Post-Superbowl Insomnia

A cold, bitter rain is falling in Seattle this morning, not the misty, spitting kind we often get in the Pacific Northwest in the middle of winter, but the big-droplet, drenching sort, rain that soaks your clothes, makes you shiver, and causes your kids to catch cold.

The weather reflects our collective mood in Seattle today, as we struggle to process what happened at the very end of last night’s Superbowl XLIX, in which the Seattle Seahawks battled the New England Patriots for the NFL championship and the Lombardi trophy.  In the final seconds of the final quarter, with the Seahawks in possession of the ball, second down and goal, mere feet from the Patriots’ end zone, Quarterback Russell Wilson threw the football instead of giving it to a running back (i.e., “Beastmode” Marshawn Lynch) for a rushing play.  As most everyone knows now, that final play didn’t go very well, resulting in a Patriots interception that sealed the win for Brady and Co. and hammered the final nail in the coffin for our Seahawks.

 

I am doing my best not to turn this post into a commentary about that play, Coach Pete Carroll’s decision-making, and the resulting outcome of the game.  But I will share here that I experienced some, shall we say, emotional intensities in response to Carroll’s authorization to throw that ball, something that surely would have been lauded as a “brilliant play” and a “gutsy move” had it resulted in a touchdown.  Those intense emotions led to . . . you guessed it . . . some sleep-maintenance insomnia last night.  I woke up at 3:16 a.m. and it took a while for me to fall back to sleep.  I’m not alone in this misery.  I’m sure there were a lot of people awake last night throughout the Puget Sound area, and not because of celebrating.  Earlier this morning some colleagues and I were talking about the game in our doctors’ lounge, and my hand surgeon friend told me he had awakened at 3:30 himself!  I strongly suspect Carroll has a number of sleepless nights ahead of him as well.

People tend to awaken in the middle of the night in the setting of intense emotions, particularly negative or traumatic ones.  This phenomenon is called early morning awakening.  Early morning awakening is part of the human condition:  we all experience emotional peaks and valleys as we move through life, and most everyone has had an occasion or two to awaken in response to the peaks and valleys.  Sounds familiar, doesn’t it?  The driver of the problem (in my case, that crazy throw) is the first thing you think about when you abruptly awaken, almost as if you had been thinking about it somehow prior to your awakening, and you turn the thing over in your head, ruminating about what went wrong, setting up all kinds of alternative scenarios, going through the “what if’s,” . . . right?  All of those thoughts and emotions have a stimulating effect, which tends to prolong awake time once aroused from sleep.

What I’m describing is a reactionary or situational form of insomnia which, again, in many respects is simply a result of human nature.  The good news is that in many or most cases, this temporary problem eventually (and usually quickly) fades and resolves as the intensity of whatever it is that you’re ruminating over fades (for us Seahawks fans, the sooner last night’s game is pushed toward the back of the vault of football history the better). However, in some cases, particularly for those with suboptimal baseline sleep habits (poor sleep hygiene), this insomnia can snowball into something more substantial and chronic, called psychophysiologic insomnia, which may benefit from medical attention if severe, sustained, or problematic enough.

I’m sure the intensity of the moment will start fading shortly for me as I delve into this week’s work, but this morning I admit I’m a little bleary-eyed and upset, which is why I was in the doctors’ lounge getting some coffee and commiserating about our loss.  Next year should be a great one.  Watch out for the Seahawks in 2015-16!

