Fox News’ Tucker Carlson Falls Asleep on Air

 

The other day, Fox correspondent and commentator Tucker Carlson was caught sleeping while taping the show Fox & Friends.  When he awoke he appeared not to be aware that he had been on air during his nap.  Take a look:

I understand that there were media references to narcolepsy (a sleep disorder associated with nocturnal sleep disruption, daytime sleep attacks, and other symptoms) pertaining to Carlson’s on-air snooze, and that he afterwards stated that he had found his nap refreshing.  However, if you listen to the above video carefully, you will hear him suggest that sleep deprivation may have been to blame:  “I sat in for Sean Hannity last night. It went late and all of a sudden I was sitting there and I was just having these happy thoughts and just dozed off.”

Alas, falling asleep on-air is a phenomenon not new to Fox News.  Just for fun, I present to you yet another incident, this time from the Fox affiliate in Austin, Texas:

This sort of thing shows up in the media from time to time:  someone in a televised program dozing on-air.  It also makes sense for morning reporters and anchors particularly to be prone to this problem, because they typically have to awaken so early to go to work.  Everybody’s having a great time with this latest episode with Carlson, too, as you can imagine:  “Tuckered Carlson!” “Fox Snooze!”  Though these incidents are kind of funny to watch, they also are an opportunity for people like me–who work in the realm of sleep medicine–to make some important points about daytime sleepiness.  Here goes:

1.  Daytime sleepiness is much more commonly caused by plain ol’ sleep deprivation than by narcolepsy.  Most adults require around 7.5-8 hours of sleep per night to feel fully rested, and in our American culture many of us do not make time for this much sleep, at least consistently.  How many people do you know that regularly get 7.5-8 hours of sleep each night?  Sleep deprivation may well be the single most common cause of daytime sleepiness in the U.S.  Narcolepsy, though not necessarily a rare disorder, is much less common than sleep deprivation.

2.  A tendency to fall asleep by accident during the day is not equal to or the same as having narcolepsy.  Narcolepsy is a central nervous system disease, of which daytime sleepiness is a cardinal symptom; however, it is a very complex sleep disorder that we in sleep medicine continue to strive to understand through research.  Many other things can cause daytime sleepiness:  sleep deprivation; irregular sleep schedules; insomnia; untreated sleep apnea; the list goes on and on.

3.  If you really DO have narcolepsy, a brief (15-20 minute) nap usually IS refreshing.  This is one of many potentially distinguishing clinical features of narcolepsy; a brief nap in the setting of sleep deprivation alone may or may not be refreshing, and can often cause the napper to feel worse, not better, upon awakening, because only a small amount of the “sleep debt” was “paid back” during that nap.  For my narcoleptic patients, I in fact typically recommend scheduled naps as part of their management regimen.  But just because you find your naps refreshing doesn’t necessarily mean you have narcolepsy either.

Have a great Labor Day, 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!

Sleep Well This Summer, Part 3: Keep Your Bedroom Quiet

It’s been a while since my last entry; too much going on this summer!  I hope you all are staying cool; it’s been a scorcher throughout most of the U.S. this month.

In recent entries we tackled how to keep your bedroom dark and cool.  I’m finishing off this summer sleep writing triad today with some tips on how to keep your sleeping environment quiet during these summer months.

Summer presents some challenges to sleeping in a peaceful quiet place.  It’s light out late, it’s vacation time, the kids are out of school, and the heat’s got people a little crazy.  So there are block parties, summer traffic, teenagers out raising a ruckus in their back yards, barbecues that run late . . . you know, all the stuff that’s great fun when you’re in the fun, but not so fun when you’re in your bedroom trying to get some winks.

As I’ve mentioned before, sleeping during the summer months is best achieved if you keep your sleeping environment dark, cool, and quiet.  Here are some suggestions to make for a quiet place in which to sleep.

1.  Fix broken or uneven windows and door and window frames, basically anything that can cause a draft.  Things that leak in unwelcome air will also leak in unwanted noise.  Doing so will probably reduce your energy bills too.

2.  Fortify your windows to insulate them from noise.  Try thicker glass or double-paned glass.  A cheaper and easier alternative would be to place thick, black curtains in front of the windows.

3.  Try a little “white noise,” particularly if you live in an area in which outside noise is unavoidable (train tracks, a busy intersection, or what have you).  A fan works well, because the convective effect of the circulating air cools you down as well.

4.  If you live in an apartment, request a corner apartment farthest away from the street.  And preferably as far away from loud, selfish, obnoxious neighbors as possible.

5.  Sleep in a room closest to the center of your dwelling.  The more drywall that separates you from the outside world, and the fewer windows in the room, the quieter in general your sleeping environment will be.

