Sleep & Wellness Magazine - Dreaming

INSPIRING DREAMS

From Lauri At The Dream Zone

SPRING 2014 // ISSUE 7 COMPLIMENTARY COPY

WHAT IS

LUCID

COPD AND SLEEP DISORDERED BREATHING: PARTNERS IN CRIME?

DREAMING?

How Does It Work?

And Crucially, Can It Help Us To Sleep Better?

From the American Association for Respiratory Care

A CLINICAL PERSPECTIVE FROM

DR.DEMENT THE FATHER OF SLEEP MEDICINE

ademy ing Ac leep h t a e r &B to S Sleep roach ry app ecialists, erican a m n A li e ip c p Th ulti-dis Sleep S oday! s, Join T t to offer a m ucation for itioner t c a r P d s e e ir f s e r e u p id h e v ro is t ts, N , Sle e. We p , Dentis ry Therapists . Our patient Medicin rofessionals o ff t a a t s ir will esp lP ffice paigns Medica Assistants, R viders and o m a c s s ian ne o be a Pro Physic nd well ls you need t cons, DME a t is p e g le lo s o t o Techn n and public curren tient to the pa he way with ded to io t n educat sist you with s te as ho lead ucation is in work further e Provider w d e ll who . a is r h o f r .T a e n C ecialist in io p p t ic S a e d Sle educ Sleep e ep me d r le a ie s c if f t in o er cepts quality the Board-c ce the of a ll e enhan r b the um under

UPCOMING EVENTS Sleep & Wellness 2014: A Conference for Healthcare Professionals: Keynote (William Dement, MD) On-demand Courses to prepare for your BRPT Boards Monthly Live Webinars Scoring Workshops on-demand Fall Online Grand Rounds for Sleep Professionals

Visit our website www.americansleepandbreathingacademy.com for more details or call 866-272-3226

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S PRIN G 2014 • S LEEP & WELLNESS MAGAZINE

CONTENTS THE DREAMING ISSUE ISSUE NO. 7

FEATURES

16 SLEEP MEDICINE: A MAJOR CLINICAL DISCIPLINE WRITTEN BY WILLIAM C. DEMENT, M.D., PH.D, DSC. HON

34

36

40

42

HAVE DIABETES? MAKE SPINNING A KEY PART OF A HEALTHY LIFESTYLE

WHAT IS LUCID DREAMING?

FROM A TIGHT CHEST TO GOOD REST

DREAM ON IT

WRITTEN BY MARCI WILLIAMS

WRITTEN BY CHARLIE MORLEY

A Breath of Fresh Air for Asthma Sufferers WRITTEN BY J. WATERMAN

WRITTEN BY LAURI LOEWENBERG

SLEEP & WELLNESS

A CONFERENCE FOR

HEALTHCARE PROFESSIONALS

MAY 1-3, 2014 S C O T T S D A L E ,

A Z

TO REGISTER OR FOR MORE INFORMATION VISIT US AT

www.sleep-conference.com or call

This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of the University of Nevada School of Medicine and American Sleep and Breathing Academy. The University of Nevada School of Medicine is accredited by the ACCME to provide continuing medical education to physicians.

The technologist and therapist portion of this conference has been planned in collaboration with the AARC. 19 credits est.

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New Diagnostic Standards for Narcolepsy Presented by Emmanuel Mignot, MD, PhD National Professional Drivers Regulations Presented by Mark Rosekind, PhD Head of the United States Department of Transportation Member Price

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Full Conference

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Our Featured Party:

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This is a great networking opportunity for sleep health professionals.

Featuring the charm of the southwest, our cowboy party on the beautiful Fort McDowell Yavapai Nation includes an old west saloon with live music, food and company.

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Physicians should claim only the credit commensurate with the extent of their participation in the activity.

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S PRIN G 2014 • S LEEP & WELLNESS MAGAZINE

CONTENTS THE DREAMING ISSUE ISSUE NO. 7

“SDB (MAINLY OSA) AND COPD ARE AMONG THE MOST COMMON PULMONARY DISEASES, SO A GREAT NUMBER OF PATIENTS HAVE BOTH DISORDERS.”

30 TART DRIED CHERRY, QUINOA & WILD RICE SALAD

12 24 “Snoring is often a symptom of obstructive sleep apnea (OSA), a condition that can have devastating consequences for your health, including an increased risk of hypertension, heart disease, diabetes, depression, and obesity.”

DEPARTMENTS

08 FROM THE EDITOR

12 COPD AND SLEEP DISORDERED BREATHING: PARTNERS IN CRIME?

WRITTEN BY JENNIFER TAYLOR

10 CONTRIBUTORS & STAFF

WRITTEN BY AMBER L GALER, BS, RRT, AND TIMOTHY R. MYERS, MBA, RRT-NPS, FAARC

11 BLINDNESS AND SLEEP

22 INFOGRAPHIC WHAT IS NARCOLEPSY?

HOW INABILITY TO SEE CAN AFFECT SLEEP/WAKE CYCLES

WRITTEN BY JULIE FLYGARE

WRITTEN BY SETH WALLACE, MD

24 THE ROLE OF THE NOSE IN SNORING AND OBSTRUCTIVE SLEEP APNEA: THE PROBLEM AND SOLUTIONS WRITTEN BY SAMUEL N. HELMAN, B.SC. AND STEVEN Y. PARK, M.D.

28 THE STUFF THAT DREAMS ARE MADE OF WRITTEN BY LISA CYPERS KAMEN, MA

32 SLEEP HEALTH WRITTEN BY RAYMOND HALL, MD

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38 SLEEP APNEA TREATMENT OPTIONS WRITTEN BY BRADLEY ELI, DDS

46 FROM DREAMS TO REALITY WIDE AWAKE AND DREAMING WRITTEN BY JULIE FLYGARE

48 THE SLEEP CORNER

SLEEP SPECIALIST IN YOUR AREA, GUIDING YOU TO BETTER SLEEP

50 THE STUFF OF DREAMS WRITTEN BY LEIGH McCLOSKEY

THE AMERICAN ASSOCIATION FOR RESPIRATORY CARE (AARC) IS THE LEADING NATIONAL AND INTERNATIONAL PROFESSIONAL ASSOCIATION FOR RESPIRATORY CARE. THE AARC ENCOURAGES AND PROMOTES PROFESSIONAL EXCELLENCE, ADVANCES THE SCIENCE AND PRACTICE OF RESPIRATORY CARE, AND SERVES AS AN ADVOCATE FOR PATIENTS AND THEIR FAMILIES, THE PUBLIC, THE PROFESSION AND THE RESPIRATORY THERAPIST.

Background: Founded in 1947, the AARC is a not-for-profit professional association with more than 52,000 members worldwide. Our primary membership consists of respiratory therapists, allied health practitioners who are trained at the 2- and 4-year college level to assist physicians in the care of patients with lung disorders and other conditions.

Respiratory therapists can be found in all areas of health care, including hospitals, home care, nursing homes, and physicians’ offices—in short, anywhere patients are being treated for lung diseases.

AARC Congress: The four-day AARC Congress is the premier educational event in the respiratory care profession. Every year, the meeting brings together more than 6,000 respiratory therapists and other health professionals from around the world, who gather to hear the latest developments in respiratory care.

Education: In addition to the AARC Congress, the Association develops and conducts a plethora of meetings, educational courses, and symposia throughout the year to provide members with opportunities to earn Continuing Respiratory Care Education (CRCE™) credits.

The newest additions to the AARC’s education line-up are online. The Association also presents regular webcasts featuring leading speakers and topics in respiratory care, which are archived for viewing any time at Webcast Central.

Contact Information: For more information, please contact us via e-mail, phone, or regular mail:

American Association for Respiratory Care 9425 N. MacArthur Blvd. Suite 100 Irving, TX 75063-4706.

Phone: (972) 243-2272 Fax: (972) 484-2720 E-mail: info@aarc.org

Advocacy: The AARC interacts with local, state, and federal government on public policies that affect our patients and our members. From Medicare and Medicaid reimbursement issues to health-care reform proposals, the AARC keeps Congress, state, and local policymakers up-to-date on the issues that are important to patient care and respiratory practice.

Publications: The Association publishes a peer-reviewed journal, RESPIRATORY CARE, and a news and feature magazine, AARC Times.

The foremost scientific journal in the respiratory care profession, RESPIRATORY CARE is listed in Index Medicus and features original research and case reports on topics such as chest radiographs, pulmonary function tests, and blood gas analyses. AARC T mes is the profession’s leading general interest publication, containing management tips, human-interest features, profiles of respiratory care leaders, and more.

Both are now available online as well.

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S PRIN G 2014 • S LEEP & WELLNESS MAGAZINE

T HE D REAM ING I S S U E

from the editor facebook.com/SleepandWellness

twitter.com/SleepnWellness

Jennifer Taylor MANAGING EDITOR

“IF I COULD TELL PEOPLE ONE THING TO PROTECT THEMSELVES AND AVOID PROBLEMS ASSOCIATED WITH TOO LITTLE SLEEP, IT IS THIS: ...THE MOMENT WHEN A CONSCIOUS EFFORT OF WILL IS REQUIRED TO KEEP YOUR EYES OPEN. DROWSINESS IS A RED ALERT THAT YOU NEED SLEEP.”

D

U R I N G F E B R U A R Y, I S T A R T T O L O O K F O R W A R D T O S P R I N G .

It seems winter has dragged on about long enough. I’m ready to go outside in a t-shirt and feel the warmth on my arms. My restlessness surprises me because I enjoy winter: Utah winters are beautiful and present many opportunities for outdoor activities. I even count shoveling snow as one of my hobbies—and yet spring seems so enticing. Perhaps I’m drawn to the promise of the new world that spring unveils every year.

Winter is still with us, but that’s all right. There are new things to discover right in this issue of Sleep & Wellness Magazine. Several of our contributors for this issue are eager to share the worlds they’ve discovered while they were sleeping.

Be persuaded to pay attention to your dreams and learn from them by Lauri Loewenberg, or let Charlie Morley entice you with promises of discovery during lucid dreaming.

You likely know that dreaming happens during REM sleep. Today, many of us understand that our nights are filled with a combination of REM sleep and non-REM sleep. However, 60 years ago, most people thought sleeping was pretty close to being dead. A researcher, William C. Dement, was among the scientists who discovered REM sleep. He has been called the “Father of Sleep Medicine” and continues his sleep research today. You can read his article in which he shares some of his experiences and touches on his current research.

< SEE PG. 16 >

This issue also explores natural remedies for asthma, the relationship between COPD and sleep-disordered breathing, and how blindness can affect sleep-wake cycles. When you’re finished reading, you can try some delicious recipes that will help you stick with your New Year’s resolutions and power through the rest of winter and into spring. Enjoy! S&W

DR. WILLIAM C. DEMENT

CUSTOMER SERVICE ©

PUBLISHING Sleep & Wellness Magazine is produced, published, and distributed quarterly by The American Sleep and Breathing Academy, LLC, Ogden, UT. The American Sleep and Breathing Academy, LLC also produces and publishes Principles of Polysomnography, Principles of Polysomnography practice examination manual, Principles of Polysomnography pocket guide, and other written educational materials key in the field of sleep. Entire contents copyright 2014 American Sleep and Breathing Academy, LLC all rights reserved. Reproduction in whole or in part is prohibited. PRODUCED IN THE UNITED STATES OF AMERICA

The American Sleep & Breathing Academy (attn) S&W Magazine Customer Care 1464 East Ridgeline Drive, Suite 104 Ogden, Utah 84405 PHONE: 866.227.3226 E-MAIL: info@sleepandwellness.net BACK ISSUES are available in digital format for 3 months after original print date online at: www.sleepandwellness.net

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S PRIN G 2014 • S LEEP & WELLNESS MAGAZINE

CONTRIBUTORS

©

Amber Galer BS, RRT, Primary Children's Medical Center, USRC: Past President Archie Roberts, MD Cindy Olsen, RPSGT Jeanette Robins, RPSGT Jessica Schweller, RRT, RN, MS, CNP Karen S. Schell, DHSc, RRT-NPS, RPFT, RPSGT, AE-C, CTTS Laree Fordyce- RPSGT, RRT, CCRP , CSE Matt Carlock Rudi Ferrate, MD Seth Wallace, MD Syed I. Nabi, MD Tala’at Al-Shuqairat, MD

THE STAFF

HEALTH AND WELLNESS EDITOR

DENTAL DIVISION EDITOR

Lisa Cypers Kamen, MA

Randy Clare

A filmmaker, positive psychology coach, author, host of Harvesting Happiness Talk Radio, professor and lecturer specializing in the field of sustainable happiness.

Lisa’s acclaimed documentary film co-produced with her now fifteen year-old daughter, Kayla, “H-Factor…

Where is your heart?” explores how people in varied circumstances find, generate and share happiness. Lisa has also published a number of articles and books entitled, Got Happiness Now?, Are We Happy Yet?, Leadership: Helping Others to Succeed and Reintegration Strategies, about combat trauma and using positive psychology principles to create wellness in a post-war new normal. In addition, she is the Happiness Expert for the Florida Department of Citrus/ Florida Orange Juice in its Take on the Day campaign.

A

R

T

&

ART DIRECTOR

Sharon Robins

AARC SPECIAL SECTION EDITOR

Timothy R. Myers, MBA, RRT-NPS, FAARC

20 years of experience in the DME and Dental sleep medicine field.

As the Senior Consultant, Distribution Management at Carefusion, he is currently working to improve patient outcomes with improved home diagnostics and innovative therapy products. He is the Managing Editor/coFounder at SleepScholar.com.

Previous experience includes President at DDMEonline.com, Vice President USA, Canada at Sleepnet Corp, and Advisory Council at Academy of Clinical Sleep Disorders Dentistry.

