Participate in Sleep Apnea Research!

I hope you are enjoying this hot and crazy summer!

As you know, we in clinical sleep medicine are here for you.  Without patients in need of help for their sleeping problems, there would be no physician sleep specialists, no sleep centers, no sleep medicine.

Sleep medicine is an independent medial subspecialty, just like cardiology, pulmonology, and neurology.  Though sleep medicine remains focused on the clinical evaluation and management of sleep disorders, it also must continue to move forward in innovation and search for answers to unknowns in our field.  These essential aspects of our work can only be accomplished through research.

An organization called SAPCON (Sleep Apnea Patient Centered Outcomes Network) is dedicated to promoting sleep apnea research around the country.  Organized in conjunction with the American Sleep Apnea Association, it is one of the largest networks to advance sleep apnea research.  My friend and mentor, Dr. Vishesh Kapur (Professor of Medicine, University of Washington; Steering Committee Member, SAPCON), asked me recently to spread the word about SAPCON, which has created a website designed to develop a sleep apnea patient community that will learn about and contribute to sleep apnea research.  Sleep apnea apnea patients may now easily connect with health care providers and researchers to share ideas and needs.  As Dr. Kapur puts it, through the website “patients will be able to learn what is new in sleep apnea research, suggest new areas of focus for sleep apnea research, and participate in research if they choose to.”  The website also contains valuable online tools to help you manage your sleep apnea.

The website:  www.myapnea.org

I encourage sleep apnea patients and their loved ones to visit the site and see all that it has to offer.

Stay cool and sleep well this summer, everyone!

 

Help Your Child Sleep Well While “Back to School”

All you parents know what’s right around the corner, if it hasn’t already happened: the start of the new school year! At least for us in the Pacific Northwest, school doesn’t start for another week, so we have one more glorious week of sun and freedom before the beginning of fall classes.  But for many of you elsewhere, school has already started in earnest.

 

One of the many concerns parents have as they transition back into the school year is how their children’s sleep habits will change. Many of us know the drill, from our children’s experiences or our own: all the staying up late on weekends, sleeping in ’til noon on Saturdays and Sundays, the Herculean effort necessary to get out of bed in the morning, especially on Mondays. Though this ritual is very common, particularly for teenagers, the stress and conflict arising from this chronic problem can wreck your family life, not to mention your grades.

This pattern, called delayed sleep phase, arises from the adolescent brain’s natural tendency to cycle its sleep-wake rhythms in a timing scheme that is longer than the 24-hour day. Many of us recall what it was like to be younger and wanting to stay up later and sleep in later if given the chance. The problem with this tendency is that children and teenagers usually engage in activities (i.e., school) that obligate them to entrain their sleep-wake behavior to the 24-hour clock. This conflicts with their biological inclination to go to bed later, resulting in sleep deprivation which makes it more difficult to awaken early in the morning and be awake and alert for classes. Friday night comes ’round, they stay up late, sleep in big-time on weekend days, and then find it impossible to fall asleep early Sunday night because their body clock’s sleep-wake phase has now been delayed from all the sleeping in, so all the sleep debt and sleep deprivation then roll into the new school week, perpetuating the cycle.

There is ongoing controversy about what can and should be done to improve this problem for young people and their families. Though some schools around the country have options of starting classes later in the day, many or most of us parents are obliged to ensure that our children are out of bed and ready for school at times earlier than what they, and their body clocks, “want.”

So what can be done? We can’t change our kids’ brains, though sometimes it’d be great if we could, right? Here are a few tips to help weary parents get their kids sleeping better as we kick off this new school year. As you will see below, these recommendations may be quick to read and absorb, but whether they are easy is another matter. The unfortunate reality is that making these sleep problems substantially better likely will be difficult, at least at first, requiring communication, motivation and insight from the child and patience and support from the parent.  Ready? Here goes.

1.  Minimize the “sleeping in” on non-school days by setting the alarm clock for reasonably similar times each day to the extent you can.  Kids hate this most of all.  Sleeping in dysregulates your body clock, causing nocturnal insomnia and daytime fatigue.  Sleep schedule dysregulation is why we have jet lag, for example.  If your child has to awaken for school at 6 a.m., say, but sleeps in ’til noon on weekends, and then tries to go to sleep early Sunday night, such abrupt changes in the brain would be the equivalent of flying from the west coast to the Bahamas, for example, and back, every week.  Regulating the wake-up time may well require a hard sell to the teenager; I’d rather the teen sleep in until 8 a.m. than until noon.  This lifestyle modification (and it’s a big one) gets substantially easier if done diligently for a couple weeks, but I won’t lie, it’ll be painful for all involved at first.  The child may need some, er, parental assistance in getting up on weekends.  A second alarm clock is also an option.  Put one alarm clock on the nightstand, and then put the second one further away, set for 2 minutes after the first clock, so that your teen will need to physically get out of bed to turn it off.  Make sure the second alarm clock is loud, and the more obnoxious the better.

