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Drowsy Driving Kills! 9 Tips for Drivers This Weekend!


Our public education campaign aimed at eliminating drowsy driving

 

Do you know that every hour four people die on our roads in the USA? Have you ever fallen asleep driving? Do you find it difficult to stay awake driving during mid-afternoon? Here are a few tips that can save your life this weekend.

Please remember that turning on the radio, stretching your neck, putting a fan on high, putting your face out of window, slapping your face, or pushing a sharp pin in your thigh does not work.

  1. Certainly before a long trip, plan and get a good night’s sleep.
  2. Avoid driving from midnight to six o’clock in the morning.
  3. Be extra careful while driving around mid-afternoon.
  4. Do not drive after an overnight flight.
  5. Take a break at least every two hours.
  6. Take a power nap in anticipation of sleepiness.
  7. Remember that a cup of coffee can be lifesaving.
  8. Talk to your doctor if you have sleep apnea, insomnia, restless legs, shift work sleep disorder, or narcolepsy symptoms.
  9. If your thoughts become dreamy, your eyelids feel heavy, or traffic signs do not mean much pull over. You are about to die!
 

About thirty-eight thousand people die on our roads each year in the USA. That is 4 preventable deaths every hour, mostly of people in their prime. By the time you finish reading this blog, one person would have died based on the National Highway Safety Administration data. Why does this happen? To explain this, I will share a story. On the very first day of my internship in this country, I did an initial evaluation of a female executive, who the paramedics had brought to the ER of Englewood Hospital Medical Center in Englewood, New Jersey. She was a restrained driver of a Volvo that ran off the road and into a tree on that cloudy afternoon on a drive back to her home in Englewood Cliffs from Newark Airport after a long transcontinental flight. Even though her car was totaled, she fortunately suffered only minor chest contusion. What struck me though was her answer when I asked her what had happened. “I just don’t know.”And that is the commonest answer I have heard during my twenty years of pulmonary practice while evaluating and treating survivors of motor vehicular accidents. I was baffled with that answer until I started my sleep medicine fellowship and learned about micro-sleeps and lack of situational awareness resulting from sleep deprivation.

Micro-sleeps are fatal. Micro sleeps, three to fourteen seconds of sleep activity seen on electroencephalographic recordings (brain waves) of awake individuals, cause uncontrollable sleep attacks without any warning in people with both acute and chronic sleep deprivation.

Loss of situational awareness kills, too. The other dangerous phenomenon seen in sleep-deprived leaders is the loss of situational awareness. With this deficit, the person loses awareness of the surrounding. Is the road ahead curving? Is there a reduced speed limit ahead? Is the car in the front braking? Are the driving conditions dangerous?

Beware of impaired decision-making too. When sleep deprived, your decision-making is impaired such that you may take a left turn when you would have waited. Or you may pass a truck on a curvy road, which you would not have done when rested. You may choose to text back while driving, which you would not have done if you were not sleep deprived.

Under our public awareness campaign, Stay Awake, Drive Safe, We do bulk emailing of above tips to colleges, high schools, hospitals, and companies a week before Thanksgiving, Forth of July, Christmas, and other major travel holidays. Please drop me an email at md4sleep@gmail.com to join that mailing list. Please write Stay Awake, Drive Safe in the subject line.

Do you have a story you can share? Have you dozed of while driving? What has your experience been? Which countermeasure works the best for you? How are you educating your kids and your coworkers about this? Take a moment to share so that we can learn from your experience and save a life.

11 Tips for Deeper Sleep


Sleep does not differentiate us from animals, sleep hygiene does!

Overworked humans are not only getting insufficient sleep but also poor quality sleep secondary to their poor sleep hygiene.  And what exactly is sleep hygiene? Sleep hygiene is your personal set of habits that together determine the quality of your sleep. Sleep hygiene helps you stay healthy by keeping your brain (most importantly, the executive center) and your body rested and strong. In order to get the most return on your investment in sleep, you will have to follow sleep hygiene fanatically.

