Former NFL Star Aaron Taylor Discusses the Importance of Sleep Apnea Diagnosis and Treatment

I must admit that, two months following Super Bowl XLVIII, I’m still flying high from our Seattle Seahawks’ resounding victory.  The win has also served to take some of the sting out of my Kansas Jayhawks’ second-round loss in the NCAA national basketball tournament several weeks ago.

Well, back to sleep problems.  If you’re reading this you probably have heard of a common but under-recognized, under-diagnosed sleep disorder called obstructive sleep apnea.  This is a breathing problem during sleep, in which one’s upper airway episodically collapses or closes down while asleep.  A study recently published in the Journal of Clinical Sleep Medicine has demonstrated that sleep apnea is independently associated with an increased risk of cancer, stroke and death, and that apnea sufferers are 4 times more likely to die if the sleep apnea is left untreated longterm as compared to people who do not have the problem. (1)

My wonderful and patient readers have had to put up with my many posts regarding the importance of diagnosing and treating sleep apnea.  Now it’s time to hear from another authority on the subject:  Aaron Taylor, former NFL offensive guard (Packers and Chargers) and now a sports analyst for CBS College Sports.  Recently Taylor was interviewed and featured on CNN’s The Human Factor.  Here he is, talking about his own journey through the discovery and management of his sleep apnea.

http://www.aasmnet.org/articles.aspx?id=4703&utm_source=WeeklyUpdate&utm_medium=email&utm_campaign=wu-4-18-14

All too frequently I hear from my patients about their longstanding symptoms of daytime fatigue and sleepiness, loud snoring, and gasping sensations out of sleep, and how something kept them from getting properly evaluated in a timely fashion:  lack of motivation or time, acclimatization to their symptoms, some misconception about the treatments.  However, for many sleep apnea sufferers, treatment can be a total life-changer, resulting in profound improvements in daytime energy levels and wakefulness, a resolution of snoring and breathing pauses during sleep, and, hopefully, reduced risks of developing medical problems in the future.  I appreciate Aaron Taylor’s advocacy in bringing sleep apnea awareness to the forefront.

 

Have a great weekend, everyone!

(1) http://www.aasmnet.org/jcsm/ViewAbstract.aspx?pid=29425&utm_source=WeeklyUpdate&utm_medium=email&utm_campaign=wu-4-18-14

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Recent Brain Death Cases: My Interview With Dr. James Bernat

Earlier this week I published a post regarding the differences between brain death, coma, and vegetative state:

https://sleephelpdesk.com/2014/01/12/the-differences-between-brain-death-coma-and-vegetative-state/

In it I aimed to clarify terms that are often used incorrectly or even casually by the public and the media.  Numerous recent news stories–such as that of the passing of former Israeli Prime Minister Ariel Sharon–have invoked these clinical terms.  Among the most gut-wrenching of these recent stories are the Marlise Muñoz case from Fort Worth, Texas, and the Jahi McMath case from Oakland, California.  I have received a lot of feedback regarding my January 12th post, so I’d like to expand on this important subject further.  In today’s post, I briefly review the background of these two cases and bring in the expertise of a world-renowned medical ethicist to weigh in on how brain death and our understanding of it may affect their courses and outcomes.

The Muñoz case involves a pregnant 33 year-old woman who collapsed following a blood clot in the lungs.  Reportedly Muñoz is now brain-dead, though as of this writing I have been unable to find documentation of a physician or hospital spokesperson officially and publicly announcing that she has been declared brain-dead.  The health status of the fetus is not clear.  Muñoz’s husband, Erick, has requested that mechanical ventilation be terminated, in keeping with what he strongly believes her wishes would be (both he and his wife worked as paramedics, and he states that she had made her wishes very clear to him regarding what she would want in such a clinical setting).  However, the hospital where Muñoz resides has declined to do so, citing a Texas law prohibiting the withholding of “life-sustaining treatment” from a pregnant woman.  As I understand it, this Texas law is intended for pregnant women who are comatose, not brain-dead.  Muñoz’s husband has now filed a lawsuit against the hospital.  The central issues in this case are whether Muñoz is in fact brain-dead, and the degree to which a hospital may or may not have the right to operate against the wishes of the spouse given the pregnancy.