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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

Dinosaurs and Seahawks: Defense Wins Championships

I was one of those dinosaur kids.  I grew up completely, hopelessly enamored by dinosaurs.  I found them endlessly fascinating.  As a preschooler I strived to learn about and memorize as many prehistoric creatures as possible.  I could tell you which eras and periods in which various dinosaurs lived, what their bony structures told us about their ways of life, where their fossils were first discovered, how they walked, what they ate.  In my young childhood days long before the Internet, I satisfied my interest in paleontology through books, flash cards, and models.  I carried dinosaur books and drawings everywhere I went.  The librarians at Whitewater, Wisconsin’s public library all knew my name and knew my favorite place to camp out while I drank in as much dino-knowledge as my young brain could handle.  My fervor for the topic even earned me and my tattered book of drawings an article in Whitewater’s newspaper when I was four:

 

Anyway, everyone I encountered as a young child asked me the same question:  “What’s your favorite dinosaur?”  That was an easy question to answer.  Of course it was Ankylosaurus.

 

(This, by the way, is my all-time favorite depiction of Ankylosaurus, taken from my all-time favorite dinosaur book.)

Strange and turtle-like in appearance, Ankylosaurus sported much more than just a hard-shell carapace to protect itself from predators.  If you examine its body further, you will notice several additional features that surely served it well:  hard lateral spikes, a series of protective horns on the crest of its head, and–the pièce de résistance–a hard, bony club at the end of its tail, great for whacking the legs of would-be aggressors that ventured a little too close.  Seriously, imagine yourself as a Tyrannosaurus Rex trying to get a piece of this guy.  Good luck.

 

I’m sure I was asked somewhere along the way by curious adults, “Why do you like Ankylosaurus so much?”  I doubt I would have been able to give a cogent reply to this more challenging question as a young child.  But as an adult, I think I now know the answer:  Ankylosaurus was a giant, living, walking, breathing defensive weapon.

In our modern world we’re constantly assailed by all sorts of crazy stuff:  an overwhelming mountain of information, people, advertisements, opportunities, and threats, coming at us like a slow-moving, never-stopping avalanche as we move through life.  Though I am probably the worst possible person to assess my own personality, I know I identify easily with the idea of hunkering down and going into shield mode, on behalf of myself and my family.  I’m more of a protector than a predator.  I suppose, then, that it’s natural that I identified with the Ankylosaurus more than I did the T-Rex as a young child.

So–and I recognize this may be the weirdest segue in the history of blogdom–I found last week’s Seattle Seahawks Superbowl win over the Denver Broncos particularly gratifying, and not just because I’m a proud Seattle resident and Seahawks fan.  After hearing for two solid weeks various commentators and pundits crowing about Payton Manning and Denver’s offensive records this season, there was a clear sense of satisfaction in watching all of that not matter as the Seahawks dismantled the Broncos with its smothering, overwhelming defense.

 

Seattle’s domination was so complete, in fact, that it had ESPN’s Stephen A. Smith and Skip Bayless eating crow and paying respect where it was due:

Sometimes a formidable offense just doesn’t matter.  The fact that the phrase “defense wins championships” is a cliché doesn’t matter either.  It’s a cliché because it’s true.  Just ask Ankylosaurus, who isn’t too ancient to provide us all a little lesson for these crazy modern times.

Football and Bridgegate: People Losing Sleep in the News

 

Last week we were bombarded by the media over the controversy surrounding New Jersey Governor Chris Christie‘s staff and “Bridgegate.”  During his recent press conference regarding this matter, Christie indicated at 2:27 in this video clip below, “I haven’t had a lot of sleep the last two nights, and I’ve been doing a lot of soul-searching.”

I want to make clear this is not in any way a political post, and is not intended to defend or criticize Christie or anyone else.  I present this here simply to illustrate one generally well-understood point, which is that emotionally significant life events–whether they be good or bad–commonly cause difficulties sleeping.

There are several potential reasons for this.  First, problematic life events–such as Christie’s–are often accompanied or followed by mood problems and anxiety, both of which can cause difficulties falling and staying asleep.  Depression is commonly associated with insomnia–in particular a phenomenon called “early morning awakening,” in which the depressed person tends to awaken spontaneously several hours earlier than the normal or desired time, with very substantial problems returning to sleep.  Second, anything that you think about in bed that is of emotional value can cause difficulties sleeping, because those thoughts have a stimulating effect which makes you more awake and alert.  The more intense the emotions or concerns (I suppose that would include “soul-searching”), the more psychologically and physically stimulated you can get (an extreme example might be the feeling of sweating and heart-pounding upon hearing devastating news), and this stimulation can cause your insomnia to snowball.

