Tag Archives: Sleep disorder

Straight, No Chaser: Quick Tips – You Snore Too Much

March 10, 2017Neurology, Sleep, Health PreventionBehind the Curtain, Nasal septum deviation, Obstructive sleep apnea, Sleep apnea, Sleep disorder, SnoringJeffrey Sterling, MD

You snore too much. What this means is your breathing is intermittently partially obstructed while you’re sleeping. Snoring is the sound of air moving past that obstruction. Whether serious or not, first you should know it’s common, occurring in about 50% of adults. It could be serious or just positional. Here are some Quick Tips for you.

Sleep on your side. This should remove the tongue as a cause of a partial obstruction.
Avoid sedatives if possible. Sedatives cause significant enough relaxation to the tissues in your throat to cause that partial obstruction.
Limit alcohol before sleeping (by about two hours). Alcohol is a sedative.
Elevate the head of your bed or prop your head up by about 4-6 inches. This should manually move partially obstructing tissue out of the way.
Fix what ails your nose. If you have chronic problems with nasal obstruction or a deviated nasal septum, you’re more inclined to breathe through your mouth. This will increase the chances that you snore. Similarly, those nasal strips you may have seen work (when they do) by increase the area in the nose through which they can breathe.
Finally, losing weight (if you have it to lose) works by reducing the tissues in and around your throat that cause snoring.

It’s time to see your physician if you find yourself awakening from sleep choking, gasping or otherwise short of breath. This could be an indicator of a serious condition, including sleep apnea. Additionally, you may want to seek care if your sleeping causes functional problems (e.g. you or your partner have difficulty sleeping as a result of your snoring).
This is a significant enough issue that I will revisit it in the future. In the meantime, sleep well.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2017 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Sleep Apnea

March 7, 2017SleepBehind the Curtain, health, Hypertension, Non-rapid eye movement sleep, Obstructive sleep apnea, Sleep, Sleep apnea, Sleep disorder, Slow-wave sleep, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

We’ve discussed many components of sleep and sleep disorders. A very common condition that many of you are walking around with undiagnosed is sleep apnea. Sleep apnea is a common, recurring sleeping disorder in which your breathing temporarily pauses during your sleep. Have you ever awakened and felt as if you were choking or coughing? We may be talking to you.
The pauses of sleep apnea range in frequency and severity. They can last seconds or minutes. They may occur about 30 times in an hour.
Let’s pause there. I just told you that many of you are suffering from a disorder in which you stop breathing while asleep. Think about what that means.
Physiologically, if you’re not breathing while you’re asleep, your body will adjust. If you are in a stage of deep sleep, you’ll be kicked into light sleep, which is a lesser quality of sleep, and your body won’t be as replenished as it would otherwise. Your body will be less rested as a result, and you will suffer throughout the day.
Sleep apnea is most commonly due to some level of obstruction—obstructive sleep apnea. Do you have a large tongue or big tonsils? Are you overweight? Are you a big snorer? We may be talking to you. That snoring may be the sound of air moving past some obstruction. By the way, obstructive sleep apnea occurs more often in overweight people, but it can occur in anyone.

Now to the “So What?” of the conversation. This is about the quality of your life. Sleep apnea is about insufficient quantity and quality of sleep. It’s about excessive daytime sleepiness. It’s about recurring episodes of inadequate levels of air resulting from the breathing difficulty. These facts have consequences. Refer to the lead picture above for an illustration of the various types of symptoms and problems that are associated with sleep apnea. Sleep apnea also brings risks for the following conditions and diseases if left untreated.

Diabetes
Heart attacks
Heart failure
High blood pressure
Irregular heartbeats (arrhythmias)
Obesity
Strokes

Sleep apnea is easy and hard to diagnose at the same time. Many of you are suffering with it unsuspectingly as we speak. The person you sleep with may have expressed concern about your snoring or choking while you sleep. If so, get checked.
Sleep apnea once diagnosed is treatable with some combination of lifestyle changes, breathing devices and mouthpieces. Surgery is used in some cases.
We’ve reviewed many components of sleep and sleep disorders. Be mindful that sleep is your body’s time to rest and recover from the day’s activity. Any disruption in its ability to do that does not bode well for you over the long term. If your sleeping habits are problematic for you, you really should get evaluated. Getting this situation addressed can dramatically improve the quality of your life.
Finally, review the attached video for an illustration of what’s happening during sleep apnea. Excuse the scary music!
http://www.youtube.com/watch?v=Wm-TZ-dO_rQ
This discussion has focused on obstructive sleep apnea and not the less common form, central sleep apnea. The symptoms are similar, so if you have the other condition, it would be determined by your physician.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2017 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Narcolepsy – The Sleep Attack

March 6, 2017General Health and Wellness, SleepBehind the Curtain, Cataplexy, Conditions and Diseases, Excessive daytime sleepiness, health, Narcolepsy, Sleep apnea, Sleep disorder, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

This is part of a Straight, No Chaser series on sleep disorders.