AMERICAN SLEEP & BREATHING ACADEMY EDUCATION COMMITTEE

Associate Executive Director of Brands Management for the American Association for Respiratory Care (AARC). He is a graduate of Lake Erie College Parker MBA Program and The Ohio State University with a Bachelor of Science degree in Respiratory Care. Previous served as AARC President for 2009-2010 and was appointed as a Trustee of the American Respiratory Care Foundation (ARCF) in 2010. He has also served as NeonatalPediatric Section Chair (2000-04), VP of Internal Affairs (2005), Board of Director Member at-large (2006-07) and CPG Steering Committee Chair and liaison to American Academy of Pediatrics Neonatal Resuscitation Steering Committee (2001-08).

AMERICAN SLEEP & BREATHING ACADEMY DENTAL DIVISION David Gergen, Executive Director Steve Carstensen, President Richard Drake, Vice- President Randy Clare, Secretary Wayne Halstrom, Sleep Director Elliot Alpher, Sleep Director Steve Marinkovich, Sleep Director Rod Willey, Standards Director Brad Eli, Pain Management Director Brian Blevins, Pain Management Director Harry Sugg, Archives Director Tara Griffin, Director

ASBA CONTRIBUTING STAFF MEMBERS Angela Kyzer Julie Thomas

CONTRIBUTING WRITERS Amber Galer, BS, RRT Bradley Eli, DDS Charlie Morley J Waterman Jennifer Taylor Julie Flygare Lauri Loewenberg Leigh J McCloskey Lisa Cypers Kamen, MA Raymond Hall, MD Samuel Helman B.SC. Steven Park, MD Seth Wallace, MD Timothy R. Myers, MBA, RRT-NPS, FAARC William C. Dement, MD,PH.D., DSC, HON

CONTRIBUTING ORGANIZATIONS

P

R

O

D

CREATIVE DIRECTOR Antoni Pham

U

C

T

I

O

PRODUCTION DIRECTOR Carline Risser

N

Accreditation Commission for Health Care American Association for Respiratory Care American Sleep Apnea Association Breather Narcolepsy Network Pro Player Health Alliance University of Pittsburgh Wake Up Narcolepsy

MANAGING EDITOR Jennifer Taylor

S LEEP & WELLN ES S MAGAZIN E • S PRING 2014

11

AND SLEEP

HOW INABILITY TO SEE CAN AFFECT SLEEP/WAKE CYCLES

WRITTEN BY SETH WALLACE, MD

PATIENT SCENARIO

A

Here is what normally happens. Light enters the eye and causes a photochemical reaction in pigments in the retina.

This reaction is kind of like flipping a switch, and electrical signals are passed down the optic nerve and on to the back of the brain, where they are processed.

DISCUSSION

There is a tiny part of the brain behind the eyes that sits next to the optic nerves called the suprachiasmotic nucleus (SCN). The SCN monitors how much traffic is going through the optic nerves.

At night, there is little activity going through the optic nerves. With morning, electric impulses start cruising down in the optic nerves, and the SCN figures it must be daytime and synchronizes itself.

24-YEAR-OLD MALE WHO HAS BEEN BLIND SINCE BIRTH HAS A LONG HISTORY OF DIFFIC U LT Y WITH HIS SLEEP S C H E D U L E . It seems like it takes longer

and longer for him to fall asleep with each night that passes, and he feels like he needs to sleep in later and later. His sleep/wake periods will become progressively more delayed, such that after nearly a month, his sleep schedule will have delayed hour by hour until he is right back where he started.

Question: Is blindness the culprit in this patient? Why does this happen?

Blindness is the cause of the progressive delay in the patient’s sleep schedule. To get an idea of what is going on, let’s first look at some basics with the internal clock in the brain. It is often referred to as the circadian clock. The prefix “circa” means around, and the suffix “dian” means day, so circadian literally means around the day. Our circadian clock isn’t exactly 24 hours; it is a bit longer, closer to 25 hours. If you had a watch that ran fast, you would have to set it back occasionally to keep it on schedule. Because our internal clocks “run fast,” we have to have a way to synchronize our clocks as the earth rotates once every 24 hours.

Can you think of a good cue that tells our brains when a new day begins a particular location on earth? How about the rising of the sun? Is it possible that somehow our internal clocks can be synchronized by the rising of the sun?

In our patient, the SCN isn’t getting the signals through the optic nerves that synchronize it with the world around it, so the patient’s clock tells him to wake up about an hour later each day.

Question: Does this daily sleep delay happen to all blind people?

Let’s pose some scenarios and see what we can determine. Let’s say that the patient has horrible focus and can’t make out any detail because everything is so blurry. Would there be the same progressively delayed sleep schedule?

No, because light is still causing activity in the optic nerve. How about if a person had a stroke which wiped out vision processing at the back of the brain resulting in blindness? If the eyes are working and the optic nerve is transmitting, the SCN still gets the word that there is light and synchronization occurs, even though that person may not be able to see.

TREATMENT Stimulating melatonin receptors is another way to signal the body that time for sleep is approaching. Melatonin is produced by the pineal gland which sits near the SCN. Melatonin production is suppressed by light, but as light decreases, levels of melatonin in the bloodstream rise. The melatonin helps regulate the circadian clock. Oral melatonin, or a new prescription medication (tasimelteon), stimulate melatonin receptors and help regulate the sleep/wake cycle.

Problems related to the circadian clock are fascinating. If you desire to learn more, you might want to research some other disorders related to the circadian clock, including delayed sleep phase disorder, advanced sleep phase disorder, shiftwork sleep disorder, and jet-lag. S&W

Dr. Seth Wallace is a native of Utah. He earned an undergraduate degree from Weber State University and received his MD from Tulane University in New Orleans. He is board-certified in sleep medicine and family medicine. Dr. Wallace is also interested in aviation and aviation medicine. He is an FAA-designated aviation medical examiner and an instrument-rated private pilot. Dr. Wallace resides in South Jordan, Utah.

Seth Wallace, MD

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COPD AND SLEEP DISORDERED BREATHING: PARTNERS IN CRIME? W R I T T E N B Y A M B E R L G A L E R , B S , R R T, A N D T I M O T H Y R . M Y E R S , M B A , R R T- N P S , FA A R C

P

A T I E N T S W I T H C H R O N I C D I S E A S E S F R E Q U E N T LY EXPERIENCE OTHER SECONDARY MEDICAL CONDIT I O N S T H AT M A K E T H E C A R E , M A N A G E M E N T A N D T R E AT M E N T O F T H E I R D I S E A S E M O R E C O M P L I C AT E D .

By several estimates, as many as 50% of US citizens have a chronic condition and half of those individuals have been diagnosed with multiple conditions. These chronic diseases may account for as much as 75% of healthcare expenditures.

Patients with chronic respiratory diseases, such as Chronic Obstructive Pulmonary Disease (COPD), are no different when it relates to data about its prevalence, secondary conditions or healthcare expenditures. This article will focus on the overlap of patients with COPD and sleep-disordered breathing (SDB).

Overview of COPD Chronic Obstructive Pulmonary Disease, or COPD, is actually a combination of several diseases. COPD is a lung disease characterized by chronic obstruction of airflow within the lungs that affects normal breathing and is considered to not be fully reversible. The most frequently reported symptoms include a cough, coughing up mucus or phlegm, difficult breathing and shortness of breath, wheezing, and chest tightness.

The specific diseases that make up COPD are chronic bronchitis, emphysema, and Alpha-One Antitrypsin Deficiency.

While the conditions that make up COPD developed from different causes, the signs and symptoms of each are similar and are often treated or managed in the same way.

S LEEP & WELLN ES S MAGAZIN E • S PRING 2014

Sleep affects breathing, including breathing control, function and muscle usage. These changes do not have a negative effect in healthy individuals but may result in significant decreases in oxygen and carbon dioxide retention in patients with COPD, particularly during rapid eye movement (REM) sleep.

Conditions that are included in COPD • Chronic bronchitis is the production of increased mucus caused by chronic inflammation in the lungs. Bronchitis is considered chronic if you cough and produce excess mucus most days for three months in a year, two years in a row.

• Emphysema is a disease that damages the air sacs or the smallest breathing parts of the lungs. This damage makes it difficult for the lungs to share oxygen with the rest of the body and remove carbon dioxide from the body. Emphysema is primary caused by exposure to dangerous fumes or substances like tobacco smoke.

• Alpha-1 Antitrypsin Deficiency (Alpha-1) is a condition passed from parents to their children through their genes.

Alpha-1 may result in serious lung disease in adults or liver disease at any age.

Overview of Sleep Disordered Breathing Sleep disordered breathing (SDB) is characterized by a collection of disorders that involve an abnormality in breathing patterns during sleep. The most common disorder is obstructive sleep apnea (OSA). OSA is manifest by recurring intermittent pauses in breathing during sleep and a combination of symptoms.

Symptoms result because of a partial or complete obstruction of the upper airway and include, but are not limited to, audible snoring, snorting, gasping or coughing. OSA interrupts sleep cycles by causing multiple arousals, thus denying the sufferer of the required amount of restful sleep. < CONTINUED >

“People with SDB usually wake up feeling

exhausted and complaining of headaches.”

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Amber Galer, BS, RRT Amber graduated from Weber State University in Ogden, Utah, with a Bachelor of Science degree in respiratory therapy. After graduation, she worked in the respiratory program as a temporary adjunct faculty member, lecturing and assisting in the clinical lab. She assisted students with their NRP certification. Amber traveled with faculty members to Ghana, West Africa, on multiple occasions for humanitarian trips. She also taught CPAP to physicians and graduating respiratory therapy students in China. She is currently employed at Primary Children’s Hospital in Salt Lake City, Utah, where she works in the outpatient sleep lab.

Amber has been involved with the Utah Society of Respiratory Care, an affiliate of the American Association of Respiratory Care (AARC), since 2008 and just concluded a term as president in December 2013.

She is the political representative for the respiratory profession and patients in the state of Utah and also works with the Tobacco Free Task Force of Utah.

The lack of deep sleep associated with SDB damages the brain and body because they cannot make and reserve energy for the following day. Learning and memory are affected by the loss of important chemicals like serotonin and dopamine. Without these chemicals, the body is unable to maintain a healthy balance or stimulate growth and development, repair muscles and tissue, and boost the immune system.

Inadequate sleep can also result in overeating and weight gain because ghrelin, a hormone that triggers hunger, is increased, while leptin, a hormone that controls the feeling of fullness, decreases.

The body tries to compensate for the disturbances in sleep by increasing the expired carbon dioxide (ETCO2) and decreasing the percentage of oxygen saturation in the blood (hypoxemia). In everyday terms, this means decreasing the heart rate and increasing the blood pressure.

Disease Overlap SDB (mainly OSA) and COPD are among the most common pulmonary diseases, so a great number of patients have both disorders. Coexistence of COPD and sleep disorder breathing (SDB) has been estimated to occur in 1% of the general adult population.

Symptoms from one disease may worsen symptoms of the other disease. Patients with this disease overlap experience more severe nighttime decreases in oxygen and increases in carbon dioxide retention than patients with either disease alone (1). They are also at a higher risk of prolonged hypoxemia (low blood oxygen) and heart arrhythmias, which can result in a higher mortality rate than one suffering from only one of the diseases.

In a recent European survey, 78.1% of patients with COPD reported some degree of nighttime symptoms (2). Survey respondents also reported that the prevalence of nighttime symptoms increased with the severity of airflow limitation. The prevalence of SDB is no greater in COPD patients than in the non-COPD population. However, other factors such as age, active smoking, swelling in the arms and legs (peripheral edema), and use of oral corticosteroids, increase the risk of obstructive apnea events.

Treatment and Management

People with SDB usually wake up feeling exhausted and complaining of headaches.

Other problems include mood swings, inability to cope well in stressful situations, an increased risk of motor vehicle accidents cause by falling asleep at the wheel, and low energy, motivation, and work productivity. Long-term health risks, which are similar to those of other pulmonary diseases, include stroke, heart attack, and hypertension.

COPD In 1998, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) was implemented with the cooperation of the National Heart, Lung and Blood Institute, National Institute of Health, and the World Health Organization. GOLD’s goals were to increase the awareness of the burden of COPD and to improve prevention and management of COPD (3).

The GOLD guidelines categorize COPD into four stages (I-IV) based on the severity of the symptoms and the disease (mild to

“AVOIDANCE OF ALCOHOL AND NICOTINE OR FOOD AND DRINKS WITH CAFFEINE BEFORE BED CAN

S LEEP & WELLN ES S MAGAZIN E • S PRING 2014

very severe). Treatment is specific to those stages and incremental as disease severity worsens.

Therapeutic options include smoking cessation, appropriate drug therapy based on symptoms and response, preventative vaccinations (influenza and pneumococcal), supplemental oxygen, rehabilitation and education programs, and continuous positive airway pressure (CPAP).

SDB Continuous positive airway pressure (CPAP) is the most common treatment for SDB and OSA. A mask seals over the nose or mouth and nose forces air to open the airway while the patient sleeps.

Supplemental oxygen can be bled into the tubing from the machine to prevent hypoxemia and related symptoms.

Surgical procedures and oral appliances are used for patients who cannot tolerate the CPAP. Special sleep pillows can also add relief for snoring in conjunction with the other procedures. Studies have shown improvement of symptoms with prolonged use of CPAP and weight loss.

Avoidance of alcohol and nicotine or food and drinks with caffeine before bed can improve the quality of sleep and decrease further risks associated with SDB and OSA. Overlap Syndrome COPD patients who experience disturbed sleep quality in addition to worsening oxygen and carbon dioxide exchange within the lungs during sleep should consider each aspect of the disorder. However, the first management principle of sleeprelated breathing disturbances in COPD should be to improve the underlying condition, which will almost invariably benefit breathing while asleep.

Correction of decreased oxygen is particularly important. In recent years, considerable interest has focused on the potential benefits of noninvasive ventilation (NIV).

Currently, CPAP with oxygen therapy as needed is the treatment of choice for overlap syndrome (3).

15

Recommended treatment for patients with overlap syndrome may include weight loss, supplemental oxygen, bronchodilators and corticosteroids, CPAP, and NIV.