OK, I will add just one brief, slightly political point here.  I wish people in the media would stop calling Christie fat and teasing him for it.  I NEVER use this term in my clinic or socially to refer to one’s weight.  Plus, he’s lost a substantial amount of weight following his gastric lap band surgery last year.  I’ve heard several Christie “fat jokes” on national radio and television programs in the past week.  Really?  Come on, folks, let’s at least be civil, yeah?

Anyhow, in a completely different matter, Pete Carroll, head coach of the Seattle Seahawks, said in a television interview last week that he hasn’t been sleeping much lately either, but that’s probably because of how crazy his schedule must be right now in addition to the excitement of prepping his team for the playoffs and, now, Sunday’s NFC championship game!  There must be some anticipatory anxiety, for sure, and this kind of emotion certainly can lead to sleepless nights as well, though for reasons quite different from (and in many ways the opposite of) Christie’s.  And hopefully–understand, I live in Seattle–he won’t have any sleepless nights due to game losses in the next several weeks!

Finally, continuing with the football theme, I will leave you today with this recent video clip of ESPN analyst and former Chicago Bears coach Mike Ditka dozing while on air during ESPN’s Sunday NFL Countdown Show.  Keyshawn Johnson had to nudge him awake!  Glad Coach was behind a desk and not behind the wheel at the time.

I have no idea what the circumstances were that led to Ditka’s on-air snooze.  Maybe he was watching George Wendt‘s State Farm commercials over and over late the previous night.

Enjoy the playoffs, everyone, no matter who you’re rootin’ for!

 

A Connection Between Exercise and Sleep

I’m a proud dad today.  Yesterday my boys both ran their first 5K race.  One, who turns 12 next March, outran me by an entire minute!  I’ve told my boys for years now that one of my goals is for them both to end up being better than me at everything, and that’s starting to happen now!

DSC_0260

A lot has been made of the relationship between exercise and quality of sleep over the years.  Recently, the 2013 National Sleep Foundation Sleep in America poll demonstrated “a compelling association between exercise and better sleep.”  Paraphrasing the data, those polled who did not exercise regularly indicated their sleep quality was “very bad” as compared to those who exercised regularly by a substantial margin:  14% as compared to 3-4%.  In addition, 76-83% of those who exercised regularly felt their sleep quality was “very good” or “fairly good,” as compared to 56% of those who did not exercise regularly, despite insignificant differences in sleep duration between the two groups.  These data and additional data from the poll support the longstanding idea of an association between good sleep habits and a lifestyle involving regular exercise.

We all know that regular exercise has been associated with improved overall health across a wide spectrum of parameters, ranging from cardiovascular fitness to mood.  Here are a couple simple exercise tips as pertains to your sleep:

1.  Exercise in the morning in general can help sleep quality and reduce the amount of time it takes to fall asleep once in bed at night.

2.  Though the notion of whether late-night exercise is detrimental to sleep has been challenged in recent years, I still recommend to my patients that it’s likely best to avoid intense aerobic exercise within 1-2 hours prior to their projected bedtimes; heavy aerobic activity can promote the release of stimulatory hormones.

3.  Consider exercise outdoors early in the morning.  The combination of aerobic activity and light exposure early in the day can further increase levels of wakefulness during the day and quality of sleep at night.

4.  Keep in mind:  the promotion of great sleep habits and hygiene originates from the same mindset that generates a schedule that includes regular exercise:  discipline to maintain a lifestyle geared toward good health, happiness, and longevity.  Use the same discipline for your sleep as you do to get yourself to the gym.  Stay regular with your sleep times and sleep scheduling.  Awaken around the same time every morning to the extent that you can.