The McMath case involves a 13 year-old girl who underwent nasal and throat surgery–including a tonsillectomy–as surgical management for sleep apnea.  She suffered cardiac arrest post-operatively, and according to hospital spokespeople she subsequently has been declared brain-dead–and therefore clinically dead–by several independently-evaluating physicians.  As such, the hospital released Jahi’s body to the coroner, who then released the body to Jahi’s mother.  At the center of this impassioned debate is the question of whether or not Jahi is dead.  The McMath family’s attorney, Christopher Dolan, reportedly said in an interview that Jahi “has not passed.  Her kidneys function, she regulates her temperature and her body moves now more than ever.  This is a real human being, not a dead body.”  Jahi’s uncle, Omari Sealey, reportedly has told interviewers that he hopes “to have her come back home with 100% full recovery.”

These are heartbreaking situations, clearly, with no simple answers or methods of resolution.  So yesterday I spoke with my former teacher and mentor, Dr. James Bernat, professor of neurology and medicine and the Louis and Ruth Frank Professor of Neuroscience at Dartmouth’s Geisel School of Medicine in Lebanon, New Hampshire.

 

Dr. Bernat is a well-respected clinician with a scholarly interest in ethical and philosophical issues in neurology.  He is extensively published in the discipline of medical ethics; his textbook, Ethical Issues in Neurology, is widely considered a seminal publication in the field.  He has particular expertise in impaired consciousness, including brain death and the vegetative state, and has provided guidance, testimony, and consultation for many organizations regarding these topics over the years.  On a more personal level, Jim is just a great guy, one of the most caring, compassionate instructors I’ve ever had.  It’s an honor to call him my mentor and friend.

(Here’s a grainy old photo of us at an Academy meeting, back in the day.)

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Dr. Bernat was kind enough to provide his thoughts and expertise regarding these two complex cases.

MC:  Jim, do you get a sense that people in general have a firm understanding of what “brain death” really is and what it means?  

JB:  Most people do not understand the concept of brain death. They regard it as a metaphor for severe brain damage causing coma but fail to understand its totality and irreversibility, and particularly do not realize that it represents a medical and legal standard for death determination in the United States.  The public press compounds the confusion when journalists who also do not understand the concept discuss “brain death” incorrectly and confuse it with coma and the vegetative state.

MC:  As a neurologist, my concern is the confusion that may arise when the public hears in the media terms like “life-sustaining treatment” and “life support” when referring to a brain-dead patient receiving mechanical ventilation and medications.  Could you speak to this concern, and are there better, more accurate terms you would suggest the media use?

JB:  In the context of the brain-dead patient, the use of the term “life support” to refer to tracheal positive-pressure mechanical ventilation is seriously misleading and further confounds the question of whether such patients are alive or dead.  The medical and legal standard of brain death means that the patient is dead so the ventilator or other treatments should not be referred to as means of “life support.”  I prefer the term “physiological support” or simply that the dead patient’s respiration is being provided entirely by a machine which thereby permits their heartbeat and circulation to continue.

MC:  Every American state has its laws defining death.  As I understand it every American state defines death as either complete and irreversible cessation of cardiac and breathing functions or complete and irreversible cessation of brain and brainstem function.  Therefore, state law defines brain death as equivalent to the actual death of an individual.  What can be done and recommended in situations in which one’s individual opinions or religion differ from state law?

JB:  Your understanding of state law is correct.  Each country adopts a unique perspective to this problem.  In the United States, where our traditions emphasize respect for religious beliefs, enforce the rights of the individual, and promote the value of a pluralistic society, we allow states to amend their death statutes or their department of health administrative regulations to provide a religious exemption to declaring brain death.  Currently, New Jersey and New York have chosen this route.  In these states, in the presence of a qualifying religious exception, physicians must use the circulatory-respiratory tests for death.  Some scholars have advocated even more personal choice over the standards for death determination but I fear that this proposal would yield chaos in hospitals.

MC:  The news reports pertaining to these two tragic cases often refer to state law and hospital policies.  If you could communicate directly with state officials and physicians caring directly for these two individuals, what clarification would you ask for to assist in a better public understanding of their situations?

