Sleep&Wellness Fall2014

MYSTERY SLEEPER: A PILOT’S FIRST!HAND STORY // HOLISTIC SLEEP BY TODD SWICK, MD

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Derek Kennard

Mark Walczak

COWBOYS/CARDINALS [Center & Guard]

CARDINALS/CHARGERS/COLTS [Tight End & Long Snapper]

Mike Haynes

Roy Green

NFL HALL OF FAME PATRIOTS/RAIDERS [Cornerback]

! N F L

Dave Gergen PRESIDENT PRO PLAYERS HEALTH ALLIANCE

F O R M E R

P L AY E R S

FALL 2014 // ISSUE 8

FORMER CONGRESSMAN

MARTY RUSSO

JOINS THE FIGHT AGAINST SLEEP APNEA COMPLIMENTARY COPY

CARDINALS/EAGLES [Wide Receiver & Cornerback]

T A C K L E !

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UPCOMING EVENTS Sleep & Wellness 2015: A Conference for Healthcare Professionals. The conference promises to be an educational and enjoyable event and will be held in Scottsdale, Arizona, on April 9-11, 2015.

On-demand Courses to prepare for your BRPT Boards Monthly Live Webinars Scoring Workshops on-demand

Visit our website www.americansleepandbreathingacademy.com for more details or call 801-410-4989

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FA L L 2 0 1 4 • S L E E P & W E L L N E S S M A G A Z I N E

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ACCORDING TO A 2009 STUDY BY MAYO CLINIC, 46% OF PLAYERS IN THE NFL AND 60% OF LINEMEN SUFFER FROM SLEEP APNEA.

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COVER FEATURE

SLEEP APNEA: A PROBLEM WE CAN TACKLE

BY INTERVIEWS AND WRITINGS, AND WITH PERMISSION FROM DAVE GERGEN, DEREK KENNARD AND ROY GREEN

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features

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OZ. CAN

12

OF SODA CAN CONTAIN:

10 teaspoons of sugar = 50 grams = 200 empty calories

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Sports’ Secret Weapon: Sleep

BY MICHAEL J. BREUS, PH.D. (THE SLEEP DOCTOR™)

Children and Soda

BY JANET PETERSON

Mystery Sleeper: Part I

BY LOUD U. SNORER

departments 10

Holistic Sleep Therapy

INTERVIEW WITH TODD SWICK, MD WRITTEN BY JENNIFER TAYLOR

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Lobby Like a Pro

BY MARTY RUSSO, FORMER CONGRESSMAN

THE REASON GROUPS HIRE professional lobbyists is that the federal goverment is huge and it’s a big job to stay informed on an issue.

THE CARDIOVASCULAR PROBLEMS like hypertension, stroke, and heart attack that Dr. Roberts treated as a physician are often experienced in conjunction with sleep disorders, such as sleep apnea, often because of obesity or large body size.

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INFOGRAPHIC: You Snooze, You Lose

HEALTH & WELLNESS 32

Understanding Sleep: Body, Mind & Social

BY JENNIFER TAYLOR

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Q&A with Cheryl Forberg, RD

BY JENNIFER TAYLOR

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Living Heart Foundation Promotes General Wellness

BY ARCHIE ROBERTS, MD

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A few Words From AARC Directors

BY TOM KALLSTROM AND TIM MYERS

REGULARS 6 8

Letter From the Editor Staff & Contributors

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LETTER FROM THE EDITOR

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AH, FALL. THERE IS SOMETHING MAGICAL ABOUT THE CRISP AIR, THE TURNING LEAVES— AND THE WAY PUMPKIN SNEAKS INTO EVERY RECIPE. While the return of autumn weather, football, and pumpkins are predictable, the changing season also comes with some new developments. In October, PBS will air a special on sleep apnea and the NFL. Who saw that coming? NFL players are primarily seen mainly as the amazing athletes they are; however, many current and retired NFL players suffer from health trouble that isn’t readily apparent: sleep apnea. NFL players have joined with the Pro Player Health Alliance and the Living Heart Foundation to bring sleep apnea, and treatment for it, to light. Many players have seen remarkable improvements in their quality of life by having their sleep apnea treated. They want to share what they have learned with the public, so others who share their

CUSTOMER SERVICE Sleep & Wellness Attn: Customer Care 275 West 200 North, Suite 202 Lindon, UT 84042 PHONE: 801-410-4989 E-MAIL: info@sleepandwellness.net BACK ISSUES are available in digital format for 3 months after original print date online at:

www.sleepandwellness.net

experiences with sleep apnea can find the same help the players have.

Public television is a great avenue for the players and the non-profit organizations to share their message about sleep apnea: it’s a problem we can tackle.

To take the message from the NFL one step further, Michael J. Breus, Ph.D., (a.k.a. The Sleep Doctor) touts sleep as the new thing for improving sports performance. Dr. Brues’ article focuses on increased sleep more than on combating sleep disorders. It’s remarkable to see how some additional sleep helped players of several sports improve their performance. Of course, if athletes improve their performance with additional sleep, it stands to reason that all of us could benefit from a little more shut-eye.

Tom Kallstrom and Tim Myers from the American Association for Respiratory Care (AARC) explain the role of the AARC, a brief overview of some common respiratory conditions and the risks they pose, and trends treatment. They tell us that respiratory therapists are being included in Accountable Care Organizations, a new trend in medical care that could help practitioners and patients contain medical costs.

Seasons come and go, but one thing is constant: our need for sleep.

The American Sleep & Breathing Academy is committed to learning about sleep conditions, treatments and trends in the industry and sharing that information with as many people as possible. After all, to quote Dr. Breus, “Everything you do, you do better with a good night’s sleep.”