The following tips will help you improve your return on investment in sleep:

  1. Create a sanctuary for sleep. Make sure your bedroom is dark, cool, and quiet.
  2. Reserve your bedroom for sleep and sex only.
    Keep work related items out of bedroom. Do not take Excel spreadsheets and PowerPoint presentations to bed. Keep Smartphone and laptop out of your bedroom.
  3. Use the might of Mother Nature to your advantage. Going against Mother Nature by ignoring circadian rhythm will result in reduced duration of your deep sleep (stage three and REM sleep). Always maintain a consistent time to rise, even when circumstances prevent you from going to bed at your normal time. And, yes, that includes weekends. There is no point in going to bed two hours late on weekends and waking up two hours late the next day. There is no net gain. In fact, there is a net loss because it disrupts your intrinsic rhythm, the sole cause of reduced productivity on Monday mornings.
    Alcohol robs you of your deep sleep.
  4. Recognize that alcohol induces sleep, but is a poor quality sleep marked by frequent arousals, leading to lighter sleep at the expense of REM sleep.  Alcohol induces sleep but robs you of your deep sleep. Because of this, general recommendation in sleep medicine practice is to avoid consuming alcohol six hours before bedtime.
  5. Make every effort to quit smoking completely because it affects your sleep, too. Nicotine is a stimulant that would rob you of your deep sleep. But if you cannot quit, certainly avoid smoking within three hours of your bedtime.
  6. Avoid eating a heavy meal before bedtime because the process of digestion will interfere with falling asleep and may reduce the amount of deep sleep.
  7. Sweat for sound sleep.  Regularly exercising even for twenty minutes a day has been shown to improve your sleep architecture. Not only does it make you fall asleep quicker, it also increases the duration of deep sleep and thus makes your sleep immensely more restorative.
    Caffeine has a 24 hour duration of action. It robs you of your deep sleep.
  8. Stay away from caffeine, certainly after one o’clock. Caffeine has the duration of action of twenty-four hours, so a cup of coffee in the morning will still be lingering in your bloodstream when you are trying to go to sleep at ten o’clock. Some of my colleagues argue, “I can drink a cup of coffee and go right to bed and fall asleep.” The fact remains, though, that it is still going to rob you of your REM sleep, making your sleep non-restorative. Please taper caffeine off slowly over three to four weeks to avoid withdrawal symptoms. Switch to decaf coffee if you must drink it.
  9. Follow the 2-20 rule of napping. Do not nap after two o’clock, and do not nap for longer than twenty minutes. A ten to fifteen-minute power nap in the early afternoon can energize your day and give you two days in one. But even a brief ten-minute nap in the evening will deconsolidate your sleep at night.
  10. Develop a relaxing bedtime routine. Listen to the music. Read a nice book. Take a warm shower because the cooling off promotes sleep. Cookies and a glass of milk can help, too, because milk contains tryptophan, a naturally occurring sleep-promoting agent.
    Prayers lead to positive emotions, which get amplified during REM sleep.
  11. REM sleep is a powerful amplifier of emotions, especially negative ones like fear, anxiety, hatred, and anger. To use this amplifier to our advantage, we need to focus on positive emotions all day and then, at bedtime, purge our mind of whatever negative emotions it has collected all day. This is where even a short prayer comes in the picture. Matthew 18:23–26 says, “Have faith in God. I assure you: If anyone says to this mountain, ‘Be lifted up and thrown into the sea,’ and does not doubt in his heart, but believes that what he says will happen, it will be done for him.” Faith drives away fear. Also, do not carry a grudge to bed with you. Bedtime is not the time to review your anger against others who have hurt you in some way. Luke 6:27–29 says it best, “But I say to you who listen: Love your enemies, do good to those who hate you, bless those who curse you, pray for those who mistreat you. If anyone hits you on the cheek, offer the other also.” Forgiveness always brings peace, and there is no better sleep aid than a soul that is at peace. Forgive yourself; forgive others.

Ignore Sleep, Ignore Life.

Sleep Well, Lead Well.

Tired? Sleepy? Exhausted? Take a PREM Nap!


A fifteen minute PREM nap can rejuvenate your afternoons and evenings.

