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)

Sleep(less) in Boston

It is my third time to visit Boston. This time I came to Boston to catch up on sleep.

No, I’m not saying that Boston is a sleeper city, for it is an exciting place to visit. Nor am I’m saying that it is a place most conducive for sleeping. In fact since we stayed in a hotel in the heart of the city, it was quite noisy, with all the cars honking and with loud police and ambulance sirens wailing. Added to that, we landed past midnight in Boston, contributing to my sleepy predicament.

Why I came to Boston is to attend a conference to catch up with the current studies, trends and technology in the practice of Sleep Medicine. Honestly I nap a little in some of the lectures, so I literally catch up on my sleep too!


theme poster of the convention

The science behind sleep has fascinated me since I was in high school, so it’s not a surprise that one of the subspecialty I pursued was on this field.

One of the fascinating sleep phenomenon that I wanted to learn more of are the Parasomias, which includes nightmares, night terrors, sleep walking, and more that goes bump in the night.

One Parasomnia is REM Behavior Disorder (RBD), in which people with this disorder reenact their dreams. Normally when we are in REM (Rapid Eye Movement) stage, a sleep stage when dreams usually occur, our muscles are disengaged and we are temporarily paralyzed, so we don’t move and act out our dreams. In people with RBD, for some reasons the muscles are not paralyzed, so they can kick, swing a punch, crawl out of bed, or even perform a complex activity while sleeping. Not only this put the patient in danger, but also the sleep partner.

One interesting fact I heard from one lecturer is that soursop which is a tropical fruit, or also known as guyabano in my home country, the Philippines, can potentially increase the incidence of RBD. I can almost read a headline news: sleeping wife punch husband, after drinking guyabano punch.


opening session

Besides the medical implications, there’s also societal implications of people having poor sleep. These are also topics discussed during the convention.

Research have shown that birds can sleep, as half of their brain can go to sleep, while on long flights. But not humans. We need all our faculties when we are doing complex task like flying a plane. Though aviator Charles Lindbergh, the first man to cross the Atlantic on solo flight was awake for more than 34 hours when he accomplished that feat, nowadays we have instituted regulations for pilots limiting their hours of flying and assuring they have a sufficient amount of sleep in between flight.

Same principle applies with operating any machinery or driving any motorized vehicle. Studies have shown that a significant number of vehicular accidents are due to driver fatigue and sleepiness. For instance a sleepy driver can have a slower reaction time. A decrease of even 50 milliseconds in reaction time in hitting the brakes means 5 feet more before coming to a stop, and that can mean safely stopping or crashing, or escaping an accident or dying.

For the medical community, especially the ones who are undergoing residency training, there’s now an imposed 16 hour limit for a first year resident for continuous work. Beyond that they should be relieved, for they need to go to sleep. During my residency training in the mid 90’s, the limit for continuous hospital duty was 30 hours. This regulations though are not enforced to doctors after they are done with their training.

We as a community really need to change our opinions. Staying awake all night to study or pulling an all-nighter to finish the job has become a badge of honor. We view sleep as only for slackers. When we should view that those people who get adequate sleep, that is 7-8 hours a night, should be the ones commended. So no more sleepless in Seattle, or Boston, or New York, or Tokyo, or any part of the world for that matter.

Just like when you’re hungry, the solution is to eat. For people who are sleepy the solution is not more coffee or energy drink, but getting adequate amount of sleep. Of course if you have a sleep disorder and not getting a restful sleep then you need to see your doctor.

Sleep is important in so many levels. Not only for health but also for safety and being more productive. In addition, dreams come when we sleep, and life without dreams would be uninspiring.

From Boston,


Boston Common (central public park in downtown Boston)



(*photos taken with an iPhone)

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)

Debunking Folks’ Medical Advice: Part 4

It’s been a while since I posted regarding folk’s medical advice. However I have noticed in my blog stats that these topics get consistent hits on a daily basis. So here’s another one for the series.

1. Huwag hawakan ang paru-paru, baka ka mabulag.

Don’t touch a butterfly, it can cause blindness.

I was told this advice when I was a child. Perhaps you have heard this too. But it is not true.

Butterflies belong to a family of insects called Lepidoptera, which means scale wings. The “powder” that you get in your fingers, which the old folks say can cause blindness, when you touch the butterfly wings, are tiny scales. These scales though very important to the butterfly, does not cause blindness.

If so much of these tiny scales are removed from the butterfly wings, just like when you heavily rub them off, will form holes in their wings and they will lose their ability to fly.