Jennifer Taylor MANAGING EDITOR

PUBLISHING SLEEP & WELLNESS MAGAZINE IS PRODUCED, PUBLISHED AND DISTRIBUTED QUARTERLY BY SLEEP & WELLNESS, LLC, IN PARTNERSHIP WITH THE AMERICAN SLEEP & BREATHING ACADEMY, INC. SLEEP & WELLNESS, LLC, PUBLISHES OTHER WORKS IN PARTNERSHIP WITH THE AMERICAN SLEEP & BREATHING ACADEMY, INC. INCLUDING 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 SLEEP & WELLNESS, LLC. ALL RIGHTS RESERVED AND PROCEEDS ARE DONATED TO THE AMERICAN SLEEP & BREATHING ACADEMY, A NOT-FOR-PROFIT ORGANIZATION. REPRODUCTION IN WHOLE OR IN PART IS PROHIBITED. PRODUCED IN THE UNITED STATES OF AMERICA.

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FA L L 2 0 1 4 • S L E E P & W E L L N E S S M A G A Z I N E CONTRIBUTORS

AMERICAN SLEEP & BREATHING ACADEMY EDUCATIONAL CONTRIBUTORS Todd Swick, MD Michael Grandner, PhD Rudi Ferrate, MD Tim Safley Syed Nabi, MD Rudy Ferrate, MD Michelle Primeau, MD Archie Roberts, MD, LHF Steven Park, MD Peter Moskovitch, MD Chad Ruoff, MD

THE STAFF

HEALTH AND WELLNESS EDITOR

DENTAL DIVISION EDITOR

AARC SPECIAL SECTION EDITOR

Michael Grandner, PhD

Rudi Ferrate, MD

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

Dr. Grandner is a licensed clinical psychologist, an Instructor in the Department of Psychiatry, and a member of the Behavioral Sleep Medicine Program (BSMP), the Center for Sleep and Circadian Neurobiology (CSCN), and the Institute for Translational Medicine and Therapeutics (ITMAT) at the University of Pennsylvania.

He completed an APA internship with the Behavioral Medicine service at the San Diego VA Healthcare System and Outpatient Psychiatric Services at UCSD. He then went on to complete an AASM-accredited Behavioral Sleep Medicine Fellowship at the University of Pennsylvania, which was part of a larger postdoctoral fellowship at the CSCN. He has published over 40 articles on issues relating to sleep and health appearing in journals including SLEEP, Appetite, Sleep Medicine, and JAMA. He currently serves on the Mental Health Task force of the NCAA. Dr. Grandner maintains leadership positions with the American Academy of Sleep Medicine, Sleep Research Society, and Society of Behavioral Sleep Medicine, and he is the outgoing President of the Pennsylvania Sleep Society.

Dr. Rudi Ferrate MD, FAAFP, DABSM, is the Medical Director for Sleep Alternatives Salt Lake in South Jordan, Utah and for In Motion Health and Wellness in Phoenix, Arizona. His private practice is in the Salt Lake Valley and is focused on Integrative Medicine and Wellness.

From very early on in his career he understood that anyone’s knowledge is quickly outdated, that medicine is a wonderful yet highly complex science that is constantly upgrading and that the different organ, emotional and biological systems interplay in ways we are just beginning to understand. For this reason he has been dedicated to continued studies in the fields and specialties pertaining to healthy aging and wellness. His practice includes healthy aging, hormone balance, weight loss, sleep disorders and nutrition. His goal is to find ways to permit the body to utilize its own healing processes and diminish the need for synthetic pharmaceutical treatment.

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 (200607) and CPG Steering Committee Chair and liaison to American Academy of Pediatrics Neonatal Resuscitation Steering Committee (2001-08).

Sharon Robins

CREATIVE DIRECTOR Antoni Pham

President - Dr. Bob Talley - Board Vice President - Dr. Peter Chase - Diplomate Medical Director - Dr. Rudi Ferrate Executive Director - David Gergen Executive Secretary - Randy Clare Congressional Liason - Marty Russo Dr. Richard Klein - Board/Diplomate Dr. Brad Eli -Board/Diplomate Dr. Elliot Alpher - Board/Diplomate Dr. Richard Klein - Board/Diplomate Dr. Erin Elliot - Board/Diplomate Dr. Harry Sugg - Board/Diplomate Dr. Paul Van Walleghem - Board/Diplomate Dr. Rod Willey - Board/Diplomate Dr. Steve Carstensen - Board/Diplomate Dr. Jeffrey Rein - Board/Diplomate Dr. Richard Drake - Board

ASBA CONTRIBUTING STAFF MEMBERS Angela Kyzer Julie Thomas

CONTRIBUTING WRITERS Todd Swick, MD Congressman Marty Russo (retired) Michael Breus, MD Cheryl Forberg, RD David Gergen Michael Grandner, PhD Archie Roberts, MD Janet Peterson Thomas Kallstrom, MBA, RRT, FAARC Timothy Myers, MBA, RRT-NPS, FAARC

CONTRIBUTING ORGANIZATIONS

A R T & P R O D U C T I O N ART DIRECTOR

AMERICAN SLEEP & BREATHING ACADEMY DENTAL DIVISION

PRODUCTION DIRECTOR

Jeanette Robins, BS, RPSGT, RST

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

MANAGING EDITOR Jennifer Taylor

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SLEEP & WELLNESS C O N F E R E N C E

APRIL 9!11, 2015

SCOTTSDALE, AZ

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Featured Symposiums:

Featured Workshops:

• Sleep Apnea • Circadian Rhythm Disorder • Behavioral Sleep • Hypersomnia

• Dental Sleep • 2-day Scoring Workshop • 1-day Accreditation Workshop

TO REGISTER OR FOR MORE INFORMATION VISIT US AT WWW.SLEEP!CONFERENCE.COM OR CALL 801!410!4989

CPAP ASSISTANCE PROGRAM (CAP) Help us save lives! CAP provides a CPAP package to patients who otherwise would not be able to afford this vital and life saving equipment.

