Tag tips

Tired in The Afternoon? 5 Tips from Your Sleep Doc | Yatin J. Patel

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

Workplace drowsiness is less apparent than this but equally disastrous.

Eliminate the MADness (Mid Afternoon Drowsiness)

The majority of mammalian species have a second sleep period during the daytime because of the mid-afternoon dip in alertness. This dip in the alertness in the middle of our working day causes a decline in our productivity and, more importantly, creates an environment conducive to disastrous mistakes. The following graph depicts the number of sleep-related accidents and their time of occurrence. Please note the steep increase in accidents between one o’clock and three o’clock.

The incidence of sleep-related vehicle accidents (n=606) by hour of day. BMJ 1995; 310: 565 Sleep-related vehicle accidents. JA Horne, professor, LA Reyner, research associate, Sleep Research Laboratory, Department of Human Sciences, Loughborough University, Leicestershire LE11 3TU.

Why does this occur? Well, our internal pacemaker, Suprachiasmatic nucleus located at the base of the brain makes us sleepy in the mid-afternoon. Fighting this tiny structure will take discipline and persistence, but this can improve your executive output by thirty percent and can eliminate disastrous decision making.

First, you have to recognize this decline in alertness and in productivity. Look for it and you shall find complacency and chaos, disastrous decision-making, and combustible communication post-lunch. Keep these tips in mind to help you get through the mid-afternoon madness:

  1. Keep moving. Pace the floor. If you are in a meeting, flex and extend your ankles. Take a trip to the restroom.
  2. Look at the light. Sit facing the sun. Minimize power point use if giving a presentation. Turn the slides off and turn the lights on every ten minutes.
  3. Eat a light lunch. If you avoid carbohydrates, you will not feel sluggish at the next afternoon meeting. Your head will be able to think clearly and handle crucial decision making duties.
  4. Use caffeine judiciously. It can improve your alertness but can rob you of your deep sleep at night as it has duration of action of 24 hours.
  5. Take a fifteen-minute power nap. It will go a long way in improving your performance as a leader. Studies have shown that a fifteen-minute power nap can improve alertness, decision-making, creativity, communication, perception, situational awareness, and problem-solving for 150 minutes.

If you follow these tips, you can maximize alertness even in the afternoon.

What has your experience been? Have you noticed sluggishness, errors, omissions, complacency, and chaos around mid-afternoon? What tips do you follow to overcome mid-afternoon madness? How did you overcome the cultural stigma associated with napping?

Happy Leading!

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!

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

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