When you hear about narcolepsy, it’s usually in the context of some joke, but it’s a horrifying condition. Looking at the lead picture, imagining blacking out while driving a car. A diagnosis of narcolepsy should prompt certain lifestyle changes. Narcolepsy is a chronic sleep disorder that causes overwhelming daytime drowsiness and is characterized by an extreme tendency to fall asleep whenever in relaxing surroundings.

To better understand this condition, let’s look at certain truths of narcolepsy.

Narcolepsy doesn’t happen just because you’re tired.

Narcolepsy is a brain disorder. The part of your brain that regulates your cycle of being awake vs. being asleep is disturbed. The drop attack is not fading into sleep. It is an irresistible shut down. Now, narcoleptics do suffer from severe sleepiness throughout the day, but the sleep attacks aren’t predictable based on how tired one is.

Narcoleptics have severe disruptions of the activities of daily living.

Just remembering that this is a drop attack will help you appreciate the danger of narcolepsy. It can occur at any time during any activity. The unpredictability of the condition renders it very dangerous to the sufferer, and it makes performing at work, at school, in social and in many other settings very difficult.

Narcoleptics are likely suffering from other sleep disorders.

Understand that narcolepsy is a disruption of the sleep/wake cycle. That disturbance can manifest in other ways, including poor sleep quality and frequent nighttime waking. However, narcoleptics do not tend to spend more total time asleep during the day than unaffected individuals.

In addition to the sleep attacks, the main symptoms are excessive daytime sleepiness and cataplexy.

Cataplexy is a sudden voluntary muscle loss while one is still awake—the horror before the horror, if you will. Individuals feel limp and/or unable to move. Other symptoms may include hallucinations and an extension of the cataplexy to outright paralysis before and after the episode. Now the drop attacks themselves typically last seconds to minutes and result in a temporary feeling of refreshment before the sleepiness phenomenon reoccurs.

There’s no special rhyme or reason to who suffers from narcolepsy.

Narcolepsy occurs the world around and in men and women at a roughly equal rate. It typically occurs in children through young adulthood, but it can occur at any age. Surprisingly, it often is underdiagnosed. Don’t let that happen to you. With any form of a blackout or sleep attack, please get evaluated and be sure to ask if the episode could have been narcolepsy.

Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2017 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Understanding Normal Sleep and How Much Sleep You Need

March 4, 2017General Health and Wellness, SleepBehind the Curtain, Non-rapid eye movement sleep, Rapid eye movement sleep, REM, Sleep, Sleep apnea, Sleep deprivation, Sleep disorder, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

It’s National Sleep Awareness Week, and Straight, No Chaser wants you to wake up, pay attention and learn why sleep is such an important part of your life!

Do you ever think about why we sleep? Our bodies are highly efficient machines that utilize a lot of energy over the course of a day. In particular, our brain utilizes an enormous amount of oxygen and energy. Sleep is meant to be a process organized by the brain and responsive to our body’s needs. Sometimes those needs are immediate, and sometimes those needs are scheduled. Contrary to what is often thought, we’re not designed to just black out when we’re tired. Sleep is actually a process orchestrated by the brain.
How and when we sleep is governed by a number of factors. These include factors under our control, such as whether or not we are sleep deprived, and factors beyond our conscious control. Chief among the latter consideration is the fact that we actually do have an internal “clock” that regulates our biologic rhythm (also called a circadian rhythm) over a 24-hour period. The circadian rhythm maintains our sleep-wake cycle and prompts us to want to sleep during similar times of the day and/or night. Sometimes that internal rhythm and the body’s routine call for sleep can be disrupted, making sleep a response to abnormal functioning within the brain (such as occurs in narcolepsy).

Sleep also has an internal organization—the sleep cycle—regulated by different areas of the brain. Sleep occurs in two categories, which recur through the night: rapid eye movement (REM) sleep and non-rapid eye movement (non-REM) sleep. Non-REM sleep is further divided into four stages (1 through 4), with stages 3 and 4 often referred to as “deep sleep.” In adults, non-REM sleep occupies around 80 percent of the night, and REM sleep 20 percent. REM sleep occurs every 90-110 minutes. These cycles recur until we awaken due to a schedule or decision to arise. You will feel most refreshed after awakening at the completion of the final stage in a sleep cycle.
The body replenishes and restores itself during non-REM sleep, releasing hormones to repair damage done during the day. During REM sleep, you process memories and thoughts from the day, and you dream. As best as we understand dreams, they also represent a form of processing mental information that you received during the day. During REM sleep, we normally lose the use of our limb muscles. Yes, it’s true that while we’re sleeping (at least in REM sleep), we have an active mind in an inactive body. This is actually a good thing. This normal loss of muscle activity during REM sleep helps prevent us from acting out our dreams. Thus, it stands to reason that sleepwalking and night terrors usually occur in non-REM sleep. When disorders of REM sleep occur and patients lose that protective phase of muscle inactivity, patients may act out violent dreams and harm themselves or others.