THREE EASY WAYS TO CONTACT US:

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WWW.SLEEPAPNEA.ORG

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CAP@SLEEPAPNEA.ORG

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888-293-3650

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FA L L 2 0 1 4 • S L E E P & W E L L N E S S M A G A Z I N E

HOLISTIC SLEEP THERAPY

THE FIELD OF SLEEP MEDICINE IS NEW AND IS RAPIDLY CHANGING. SLEEP AND WAKEFULNESS ARE FUNCTIONS THAT ARE CONTROLLED BY THE BRAIN VIA NEURAL PATHWAYS MEDIATED BY A VAST ARRAY OF NEUROCHEMICALS. IT HAS BEEN SHOWN THAT A DECREASE OR ABSENCE OF CERTAIN OF THESE CHEMICALS DIRECTLY LEADS TO SPECIFIC SLEEP DISORDERS, WHEREAS AN EXCESS AMOUNT OF THESE NEUROCHEMICALS CAN BE EQUALLY PROBLEMATIC IN TERMS OF DISRUPTION OF NORMAL SLEEP AND WAKEFULNESS.

✒ BY

JENNIFER TAYLOR

S L E E P & W E L L N E S S M A G A Z I N E • FA L L 2 0 1 4

“While medication can provide a “quick fix,” individuals with sleep disorders would benefit by considering holistic treatments as a viable, long-term solution.”

The ability to treat sleep and wake disorders can and should rely on the basic premise of medicine: “First do no harm!” If a disorder can be managed without introducing a drug or other external compound, more natural remedies should be tried first. As such, holistic treatments for sleep disorders are gaining in popularity. Because sleep affects our daytime functioning, and daytime functioning affects the quality and quantity of our nocturnal sleep, it seems reasonable to treat sleep disorder patients as a whole, looking at all aspects of their lives and looking at ways to change habits and diet that can affect nocturnal sleep as a first step.

Prescribing medication, which often treats limited symptoms while leaving the root cause of sleep trouble unresolved, is typically a short-term remedy; in fact, medication can cause even more serious, long-term problems.

Holistic treatments take into account not only sleep patterns but also a person’s lifestyle, including work, school, interpersonal relationships, and social issues.

Holistic treatments also involve evaluating physical qualities that might not seem immediately tied to sleep, such as weight, diet, level of physical activity, and stress.

Conditions such as insomnia and sleep apnea don’t just affect night time sleep; there are significant daytime conse-

Dr. Todd Swick This article was written using information from an interview with Dr. Todd Swick.

Dr. Swick is a board-certified neurologist, sleep specialist, and assistant clinical professor of neurology at the University of Texas Medical School at Houston.

quences such as excessive daytime sleepiness, loss of concentration and impaired motor reflexes, leading to an increase in depression, anxiety, physical illnesses and motor vehicle accidents.

There is clearly an interaction between sleep and mood disorders. What is not clear is the exact cause and effect. Does impaired or fragmented sleep lead to depression, or does depression cause poor sleep? Treatments that improve sleep have been shown to improve depression, and vice versa, so it can be helpful to consider both conditions before treating either.

While medication can provide significant benefits for people with sleep disorders, there is merit to a form of treatment known as cognitive behavioral therapy for insomnia (CBT-I). CBT-I is an interactive and collaborative process that gradually changes the patient’s lifestyle and habits resulting in improved quality and quantity of sleep.

Studies have shown that CBT-I is as effective as pharmaceutical therapy for insomnia; in many cases, CBT-I is more effective. CBT-I has longterm applicability in that an individual who completes CBT-I is armed with an understanding of how different behaviors—such as sleep patterns, alcohol consumption, medication, job stress, and so forth—can affect the quantity and quality of sleep. Further, the patient knows how to adapt behavior to improve sleep.

While medication can provide a “quick fix,” individuals with sleep disorders would benefit by considering holistic treatments as a viable, longterm solution. S&W

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SPORTS’ SECRET SECRET SPORTS’

WEAPON: WEAPON:

SLEE SLEE

EP EP

S L E E P & W E L L N E S S M A G A Z I N E • FA L L 2 0 1 4

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BY MICHAEL J. BREUS, PH.D. (THE SLEEP DOCTOR™)

THE SEARCH FOR PERFORMANCE ENHANCEMENT LEADS SOME ATHLETES TO TURN SOME PRETTY DARK CORNERS. IT’S A SHAME, AND NOT JUST BECAUSE DOPING IS DANGEROUS, UNETHICAL, AND FREQUENTLY ILLEGAL. IT’S ALSO A SHAME BECAUSE ATHLETES AT ALL LEVELS OF PLAY HAVE ACCESS TO A POWERFUL TOOL TO IMPROVE THEIR PERFORMANCE, ONE THAT WON’T BREAK ANY LAWS OR PUT ANYONE’S HEALTH AT RISK. CONTINUED

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SPORTS’ SECRET WEAPON: SLEEP

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WHAT’S THIS WONDER DRUG?

SLEEP. There’s been a welcome uptick in the attention paid by the media and athletic professionals to the benefits of sleep for competitive athletes, and to the research that shows just how sleep can improve physical performance in sports. The NY Jets brought sleep specialists into the locker room, signaling their intention to use sleep as part of their training strategy. At the other end of the spectrum, I was disappointed to read that Manchester United is addressing its players’ sleep problems by issuing sleeping pills. This strategy—and the coach’s seemingly cavalier attitude toward medicating players for sleep—is not what I recommend when I suggest that athletes and coaches pay more attention to sleep.

In recent years, Stanford University’s Center for Sleep Sciences and Medicine has been at the leading edge of examining the sleep-sport performance connection. Researchers there have conducted studies with several groups of Stanford student-athletes, examining the effects of extended sleep on athletic performance.

“SLEEP PROMOTES MUSCLE RECOVERY. SLEEP IS A CRITICAL TIME FOR CELL REGENERA! TION AND REPAIR IN THE BODY.”

