Tag sleep. doctor

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.

Curing Excitement Insomnia during ICC World Cup

Don’t let the victory keep you up at night!

For my friends suffering from excitement insomnia during ICC World Cup, here are a few helpful tips for this Thursday and Friday night.

  • Avoid caffeine as it will make your insomnia worse.
  • Get 30 minutes of exercise as it will improve your deep sleep.
  • Assign ten o’clock at night to six o’clock in the morning as sacred time, reserved for resting and recharging instead of worrying about India’s performance.
  • Get rid of all your work-related (in this case, cricket-related) material from your bedroom.
  • Continue your relaxing bedtime ritual: shower, relaxing reading, cookies and milk, and meditation, per your preference.
  • Read your favorite lines from the Gita or any other religious book to calm your nerves.Therefore, O Sachin, surrendering all your works unto Me, with mind intent on Me, and without desire for gain and free from egoism and lethargy, fight. -Chapter 3-40
  • Perform Mindful Meditation especially if you can not relax. You can learn about it here.

  • Do not worry. India is going to win. Relax. Turn off the lights and go to sleep.

Sweet dreams!

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!

Seven tips for Joe Biden on how not to fall asleep in public

Staying maximally alert despite insufficient sleep will take practice, patience, perseverance, and faith.

Joe Biden joined the ranks of President Bill Clinton, Hillary Clinton, Sen. John McCain, and others who were caught napping at the wrong time and wrong place.  How can we prevent this from happening again? Well, the surest and most natural cure for abnormal sleepiness is sleep, but what do you do when you cannot get sufficient sleep because of hectic schedule and unavoidable demands? Going against the might of Mother Nature, you can summon the help of these seven friends.

Seven Friends and a Foe

  1. physical exertion
  2. PREM nap
  3. light
  4. caffeine
  5. smart snacking
  6. massage
  7. faith (my all-time favorite)

And beware of a formidable foe in alcohol when faced with insufficient sleep and long days. Let us discuss them one by one.

Exertion Enhances Alertness

Regular exercise improves REM sleep and hence alertness and the executive function. Here we discuss the role of physical activity in improving alertness when sleep deprived.

Learn How to Deskercise

On average, executives spend seven and a half hours per day sitting in meetings, sitting at their desks, sitting in an automobile, or sitting in boardrooms. Our bodies do not like staying still for long periods. That much sitting causes tension to build. Muscles become tight, and joints become stiff. Alertness starts declining the longer you stay still.

One way to prevent these otherwise inevitable results of physical inactivity is to “deskercise” every hour. Deskercising will help you to reduce muscle tension and stress while helping you preserve the flexibility, strength, and muscle tone you already have. The following are some simple deskercising techniques to try:

The Wrist Muscle Stretch

Most executives spend a good deal of time in front of computer screens. Computers have become essential tools in the management of business. However, with this increased use of computers, executives are becoming more susceptible to carpal tunnel syndrome, an ailment that used to be the exclusive domain of secretaries and other office workers who used typewriters and word processors most of the working day. Carpel tunnel is a painful wrist difficulty produced by repetitive motion.

When working at the computer, stop occasionally and deskercize using the wrist muscle stretch. Not only will this give you a well-deserved break, it will go a long way in preventing carpel tunnel. Slowly stretch your wrist muscles by using a full range of motion. Joints that have become sore and stiff because of repetitive motion activity will respond to slow stretches. Don’t risk pulling a muscle by attempting the stretch rapidly. Get the full benefit of the stretch by doing it slowly.

The Pectoral Stretch

The following is an easy stretch you can do at your desk. Simply clasp your hands behind you head, and slowly move your shoulders and elbows back. Repeat this a few times. It is a great way to stretch your pectoral and chest muscles.

Wrist Flexion

Using your left palm, gently apply force to the right hand, causing the right wrist to stretch toward the underside of the right arm. Hold it there for five seconds and then release and repeat on the left hand. Repeat the exercise five times.

Wrist Hyperextension

Using the left palm, slowly apply force to bend the right hand backward. Hold it there for five seconds and then release and repeat to the left hand. Repeat the exercise five times.

Sitting Bend

In a sitting position, with your feet flat on the floor, your knees about ten inches apart, and hands at your sides, bend over as far comfortable with your hands reaching toward the floor. Hold the position for five seconds and then slowly pull yourself back into a sitting position while tightening your abdominal muscles. Repeat four times. This exercise stretches your lower back muscles and hamstrings.

Vertical Stretches

Vertical stretches provide an excellent way to reduce tension and activate all of your major muscle groups. With your feet shoulder-width apart, lift yourself upward on your toes and extend your arms over your head. Reach each hand as high as possible for about seven seconds and then relax. Repeat four times.

Get Up and Walk Around

Sitting too long can have several negative effects. It puts stress on the lower back and can lead to muscle atrophy and diminished flexibility. It’s important to get up and walk around at least once each hour. A ten-minute walk around the office would be excellent. But, when that’s not possible, shorter walks to the water cooler, filing cabinet, or restroom are better than nothing.