JB:  Hospitals are constrained about how much specific patient medical data they release to the public by HIPAA regulations and by their internal risk management-legal advice.  The dearth of specific information complicates the role of commentators because they lack a clear and complete understanding of the facts of the case.  Additionally, when hospitals’ every decision or statement is exposed to public scrutiny by an interested press, it is understandable that they become cautious in their decisions and public statements.  Despite these constraints, the public relations aspects of the cases require optimal management to provide sufficient facts and clarity for commentators and the public to understand the reason for their actions.  These facts include the diagnosis, how the diagnosis was made, whether brain death was formally determined, and the reasons for the hospital’s actions in each case.

MC:  What else can be done to ease the suffering of the families of these two unfortunate people?

JB:  These are both tragic cases of young people who died from massive brain damage.  As a parent, I cannot imagine the extent of suffering that these tragedies caused to their loving families.  In addition to taking every measure to inform and comfort such families, I strongly recommend offering the opportunity for organ donation.  Although some may criticize this approach as a predatory action, organ donation offers transcendent meaning to the families of brain dead patients.  Numerous studies have demonstrated that families later emphasize how important and meaningful they found the donation process because it helped mitigate their suffering by creating good for the organ recipients from an otherwise senseless tragedy.

Morgan Freeman Falls Asleep During an Interview

I can’t resist.

The other day actors Michael Caine and Morgan Freeman conducted a live interview with Bill Wixey and Kaci Aitchison from Q13 Fox News right here in Seattle.  The interview centered around their upcoming film, Now You See Me.  But as you now see here in this abridged clip, Mr. Freeman was having a bit of a struggle staying awake while Mr. Caine spoke.

I like in particular how he arouses briefly, nods his head slowly, as if he’s been fully attentive the entire time, and drifts back off.

Here is an online article, which includes Bill Wixey’s post-interview reaction and also the full video interview with Caine and Freeman.  It’s worth watching the entire interview here:  there is much more sleep time than what is seen in the brief clip above.

http://mynorthwest.com/76/2280849/Seattle-news-anchor-puts-Morgan-Freeman-to-sleep

Now, to be fair about this, this soporific faux pas is likely not Freeman’s “fault,” and is probably not due to boredom, as at least one journalist has suggested.  It appears that Caine and Freeman were interviewed from a studio in New York.  I’m guessing Freeman had flown from Los Angeles to New York shortly prior to the interview, and if this was the case he was probably recovering from jet lag.

Remember, there’s a 3-hour time difference between the west coast and the east coast.  Sleepwise, it’s particularly tough to go from the west coast to the east coast, because upon arrival your brain is essentially asked suddenly to go to bed earlier and awaken earlier than usual, setting you up for insomnia and sleep deprivation.  I know this from experience:  I fell asleep at my table and virtually fell out of my chair once during a loud, boisterous classic rock awards banquet shortly upon arriving in London several years ago.

Additionally, in general, the older we get, the less tolerant our bodies become to insomnia, sleep deprivation, and shifts in our usual sleep scheduling.  So I definitely empathize with our nearly 76 year-old Mr. Freeman, who was sitting in a comfortable, quiet environment during the interview, his uncooperative body clock begging for a snooze.

One final comment.  I’m often asked if you fall asleep during the day just because you’re bored.  The answer is no.  However, if you are prone to becoming excessively sleepy during the day (due to sleep deprivation, an untreated sleep disorder, or the like), then your sleepy tendencies will be more likely to express themselves in the form of falling asleep by accident when you are sedentary as compared to when you’re active.  When you’re bored you’re usually sedentary, so in that setting you’re therefore more likely to fall asleep.  This is an important distinction to make; many people don’t get evaluated for their sleep disorders because they believe that falling asleep frequently during the day is normal because they’re bored.

 

Have a good, wakeful day, everyone!

My Name is Maracujá!: My Interview With Eduardo Mendonça, Part 2

As those in my musical circles are aware, I have a Brazilian name.  I am Maracujá.

Maracujá is the Portuguese name of a passion fruit (Passiflora edulis) native to many South American countries, including Brazil.  It is often used in desserts and drinks (including the caipirinha, a famous Brazilian beverage, as well as bottled fruit drinks, such as depicted in the photo below).  In addition, it is known as a mild sedative, and it is an active ingredient in numerous sleep aids in Brazil.

I love the name.  It means a lot to me.  There is affection and friendship imbued in it, and as you can see it is also relevant to my career and my work.