HERE’S A SAMPLING OF THEIR RESULTS, WHICH SHOW IMPROVEMENTS ACROSS A VARIETY OF SPORTS:

SWIMMING

TENNIS

Five members of the Stanford men’s and women’s swimming teams increased their sleep goal to 10 hours per night for a period of 6-7 weeks. This led to improvements in speed, reaction time, turn times and kick strokes.

Swimmers shaved an average of .51 seconds off a 15meter sprint, they left the blocks .15 seconds faster, shaved .10 seconds off their average turn time, and added an average of 5 kicks to their stroke frequency.

Out of the water, swimmers reported reductions in their levels of daytime sleepiness, improvements to their mood, more energy and less fatigue.

Researchers asked five members of the women’s tennis team to increase their sleep goal to 10 hours per night for 5-6 weeks.

Players improved their sprint times, dropping from an average of 19.12 to 17.56 seconds. They also increased their serve accuracy, going from an average of 12.6 valid serves to 15.61.

BASKETBALL For 5-7 weeks, 11 members of the university’s basketball team extended their nightly sleep to 10 hours. As a result, shooting accuracy among the players improved significantly: Free throw shooting improved 9%, and three-point shooting 9.2%.

FOOTBALL Seven players on the Stanford football team spent 7-8 weeks attempting to sleep for 10 hours per night. Their extended sleep resulted in improvements to their 20yard shuttle—average time decreased to 4.61 seconds from 4.71—and to their 40-yard dash, which dropped to an average of 4.89 from 4.99 seconds.

(Both the shuttle and the dash are among the drills conducted at the NFL Scouting Combine.) Players also reported improvements to their daytime energy levels and mood, and reduced daytime fatigue.

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SO WHAT’S BEHIND THE PERFORMANCE BOOST FROM

SLEEP?

Sensing a pattern? Extending sleep times translated into significant improvements to critical game-day skills. Worth noting: not all athletes across these studies actually slept for 10 hours per night, but attempting to sleep for 10 hours per night got them additional sleep compared to their regular routine. According to researchers, many of these athletes came to their sleep-sport studies already sleep deprived.

And that gets to the flipside of the advantages that additional sleep can give to athletes. Sleep deficiency can inhibit performance. Research shows lack of sleep can also affect the longevity of players’ careers. Two recent studies investigated the relationship between sleep and career duration and stability among NFL players and MLB players. The NFL study looked at 55 players from across the league. Those who reported higher levels of daytime sleepiness were

less likely to remain with the team that drafted them than those players who reported lower levels of daytime tiredness. And MLB players who reported higher levels of daytime tiredness had attrition rates far higher than league averages.

There’s also evidence that sleep can increase the risk of injury among athletes. In this study of teenage student-athletes, those who slept at least eight hours per night were 68 percent less likely to injure themselves playing sports than those who slept less than eight hours nightly. Researchers examined the sleep patterns and sports-related injuries of 112 male and female athletes from grades 7-12.

They discovered that sleep and age were the most significant factors in assessing injury risk. (In addition to being more injury-prone when short on sleep, students were also more likely to injure themselves as they moved to higher grade levels.)

Dr. Michael J. Breus This article was originally published on www.theinsomniablog.com on November 19, 2012, where you can see details of the research for this article. You can read more of Dr. Brues’ insights on his web site, www.thesleepdoctor.com, or by following him on Twitter @thesleepdoctor.

The cognitive benefits of sleep translate onto the field. Memory, learning, reaction time and focus: sleep is critical to the brain’s ability to perform these mental tasks efficiently and well.

The brain uses sleep to consolidate memory into longer-term knowledge, clearing the area of the brain used for short-term memory in preparation to absorb new information. During sleep, the brain also works to prioritize the information it thinks will be important in the future. Sleep deprivation has well-studied negative effects on reaction times—and even a single night of sleep deprivation can slow quick response times.

Sleep promotes muscle recovery. Sleep is a critical time for cell regeneration and repair in the body. During non-REM stages of sleep, cell division and regeneration actually becomes more active than during waking hours. Insufficient sleep, on the other hand, hinders muscle recovery.

Sleep is a stress reducer.

Sleep and stress have a tangled relationship—and both are dangerous to healthy immune function when we don’t get enough (sleep), or have too much (stress). Stress can interfere with sleep. This study ranked worry as the most common cause of sleeplessness among adults 34-79, but lack of sleep can also affect mood and make us more susceptible to stress and anxiety.

Is sleep the next big thing in sports? I’d say it’s more than earned its shot in the big show. S&W

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LOBBY “ T h e r e a s o n g r o u p s h i r e p r o f e s s i o n a l lobbyists i s t h a t t h e f e d e r a l gove r nm e nt is hug e a n d i t' s a b i g

job to stay informed on an issue.”

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LIKE A PRO ✒ BY

MARTY RUSSO, FORMER CONGRESSMAN

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I FIRST BECAME AWARE OF THE WIDE-RANGING IMPACT OF SLEEP DISORDERS WHILE BEING TREATED WITH ORAL APPLIANCE THERAPY BY DR. ELLIOTT ALPHER OF THE ALPHER CENTER IN WASHINGTON, D.C. WHILE I WAS BEING FITTED FOR THIS NEW TECHNOLOGY FOR SLEEP APNEA, DR. ALPHER GAVE ME A RUNDOWN OF ALL THE WAYS THE FEDERAL GOVERNMENT WAS GETTING INVOLVED IN REGULATING SLEEP DISORDERS. THE U.S. DEPARTMENT OF TRANSPORTATION WAS LOOKING AT THE TRUCKING INDUSTRY AND HOW SLEEP IMPACTS SAFETY ON OUR ROADS. THE NATIONAL TRANSPORTATION SAFETY BOARD WAS INVESTIGATING AIRLINE AND TRAIN ACCIDENTS TO DETERMINE IF FATIGUE DUE TO LACK OF SLEEP PLAYED A ROLE. DR. ALPHER HAD A MISSION TO GET THE LATEST SCIENCE ON TREATING SLEEP DISORDERS INTO THE HANDS OF FEDERAL POLICYMAKERS SO THAT THEIR DECISIONS COULD BE MADE BASED ON FACTS AND NEW CUTTING EDGE TECHNOLOGY.