So you can hurt them, but they don’t hurt you. Perhaps the old and wiser folks just don’t want us kids to hold the butterfly so not to injure them.

The only “butterflies” I know that can cause blindness are the ones dancing in beer gardens, especially under the dazzling flickering lights and after rounds of beer.


2. Huwag kumain ng maanghang na pagkain, baka ka magkaalmuranas.

Don’t eat spicy food, for you will develop hemorrhoids.

Filipino foods are not particularly spicy. Except for the Bicol region perhaps. Unlike other cultures, like Indian or Indonesian cuisines, even their baby food can make a grown man sweat.

I heard many times before though, that spicy foods can cause bothersome hemorrhoids. If this is true, then all true blue Bicolanos will be suffering from this, and Bicolandia will be the center of hemorrhoids country. But that’s not the case.

I think this advice associate the fiery sensation in our lips and tongue will somehow cause also a fiery sensation in our bottom. Simply, not true.

There are several scientific and medical studies that have looked into this perceived relationship, and no study have conclusively proven this.

In one particular study done by Italian researchers, they have 50 patients with severe symptomatic hemorrhoids randomly take a capsule containing red-hot chili powder or a placebo pill, and then they crossover after a week. The results showed no statistically significant worsening in their symptoms. So they concluded that red-hot chili pepper does not worsen hemorrhoids.

So go ahead, enjoy your jalapeños and your siling labuyo. It will zing your mouth, not your bottom.

3. Huwag pagalaw ang kanser, ito ay lalo lang kakalat.

Don’t disturb the cancer, it will spread.

Meaning, don’t have a tumor biopsied or do surgery on it, for it will get worse. Bawal mahanginan, baka magalit (Don’t expose it to air, it will grow angrier).

This notion is deeply seated in the people’s mind. But there’s no medical truth on this.

Perhaps we Filipinos get this conception, when in Jose Rizal’s 19th century novel Noli Me Tangere (Touch Me Not – in Latin), he addressed the ills of the society as “social cancer.” Don’t dare touch it, for the situation just gets worse.


(image taken from the net)

With 21st century’s scientific knowledge and technology, the fact of the matter is doing biopsy on a tumor is the only way we can ascertain that it is cancer or not. And there are several kinds of cancer, that the preferred treatment is surgical excision. And sometimes if it is too big to take it all out, debulking the tumor can help. Only if the cancer is far too advanced that any form of treatment may be futile.

I’m sure if you have cancer, and Jose Rizal who is a physician himself, is alive today, he will advise you, Ego Tangeret (I touch you).

4. Huwag matulog ng sobrang busog, baka ikaw ay mabangungut.

Don’t sleep when you’re so full, you’ll have nightmares.

There’s currently a lot of medical evidences that eating a full meal so close to bedtime may disrupt your sleep. Digestion can increase your metabolic rate and body temperature, as well as release of certain hormones, that can throw off the internal stimulus of inducing sleep. Thus many medical experts advice that your dinner be two hours or more, before your bedtime. Though it is still uncertain whether sleeping on a full stomach can directly cause nightmares.

The more enigmatic topic though is bangungut as a specific entity that cause sudden death at night. It is not an urban legend but rather a real medical condition also known as Sudden Unexplained Nocturnal Death Syndrome (SUNDS).

SUNDS has been reported worldwide, though it is more common among Southeast Asian males. It is termed bangungut in Philippines, lai tai in Thailand, and pokkuri in Japan.

In recent years SUNDS is thought to be related to Brugada syndrome, a genetic disorder wherein there’s inherent faulty electrical conduction in the heart that can lead to fatal cardiac arrhythmia. This usually occurs when they are sleeping or resting, in these apparently healthy young males. It has been suggested that a high carbohydrate meal may precipitate sudden cardiac death in these predisposed individuals, as the release of insulin drive their potassium down causing the arrhythmia.

So I would say there is some wisdom to this old folks’ advice. And you thought they were all non-sense?

But then again you probably thought as well, that bangungut was caused by a kiss of an evil spirit.


kiss of death statue (image taken from the net)


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)

Sleep Session

I am currently attending an almost week-long international physicians’ convention in a city I have never been before. Doctors are required to garner certain amount of hours of continuing medical education (CME) to maintain their certification. Besides, I try to stay updated with the most current practice of Medicine (aside from being updated with blogging!), to stay competitive and relevant.

Of course the real reason for going to these conferences is that it gives me and my family a reason to travel. This year, it brought us to the “city of brotherly love,” Philadelphia. (I’ll write about Philadelphia in another post.)


