A new study published in the journal Sleep reveals that people with insomnia are more likely to develop depression later in life. The traditional thinking is that insomnia is a symptom of depression, but the authors argue that insomnia may come before depression.
My take on this is: "So what,this is old news". However, if you were to look at insomnia from a sleep-breathing paradigm which I describe in my forthcoming book, Sleep, Interrupted the issue becomes a lot more complex and all that more meaningful.
In the book I propose that both insomnia and depression are manifestations of interrupted breathing while sleeping that deprives you of deep, restful, restorative sleep. This process begins in early childhood, and is affected by multiple factors, including anatomic issues, diet, infections or stressful situations.
The beauty of my sleep-breathing paradigm is that it doesn't contradict what's out there in insomnia knowledge and research. Instead, it suggests a revolutionary approach on thinking about medical concepts that we take for granted. For the most part, it even agrees with and supports the evidence in insomnia research. My theory is that it's not important which comes first (insomnia or depression), but that both can coexist together. If this is so, what can cause both to occur?
This is another example of the peculiarities of medical research when you try to isolate and correlate one variable against another. Yes, you'll get some interesting results, but more often than not, you'll end up asking more questions as a result, or end up with multiple conflicting results. Once you look at humans as a complex interaction of innumerable processes, by looking at the "big picture," things just make more sense. This is one of my overriding themes in my book.
Showing posts with label sleep. Show all posts
Showing posts with label sleep. Show all posts
Friday, April 18, 2008
Saturday, February 16, 2008
Sleep Better With Duct Tape
I happened to go into my son Devin's room, to check on something after he went to bed. To my surprise, a very bright neon-blue light emanated from beneath his bed, like those cars from the 80s. It lit up his entire room and I wondered how he could sleep with the room so brightly lit.
When I looked underneath his bed, I realized that I had recently placed a powerstrip to connect his aqaurium next to his bed. The blue LED light on the powerstrip was so powerful that it lit up the entire room. I quickly got some black electrical tape and placed it over the light, and the room was dark again. (Duct tape would have worked as well.)
I've noticed over the years that with more efficient LED lights on electronic appliances, our bedrooms can be lit up to the point of preventing a good night's sleep. In our bedroom, I taped off our air purifier (5 different places), our wireless phone (which was really bright), our humidifier, and had to turn upside-down our two cell phones as well. Not only are individual LEDs much more powerful than a standard night light, a typical bedroom can have 3-5 bright lights, which can prevent someone from falling asleep. Even my new alarm clock is MUCH brighter than my old one.
There's been much written about how the invention of the light bulb really disturbed our sleep patterns in this century, and the proliferation of more and more powerful LEDs are definitely taking it up another notch. Lack of light is what signals our brains to produce signals to initiate sleep. Besides all the other distractions that prevent us from getting proper sleep (such as televisions, cell phones, internet, etc.), we don't need more lights.
So take a few minutes and survey your bedroom, as well as your children's bedroom. Make sure you give your eyes a few minutes to adjust to the darkness. Then cover anything that emits light with a small piece of black electrical tape or duct tape.
Another option, of course, is to tape your eyes. But you could get an eye mask instead.
Saturday, February 2, 2008
The New York Deli Phenomenon
One of my biggest pet peeves is whenever I order a deli sandwich, the deli guy sometimes forgets one or more of my requested ingredients. For example, if I order a roast beef on a roll with lettuce, tomato, mayo, mustard, onions and sweet peppers, the last few ingredients are typically left out. Usually, it's the ingredients listed at the end, never the first few items. Ever since I noticed this, I watch the sandwich maker like a hawk. I hate it when they have to turn their backs to me to make a sandwich, since I can't see what they're doing. Every time I let my guard down, I always regret it.
You may be asking by now what this has to do with sleep and breathing and medicine in general. Unfortunately, too much.
When it comes to medical diagnoses, many physicians are guilty of the same phenomenon. For example, when I had to learn about obstructive sleep apnea in medical school, I had to memorize a long list of signs and symptoms. Usually, they're listed in order of importance. By the time you get to the 39th or 40th sign and symptom, your brain can't memorize any more. Most multiple test exams in medical school test you on the more common signs or symptoms, and rarely an unusual one. So by default, we tend to memorize the items higher on the list.
