Top 5 Ways That Television is Ruining Your Sleep.

As a sleep physician, I spend a lot of time educating patients about what sleep is and how it works. Sleep, as I often explain, is not simply the lack of being awake; anymore than landing a plane is simply the lack of flying. It’s becoming increasingly understood that sleep is an actively generated state, created by a series of neuro-hormonal changes which work in concert to nudge the brain into the sleep state. To stretch the plane analogy further, if being asleep were like the plane being on the ground, then falling asleep is like the act of landing the plane. And just like when you land a plane, there are a lot of variables that are involved. There are numerous events that must happen in succession, each affecting and triggering other events which ultimately induce the brain to sleep. A recent study demonstrates just how watching too much television can wreak havoc in this delicate process. Here’s just a few of the ways that television can ruin your sleep.

     5. Watching television makes you go to bed later.

Television watching has steadily increased in our society, and its migration into our bedrooms marked a time when it began to disrupt our collective sleep and sleep habits. The most obvious effect that this might have is the most simple; we stay up later watching a program that has our attention. This few minutes a night may seem innocent enough. But our brains have a pre-determined amount of sleep they need to function well. When we miss that sleep we build up a “sleep debt” that can make us tired all of the time. Even if we catch up on a bit of sleep the next day, unless that sleep debt is paid back, the brain will still be fatigued.

     4. Watching television alters your brain’s bedtime habits. Continue reading “Top 5 Ways That Television is Ruining Your Sleep.”

Top 5 CPAP Travel Tips from a Sleep Doctor and CPAP User.

Sleep Apnea is a condition that aflicts millions of people.  There are 2 types of sleep apnea, central, and obstructive. Obstructive is by far the most common, and is usually what is referred to when people talk about “sleep apnea”. Obstructive sleep apnea occurs when, during sleep, the airway passages in the throat close and block the movement of air. Common symptoms are snoring, gasping during sleep, sleepiness during the day, and the overall feeling that your sleep was not restful. While we all may have a laugh recalling that uncle or grandpa that was “sawing logs” all night when they slept over, the truth is that sleep apnea can have profound negative effects on overall health. Sleep apnea has been linked with stroke, cardiovascular disease, hypertension, and is an important contributor to deaths and injuries due to traffic accidents. The most common and effective treatment for sleep apnea is the use of a CPAP (Continuous Positive Airway Pressure) device. As a sleep physician, and a CPAP user myself I know the importance of using your CPAP whenever you sleep, that includes during travel.

Whether I’m travelling across a state line or an equatorial line, whether the destination is medical education, or a mediterranean beach, my CPAP is along for the ride. Because of this, I’ve also run into pretty  much every complication, problem, pitfall, morass, and quagmire that you can have when travelling with your CPAP. Thus I present to you, gleaned from both my experiences and those of my patients, my Top 5 tips for travelling with your CPAP.

  1. Bring Your CPAP With You!

This would seem obvious, but it’s not. Alot of people see their CPAP as an assistive  device which they only need to use when they need it. But they really need to look at it for what it is: therapy. You take your hypertension and diabetes medicines with you when you travel, think of your CPAP the same way. Besides, if you’re travelling for business, you need to be sharp and focused. If you’re travelling for pleasure, well who wants to spend their hard earned vacation being tired and irritable? CPAP will help you get the most out your travels! Continue reading “Top 5 CPAP Travel Tips from a Sleep Doctor and CPAP User.”

5 Things No One Taught Me in Residency

Below is a Repost of a previous article, that is appropriate to this time of year.

Since medical school, I’ve gone through an additional 6 years of training, read countless volumes of medical literature, and had the fortune of having some great teachers. Through it all, experience has been the greatest teacher, which I suppose is what training is about. I’ve watched with interest as advice has been hashed out on the web around this time of year to new trainees on all matter of subjects. And much of it is good and useful, to be sure.
Being the helpful person that I am, I naturally want to do my part. What, I thought, could I contribute to this discussion that hasn’t been said already?
To that end I’ve come up with my own list of of trivial and only slightly helpful tidbits of information, based on my own experiences over the last 11 years post graduation. Here I give you my top 5 list of things that no one ever told me in medical training. . .but should have. Enjoy.

1. Before conducting a family meeting, go the restroom. Scan your face for things that might appear distracting or unseemly,  like nasal boogies or lettuce stuck in your teeth, and quickly remove them. If you are one of the few convertible drivers with hair, pay special attention to this area; the “mad scientist” look is generally not one which inspires confidence in these situations.

