Rx: Sleep

This year is quite hectic for me. Besides the load at work and other responsibilities, I also have to renew 2 of my 3 board certifications. That means I have to study and pass my board exams to keep my certifications.

The governing bodies of Medicine wants all the practicing physicians to be updated and competent in their field of expertise. After all the discipline of science and medicine is ever evolving and what may be true some years ago, may not be applicable today. That’s why doctors have to take regular scheduled exams to maintain their qualifications.

Most of the medical specialties need re-certifications every 7 to 10 years. But now, they are introducing an option of taking the test every 2 or 3 years. More frequent test, oh fun!

The first exam I had to re-certify for this year is for my Pulmonary boards. I am relieved to say that it is past and done. I took my re-certification exam last May, and for 4 months before the boards, I devoted at least 30 minutes a day for review. It must have been worth the efforts for I’m proud to say that I passed it. I’m good for another few years on this sub-specialty.

The next exam to tackle is this coming November. It is for my Sleep Medicine boards.

I took a break in studying the month of June. But this July I’m back to the books again. I’m allotting half an hour (or more) every day for study.

Come to think of it, this might eat up some of my time for training for the annual half-marathon that I do in October. Should I just skip the half-marathon this year? Though I think I should still do my regular 2 to 3-mile run to keep me from getting too flabby.

Should I take a break from blogging too? Nah! Blogging is actually my relaxation.

I was on 24-hour duty the other day, and it was a busy call. It was not until 2 o’clock in the morning that I went to bed in our hospital call room, only to be called several more times during the remainder of the night, or should I say early morning. One particular ICU patient that I admitted around midnight was so sick, that he died 6 hours later despite our best efforts to keep him alive.

By the way, my other sub-specialty is Critical Care (ICU Medicine) and my Critical Care boards re-certification is due next year. That means I will be studying again for next year. Who said you’re done taking test after you graduate from school?

Anyway, I was off the next day after my 24-hour call. I decided to do some “light” reading to prepare for my Sleep Boards. My brain may be half-awake, but I was resolute to stick to my schedule. But do you know that according to research, dolphins can have half of their brain asleep while the other half awake? Maybe I was trying to be a dolphin.

It so happened that when I opened my reviewer, the chapter I was about to read was about sleep deprivation and its ill effects on our health. Wasn’t it so ironic? I was studying about the bad effects of sleep deprivation, and I myself was sleep deprived!

I stopped reading. I put down the book and did the best thing. I went to sleep.

(*photo from the web)

How Much Is a Good Night Sleep?

How much are you willing to pay for a good night sleep? A hundred dollars? Few hundreds? A thousand dollars?

Few nights ago, I was “rudely” awakened by a phone call. It was a weekend night, and it was 2 o’clock in the morning. And I was not even on-call!

The call was from our answering service, telling me that they cannot get hold of my partner who was supposed to be on-call. They also tried some other partners, but no luck. So they called me. Lucky me, I answered.

So even I was not on-call, I took care of what needed to be done. The trouble was the calls never stopped. I ended up admitting a total of 5 patients into the ICU in a short span of the unholy hours of the morning and I answered calls in 3 different hospitals the rest of the time I should be snoozing.

What happened to the one on-call? There was a snowstorm that night, and at that time, I was also concern if something happened to him. Anyway, I would not divulge any further details on that here, except that he was not abducted by the aliens.

You might say, I should have turned off my phone, which I was tempted to do. But people lives were on the line, as these patients were critically ill, and needed somebody to care for them. So I just suck it up.

That night, if only I could find somebody else to take the call, I was willing to pay more than a hundred dollars, so I could go back to sleep even for just a couple of hours more.

Ensuring a good night sleep is a big business. People are willing to shell out even several hundreds of dollars for a good mattress or bed. Come to think that you will spend a third of your lifetime in bed, why not get a good one. People also spend billions of dollars yearly for sleep medications. Yes, that’s billion with a B!

The cost of bad sleep is staggering too. In a study published in Time not too long ago, it was estimated that the productivity lost from workers in the US who are sleep deprived is about 63 billion a year. Again that is billion with a B!