But this is where the problem starts. For example, going back to the obstructive sleep apnea example, the most frequent findings that are mentioned in textbooks or in a lecture are: older, obese, snoring, male, and big neck. Since these were the features first described in obstructive sleep apnea, no wonder. But if you read further down the list or look at published studies on this condition, you'll find dozens or even hundreds more common and uncommon features that no one has time to list out when asked about this condition. So lecture after lecture, I've seen the same description about obstructive sleep apnea: typically seen in older, snoring, obese men, and untreated, can lead to diabetes, high blood pressure, heart disease, heart attacks and strokes. It still continues to this day, even with numerous studies showing that obstructive sleep apnea can occur even in young thin women that don't snore. Of course, in a young thin woman complaining about sinus infections or fatigue, sleep-breathing problems are near the bottom of the list.
Despite the facts that doctors know about obstructive sleep apnea in the typical patients, they forget about the second part: the link with heart disease, heart attack and stroke. It's shocking to me how many people I see that have suffered from heart attacks or strokes that are found to have significant obstructive sleep apnea when eventually tested. The same can be said about sinusitis, throat infections, ear infections, etc. Too often, ear pain alone with no obvious infection is treated with antibiotics.
It's obvious that a human being is not a deli sandwich. To label a person with "sinusitis" is like saying, remember to add nasal congestion, yellow pus, fever, facial pain, poor sleep, ear fullness, or post-nasal drip. The problem is that this list gets whittled down to yellow pus and facial pain. Or that obstructive sleep apnea patients snore and are overweight, Yes, the majority of people with these symptoms will have the respective conditions, but you're missing out on many other patients that only have poor sleep or ear fullness for sinusitis and post-nasal drip for obstructive sleep apnea.
So if you have post-nasal drip, and are treated for allergies, no wonder the medication didn't work. Without getting a full and complete medical history and thorough physical exam, it's hard to get a complete picture of what's going on. In this age of managed care and rushed doctor's visits, it's no wonder that we end up treating the symptoms only and almost never the true cause of the illness, leading to missed diagnoses and incorrect treatment regimens.
Unfortunately, the New York Deli phenomenon will continue, with doctors making diagnoses and prescribing treatment based on incomplete pictures. Just as an incomplete sandwich just doesn't taste right, an incomplete history and examination can lead to an unsatisfying outcome.
You may be asking by now what this has to do with sleep and breathing and medicine in general. Unfortunately, too much.
When it comes to medical diagnoses, many physicians are guilty of the same phenomenon. For example, when I had to learn about obstructive sleep apnea in medical school, I had to memorize a long list of signs and symptoms. Usually, they're listed in order of importance. By the time you get to the 39th or 40th sign and symptom, your brain can't memorize any more. Most multiple test exams in medical school test you on the more common signs or symptoms, and rarely an unusual one. So by default, we tend to memorize the items higher on the list.
But this is where the problem starts. For example, going back to the obstructive sleep apnea example, the most frequent findings that are mentioned in textbooks or in a lecture are: older, obese, snoring, male, and big neck. Since these were the features first described in obstructive sleep apnea, no wonder. But if you read further down the list or look at published studies on this condition, you'll find dozens or even hundreds more common and uncommon features that no one has time to list out when asked about this condition. So lecture after lecture, I've seen the same description about obstructive sleep apnea: typically seen in older, snoring, obese men, and untreated, can lead to diabetes, high blood pressure, heart disease, heart attacks and strokes. It still continues to this day, even with numerous studies showing that obstructive sleep apnea can occur even in young thin women that don't snore. Of course, in a young thin woman complaining about sinus infections or fatigue, sleep-breathing problems are near the bottom of the list.
Despite the facts that doctors know about obstructive sleep apnea in the typical patients, they forget about the second part: the link with heart disease, heart attack and stroke. It's shocking to me how many people I see that have suffered from heart attacks or strokes that are found to have significant obstructive sleep apnea when eventually tested. The same can be said about sinusitis, throat infections, ear infections, etc. Too often, ear pain alone with no obvious infection is treated with antibiotics.
It's obvious that a human being is not a deli sandwich. To label a person with "sinusitis" is like saying, remember to add nasal congestion, yellow pus, fever, facial pain, poor sleep, ear fullness, or post-nasal drip. The problem is that this list gets whittled down to yellow pus and facial pain. Or that obstructive sleep apnea patients snore and are overweight, Yes, the majority of people with these symptoms will have the respective conditions, but you're missing out on many other patients that only have poor sleep or ear fullness for sinusitis and post-nasal drip for obstructive sleep apnea.