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LOBBY LIKE A PRO

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I spent 18 years of my career in Congress and the past 22 years as a lobbyist, and I had no idea that sleep issues were so hot at the federal level. I dug a little deeper and discovered that the Veterans Administration is very concerned about sleep for returning veterans who experience PTSD. The Center for Medicare Services is looking closely at how to reduce the high cost of treating health issues that result from sleep disorders and fatigue. In fact, throughout the federal government there are many agencies that are waking up to sleep disorders.

What does this mean for sleep specialists? I can tell you from years in Washington, D.C., that when the federal government starts investigating an issue, the people who care about that issue need to be ready. A famous saying is, "If you're not at the table, you're on the menu." This means that the sleep community needs to get active and take its seat at the table so that federal actions will help the cause, not hurt it.

As a Democrat, I think the government has a role in helping people. But as a lobbyist I know that federal policymakers often do not have the information they need to make good decisions. As a lobbyist, I was frequently hired to help a business dig out of a hole created by the unintended consequences of a federal action.

Whether you are a sleep expert or just a person who has learned first-hand the dangers of sleep disorders, my message is, "Get involved.

You can make a difference."

HERE ARE SOME FOOTBALL ANALOGIES TO INSPIRE YOU TO RUN OUT ONTO THE FIELD AND MOVE THE BALL FORWARD ON SLEEP DISORDER AWARENESS: • Scout. Research what is happening in the federal agencies and who in the sleep community is already involved. Who agrees with you? Who is opposed? Where are good sources of information?

• Team up. Professional lobbyists don't go it alone. They build up a groundswell of support from stakeholders. Talk to colleagues, professional medical and dental academies, trade associations, local officials, healthcare leaders, and people who care. Tell them your mission and ask for help in getting your message out.

Marty Russo, Former Congressman A native of Chicago, Former Congressman Marty Russo has spent a career navigating the maze of federal institutions in Washington, D.C. First elected to Congress at the age of 30, Marty served his constituents for nine terms alongside legendary Congressional leaders and Presidents from both political parties.

Marty believes in taking an active role to make our government and country a better place. As part of a capstone to a successful career as a top lobbyist, he speaks to audiences about how to have more influence so your voice can be heard to make a difference in Washington.

• Train. Develop your message points in a clear, easy to digest format, and keep your team informed. Meet with your member of Congress.

Send your materials ahead of time (one-page summary with technical documentation as needed). Educate the Congressman on sleep disorders in a brief, focused meeting. Let him or her know that you are available as a resource.

Send updates on scientific advances and federal activity. I tell people that developing an ongoing relationship with your Congressman and Congressional staff before you ask for help is the single best action you can take.

• Play Defense. Educate regulators before they act. Comment on a proposed policy. Write a letter. Make sure there is an abundance of good information in the right hands so that when someone puts the regulatory ball in play, your message is already ingrained in the system.

• Play Offense. Sometimes agencies get it wrong.

When the Federal Aviation Administration issued a policy on pilot fatigue that caught the sleep community off guard, there was so much uproar that the policy was reversed within a week. When you hear of movement taking place, deploy your team, get your message out, contact your Congressman and have your voice heard.

• Stay in the game. Most important, stay involved. It takes time and effort to move the ball up the field. Don’t expect a score every time you touch the ball. The reason groups hire professional lobbyists is that the federal government is huge and it's a big job to stay informed on an issue and then know when, where, and how to make your move.

The advantage you have is that you care about sleep and want the government to make smart decisions when making policy. That’s worth all your effort. You may save a life. S&W

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Derek Kennard COWBOYS/CARDINALS [Center & Guard]

Mike Haynes

Roy Green

NFL HALL OF FAME PATRIOTS/RAIDERS [Cornerback]

CARDINALS/EAGLES [Wide Receiver & Cornerback]

Dave Gergen PRESIDENT PRO PLAYERS HEALTH ALLIANCE

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A PROBLEM WE CAN TACKLE ✒

Mark Walczak CARDINALS/CHARGERS/COLTS [Tight End & Long Snapper]

BY INTERVIEWS AND WRITINGS, AND WITH PERMISSION FROM DAVE GERGEN, DEREK KENNARD AND ROY GREEN

THE PRO PLAYER HEALTH ALLIANCE (PPHA) IS A GROUP OF FORMER NFL FOOTBALL PLAYERS WHO HAVE BANDED TOGETHER WITH DAVID GERGEN, A DENTAL LAB TECHNICIAN IN PHOENIX, ARIZONA, WHO SPECIALIZES IN TREATING SLEEP APNEA. DAVID GERGEN INITIALLY APPROACHED DEREK KENNARD, A FORMER NFL GUARD, WHEN KENNARD WAS DOING A COACHES CLINIC AT ARIZONA STATE UNIVERSITY. GERGEN TOLD KENNARD HE HAD THE SLEEP APNEA LOOK—RACCOON EYES—AND THAT, TOGETHER WITH HIS HIS RASPY VOICE, SUGGESTED THAT HE’D EITHER BEEN UP ALL NIGHT YELLING AT SOMEONE OR HE HAD SLEEP APNEA. HE ENCOURAGED KENNARD TO BE TESTED. KENNARD UNDERWENT A HOME SLEEP STUDY, WAS DIAGNOSED WITH SLEEP APNEA, AND WAS SUBSEQUENTLY FITTED WITH A SPECIALIZED DENTAL DEVICE THAT COMPLETELY CHANGED THE QUALITY OF HIS LIFE.

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he concept of jaw position as a fundamental piece of sports performance is not new. Dr. Harold Gelb introduced this concept in his early work in the 1970s. The culmination of his work in improved performance was the 2000 Baltimore Ravens who triumphed over the New York Giants to win Super Bowl XXXV. Every player on the team wore a custom oral appliance that positioned the jaw in Dr. Gelb’s Jaw position called the Gelb 4/7 position. Since that time, professional sportsmen all over the world have been adopting a daytime mouth guard to protect them from injury and improve their performance.