Maracujá was bestowed upon me by my friend, Eduardo Mendonça, leader of the Seattle-based band Show Brazil!.  During an outdoor festival performance last year, Eduardo introduced me to the audience as Maracujá for the first time.  He also told the crowd that this was to be a christening:  he summoned everybody to shout out the name after him.  Three times a crowd of hundreds of people roared my new name.  All I could do was bow in gratitude and humility.  It was a wonderful experience, and I have Eduardo to thank forever for that brief but profound life moment.  Eduardo has introduced me to our audiences with this name ever since.

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During a recent chat over coffee I asked Eduardo to recount how he came up with this title that is now mine.

MC: As you know, you are the one who christened me with this name, Maracujá, which I hold sacred, personally, and which I appreciate very much. I was hoping you could talk about how you arrived at the name, and what it means historically and culturally in Brazil.

EM: Sure. To baptize you with this name was very much an honor for me, because giving a Brazilian name to someone requires a very strong connection, a connection with what you do and what kind of person you are. To best represent you, I came up with the Maracujá name because of the work that you do, helping people with sleep disorders and making life better, right? That’s very important, you thinking of the well-being of someone. How I could connect that, your work and yourself as a person helping others with a Brazilian meaning that could represent you very well? Maracujá is used in Brazil as a natural medicine to relax people. Some people put in a lot of sugar, even though sugar doesn’t go well with relaxing.  But if you put in the right dose of sugar, it would be fine, and would really create a natural relaxing time and relaxing moment, to help you with sleep, to help you calm down, and that’s how I came up with the name for you. It was not difficult at all to connect it to what you are, what you do, with something in Brazil that is a function that can make things good for somebody.

MC: There’s clearly a deep connection between relaxation and sleep. Is it known in the Brazilian culture that the passion fruit or its derivatives can help a person sleep? Does it really have a sedative property, actually make you drowsy?

EM: Yes.  Of course it depends on the quantity that you have. Definitely I remember my parents, when I was a kid, preparing the passion fruit, the maracujá juice to make a very energetic kid calm down. It helped me sleep. If you give it a few hours before you go to bed, and of course if you don’t have anything else in your body to cut that effect, it definitely helps you relax and sleep.

MC: Again, I’m honored to have the name, and I wear it proudly.  Thank you, Eduardo.

Show Brazil! plays all year ’round, and the summer season promises to be great this year!  Obrigado, Eduardo!

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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.

Snoring in a Song: My Interview With Eduardo Mendonça

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I play alto saxophone and percussion for Show Brazil! here in Seattle.  Originally from Salvador in the northeastern Brazilian state of Bahia, the band’s leader, Eduardo Mendonça, is an internationally renowned and award-winning recording and touring artist, accomplished songwriter, teacher, community leader and benefactor to the Puget Sound area Brazilian community.  His music is played and appreciated worldwide.  He has played for the Dalai Lama, Pope John Paul II, and Nelson Mandela, as well as audiences all around the world.  I’m honored that Eduardo christened me with my Brazilian name, Maracujá, about which I will write in an upcoming entry.

One of Eduardo’s many great songs is “Vingança,” a live version of which is shown here (from a Carnaval gig we played in 2011).

“Vingança” features both Portuguese and English lyrics.  Here are the English lyrics, which served the basis for a casual over-coffee discussion I recently had with Eduardo pertaining to sleep and snoring.

She left me just because I snore
It is so bad, I sing when I dream
To me it is nothing, it is nothing to me
Boy, I am crazy, please come back to me
Always back, come back to me
Baby, it is hard, come back to me
Yeah, I made my revenge
I scratched up all her pans
She got that stuff from my mother-in-law
Yeah, it was really nice
I broke her porcelain
It is my revenge because she’s gone away
I am so bad

So, here is my interview with my friend Eduardo, who I asked to provide the song’s backstory.

EM: The wife’s left this guy and he’s really mad. He reacts with non-violence. He wouldn’t hit this woman or anything, but he’s mad, and he starts to destroy the things that she likes, like the porcelain given by her mother-in-law, and he feels really compelled to do this. It’s funny; it’s humor. It’s nothing like asking anyone to be violent to solve the problem. I didn’t compose the Portuguese and English together.

MC: So you wrote the Portuguese portion first and later you added the English?

