For years is has been understood that doctors take call and could have been up the night before you have an elective surgery the next day. During training I would go days in a row with minimal sleep and I just considered it the norm. I knew it affected my work, but as a resident we just pushed through. Now there are increasing guidelines for training programs making sure that residents have enough sleep.

The real problem is that there are no regulations for surgeons in private practice. Most surgeons are required to cover the ER call on a rotation basis. There is a good chance that a surgeon could be up most of the night and still have a full day of elective surgery the next day. The question is….. “Does being sleep deprived affect the surgeon’s performance?”

This is the question you should be asking as either you or family members come in the morning of surgery for an elective procedure. A recent study in the American Journal of Surgery (http://www.americanjournalofsurgery.com/article/S0002-9610(11)00616-7/abstract) showed that surgeons who don’t get enough sleep can still do the learned tasks as well as rested surgeons. However, their brains had to work much harder to accomplish the same task. What this means is that as long as the procedure went as planned everything was the same between rested and sleepy surgeons. But when an unexpected problem arose, then the tired surgeons had an increased difficulty adapting to the changing circumstances.

Likewise in a recent JAMA article(http://jama.ama-assn.org/content/302/14/1565), is was shown that there are actually more complication when surgeons have less than 6 hours of sleep the night before. This is in line with studies showing that pilots, truck drivers and train conductors also have impaired reaction times when tired.

So what are we to do. Surgeons are still required to take call. Patients want their procedures at the scheduled time as they have made multiple arrangements to adjust their lives for that day and the post op period. Moreover, the surgeon doesn’t want to constantly reschedule his practice when he has to unexpectedly work the night before.

It’s a real problem!! I think as the patient, you have the right to ask your surgeon if he/she had a good night’s rest. If not, remember the procedure is often elective and you can reschedule for another day. It is also the surgeon’s responsibility to have the patient’s best interest at heart. If he/she is too tired to work at their best, they can also make the decision to postpone the procedure to another day.

Even though working with fatigue has been part of the culture of medicine for many years, it’s time to take a long look at what we can do to ensure that surgeons have enough rest prior to performing elective cases. The more we learn about the effects of lack of sleep, the more we can hopefully prevent unnecessary complications. Once again we see how important sleep is and how much it can affect every aspect of our daily lives!!

                          

Here are the main points the survey uncovered:

Hard Day’s Night. About 40 percent of Chicagoans surveyed experience problems at work due to lack of sleep.

Everyone does it (almost). Nearly 70 percent of people say that there is at least one person in their household who snores.

Disrupted slumber. More than 60 percent of respondents report being awakened by their partner’s snoring. More than a third of Chicagoans surveyed have been awakened by their own snoring!

Snorers keep out! About a third of survey respondents have slept apart to get away from a snoring partner.   (One in every three respondents)

Snoring tests relationships.  Nearly 30% of people surveyed say snoring causes problems in their relationships.

Snoring takes a toll on your sex life. Nearly 20% of respondents who snore say if they didn’t snore they would possibly have more sex with their partner.

Snoring Breakups. Nearly 46% of respondents say they would consider dumping a dating relationship if his or her snoring kept them from getting a good night’s sleep.

Take care of your snore! More than 60 percent of Chicagoans surveyed believe that snoring warrants treatment.

Additionally:

*More than half of the survey respondents reported suffering from seasonal allergies, 49% of which treat them with over the counter medication.

**When asked which professional athlete they think snore the most, most respondents guessed the Chicago Bears, specifically Brian Urlacher!

                          

Even more surprising was that people who only “snorted or stopped breathing” on average 5 nights a week, but didn’t have sleep apnea, showed an increased risk of depression as well. Men with these symptoms had 5 times the risk, while women were twice as likely to develop depression. The study doesn’t go into why, but this is one more example of how sleep affects all aspects of our lives.

So, if you or your partner snore or have developed sleep apnea, consult your doctor. This could be a reason you have been more depressed lately. Improving your sleep could make all the difference. Call us today at The Snoring Center and let’s get you sleeping better. Good sleep is essential to good mental health!!