How much sleep you need is best defined by how well you function on different amounts of sleep, and as such, there is quite a bit of variation on what is considered normal and needed. For many adults, the average normal amount of sleep is around 7.5 hours per night. Many of you know people that can function on much less, and others that require as much as 9 hours per night. In general, your body feels most rested if you awaken at the end of a full sleep cycle. Given that each cycle takes about 90 minutes, many people find that they’re more refreshed if they sleep some increment of 1.5 hours (e.g., 6, 7.5 or 9 hours).
If you are getting what you consider to be an adequate amount of sleep but are still unrefreshed and sleepy, then you might have an organic sleep disorder and should consider seeking professional consultation. Throughout this week, Straight, No Chaser will review several sleep disorders. Until then, sweet dreams.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2017 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Quick Tips – You Snore Too Much

March 13, 2016Neurology, Sleep, Health PreventionBehind the Curtain, Nasal septum deviation, Obstructive sleep apnea, Sleep apnea, Sleep disorder, SnoringJeffrey Sterling, MD

Sleep on your side. This should remove the tongue as a cause of a partial obstruction.
Avoid sedatives if possible. Sedatives cause significant enough relaxation to the tissues in your throat to cause that partial obstruction.
Limit alcohol before sleeping (by about two hours). Alcohol is a sedative.
Elevate the head of your bed or prop your head up by about 4-6 inches. This should manually move partially obstructing tissue out of the way.
Fix what ails your nose. If you have chronic problems with nasal obstruction or a deviated nasal septum, you’re more inclined to breathe through your mouth. This will increase the chances that you snore. Similarly, those nasal strips you may have seen work (when they do) by increase the area in the nose through which they can breathe.
Finally, losing weight (if you have it to lose) works by reducing the tissues in and around your throat that cause snoring.

It’s time to see your physician if you find yourself awakening from sleep choking, gasping or otherwise short of breath. This could be an indicator of a serious condition, including sleep apnea. Additionally, you may want to seek care if your sleeping causes functional problems (e.g. you or your partner have difficulty sleeping as a result of your snoring).
This is a significant enough issue that I will revisit it in the future. In the meantime, sleep well.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress

Understanding the Horror of Night Terrors

March 12, 2016Pediatrics/Kids Health, Sleep, Health Prevention844-SMA-TALK, Behind the Curtain, Conditions and Diseases, health, Night terror, Sleep, Sleep deprivation, Sleep disorder, Sleepwalking, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Stress, There are 72 Hours in a DayJeffrey Sterling, MD

Introduction

This Straight, No Chaser post on night terrors is part of a series on sleep and sleep disorders.

During a night terror, Little Johnny may be sleep walking, or he seems to wake up in the middle of the night and just starts screaming. He’s really not communicative; he’s just terrified. These episodes generally last about 15 minutes. Then he goes back to sleep. The next morning, the child has no recollection of the event.

Causes and Triggers of Night Terrors

The cause of night terrors is unknown but they seem to be triggered by emotional stress and lack of sleep. Febrile illnesses also seem to correlate with the presence of these episodes.

Who gets these? Children less than age seven, more frequently boys. These episodes usually stop by age 10. There often is a family history.

There’s really no testing or treatment for these until they are frequent and prolonged, or unless a secondary injury occurs from all the trashing about.

I bring this to your attention because many parents are aware of this phenomenon and have no idea what to do when it occurs. My best advice is to ensure that the child is safe during the episode for otherwise stress free children. You may want to consider medical or psychological screening if the problem worsens. Sleep well…

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Ask your SMA expert consultant any questions you may have on this topic. Also, take the #72HoursChallenge, and join the community. Additionally, as a thank you, we’re offering you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!

Order your copy of Dr. Sterling’s books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.jeffreysterlingbooks.com. Another free benefit to our readers is introductory pricing with multiple orders and bundles!

Thanks for liking and following Straight, No Chaser! This public service provides a sample of http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK. Likewise, please share our page with your friends on WordPress! Also like us on Facebook @ SterlingMedicalAdvice.com! Follow us on Twitter at @asksterlingmd.

Straight, No Chaser: Your Rebuttals and Questions about Insomnia

March 11, 2016SleepBehind the Curtain, Benadryl, Conditions and Diseases, Emergency department, Gamma-Aminobutyric acid, health, Home Page, Insomnia, Sleep deprivation, Sleep disorder, Sleep Disorders, Somnolence, StimulantJeffrey Sterling, MD

You are certainly an entertaining group behind the scenes. Here are some of your questions on insomnia. Be reminded that should you want to leave me a private question, just go to the Home Page, or type https://jeffreysterlingmd.com into your browser. Here’s five questions from yesterday’s post on insomnia.
1. Aw, hell! You’re telling me I can be dying from something causing insomnia?

It’s way more likely that level of stress you’re displaying is keeping you awake at night.