One group of people who can suffer from sleep deprivation are people who travel a lot for work. From the changing time zones and dealing with jet lag, to the fatigue of travel alone, and to sleeping in different places or beds other than their home, all contribute to this. I’m sure they are more than willing to pay top dollars to travel business class or book in a decent hotel just to secure a good night rest. That’s a multibillion-dollar business too.


sleeping in the city that never sleeps

Last time I went home to the Philippines, I was on-call on the weekend before the day that I flew back to Manila. Knowing that I would be working for 3 days and 2 nights straight that weekend, and come Monday, I would be embarking on an almost 24 hours travel (total of 17 hours of flight time on 3 plane rides, and 6 hours of layover in airports), I just could not imagine my body taking the toll of that travel, after being on-call. So I was willing to pay a little more for a better night/day sleep on the airplane. The few inches of space and the few degrees of recline was worth it.

People with untreated sleep disorders and people who are chronically sleep deprived would do anything to get a better sleep. I know they do, for I deal with them everyday. They are like zombies in The Walking Dead. So getting a good night rest for them is something to die for. Sorry, pun intended.

If you are always not getting enough rest at night, over time you will pay for it dearly. For you pay it with your health. Poor health that is.

Ironically, doctors who should be giving advice on how to have a good night sleep, are among the most sleep deprived people in the world, according to a national survey. That may include me. A sleep-starved sleep specialist?

“Physician, heal thyself!” Or in my case, please just let me sleep.


PS. I’m keeping my dream alive. So I’m going back to sleep.

(*photo: most expensive condo in New York city, from askmen.com)

Busting the Sleep Myths

As a society, we are 24/7 and driven by productivity. With the night time being the new frontier, our culture just doesn’t want to go to sleep.

According to the documentary “Sleepless in America,” a collaboration by National Geographic, National Institute of Health and The Public Good Projects, 40% of American adults are sleep-deprived, and the average American sleeps less than 7 hours per night.

As a sleep specialist, I was interviewed by our city’s newspaper* last week, regarding sleep issues and pervading myths about them. Here are what we discussed.

Myth #1: Chronic sleep deprivation won’t dramatically harm health.

Fact: Not getting your ZZZZZs can cause obesity, Alzheimer’s disease, mental illness and depression, diabetes, cardiovascular disease, and possibly even cancer, studies show.

When we don’t get enough sleep, our body releases a hormone that makes us feel hungry or not satisfied, so we’re likely to eat more. When this happens day after day it can lead to obesity.

Lack of sleep can cause insulin-resistance leading to diabetes. It can also impairs memory and many of the mental illness known includes sleep problems.

Myth #2: A nap disrupts sleep at night.

Fact: Short naps lasting 15 to 30 minutes are good for you.

Our normal circadian rhythm causes a dip (in energy) every afternoon sometime between noon and 3:00. A short nap, research shows, can improve functionality.

However, naps lasting more than 30 minutes produce a deeper level of sleep. Those are more difficult to awaken from, can leave you feeling groggy, and definitely make it harder to get to sleep at night.

nap at work

Myth #3: You have more important things to do than sleep.

Fact: In the 19th century people slept nine or 10 hours a night. Now we average just six or seven hours a night. Of course they don’t have television and internet in those days. Now we have developed this thinking that sleeping is a waste of time when that’s not true.

Adequate sleep benefits your mental sharpness and mood. It provides the energy that allows you to accomplish more during the day.

Myth #4: Some people do fine with less than 7 hours of sleep.

Fact: Most sleep experts agree that nearly everyone needs between seven and nine hours of sleep per night.

Some people may function well with fewer than 7 hours of sleep, but that’s not the norm. That said, studies indicate nearly 30 percent of Americans sleep less than six hours. That can increase risk of early death up to 12 percent.

If you fall asleep within five minutes after your head hits the pillow every single time, that may be a sign that you are sleep deprived. So unless you are a Giraffe, which only sleeps an average of 2 hours a day, you better get more hours of sleep.

Myth #5: You can catch up on sleep on weekends.

Fact: When you sleep deprive yourself, your sleep debt increases each day. You need to pay it back within the next day or so, not delay to the weekend.

The problem with “banking sleep” until the weekend is that sleeping in usually causes you to be awake later that night. Come Monday morning, you’re apt to start the week already sleep deprived, and the vicious cycle continues.