Sleep article abstract: http://www.journalsleep.org/ViewAbstract.aspx?pid=28460

                          

Disturbed sleep widely impacts our day-to-day mood and behaviors.  Below is a series of questions and answers looking at the effect poor sleep may have on our health—specifically our stress hormone levels, appetite, metabolism, and mood.

Poor sleeping habits affect the production of cortisol and adrenaline in what way?  What are the consequences of that? 

Poor sleep can lead to an increase in the production of cortisol and adrenaline, which are also referred to as the “stress hormones.”  Generally speaking, having a chronic higher level of stress hormones can increase the risk of high blood pressure, heart disease, heart attack, and stroke.

• Does lack of sleep affect your hunger levels and the type of foods you crave?

Yes, it can, particularly an acute lack of sleep.  Research has found that subjects who had a limited night of sleep had more cravings for high-calorie, carbohydrate-rich foods, and in fact did eat on average over 500 calories more in a day without increasing their activity level.

• What about the effect on metabolism? Does lack of sleep slow down your metabolism? Does it affect how your body processes and stores fat?

Over the long term, certainly metabolism can be affected, but it’s a more complicated picture.  Let’s go back to cortisol–which is one of the stress hormones that is critical for health, when in proper balance. 

The increased levels of cortisol that can occur with poor sleep may lead to complications such as high blood pressure, glucose intolerance and diabetes, osteoporosis, hair loss, cold intolerance, acne, and low libido.

In terms of fat storage, when in a high cortisol state, the body tends to deposit fat around the middle—leading to abdominal weight gain.

• Comment on this statement: “One of the common symptoms of sleep debt is that inability to wind down come evening time.” 

Well, again referring to the increased levels of stress hormones present, these higher levels of cortisol and adrenaline may cause you to feel like you’re in ‘overdrive.’  You may feel tired, yet wired; you may have a higher sense of anxiety; you may have scattered or racing thoughts and not be able to focus; you may have a shorter fuse. 

• Does poor sleeping affect how easy your body heals (for example, from illness or from an intense workout)? Are you more likely to suffer from pains and aches if you don’t sleep well or enough?

Poor sleep definitely affects how well the body heals.  We know that sleep loss impairs immune function, and sleep architecture is altered during infection to improve the body’s defenses.

It also appears that poor sleep, or sleep deprivation, can increase the likelihood you will suffer from aches and pains.  For example, one study looked at a healthy group of middle-aged women and deprived a portion of that group of slow wave sleep (the deepest stage of sleep) for a period of three days.  In response, those women showed a decreased tolerance for pain and increased levels of discomfort and fatigue. 

Overall, despite a significant amount of research into sleep and sleep disorders, there are still large gaps in terms of our current knowledge—not the least of which is exactly why we require sleep.

                          

“Gremlin?  No, ghrelin.”

This month the American Heart Association meeting in San Diego presented a study that further supports the idea that lack of sleep contributes to obesity.

Researchers at Mayo Clinic in Rochester, MN, tested whether lack of sleep altered the levels of the hormones leptin and ghrelin, increased the amount of food people ate, and affected energy burned through activity.  The hormones leptin and ghrelin are associated with appetite.  Ghrelin, which is produced in the gastrointestinal tract, stimulates appetite, while leptin, produced in fat cells, sends a signal to the brain when you are full.

The researchers studied 17 normal, healthy young men and women for eight nights, with half of the participants sleeping normally and half sleeping only two-thirds their normal time.

Participants ate as much as they wanted during the study.

Researchers found:

• The sleep deprived group, who slept on average one hour and 20 minutes less than the control group each day, consumed about 550 more calories per day.
• The amount of energy used for activity didn’t significantly change between groups, suggesting that those who slept less didn’t burn more calories.
• Unexpectedly, the lack of sleep cohort was associated with increased leptin levels and decreasing ghrelin — changes that were more likely a consequence, rather than a cause, of over-eating.