2. How is it that sex makes you sleepy?

When you do exert yourself vigorously, the greater utilization of muscles will deplete glycogen (energy) stores and make you drowsy. Also, it’s well established that certain hormones (e.g. prolactin, GABA and oxytocin) that promote sleep are released after an orgasm.

3. You mentioned tea. A good cup of tea at bedtime helps me sleep.

If that works for you, go for it. Some people have paradoxical effects to stimulants (In fact, stimulants are the most common treatment for ADHD – a topic for another day.)

4. What about giving my baby Benadryl?
I’m giving information here, not practicing medicine, so that’s a question for your physician. I will say there are many drugs (most notably those in the anticholingeric class) that have drowsiness as a side effect, and many emergency departments will give Benadryl to adults for that purpose. That said, these medications are not primarily used for drowsiness, and you’ll have to deal with other drug effects (such as the intended purpose for the medication) in addition to any possible drowsiness that occurs.
5. Sex at night keeps me wide awake.
That’s why a lot of you are shy about putting comments in the inbox… Sorry, but the answer to that question was not meant for public consumption.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Sleep Apnea

March 8, 2016SleepBehind the Curtain, health, Hypertension, Non-rapid eye movement sleep, Obstructive sleep apnea, Sleep, Sleep apnea, Sleep disorder, Slow-wave sleep, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Diabetes
Heart attacks
Heart failure
High blood pressure
Irregular heartbeats (arrhythmias)
Obesity
Strokes

Sleep apnea is easy and hard to diagnose at the same time. Many of you are suffering with it unsuspectingly as we speak. The person you sleep with may have expressed concern about your snoring or choking while you sleep. If so, get checked.
Sleep apnea once diagnosed is treatable with some combination of lifestyle changes, breathing devices and mouthpieces. Surgery is used in some cases.
We’ve reviewed many components of sleep and sleep disorders. Be mindful that sleep is your body’s time to rest and recover from the day’s activity. Any disruption in its ability to do that does not bode well for you over the long term. If your sleeping habits are problematic for you, you really should get evaluated. Getting this situation addressed can dramatically improve the quality of your life.
Finally, review the attached video for an illustration of what’s happening during sleep apnea. Excuse the scary music!
http://www.youtube.com/watch?v=Wm-TZ-dO_rQ
This discussion has focused on obstructive sleep apnea and not the less common form, central sleep apnea. The symptoms are similar, so if you have the other condition, it would be determined by your physician.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Narcolepsy – The Sleep Attack

March 7, 2016General Health and Wellness, SleepBehind the Curtain, Cataplexy, Conditions and Diseases, Excessive daytime sleepiness, health, Narcolepsy, Sleep apnea, Sleep disorder, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

This is part of a Straight, No Chaser series on sleep disorders.

To better understand this condition, let’s look at certain truths of narcolepsy.

Narcolepsy doesn’t happen just because you’re tired.

Narcoleptics have severe disruptions of the activities of daily living.

Narcoleptics are likely suffering from other sleep disorders.

In addition to the sleep attacks, the main symptoms are excessive daytime sleepiness and cataplexy.

There’s no special rhyme or reason to who suffers from narcolepsy.

Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Understanding Normal Sleep and How Much Sleep You Need

March 5, 2016General Health and Wellness, SleepBehind the Curtain, Non-rapid eye movement sleep, Rapid eye movement sleep, REM, Sleep, Sleep apnea, Sleep deprivation, Sleep disorder, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

It’s National Sleep Awareness Week, and Straight, No Chaser wants you to wake up, pay attention and learn why sleep is such an important part of your life!

How much sleep you need is best defined by how well you function on different amounts of sleep, and as such, there is quite a bit of variation on what is considered normal and needed. For many adults, the average normal amount of sleep is around 7.5 hours per night. Many of you know people that can function on much less, and others that require as much as 9 hours per night. In general, your body feels most rested if you awaken at the end of a full sleep cycle. Given that each cycle takes about 90 minutes, many people find that they’re more refreshed if they sleep some increment of 1.5 hours (e.g., 6, 7.5 or 9 hours).
If you are getting what you consider to be an adequate amount of sleep but are still unrefreshed and sleepy, then you might have an organic sleep disorder and should consider seeking professional consultation. Throughout this week, Straight, No Chaser will review several sleep disorders. Until then, sweet dreams.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Sleep Apnea

March 5, 2015General Health and Wellness, Sleephealth, Hypertension, Non-rapid eye movement sleep, Obstructive sleep apnea, Sleep, Sleep apnea, Sleep disorder, Slow-wave sleep, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

This is part of a Straight, No Chaser series on sleep disorders.