Conclusion While the prevalence of SDB is not exceptionally higher in COPD patients than the general population, COPD patients are at much greater risk of short- or long-term problems. Daytime retention of carbon dioxide and pulmonary hypertension in patients known to have only one disease (either OSA or COPD), mild in severity, should prompt assessment for the other disorder.

Patients suffering from combined pulmonary diseases are at a higher risk for daily problems and death than a person experiencing one or the other. A simple visit to the pulmonologist for a pulmonary function test to determine severity of COPD and a night stay at a sleep lab will evaluate the quality of sleep and severity of SDB. Early diagnosis and prevention is the key to tackling and treating symptoms for an improved quality of life.

While each condition has its own treatment guidelines and course, individuals with overlapping conditions must be more aggressive with prescribed therapies and prevention to avoid worsening either or both conditions. S&W

Timothy Myers Associate Executive Director of Brands Management for the American Association for Respiratory Care (AARC).

Timothy Myers is a graduate of Lake Erie College Parker MBA Program and The Ohio State University with a Bachelor of Science degree in Respiratory Care. He previously served as AARC President for 20092010 and was appointed as a Trustee of the American Respiratory Care Foundation (ARCF) in 2010. He has also served as Neonatal Pediatric Section Chair (2000-04), VP of Internal Affairs (2005), Board of Director Member at-large (200607) and CPG Steering Committee Chair and liaison to American Academy of Pediatrics Neonatal Resuscitation Steering Committee (2001-08).

REFERENCES 1. Owens RL, Malhotra A. Sleep-Disordered Breathing and COPD: The Overlap Syndrome. Respir Care 2010;55(10):1333–1344.

2. Price D, Small M, Milligan G. The prevalence and impact of nighttime symptoms in COPD patients – results of a cross-sectional study in five European countries. Proc of the IV World Asthma and COPD Forum 2011.

3. Global Initiative for Chronic Obstructive Lung Disease (GOLD). http://www.goldcopd.org (accessed December 16, 2013).

4. Stanchina ML; Welicky LM; Donat W; Lee D; Corrao W; Malhotra A. Impact of CPAP use and age on mortality in patients with combined COPD and obstructive sleep apnea: the overlap syndrome. J Clin Sleep Med 2013;9(8):767-772.

IMPROVE THE QUALITY OF SLEEP AND DECREASE FURTHER RISKS ASSOCIATED WITH SDB AND OSA.”

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“REM

sleep

occupied

around

25%

of

the

night

on

average,

while the remainder was non-REM sleep.”

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SLEEP

MEDICINE:

A MAJOR CLINICAL DISCIPLINE

BY WILLIAM C. DEMENT, M.D., PH.D, DSC. HON

SLEEP AND WAKEFULNESS ARE COMPLEMENTARY PHASES IN THE DAILY CYCLE OF HUMAN EXISTENCE. ALTHOUGH I UNDERSTAND RELATIVELY LITTLE ABOUT THE EVOLUTION OF LIFE IN GENERAL AND HUMAN LIFE IN PARTICULAR, THE COMPLEXITY OF THE HUMAN BRAIN, AND THE DEVELOPMENT OF CONSCIOUSNESS AND COMMUNICATION, I HAVE ASSUMED THAT LIFE EVOLVED IN EQUATORIAL ZONES WHERE THE LIGHT OF DAY AND DARK OF NIGHT SUCCEEDED ONE ANOTHER IN A HIGHLY REGULAR MANNER WITH LITTLE, IF ANY, SEASONAL CHANGE. I ALSO ASSUME THAT AS HUMANS EVOLVED, THEY WERE AWARE THAT NIGHT DID NOT ALWAYS ENTAIL TOTAL DARKNESS. (THERE WERE THE MOON AND THE STARS, AFTER ALL.) NONETHELESS, UNTIL MAN LEARNED TO CONTROL FIRE AND THUS PROVIDE SOME LIGHT IN THE NIGHT, AS AN ANIMAL PRIMARILY DEPENDENT UPON VISION, HUMANS HAD TO PERFORM ALMOST ALL THEIR ACTIVITIES IN THE DAYTIME. OF COURSE THEY ALSO HAD A BIOLOGICAL NEED TO OBTAIN ADEQUATE SLEEP ON A REGULAR BASIS.

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SL EE P M EDI C IN E: A M A J O R C LI NI C A L DI SC IP L IN E

I vividly recall visiting the newborn nursery for the first time at the University of Chicago and seeing typical REM in many newborn infants. Nobody believed me. I also noted an even higher percentage of REM sleep in a few premature infants. Today we know that REM sleep is present in newborn babies, at a very high level: 50% of their average daily 16-hour sleep time is REM sleep.

It must be emphasized that even today, we do not know why REM sleep exists and what purpose it serves. There is vast literature of speculations on these purposes of REM sleep, but nothing is established as certain fact. It is obvious that non-REM sleep fosters alertness during the daytime and conserves calories, but that is not necessarily its primary purpose.

DREAMING

“

“

REM SLEEP IS PRESENT IN NEWBORN BABIES, AT A VERY HIGH LEVEL: 50% OF THEIR AVERAGE DAILY 16-HOUR SLEEP TIME IS REM SLEEP.

REM SLEEP It is now a well established fact that sleep consists of two entirely different states: REM sleep (a period of rapid eye movement) and nonREM sleep. This fact was discovered in the 1950’s, when it was first possible to create continuous brainwave recordings. I was one of the key researchers in those early days of sleep science, and I have continued the study of sleep throughout my professional career.

When I carried out the first allnight, continuous brainwave and eye movement recordings, I discovered the regular alternation between the two types of sleep. In addition, I found that REM sleep occupied around 25% of the night on average, while the remainder was non-REM sleep. These early findings about REM during sleep were reported and published in the scientific literature by Aserinsky, Kleitman and me, and today they are broadly accepted.

During my early studies, I observed that brain activity was elevated during periods of REM sleep, while the body was essentially paralyzed.

I suspected that REM sleep might be when dreaming occurred.

Accordingly, I scheduled a study with a series of arousals during the two separate states. After several hundred of such awakenings, it was absolutely clear that vivid, complex dream adventure stories were reported after REM awakenings, while highly simplified—or no reports at all—were reported after non-REM arousals.

It is now apparent human beings live in two worlds: the “real world” and the “dream world.” One major difference between the two is the continuity of the real world from day to day and the discontinuity of the dream world, both from one period of REM sleep to another and from night to night. Dreams may include continuing themes, but those themes are rarely obvious.

Another insight from my study of sleep and dreams was that, rather than being a virtually instantaneous scene or two, dreams actual-

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Since REM sleep was discovered in infants, there has been a controversy regarding whether babies dream during their eight hours of REM sleep. Rudiments of dream recall are certainly present in 1- and 2-year-olds, and by the time children are three or four years old, they can recall dreams nearly as vividly as adults.

People have believed that dreams were caused by stimuli from the environment, including some unique ideas like eating cheese sandwiches.

Scientific study has revealed a few facts about dreaming: • We dream in color.

• The course of time in the dream world is approximately the same as in waking world.

• Dreams are not continuous through the night, and are not very much influenced in terms of events on the previous day.

SLEEP LABORATORIES As sleep was considered essentially one step up from death for ages, studies that discovered high levels of brain activity during sleep led to a tremendous upgrade in scientific interest in sleep. Since 1952, when there was one laboratory carrying out all-night, sleep electro-physiology recording, there has been enormous growth in the discipline of sleep study.

“

PATIENTS WITH NARCOLEPSY HAVE ATTACKS OF CATAPLEXY, OR BODY WEAKNESS OR PARALYSIS THAT USUALLY ACCOMPANIES DREAMING, WHEN THEY ARE AWAKE.

In the early days, I was not allowed to study the sleep of adult females.

My professor was somewhat fearful that a scandal could result from a female staying all night in a bedroom with a male. It has been rumored for years that I got married to have a “safe” female subject.

Today there are more than 2000 sleep laboratories. The vast majority of such laboratories are clinical facilities to examine and treat individuals who have problems sleeping.

SLEEP DISORDERS The increased number of sleep laboratories and sleep studies has been instrumental in characterizing a number of sleep disorders.

Today, there are over 80 recognized sleep disorders. The most common disorders are nightmares (which range from uncomfortable to terrifying), obstructive sleep apnea (OSA), Restless Leg Syndrome (RLS), and a collection of insomnias.

OSA is the most common destructive sleep disorder. An individual who experiences 5 apnea events per hour during sleep is diagnosed as having OSA. In the U.S., it affects

“

ly involved long, continuous adventures. However, the recall of a dream was rarely as accurate and detailed as recall of a wakeful activity. Further, studies showed that individuals awakened from REM sleep varied greatly in their ability to recall their dreams—from people who never remembered a dream to people who had complex recall from every REM period arousal. An individual’s ability to recall dreams did not appear to relate significantly to other qualities of the individual, such as waking memory, IQ, or other personality variables.

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about 25% of adult males and 9% of adult females. In other words, over 30% of Americans are afflicted OSA. If OSA remains unrecognized and untreated it can eventually, mainly though the development of hypertension and heart problems, lead to death. Individuals with untreated OSA must wake up to breathe properly, so another great problem is that they tend to be tired and drowsy during the daytime. The most obvious risk in this condition is the drowsy driver.

Two other distinct disorders, which my research team characterized, involve REM sleep. The first is narcolepsy. The odd collection of symptoms that characterize narcolepsy were first reported in 1880 and continued to be a mystery until recent years. The second illness is REM Behavior Disorder. It too had to await the discovery and understanding of REM sleep before it was understood.

Narcolepsy involves a collection of signs and symptoms, which include persistent daytime sleepiness, attacks of sleep paralysis, and hypnagogic hallucinations— shapes, colors, or images, sometimes accompanied by sounds, experienced during the period between wakefulness and sleep. < CONTINUED >

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SL EE P M EDI C IN E: A M A J O R C LI NI C A L DI SC IP L IN E

“

HEALTHY SLEEP INVOLVES A SUFFICIENT AMOUNT AND CONTINUITY OF SLEEP TO AVOID SLEEP INDEBTEDNESS, OR THE CUMULATIVE EFFECTS OF TOO LITTLE SLEEP.

“

As a result of strong emotion, patients with narcolepsy have attacks of cataplexy, or body weakness or paralysis that usually accompanies dreaming, when they are awake. Narcolepsy is understood better now that we know that patients are experiencing misplaced, physical characteristics of REM sleep instead of strange, random symptoms (even though they are not asleep).

REM Behavior Disorder is the opposite of narcolepsy. Patients with this problem are not protected by the muscle paralysis that generally inhibits violent movement during dreaming. Patients can be injured or hurt others by acting out their dreams.

OUR 24-HOUR LIVES & THE NEED FOR SLEEP Today we know that it is impossible for human beings to go without sleep for more than a day or two solely because they want to. People may be kept awake for a long period of time only if they are perpetually stimulated and carefully watched by others, as their tendency to fall asleep strongly increases with cumulative time awake.

Tired people do not function well until after they are able to get some rest.

Although I have said that sleeping at night and engaging in wake activities during the day was an excellent adjustment to the earth’s rotation, with modern technology, our lives run 24 hours a day, 7 days a week. Our fire and police departments, factories, and hospitals operate around the clock. Nonetheless, most human beings sleep and dream at night.

Dr. William Charles Dement Dr. William Charles Dement is commonly known as the father of sleep medicine. He is completing his 56th year of sleep research, which has been instrumental in defining and developing the clinical discipline of sleep medicine. He has written textbooks, is the author or co-author of over 500 scientific publications, and is public policy leader in applying sleep knowledge to families, workplaces, and safer transportation throughout America.

Dement also teaches undergraduates, medical students and primary care physicians. He is affiliated with the Lowell W. and Josephine Q. Berry Professor of Psychiatry and Behavioral Sciences at the Stanford University School of Medicine, and he is the Director Emeritus of the Stanford Sleep Disorders Clinic and Research Center. Dement was appointed in 1990 as Chairman of the National Commission on Sleep Disorders as federally mandated by the U.S. Congress. He was cofounder of the Sleep Research Society in 1961 and founded and led the American Academy of Sleep Medicine for its first twelve years (1975-1987).

Dement’s “Sleep and Dreams” course at Stanford University is one of the most popular and largest classes offered.

In my onion, the biggest problem with regard to sleep is the failure to deal with the topic adequately in the mainstream educational system. Most people today have not learned about sleep or the impairments caused by sleep deprivation. If I ask a large group of Stanford University freshmen if they were taught the details of sleep knowledge in high school, the vast majority say no. As a result, they are vulnerable to the impairment of sleep disorders and sleep deprivation. Healthy sleep is associated with optimal performance. Healthy sleep involves a sufficient amount and continuity of sleep to avoid sleep indebtedness, or the cumulative effects of too little sleep. Healthy sleep is also reasonably synchronized with the circadian predisposition to sleep and wake; in other words, people with healthy sleep patterns are able to wake and sleep at the appropriate times.

I’m currently studying the effect of extra sleep on Stanford varsity athletes.

Preliminary results suggest there is a statistically significant improvement in an athlete’s personal best and their overall performance when they obtain extra sleep. There are almost no individuals who cannot obtain extra sleep by going to bed earlier than usual or sleeping later than usual. Probably most human beings go through life slowly accumulating sleep debt; at some point, they must obtain extra sleep to continue their regular activities. This cycle is repeated over and over.

Our 24-hour “on” lives make us vulnerable to the dangers of too little sleep. If I could tell people one thing to protect themselves and avoid problems associated with too little sleep, it is this: the absolute most important thing to be fully aware of is the moment of drowsiness, the moment when a conscious effort of will is required to keep your eyes open. Drowsiness is a red alert that you need sleep. If you are drowsy, stop what you are doing and rest! S&W

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I N F O G R A P H

INFOGRAPHIC

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Julie Flygare, JD is a leading narcolepsy spokesperson, awardwinning author, and blogger diagnosed with narcolepsy with cataplexy in 2007. She received her B.A. from Brown University in 2005 and her J.D. from Boston College Law School in 2009. Julie’s story has been featured by Marie Claire, ABC, NBC, Psychology Today, Huffington Post and the Discovery Channel. She is the creator of the NATIONAL SLEEP WALK, the NARCOLEPSY: NOT ALONE international awareness campaign and the first-ever Narcolepsy Mobile App. Julie currently serves on NIH’s Sleep Disorder Research Advisory Board and lives in Los Angeles, CA.