Leptin and ghrelin are two hormones that have been recognized to have a major influence on energy balance.  Leptin is a long-term regulator of energy balance, suppressing food intake and thereby inducing weight loss.  Ghrelin on the other hand is a fast-acting hormone, playing a role in meal initiation.

In light of this study, what if you feel that you go to bed early to get a good night’s rest, but still feel fatigued and are having difficulty with weight maintenance?  Obstructive sleep apnea, which snoring is a common sign, may be the issue.  The disruptions suffered in sleep apnea effectively reduce the amount of restorative sleep. 

Patients who suffer from sleep apnea are more likely to be obese.  Patients with sleep apnea also have uncharacteristically high levels of leptin.  What’s more, when their apnea is treated, leptin levels drop — and somehow that helps them to lose weight.

So why does low leptin seem to cause weight gain in some folks while allowing others to lose weight?  One theory says that it may not be the level of this hormone that matters so much as a person’s individual response to it.  In much the same way that obese people can become resistant to insulin and develop diabetes, people with apnea may be resistant to the fullness signal that leptin sends to the brain.

It is known that in obese subjects the circulating level of leptin is increased, whereas the level of ghrelin is decreased. It is now established that obese patients are leptin-resistant. However, the manner in which both the leptin and ghrelin systems contribute to the development or maintenance of obesity is still not clear, and continues to be studied.

Until doctors do know more, most experts agree that if you are dieting, making sure you get at least 7 to 8 hours of sleep a night is not a bad idea, particularly if you get six hours of sleep or less a night currently.  You may just discover that you aren’t as hungry, or that you have lessened your craving for sugary, calorie-dense foods that you reach for just to stay energized.  This change alone translates to fewer calories consumed.

And again, on the other hand, if you already sleep a lot, or you increase your sleep and feel even more tired, you should talk to your doctor. Experts say you may be one of the thousands of people with undiagnosed sleep apnea.

Simply put, with continued research, more and more data shows that you simply can’t cut back on sleep without paying some price.

                          

Allergy Season is Early this Year!!  By Dr. Paul Fulmer, MD

Everyone who suffers from allergies knows that when the trees start budding and the flowers bloom they better get ready!!  Allergy season is upon them.  For most sufferers, taking an antihistamine or a nasal spray will usually do the trick.  However, there are several things you can do to help minimize the side effects associated with allergies.

First, AVOIDANCE!!  Always try to avoid going outside during your most allergic time of year. Get someone else to do the yard work or clean the back porch. Second when you have to mow the yard or work in the flower beds, use a mask to help decrease the allergy load to your system. Third, after being out in the wind and allergic environment, come in and take a shower, rinse your nose with salt water nasal spray (normal saline) and change your clothes. This will often minimize your suffering and decrease your nasal congestion.

If you always seem to have allergies in the spring, consult with your doctor.  There is a good chance you could be given a prescription for a nasal steroid spray (i.e. Flonase, Nasacort AQ, Nasanex) in combination with an over the counter antihistamine (i.e. Claritin, Allegra, or Zyrtec.)  This could help control your symptoms.

However, if you are already using the above medicines or are frustrated with the need to have to continue to use them, you may be a candidate for a different treatment.  Chronic sufferers of nasal congestion can benefit greatly from a relatively new procedure called Turbinate Coblation.  This involves using radio frequency energy to shrink the tissues along the side walls inside the nose for lasting improved airflow and significant decreased congestion.  This simple 15 minute in office procedure is painless and you’re back at work the same day.

Visit us at www.snoringcenter.com and learn more about this exciting and innovative way to improve your nasal breathing and decrease the symptoms associated with allergies this time of year.

                          

Learn more about The Snoring Center minimally invasive treatments for snoring and sleep apnea.

