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Your Valentine Wants You to Get Treated for Sleep Apnea!


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She has been telling you for months to get your sleep apnea diagnosed and treated, but you have been putting it off. You have argued, “I don’t snore. I am not tired. It is just stress. I have been working too much.”

But, you have been dozing off in the recliner. You are cranky, nervous, and irritable. You are inattentive to her needs. Your sex drive is down. Your problem-solving skills, innovative ability, interpersonal skills, and your energy level are down. It is about time you listened to her and got treated. That would be the true Valentine’s day gift that will keep on giving for the rest of your life.

Sleep apnea, a serious and fatal yet severely under diagnosed disorder affects approximately 20 percent of the adult population. Snoring, daytime fatigue, witnessed apnea (cessation of respiration for more than ten seconds), morning headaches, dry throat, and waking up gasping for air are common features of this disorder, which is being increasingly recognized as a formidable enemy of a full and joyous life. It prevents the person from reaching deep and restorative stages of sleep, making the person grumpy, irritable, nervous, forgetful, inattentive, and tired.

It also increases your risk of stroke, heart attack, and early death because of nightly struggle to breathe, which causes frequent elevation of blood pressure and sustained drop in blood oxygen level while simultaneously increasing the oxygen consumption of the heart muscles. Untreated, the sleep apnea increases the risk of motor vehicular and industrial accidents. It can also contribute to erectile difficulties.

Use the STOP questionnaire to determine your risk for obstructive sleep apnea.

  • S … Do you snore loudly?
  • T … Do you often feel tired, fatigued, or sleepy during the daytime?
  • O … Has anyone observed you stop breathing during sleep?
  • P … Do you have or are you being treated for high blood pressure?

If you answer yes to two or more of these questions, then you are at high risk for obstructive sleep apnea, and you should talk to your doctor.

To make an accurate diagnosis, you may need an overnight sleep study in a sleep lab where your respirations, the oxygen level, heart rate, EKG, leg movements, and sleep stages will be monitored all night long without using needles. Now, there is also a convenient and economical alternative in Apnea Link, a home sleet test. Talk to your doctor about it.

The commonest and most successful treatment includes wearing a mask hooked to a machine, continuous positive airway pressure (CPAP), which acts as a pneumatic splint and prevents your throat from collapsing at night. Weight reduction, oral appliance (a customized denture that keeps your lower jaw pulled forward), and ENT surgery are the other options.

It is extremely rewarding to be treated for sleep apnea. Patients tell me:

  • “Doc, I did not know how sleepy I was until I started wearing CPAP.”
  • “A hazy screen has been lifted off from my eyes.”
  • “I thought it was all stress and aging, but now I feel young again.”
  • “I am thinking clearer. I am planning better. I am getting more done at work and home.”
  • “I have so much energy that I don’t know what to do with it.”
  • “My blood pressure is better; my sugars are better controlled.”
  • “I should have done this a long time ago.”

Listen to your Valentine and please talk to your doctor and get treated. It will give you a new life.

If you need additional information, please visit http://www.md4lungs.com. If you are in Michiana, please call our clinic at 574-534-9911.

Happy Valentine’s Day!

10 Tips to Prevent a Road Death This Weekend


A Fourth of July fireworks display at the Wash...

A Fourth of July fireworks display at the Washington Monument. (Photo credit: Wikipedia)

Busiest Driving Day of the Year

According to the American Automobile Association, this Independence Day holiday period, from July 2nd  to July 5th, approximately 45 million Americans will travel 50 miles or more from home.

Deadliest Day of the Year

Stay Alert. Stay Focused.

Historically speaking, one of the worst days for traffic fatalities is July 4. An analysis by the Insurance Institute for Highway Safety has found that July 4 has been the deadliest day on the road in recent years. The institute looked at accident statistics from 2004 to 2008 and found that on average, 148 people died in motor vehicle crashes on July 4, more than on any other day.

English: An advisory sign on Interstate 15 in ...

An advisory sign on Interstate 15 in Utah near Mt. Nebo. (Photo credit: Wikipedia)

Drowsiness, Drunk Driving, & Distractions Kill

Here are my 10 tips to prevent a death this weekend. Please share these tips freely and it might just save an innocent life. 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. Do not drive if you have untreated sleep apnea, insomnia, restless legs, shift work sleep disorder, or narcolepsy.
  9. If your thoughts become dreamy, your eyelids feel heavy, or traffic signs do not mean much pull over. You are about to die!
  10. Keep your eyes on the road and away from the iPhone.
  11. Do not drive drunk.

Watch my interview with Gary Sieber discussing drowsy driving tips.

How Does Drowsy Driving Kill?

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,

Spread the Word. Save a Life. Please share this blog with your friends and family on Facebook, Twitter, and other social media. God bless you.

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.

Love Coffee? 8 Tips from Your Sleep Doc!


Caffeine has a 24 hour duration of action. It robs you of your deep sleep.

I was seeing a middle-aged patient, husband of my kids’ elementary school teacher,  in the clinic for snoring,  daytime fatigue, and tiredness. He already had a sleep study done which was negative for sleep apnea but did show increased arousal index ( number of times brain waves show wakefulness activity lasting for 5-10 secs.) Increased arousal index can be seen with arthritis, sedentary life,  fibromyalgia, alcohol usage, and leg movements of sleep. I went over sleep hygiene instructions, reassured him that he did not have sleep apnea, and as I was leaving the exam room asked him what he did for fun. “I grind coffee beans,” he replied with a wide smile on his face! His fatigue and tiredness disappeared soon after he eliminated bedtime coffee and switched to decaf coffee in the morning!

Here are a few more tips from your sleep doc:

1. Avoid caffeine after 1 PM.

2. Smell, sip, and  enjoy decaf coffee same way you enjoy a glass of good wine.

3. If you are a morning person, you do not need coffee in the morning. Go with a glass of orange juice.

4. If you are not a morning person, enjoy a nice cup of coffee in the morning to kick start your day. My personal favorite though is “bed to bike” routine. Jump on the stationary bike as soon as the alarm goes off. Do not let your mind talk you out of it. You can read on the bike, watch news, or check emails (you can get a very nice laptop stand which can work with bike or even with your treadmill. I bought one from http://www.airdesks.com and I love it.)

5. The surest indication for a strong cup of coffee is drowsy driving. Coffee here can be life saving. Go ahead. Enjoy it. You have my full support. Power nap can also provide similar benefit without robbing you of your deep sleep (REM sleep and stage 3 NREM sleep.)

6. Never drink just to drink. You will not take medication just to take medication. Caffeine is no different. It has to be taken for a reason; to maximize alertness while driving or attending an important meeting.

7. After dinner coffee is suicidal for sleep. I feel like getting up and yelling a loud NO when the waiter offers coffee after the dinner.  Please help me stop that life-robbing tradition.

8. Avoid caffeine before and during menstruation as it worsens both the PMS and also the insomnia associated with menstruation.
What is your routine? How do you feel about decaf coffee? Does after-dinner coffee disrupt your sleep?
 
This is post is dedicated to my daughter Priyata (a Starbucks’ enthusiast) and my medical assistant Barb Reinhardt and other caffeine lovers around the world in the hope that they will consume caffeine judiciously and selectively.

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!

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