Julie Flygare

I C

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“Americans spent roughly $32 billion in 2012 in the hopes of obtaining a good night’s sleep.”

THE ROLE OF THE NOSE IN SNORING AND OBSTRUCTIVE SLEEP APNEA:

THE PROBLEM AND SOLUTIONS W R I T T E N B Y S A M U E L N . H E L M A N , B . S C . / S T E V E N Y. P A R K , M . D .

SNORE NO MORE!

S

NORING HAS PLAGUED OUR SOCIETY FOR G E N E R A T I O N S . Indeed, this cacophonous

phenomenon has been the ire of bed-partners and passers-by alike. In the late 1800s, American gunslinger and outlaw John Wesley Hardin famously shot at the bedroom of a snoring gentleman staying at the same hotel.1 Besides being an auditory nuisance, snoring has serious implications for the snorer and bed-partner.

Snoring is often a symptom of obstructive sleep apnea (OSA), a condition that can have devastating consequences for your health, including an increased risk of hypertension, heart disease, diabetes, depression, and obesity. OSA has also been associated with higher rates of heart attack and stroke.

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Snoring is often believed to be caused by nasal congestion; there are numerous examples of companies and physicians primarily targeting nasal congestion to relieve snoring and sleep apnea. Their efforts are not completely in vain, since nasal congestion is commonly found in snorers and patients with OSA, and obstructed nasal breathing is a strong risk factor for OSA.2,3,4 As far back as 1889, William Hill advocated treating nasal congestion as a means of curing “stupid children.” George Catlin, an American painter in the Civil War era, observed that American Indians, who were nasal breathers, were healthier and less prone to infection.5,6 However, recent research indicates that the answer is not so clear-cut. While treating nasal congestion can alleviate sleep-related breathing disorders, overall results in the research literature have been mixed. This article will review the role of nose in snoring and obstructive sleep apnea and highlight some relationships between treatment for nasal disorders and OSA.

GETTING TO KNOW THE NOSE From the outside, the nose appears to be an unassuming structure.

However, the interior of the nose is remarkably complex. The nasal cavity is separated by a bone and cartilage-containing structure called the nasal septum. Inside the nose, nostrils (technically called nasal turbinates) smooth airflow, humidify, filter and heat air, and even have an antibacterial effect by releasing bacteria-toxic nitric oxide.7 The turbinates are surrounded by soft tissue.

When the sympathetic nervous system, which is part of the autonomic nervous system responsible for the so-called fight or flight response, is activated, the turbinates receive less

“Snoring is often a symptom of obstructive sleep apnea (OSA), a condition that can have devastating consequences for your health, including an increased risk of hypertension, heart disease, diabetes, depression, and obesity.”

blood supply and decrease in size.

You may have experienced this phenomenon when you had a stuffy nose that was relieved by exercise, as the sympathetic system gets revved up during physical activity. Alternatively, when the parasympathetic or antisympathetic nervous system is activated, the turbinates distend and swell, causing nasal congestion.

Many blood pressure medications trigger this anti-sympathetic effect and can cause nasal congestion.

The nose typically cycles between stages of congestion and decongestion without causing any perceptible problems for an individual. However, narrow nasal passages can result in bothersome symptoms during the congestion cycle. Additionally, in some individuals with autonomic nervous system abnormalities, the nasal cycle can lose its normal regulation and lead to obstructive sleep apnea (OSA).8 The nasal entrance is the narrowest point in the human upper airway and has the highest amount of airway resistance. Skin, cartilage, muscle, and other soft tissue reinforce this valve to prevent it from collapsing during breathing. However, ethnic origins, internal nasal factors, and a history of surgeries such as rhinoplasty can cause the soft tissue envelope of the nostrils to collapse

by varying degrees. Nasal collapse can exacerbate nasal congestion caused by other conditions, such as polyps, chronic sinusitis, enlarged adenoid glands, upper respiratory tract infection, and allergic or nonallergic inflammation of the nostrils.

If an individual is susceptible, having a stuffy nose can trigger sleep apnea. Imagine breathing through a narrow straw. If air is pulled in slowly, a small amount of air comes through. However, if you breathe too hard, the straw collapses. In the case of the upper airway, partial or total obstruction of the nose can lead to collapse of downstream structures such as the soft palate or the base of the tongue.

THE ORIGINS OF A LIFE-LONG PROBLEM Some difficulties with nasal passages and breathing can begin during infanthood. A newborn, shortly after announcing his arrival with an ear-shattering yowl, breathes exclusively through his nose during the first four to six months of life. For some infants, a deviated nasal septum, which can follow trauma to the nose when an infant is delivered from the birth canal, is associated with poor positioning of the jaws and teeth and hence a higher chance of nasal congestion.9 < CONTINUED >

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“...mouth breathing is associated with up to two and a half times higher airway resistance and lower oxygen uptake in the lungs when compared to nasal breathing.”

Infants begin mouth breathing after a process called laryngeal descent, when the epiglottis and voice box begins to separate from the soft palate.10 At the same time, the widening of the arch of the mouth in general may depend on the way the child is fed.

One study revealed that communities in the United States that fed their children soft foods instead of hard foods had higher rates of dental crowding and narrowed upper and lower jaws.11 Bottlefeeding has also been shown to cause greater rates of dental crowding and narrowed dental arches.12 This in turn produces crowding of the soft tissues of the mouth and nose such as the tongue, the nasal turbinates, and septum.

NASAL OBSTRUCTION AND SNORING

Samuel N. Helman Samuel N. Helman completed his bachelor’s degree in Neuroscience at McGill University and is currently a fourth-year medical student at Albert Einstein College of Medicine of Yeshiva University in New York.

Helman's research interests include obstructive sleep apnea, angioedema and airway management, head and neck oncology, craniofacial reconstruction, and general otolaryngology.

Contrary to the prevalent view that snoring comes solely from nasal obstruction, the offending vibrations in fact originate from the uvula and soft palate. With heavy snoring, other structures, such as the tonsils, the epiglottis, and tongue base, can vibrate. It is commonly believed that snoring and sleep apnea are one in the same. However, snoring is simply the vibration of sound across soft tissues, whereas apnea is the arrest of breathing during sleep.

Obstructive sleep apnea is more related to health problems, but snoring has also been associated with behavioral troubles in childhood and a higher rate of carotid artery atherosclerosis.13,14

NASAL OBSTRUCTION AND SLEEP APNEA Multiple studies indicate that nasal congestion leads to apnea events, worsened sleep quality, disturbed sleep breathing patterns, and fragmented sleep cycles.15,16,17,18,19 When a person’s nose is congested, he must breathe through his mouth. However, mouth breathing is associated with up to two

and a half times higher airway resistance and lower oxygen uptake in the lungs when compared to nasal breathing.20,21 A number of studies also indicate that in the open and functioning nose, nasal breathing stimulates breathing and increases ventilation of the lungs, whereas an obstructed nose may trigger sleep-disordered breathing. 22, 23 Nasal obstruction has also been associated with upper airway resistance syndrome (UARS). UARS is described as frequent sleep-related upper airway resistance and flow limitation that causes arousals and sleep fragmentation but does not meet the criteria for sleep apnea or hypopnea (especially slow or shallow breathing) during a sleep study.

Like sleep apnea, UARS can lead to excessive daytime sleepiness.24 Chronic nasal obstruction also can lead to facial growth patterns in children that include an elongated and narrow face with an open-mouth posture.25

HOW DO YOU KNOW IF YOUR NOSE IS CONTRIBUTING TO YOUR POOR SLEEP, AND WHAT CAN BE DONE? Spending on sleep remedies, anti-snoring gizmos, sprays, pillows and sleep in general has reached astonishing proportions. Americans spent roughly $32 billion in 2012 in the hopes of obtaining a good night’s sleep.26 While many devices and interventions have merit, the best treatment usually begins with a visit to an ear, nose and throat physician experienced in sleep medicine.

The doctor can perform a physical exam to determine if your nose is contributing to poor sleep. A nasal speculum and a rigid or flexible fiberoptic endoscope

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REFERENCES Hardin, JW. The Life of John Wesley Hardin: As Written By Himself. Seguin, Texas: Smith & Moore. 1896.

1

Fairbanks DN. Snoring: surgical vs. nonsurgical management. The Laryngoscope.

1984;94(9):1188-92.

2

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“While many devices and interventions have merit, the

best treatment usually begins with a visit to an ear, nose and throat physician experienced in sleep medicine.”

Young T, Finn L, Palta M. Chronic nasal congestion at night is a risk factor for snoring in a population-based cohort study. Archives of internal medicine. 2001;161(12):1514.

3

Young T, Finn L, Kim H. Nasal obstruction as a risk factor for sleep-disordered breathing.

Journal of Allergy and Clinical Immunology.

1997;99(2):S757-62.

4

Hill W. On some causes of backwardness and stupidity in children. Br Med J. 1889 Sep 28;2(1500):711-712.

5

Catlin G. Shut your mouth and save your life.

Trübner & CO; 1878.

6

DeGroote, M. A., & Fang, F. C. Antimicrobial properties of nitric oxide. In Nitric oxide and infection (pp. 231-261). Springer US. 2002

7

Woodson BT, Brusky LT, Saurajen A, Jaradeh S. Association of autonomic dysfunction and mild obstructive sleep apnea. Otolaryngology--Head and Neck Surgery. 2004;130(6):643-48.

8

Podoshin L, Gertner R, Fradis M, Berger A. Incidence and treatment of deviation of nasal septum in newborns. Ear, nose, & throat journal.

1991;70(8):485.

9

Davidson TM. The Great Leap Forward: the anatomic basis for the acquisition of speech and obstructive sleep apnea. Sleep medicine.

2003;4(3):185-94.

10

Corruccini RS. How Anthropology Informs the Orthodontic Diagnosis of Malocclusion's Causes.

Lewiston:Mellen Press; 1999.

11

Palmer B. Snoring and sleep apnea: how it can be prevented in childhood. Das Schlafmagazin.

2005 Aug;3:22-23.

may be used with patients sitting and lying down to look at the anatomy of the nose and the back of the mouth and tongue to see if these areas are amenable to medication, oral appliance, nasal CPAP, or surgery. There are a variety of non-invasive maneuvers that can be performed during endoscopy to determine the amount of airway collapsibility and nasal obstruction. For some patients, the doctor may recommend imaging with a CT scan and MRI. The physician may refer you for a sleep study, called a polysomnogram, to determine the number of nighttime episodes of obstructed breathing. Patients are often referred to an allergist for skin testing and possible immunotherapy, as allergens can trigger inflammation that affects breathing.

12

Bonuck K, Freeman K, Chervin RD, Xu L. Sleepdisordered breathing in a population-based cohort: behavioral outcomes at 4 and 7 years.

Pediatrics. 2012;129(4):e857-65.

13

Lee SA, Amis TC, Byth K, Larcos G, Kairaitis K, Robinson TD et al. Heavy snoring as a cause of carotid artery atherosclerosis. Sleep.

2008;31(9):1207.

14

Taasan V, Wynne JW, Cassisi N, Block AJ. The Effect of nasal packing on sleep-disordered breathing and nocturnal oxygen desaturation.

The Laryngoscope. 1981;91(7):1163-72

15

Johannessen N, Jensen PF, Kristensen S, Juul A. Nasal packing and nocturnal oxygen desaturation. Acta Oto-Laryngologica. 1992;112(S492): 6-8.

16

Olsen KD, Kern EB, Westbrook PR. Sleep and breathing disturbance secondary to nasal obstruction. Otolaryngology--head and neck surgery. 1981;89(5):804.

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Zwillich CW, Pickett CK, Hanson FN, Weil JV. Disturbed sleep and prolonged apnea during nasal obstruction in normal men. The American review of respiratory disease. 1981;124(2):158.

18

Lavie P, Fischel N, Zomer J, Eliaschar I. The effects of partial and complete mechanical occlusion of the nasal passages on sleep structure and breathing in sleep. Acta oto-laryngologica. 1983;95(1-4):161-66.

19

Fitzpatrick MF, McLean H, Urton AM, Tan A, O'donnell D, Driver HS. Effect of nasal or oral breathing route on upper airway resistance during sleep. European Respiratory Journal.

2003;22(5):827-32.

20

Blitzer ML, Loh E, Roddy, MA, Stamler JS, Creager MA. Endothelium-derived nitric oxide regulates systemic and pulmonary vascular resistance during acute hypoxia in humans.

Journal of the American College of Cardiology.

1996;28(3):591-96.

21

Basner RC, Simon PM, Schwartzstein RM, Weinberger SE, Weiss JW. Breathing route influences upper airway muscle activity in awake normal adults. Journal of Applied Physiology.

1989;66(4):1766-71.

22

White DP, Cadieux RJ, Lombard RM, Bixler EO, Kales A, Zwillich CW. The effects of nasal anesthesia on breathing during sleep. The American review of respiratory disease. 1985;132(5):972.

23

Rappai M, Collop N, Kemp S. The nose and sleep-disordered breathing: What we know and what we do not know. CHEST Journal.

2003;124(6):2309-23.

24

Parsons WB. The Influence of Nasal Obstruction on the Form of the Face. The Lancet. 1905;166(4283):956-58.

25

TIME Magazine (Jan. 28, 2013). The Sleep Industry: Why We’re Paying Big Bucks for Something That’s Free.

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The first line of defense against sleep trouble is conservative recommendations. For example, patients with allergies that affect their breathing should avoid allergens and triggers, thus reducing underlying inflammation. Patients should also avoid eating or ingesting alcohol within three to four hours of bedtime. Nasal saline rinses may also have some benefit and are cheap and easy to use.