EM: Right, many years later. After I moved to the United States, I was willing to have Americans understand a little bit more about what I was saying.  I was reflecting about how snoring and sleeping problems really can damage any marriage, right? Any relationship. Snoring is in my family. My mother always complained a lot about how much my father was snoring and sometimes talking in the night, and they stayed married for many years until she passed away. She was a hero to keep living with this problem. They slept in the same room and everything, but she complained, I remember she complained. Later I found out I snore as well, though not all the time.

MC: Your wife complains about your snoring?

EM: When I’m really tired, she starts to complain about the snoring, and she reports it to me, like my mother complained, and I saw that it can cause a problem in the relationship. You sleep when you sleep. You don’t have a clue that you’re interfering with somebody else’s sleep!

MC: It’s no fault of your own, but it’s causing distress to your spouse.

EM: That’s where “Vingança” came from.  From my family’s experience, from my experience, and just to alert people: who has the problem? When I wrote this song, “to me it’s nothing, it’s nothing to me.” Of course not, right? Because you don’t know that you’re causing somebody else’s problem. And that’s the humorous part: when you say it’s not a problem, but it is a problem for somebody else. That’s what’s the music is about: just to make people aware that it’s something that needs to be reviewed, something that needs to be treated and talked about, because it does interfere in any kind of relationship.

MC: So he acknowledges that he is doing something that his wife is not liking, and that is a component in what eventually ends up being a dysfunctional relationship that gets worse and worse.

EM: Yes. She left because of that, right?

MC: But did she really leave only because of the snoring?

EM: Only because of the snoring! [we both laugh]

MC: Now, I will tell you that I have had patients that have gotten divorced in large part because of the snoring.

EM: I can believe that.

MC: And it’s not really because of the loudness and the obnoxiousness of the snoring, but because the person doing the snoring didn’t believe it, or didn’t do anything about it. It’s like, “I don’t care that you’re bothered by it; I don’t care.” So I’ve actually had patients that have been in that situation, when they refuse to do anything about it, knowing that it’s bothering the spouse, and then they get divorced. That’s happened!

EM: Yep, that’s my song.

MC: So what that song is then is basically a communication to people that you shouldn’t be ignoring those things, problems that you may not necessarily help, but don’t ignore it, or else your spouse isn’t going to be happy. And it’s humorous on one hand, but on the other hand, it’s deadly serious.

EM: Yes, it’s serious. The song treats a serious problem in a light way, because sometimes we can address some problem–and can make people reflect–not in a drastic way, but with humor. It’s a way to reflect on some cause, that the action that makes that cause can be changed, can be treated, and can be rethought.

MC: You can do something about it.

EM: Right. And this guy didn’t do anything about it.

MC: And he paid a price, because she left.

Obrigado to my old friend Eduardo for bringing some awareness to sleep problems such as snoring!  His music may be found on Amazon, iTunes, and Spotify; Show Brazil! is constantly touring, throughout the Pacific Northwest and beyond.  I highly encourage you to explore Eduardo Mendonça’s wonderful songs.

“Speed and Sleep:” My Interview With Kristin Hersh

The early nineties were a turbulent period for me: uneasy, scary, and fascinating, one of huge new responsibilities and intense personal and geographic exploration. And through it all, as has always been the case, music was there, providing stimulation, comfort, and light during an uncertain and often dark time.

My home state of Kansas has always been a classic rock, Zeppelin-n-Stones kind of place, but I was always able to find music not heard on Wichita radio. For years, alternative rock to me was electronic (Depeche Mode, Kraftwerk), gothic (The Mission U.K., Sisters of Mercy), or flannel (Pearl Jam, Nirvana). Then one day—I forget where or how—I came upon “Not Too Soon” by a Rhode Island band called Throwing Muses. I found their music totally different and completely compelling: dreamlike lyrics, edgy, unconventional guitar chord structures, tempo changes out of nowhere. Later, in 1994, when Throwing Muses’ cofounder, guitarist and singer, Kristin Hersh, released her first solo album, Hips and Makers, I was smitten. Even now, “Beestung” and “Your Ghost” transport me instantly back to my training days in New England, their delicate, dark acoustic melodies beautifully reflecting the shadows and quiet chaos I lived in at the time.