2. Using hospital Jello-O and graham crackers as the base of your food pyramid makes for a reasonably strong pyramid.  At least as  strong as any other pyramid that has a soft mushy substance at its base.

3. Sometimes an appropriately discharged patient will refuse to leave the hospital. Follow your hospital’s policy in these situations. If it is your hospital’s policy to call security, then do so. However it would be wise to have your patient fill out the house officer rating/feedback form before doing so.

4. If your attending physician gives you an answer that seems wishy-washy, it’s because they don’t know the answer. They still know a heck of a lot more than you, though.

5. When entering a room to declare death on a patient, whose family is in the room, make sure your pager is on vibrate. Particularly remember to silence any cutesy ring tones (such as Cee Lo Green or the Benny Hill theme) that might bring unwanted awkwardness to an otherwise somber moment.

Thank you and Good Luck!

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Top 10 Advances in Medicine (1-5)

As promised, here’s the conclusion of my list of the Top 10 advances in medicine.  As stated before, here are the ground rules: I’m not ranking surgical advances,  I’m sticking to American medical problems, and we’re not including public health initiatives like clean drinking water. No, what we have here is a rare tribute to our  much maligned pharmaceutical industry in all its capitalistic chemical glory.
So once again, without further delay or  pre-authorization, here’s the cream of the crop of the top 10 medical advances.

5. Antihypertensives. Hypertension, like diabetes is a common contributor to vascular disease which lead to, among other things, stroke and coronary artery disease. The greater control of blood pressure by these medications has undoubtedly contributed to a reduction in morbidity. In addition, medications like angiotensin converting enzyme inhibitors and beta-blockers have other beneficial effects that go beyond their blood pressure lowering effects.

4. Birth control. In olden times in this country, and in many parts of the world today, it has been financially advantageous to have children. In an agrarian world, children contribute to labor, and tend to their parents as they age. Marriage of children could also mean merging of families and greater wealth. Nowadays, it costs close to $300,000 to raise a child. In addition, fewer children has meant more women in the job force and reduced strain on people, and marriages, which make for healthier people. Fewer children also means more resources for each child, which make for healthier children.

3. Insulin and other hypoglycemic agents: Diabetes is a major contributor to disease in the world. While it only ranks as the number 7 cause of death in the U.S. it is being increasingly understood that even minor amounts of hyperglycemia can contribute to vascular disease, particularly heart disease and stroke (which rank as the first and fourth most common causes of death). Undoubtedly without these treatments the incidence of vascular disease and infection would be astronomically higher.

2. Anesthetics and Pain medication. Imagine a world in which only the most basic surgical  procedures could be performed. A world where even lancing a boil would be considered barbaric and avoided at all costs. That’s what the world was like in the dark age before anesthesia and pain medicines. So many things that we take for granted in today’s medical world, like medicines for a minor procedure or obstetrical deliveries would not be possible without anesthetic agents. And that’s before we even consider things like hip repairs, open heart surgeries, and appendectomies. No, I think I would rather not try to imagine that world.

1. Antibiotics. Ok, this was an easy one, even most kids know about the invention of the first antibiotic. I shudder to think of where we would be today without the father of modern medicine, Dr. Penicillin, whose incredible legacy is today carried on by his grandson, Dr. Vancomycin. I kid. Check out this fascinating  first-hand account of the first use of penicillin in the U.S.; a 33 year old woman at Yale, New Haven hospital. A single vial of the “black magic” was shipped from England, the physicians actually collected the patients urine to reclaim the drug and re-administer it. She lived to the age of 90. Awesome stuff.

Check out the CDC’s list of the top 10 public health achievements of the previous decade. I found the statistics on the benefits of vaccines of particular interest; “A recent economic analysis indicated that vaccination of each U.S. birth cohort with the current childhood immunization schedule prevents approximately 42,000 deaths and 20 million cases of disease, with net savings of nearly $14 billion in direct costs and $69 billion in total societal costs.”

Related Articles: Top 10 Medical Advances (6-10);   Top 5 Things No One Taught Me in Training;   Top 5 Things You Don’t Know About Your DoctorTop 5 OTC Meds That Would Require  Prescription if Released Today.