Your physician may also prescribe medicated nasal sprays or an anti-inflammatory medication if she determines that they may help you. Patients with sleep apnea can be prescribed a CPAP (continuous positive airway pressure) machine.

However, these devices may not be well tolerated, especially if your nose is stuffy.

Unfortunately, some patients do not respond consistently to medical therapy. When conservative options fail, nasal surgery may be the next step.

The choice of nasal procedures depends on the patient’s clinical situation. Most people will undergo septoplasty, which is surgery performed on the nasal septum, with or without a turbinate procedure. For other individuals, it may be advisable to have the tonsils or adenoids removed, nostril stiffening procedures performed, or sinus surgery.

In summary, surgery isn’t perfect, and patients should be counseled that nasal surgery is unlikely to significantly diminish sleep apnea. Nasal surgery may help you to breathe better but only cures obstructive sleep apnea about 10% of the time. The main purpose of nasal surgery in individuals with sleep apnea is to help CPAP or oral appliances work better. Surgery combined with these other treatments may provide marked relief of snoring and OSA. S&W

Steven Y. Park, MD Dr. Steven Park is an assistant professor of otorhinolaryngology at the Albert Einstein College of Medicine in the Bronx, NY. He is board-certified in both otolaryngology and sleep medicine. Dr. Park is the author of Sleep, Interrupted: A physician reveals the #1 reason why so many of us are sick and tired, which was endorsed by numerous New York Times bestselling authors including Dr. Dean Ornish, Dr. Christiane Northrup, Dr. Mark Liponis, and Mary Shomon.

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“Ideally, it is best to eat about 4 hours before bed in order to properly digest.”

THE STUFF THAT DREAMS ARE MADE OF WRITTEN BY LISA CYPERS KAMEN, MA

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WE ARE SUCH STUFF AS

DREAMS ARE MADE ON, AND OUR

LITTLE LIFE IS ROUNDED

WITH A SLEEP. -WILLIAM SHAKESPEARE, THE TEMPEST

M

OST FOLKS ARE SLEEP D E P R I V E D . In fact, it’s

estimated that 50% of all adults experience some form of disrupted sleep. Many of us walk around yearning for more peaceful rest and relaxation but are too preoccupied with the stress and strain of daily life to make satisfying sleep a priority, let alone recognize the need for it as an essential healthy lifestyle habit.

But what if I told you the secret to a healthier and balanced body weight lies in our sleep? Good sleep, that is.

The secret to slim, well-toned bodies is not a diet of prescribed weights and measures but rather a balanced lifestyle that includes training for optimal Zzz’s.

There is substantial medical evidence suggesting a direct relationship between the duration and quality of sleep and our body weight.

Experts believe that sleep disruption influences our weight, partly because the hormones that influence appetite are regulated in part by our sleep.

Ghrelin is a hormone produced in the gastrointestinal tract that stimulates the appetite; leptin, a hormone manufactured in fat cells, sends a signal to the brain to indicate when a person is full. When we don't get enough sleep, leptin levels decrease, which means we don't feel as satisfied after eating. Lack of sleep also causes ghrelin levels to rise, stimulating appetite.

At the same time, we’ve all heard the cliché expression over and over again, “you are what you eat.” We all intellectually know what it takes to lose weight: good nutrition and regular exercise. And yet these two simple, optimal lifestyle directives can seem as daunting as the thought of climbing Mount Everest. Seemingly, there is a disconnection between what common sense tells us and the choices we make to support our health and wellbeing. The rigors of life, combined with our slothful habits, do not always yield a good self-care routine.

Consider the location we visit when we sleep as our inner garden. Within this internal landscape, we rest our weary minds and bodies by restoring them both with a cycle of good solid deep sleep. For many of us, this is more easily said than done. What should be a seamless and natural bodily function can become a nervewracking, desired illusion. The seductive concept of sweet dreams can evoke an anxiety attack for the ranks of the sleep-disrupted. While the sandman sends some people off to bed with contented dreams of rainbows, unicorns and winning the lottery, others begin to hyperventilate at the thought of bedtime, triggering our thought police to be on high tactical alert.

“IF YOU DON’T TAKE CARE OF YOUR BODY, WHERE ARE YOU GOING TO LIVE?”

The good news is there is hope for our sleep-deprived planet. I humorously call it sleep foreplay. It begins at our kitchen table and rests on our meal plates. What we eat positively or negatively impacts our dream-state.

-UNKNOWN

Let’s name it kitchen table wisdom.

And I whole-heartedly believe that magic can happen around it. You see, stress and anxiety takes a huge toll on our moods, emotions, and ability to sleep well. One of the simplest ways to de-stress is to positively engage with our loved ones.

Communing around the dinner table with healthy, nutrient-rich food, engaging conversation and hearty laughter in an inviting atmosphere can set the soothing tone and attitude for the rest of the night. Kitchen table wisdom breeds connection while satisfying our hearts, minds, and bellies. Relaxation invites sleep, plain and simple.

So go ahead and test-drive a little kitchen table wisdom in your home.

Did you know that there are several foods that actually promote relaxation and induce sleep? I could probably create a cookbook of walletwise, healthy, nutrient-rich recipes designed to invite sleep.

We can all invite the sandman into our homes by preparing foods that are high in: ✓ Tryptophan, an amino acid that assists in the production of mood-balancing serotonin ✓ Low-fat protein for muscle repair, improved immune function and to fight acid reflux ✓ Magnesium to help relax muscles and calm the body ✓ Slow-burning carbohydrates to help with serotonin production ✓ B vitamins, vital to the body in manufacturing serotonin and other healthy brain-function chemicals ✓ Melatonin, a hormone manufactured in the brain that helps regulate sleep/awake cycles

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Sleep-Inducing Super Foods:

-THE STUFF THAT DREAMS ARE MADE OF-

• Turkey, a great protein source, has one of the highest levels of tryptophan of all foods followed by chicken, seafood and soybeans.

• Dairy products including milk, cheese and yogurt are protein-rich and contain high levels of soothing tryptophan.

• Nuts, beans and soy also are magnesium, B vitamin and tryptophan-rich super-foods.

Below is a quick and easy hearty anytime dinner menu guaranteed to invite some good Zzz’s and provide a happy food coma to you and yours. The best part of the stuff that dreams are made of is that it can be prepared ahead and popped into the oven at once.

• Leafy green vegetables such as kale, chard, spinach and collards are loaded with magnesium and B vitamins.

• Whole grains such as wild rice, quinoa and potatoes are slow-burning carbohydrates that boost serotonin production.

Directions:

1 Pre-heat oven to 350° F. 2 Rinse turkey breast and pat dry.

3 Place turkey breast, skin side up, on a rack in a roasting pan.

• Tart cherries, olive oil and walnuts are melatonin-rich super-foods.

A great place to start is with a simplified, quick and healthy version of a traditional Thanksgiving turkey dinner. Make it a fun anytime tradition to celebrate simple gratitude for being together as a family or with friends. Ideally, it is best to eat about 4 hours before bed in order to properly digest.

Time your meal accordingly. Set the tone by creating a soothing environment with candles and relaxing music. Retire all electronics for the night. The five minutes of extra effort will delight your loved ones and even help relax your kids. There is no need to wait for the weekend to make this happen. Every night is worthy of great rest and relaxation.

Remember a good night’s sleep is good for your brain, body, mood, performance and waistline.

Consider a solid restful and restorative sleep a most noble pursuit that delivers a high return of big time wellbeing.

4 Gently loosen the skin from the meat and evenly spread ½ mustard on the meat and the other ½ on the skin.

5 Sea salt and ground pepper to taste.

ROASTED TURKEY BREAST A gobble of gratitude at your table any day of the week PREP TIME: 20 minutes COOKING TIME: 1½ -2 hours SERVES: 6 people

Ingredients:

• 1 whole bone-in turkey breast (6-7 pounds) • ¼ cup of your favorite flavored mustard (mine is the Garlic Aioli from Trader Joe’s) • Fresh ground pepper to taste • Sea salt to taste • Smoked paprika • 1 cup vegetable/chicken stock or white wine

6 Sprinkle smoked paprika on turkey breast to aid in browning and crisping the skin.

7 Pour vegetable/chicken stock or white wine into the roasting pan.

8 Roast the turkey breast for 1½ - 2 hours. Use an instant-read thermometer inserted into several of the thickest areas of the turkey breast to check for an internal temperature of 165 degrees F to confirm doneness.

9 Check and baste occasionally. If the skin is overbrowning, loosely cover the turkey breast with aluminum foil tent. When done, cover with foil and allow it rest at room temperature for about 15 minutes before slicing and serving.

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TART DRIED CHERRY, QUINOA & WILD RICE SALAD A flavorful and satisfying whole grain side dish that can be made a PREP TIME: 30 minutes COOKING TIME: 1 hour SERVES: 6-8 people

Ingredients:

• ½ cup quinoa (available at Costco, Whole Foods, Trader Joe’s, health food stores and other fine markets) • ¾ cup wild rice • ¼ cup extra virgin olive oil • ¼ cup flavored vinegar (balsamic or berry) • Sea salt to taste • Ground pepper to taste • ½ cup chopped walnuts or almonds • ½ cup dried tart cherries (available at Costco, Whole Foods, Trader Joe’s, health food stores and other fine markets) • 2 stalks of celery, diced

ROASTED KALE CHIPS A surprisingly addictive, crunchy, healthy green the whole family will love. A great accompaniment or anytime super snack food PREP TIME: 15 minutes COOKING TIME: 15-20 minutes SERVES: 6-8 people

Directions:

1 Bring large saucepan of water to a boil over high heat. Add wild rice, and cook for about 30 minutes. Add quinoa to the saucepan with wild rice and cook both together until tender, about 15 minutes more. Drain and rinse combined grains.

Drain well to remove excess water.

2 While grains are cooking, whisk oil, vinegar, salt and pepper in a large (serving) bowl.

3 Add and combine rice, quinoa, dried cherries, diced celery, chopped scallions, diced cheese and chopped nuts. May be served at room temperature or chilled.

• 2 scallions chopped • ¾ cup of diced goat cheese or any other favorite quality cheese

ONE CANNOT THINK WELL, LOVE WELL, SLEEP WELL, IF ONE HAS NOT DINED WELL. -VIRGINIA WOOLF

4 Wash and dry kale very well.

Ingredients:

• Cooking spray • 2 bunches raw kale • 2 tables spoons olive oil • Sea salt to taste • Your favorite unsalted herb and spice blend or garlic powder to taste • Smoked or regular paprika to taste Directions:

1 Preheat oven to 350° F. 2 Spray 2-4 baking trays or cookie sheets with cooking spray.

3 Remove center stems from kale by tearing or cutting it into 2-3 inch pieces.

5 Place kale into a large bowl and drizzle with oil and spices. Massage ingredients with hands to evenly distribute them.

(Kids will love helping with this.)

6 Distribute kale onto baking trays/cookie sheets evenly in a single layer.

7 prinkle paprika across the kale to aid in browning and crisping.

8 Roast until crisp and edges are slightly browned for about 15 minutes. Watch carefully to prevent burning.

9 Repeat process until all kale is cooked.

I like to store leftovers in a brown paper lunch bag to absorb any excess oil. They are great as a lunch box food and can be sprinkled on soups and salads too. S&W

Lisa Cypers Kamen is a filmmaker, positive psychology coach, author, host of Harvesting Happiness Talk Radio, professor and lecturer specializing in the field of sustainable happiness. She is widely recognized as an expert on the subject. Lisa’s acclaimed documentary film co-produced with her now fifteen year-old daughter, Kayla, “H-Factor…Where is your heart?” explores how people in varied circumstances find, generate and share happiness. In addition to her film on happiness, Lisa has published a number of articles and books, including Got Happiness Now?, Are We Happy Yet?, Leadership: Helping Others to Succeed, and Reintegration Strategies, about combat trauma and using positive psychology principles to create wellness in a post-war, new normal. Lisa’s written work is featured on blogs for the Huffington Post, PositivelyPositive.com and InspireMeToday.com, and she is a community event speaker for TEDx, a nonprofit dedicated to Ideas Worth Spreading.

Lisa is also the Happiness Expert for the Florida Department of Citrus/ Florida Orange Juice in its Take on the Day campaign.

Lisa Cypers Kamen, MA

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SLEEP HEALTH WRITTEN BY RAYMOND HALL, MD SLEEP SCIENCE EXPERT, INVENTOR, AND SPORTS MEDICINE CHIROPRACTOR OF PACIFIC COAST SPORTS MEDICINE, LA

M

• Tired in the afternoon?

Take a nap or siesta!

Napping has been shown to improve productivity, improve alertness, reduce stress and the risk of heart disease, and reduce accidents at work and on the road. Even a work-friendly, 10- to 20-minute nap should be enough to set you up for a productive afternoon.

ORE THAN 40 MILLION AMERICANS SUFFER FROM CHRONIC SLEEP DISORDERS W I T H D E VA S TAT I N G C O N S E Q U E N C E S .

Sleep health has been neglected for so long, we’ve become a nation that is carrying the weight of increased obesity, auto accidents caused by drowsy driving (even more than texting), increased neck pain and even advanced signs of aging through poor quality and disrupted sleep.

Proper sleep hygiene, which is the routine that promotes healthy sleep patterns, can prevent the development of sleep problems and disorders as well as being an important factor in the quest to stay looking and feeling as young as possible throughout your life.

Here are recommendations to take control of your sleep health and live your optimal life:

• Be consistent with sleep. Sleep is as important to a person as fuel is to a car, both in terms of quality and quantity. You need proper sleep to run your physiological engine. Poor quality sleep is like water in your fuel tank. You can’t store extra deep sleep or REM sleep, so approach your sleep health with balance and respect. It takes approximately 90 minutes to complete one sleep cycle, and a good night’s rest includes about five full cycles. Allowing yourself enough rest has great benefits during the daytime, as you will feel rejuvenated and alert and will be less prone to illness.

