Tag life

Are You Awake? I Don’t Think So!

Photo Credit -Alex Bramwell

Photo Credit -Alex Bramwell

Several years ago, a patient surprised me, and the staff, “Doc, this is the first time I came to your clinic. I wasn’t here last week.” He, in fact, was seen at the clinic the prior week (he had filled out all the necessary paperwork, and had a progress note to prove his visit) and was sent to the sleep center for a sleep study! But, he was so sleep-deprived that he was living in a truncated level of wakefulness that he did not remember to coming to the clinic at all. For people like this, a quote shared by another patient comes true, “It feels like when I went to bed I was 18, and when I woke up I was 81!”

If you take care of your sleep, only then you can reach the highest wakefulness, a state full of lasting energy, enthusiasm, vigor, and vitality. At that highest level of wakefulness, you can squeeze out one magical moment after another from this greatest gift called life. If not, then your whole life will feel like a fleeting moment.

Here is how you can get started.

  1. Make sure your bedroom is dark, cool, and quiet.
  2. Reserve your bedroom for sleep and sex only. Keep work-related items out of the bedroom.
  3. 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.
  4. Avoid consuming alcohol three hours before bedtime.
  5. 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.
  6. Sweat for sound sleep.  
  7. Stay away from caffeine, certainly after one o’clock. 
  8. Do not nap after two o’clock, and do not nap for longer than twenty minutes.
  9. Develop a relaxing bedtime routine. Listen to the music. Read a nice book. Take a warm shower because the cooling off promotes sleep.
  10. Pray on the pillow. 

If you follow these tips consistently and religiously, only then you can be at the highest level of wakefulness and only then you can proclaim, “I am awake.”

So, Are you awake yet?

Enjoy Multiple Lives in Each Moment

On a beautiful Summer evening, Lord Vishnu mischievously asks his friend, ” Hey Narad, Can you go through the city with this pot filled with ghee (liquid purified butter) without spilling a single drop?” Naradji, in a light mood himself, picks up the pot, very carefully goes down the steps of the palace, and very cautiously finishes the tour of the city and proudly puts the pot on the table in front of the Lord.

“What did you see in the city, Narad? Were the kids playing? Was there a fragrance in the air? Did you hear the music near the park?” Lord asked. “Are you kidding me?” Naradji retorted in disbelief, “All my attention was fixated on the ghee, my Lord.”

In life, we too are preoccupied with irrational anxieties that we end up wasting our precious moments. What can we do about this? How can we change this? Answer is simple. Learn Mindfulness; be fully present in this moment, do not worry about the future, do not lament the past. Just be totally immersed in the present moment!


We need to experience each moment with openness, honesty, and with curiosity. We need to be pleasantly aware of our physical sensations, our emotions, and our intellect. We need to be fully aware of the feelings of others without any expectation, bias or prejudgement. We need to explore nature with curiosity and openness. In short, we need to be fully present in each moment. We need to find these lives buried in each moment. If we practice mindfulness, we will find a multitude of lives in each moment. If we do not, our whole life will feel like a fleeting moment.

“When I went to bed, I was 18. When I woke up, I was 81!” One of my patients recently shared this with me. Let us make sure this does not happen to us. Let us make a habit of being fully present in each moment. Let us cherish every moment.

Lack of Sleep Promotes Cheating! 5 Tips for Ethical Behavior.

People who cheated in an experiment had slept an average of 22.39 minutes less the night before than non-cheaters, according to research led by Christopher M. Barnes of Virginia Tech. The study, in which cheaters over-reported their scores on a test in order to gain financial advantage, shows that low levels of sleep are associated with unethical behavior. Managers who demand results that require employees to stay up late and miss sleep may be increasing the likelihood that workers will fudge results and engage in other forms of cheating, the researchers suggest.

– From Harvard Business Review June 24, 2011

We all have experienced this. We have been working on this project for a while. The presentation is tomorrow. We feel that our case can be more compelling if we bend the truth a little. We convince ourselves saying that this is in the best interest of the company. What can one do to prevent such unethical behavior? Here are a few tips.

1. Promote sound sleep of sufficient duration in yourself and in your colleagues. Use these Twelve tips for Sound Sleep routinely.

2. Be cognizant of the untoward effect of insufficient sleep on ethical behavior and try to resist that temptation to bend the truth. Use LAMP (Leader’s Alertness Maximization Plan) to maximize alertness even when sleep deprived.

3. A prior study did show that leaders who were high on Emotional Intelligence were able to counteract this effect partially. Work on your Emotional Intelligence (intrapersonal management, interpersonal management, motivation, and social skills.)

4.   Use these 4 tips, and cure procrastination. It is the procrastination that makes you stay up at night prior to the big meeting and then bend the truth, fudge the numbers, or distort the reality in the name of greater good. Avoid it. Worship truth and you will be amazed.

5. And lastly, my all-time favorite, develop a deep and unshakable faith in the Almighty that the truth shall always prevail.

Sleep Well, Lead Well

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.

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.
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