6.  Sleep in the basement, if you must.  Nothing like surrounding earth to insulate you from the noise and heat in the summertime.

7.  Though earplugs may be helpful, I personally advise against this, simply because you want to be able to hear potential problems around the house:  a crying baby, for example, a fire alarm, etc.

8.  If your bed partner snores substantially, discuss this with your bed partner and consider informing his or her physician.

9.  This is embarrassingly obvious, but turn off whatever beeping, pinging, whirring, droning electronic gadgets you have in your bedroom if you possibly can.

10.  Turn off TV’s, radios, and iPods.  Many people feel like they can’t sleep without background noise from such gadgets, but let me assure you that the reason why this feels this way is because of simply habituation:  your body does not biologically require such noises, but if you’ve had some sounds in the room at night for years, it feels like you need them when you don’t.  Turn off these devices and you should fairly quickly come to enjoy the silence.

11.  Particularly if you work night shifts, have open discussions with your family and loved ones about how to keep the noise of other people from disrupting your sleep.  As with most other situations, it’s always best to communicate openly and honestly about such topics!

Enjoy the rest of our summer, everyone!  I wish you deep, comfortable sleep!

 

Woman Falls Onto Train Tracks After Falling Asleep Standing Up!

Here’s another scary recent incident in the news pertaining to sleepiness.

In Prague, Czech Republic, a woman in a train station appeared to fall asleep while standing and waiting for her train.  Take a look at this.

This video is fascinating.  From a couple different camera angles you witness this woman gradually giving in to the relentless pressure of sleepiness.  She slowly leans forward as slumber starts to overtake her.  She rights herself briefly in an attempt to regain alertness, but she then walks forward a bit and eventually leans in again, knees buckling, until her body weight finally forces her to tumble onto the train tracks.  Miraculously, she lands in the deep groove between the tracks, and  though the train rolls over her she reportedly gets up, dusts herself off, and walks away after the train departs from the station!

According to reports, upon being questioned her following the incident, this woman told law enforcement officers that she was “merely tired.”  She refused a medical evaluation and breathalyzer test.

This is a dramatic example of the inevitable effects of daytime sleepiness, regardless of cause.  You may have untreated sleep apnea or you may be simply chronically sleep deprived, but the bottom line is that a primary response of your body to poor-quality or poor-quantity sleep is that at some point you will be forced to sleep, including in inopportune times or places and in very dangerous situations.  I’ve had patients, for example, who have come to my clinic because they’ve fallen asleep behind the wheel of their 18-wheel trucks, at the controls of their motorcycles on the freeway, in the cab of their cranes, and in front of industrial saws.  No matter how much you try and no matter how bad your insomnia may be, your body will give in eventually and oblige you to sleep.  Remember, sleep is a required biological requirement; you absolutely need your sleep, and your body will make you get it one way or another.

Have a great Independence Day, everyone!

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.

It’s Not About the Nail!

In this video, a woman describes some difficulties she’s had recently:  a multitude of strange, bothersome symptoms, including problems sleeping.  Take a look.

I thank my great friend and former partner in crime, David B., for bringing this piece to my attention.  It’s absolutely hilarious, but this video short does illustrate a couple important and serious reminders for me, however.

First, for each of us, there may be times in which the underlying cause of a problem can be right under your nose (or in this case, nailed to your forehead) for ages before it’s realized.  I saw a woman in my clinic this morning, for example, for her insomnia.  She’s awakened at 3 a.m. every morning because her cat sits on her face.  She told me she then gets up to put the cat into the garage.  I asked her how often she does this.  Her answer:  “every night.”  Sooo . . . why not put the cat in the garage at the beginning of the night before bedtime?  My point is that we’re creatures of habit, and we’re used to what we’re used to.  Whether we’re talking about sleep hygiene or a nail protruding from your head, what you’re used to is your “normal.”

Second, though we docs are trained and conditioned to move quickly to act and save our patients from their medical problems, sometimes what is asked of us is to just listen.  Given the changes happening in health care at the moment, I fear that the doctor’s ability to spend the time to listen to our patients will become as extinct as the dinosaurs.  Many feel that it already is.  I hope that someday there will again be a place for more humanity in the administration of health care.

Have a great evening, everyone, and remember, “it’s not about the nail!”

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!

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!

This Morning’s Dream and Changes to Come

I’ve had a lot of whacky dreams lately.