 

Technique of a Conventional Power Nap

Following tips will you help you rejuvenate your day with a 15 minute power nap.
• Proudly let your staff know that you will be taking a fifteen-minute nap. “Doctor’s orders,” you may add.
• Set your Smartphone alarm, preferably on vibrate, to go off in fifteen minutes. A study from Australia has shown that napping for less than ten minutes is suboptimal. More than twenty minutes can be counterproductive because of post-nap grogginess.
• Turn on relaxing music. You can try noise-canceling headphones. Bose are the best.
• Put on eye shades. I find my Notre Dame cap very useful, especially when taking a nap in the public place. I just pull it down over my eyes, and I am off to the land of dreams.
• Stretch on the couch or recline in the chair. Turn the chair away from people and toward the window or wall. A study from China showed greater benefit with stretching on the couch as opposed to sitting.
• Close your eyes, shut off your mind, and relax.
• Wake up with a smile and vigor when the alarm goes off.

A REM nap improves creative problem solving by a whopping 40 percent. A very interesting study done by Dr. Sara Mednik and her team at University of California, San Diego, looked at creative problem solving before and after a nap. Participants were given three words and asked to find a word that can link all of the three words, for example, sixteen, candy, and heart. The answer is sweet: sweet sixteen, sweet candy, and sweet heart. There was an amazing 40 percent improvement after a nap containing REM sleep.

Remember that REM sleep has an active brain in a paralyzed body. Mother Nature made it so we do not act out our dreams. Also, studies have shown that REM sleep has a tremendous amount of random, bizarre, and seemingly unrelated activity going on, which our brain is trying to connect together to make some sense of it. Some researchers believe this is why REM nap is able to boost creative problem solving by linking these random and totally unrelated activities together. This is the wildest and craziest form of thinking outside the box. Studies have shown that REM sleep plays a pivotal role in memory consolidation, too.

Can we do better than just lie down and relax for fifteen minutes? Can we modify our technique to make our nap more restorative, more recuperative, and more energizing? I think we can by adding just a few steps to our conventional nap. I should clarify that these recommendations are not based on any specific scientific studies, but my experience as a practicing sleep specialist and lifelong nap-taker.

Let us learn to take PREM (Patel’s Relaxed Eye Muscles) nap.

Read a couple of lines from the Bible, Gita or any other religious book before the nap. You can store them on your Smartphone and read them before setting up the fifteen-minute alarm. REM sleep, the sleep stage with vivid dreams, unfortunately, has predominantly negative emotions like fear, anxiety, guilt, and anger. Here, we are trying to replace them with joy, optimism, love, and faith. Matthew 18:23–26, says, “Have faith in God. I assure you: If anyone says to this mountain, ‘Be lifted up and thrown into the sea,’ and does not doubt in his heart, but believes that what he says will happen, it will be done for him. Luke 6:27–36 says, “But I say to you who listen: Love your enemies, do good to those who hate you, bless those who curse you, pray for those who mistreat you. If anyone hits you on the cheek, offer the other also.”

• Begin your nap with five to ten slow, deep, and regular breaths. Control of breathing is control of life. Breathing, unlike heart rate, blood pressure, temperature, and gastrointestinal motility/secretions, is the only vital function that we can easily control. And it is a time-tested tool used for centuries to achieve relaxation.

• Progressive muscle relaxation is incompatible with somatic anxiety. So, by focusing on respiration and relaxation, we are getting rid of anxiety, both from our conscious and our subconscious. As you breathe in and out, relax the muscles of your eyeballs and then continue to relax all the other muscles from head to toe and drift down into a state of pleasant relaxation. And when the alarm goes off, wake up with tremendous positive energy.

I call this my PREM nap! This revolutionary power nap taps into REM sleep’s restorative power and limitless creativity.

Please watch this seven minute instructional video and start regaining your afternoons and evenings.

Happy Napping!

Save Lives, Save Billions during Sleep Awareness Week and beyond


This week is National Sleep Awareness Week. Let us make a resolution to save lives and save billions through sound sleep.

Our public education campaign aimed at eliminating drowsy driving

Save Lives!

About thirty-eight thousand people die on American roads each year. That is four preventable deaths every hour, mostly of people in their prime. At least two of them are secondary to drowsy driving based on the National Highway Safety Administration.

Save Billions!