Myth #6: Driving when tired is okay as long as you drink plenty of caffeine.

Fact: Fatigue is the No. 1 cause of high-severity car crashes.

Although caffeine can help fight fatigue, it takes at least 30 minutes before it takes effect. If you’re awake for 17 or 18 hours straight, your reflexes are so slow it’s as if your blood alcohol level were .05 percent. You’re as good as drunk.

sleep pals

Myth #7: Teens don’t need to sleep in like they do.

Fact: Staying up late and then wanting to sleep in is really not teenagers’ fault entirely. Their physical-mental-behavioral “clocks” ― called circadian rhythms ― are to blame.

Teens’ circadian rhythms are delayed a bit, which is known as Delayed Sleep Phase Syndrome. They don’t usually feel sleepy until midnight or later, but then they don’t want to get up in the morning. That’s not a problem until they need to follow society’s schedule for school or work.

According to “Sleepless in America,” teens who sleep more hours do better in school and has less rate of developing depression.

To help teens achieve wakefulness in the morning (which helps them fall asleep earlier at night), more exposure to sunlight or light therapy can be recommended. This helps reset their circadian rhythm to be more alert earlier in the day.

Myth #8: Shift workers adjust to their work schedules.

Fact: No one really gets used to shift work. Humans are diurnal creatures, meaning they are wired to be active in the daytime. Except Batman maybe.

But in our round-the-clock society, someone has to work the graveyard shift. For those who do, these tactics will help improve the quality and duration of sleep:

  • When going home from work in the morning, try to avoid light, which stimulates wakefulness. Put dark sunglasses on.
  • When sleeping during the day, make sure the bedroom is cool and dark. Turn off your phone. Minimize all the things that can disrupt sleep.
  • When working at night, make sure you’re exposed to light and that your work area is well lit.
  • If you’re sleepy when working, using your break for a quick nap can really help.

Myth #9: You just have to live with your current sleep habits.

Fact: Many people have had poor-quality sleep for so long they believe nothing can ever change it. Not true.

Poor sleep habits can be very hard to break, but they can be broken. It starts with educating ourselves on how important good sleep is, and how it will benefit us in the long run.

So there you go folks, unless you are a Christmas elf, you should not ditch sleep tonight.

sleeping hippo

(*photos taken from the web)

(**post note: above interview was published in The Des Moines Register on January 11, 2015)

Wonders of Sleep

One boring and sleepy afternoon, while I was reviewing and interpreting sleep studies, which are 6 to 8 hour-long tracings and video of a patient’s sleep data, a reflective thought came upon me. I came a long long way from the boy who got intrigued with the mystery of sleep. I never imagine at that time that I will earn a living by watching people sleep. I can also claim that I interpret people’s sleep info, though not necessarily their dreams.

I love sleep. I don’t mean that I love to sleep (though that may be true sometimes), but the science of sleep. Long before I became a sleep specialist, I was always fascinated with the phenomenon of sleep. I admit though that as a little boy I hate taking naps, and I would often sneak out of my room during afternoons when my mother told me to do so.

When I was in grade school, I clipped and collected Johnny Wonder’s strips about scientific facts of sleep from a newspaper cartoon section. So long before the rock band REM became popular during my college days, I already knew what REM means, that is rapid eye movement, which is a stage of sleep, and is probably the most intriguing phase of our sleep.

In highschool, I wondered if people can hear and learn things while they are sleeping. So I did an experiment. I recorded myself reading my world history book. Then I played back the tape while I was sleeping, and determine how much facts I will retain for our test the next day. The result? I passed the test! Maybe it was the reading that helped me remember the facts and not necessarily that I learned something while I was sleeping. However a recent study from Israel showed that people can really learn new information while they are sleeping.

new way of learning?

The phenomenon of sleep is not something to snore about, for it is really an interesting science. Here are some amazing facts about sleep.

1. A human can last longer without food, than without sleep. Because at some point after several hours or days of continued wakefulness or sleep deprivation, a person will involuntarily fall asleep even how much he fights it. The record for longest period without sleep is 18 days, 21 hours, and 40 minutes during a rocking chair marathon. But a human can survive more than a month without food, though with water.