So if you have post-nasal drip, and are treated for allergies, no wonder the medication didn't work. Without getting a full and complete medical history and thorough physical exam, it's hard to get a complete picture of what's going on. In this age of managed care and rushed doctor's visits, it's no wonder that we end up treating the symptoms only and almost never the true cause of the illness, leading to missed diagnoses and incorrect treatment regimens.
Unfortunately, the New York Deli phenomenon will continue, with doctors making diagnoses and prescribing treatment based on incomplete pictures. Just as an incomplete sandwich just doesn't taste right, an incomplete history and examination can lead to an unsatisfying outcome.
Thursday, January 24, 2008
My First Post
I just got back from the annual Integrative Healthcare Symposium, and I thought what I learned would be a good subject for the inaugural entry in my blog. As you may or may not be aware, my passion is to help people live more fulfilling lives by allowing them to breathe better while sleeping. This is why I wrote my forthcoming book, Sleep, Interrupted. It’s about a new way of looking at health and disease in general from a sleep-breathing perspective—based on the premise that all humans are susceptible to breathing problems while sleeping, to various degrees.
During the one-year process of writing this book, I’ve traveled a great journey. What I discovered is that to treat isolated conditions such as sinusitis or middle ear infections, you must treat the whole person, including their overall medical status, diet, lifestyle, stresses, and emotional state of mind. Going to the Integrative Healthcare Symposium only solidified my suspicions that you must treat the entire person first, before treating a symptom or medical condition.
In a sense, this journey has been a healing process for me as well, as I’ve learned to take the time to re-examine the way I value my own health, my relationships with others, and my goals and priorities in life. I have to admit that when I first started writing my book, I was somewhat overwhelmed with the added time commitments, financial burdens, and strains on my relationships with my family and friends. Slowly but unexpectedly, as I researched and read through the material needed for my book, I saw a small but significant change in myself for the better. I seem to be less stressed or worried, I’m eating healthier, I’m running competitively again for the first time in 20 years, and my relationship with my wife and children has improved. All this from simply writing a book. Most of it was through great guidance and coaching from my book authoring mentoring program. Through goals-setting exercises, time blocking, and transformational mind-shifts, I found that I had more time to accomplish more activities more effectively.
The symposium was truly eye-opening. In contrast to the typical medical conferences that I usually attend, there was so much more hope, excitement, and enthusiasm than I’m used to seeing. There was much less statistical analysis and academic pontification, and much more practical and empowering information that I could implement immediately in my practice. For the first time ever after a meeting or conference, I was excited about what I learned and was confident about making significant positive changes in the fundamental way that I practice medicine: not focusing on better medicines or surgical techniques, but to focus on significantly improving doctor-patient relationships, and improving the overall health and wellness of the patient as a human-being, not just a person with sinusitis.
I have to admit that the very first keynote talk that I heard was very nerve-racking. One example had to do with known toxins and carcinogens that are required to be applied in all mattresses in the US as a flame retardant due to fires from unextinguished cigarettes, but was never rescinded even after self-extinguishing cigarettes came out. This material was banned in Europe, and is still found in certain mattresses, even infant crib mattresses. Another example is the effect of environmental toxins that mimic estrogens that are causing an epidemic of early puberty, with one study citing 27% of African-American girls in the US developing pubic hair and breasts by age 7, and 48% by age 8, and in White girls, the numbers were 6% and 14%, respectively. The shocking number was that 3% of African-Americans and 1% of White girls had pubic hair and/or breast development by age 3. Obviously, I was somewhat paranoid by the end of this talk.
I then got into the meat of the sessions, with a number of great lectures on nutrition and the concept of nutrigenomics, which is the ability of foods to modify to various degrees the amount of our innate gene expression. After these talks, I was pretty convinced that our country’s SAD diet (Standard American Diet) is a major part of what’s making us one of the sickest countries in the developed world.
I could go on and on about the other talks, but I do want to mention some of the vendors that I came across in the exhibition area. I’m normally not into vitamins and nutritional supplements, but I happened to come across a new type of grain called Salba which had some wild claims: ounce per ounce, Salba had 8x more omega-3s than salmon, 15x more magnesium than broccoli, 3x more iron than spinach, 1.1x more fiber than bran, 3x more antioxidants than blueberries, and 6x more calcium than whole milk. The reps claimed that it was the choice of the ancient Aztec runners for energy and stamina. With these incredible claims, and having just signed up for the Bronx ½ marathon in 4 weeks, I ordered a one month supply to test it out. Stay tuned for my results.