Liberty Bell

Attending these conferences may make me feel smart, but with all these very intelligent speakers who come from the most prestigious academic centers around the world and who are on the top of their game, sometimes makes me feel otherwise. In other words, it makes me feel down-right ignoramus. When they start mentioning these current studies or researches that I have never heard before, and talking high-falutin technological terms that sounds Greek (and the speaker was not even from Greece) to me, I often wonder, am I the only one who is not getting this?

I often times look around the room to see the consensus response, and most attendees seems to be nodding their heads, indicating that they understand what the speaker is saying. Or maybe they are just nodding to fake it off (some doctors will not admit that they don’t know). Or maybe they are nodding, because they are sleepy.

On the first day of the meeting, I enrolled in an 8-hour long course on the technological advances in Sleep Medicine. Sleep Medicine is one of my subspecialties by default. With the prevalence of sleep apnea, which is arguably the most common sleep disorder seen, thus the management of sleep diseases falls on the lap of lung specialists.


Lobby of Philadelphia Convention Center

I was still weary from the travel and was still trying to adapt to the time difference (Philadelphia time is an hour advance than Des Moines), when the seminar started early in the morning. I don’t envy those attendees from other countries who have to battle greater jet lag. It was kind of ironic that here we were, attending a sleep seminar and we ourselves were sleep deprived.

By the way, habitual sleep deprivation due to poor lifestyle choices, is the most common cause of daytime sleepiness in our current society, more than any sleep disorder, including sleep apnea.

I was able to stay awake for the first speaker who spoke for about an hour. By the second speaker, I was really fighting doziness and was just trying to keep my eyes open, even though my brain was already half asleep.  It did not help that the subject the presenter was discussing was difficult with a lot of technical jargon.

As the lecture continued, I cannot contend any longer. The spirit was willing but the flesh was weak. So I did the best thing a sleep specialist will advise for any sleep deprived individual. I slept.

It was a “sleep session” after all.

My Restive Dance

“Mom, my legs feel funny. I have to move them to make it go away.” That was what my son told my wife a few days ago. Sadly to say, I think he inherited my condition. Poor kid, he has to deal with this. And he is not even 10 years old.

I have Restless Leg Syndrome (RLS). At least that’s my excuse for being fidgety.

I am not the first one in my family with this condition. I remember when we were very young, my father will have this “fits” at night that he had to move his legs like he was swimming in bed. My mother said that he was “balisa” (Tagalog for restless), and chalked it all up to stress. My dad would ask me and my little sister to massage his legs with our little hands, and that seemed to soothe him. We had no idea of what RLS was at that time.

When I was in college, I started noticing the same symptoms. But not only at night, but also during the day. I had to move my legs a lot, to be comfortable. I always do the “kuyakoy” (legs shaking) whenever I was sitting. I thought that was just normal.

Once, when I was in medical school, we were taking an exam, and I was constantly jiggling my legs to help me relax. Another classmate who was sitting at the other end of the table was doing the same. The whole table was shaking like an earthquake, that the one who was in the middle, complained and called our attention. I did not suspect that I have RLS then yet.

Now that I am older, I still have antsy legs, if not even worse. There were episodes at night when I was lying in bed that I would have this urge to move my legs (sometimes arms as well) and I would kick and flail vigorously like a fish out of the water. The difference now is at least I understand what RLS is.

RLS is a disorder in which there is an irresistible urge or need to move the legs to relieve the unpleasant sensation. It can develop at any age and generally worsens as one gets older. It can disrupt sleep and can cause daytime sleepiness and fatigue. It is one of the more common condition of sleep disorders we see. It is ironic that as a sleep specialist, I myself suffer from this condition.

In many cases, no known cause for RLS can be identified. Though studies have shown that it may be related to imbalance in the neurotransmitter dopamine in the brain. Dopamine is a chemical released by the nervous system to send messages to control muscle movement.

RLS for most part is not a serious condition, but more of just an annoyance. Though sometimes it can be related to other medical conditions, like peripheral neuropathy, iron deficiency, Parkinson’s disease, and renal failure. Pregnancy for some reason can worsen this syndrome.

I know I don’t have any other medical conditions related to RLS. I don’t have iron deficiency as I eat steel nails for breakfast. Not! I am also definitely sure that I’m not pregnant, for the last time I checked, I am a male. Just blame it on my genes.

RLS can be hereditary and runs in the family in at least half of the cases. Scientists have identified the site in our chromosomes where the genes for RLS may be located. So the problem is not just in the legs or in the brain, it is deep in our genes.