While the exact economic consequences of sleep deprivation in America are unknown, they are estimated to be at least $100 billion per year due to lost productivity, medical expenses, sick leave, and property and environmental damage. The staggering cost of sleep deprivation also includes such things as oil spills, plane crashes, and automobile accidents where the lack of sleep was a factor.

Insufficient Sleep and that too of Poor Quality!

According to National Sleep Foundation, almost a third of Americans are not getting enough sleep and twice as many people get poor quality sleep which compounds the problem. Please make a resolution this week to get 7-8 hours of sleep every night and stick to it.

Sleep does not differentiate us from animals, sleep hygiene does!

Sleep hygiene is your personal set of habits that together determine the quality of your sleep. Sleep hygiene helps you stay healthy by keeping your brain (most importantly, the executive center) and your body rested and strong. In order to get the most return on your investment in sleep, you will have to follow sleep hygiene fanatically.

The following tips will help you improve your return on investment in sleep:

1. Create a sanctuary for sleep. Make sure your bedroom is dark, cool, and quiet.

2. Reserved your bedroom for sex and sleep only.

3. Do not take Excel spreadsheets and PowerPoint presentations to bed. Keep Smartphone and laptop out of your bedroom.

4. Use the might of Mother Nature to your advantage. Going against Mother Nature by ignoring circadian rhythm will result in reduced duration of your deep sleep (stage three and REM sleep). Always maintain a consistent time to rise, even when circumstances prevent you from going to bed at your normal time. And, yes, that includes weekends. There is no point in going to bed two hours late on weekends and waking up two hours late the next day. There is no net gain. In fact, there is a net loss because it disrupts your intrinsic rhythm, the sole cause of reduced productivity on Monday mornings.

5. Recognize that alcohol induces sleep, but is a poor quality sleep marked by frequent arousals, leading to lighter sleep at the expense of REM sleep. Alcohol induces sleep but robs you of your deep sleep. Because of this, general recommendation in sleep medicine practice is to avoid consuming alcohol six hours before bedtime.

6. Make every effort to quit smoking completely because it affects your sleep, too. Nicotine is a stimulant that would rob you of your deep sleep. But if you cannot quit, certainly avoid smoking within three hours of your bedtime.

7. Avoid eating a heavy meal before bedtime because the process of digestion will interfere with falling asleep and may reduce the amount of deep sleep.

8. Sweat for sound sleep. Regularly exercising even for twenty minutes a day has been shown to improve your sleep architecture. Not only does it make you fall asleep quicker, it also increases the duration of deep sleep and thus makes your sleep immensely more restorative.

9. Stay away from caffeine, certainly after one o’clock. Caffeine has the duration of action of twenty-four hours, so a cup of coffee in the morning will still be lingering in your bloodstream when you are trying to go to sleep at ten o’clock. Some of my colleagues argue, “I can drink a cup of coffee and go right to bed and fall asleep.” The fact remains, though, that it is still going to rob you of your REM sleep, making your sleep non-restorative. Please taper caffeine off slowly over three to four weeks to avoid withdrawal symptoms. Switch to decaf coffee if you must drink it.

10. Follow the 2-20 rule of napping. Do not nap after two o’clock, and do not nap for longer than twenty minutes. A ten to fifteen-minute power nap in the early afternoon can energize your day and give you two days in one. But even a brief ten-minute nap in the evening will deconsolidate your sleep at night.

11. Develop a relaxing bedtime routine. Listen to the music. Read a nice book. Take a warm shower because the cooling off promotes sleep. Cookies and a glass of milk can help, too, because milk contains tryptophan, a naturally occurring sleep-promoting agent.

12. Pray on the pillow. REM sleep is a powerful amplifier of emotions, especially negative ones like fear, anxiety, hatred, and anger. To use this amplifier to our advantage, we need to focus on positive emotions all day and then, at bedtime, purge our mind of whatever negative emotions it has collected all day. This is where even a short prayer comes in the picture. Matthew 18:23–26 says, “Have faith in God. I assure you: If anyone says to this mountain, ‘Be lifted up and thrown into the sea,’ and does not doubt in his heart, but believes that what he says will happen, it will be done for him.” Faith drives away fear.