5.  Your exercise tolerance and energy levels probably will improve with proper amounts of sleep every night!  Obey your body’s intrinsic need for sleep; most adults require around 7.5-8 hours of sleep per night, regularly, to feel fully awake and alert during the day.

Stay healthy, everyone!

 

Are You Ready For Some Football?

Indulge me for a moment.  Walk outside, stand quietly, and take in a deep breath.  What do you smell?  What is that that you sense?  You know what it is.  It’s the coming fall.

I love autumn.  Always have.  Even though I’ve been (thankfully) out of school for many moons now, the fall season to me is still all about the start of the new school year (now for my kids), intellectual beginnings and renewals, new activities, a prelude to colder weather and the holiday season, and, of course, that great American institution, football.

 

 

Truth be told, I’ve always been more of a basketball fan than a football fan, but I thoroughly enjoy a good gridiron game now and then.  Our Seattle Seahawks are lookin’ great this year, but I have mixed feelings and loyalties regarding the upcoming preseason rematch with the Green Pay Packers, my first NFL love (having spent 5 years of my childhood in south central Wisconsin).  Admittedly, what I love more than the game itself is the feeling of football season:  those bright crisp autumn days, the stadiums, the pulse of the marching band (in which I participated all through high school), tailgating parties, communion with close friends while rooting for our team.  That nondescript but powerful feeling remains part of why autumn has always been my favorite season.

Why is football pertinent to a discussion regarding sleep, other than sleepless nights from all the excitement?  Football players–particularly defensive and offensive linemen–have a particularly high risk of having obstructive sleep apnea, a breathing disorder in which prolonged pauses in breathing–due to closure of the upper airway–are followed by brief arousals from sleep, thus leading to symptoms such as nocturnal sleep disruption and substantial daytime sleepiness and fatigue.  Unfortunately, untreated sleep apnea increases the risk for developing heart disease, high blood pressure, and sudden cardiac death during sleep.  Reggie White, for example, was a Green Bay Packer whose tragic, unexpected death at 43 years of age has been attributed to sleep apnea.

 

People often–and mistakenly–presume that you need to be obese to have sleep apnea.  Though certainly it is true that being overweight increases your risk of developing sleep apnea because of increased soft tissues surrounding your airway, you don’t need to be obese to have the problem.

Many or most college and professional football players are not necessarily obese, per se, but they tend to be big people, obviously, often with large necks due to hypertrophied neck strap muscles.  In general, having a big neck does increase your statistical risk of developing or having sleep apnea.  In a clinical setting, the magic number is 17:  adults with shirt collar sizes of 17 or higher are at increased risk.

 

Earlier this month, the American Academy of Sleep Medicine announced its campaign to raise awareness of sleep apnea in football players.  CBS Sports college football analyst Aaron Taylor (also formerly a Packers player) is helping the AASM get the word out regarding the importance of diagnosing and treating sleep apnea:  he himself has been diagnosed with this disorder, and he has enjoyed substantial clinical benefit from being treated.  I appreciate the fact that Mr. Taylor is encouraging athletes to consider sleep apnea diagnosis and management.

 

To read more of Taylor’s story, click here:

http://www.sleepeducation.com/news/2013/08/08/aaron-taylor-warns-young-football-players-to-be-aware-of-sleep-apnea-risk

The take-home point here tonight is that certain athletes are at risk of having sleep apnea–such as football players and wrestlers–in part related to increased neck size, even if not due to fat.  If you know someone who is a football player, and if that person is a loud snorer who tends to feel tired and sleepy during the day, it may well be beneficial for that person to seek medical attention.  Treating sleep apnea can result in dramatic improvements in levels of energy and wakefulness during the day, and may even improve muscular strength and athletic endurance.  Then, hopefully, everybody wins:  players, families, teams, and fans!

It should be a great football season, y’all, and not a bad prelude to Jayhawk basketball!  Cheers, everyone!