In recent years, awareness of the potentially lifethreatening effects of obstructive sleep apnea (OSA) has begun to rise, but there’s still widespread confusion about who can be affected by the disorder. Most of those who are aware of the dangers of OSA believe that it affects only overweight and unhealthy people.

In fact, even some of the best athletes in the world suffer the consequences of OSA, especially players in the National Football League. According to a 2009 study by Mayo Clinic, 46% of players in the NFL and 60% of linemen suffer from sleep apnea. The problem is endemic and has even affected draft results. For example, sleep apnea took a toll on the 2007 #1 NFL draft pick JaMarcus Russell, who played for the Oakland Raiders.

HISTORY OF PRO PLAYER HEALTH ALLIANCE

David Gergen rolled out of bed on December 4, 1982, and had his career “aha” moment. Gergen knew he was going to be an orthodontic technician, and he knew he was going to help people all over the country. Since then, he has built one of America’s most successful dental labs in Phoenix, Arizona, revolutionized the sleep industry through oral appliances and special programs, and was once voted top dental laboratory technician in the country.

Derek Kennard had been seeing a doctor about his sleep trouble twice a year for eight years but had been unable to reach a resolution. He’d reached the uncomfortable conclusion that sleep apnea was something he’d just have to live with. Unfortunately, there was a much more difficult lesson about sleep apnea in store for him. When his younger brother,

“WE REACHED OUT TO OTHER PLAYERS WE’D PLAYED WITH, AND AGAINST, THE NATIONAL FOOTBALL LEAGUE, AND THE PLAYERS UNION, AND WE STARTED TESTING PLAYERS.”

Donald, passed away from cardiac arrest brought about, in part, by sleep apnea, Kennard felt a new urgency to find a solution to his problem and was receptive when David Gergen approached him at the clinic.

Mark Walczak, a former tight end for the Phoenix Chargers, also faced health trouble associated with sleep apnea and achieved good results with a dental device.

The players’ friends could see how much Kennard’s and Walczak’s lives improved.

Another former teammate, Roy Green, who also had problems with his health, was intrigued enough to ask and pursue a solution—and Kennard, Walczak, Green, and Gergen realized their sleep stories and solutions were something worth sharing. They formed the Pro Player Health Alliance with the goal of helping other NFL players.

After noticing NFL players seeking treatment for their obstructive sleep apnea, Gergen decided there was an urgent need to spread awareness of the disorder throughout the United States.

His response was to form Pro Player Health Alliance (PPHA), which brings current and former professional football players to different communities throughout the U.S. to promote awareness of sleep apnea. “Pro Player Health Alliance was created to treat the sleep health needs of retired NFL players,” explains Gergen, “while at the same time raising awareness of sleep apnea as a silent killer.”

PPHA events have reached thousands of people and have the

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Roy Green

potential to reach many more, potentially the entire NFL fan base. The beauty of PPHA’s efforts is that they benefit everyone involved: the public meets their sports heroes while becoming informed on the lifethreatening risks of sleep apnea; players receive treatment for this debilitating condition, which means better athletic performance and more exciting games; dental practitioners, especially those who help host PPHA events, are able to attract attention and patients to their sleep practices; and dental sleep appliance labs like Gergen’s are able to conduct more research and develop improved oral appliance solutions.

“We reached out to other players we’d played with, and against, the National Football League, and the players union, and we started testing players,” Green said.

The Pro Player Health Alliance has tested over 200 former and current NFL players and has seen great results. Roy Green said, “We heard stories that were so unbelievable.

Lives were changing. We decided to reach out to our communities, to everyone we know. We know this is saving lives. This is helping so many people. It’s just become a passion of

ours, so that’s what we do now. We’re feeling so much better, and we know so many people are unaware that it is sleep apnea that they’re suffering from. Just a simple test and a simple appliance can change lives.”

Along with Kennard, Walczak, and Green, Eric Dickerson, Mike Haynes, and Larry Fitzgerald Jr., other NFL greats like Warren Moon, Marcus Allen, Dave Krieg, Nesby Glasgow, OJ Anderson, Bart Oats, Carl Eller, Preston Pearson, J.T. Smith, Lincoln Kennedy, Ed “Too Tall” Jones, Isiah Robertson, Chuck Foreman, and Nick Lowery, have all also received oral appliance sleep apnea treatment and subsequently teamed up with PPHA. Together, these players have visited schools, held meet-the-players events for fans, and even hosted golf-tournaments to spread a simple message: get diagnosed for sleep apnea, get treated, and get a good night’s sleep.

As Derek Kennard explains, “You can’t put a price on a good night’s sleep.”

Eric Dickerson, another Heisman Trophy winner and NFL Hall of Famer, also suffered from terrible morning headaches and needed extensive dentistry due to sleep

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apnea. However, Dickerson is sleeping better than ever after receiving treatment for his OSA by Dr. Harry Sugg, in Dallas, Texas. Dr. Sugg placed Dickerson in a Gergen’s Orthodontic Lab Herbst appliance for night-time use and a Gelb Splint to prevent overclosing for daytime use.

Tony Dorsett, a former Heisman Trophy winner and NFL Hall of Famer, claimed he was “snoring like a freight train” before being diagnosed with sleep apnea. Then he received his dental sleep device, a Herbst appliance custom fit

by Gergen’s Orthodontic Lab. Now that he breathes well while he sleeps, he proudly boasts, “Superman ain’t got nothing on me.”

Members of the Pro Player Health Alliance travel around the country promoting sleep wellness and they are surprised by how few people know about sleep apnea, the negative effects it can have, and how easy it can be to treat.