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So it is with some delight that I can say that in recent years I have become friends with Kristin Hersh. She is as lovely and intriguing as her music. Self-described as shy, she absolutely tears it up onstage. She lives and records music in New Orleans. She is a wife, mom, bandleader, touring artist, and author. She is also an insomniac of long standing.

Kristin’s difficulties with sleep are thoroughly chronicled in her excellent memoir, Rat Girl. On the very first page, introducing her 1985 self to us and upon finding a place to crash for the night: “So I park myself under a sad crucifix and watch tiny blue, green, red and orange bulbs blink on and off. Insomniacs like to waste time.”

Rat Girl‘s depiction of Kristin’s concept of musical creation demonstrates an altogether higher plane of creativity.  She has the gift of synesthesia, in which senses interplay and stimulate one another.  She sees music and melodies in colors; songs are born, and she is their pained, sometimes even reluctant, conduit. Her description of the sensation of sleeplessness is in many ways similar to that of her perception of music: colorful, raw, graphic, desperate, vivid almost to the point of shocking. “Sleep stopped coming, days stopped ending—now sleep doesn’t come and days don’t end. Sleeping pills slow my thinking, but they can’t shut down my red-hot brain. If I do manage to drop off, wild dreams wake me up. So I’m different now; my thinking is liquid and quick, I can function at all hours. My songs are different, too, and when I play them, I become them: evil, charged.”

People with psychophysiologic insomnia (a clinical form of insomnia, associated with excessive worry and frustration from not sleeping well) can easily relate to this portrayal of the sleepless mind. The urgency of her music further exacerbates her problems when birthed at night: “If I fall asleep, the song wakes me up, whispering, chanting and shouting, suggesting bass lines and backing vocals, piano parts and guitar solos. It’s that—the clattering noise of the thing, louder and louder, first whispering, then gasping with its own impact—that’s so upsetting, so overwhelming. A sickening frenzy.” Finally, conjoined with her insomnia, Kristin’s diagnosed bipolar disorder is also an important, recurring theme in her book; compromised sleep, particularly in the “manic” phase, is in fact a hallmark clinical feature of bipolar affective disorder and a primary contributor to the “red-hot brain.”

I checked in with Kristin recently and asked her some questions regarding her long struggle with insomnia.

MC: How long have you had your insomnia, Kristin? How has it changed or evolved over the years?

KH: I stopped being able to sleep reliably when I was a teenager and experienced my first manic episode. I could no longer fall asleep at night and songs came to me at 4 a.m., so I was only sleeping about fifteen minutes at a time. After that, life on the road, sandwiched between four pregnancies and subsequent sleep disruption due to nursing babies, was difficult to distinguish from that caused by manic and depressive episodes or even blood sugar imbalances.

MC: How has your insomnia affected your life? Like your thoughts, your songwriting, your relationships with others?

KH: It is the number one problem in my life (and in my husband’s life, though he has never experienced it himself!). Not only is it caused by bipolar imbalances, it also can trigger them. It reduces immune function and is so isolating that it imbues my worldview with a sharp loneliness that is very difficult for me to shake. I think my songs would be a lot less melancholy if I were healthier.

MC: How does the insomnia change, if at all, when you’re on tour?

KH: Crossing time zones shakes up any healthy pattern I’ve been able to implement but it also offers a handy scapegoat when I’m already out of balance! Sometimes it actually allows me to start over and clean up my sleep act. Additionally, playing music every night is such a release, there is very little tension or mind chatter left to keep me awake. That said, living without a schedule is difficult. The availability of meals and beds and showers and exercise is unpredictable at best.

MC: Have you found anything specific that has reliably helped you?

KH: Acupuncture helps immensely, but sleep medication doesn’t seem to work; it makes my brain more buzzy. Exercise helps and adhering to a strict schedule and diet help. 5-HTP and melatonin when I’m crossing time zones help temporarily.

A huge thank-you goes to Kristin for helping raise the awareness of insomnia and the effect it has on people’s lives.

I’ll conclude with Kristin’s perfect description of Throwing Muses music from Rat Girl, a book I recommend without reservation for its wit, honesty, and importance in the world of modern music. “Some music is healthy, anyway. I know a lot of bands who’re candy. Or beer. Fun and bad for you in a way that makes you feel good. For a minute. My band is . . . spinach, I guess. We’re ragged and bitter. But I swear to god, we’re good for you.”