There are several medications that can be effective for RLS. Moreover there are plain lifestyle changes and home remedies that can help people with this disorder, like warm baths and massages, heating pads, relaxation techniques, exercise, and avoiding caffeine, alcohol and tobacco.

You may say, “Physician, heal thyself,” but I am not prescribing myself any medications. At least not yet. Besides I am not fond of taking pills. I prefer using lifestyle and simple remedies. I find that listening to relaxing music is very effective for me. A caressful rubbing from my wife also helps. If nothing else works, I just do my ‘horizontal’ Celtic dance in bed. And I am not even Irish.


The real Irish dance (photo from Riverdance)

My wife also suffers from some form of restless legs. She just have to walk it off. In the mall. Shopping. Is that genetic too?

One Sleepless Night

I woke up to the sound of crying. It was coming from my son’s bedroom. It was not a wailing cry but rather of a quiet whimpering. I am not a light sleeper, for I can sleep through thunder, storms and screaming sirens. But somehow I was awakened, perhaps it was the parent in me that heightened my sensation to this kind of sounds.

I called my son to come to our bedroom. When he came in and I asked him what was wrong, he answered matter-of-factly, “I cannot sleep.” It was about midnight.

It was just our third night after we came back from the Philippines. With the 14-hour time difference between Manila and Des Moines, it was understandable that our day and night biorhythm was way out-of-order. Though I confess, I had no problem falling asleep that night, as I already started working the next day we arrived, and with my ICU rotation, that made me very tired. In fact, I was even on-call the night before, so my body was so sleep deprived that no amount of jet-lag can keep me from sleeping.

Goodbye Manila! (photo taken after taking off at NAIA)

I asked my son to hop into our bed and tried to console him. He is usually jolly most of the times and we know that he is unafraid of the dark. Perhaps it was being alone in the dark with nobody to talk to, while everybody else was sleeping that made him doleful. Or maybe it was the fact that for the past couple of weeks he was sleeping with lots of people (his cousins) in a room, and now all of a sudden he is by his lonesome in his bedroom and he is missing all of them. Or maybe it was just the exasperation of lying awake for more than 2 hours and cannot fall asleep.

My son then asked me what can he do to fall asleep. He asked me this not because he knows that I am a Board-certified sleep expert, but because I am his dad. I told him that he can read a book, but he was not interested in that. I then suggested that he can eat a banana for it has tryptophan that can induce the body to produce melatonin, a natural sleep-inducer, but he was not convinced with my science. (Of course I won’t offer him to take any medications for sleep.) That was when I told him to count sheep. He asked me where did I get that silly idea, and I told him that I learned it not from my medical books but rather from Sesame Street, when I was about his age.

Ernie counting sheep (courtesy of Sesame Street)

At that point, he already stopped crying. I quietly accompanied him out of our bedroom and back to his room so as not to wake up his mom whom we left sleeping in our bed. I told him he can play with his Lego while I climbed up in my son’s bed and lay there just to keep him company. Maybe I can finally get back to sleep.

However, as I laid there in my son’s bedroom, it was my turn to be wide awake. My mind cannot stop wandering…..

I thought of the many times that I have read bedtime stories to this boy who is now contentedly playing on the floor, and the thousand of times I have tucked him to bed. I also recalled the instance that he called me one night in distress and would not go to sleep as there was a “big” (it was really an itsy-bitsy) spider on the wall near his bed. There were also a few opposite occasions in the past, that we brought him to an evening event but he fell asleep through the show and missed it all. In fact, it was just a little more than a week ago when we were in Manila, and our relatives wanted to show us the new dancing fountain in Rizal Park, but my son was too tired and fell asleep throughout the trip. I ended up taking a video of the fountain instead and showed it to him in the morning. Oh there were more wonderful memories……

Luneta’s new dancing fountain (photo taken with iPhone)

After an hour of me lying awake in my son’s bedroom, my wife woke up and came in to the room and joined me in my son’s bed. Several minutes later, my son finally got tired and grab his sleeping bag from the closet and slept on the floor, while me and my wife laid in his bed. Not too long after he was in La La land.

I hope someday my son will remember this night, and appreciate what his old man did for him. I did not do anything really, except lay in his bed and kept him company in one long sleepless night.

Or maybe someday when I am in my golden years, and I feel alone in the darkness of our retirement home, that I will pick up the phone in the wee hours of the morning and call my son to return the favor, and tell him, “Son, I cannot sleep.”

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.