• Reduce pain and improve healing responses. After 29 years of treating headaches, neck and back injuries, as well as chronic muscle and joint pain, I firmly believe that sleep disruptions or sleep deprivation can have a major impact on pain as well as healing. Disruptive sleep due to abnormal breathing patterns can literally change oxygen concentrations in the bloodstream, which can also lead to headaches and poor healing.

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• Stay young! Sleep affects every vital organ of our bodies in a profound way and can dramatically affect the aging process. Visible aging begins when the breakdown and oxidation of tissue exceeds the normal growth and maintenance of tissues within our bodies. Skin is the most visually dramatic and recognizable organ that expresses aging. Aim for optimal aging, or maximizing the body’s natural, daily healing process to rejuvenate and restore cellular tissue as well as actively minimize the breakdown and oxidation of all of the trillions of cells within your body. Good sleep hygiene is a critical factor in optimal aging.

• Improve mental alertness. Think of your sleep control mechanism as a variable dimmer switch that controls your lights. When you crawl into bed from a busy day, your dimmer switch is on high. You slowly lower the switch as you progress through the different stages of sleep; in stage 4, deep or delta sleep, your light is completely dark. Deep sleep is very important for hormone production and physiological regeneration.

After about 50-60 minutes, your dimmer reverses itself, creating a brighter “light” and REM sleep kicks in. REM sleep is sometimes called paradoxical sleep because your muscles become essentially deactivated but your brain activity is similar to when you are awake. REM sleep lasts about 20-30 minutes and is said to be essential. We can consider REM sleep in computer terms: during REM sleep, you empty your recycle bin (decreasing some “mind clutter”) and transfer information from your memory to your hard drive. REM sleep has been scientifically proven to be a creative stage of sleep that can increase the associative networks in our brain and is linked to improved learning, focus and memory.

• Make wise choices about your sleep environment.

Seek out a mattress that supports your body (not one that molds around you) and remains cool and breathable. Find a pillow that offers correct, anatomical support for your neck to open your airways and increase oxygenation. Your pillow should not push your head into a forward posture, similar to the posture you may assume during the day, with your shoulders curved and head and neck pushed forward over a computer or smartphone. When you sleep on your back or side, your pillow should support and lengthen your spine, encouraging more restful sleep, preventive health and improved beauty sleep. Sleeping on your back, with the correct contour for your neck, prevents wrinkles and promotes healthy sleep, naturally!

Remember, you’re in control of your sleep health, and making good choices will reap great results. S&W

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“Regular participation in Spinning rides will help lower blood pressure, a key worry among diabetes patients, by positively impacting the blood/lipid ratio.”

HAVE DIABETES?

MAKE SPINNING A KEY PART OF A HEALTHY LIFESTYLE WRITTEN BY MARCI WILLIAMS

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I

NDIVIDUALS WITH A DIABETES DIAGNOSIS UNDERS TA N D T H AT T H E Y FA C E CHALLENGES BEYOND SIMP LY M A I N T A I N I N G B L O O D S U G A R L E V E L S . They must also manage

their weight, energy and a healthy, happy lifestyle.

Those challenges can be addressed by finding the right exercise routine that tones muscles, improves cardiovascular endurance and offers a fun way to spend 45-60 minutes exercising at least three times a week. Spinning can address diabetes risk and symptoms as part of a healthy lifestyle.

Spinning is an upbeat, calorieburning, indoor cycling program that offers energizing music and the encouraging guidance of certified instructors. Like many fitness programs, Spinning, which has helped millions of people around the world meet and exceed their fitness goals for over 20 years, can help decrease the risk of type 2 diabetes by up to 58 percent and can help reduce symptoms if you have already been diagnosed.

Regular activity is a key part of managing diabetes, along with proper meal planning, taking medications as prescribed and stress management. Adding aerobic exercise, such as Spinning, can assist the cells in becoming more sensitive to insulin, which helps the body to work more efficiently. These cells also remove glucose from the blood using a mechanism separate from insulin during exercise.

Regular participation in Spinning rides will help lower blood pressure, a key worry among diabetes patients, by positively impacting the blood/lipid ratio. Spinning may also lower the risk of heart disease and stroke by strengthening the heart

and improving circulation, in addition to burning calories, aiding in weight loss and increasing healthy, lean muscle tissue.

Patients with diabetes typically feel tired or lack in energy for life’s daily tasks. Spinning has been proven to help increase the amount of energy a person feels but is also joint friendly, as there is no “pounding” of the knees on pavement like one might experience with running.

Even though there is an instructor leading all Spinning classes, there is no pressure like one might find in other group exercise classes as it is designed with individual riders in mind. Participants can easily modify or adapt to their own unique fitness levels with a simple twist of the resistance knob. They can also control the intensity with pedal speed or position by sitting versus standing.

For anyone facing a chronic condition like diabetes, the diagnosis itself can be self-limiting. Group exercise offers social benefits and builds confidence in an empowering way; it’s a reminder that you are more than your medical label. The countless millions who are part of the world-wide Spinning community are also there to help lend a hand and offer support whenever needed, even outside of the Spinning studio. Once you’re part of Spinning, you become part of something that is bigger than you and is incredibly rewarding.

Effective for all ages, genders and fitness levels, Spinning is great way to strengthen muscles, increase bone density, relieve stress and improve sleep. There are over 35,000 official Spinning facilities around the world. To find one near you, visit www.Spinning.com and ride your way to wellness. S&W

Marci Williams currently works as a center director, a wellness coach, and a management consultant. She directs a large recreation and fitness facility in which she oversees the day-to-day administration, operations, and programming. She has over 28 years of experience in the fitness and recreation industries, both in the private and public sector.

She holds multiple certifications, along with a degree in psychology. To learn more, visit www.Spinning.com.

Marci Williams Spinning® Master Instructor

Spinning is a registered trademark that is owned or used under exclusive license by Mad Dog Athletics, Inc.

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“...most people wake up feeling much more refreshed from lucid dreams that from everyday non-lucid ones!

WHAT IS LUCID DREAMING? WRITTEN BY CHARLIE MORLEY

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UCID DREAMING IS ONE OF THE HOTTEST TOPICS WITHIN SLEEP AND DREAM RESEARCH RIGHT N O W , B U T W H A T I S I T ? How does

it work? And crucially, can it help us to sleep better?

Charlie Morley, author of the bestselling book on the subject, Dreams of Awakening, helps us find out.

SO WHAT IS A LUCID DREAM? A lucid dream is a dream in which the dreamer is consciously aware that he is dreaming while the dream is happening. A

lucid dream is not just a very vivid dream or a very intense dream. Most people have experienced this type of dream at some point in their lives. Through the process of learning the art of lucid dreaming, you can experience this amazing phenomenon at will.

In a lucid dream, the dreamer has not awakened. In fact, he is sound asleep but part of the brain has reactivated, allowing the dreamer to experience the dream state with self-reflective awareness. Once you know that you are dreaming as you are dreaming, you gain access to the most powerful virtual reality generator in existence: your mind.

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Hay House author Charlie Morley received the traditional “authorization to teach” lucid dreaming from the Tibetan Buddhist master Lama Yeshe Rinpoche in 2008 and was asked to teach by meditation teacher Rob Nairn, who described him as “the most authentic practitioner of lucid dreaming and dream yoga teaching in Europe.”

Charlie has run retreats and workshops around the world, written the book Dreams of Awakening, and given the first talk on lucid dreaming at the well-known “TED” conferences. You can learn more about Charlie at www.charliemorley.com or by watching Charlie’s TED talk on YouTube (www.youtube.com/watch?v=p1i6A7t6L2g).

Charlie Morley

SOUNDS GREAT, BUT DO WE HAVE SCIENTIFIC PROOF OF ALL THIS? Yes. Up until the late 70’s, lucid dreaming was scoffed at by much of the scientific community as a “paradoxical impossibility,” which had no data to support its validity other than the subjective accounts of the lucid dreamers themselves. However, in the early 80’s lucid dreaming was scientifically verified through the joint efforts of Stephen LaBerge and Keith Herne (both universitybased sleep researchers).

“

IN A LUCID DREAM YOU ARE NOT ONLY EXPERIENCING A MUCH DEEPER LEVEL OF THE UNCONSCIOUS (YOU CAN’T GET MORE UNCONSCIOUS THAN ASLEEP) BUT YOU ALSO GAIN ACCESS TO IT OF YOUR OWN VOLITION.

More recently, studies from Frankfurt University’s neurological clinic and the Max Planck Institute of Psychiatry found that specific alterations to brain physiology appeared in lucid dreamers. Using brain-imaging technology such as magnetic resonance tomography and EEG, scientists can now pinpoint the actual “‘Aha! I’m dreaming!”’ moment of lucid awareness and its neurophysiological correlates.

The researchers concluded that “lucid dreaming constitutes a hybrid state of consciousness with definable and measurable differences from the waking state and from the REM (rapid-eye movement) dream state.” They discovered that when lucid consciousness was attained within the dream, activity in areas associated with self-assessment and self-perception increased markedly within seconds. The apparent paradox of being both aware and asleep, which had previously caused a lot of resistance and skepticism from the scientific establishment, was simply a failure to understand how two distinct brain regions could be activated simultaneously.

OK. SO IT’S BEEN SCIENTIFICALLY PROVEN, BUT WHAT’S THE POINT OF LUCID DREAMING? A person who is having a lucid dream is conscious within the unconscious. This is a similar state to that used by hypnotherapists to guide us into the unconscious

mind and offer suggestions for healing.

However, in a lucid dream you are not only experiencing a much deeper level of the unconscious (you can’t get more unconscious than asleep) but you also gain access to it of your own volition. In lucid dreams, we gain conscious access to the vast storehouse of knowledge that resides in our unconscious mind and thus open up a possibility to heal ourselves from addictions, phobias, negative thought processes, and limiting belief systems—all while we are sound asleep. I explore the benefits of lucid dreaming and teach how to actually do it in my book, Dreams of Awakening.

BUT WON’T I WAKE UP TIRED? No, in fact most people wake up feeling much more refreshed from lucid dreams that from everyday non-lucid ones! Lucid dreaming occurs almost exclusively within REM sleep, which is not a restful sleep state; in fact, an alternate name for REM sleep is “paradoxical sleep,” the paradox being that the brain is actually more active during dreaming than it is while we are awake. If we are not resting during our dreams, we might as well use them for self-development and psychological healing, right?

Sleep research has demonstrated that once we are fully aware within our dreams, the brain starts exhibiting certain high-frequency brain waves that have been linked to feelings of oneness and psychological contentment, which will lead to a much more refreshing sleep.

SOUNDS GREAT! HOW DO I SIGN UP? There are loads of books available on the subject and some great websites too, which will help you to learn how to lucid dream. Get Googling! If you want a more practical experience, you can check out my workshop schedule for next year at www.charliemorley.com. S&W

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SLEEP APNEA TREATMENT OPTIONS WRITTEN BY BRADLEY ELI, D.D.S.

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F YOU’VE EVER WALKED DOWN THE TOOTHBRUSH A I S L E I N TA R G E T Y O U ’ V E N OT I C E D T H E R E A R E A WIDE VARIETY OF TOOTHBRUSH MANUFACTURERS A N D S T Y L E S . Without some guidance from your dental

hygienist, it’s hard to know which is best for you.

“A LEAKING MASK COMPROMISES YOUR TREATMENT. ALWAYS CONTACT YOUR SLEEP TREATMENT PROVIDER IF YOU MASK LEAKS OR IF YOU’RE CONSISTENTLY DISLODGING THE MASK AS YOU SLEEP.”

It’s too bad there isn’t a sleep treatment aisle at Target too, because there are just as many treatment choices. In the last decade sleep treatment has expanded to include many choices in positive airway pressure therapy (commonly known as PAP or CPAP), oral appliance therapy, positional therapy, valve therapy (EPT), and other therapies that can be used singularly or in conjunction with each other. CPAP masks alone have gone from the one-size-fitsall style to over 100 styles, each one designed for a specific patient need. Without guidance from a sleep treatment provider, you may not know which treatment or mask will work best for you.

Our sleep treatment center offers all non-surgical treatment choices. We've made it our mission to help match our patients to their best treatment. That means helping patients explore the wide variety in masks when CPAP is their best treatment option.

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Dr. Brad Eli's career is dedicated to patients who face complex pain and sleep challenges and need expert personalized care.

He is one of less than 100 doctors in the U.S. with his unique training which includes a post-doctoral master's degree and extensive post-graduate education in pain management and sleeps disordered breathing. He is a nationally recognized expert in pain and sleep by both his physician and dentist colleagues, and his practice is devoted solely to these disorders.

His primary office is located in Encinitas, California.

Bradley Eli, D.D.S. If CPAP is your best treatment option, consider these important facts to choose the right mask when you work with your sleep treatment provider: • There are three major types of CPAP masks on the market today: 1 Nasal pillows – We find these are a good option for patients who are claustrophobic and cannot tolerate a full mask or patients who suffer with mouth, jaw, or facial pain.

WATCH FOR pressure increasing during the night due to leaks and/or nasal dryness.

Masks are like any other medical equipment. They must be cleaned and they have a replacement lifespan to stay effective. Here are our recommendations for cleaning and replacement.

• CLEANING

2 Nasal mask – This mask covers just the nose and is a good option between a full mask and nasal pillows.

Many of our patients find this mask more comfortable than nasal pillows and find it stays in place well.

WATCH FOR pressure increasing during the night due to leaks and/or nasal dryness.

3 Oral/Nasal or Full-Face mask – This mask covers both the nose and mouth. It works well for our patients who are mouth breathers at night and those who are not bothered with claustrophobia.

WATCH FOR facial irritation and/or leaking around the mask • A leaking mask compromises your treatment. Always contact your sleep treatment provider if you mask leaks or if you’re consistently dislodging the mask as you sleep.

• When using CPAP, it’s best to sleep on your side. Some patients complain that the mask moves when they sleep on their side.

That’s often because they’re restless and can’t get comfortable.