We’ve discussed many components of sleep and sleep disorders. Sleep apnea is a very common condition that many of you are walking around with undiagnosed. Sleep apnea is a common, recurring sleeping disorder in which your breathing temporarily pauses during your sleep. Have you ever awakened and felt as if you were choking or coughing? We may be talking to you.
The pauses of sleep apnea range in frequency and severity. They can last seconds or minutes. They may occur about 30 times in an hour.
apnea111
Let’s pause there. I just told you that many of you are suffering from a disorder in which you stop breathing while asleep. Think about what that means.
Physiologically, if you’re not breathing while you’re asleep, your body will adjust. If you are in a stage of deep sleep, you’ll be kicked into light sleep, which is a lesser quality of sleep, and your body won’t be as replenished as it would be otherwise. Your body will be less rested as a result, and you will suffer throughout the day.
Sleep apnea is most commonly due to some level of obstruction within the airway—obstructive sleep apnea. Do you have a large tongue or big tonsils? Are you overweight? Are you a big snorer? We may be talking to you. That snoring may be the sound of air moving past some obstruction. By the way, obstructive sleep apnea occurs more often in overweight people, but it can occur in anyone.

Now to the “So What?” of the conversation. This is about the quality of your life. Sleep apnea is about insufficient quantity and quality of sleep. It’s about excessive daytime sleepiness. It’s about recurring episodes of inadequate levels of air resulting from the breathing difficulty, which can lead to inadequate levels of oxygen getting into your bloodstream and circulating throughout your body. These facts have consequences. Refer to the lead picture above for an illustration of the various types of symptoms and problems that are associated with sleep apnea. Sleep apnea also brings risks for the following conditions and diseases if left untreated.

Diabetes
Heart attacks
Heart failure
High blood pressure
Irregular heartbeats (arrhythmias)
Obesity
Strokes

Sleep apnea once diagnosed is treatable with some combination of lifestyle changes, breathing devices and mouthpieces. Surgery is used in some cases.
Straight, No Chaser has reviewed many components of sleep and sleep disorders. Be mindful that sleep is your body’s time to rest and recover from the day’s activity. Any disruption in its ability to do that does not bode well for you over the long term. If your sleeping habits are problematic for you, you really should get evaluated. Getting this situation addressed can dramatically improve the quality of your life.
Finally, review the attached video for an illustration of what’s happening during sleep apnea. Excuse the scary music!

This discussion has focused on obstructive sleep apnea and not the less common form, central sleep apnea. The symptoms are similar, so if you have the other condition, it would be determined by your physician.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what 844-SMA-TALK and http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

Straight, No Chaser: Narcolepsy – The Sleep Attack

March 4, 2015General Health and Wellness, SleepCataplexy, Conditions and Diseases, Excessive daytime sleepiness, health, Narcolepsy, Sleep apnea, Sleep disorder, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

This is part of a Straight, No Chaser series on sleep disorders.

To better understand this condition, let’s look at certain truths of narcolepsy.

Narcolepsy doesn’t happen just because you’re tired.

Narcoleptics have severe disruptions of the activities of daily living.

Narcoleptics are likely suffering from other sleep disorders.

In addition to the sleep attacks, the main symptoms are excessive daytime sleepiness and cataplexy.

There’s no special rhyme or reason to who suffers from narcolepsy.

Thanks for liking and following Straight, No Chaser! This public service provides a sample of what 844-SMA-TALK and http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

Straight, No Chaser: Understanding Normal Sleep and How Much Sleep You Need

March 2, 2015General Health and Wellness, SleepNon-rapid eye movement sleep, Rapid eye movement sleep, REM, Sleep, Sleep apnea, Sleep deprivation, Sleep disorder, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, WordPressJeffrey Sterling, MD

This week is National Sleep Awareness Week, so Straight, No Chaser wants you to wake up, pay attention and learn why sleep is such an important part of your life!
Do you ever think about why we sleep? Our bodies are highly efficient machines that utilize a lot of energy over the course of a day. In particular, our brain utilizes an enormous amount of oxygen and energy. Sleep is meant to be a process organized by the brain and responsive to our body’s needs. Sometimes those needs are immediate, and sometimes those needs are scheduled. Contrary to what is often thought, we’re not designed to just black out when we’re tired. Sleep is actually a process orchestrated by the brain.
How and when we sleep is governed by a number of factors. These include factors under our control, such as whether or not we are sleep deprived, and factors beyond our conscious control. Chief among the latter consideration is the fact that we actually do have an internal “clock” that regulates our biologic rhythm (also called a circadian rhythm) over a 24-hour period. The circadian rhythm maintains our sleep-wake cycle and prompts us to want to sleep during similar times of the day and/or night. Sometimes that internal rhythm and the body’s routine call for sleep can be disrupted, making sleep a response to abnormal functioning within the brain (such as occurs in narcolepsy).