I also underwent acupuncture for the first time. I got 5 needles in each ear for stress reduction and relaxation. I have to admit, after the first few minutes of mild irritation, I was soooooo relaxed, I lost total track of time. My arms and legs were so heavy, and I felt like I was in a trance in the middle of a very busy and noisy convention floor. Despite that fact that acupuncture’s theories are completely different from that of Western medicine, it’s been shown in multiple studies that the needles affect your nervous system, realigning the imbalances in your body. So if you have too much of the stress response (sympathetic nervous system), then acupuncture can lower this part and raise the relaxation portion (parasympathetic) of your nervous system.
Not surprisingly, many western physicians are somewhat skeptical of the validity of many of these complementary and alternative medicine (CAM) methods. Our model or definition of the usefulness of any intervention has to be shown in a large randomized, double-blinded, placebo-controlled, prospective studies that shows statistical significance. So if you have enough numbers to show that the “drug” is 10% better than a placebo with statistical significance, then it can get FDA approval.
One of the major criticisms of CAM medical models is that there are no convincing large-scale studies proving that they work. Although there are a number of smaller often conflicting studies out there, there are no “landmark” studies that are convincing enough for the traditional allopathic community.
However, people in the CAM fields would argue that that’s not the point. Statistics and studies are important, but what’s more important is to look at the person as a whole, not just a number in a large-scale study. They would argue that if you used CAM’s definition of “success”, Western medications and interventions would fail miserably for certain chronic conditions such as heart disease, diabetes, cancer or obesity. Yes, for acute conditions such as certain bacterial infections or major trauma, Western medicine is great. CAM practitioners define wellness very differently from Western practitioners. A Western doctor thinks you’re well if she cured your sinus infection with an antibiotic. A CAM practitioner thinks you’re well, once your entire mind, body and spirit are in balance, and that what predisposed you to getting the bacterial infection is addressed, as well as how your body responds to infections is optimized, with minimal to no side effects. Unfortunately, in Western medicine, complications and side effects are more the rule than the exception.
Don’t get me wrong—I’m not crossing over completely into CAM. What I’ve found over the course of the last year writing my book is that all the journal reading, conference attending and test ordering has not made significant improvements in my practice. What has made a big difference is when I got to know the patient by taking time to really know the patient en toto, as a whole person, that’s when great things started to happen. I still believe firmly in the original goals of Western medicine; it’s just that we’ve lost our focus and clarity in light of the obstacles and hurdles that we doctors have to face dealing with administrative hassles and overwhelming paperwork. But that’s no excuse.
During the one-year process of writing this book, I’ve traveled a great journey. What I discovered is that to treat isolated conditions such as sinusitis or middle ear infections, you must treat the whole person, including their overall medical status, diet, lifestyle, stresses, and emotional state of mind. Going to the Integrative Healthcare Symposium only solidified my suspicions that you must treat the entire person first, before treating a symptom or medical condition.
In a sense, this journey has been a healing process for me as well, as I’ve learned to take the time to re-examine the way I value my own health, my relationships with others, and my goals and priorities in life. I have to admit that when I first started writing my book, I was somewhat overwhelmed with the added time commitments, financial burdens, and strains on my relationships with my family and friends. Slowly but unexpectedly, as I researched and read through the material needed for my book, I saw a small but significant change in myself for the better. I seem to be less stressed or worried, I’m eating healthier, I’m running competitively again for the first time in 20 years, and my relationship with my wife and children has improved. All this from simply writing a book. Most of it was through great guidance and coaching from my book authoring mentoring program. Through goals-setting exercises, time blocking, and transformational mind-shifts, I found that I had more time to accomplish more activities more effectively.
The symposium was truly eye-opening. In contrast to the typical medical conferences that I usually attend, there was so much more hope, excitement, and enthusiasm than I’m used to seeing. There was much less statistical analysis and academic pontification, and much more practical and empowering information that I could implement immediately in my practice. For the first time ever after a meeting or conference, I was excited about what I learned and was confident about making significant positive changes in the fundamental way that I practice medicine: not focusing on better medicines or surgical techniques, but to focus on significantly improving doctor-patient relationships, and improving the overall health and wellness of the patient as a human-being, not just a person with sinusitis.