Top 10 Advances in Medicine (6-10)

I’ve been thinking lately about all the great advances in medicine over the years. There have been lots of them. And despite everything you’ve heard about looming cuts in healthcare, I have no doubt that the hits will keep on coming. Since I seem to be on this Top 5 thing lately, I figured I would continue this ride and rank my top 10 medical advances over the years. There had to be a few ground rules before putting together a list like this. I’m a medical doctor ranking medical therapies, and so surgical advances can take up space on someone else’s server. And just to be clear,  since it’s been awhile since I’ve treated malaria and cholera, I’m going to stick to western world problems and western world drugs.  I’m also not the young idealist I once was, so public policy initiatives, like seat belts, clean drinking water, and vaccinated babies are being tossed out with the bathwater. No, we’re talking about good old fashioned chemicals with long complicated names produced in soot belching factories and administered in our nations pharmacies and hospitals with epic markups to ensure future stock gains research funding.
So without further delay, and with no pre-authorization required, here is the latter half of the top 10 medical advances.

10. Psychiatric Meds. One has only to look at the CDC’s list of the top causes of mortality in America to see the logic behind this choice, as suicide rounds out the top 10 causes of death. But psychiatric problems also have a much greater impact beyond suicide. Problems like depression and anxiety often exacerbate other medical conditions, increasing the risk of complications.  They put strain on family members and cause lost productivity and income. They are one of the most common reasons for enrollment in disability. Continue reading “Top 10 Advances in Medicine (6-10)”

Top 5 Trivial Things No One Taught Me in Training.

Since medical school, I’ve gone through an additional 6 years of training, read countless volumes of medical literature, and had the fortune of having some great teachers. Through it all, experience has been the greatest teacher, which I suppose is what training is about. I’ve watched with interest as advice has been hashed out on the web around this time of year to new trainees on all matter of subjects. And much of it is good and useful, to be sure.
Being the helpful person that I am, I naturally want to do my part. What, I thought, could I contribute to this discussion that hasn’t been said already?
To that end I’ve come up with my own list of of trivial and only slightly helpful tidbits of information, based on my own experiences over the last 11 years post graduation. Here I give you my top 5 list of things that no one ever told me in medical training. . .but should have. Enjoy. Continue reading “Top 5 Trivial Things No One Taught Me in Training.”

Top 5 Things You Don’t Know About Your Doctor.

 

1. Your doctors never actually stood up, raised their right hand and took the Hippocratic Oath. If they did, they don’t remember it. The closest thing they’ve taken to a Hippocratic Oath is that time they swore they’re never again staying at that terrible hotel in Athens with lousy views of the Acropolis.

2. Your doctor’s degree of willingness to do something is inversely proportional to how happy they say they are to do it. As in “I’m happy to do that for you” = “I’m very unhappy to do that for you”. And “I’m more than happy to do that for you” = “I’m extremely unhappy to do that for you”

3. Your doctor doesn’t really know whether the respiratory illness you have is viral or bacterial. Chances are that it’s viral and you don’t need an antibiotic. But if you pester enough, you’ll probably get the antibiotic.

4. When you ask for copies of reports to be sent to your other doctors, you should not take their acknowledgment of your request as confirmation that the task will be performed. We may simply be acknowledging that yes, that would be a good idea in theory, or yes we would approve of that kind of bold initiative taking. However, the back and forth motions of our heads may also just be due to migraines brought on by filling out pre-authorizations for nasal sprays.

5. Your doctor lives in deathly, livid, morbid fear that you are going to sue them, put them in prison, infest their home with termites, send their kids to sanitize sweatshop latrines in China, and send them videos of you partying with their significant other on a yacht in the Mediterranean. That is why you are having your 4th stress test in 2 weeks.

Top 5 OTC Meds That Would Require a Presciption if Released Today

Looking at the administrative, legal, and safety hurdles that drug companies have to jump through today, I can’t help but feel (some, just a little) pity for them. I’m sure right now there’s a drug company executive waxing nostalgic over a bygone era where they could do some basic safety research, wine and dine a few physicians in their favorite tax haven, and then get their drug out there for public consumption. But times have changed, and getting FDA approval for medications is alot harder than it used to be. And unless your drug is a quasi-herbal supplemental type of thing made in someone’s back yard, getting the FDA to allow it over the counter is even harder. Here’s my list of the top 5 OTC meds that, if they had been released today, would require a prescription.

1. NSAIDS: (Aspirin, ibuprofen, naproxen, etc. . .) These medications are great for pain and for their blood thinning effect by blocking platelet function. But they are also great at eroding stomach lining leading to ulcers, causing kidney damage, reye’s syndrome, hearing problems, etc. . . Would this be allowed OTC by the FDA today? Heck no!

Continue reading “Top 5 OTC Meds That Would Require a Presciption if Released Today”