Sleep also has an internal organization—the sleep cycle—regulated by different areas of the brain. Sleep occurs in two categories, which recur through the night: rapid eye movement (REM) sleep and non-rapid eye movement (non-REM) sleep. Non-REM sleep is further divided into four stages (1 through 4), with stages 3 and 4 often referred to as “deep sleep.” In adults, non-REM sleep occupies around 80 percent of the night, and REM sleep 20 percent. REM sleep occurs every 90-110 minutes. These cycles recur until we awaken due to a schedule or decision to arise. You will feel most refreshed after awakening at the completion of the final stage in a sleep cycle.
The body replenishes and restores itself during non-REM sleep, releasing hormones to repair damage done during the day. During REM sleep, you process memories and thoughts from the day, and you dream. As best as we understand dreams, they also represent a form of processing mental information that you received during the day. During REM sleep, we normally lose the use of our limb muscles. Yes, it’s true that while we’re sleeping (at least in REM sleep), we have an active mind in an inactive body. This is actually a good thing. This normal loss of muscle activity during REM sleep helps prevent us from acting out our dreams. Thus, it stands to reason that sleepwalking and night terrors usually occur in non-REM sleep. When disorders of REM sleep occur and patients lose that protective phase of muscle inactivity, patients may act out violent dreams and harm themselves or others.

How much sleep you need is best defined by how well you function on different amounts of sleep, and as such, there is quite a bit of variation on what is considered normal and needed. For many adults, the average normal amount of sleep is around 7.5 hours per night. Many of you know people that can function on much less, and others that require as much as 9 hours per night. In general, your body feels most rested if you awaken at the end of a full sleep cycle. Given that each cycle takes about 90 minutes, many people find that they’re more refreshed if they sleep some increment of 1.5 hours (e.g., 6, 7.5 or 9 hours).
If you are getting what you consider to be an adequate amount of sleep but are still unrefreshed and sleepy, then you might have an organic sleep disorder and should consider seeking professional consultation. Throughout this week, Straight, No Chaser will review several sleep disorders. Until then, sweet dreams.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what 844-SMA-TALK and http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

Straight, No Chaser: Insomnia – You are Not Getting Sleepy…

April 1, 2014Health Prevention844-SMA-TALK, Circadian rhythm, Conditions and Diseases, Edward R. Murrow, health, Insomnia, Night, Sleep apnea, Sleep deprivation, Sleep disorder, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Talking about insomnia makes me, well, tired. You know what the problem is. You either can’t fall asleep or you can’t stay asleep. You’re tired when you wake and throughout the day. Lack of sleep saps your energy and your productivity.

Insomnia really isn’t very cool to deal with, either as a person or as a physician. Patients are frustrated and sometimes cranky from being tired, or they can be extremely nervous and stressed, which will perpetuate a vicious cycle. There are so many mental factors that can disrupt your ability to sleep.

Medical professionals tend to think of insomnia in two forms for purposes of evaluation. Either the insomnia is the main problem (primary insomnia), or it’s secondary to another condition (secondary insomnia) such as reflux, uncontrolled asthma, arthritis or other pain syndromes. It could be due to medications, depression or just stress. It could be due to some undiagnosed condition, such as cancer, an enlarged prostate (making you have to get up to urinate throughout the night), thyroid disease or sleep apnea. Then there’s the caffeine (coffee/tea), nicotine (cigarettes) and drunk scene (alcohol).

The thing is, whether acute, intermittent or chronic, any type of insomnia really is an inconvenience and can even be incapacitating. Before you subject yourself to a million dollar medical workup, just remember: If it’s secondary insomnia, and you know (for example) that your pain is keeping you awake, try dealing with the primary issue. Alternatively, if it’s primary insomnia, there are a lot of things you might try. In fact, consider this my Top Ten Tips presented in the order you might consider implementing them.

Adhere to good diet and exercise habits, which make your body perform as it should and which will clean up a lot of potential problems that will affect sleep.
Avoid naps during the day. You want to be good, tired and ready to sleep when night comes.
Develop the habit of only using your bed for sleep or sex. That conditions your body to be ready to sleep when confronted with the stimulus of your bed.
Get your snoring partner some help if s/he is part of what keeps you awake. Check here for tips to deal with snoring.
Try not to eat for several (3-4) hours before you sleep. Nothing says “no sleep” like heartburn all night. (By the way, this is the real reason you shouldn’t eat after a certain hour – not concerns about your weight.)
Avoid nighttime stimulants (e.g., cigarettes, coffee, tea and exercise close to the time you want to sleep, if this proves to be a problem).
Don’t drink and sleep. Although alcohol is a sedative, it’s also on the “don’t do” list, because it can cause restless sleep and interrupt the sleep cycle.
Find a way to relax before sleep. Consider a bath, sex, a book or soothing music … or all of them.
Set the alarm for the morning. Then hide your clock. You don’t need to have a clock to remind you that you aren’t sleeping all night.
Use “white noise” for background if you’re bothered by other sounds.

Here’s a bonus tip: If you fell asleep during the reading of this post, keep it for future reference.
As Edward R. Murrow used to say (well before I was born),

Good night and good luck.

