neurologic tissue–called the retinohypothalamic tract–that connects your eyeballs to the hypothalamus, the seat of your body block.  This tract is stimulated when the back of your eye–the retina (the cells of which are illustrated above)–are exposed to bright light, and the resulting signal to the brain leads to a sensation of wakefulness and alertness, the exact opposite of what you want when your goal is to fall asleep for the night.  This is why it’s important to avoid bright light late at night and to expose yourself to bright light early in the morning if you have insomnia.

The problem is that modern backlit e-readers are not only capable of emitting very bright multi-colored light, but also held very close to your eyes:  unlike your television set, which is across the room, your iPad is on your lap or held right in front of your face, bathing your retinas with light.

So here are some suggestions for you if you’re having difficulties falling asleep following backlit e-reader use at bedtime:

1.  Turn down the intensity or brightness of the screen.
2.  Try an e-reader without a backlit display, such as a basic Kindle.
3.  Call me old-fashioned, but you could always go back to paper books, and save your e-mail for tomorrow morning.
4.  Read in relatively dim light.
5.  In general, avoid intense light for about 1-2 hours prior to your projected bedtime.

Happy reading, everyone!

Post-Traumatic Stress Disorder and Sleep: My Interview With Captain Ken LeBlanc

I want to tell you about my old and dear friend, Ken LeBlanc, a Captain in the United States Army. Ken and I went to high school together and have watched our lives and careers evolve in recent years.  He lives in and is stationed in Wiesbaden, Germany, near Frankfurt, and he works at US Army Headquarters for the G-34 Force Protection Directorate at Wiesbaden Army Airfield.  He is an Operations Officer.  His responsibilities include the entire Black Sea region of eastern Europe. He assesses and mitigates risk by developing site-specific guidelines for force protection and personnel safety, including counter-surveillance, stand-offs, and personnel access.  He develops travel guidelines, working with the DIA and Department of State for any individual and group travel to foreign lands. He has been deployed several times.  I consider Captain LeBlanc a hero, not only because of what he’s done for the benefit of our country, but also how he has handled the many intense experiences he has had as part of his military duties over the years.

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Ken tells me that he has had some genuine difficulties with his sleep since relocating to Germany.  Troubled by vivid dreams, he suffers from disrupted sleep, frequently awakening with a sensation of anxiety and in a cold sweat.

Ken has been diagnosed with post-traumatic stress disorder (PTSD).  He tells me that he’s not alone:  many of his colleagues have had similar symptoms upon returning from their deployment and have been diagnosed with PTSD, reflecting recent Veterans Administration reports that indicate that nearly 30% of VA patients who served in the Iraq and Afghanistan wars have been diagnosed with this disorder.  He also believes that PTSD is still under-recognized and under-treated in the military.

PTSD is commonly associated with sleep problems, often stemming from a combination of factors:  the self-protective mode of constantly being “on alert,” worry, physical symptoms (such as chronic pain) associated with previous trauma, and frequent nightmares which may or may not be directly related to previous traumatic experiences.  Chronic sleep-onset and sleep-maintenance insomnia and daytime fatigue are commonly observed in those suffering from PTSD.

Captain LeBlanc was kind enough to agree to describe some of his experiences with Sleep Help Desk from his home in Wiesbaden.

MC:  You’ve been in the military for many years, Ken; you’ve visited many countries and you’ve seen many things most Americans never will see. How does a soldier process all of the intense experiences such as the ones you’ve had?

KL:  If possible, by processing the good and bad with groups of others. The Army has many specific programs to help deal with and process activities and experiences. As an Officer I have a duty to help younger Soldiers with any issues that might arise from their combat- and noncombat-related experiences. Sometimes being far away from your family causes things to happen such as divorce and bankruptcy, and this can be as difficult to process as combat. As Soldiers one hopes that the foundation they have morally and psychologically helps them to diffuse critical events but being with like-minded others brings a support system unlike any other I have been involved with.

MC:  How do you perceive your experiences have affected your sleep?

KL:  Sleep is a critical and performance-altering behavior. I am an older Soldier who has witnessed many things younger Soldiers have not experienced and I’ve thought from the very beginning that this would be my personal asset. They aren’t, however, like good experiences (like the birth of a child or success at work), which do not replay in your head during times of attempted sleep. It might be thunder or loud noises or strange noises, but they all bring me back to unfavorable experiences. Dreams become more vivid and after awakening one goes through a litany of questions concerning that event. After a few months it gets a little better but when one least expects it one might dream of something as innocuous as a large crowd and begin to feel the anxiety that accompanies it. My military experiences cause many sleepless nights because after waking up (usually in a sweat) it becomes hard, if not impossible, to regain drowsiness and fall back to sleep.

MC:  So let’s talk more about your dreams, Ken.  How often and how intensely do your dreams relate to your current work or previous military experiences?

KL:  After returning stateside I had incredibly vivid dreams every night. I would wake up and go through them repeatedly. I would feel foolish for having them. Most of the time they relate directly to military experiences but after a while they lose that flavor and start to relate to difficult periods in my life. It feels as if it becomes a habit:  waking up to dredge over bad experiences no matter what the setting. I would normally not associate one with the other except that in prior times this never happened. The causality of combat and dream behavior is in my opinion directly linked.

MC:  What helps?

KL:  The honest truth is that alcohol and I have self-medicated many a night in order to fall asleep. This is not a good sleep, but it is the ability to get to sleep that one desires more than any other thing. Once in the habit it is very hard to break (thankfully I have recognized this as a direction I did not want to go and have stopped drinking as a habit). It affects performance at work and weight and psychological issues so this is not something I would recommend to anyone. I have also tried prescription medications. This is not a good alternative for me either as I still wake up, unknowingly, and re-medicate. I remember one night in particular, in which I woke up the next day to find that out of 30 prescription pills, some time during the night I had ingested 20 (and lived). This was my wake-up call and I stopped all medication thereafter. Now I read as long as I can before trying to sleep. It gets me to sleep but not for very long. I awaken again, usually in a sweat, and either get up for the day or lie in bed all night until a reasonable hour and then get up. I have tried many nights to stay awake for several days and then “reset” my body clock only to find I experience the same outcome as if I had gone to bed every night. It truly makes me wonder why I can function on such little sleep.

MC:  Is there anything that happens in your current work life that triggers a worsening of your sleep, other than jet lag from travel?

KL:  As a Soldier I always have different report times as the events I manage don’t stop to allow me to get some rest. At the risk of sounding cavalier, they are life-and-death situations and as a result I never really know when I will be able to shut work out completely and rest. This is true for all Soldiers, not just me. In what other career can something happening 10,000 miles away affect your daily life? Sometimes it’s just the Army philosophy of early to rise. My days have started as early as 0345 to 0900 and there usually isn’t a cut-and-dry schedule as to when that will be.

MC:  Ken, tell me about how your colleagues handle their own problems with sleep.

KL:  Honestly, alcohol is pretty prevalent. Some medicate with sleep aids; some try relaxation techniques. Most Soldiers diagnosed with any form of PTSD is prescribed some form of selective serotonin reuptake inhibitors (SSRIs). This helps many deal with what I would refer to as “sleep anxiety.” I can only speak for myself when I say going to bed is one of the hardest events of my day. I know I’m not going to sleep, or the sleep will be lousy, but I also know if I don’t try I’ll be worthless the next day.

My deepest thanks go to Captain LeBlanc for bringing attention to this important problem, and for his honorable and courageous work in securing and protecting our country.