                          

Daylight Saving- Great Time to Reset Your Sleep Habits

It’s that time again.  I know it feels as if we just turned our clocks back by one hour, how could we possibly be springing ahead so soon?  Well, that sense of Daylight Savings Time (DST) sneaking up on you a lot earlier than you remember growing up is not just due to the flight of time as we age.  The current time frame that the US employs for DST went into effect only 5 years ago, in 2007, giving us one full month more of increased sunlit hours in the evenings than we used to have.  We all need to transition from Standard Time (ST) to Daylight Savings Time (DST) earlier in the year than we used to, and transition back later than we used to.  Since 2007, we are expected to move our clocks one hour ahead starting the second Sunday of every March—which happens to be this Sunday, March 11, 2012.  We used to start DST the first Sunday of every April, and switch back to ST the last Sunday of every October.  Now we switch back the first Sunday of every November.

For some, even these small changes could adversely affect sleep—particularly since they now happen seemingly in such quick succession.  So, it may be wise to not only set your clock, but also to make a concerted effort to reset your sleeping habits as well, so as to minimize the risk to the quality of your rest.

Some tips to manage your sleep habits at this time of year include:

• The weekend of the time change, go to bed half an hour earlier than usual on Friday night and an hour earlier on Saturday night. Then get up a half hour earlier than usual on Saturday morning and an hour earlier on Sunday to spread out your body’s adjustment period over two days instead of having it all hit on Sunday morning.
• Plan Saturday’s activities, including meals, an hour earlier than normal to train your body for the change on Sunday.
• Set the clocks ahead one hour at 6 pm on Saturday afternoon instead of at bedtime to start the adjustment early.
• Avoid spending more time in bed than needed.
• Set your alarm to wake up at the same time you normally would on Sunday. Whatever you do, don’t sleep in on Sunday morning. Sleeping late just prolongs your body’s adjustment period into Monday, when you have to go back to work.
• If the weather allows, go for a walk or plan some other outdoor activity on Sunday morning. Getting sunlight helps your body adjust and promotes a better night’s sleep Sunday night.
• Avoid the temptation to take a nap on Sunday. Like sleeping in, a nap prolongs the adjustment period and makes it harder to go to sleep on time Sunday night.
• If you have any problems with your heart, get plenty of sleep and limit your stress the week after daylight saving time. A 2008 New England Journal of Medicine study noted a 5 percent increased risk of heart attack during the first three days after the time change.
• On Monday, eat a high-protein diet and limit your caffeine so you can get to sleep on time.

Learn more about The Snoring Center minimally invasive treatments for snoring and sleep apnea.

                          

Learn more about The Snoring Center minimally invasive treatments for snoring and sleep apnea.

                          

National Sleep Awareness Week

Today begins National Sleep Awareness Week. Sleep is such an important part of our lives. Studies have shown that 21% of females and 30% of males are “sleepy”. A recent poll done by the National Sleep Foundation shows that one quarter of train operators and pilots report being sleepy on the job and admit that this has affected their work performance. Most of these workers attributed their lack of sleep to crazy schedules and poor sleep habits. Even though many of these workers do admit to taking frequent naps throughout their day to help keep their performance at its best, it is still very troubling that such a high percentage are impaired on the job.

What can you do to improve your sleep? Taking proactive steps toward correcting your sleep hygiene is the first step.

1). Go to sleep and wake up at the same time each day

2). Avoid bright light in the evening, but make sure to get plenty of sunlight during the day. This lets your “body clock” help in your sleep/wake cycles.

3).Choose a relaxing bedtime ritual such as a warm bath and some relaxing music.

4). Make sure your bedroom is conducive to sleep. Cool, dark, and quiet with a comfortable bed and pillows.

5). Use your bedroom for sleep and sex. Keep computers, TV’s and work materials out of the bedroom. This will strengthen your association of bed and sleep.

6). If you can’t sleep, get up and go into another room for a bit and do something relaxing. Then once you feel more tired you can return to bed.

7). Exercise regularly, but avoid strenuous exercise close to bedtime.

8). If you try these tips and continue to have excessive daytime tiredness, snoring or ” stop breathing” episodes, then you should contact your doctor.

Remember, sleep is an important part of each day and helps set our biological clock for the rest of the day. Getting enough sleep is essential to improved work performance and a better quality of life. So use this National Sleep Awareness week as a jump start toward getting better sleep for 2012.

Learn more about The Snoring Center minimally invasive treatments for snoring and sleep apnea.