2.  Don’t go to bed until substantially sleepy.  If the first step is done properly and done the same way every day, then this second step should fall naturally into place eventually, because the resulting sleep deprivation should make your teen become drowsy gradually earlier in the evening on weekends.  Force your child to go to bed too early, however, and residual insomnia results.  Taking advantage of children’s sleep needs allows them to fall asleep quickly and earlier (including on Sunday nights) and at the same time get proper amounts of sleep (which for children and teens can be 9-10 hours per night), both of which are important in physical and cognitive development and proper performance in school.

3.  Declare a curfew from light and technology.  Light exposure greatly impacts our levels of wakefulness and alertness; add to this the perceived need to always be constantly “plugged in” socially through mobile devices, and you have a recipe for “up all night.”  Shield your child’s bedroom from outside light and noise, such as with black thick curtains, particularly as these summer months continue to wane.  Start dimming your home’s ambient light several hours prior to the projected bedtime.  And, finally and importantly, I recommend laying off lit-screen gadgets (including iPads, laptops, and smart phones) 2-3 hours prior to the projected bedtime.

Now that I think about it, I’m pretty sure this last recommendation is actually what kids hate the most.  But complete these 3 steps, and utilize them consistently, and chances are your child will sleep better.

Best of luck to students and parents alike this upcoming school year!

 

Sleep Well This Summer!

 

Shortly I’ll be on a plane to Wichita, Kansas, for my high school reunion.  Every time I step foot on Kansas soil a flood of great memories returns:  Friday night football games, Knolla’s Pizza, midnight movies, parties, Bionic Burger, the River Festival, Galaga, and, especially around this time of year, the all-important beginning of summer.

 

Where I grew up, summer was all about crowded public swimming pools, Dairy Queen Hot Fudge Brownie Delights, baseball, mowing a huge yard all day every Saturday, hay fever, washing dishes at a restaurant by day, dragging Douglas by night, and listening to the Police and Marillion in my little green 2002.  It was also about hanging out with my friends, and to be perfectly honest I often didn’t sleep as much as I should have.  What did I know?  Sleep deprivation and sleeping in were pretty common during the sweltering, humid summer months of my teenage years.

Sleep often suffers in the summertime.  So before I depart I will leave you with some quick, easy tips to make your sleep easier, better, and more enjoyable during these hot summer months.

1.  Keep your bedroom dark, quiet, and cool.  Insulate your room and windows from noise and light to the extent that you can.  It’s a tough time for many of us financially, but if you are unable to sleep because the room is hot, use your air conditioning; sleeping well is worth the money spent on utilities.  If you can’t fix your hot, light, loud bedroom, try sleeping in the basement.

2.  Strive to keep your sleep schedules regular.  School’s out; loved ones are visiting; the neighborhood BBQ is in full swing; you’re off on a family vacation.  There is always the temptation to party late, sleep in, and not set your alarm clock during the summer.  Your body clock doesn’t care about any of that, however.  A common cause of insomnia and daytime sleepiness is dysregulation of sleep schedules.  Continue to awaken around the same time every morning (if you don’t have to awaken at any one specific time, you would do well to choose a preferred awakening time and stick with it), including on weekends and non-work days.

3.  Mind your late-night alcohol.  Alcohol has sedative effects for the first couple hours after you ingest it.  However, after several hours it tends to be a sleep disrupter.

4.  If you’re a night shift worker, get thick black curtains for your bedroom windows and wear dark sunglasses on your way home from work in the early morning.  Remember:  it’s light out early in the morning and late in the evening when it’s summertime, so your brain can be tricked into making you feel more awake and alert if there is bright light exposure around the time that you should be sleeping.

5.  Avoid late-night exercise.  The release of stimulatory hormones when you exercise hard can last for several hours, causing insomnia.  I recommend that you stop heavy aerobic activity 2-3 hours prior to your projected bedtime.