2. All mammals sleep. All birds, many reptiles, amphibians, and fish too. Humans sleep on average around three hours less than other primates like chimps, rhesus monkeys, and baboons, all of whom sleep for 10 hours. A giraffe sleeps an average of less than 2 hours per day. (And they still grow so tall!) Though some people try to be giraffes! Adult humans need 7-9 hours of sleep a day to function properly. Newborns needs up to 18 hours, while toddlers and school children require 10 hours and more.

3. Anything less than 5 minutes to fall asleep at night means that you are sleep deprived. The normal sleep latency is between 10 and 15 minutes. So if you’re falling asleep the moment you hit the pillow or faster than you can recite the alphabet, that is a telltale sign that something is amiss. Other signs of sleep deprivation includes  decreased performance, alertness, and memory and cognitive impairment.

4. During the REM phase of sleep, is when we dream dreams that we can vividly recall. Dreams though can also occur in non-REM phase of sleep. REM sleep occurs in bursts totalling about 2 hours a night, usually beginning about 90 minutes after falling asleep. It is thought that REM consolidates certain memories. It is also believed to help developing brain mature. Premature babies can have 75% REM phase, while a normal adult has an average of 20-25 % REM phase of his total sleep time. Life will be dull if you’re deprived of REM, because you won’t have much dreams! Unfortunately most of the sleeping pills used can actually suppress REM phase of sleep.

5. It is impossible to tell if someone is really awake without close supervision. People can take cat naps with their eyes open without even being aware of it. We use electroencephalogram (EEG) to determine if a person have fallen asleep and to determine the stage of their sleep, when we perform sleep studies. Some students are good example of this, sitting in a lecture hall with eyes wide open but are really sleeping. Especially after they stay up late partying the night before. But then again some people really go through life fast asleep, figuratively speaking.

Have a goodnight, sleep tight, and pleasant dreams to you.

(*photo from here)

(**some facts are taken from National Sleep Research Project)

Good Night, Sleep Tight

(The following article was written for our local church newsletter.)

“Indeed, He who watches over Israel will neither slumber nor sleep.” Psalms 121:4

That statement of the psalmist pertains to God. However, humans in this modern age also try not to sleep nor slumber. With our 24-hour-a-day schedule, and with a society that makes the night the frontier of the next day, people deprived themselves of sleep. And that is not good for our health.

God created men to work, to play, AND to sleep. Though some creatures only require less hours of sleep, like the giraffe who sleeps less than 2 hours a day. But for an adult human, we need an average of 7-8 hours of sleep to stay healthy and to function properly. (Babies and kids need more.) Even though we still not fully understand the science behind it, we know that sleep is needed to regenerate certain parts of our body, especially our brain. Somehow sleep resets our brain to work optimally.

Sleep deprivation has become one of the most prevalent public health problems of our time. It is estimated that in our modern culture we sleep an hour and a half less than people did a century ago. Of course, they don’t have televisions that have programs like “Late, Late Night Show” or computers and internet that is basically 24/7, a century ago.

Rx for sleep deprivation is more sleep, not more coffee.

Our society’s lack of sleep is evident on many mishaps that we had. The 3-Mile Island, space shuttle Challenger and Exxon Valdez accidents were partly blamed on human errors caused by operators who were sleep deprived. The American Academy of Sleep Medicine reports that 1 out of 5 serious injuries from traffic accidents is related to a tired and sleepy driver.

When we lack sleep, it impairs our cognitive function, judgement, reflexes and reaction time. In studies, people who were awake for 17-19 hours and drove, they performed as bad as people who were drunk with an alcohol level of 0.5 percent. That means if you are awake since 6 AM and driving at past midnight, you are as good as drunk! Now what if you even had a real drink too? That will be really bad.

Some people who are always tired and sleepy may have real sleep disorders, like sleep apnea, restless leg syndrome or narcolepsy. They need to see their doctors or better yet referred to a sleep clinic. But many of us who are sleep deprived, are because of our own choosing not to sleep.

If you cannot sleep because of many worries and anxiety, which is by the way the most common cause of insomnia, then maybe you can find comfort in this text: “I will both lay me down in peace, and sleep: for thou, Lord, only makest me dwell in safety.” Psalms 4:8.

Good night. Sleep tight.