Straight, No Chaser: The Horror of Night Terrors

March 18, 2014Pediatrics/Kids Health, Sleep, Health PreventionConditions and Diseases, health, Night terror, Sleep, Sleep deprivation, Sleep disorder, Sleepwalking, StressJeffrey Sterling, MD

I wonder how many of you have been exposed to night terrors. These are different than nightmares, which we all know and experience. In a nightmare, Little Johnny has had a bad dream, maybe thinking there’s a monster under his bed. He wants to be comforted by you, and he is still upset the next morning. That’s not what a night terror looks like.
During a night terror, Little Johnny may be sleep walking, or he seems to wake up in the middle of the night and just starts screaming. He’s really not communicative; he’s just terrified. These episodes generally last about 15 minutes. Then he goes back to sleep. The next morning, the child has no recollection of the event.
The cause of night terrors is unknown but they seem to be triggered by emotional stress and lack of sleep. Febrile illnesses also seem to correlate with the presence of these episodes.
Who gets these? Children less than age seven, more frequently boys. These episodes usually stop by age 10. There often is a family history.
There’s really no testing or treatment for these until they are frequent and prolonged, or unless a secondary injury occurs from all the trashing about.
I bring this to your attention because many parents are aware of this phenomenon and have no idea what to do when it occurs. My best advice is to ensure that the child is safe during the episode for otherwise stress free children. You may want to consider medical or psychological screening if the problem worsens. Sleep well…
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress, Facebook @ SterlingMedicalAdvice.com and Twitter at @asksterlingmd.
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Straight, No Chaser: Sleep Apnea

December 17, 2013Sleephealth, Hypertension, Non-rapid eye movement sleep, Obstructive sleep apnea, Sleep, Sleep apnea, Sleep disorder, Slow-wave sleep, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

Diabetes
Heart attacks
Heart failure
High blood pressure
Irregular heartbeats (arrhythmias)
Obesity
Strokes

Click here for a discussion of normal sleep and how much you need a day.
Click here and click here for discussions about insomnia.
Click here for a discussion of night terrors.
Click here for a discussion of hypersomnia (excessive sleepiness).
Click here for a discussion of narcolepsy (sleep attacks).

Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

Straight, No Chaser: Understanding Normal Sleep and How Much Sleep You Need

December 15, 2013SleepNon-rapid eye movement sleep, Rapid eye movement sleep, REM, Sleep, Sleep apnea, Sleep deprivation, Sleep disorder, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, WordPressJeffrey Sterling, MD

Do you ever think about why we sleep? Our bodies are highly efficient machines that utilize a lot of energy over the course of a day. In particular, our brain utilizes a lot of oxygen and energy. Sleep is meant to be a process organized by the brain and responsive to our body’s needs. Sometimes those needs are immediate, and sometimes those needs are scheduled. Contrary to what is often thought, we’re not designed to just black out when we’re tired. Sleep is actually a process orchestrated by the brain.
How and when we sleep is governed by a number of factors. These include factors under our control, such as whether or not we are sleep deprived, and factors beyond our conscious control. Chief among the latter consideration is the fact that we actually do have an internal “clock” that regulates our biologic rhythm (also called a circadian rhythm) over a 24-hour period. The circadian rhythm maintains our sleep-wake cycle and prompts us to want to sleep during similar times of the day and/or night. Sometimes that internal rhythm and the body’s routine call for sleep can be disrupted, making sleep a response to abnormal functioning within the brain (such as occurs in narcolepsy).
Sleep also has an internal organization—the sleep cycle—regulated by different areas of the brain. Sleep occurs in two stages, which recur through the night: rapid eye movement (REM) sleep and non-rapid eye movement (non-REM) sleep. Non-REM sleep is further divided into four stages (1 through 4), with stages 3 and 4 often referred to as “deep sleep.” In adults, non-REM sleep occupies around 80 percent of the night, and REM sleep 20 percent. REM sleep occurs every 90-110 minutes. These cycles recur until we awaken due to a schedule or decision to arise. You will feel most refreshed after sleeping and waking up at the completion of the final stage in a sleep cycle.
The body replenishes and restores itself during non-REM sleep, releasing hormones to repair damage done during the day. During REM sleep, you process memories and thoughts from the day and you dream. As best as we understand dreams, they also represent a form of processing mental information that you received during the day. During REM sleep, we normally lose the use of our limb muscles. Yes, it’s true that while we’re sleeping (at least in REM sleep), we have an active mind in an inactive body. This is actually a good thing. This normal loss of muscle activity during REM sleep helps prevent us from acting out our dreams. Thus, it stands to reason that sleepwalking and night terrors usually occur in non-REM sleep. When disorders of REM sleep occur and patients lose that protective phase of muscle inactivity, patients may act out violent dreams and harm themselves or others.
How much sleep you need is best defined by how well you function on different amounts of sleep, and as such, there is quite a bit of variation on what is considered normal and needed. For many adults, the average normal amount of sleep is around 7.5 hours per night. Many of you know people that can function on much less, and others that require as much as 9 hours per night. In general, your body feels most rested if you awaken at the end of a sleep cycle. Given that each cycle takes about 90 minutes, many people find that they’re more refreshed if they sleep some increment of 1.5 hours (e.g., 6, 7.5 or 9 hours).
If you are getting what you consider to be an adequate amount of sleep but are still unrefreshed and sleepy, then you might have an organic sleep disorder and should consider seeking professional consultation.
Additional Straight, No Chaser Blogs have addressed several of the sleep disorders.