6.  Take care of yourself.  Don’t sacrifice your health for all that summertime fun.  Obviously, anything that causes physical discomfort can be a detriment to your sleep.  Avoid sunburns and dehydration.  Use nasal sprays or see your doctor for those seasonal allergies.  Minimize hangovers.  Don’t overextend yourself.  And, as I will probably see firsthand this weekend, it’s best to remember you’re not in your 20’s when you’re, uh, no longer in your 20’s, just ’cause it’s summer.

Utilize these simple suggestions and chances are you likely you’ll be able to avoid a . . .

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!

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!

Is Daytime Sleepiness a Problem?

 

The answer, of course, is yes.  However, it may not necessary feel like a problem to the sleepy person.  Why?  Because if you’re used to feeling a certain way during the day for years, and if there’s no pain or other immediately negative consequence involved, then that way feels tolerable for years and thus becomes normal–to you–because what feels normal is simply what you experience regularly and every day.

Here is a not-uncommon scenario in my clinic.  A man and his wife walk in.  I ask the gentleman if he feels sleepy during the day.  “Not at all,” he may tell me, or he may reply with a more vague “not any more than usual” or “not any more than anyone else.”  Does he tend to doze off if he’s in front of the TV, for example, I ask, or while reading at home?  “No, never,” he replies casually.  This is when the silent eye-rolling from his wife, who cajoled him for months into this visit, changes to an exasperated gasp.  The frustration now is just too much for her.  “He falls asleep all the time,” she tells me, much to the man’s annoyance.  “No I don’t!,” he exclaims, challenging her angrily with his eyes.  “You fall asleep at the dinner table!,” she returns.  “Every night!  Even when we have company!”  The exchange continues in its escalation, both voices now raised to the point in which they can be heard outside the clinic room.  There have been times in which I’ve had to intervene in a mounting spousal fight over this question of sleepiness.  It’s not like he thinks she’s deliberately lying.  He may believe she’s exaggerating, and may accuse her of being prone to exaggeration during this visit.  But the primary problem here is more inscrutable:  the manifestations of daytime sleepiness just don’t seem to be a problem to him like they are for her–what’s wrong with napping when you’re bored, after all–and therefore he doesn’t believe it signals the presence of a medical issue or something that needs to be acted upon or repaired.

There are several problems with this logic.  First, the tendency to drowse and fall asleep by accident, though not necessarily painful in and of itself, can in fact lead to things that are painful, like fall-asleep car crashes.  According to the National Highway Traffic Safety Administration, about 100,000 police-reported car accidents occur in the United States annually due to or associated with driver fatigue or sleepiness.  I’ve seen patients who admitted to me that they’ve fallen asleep behind the wheel of their 18-wheelers, or while driving their motorcycles on the freeway.  Tell me how this is not a dangerous problem.  Secondly, the idea that it’s normal to fall asleep by accident just because you’re sedentary or bored is not based on fact.  If you get proper amounts of sleep regularly and if there are no sleep disorders, you generally shouldn’t be falling asleep easily during the day, even if you’re bored.  Finally, and importantly, the tendency to struggle to stay awake is a symptom of something, not necessarily the problem itself but an indicator that something is wrong, wrong with the quantity of your sleep, the quality of your sleep, or both.

Excessive daytime sleepiness is an incredibly prevalent problem with far-reaching implications.  In 2008 the National Sleep Foundation conducted a survey (called The 2008 Sleep in America Poll).  Of its respondents, 36% nodded off behind the wheel during the previous year; 29% fell asleep at work or drowsed substantially at work; 20% had sex less often or lost interest in sex due to sleepiness; 14% missed family events, work functions, and leisure activities because they were too sleepy or had sleep problems.

The most common cause of daytime sleepiness is simple sleep deprivation.  The vast majority of human adults require between 7.5 and 8 hours of sleep per night regularly to feel awake and alert consistently during the day.  However, as you are probably well aware, many of us tend to get less than that, and often much less than that.  In addition, there are many medical sleep disorders, ranging from obstructive sleep apnea and periodic limb movement disorder to narcolepsy and idiopathic hypersomnia, for which daytime somnolence is an important clinical feature.  If you are struggling to stay awake during the day despite proper amounts of sleep each night, perhaps a sleep disorder needs to be uncovered and managed.

Bottom line:  daytime sleepiness is in fact a real problem, one that can directly and indirectly impact your quality of life.  Consider doing something about it.

Have a great week, everybody!  Cheers!