They have seen some of their former heroes limping around, not feeling well. When questioned, these guys invariably say something about their poor quality of sleep. With a proper diagnosis and treatment, these guys who thought they were on the back nine, without much to look forward to, are active again and enthusiastic about life.

The bottom line is that sleep apnea is a problem we can tackle!

What’s next? In addition to continuing to promote awareness and treatment for sleep apnea with the PPHA, recently, Gergen has been working with NFL Hall of Famer Mike Haynes and NFL All-Pro Derek

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Mike Haynes

Kennard, who are both active in the POP Warner communities. Together, they are working on a new appliance that could potentially reduce concussions and improve performance on the playing field.

SPOTLIGHT ON PRO PLAYER HEALTH ALLIANCE FOUNDER: DAVE GERGEN

In a 2012 dental conference in Las Vegas, Dr. Gelb paid Gergen a high compliment, saying, “David Gergen is the finest technician ever to live. He is heads and tails above the competition.” Gergen was honoring Dr. Gelb for his 65th year in dentistry at the presentation, and Dr. Gelb mentioned, “There are two legends in this room.”

Sleep medicine specialist Rudi M. Ferrate, MD, DABSM, complimented David Gergen for his strength of character, his passion for excellence, and his desire to help as many people as possible, adding, “He could easily sit back and enjoy the fruits of his business, but instead he spends his time and resources promoting education and awareness of sleep disorders. He is single-handedly the most important force bringing sleep physicians and sleep dentists together and now is using his

“ACCORDING TO A STUDY BY THE UNIVERSITY OF PENNSYLVANIA SPONSORED BY THE FMCSA AND THE AMERICAN TRUCKING ASSOCIATION, 28% OF TRUCKERS HAVE MILD TO SEVERE CASES OF SLEEP APNEA. THIS IS AN ALARMING NUMBER, CONSIDERING THAT THERE ARE OVER 3 MILLION TRUCKERS ON AMERICAN HIGHWAYS.”

skills and reputation to bring everyone else on board—from legislators to sports legends.”

DENTAL DEVICES HELP MORE THAN JUST FOOTBALL PLAYERS….

For more than 20 years in Phoenix, Gergen spent the fall coaching POP Warner football and high school football. Most of the important lessons of his life were learned either watching football legends, creating challenges for himself on the field, or teaching children the values of courage and teamwork on the field. It comes as no surprise that Gergen, father of nine children, would focus a good deal of his professional life on helping children achieve their goals.

Gergen is a certified dental technician, and some would say a master technician that children and adults have relied on for excellent results.

HELPING CHILDREN BREATH BETTER:

In his professional life, Gergen worked to straighten teeth for cosmetic reasons, and to help create functional oral structures for patients with severe trauma or developmental issues.

Recently, some of his attention has turned to the effects of poor jaw position on children. “A small airway often forces children to breathe through their mouth and posture their head forward resulting in rounded

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shoulders and back problems,” explains Gergen.

“Continuing this position over many years will create permanent changes in posture. Poor breathing habits can result in heart and lung problems in later life.”

After 30 years of establishing better jaw and tooth function through orthodontics, Gergen decided to focus on the airway. His pediatric sleep appliance, Gergen’s Bionator, is a direct result of his experience and experimentation. Gergen is eager to demonstrate to physicians and the public that oral appliances are an effective solution for sleep and airway problems.

Gergen’s Bionator is worn on the child’s upper and lower teeth, and gives dentists an opportunity to guide the growth of patients’ teeth— more importantly, the jaw and the airway. Expansion of the upper jaw will create more room for the tongue to pos-

ture forward and open the airway.

“The simple shape and construction of the lower appliance will help stage the growth of the child’s teeth, allowing the dentist to control the growth rates of the teeth for maximum cosmetic and palliative effect,” said Gergen. “One of the best parts of the treatment is that while growth is being controlled, the jaw is held slightly forward, creating an open airway that produces better and deeper sleep patterns.”

Children undergoing standard orthodontic care have noticed their grades improve, sometimes dramatically. In the past, this improvement has been attributed to improved self-image or a growth spurt. Today, experts have measured the improved sleep patterns and the increase in airway size that comes from a better jaw position. These patients breathe better at night, and wake up more able to deal with the demands of the day.

Professional Drivers: According to a study by the University of Pennsylvania sponsored by the FMCSA and the American Trucking Association, 28% of truckers have mild to severe cases of sleep apnea. This is an alarming number, considering that there are over 3 million truckers on American highways.

In 2013, Gergen appeared before the Department of Transportation to request that an assessment for sleep apnea be required for commercial truck drivers. On October 17, 2013, H.R. 3095, which sets standards for the evaluation of truck drivers for sleep apnea, was signed into law. Also in 2013, on behalf of

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the entire dental sleep community, David Gergen testified before the Department of Transportation to request that dentists be able to order home sleep tests for their patients.

Increased testing may help reverse the trend of undiagnosed sleep apnea.

Dental Education: In August 2011, Gergen’s first sleep training program was presented to a group of 25 doctors in Sonoma, California, and Gergen’s Orthodontic Lab team and training programs have gotten better since then. They maximize on their experience, developing specialties as educators and covering topics thoroughly in their seminars and meetings. They were selected by Henry Schein to participate in their dental sleep apnea programs. Their seminars emphasize long-term education and selfdeveloping practices.

Dr. Archie Roberts, retired NFL player and founder of the Living Heart Foundation and NFL HOPE program, has been one of the Gergen team’s keynote speakers. Roberts established a strong correlation between OSA and heart disease in the general population. He asked Gergen to be the sleep apnea director in the HOPE program that the Living Heart Foundation launched at the Mayo Clinic in Scottsdale, Arizona.

David Gergen serves the dental sleep community as the Executive Director of the ASBA Dental Division. The ASBA Dental Division is a for profit group that has partnered with the not for profit American Sleep & Breathing Academy. For more information visit www.americansleepandbreathingacademy.com and click on Dental Division. S&W

This article is for informational and commercial purposes about the Pro Player Health Alliance and the Herbst oral appliance. Views set out are those of the authors and do not necessarily reflect the official opinion of the Sleep & Wellness Magazine.