Even when you’re involved in meetings, seminars, or workshops, get up at least once every twenty minutes and move around. You’ll feel better, you’ll be healthier, and you’ll sleep better.

  • A PREM (Patel’s REM) nap can improve alertness for three hours. Studies have shown that a fifteen-minute nap can improve alertness and last for almost three hours. 
  • Massage especially when combined with a PREM nap can improve alertness because it relieves muscle aches, back pain, headaches, burning in the eyes, and other distracting physical symptoms precipitated by sleep deprivation. Untreated, these symptoms can drag your energy level and your alertness down.
  • Caffeine has alerting property, but it has the duration of action of twenty-four hours, so a cup of coffee consumed at one o’clock is still in your bloodstream at midnight when your brain is trying to get into REM sleep. Because of this reason, caffeine should not be used indiscriminately. It should be used as a medicine, at the right dosage, at the right time, and for the right reason. The surest indication for caffeine is driving when sleep deprived. This can be lifesaving.
  • Bright light has tremendous alerting influence. Use this to your advantage. Sit facing the window. During long meetings in the boardroom, look up at light often. Especially on cloudy days, put a bright light lamp behind your desktop while working on it. Every fifteen minutes, turn off the PowerPoint presentation and turn on the lights.
  • Small protein snacks every two to three hours will maintain your energy and alertness while eating a large starchy meal will degrade your alertness. Grilled fish or chicken is fine. Avoid rice, pasta, and dessert.
  • Spiritual support has helped me the most during my post-call days in the clinic. Going from one exam room to next, I would look up and ask for divine help. “Give me energy, my Lord, to serve my patients well.”
  • Even the legal limit of alcohol will impair your leadership when sleep deprived. Avoid even a small glass of wine or a beer when sleep deprived. Resist that temptation.

LAMP will improve your alertness and hence your life significantly. It will help you avoid disastrous decisions too.

Here is the summary of what we just discussed.

Leader’s Alertness Maximization Plan (LAMP)

  • Keep moving.
  • Face the light.
  • Take a PREM nap.
  • Get a relaxing massage.
  • Snack smartly.
  • Consume caffeine judiciously.
  • Seek spiritual support.
  • Avoid alcohol.

This blog post is dedicated to my good friend Mahesh Patel MD who has devoted his life to saving premature babies in Bismarck, ND, and millions like him who have spent nights after nights serving others. God Bless You All.

Adopted from the book “Sleep Well, Lead Well” now available on Amazon Kindle and at http://sleepwellleadwell.com

Ten Commandments for the Sleep Deprived Leader

Breath, Relax, Smile, Walk, Pray, Sleep

1.       Thou shall never make important decision while sleep deprived. Our creativity, adaptability, goal setting, and problem solving are adversely affected because of  insufficient sleep.

2.       Thou shall always speak slowly, softly, and clearly. Verbal fluency is adversely affected when we are sleepy. We tend to eat our words, rush our sentences, and confuse our colleagues. Take it easy. Slow down. Speak clearly.

3.       Thou shall not get upset when the whole world does not yield to you. Sleep-deprived people have this odd way of thinking. They truly believe that the sun rises and sets at their whim. They truly believe that employees will jump through hoops and bend over backwards, and they are quick to get angry when that does not happen. See what a lack of sleep can do to you?

4.       Thou shall stretch your body, gently massage your eyes, and take a timely power nap. If you find yourself falling asleep at your desk, take action. Stand up, stretch your body, and gently massage your eyes for a few seconds. Then sit back down in your chair, and take a quick nap. You will be surprised what only a few minutes can do for your body.

5.       Thou shall strive for excellence in everything you do. When sleep deprived, we have a  natural tendency to just finish the work and head home without thinking about the quality of our work. So remember, in order to become an effective leader, you must strive for excellence and lead well even when you are sleep deprived.

6.       Thou shall be nice to yourself, and reward yourself for excellent work. When sleep deprived, we have a tendency to be critical of ourselves. Fight that tendency and congratulate yourself for excelling despite sleep deprivation. Reward yourself with a glass of wine or a relaxing massage at the end of the day.


7.       Though shall postpone appropriate work for a well-rested you later on. A great leader will not try to make decisions when too sleepy to think clearly. Presidents, heads of corporations, nonprofit executives, and others all have a history of saying, “Let me sleep on this.” And guess what? It does work!

8.       Thou shall look for humor, smile often, and even laugh out loud, especially when things get worse. If things are getting out of control and not working out the way you need them to, start looking at the brighter side. Smile, and try to enjoy the moment.

9.       Thou shall always walk away from a complex problem, an argument, or a tough adversary. If you are too sleepy and find yourself in the middle of a complex problem that needs your immediate attention, find a way to walk away. There is no shame in saying that you need more time to make a crucial decision. A good leader knows the importance of walking away.

10.    Thou shall never eat a heavy meal when sleep-deprived. Have you ever been sleep deprived and then decided to eat a very heavy meal? Remember the outcome? It made your ability to make a sensible decision even worse, and, at the same time, it was damaging to your health. So, if you find yourself sleep deprived, instead of heading to the kitchen for a bite to eat, head to the nap room for some much-needed rest.

Happy Leading

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