Click here and click here for discussions about insomnia.
Click here for a discussion of night terrors.
Click here for a discussion of hypersomnia (excessive sleepiness).
Click here for a discussion of narcolepsy (sleep attacks).
Check back for a discussion of sleep apnea.

Straight, No Chaser: Narcolepsy – The Sleep Attack

December 14, 2013SleepCataplexy, Conditions and Diseases, Excessive daytime sleepiness, health, Narcolepsy, Sleep apnea, Sleep disorder, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No ChaserJeffrey Sterling, MD

This is part of a series on sleep disorders.

Click here and click here for discussions about insomnia.
Click here for a discussion of night terrors.
Click here for a discussion of hypersomnia (excessive sleepiness).
Check back for a discussion of sleep apnea.

To better understand this condition, let’s look at certain truths of narcolepsy.

Narcolepsy doesn’t happen just because you’re tired.

Narcoleptics have severe disruptions of the activities of daily living.

Narcoleptics are likely suffering from other sleep disorders.

In addition to the sleep attacks, the main symptoms are excessive daytime sleepiness and cataplexy.

There’s no special rhyme or reason to who suffers from narcolepsy.

Check back for a discussion of causes, diagnosis and treatment of narcolepsy.

Straight, No Chaser: Why Are You So Sleepy?

December 13, 2013SleepConditions and Diseases, health, Hypersomnia, Sleep apnea, Sleep disorder, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, Twitter, WordPressJeffrey Sterling, MD

This is part of a series on sleep disorders.

Click here and click here for discussions about insomnia.
Click here for a discussion of night terrors.
Check back for discussions of narcolepsy and sleep apnea.

Are you one of those individuals who is always tired and sleepy? You take iron, you exercise and you’re getting sleep at night. However, you’re still tired? What’s that about?
Hypersomnia (i.e., excessive sleepiness) is characterized by prolonged nighttime sleep and/or recurrent bouts of excessive daytime sleepiness or prolonged nighttime sleep. This is not the variety of sleepiness due to physical or mental exhaustion or insufficient sleep at night. Hypersomnia makes you want to nap repeatedly during the day. Ironically, even if you do take a nap or even after you sleep overnight, you’re still fatigued.
The functional importance of this is somewhat obvious. Hypersomnia interrupts your life, your work, your ability to normally interact with others. Symptoms are what you might expect from someone not getting enough sleep. Here’s a typical list:

restlessness
anxiety and irritation
decreased energy
slow thinking
slow speech
loss of appetite
hallucinations
memory difficulty
loss the ability to function in family, social, occupational, or other settings

Hypersomnia is difficult. It takes time to realize you’re affected beyond just regular fatigue. It’s also difficult to pin down the cause. Consider the following potential groups of causes:

Physical causes may include damage to the brain (e.g., from head trauma) or spinal cord, or from a tumor.
Medical and mental/behavioral health causes may include obesity, seizure disorder (epilepsy), encephalitis, multiple sclerosis and other sleep disorders (e.g., sleep apnea, nacolepsy).
Mental/behavioral health causes may include depression, drug or alcohol use.
Medications or medication withdrawal may cause hypersomnia.

Unfortunately, treatment is symptomatic and often requires some degree of trial and error. For some individuals, stimulants, antidepressants and other psychoactive medications are effective. For others, behavioral changes appear to be more effective.
Any disruption in the quality or amount of sleep warrant investigation. Discuss your concerns with your physician if you have the opportunity. You always have the option of discussing with your SterlingMedicalAdvice.com expert consultant.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

Straight, No Chaser: Your Rebuttals and Questions about Insomnia

August 30, 2013Medical Treatment, Sleep, Health PreventionBenadryl, Conditions and Diseases, Emergency department, Gamma-Aminobutyric acid, health, Home Page, Insomnia, Sleep deprivation, Sleep disorder, Sleep Disorders, Somnolence, StimulantJeffrey Sterling, MD

You are certainly an entertaining group behind the scenes. Here are some of your questions on insomnia. Be reminded that should you want to leave me a private question, just go to the Home Page, or type https://jeffreysterlingmd.com into your browser. Here’s five questions from this morning’s post on insomnia.
1. Aw, hell! You’re telling me I can be dying from something causing insomnia?

It’s way more likely that level of stress you’re displaying is keeping you awake at night.

2. How is it that sex makes you sleepy?

When you do exert yourself vigorously, the greater utilization of muscles will deplete glycogen (energy) stores and make you drowsy. Also, it’s well established that certain hormones (e.g. prolactin, GABA and oxytocin) that promote sleep are released after an orgasm.

3. You mentioned tea. A good cup of tea at bedtime helps me sleep.

If that works for you, go for it. Some people have paradoxical effects to stimulants (In fact, stimulants are the most common treatment for ADHD – a topic for another day.)

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