At our center, we’ve found helping patients select and use the right pillows makes a huge difference. Using the correct pillows to support neck, shoulder, and hips provides sleep comfort, reduces restlessness, and allows the mask to stay in place throughout the night.

• The comfort of a mask is directly related to the pressure setting. Even the most comfortable mask won’t feel right if your pressure setting is wrong. So before you change the mask, be sure the pressure setting on your machine is correct.

• “Just Try Harder” is not the proper response to an uncomfortable or ill-fitting mask. If your mask doesn’t fit or isn’t comfortable to wear all night, you and your sleep treatment provider need to make adjustments: re-check the pressure setting, use pillows to support your body and encourage side sleeping, check to see if the mask has areas that rub or irritate you. If you’re not using your mask all night, you’re not effectively treating your sleep apnea.

Clean your mask with mild dish soap and warm water at least once a week. Never put your mask in the dishwasher as it will damage delicate parts. You can use a sponge, cloth, or soft toothbrush to clean your mask.

• REPLACEMENT

Watch for wear spots, thinning, and irregularities where the mask touches your skin. Look for fraying or discoloration on the headgear. Be sure there are no unexpected pinholes in any part of the mask or tubing. If you see any of these problems, you may need replacement parts. Breakdown in the seal between mask and skin will cause leakage and compromise your treatment. Headgear that is fraying or pinholes in tubing will also contribute to leakage.

Your mask and tubing should be replaced every three to four months for best results and maximum comfort.

The key to comfortable, restful, healing sleep is matching a sleep patient to his or her best treatment option. For patients who use CPAP, the mask is pivotal. Without a properly fitting mask, it’s impossible to achieve the best treatment results.

Always be sure your mask is clean, comfortable, and well-fitted so you can enjoy the rest and health benefits that result from quality sleep and effective treatment. S&W

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“Add negative ions in your bedroom.

Negative ions reduce inflammation in the lungs and clean the air.”

FROM A TIGHT CHEST TO GOOD REST

A BREATH OF FRESH AIR FOR ASTHMA SUFFERERS

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R E A T H I N G I S T H E O N LY T H I N G M O R E V I TA L T O Y O U R H E A LT H T H A N S L E E P I N G . Asthma sufferers are on the short end

of the breath as they try to gasp themselves to sleep at night. Having struggled most of my life with breathing conditions, I understand how frustrating it is to wake up multiple times in the night for a breather, which is unfortunately the norm for people with asthma.

WRITTEN BY J. WATERMAN

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J. Waterman is a Wellness master who reveals that sleep is more important than food and water. He teaches that when sleep is optimized, people thrive.

Optimizing his own sleep has made him invincible to sickness, infections and fatigue. His teachings about breathing and its effects on sleep are remarkable and have proven effective for individuals and couples across North America. Waterman is the author of 7 Unusual Habits You Need For Good Sleep. His upcoming book, Sleep Sense: Stimulate the 5+ Senses for Anti-Aging Sleep, includes information that can be easily applied to enjoy sleep every night—and life every day.

J. Waterman

A longtime asthma sufferer, Sharmin Q said, “I used to wake up a minimum of two to three times per night to

HERE ARE

take my puffer and nasal spray. On really bad nights, I would use a sleep apnea device to help me breathe.”

Her interrupted sleep pattern left her with low energy and extremely dehydrated from mouth breathing through the night, creating another reason to be awakened. By adopting new lifestyle habits, Sharmin has been added to the roster of happy people who sleep soundly. “Now I sleep through the night and don’t need those medications,” she said. She has also switched from a mouth breather to a nose breather, eliminating the need to wake up for a sip of water.

Simple lifestyle changes can quickly take you from a tight chest to a good rest.

The results achieved from implementing the right habits can be a breath of fresh air. With just one week of implementation, huge successes have been observed in over 50 cases.

(1) Eliminate Dairy: Dairy is a mucus-forming food for many people. If you drink milk and suffer from asthma, it is likely one of the biggest contributing factors to your respiratory challenges. When you lie on your back at night and feel like there is a huge weight on your chest, that’s the weight of unwanted mucus buildup in the lungs. Eliminating dairy will help reduce excess production of mucus.

(2) Sweat it Out: Get active, and make sure you sweat. As your body heats up, solid mucus becomes liquid, allowing the body to drain it from your lungs and loosening it up enough for you to cough it out. You can accomplish this through exercise, saunas, steam rooms or a hot shower. You can also heat up your insides and melt that mucus by taking a walk outside in the cold. Ever noticed how your nose runs when you are out in the cold?

The cold weather causes your body to react by warming up, thus melting the mucus for removal.

(3) Eat Spicy Foods: Add some chili, garlic, ginger or horseradish to your meals, and watch that mucus melt away like the wicked witch of the chest.

TO BLOW ASTHMA AWAY FOR REJUVENATING SLEEP!

(4) Improve Air Quality: Add negative ions in your bedroom. Negative ions reduce inflammation in the lungs and clean the air, which is like hitting two birds with one stone or, in this case, two lungs with one negativelycharged particle. Studies have shown improved lung function in asthma patients when exposed to enough negative ions. For best results, get a device that emits a minimum of 5000 negative ions per cubic centimeter.

(5) Hypoallergenic Mattress: If your mattress is 5 years old or older, it is likely laden with dust mites and allergens that hinder optimal breathing conditions. Consider a new mattress, especially one that allows you to change the fabric or sleeping surface in an economical way to maintain a more hygienic environment.

(6) Reduce Stress: Stress causes inflammation. To breathe well while sleeping, you must reduce inflammation. While negative ions clean the air, you must clean your mind. Breathing exercises, thought field therapy, heart coherence, or just a hot bath in Epsom salts are a few amazing ways to help you relax to

reduce stress and thus inflammation of the lungs for good sleep.

(7) Eliminate Inflammatory Proteins: Today’s foods contain a large number of indigestible proteins, which can wreak havoc by causing inflammatory conditions throughout the body, including the lungs.

Asthma sufferers may avoid problems by eliminating these proteins.

Gluten from wheat and casein from dairy can cause inflammation for some people. You can avoid gluten by switching from grains to seeds such as quinoa, buckwheat and millet. Swap dairy for a seed “milk” such as hemp, sesame or almond. You can swap a few ingredients and still make your favorite recipes without the negative side effects caused by indigestible proteins.

My advice: Try these strategies for 30 days.

These beneficial habits will help you reap the rewards of effortless breathing and tranquil sleep. Adopting these habits will help you to get rejuvenating sleep and increase your energy, reduce stress, and let you live a more fulfilling life. S&W

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DREAM WRITTEN BY LAURI LOEWENBERG

“We

enter

a

dream

state

(known

as

REM

sleep)

every 90 minutes, and dream cycles increase in length throughout the night.”

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W

H AT D O T W I L I G H T, A V ATA R , GOOGLE, THE SEWING MACHINE, AND THE THEORY OF R E L A T I V I T Y H A V E I N C O M M O N ? They were all

inspired by a dream—the kind of dream that you have when you sleep. Artists, writers, inventors and scientists throughout history have solved problems and drawn great inspiration from their dreams. You are literally “dreaming up” great ideas and personal solutions each and every night too.

We dream every night, whether we remember our dreams or not.

We enter a dream state (known as REM sleep) every 90 minutes, and dream cycles increase in length throughout the night. The first dream of the night may only be three minutes, while the last dream before waking (after 7-8 hours of sleep) can be 45 minutes to an hour long. On average, you dream about five times every night. If you live to a ripe old age, you will have had over 100,000 dreams throughout your lifetime! That’s a lot of great ideas, advice and solutions that unfortunately will go unnoticed, unremembered, or simply dismissed as “just a dream.” I hope you’ll never dismiss the dreams you remember again.

What are these movies that play in our heads at night when we sleep? Where do they come from? What purpose do they serve?

Does my dream last night about purchasing a baby crib full of spaghetti mean I need to seek professional help?

Since prehistoric times, mankind has wondered about dreams. In 2001, an expedition into the Chauvet Cave in the valley of the Ardèche River in France discovered cave drawings believed to depict a dream. Ancient Romans thought dreams were messages from the gods; many would take pilgrimages to Dream Temples, where they would spend the night in hopes of receiving a dream of wisdom or healing. There are over 700 references to dreams and visions within the pages of the Bible, all suggesting that dreams are messages from God or His angels. The ancient Chinese believed that a dream is when the soul leaves the body to travel the world—and that if a person were awakened suddenly, < CONTINUED >

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S PRIN G 2014 • S LEEP & WELLNESS MAGAZINE

Lauri Loewenberg is a Certified Dream Analyst, syndicated columnist, author, popular radio personality, speaker, and member the International Association for the Study of Dreams. She has analyzed and researched over 75,000 dreams from people of all walks of life. She has been a guest on numerous television programs, including The Dr. Oz Show, the View, Good Morning America, and The Today Show. She has also been a recurring guest on nationally syndicated radio shows and has been featured in many magazines, including Esquire, Glamour, and Prevention. Lauri’s third book, Dream on It: Unlock Your Dreams, Change Your Life, is available in bookstores or from her web site, www.lauriloewenberg.com. Lauri is also a self-taught artist and enjoys bringing her own dreams to life through her artwork. Lauri lives in Tampa, Florida, with her strikingly handsome husband and very loud son.

Lauri Loewenberg

the soul might fail to return to the body. These beliefs reflect that dreaming is a powerful experience and is connected to something greater than ourselves.

The Greek philosopher Plato was one of the first to believe that dreams come from within instead of from an outside source; he believed dreams originated from the liver. Two thousand years later, Sigmund Freud, the father of modern psychoanalysis, taught that dreams come from the subconscious self and are about the self, specifically the sexually suppressed self. Freud’s protégé, Carl Gustav Jung, taught that dreams come from the self, are about the self, and that understanding dreams helps us improve ourselves. I subscribe to Jungian dream philosophy that everything in our dreams is connected to some part of the self or to something or someone that directly affects the self.

There are common archetypes (symbols, images and themes) that appear in dreams that hold a collective or shared meaning for almost all of us. For example, an unfamiliar woman (that is, one who does not exist in reality) in your dream is your Anima, your female energy, or that part of you that is sensitive, caring and creative. An unfamiliar man is your Animus, your male energy, that part of you that is assertive and takes action. An unknown child is your fun-loving, carefree self or your childish, naïve self. The condition of these archetypes and the way they behave in the dream reflect how well or how poorly you are using these parts of your self in the waking world.

I believe that dream analysis, medically known as oneiroscopy, is the most insightful form of self discovery available. I believe that dreams are insightful and

powerful thoughts. When you are dreaming, you are thinking on a deeper and more focused level than when you’re awake. When you go to sleep, the world around you is shut out. There are no distractions. Your mind doesn’t stop working at this point. As your conscious, literal mind slips into a state of rest, your subconscious mind takes over. When you enter REM sleep, the pons, a structure located on the brain stem, signals to the cerebral cortex (the region of the brain responsible for most of our thought processes) that dreaming has begun; subsequent thoughts are expressed using the images, experiences, and emotions of your dreams.

Dreams can be bizarre because when you dream, you think with metaphors. “He’s as healthy as a horse.” “It’s raining cats and dogs.” Metaphors compare two things to create a picture that helps us make our point. The next time you have a conversation, take a mental note of how many metaphors are used between you and the other person. We naturally communicate this way.

Dreams work in the same way, except rather than speaking the metaphor, they bring it to life.

Suppose you dream of drowning. When you wake up and catch your breath, ask yourself what part of your life could be compared to drowning? Where in your life are you having a hard time staying afloat? What’s bringing you down? Like a metaphor, your dreams illustrate what’s going on in your life, how you truly feel about it, and even what you need to do about it!

Through our dreams, we speak to ourselves about what is going on in our lives. We guide ourselves through difficult situations, and we point ourselves toward what we really need to live the life we are meant to live.

When you understand your dreams, you’ll find they are the best glimpse of reality available. They are how you are brutally honest with yourself when your conscious waking mind refuses to be. A recurring dream is the way you nag yourself over a behavior you need to correct or an issue that needs more attention. Dreams can serve as your friend and advisor when you need to make a tough decision or solve a difficult problem. YOU are the one who truly knows what is best for you! The truth is, your best thinking isn’t done in the shower; it’s done while you dream. When we say, “Let me sleep on it,” what we’re really saying is, “Let me DREAM on it.” S&W

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FROM DREAMS TO REALITY

WIDE AWAKE AND DREAMING W R I T T E N B Y J U L I E F LY G A R E

T

H E R E A R E M A N Y C O M E D I C P O RT R AYA L S O F N A R C O L E P S Y I N T H E M E D I A - Mr.

Bean, Deuce Bigalow Male Gigolo, Moulin Rouge—these films feature characters with narcolepsy who fall asleep while standing, and the audience gets a quick laugh. Yet as a law student diagnosed with narcolepsy at age 24, I'd never fallen asleep while standing. Narcolepsy was so much more complicated and fascinating, involving aspects of dream sleep taking place while conscious. Moreover, my experience with narcolepsy was far from a joke.

After graduating from law school in 2009, I thought our society deserved an honest look at narcolepsy.

Having studied writing in college, I decided to write

“Writing about it years later made it very raw and real.

Sometimes

I

was

left

sobbing.”

S LEEP & WELLN ES S MAGAZIN E • S PRING 2014

Julie Flygare, JD, is a leading narcolepsy spokesperson, award-winning author, and blogger diagnosed with narcolepsy with cataplexy in 2007. She received her B.A. from Brown University in 2005 and her J.D. from Boston College Law School in 2009. Julie’s story has been featured by Marie Claire, ABC, NBC, Psychology Today, Huffington Post and the Discovery Channel. She is the creator of the NATIONAL SLEEP WALK, the NARCOLEPSY: NOT ALONE international awareness campaign and the first-ever Narcolepsy mobile app. Julie currently serves on NIH’s Sleep Disorder Research Advisory Board and lives in Los Angeles, California.

Julie Flygare

a memoir. So, clinging to my writing background and a dream for change, I set out into the unknown.