Do not carry a grudge to bed with you. Bedtime is not the time to review your anger against others who have hurt you in some way. Luke 6:27–29 says it best, “But I say to you who listen: Love your enemies, do good to those who hate you, bless those who curse you, pray for those who mistreat you. If anyone hits you on the cheek, offer the other also.” Forgiveness always brings peace, and there is no better sleep aid than a soul that is at peace. Forgive yourself; forgive others.

Alertness is Life. Drowsiness is Death.

Body at Work, Brain at Home?


What would you do if  your CFO came drunk to board meeting? Coming to work after only 4 hours of sleep is no different, may be even worse as the impairment is less obvious.  Abnormal sleepiness costs US corporations at least 100 billion dollars every year in lost productivity, medical expenses, sick leave, and property and environmental damage. The staggering cost of sleep deprivation also includes such things as oil spills, plane crashes, and automobile accidents where the lack of sleep was a factor. And they include less visible costs associated with mortality, morbidity, performance, other forms of accidents and injuries, quality of life, family well-being, and health care utilization.

Work place drowsiness is less obvious than this but equally disastrous.

How common is work place drowsiness? In 2008, the National Sleep Foundation surveyed a thousand employees, and there were startling and alarming results:

  • 36 percent admitted to having nodded off or fallen asleep while driving.
  • 29 percent said they had fallen asleep or become very sleepy at work.
  • 12 percent confessed to researchers that they had been late to work because of sleepiness.

What is the medical evidence? The prefrontal cortex, part of the frontal lobe, is the most active area of the brain in rested individuals. However, in sleep-deprived people, this part of the brain nearly shuts down. The majority of the deficits created because of this persist despite strong motivation. The prefrontal cortex governs executive function, which includes our ability to:

  • Make sound decisions
  • Predict the consequences of our actions
  • Remain goal-oriented
  • Conduct ourselves in a socially acceptable manner, that is, control our urges so as to avoid behavior that is unacceptable or even illegal
  • Plan, discriminate, make decisions, direct and sustain attention while ignoring distractions, and initiate goal-directed behavior
  • Have flexible and innovative thinking and decision making in response to novel and unexpected information and events
  • Integrate emotions and cognition to help resolve ethical dilemma

In general, sleep loss results in:

  • Lapsing, cognitive slowing, memory impairment, and reduced vigilance
  • Change in mood and motivation, failure to complete routines, slower responses, physical exertion, and bickering
  • Increased reaction time and decreased vigilance and attention
  • Impaired working memory, verbal fluency, logical reasoning, decision making, and judgment
  • Decrements in innovative, flexible thinking and strategic planning
  • Increased perseveration (trying failed solutions repeatedly) and lack of flexibility
  • Inability to focus on greater good and resultant indecisiveness when faced with an ethical dilemma
  • Inability to set ambitious goals
  • Diminished problem solving abilities
  • Severely diminished ability to manage information
  • Reactive instead of proactive response
  • Diminished verbal fluency and communication skills
  • Emotional agnosia (inability to recognize and manage emotions)
  • Impaired mood, cognition, and psychomotor vigilance (makes you grumpy, foggy, and clumsy)

Because of the effect of sleep deprivation on the prefrontal cortex, sleep-deprived leaders lack the speed and creative resources to make quick, logical decisions and implement them well. These same studies indicate that a sleep-deprived person lacks the ability to consider multiple tasks simultaneously, which reduces the speed and efficiency of one’s actions.

What can you do?
  • Lead by example. Guard your sleep with same tenacity you guard your bottom line as both are intricately tied together.
  • Promote 7-8 hours of sound sleep in your department, and in your company.
  • Maintain regular sleep-wake schedule even on weekends.
  • Get 30 minutes of exercise every day.
  • Avoid caffeine certainly after 1 PM.
  • Avoid alcohol within 3 hours of bedtime.
  • Keep bedroom cool, quiet, and dark.
  • Keep laptop, Smartphone, and work related material out of bedroom.
  • Pray before going to bed.
  • Request referral to a sleep physician if your colleague has excessive sleepiness.
Remember, suboptimal alertness leads to suboptimal leadership.
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