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!

 

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Governor Chris Christie Undergoes Weight Loss Surgery

 

Today it was announced that New Jersey Governor Chris Christie underwent lap band surgery for weight reduction in February.  Governor Christie’s longstanding struggle with his weight has been the subject of intense media scrutiny–perhaps in some cases unfairly–in recent years, but at least the publicity has brought some high-profile attention to a problem that many find difficult to discuss openly:  what to do about the American epidemic of obesity.

Bariatric surgery for weight loss has been around for a long time, but public awareness of the availability and benefits of bariatric programs has increased substantially in the past decade or so.  There are now numerous surgical techniques to modify the anatomic volume and functional volume of the stomach and surrounding gastrointestinal structures to reduce hunger, food intake volume, and therefore weight.  Historically bariatric procedures centered around the physical reduction of stomach size.  More recently, however, technological advances have allowed for many to undergo less invasive procedures, such as gastric banding (commonly known as lap banding).

 

Aggressive measures to lose weight are not just for cosmetic reasons.  Many people undergo bariatric surgery due to medical problems associated with obesity–such as diabetes and hypertension–or to reduce the likelihood of later developing obesity-associated chronic illnesses, including cardiovascular disease.  Though it is a misconception that you have to be overweight to have obstructive sleep apnea, it is true that your chances of having sleep apnea increases substantially if you’re overweight or obese.  Over the years a great many of my sleep apnea patients have undergone such gastric procedures, usually with great–and even dramatic–success.  Usually these folks experience a gradual improvement in their baseline sleep apnea as the weight loss progresses, and in some cases the sleep apnea may go away completely with sufficient loss in weight.

It’s important to know that a sleep evaluation is usually a standard, integral component in the overall assessment for one’s fitness for bariatric surgery, not only because sleep apnea is a common medical problem for overweight people, but also because sleep apnea represents a peri-operative risk, particularly following extubation while recovering from anesthesia.  Often I am called upon to evaluate a bariatric candidate’s sleep well prior to surgery.  If sleep apnea is diagnosed, treatment is initiated and continued.  In addition, the patient and the physician sleep specialist should interact regularly in the months following surgery.  If CPAP (continuous positive airway pressure) is utilized for the patient’s sleep apnea, for example, the CPAP air pressures likely will start to feel uncomfortably strong as the weight goes down, and adjustments will need to be made accordingly.  Mask and headgear fit often also require adjustments and re-adjustments.  Finally, once the weight has “plateaued” (such that no further substantial weight loss is anticipated), it’s standard to reassess the patient formally to determine the extent to which the pre-existing sleep apnea has improved or, hopefully, resolved completely.

There are many great bariatric programs around the country.  They offer hope to many people that have utilized more conservative measures to lose weight with limited success.  I wish the very best for Governor Christie.

Have a great evening, everyone!