I have to admit that the very first keynote talk that I heard was very nerve-racking. One example had to do with known toxins and carcinogens that are required to be applied in all mattresses in the US as a flame retardant due to fires from unextinguished cigarettes, but was never rescinded even after self-extinguishing cigarettes came out. This material was banned in Europe, and is still found in certain mattresses, even infant crib mattresses. Another example is the effect of environmental toxins that mimic estrogens that are causing an epidemic of early puberty, with one study citing 27% of African-American girls in the US developing pubic hair and breasts by age 7, and 48% by age 8, and in White girls, the numbers were 6% and 14%, respectively. The shocking number was that 3% of African-Americans and 1% of White girls had pubic hair and/or breast development by age 3. Obviously, I was somewhat paranoid by the end of this talk.
I then got into the meat of the sessions, with a number of great lectures on nutrition and the concept of nutrigenomics, which is the ability of foods to modify to various degrees the amount of our innate gene expression. After these talks, I was pretty convinced that our country’s SAD diet (Standard American Diet) is a major part of what’s making us one of the sickest countries in the developed world.
I could go on and on about the other talks, but I do want to mention some of the vendors that I came across in the exhibition area. I’m normally not into vitamins and nutritional supplements, but I happened to come across a new type of grain called Salba which had some wild claims: ounce per ounce, Salba had 8x more omega-3s than salmon, 15x more magnesium than broccoli, 3x more iron than spinach, 1.1x more fiber than bran, 3x more antioxidants than blueberries, and 6x more calcium than whole milk. The reps claimed that it was the choice of the ancient Aztec runners for energy and stamina. With these incredible claims, and having just signed up for the Bronx ½ marathon in 4 weeks, I ordered a one month supply to test it out. Stay tuned for my results.
I also underwent acupuncture for the first time. I got 5 needles in each ear for stress reduction and relaxation. I have to admit, after the first few minutes of mild irritation, I was soooooo relaxed, I lost total track of time. My arms and legs were so heavy, and I felt like I was in a trance in the middle of a very busy and noisy convention floor. Despite that fact that acupuncture’s theories are completely different from that of Western medicine, it’s been shown in multiple studies that the needles affect your nervous system, realigning the imbalances in your body. So if you have too much of the stress response (sympathetic nervous system), then acupuncture can lower this part and raise the relaxation portion (parasympathetic) of your nervous system.
Not surprisingly, many western physicians are somewhat skeptical of the validity of many of these complementary and alternative medicine (CAM) methods. Our model or definition of the usefulness of any intervention has to be shown in a large randomized, double-blinded, placebo-controlled, prospective studies that shows statistical significance. So if you have enough numbers to show that the “drug” is 10% better than a placebo with statistical significance, then it can get FDA approval.
One of the major criticisms of CAM medical models is that there are no convincing large-scale studies proving that they work. Although there are a number of smaller often conflicting studies out there, there are no “landmark” studies that are convincing enough for the traditional allopathic community.
However, people in the CAM fields would argue that that’s not the point. Statistics and studies are important, but what’s more important is to look at the person as a whole, not just a number in a large-scale study. They would argue that if you used CAM’s definition of “success”, Western medications and interventions would fail miserably for certain chronic conditions such as heart disease, diabetes, cancer or obesity. Yes, for acute conditions such as certain bacterial infections or major trauma, Western medicine is great. CAM practitioners define wellness very differently from Western practitioners. A Western doctor thinks you’re well if she cured your sinus infection with an antibiotic. A CAM practitioner thinks you’re well, once your entire mind, body and spirit are in balance, and that what predisposed you to getting the bacterial infection is addressed, as well as how your body responds to infections is optimized, with minimal to no side effects. Unfortunately, in Western medicine, complications and side effects are more the rule than the exception.
Don’t get me wrong—I’m not crossing over completely into CAM. What I’ve found over the course of the last year writing my book is that all the journal reading, conference attending and test ordering has not made significant improvements in my practice. What has made a big difference is when I got to know the patient by taking time to really know the patient en toto, as a whole person, that’s when great things started to happen. I still believe firmly in the original goals of Western medicine; it’s just that we’ve lost our focus and clarity in light of the obstacles and hurdles that we doctors have to face dealing with administrative hassles and overwhelming paperwork. But that’s no excuse.
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