Nothing particularly awe-inspiring or epiphanic, mind you.  Just a big mish-mash of strange, loosely connected but extremely realistic and visually intense viewscapes and scenarios.  Though there is much that is still unknown about the neurophysiologic mechanisms that drive rapid eye movement (REM) sleep and dream content, there appears to be a deep connection between dreams and mood.  I think it’s safe to say that I’ve been on a bit of roller coaster ride lately:  I’ve decided to make some major changes at work (which explains my recent lapse in writing; sorry!), and though these changes are definitely for the better, executing the change can often be a daunting challenge.  It’s all good, I want to reassure you!  But I think the ultra-vivid quality of my recent dreams probably reflects my inner adaptations to the upcoming work restructuring I’ve decided it’s best to undertake.

Yesterday I awakened at 5 a.m. disappointed that I didn’t get to taste the margarita I had just made for myself in some bar in Cabo San Lucas.

Here’s this morning’s little adventure.

I’m in my car.  It’s a cool, sunny late morning.  I’m hungry and looking for a place to eat an early lunch.  As I drive slowly and silently down this flat, straight suburban road, nondescript shopping malls loom and pass by on my left.  I pass an Olive Garden.  Then a Macaroni Grill.  Then a whole bank of other large, corporate restaurants.  I’m just not in the mood for any of that today.  I’ve eaten at all of these places before.  This morning I need something different, something local, something smaller.

At the end of this row of restaurants there is a place that seems to fit the bill.  Set back a fair ways off the road sits a short, squat, long chrome silver building, designed to resemble the dining car of a passenger train.  I don’t see (or remember) the name of the establishment, but it’s pretty clear it’s a family-owned, greasy-spoon kinda place.  I’m looking for something different, to be sure, but I wonder if there is anything halfway healthy on the menu.  I decide to pull in and take a look at the menu.

I walk inside and take in what is now before me.  The place is much bigger and more stately than its exterior presentation would suggest.  Various strangers sit quietly in their booths, paying me no attention.  The sound of clinking spoons and the smell of coffee and waffles make me smile as I stand for a few minutes looking for a waitress, who is nowhere to be found.  Eventually I decide that I’m expected to seat myself, which I do, at a quiet booth meant for four.

The slow, muffled rhythmic activity of the place continues as I wait in vain for service.  There’s no menu at my table.  Growing impatient, I stand up and look around for one.  I finally see one at an empty booth, so I walk over to take it.  At the moment I arrive at the booth and extend my arm, I realize that on top of the menu there are car keys and a wallet. A split-second later, a sudden, loud male voice booms, “Hey!”  I look up.  A large man in his fifties walks toward me.  He’s clearly pissed off.  He thinks I’m trying to steal his wallet!

I back up a few steps in a defensive posture and tell him I mean no harm, I just want a menu because I can’t find one anywhere.  He calms down and sits.  I walk away, embarrassed, and wander through the aisles of the diner looking for someone to help me.  There’s gotta be some way to order something in this place!  I’m starving at this point.  I ask myself if my body and my primary care physician would forgive me if I have the chicken-friend steak, because I see one coming out of the kitchen and it looks damn good.

And that’s when I awoke.

 

In retrospect, I’m pretty sure that the diner was loosely modeled in my mind after the Quechee Diner, where we ate sometimes on Sunday mornings in my old Vermont days.  But I gotta put more thought into what the rest of this morning’s dream sequence might say about my current frame of mind and how I’m processing the changes that will soon take place.

Have a great holiday weekend, everyone, and dream good dreams tonight.  Cheers, all!

Where Children Sleep Around the World

Today I am sharing a post I recently discovered through my dear friend Reta Wright, a reknowned “sleep coach.”

 

There is a book by photographer James Mollison called Where Children Sleep.  This book contains photos of where children sleep around the world.  Many countries are represented, from Africa to North America.  As a disclaimer, I have not yet myself seen or read Mollison’s book (though I intend to), but Linen recently posted a blog on Demilked about it.  To see some of Mollison’s photos, please click on this link to Linen’s posted entry:

http://www.demilked.com/where-children-sleep-james-mollison/

I find this work completely fascinating.  The children depicted here all have stories, stories told on their faces and by their sleeping environments.  The universality of sleep comes through in these photos:  the basic need for a bed or at least a bed equivalent; a place of relative quiet and privacy; a personal space in which one’s personality and circumstances may be expressed.  However, as you can see from the photos, that’s where the similarities end.  The obvious contrasts between sleeping quarters from different corners of the world are equally engaging.  My understanding is that Mollison was born in Kenya and raised in England; perhaps he may have had personal experiences to mirror such contrasts, at least to some degree.

One could come up with all sorts of political and social commentary by viewing these photographs, I suppose, but for me I am drawn in particular to the themes of the ubiquitous need for sleep and the necessity of getting sleep where and how you can, no matter who you are, where you are, or where you’re from.  I encourage you to take a look.

Something to consider today.  Cheers, everyone!