Writing the first draft was exhilarating. I felt so “high on life” after finding a new beautiful way of describing something.

I’m very focused on how my writing sounds, as much as what it says. I want my words to slip off the tip of the tongue like poetry.

“EDITING AND PROOF-READING WAS CHALLENGING WITH NARCOLEPSY. I WOULD ENTER A SLEEP HAZE WHILE WORKING AND EVENTUALLY FALL ASLEEP, BUT WHEN I’D WAKE UP, I COULDN’T REMEMBER HOW FAR I’D GOTTEN IN MY EDITING BEFORE MY CONSCIOUSNESS FIZZLED.”

I am old-fashioned and wrote my first draft entirely by hand, resulting in countless notebooks of writing. I wrote so quickly, like a mad-woman, that I could barely re-read my own writing, so I had to quickly transcribe it onto my computer.

I treated writing the first draft of my book like a 9-5 job, but unfortunately creative inspiration doesn’t always work on a 9-5 schedule. If I wasn’t inspired, I worked on my blog, edited prior writing, or went for a run. Sometimes, a key phrase would hit me while out running and I had to stop to type it into my phone before I forgot it. Also, I woke up from dream-filled naps with words on the tip of my tongue.

Writing “Undertow” (Ch 8) and “Monster” (Ch 11) were particularly emotional – especially the scenes about cataplexy and hallucinations. I mentally re-lived those experiences to describe them accurately. I suppose I was in shock or survival mode the first time around and couldn’t process it all. Writing about it years later made it very raw and real.

Sometimes I was left sobbing.

Editing and proof-reading was challeng-

ing with narcolepsy. I would enter a sleep haze while working and eventually fall asleep, but when I’d wake up, I couldn’t remember how far I’d gotten in my editing before my consciousness fizzled, so I usually had to go back 5 or 10 pages to resume editing. It made for a long process to ensure there were no errors in the final draft.

Entering the publishing world as a “newbie” was very challenging. I knew the literary world would not be easy to enter: everyone is skeptical of unestablished authors. I was determined and became totally resilient to rejection, which helped me through the jungle.

Three and a half years after starting this journey, on December 15, 2012, I published "Wide Awake and Dreaming: A Memoir of Narcolepsy." Since publication, the book has been highlighted by various TV shows, radio programs, news articles and blogs. I have given many presentations and conducted 7 book signing events across the country.

Last spring, my book won First Prize in the San Francisco Book Festival Biography/Autobiography Contest 2013.

I set out to change perceptions of narcolepsy, and I believe my book is accomplishing that goal. But I must admit, there hasn't been one defining "aha" moment when I knew writing this book was worth it. Instead it's been a collection of small quiet moments emails, book reviews, hugs, letters, and heart-felt thank you's and "me too's" from readers around the world. I can't thank my readers enough for giving my book a chance and spreading the word. S&W

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S PRIN G 2014 • S LEEP & WELLNESS MAGAZINE

SLEEP SPECIALIST IN YOUR AREA, GUIDING YOU TO BETTER SLEEP

Sleep Elite offers hospitals and facilities "partnership savings" through outsourcing to meet current demands of an accurate diagnosis and quick turnaround for sleep study patients.

BryanLGH Center for Sleep Medicine is accredited by the American Academy of Sleep Medicine and is designed to help people get a better night’s sleep and improve their quality of life.

In today's budget reducing health care system, Sleep Elite assists in keeping sleep labs "patient focused", by offering not only a highly skilled team of health professionals for collecting data and scoring, but also the latest innovations in technology to insure efficiency and accuracy.

Registered polysomnographic technologists, respiratory therapists and nurses work side by side to conduct sleep evaluations for the diagnosis and treatment of problems such as sleep apnea and excessive snoring, narcolepsy, insomnia, night terrors, sleepwalking and shift work adaptation.

We are successful in reducing overhead operational costs such as recruitment, hiring, and training along with other expenditures without sacrificing care and service.

For more information, call 877-861-0300 or 800-646-2962 (fax) Email: info@sleepelite.com

At Alegent Health Sleep Disorders Services…we’re on a mission to provide you with a better night’s sleep. Fully accredited by the American Academy of Sleep Medicine (AASM), we offer four convenient metro locations: Immanuel One Professional Center 6828 North 72nd Street, STE 6100 Omaha, NE 68122 Lakeside One Professional Center 16909 Lakeside Hills Court, STE 110 Omaha, NE 68130 Mercy Hospital 800 Mercy Drive Council Bluffs, IA 51503 Midlands Hospital 11111 South 84th Street Papillion, NE 68046

Sleep Associates, Inc. is a four bed, independently owned, full-service sleep center. Our focus is the health and wellbeing of our patients and the surrounding communities.

We believe that testing is not the end, but the beginning of the journey to health.

Excellence is the standard of care here at Sleep Associates where we "Provide 24-Hour Sleep Disorder Diagnostics For the REST Of Your Life" Sleep Associates, Inc. 4215 Fashion Square Blvd., Suite 2 Saginaw, MI 48603 Phone: 989-792-9253 Fax: 989-792-3855 www.sleepassociates.net

The center’s medical director is a sleep specialist certifed by the American Board of Medical Specialties. For insomnia, the center also provides biofeedback serfvices by a certified biofeedback therapist.

The Sleep Institute of Utah and its team of Board Certified Sleep Specialists, Registered Sleep Technicians, and Respiratory Therapists are here to take care of all of your sleep disorders. Our services are range from Physician Consultations, In-Lab Sleep studies, InHome Sleep Studies, to DME homecare.

We have six convenient locations throughout the Wasatch front – call us today so you can start sleeping better tonight.

Sleep Institute of Utah Phone: 866-716-6117 Fax: 866-719-6117 www.sleepiu.com

For more information, call BryanLGH Center for Sleep Medicine 402-481-9646 or 1-800-742-7845 x19646 www.bryanlgh.org

St. Patrick Hospital Sleep Center is accredited by the American Academy of Sleep Medicine. We have two Board certified Sleep Physicians and a team of RPSGT, RRT, R.EEG T., CRTT, and LPN staff. We are located between Glacier and Yellowstone Parks in Missoula, a major medical hub in western Montana.

Our 4 bed sleep lab, and full neurodiagnostics dept., are here to serve the needs of our community and surrounding area.

As a comprehensive center, The Sleep Disorders Center of Gwinnett Pulmonary Group deals with the diagnosis and treatment of all sleep disorders.

The most common disorders are Obstructive Sleep Apnea Syndrome, Narcolepsy, Periodic Limb Movement Disorder, Restless Legs Syndrome, and Insomnia. Please contact us anytime! We look forward to hearing from you.

Gwinnet Sleep Center 631 Professional Dr., Suite 350 Lawrenceville, Ga 30046 Phone: 678-942-5982 Fax: 770-623-1485 www.gwinnettsleep.com

St. Patrick Hospital Sleep Center/Neurodiagnostics Services Missoula, MT 59802 406-329-5650 www.saintpatrick.org

United Sleep Diagnostics, Inc. (USD) is a JCAHO accredited and Medicare certified sleep diagnostic company. USD provides comprehensive diagnostic sleep testing and treatment in our state-of-theart sleep laboratories, the patient's home or hospital environment. Our service is designed to ensure high quality, cost effective sleep services to physicians and their patients.

MNAP Sleep Disorders Center brings together Board-Certified Sleep Specialists and staff to diagnose problems in an advanced, 4-room, sleep center.

While patients sleep, Polysomnographic Technologists observe the sleep patterns in a separate room. Brain activity, breathing patterns, muscle activity, and heartbeat are monitored. MNAP Sleep Disorders Center can improve patients' health and quality of life by diagnosing a full range of disturbances.

United Sleep Diagnostics, Inc 2241A N. University Dr. Pembroke Pines, FL 33024 Phone: 954-442-8694 Fax: 954-442-8695 www.unitedsleepdiagnostics.com

MNAP Diagnostic Center 9908 E. Roosevelt Blvd.

Philadelphia, PA 19115 Phone: 215-464-3300 ext.1345 Fax: 215-464-0835 www.mnap.com

S LEEP & WELLN ES S MAGAZIN E • S PRING 2014

SLEEP SPECIALIST IN YOUR AREA, GUIDING YOU TO BETTER SLEEP

St. Vincent Hospital’s Regional Sleep Disorders Center is accredited by the American Academy of Sleep Medicine (AASM). The Center provides a full range of diagnostic and treatment procedures for disorders of sleep and maintaining wakefulness for both children and adults.

St. Vincent Regional Sleep Disorders Center 1821 S Webster Ave Green Bay, WI 54301 Phone: 920-431-3053 Richard Potts DO, FCCP, FAASM- Medical Director Marla Van Lanen RRT RPSGT, Supervisor Marla.vanlanen@stvgb.org www.stvincenthospital.org

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Most sleep problems can be treated and some even cured with expert evaluation and appropriate treatment. The Sleep Disorders Center at McKay-Dee Hospital utilizes the latest technology in diagnosing and treating sleep/wake disorders.

Athens Center for Sleep Disorders provides a comfortable and convenient alternative to hospital-based sleep studies. We provide an environment that is soothing and inviting, with comfortable amenities and friendly, welcoming faces.

Talk with your doctor, or call (801) 3872700 to schedule an appointment and get more information.

Athens Center for Sleep Disorders is the first sleep disorders center in Henderson County to be eligible for accreditation by the American Academy of Sleep Medicine.

Sleep Center McKay-Dee Hospital Center 4401 Harrison Blvd.

Ogden, UT 84403 Phone: 801-387-2700 www.intermountainhealthcare.org/ hospitals/mckaydee/services/sleep-center

Athens Center 704 South Palestine Athens, TX 75751 Phone: 903-675-1717 or e-mail: sleep@athenssleepcenter.com Fax: 903-675-3338 www.athenssleepcenter.com

Houston Sleep & Neurology Consultants

A speciality medical practice devoted to Sleep Medicine, Neurology, and Clinical Research Trials. We offer three convenient locations in the Greater Houston area.

Cypress • Katy • Memorial "Improving the Quality of your Life by Improving the Quality of your Sleep" Houston Sleep & Neurology Consultants Todd J. Swick, MD, ABSM, Medical Director Houston, Texas 713-465-9282 www.houstonsleepcenter.com www.toddswickmd.com

Central Washington Sleep Diagnostic Center is a specialized medical facility. It treats all varieties of sleep disorders in adults and children, including but not limited to, insomnia, narcolepsy, obstructive sleep apnea, and complex sleep apnea, all with the goal of getting people rested, healthy and back to a normal, productive life.

Accepting most Insurance and Medicare.

Eric Haeger, MD Board Certified Sleep Medicine Central Washington Sleep Diagnostics Center 410 Washington St Wenatchee, WA 9880 Phone: 509-663-1578 www.cwsleepcenter.com

We are fully AASM accredited 6-bedroom Sleep Disorders Center with additional OCST accreditation. We are also Centermember of National Sleep Foundation. We offer unsurpassed patient access and comfort, state-of the art diagnostic and treatment resources and professional services provided by the board certified sleep specialists.

BMC Sleep Disorders Center 165 Tor Court Pittsfield, MA 01201 Phone: 413-447-2701 Fax: 413-447-2101 www.berkshirehealthsystems.org

Gergens Ortho and Sleep Appliance Lab is family owned and has serviced the United States since 1985. Based out of Phoenix, we employ over 45 tech and support personnel. We fabricate ortho, pedo, TMJ and Sleep Apnea appliances We have built our reputation on great quality, customer service, and having knowledgeable technicians. Our customers from across the United States share a common characteristic: They genuinely care about their patients and want them to have the finest dental appliances available.

1745 W. Deer Valley Road Building 1, Suite 112 Phoenix, AZ 85027

Roper St. Francis Health Sleep Center is located in Charleston, South Carolina.

We are a 10-bed Sleep Center testing at various facilities within the Roper St. Francis Healthcare System. Our Roper Hospital Sleep Center in downtown Charleston is accredited by the AASM, recently receiving reaccreditation for 20 years now. We have 9 board-certified sleep specialists with our Center and all RPSGTs on our clinical staff.

Chase Dental SleepCare is a treatmentoriented facility, which concentrates on sleep apnea, snoring and sleep breathing disorders. There are several convenient locations for patients to visit. Each practice is equipped with state of the art technology, knowledgeable staff and Dentists that treat all patients with above standard care. If you or someone you know suffers from Sleep Apnea or Snoring, or cannot tolerate their CPAP machine, please call to schedule a free consultation.

Roper Hospital 843-724-2000 316 Calhoun Street Charleston, SC 29401 www.ropersaintfrancis.com

Chase Dental Sleepcare Headquarters 324 South Service Road, suite 116 Melville, New York 11747 Tel: 631 393 6888 www.ChaseDentalSleepCare.com

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S PRIN G 2014 • S LEEP & WELLNESS MAGAZINE

- LEIGH J MCCLOSKEY

In the Mind of An Ancient God by Leigh J McCloskey

In the Dragon's Mouth by Leigh J McCloskey

WEB EXTRA

View more of Leigh's paintings and read his article "The Stuff of Dreams" on our website, www.sleepandwellness.net Universe as Organism #5 by Leigh J McCloskey

Leigh J McCloskey is a modern renaissance man. He is an artist, author, actor and visual philosopher. His life, career and art reveal in beauty and meaning his devotion to the ideal of cultivating renaissance and imaginative rebirth through shared enthusiasm for the more interesting and inspiring stories of being human. McCloskey has enjoyed a long career in Hollywood as a professional actor starring in numerous TV and film productions. In 2005 Keith Richards selected McCloskey’s art to tour with the Rolling Stones for their “Bigger Bang Tour.” More recently his art formed the visuals for Flying Lotus’ highly acclaimed album, Cosmogramma. He has written, illustrated and published seven books as well as many articles. Leigh lectures both nationally and internationally and has given numerous talks and presentations of his mythic art and visual philosophy. He has posted many of his talks on YouTube.

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