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children

soda

✒ BY

JANET PETERSON

SODA CONSUMPTION HAS INCREASED DRAMATICALLY SINCE THE 1960S, MIRRORING THE INCREASED RATES OF OBESITY. IT IS ESTIMATED THAT 95 PERCENT OF AMERICANS DRINK SODA AT SOME POINT DURING THE YEAR AND MORE THAN 50 PERCENT DRINK ONE OR MORE SODAS EVERY DAY. BOYS ARE MORE LIKELY TO DRINK SODA AT A YOUNGER AGE WITH OVER 70 PERCENT OF THEM CONSUMING ONE OR MORE SODA PER DAY. THESE STATISTICS ARE FOR SODA ALONE! IF YOU TAKE IN TO ACCOUNT ALL SUGARY DRINKS (SWEETENED JUICES, LEMONADES AND ICE TEAS) THE AMOUNT OF ADDED SUGAR CONSUMED DAILY GREATLY INCREASES. ADDED SUGAR INTAKE DURING CHILDHOOD INCREASES THE RISK OF HEALTH ISSUES LATER IN LIFE.

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LEARNING DISORDERS

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INABILITY TO CONCENTRATE

STROKE

TOOTH DECAY PERIODONTAL DISEASE AND GINGIVITIS

THE HEALTH RISKS OF SODA

SLEEP DISORDERS

HEART BURN AND STOMACH ACHES

PANCREATIC CANCER

WEAK OR BRITTLE BONES METABOLIC SYNDROME

OVERWEIGHT AND OBESITY

TYPE 2 DIABETES

HEART DISEASE

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children and soda

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12

OZ. CAN

OF SODA CAN CONTAIN:

10 teaspoons of sugar = 50 grams = 200 empty calories

• soda lacks gOOd nutrition

Food and drink are classified as nutrient dense--lots of good quality nutrients and not a lot of calories-- and energy dense--very little nutritious value with lots of calories, in other words “empty calories.” Soda and other high sugar drinks are classified as energy dense, loaded with empty calories.

The average 12 ounce soda has more than 10 teaspoons of sugar (50 grams) which is equivalent to 200 empty calories. That is a lot of extra sugar, not to mention calories in one’s diet, particularly for a child. The current recommendation for sugar consumption per day for children is 10 teaspoons (50 grams) for girls and 15 (75 grams) for boys and no more. Most children meet or exceed

“WITH EVERY SINGLE SERVING OF SODA YOUR CHILD CONSUMES THEIR

RISK OF BEING OVERWEIGHT OR OBESE INCREASES BY 60 PERCENT!”

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the recommended sugar intake simply through what they eat in their regular diet.

The additional sugar intake from beverages such as soda or other sweetened drinks can be detrimental to your child’s health.

• Health and soda consumption

Perhaps the most urgent concern for our children is the contribution of soda to the overweight and obesity epidemic. With every single serving of soda your child consumes their risk of being overweight or obese increases by 60 percent! Most people drink soda in addition to eating all the calories they require in a day. Any excess calories consumed-- more than you are burning during the day--from any source (protein, fat or carbohydrate, i.e. sugar) will be stored as fat. Most experts argue that drinking excess calories from soda in combination with a sedentary lifestyle is a major contributor to becoming obese.

Obesity is not the only soda-related health concern: soda consumption has been linked to type 2 diabetes, tooth decay, weak bones, digestive issues, inability to concentrate, pancreatic cancer, sleep disorders and learning problems. “One of the issues I’ve seen with drinking soda is that children may be replacing a glass of milk (or dairy products) with the soda,” says Kelly Pritchett, Ph.D., assistant professor and registered die-

titian at Central Washington University. Low dairy consumption is associated with reduced calcium intakes, resulting in weak bones and teeth.

• The importance of role modeling

A majority of soda consumption occurs in the home-not when the kids are at school or out and about. In fact, only 1.4 percent of all sodas consumed by children are done so in schools. So where are kids getting all this soda from? Mostly, their parents are providing the sugar-laden drinks. Parental role model-

ing has a large influence on the dietary (and other lifestyle) choices children make. If you drink soda, then it is very likely that your children will as well.

One of the first steps you can do to reduce your child’s soda consumption is to not purchase or drink soda in the home. This will provide health benefits for the whole family.

• If I can’t drink soda, what can I drink?

“A MAJORITY OF SODA CONSUMPTION OCCURS IN THE HOME--NOT WHEN THE KIDS ARE AT SCHOOL OR OUT AND ABOUT. IN FACT, ONLY 1.4 PERCENT OF ALL SODAS CONSUMED BY CHILDREN ARE DONE SO IN SCHOOLS.”

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Is there anything that children can drink that is considered healthy? The answer is a resounding yes!

Pure and simple the answer is water: Noncarbonated, unflavored, tap water is the best option. Sure, the occasional glass of fruit juice is ok, as long as the calories are accounted for, but most of your daily fluid intake should come from water. Not happy with that answer? Some other alternatives to soda that are low in calorie and noncarbonated include unsweetened or diluted fruit juices, flavored waters and unsweetened (decaffeinated) iced tea. S&W

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UNDERSTANDING SLEEP:

BODY, MIND & SOCIAL

✒ BY DR. MICHAEL GRANDNER IS A RESEARCH PSYCHOLOGIST AT THE UNIVERSITY OF PENNSYLVANIA. THE PRIMARY FOCUS OF HIS RESEARCH IS TYPICAL SLEEP PATTERNS AND HABITS AND HOW THEY RELATE TO HEALTH OUTCOMES. THIS ARTICLE IS BASED ON A DISCUSSION WITH DR. GRANDNER AND A MEMBER OF THE AMERICAN SLEEP & BREATHING ACADEMY.

JENNIFER TAYLOR

BIOPSYCHOSOCIAL MODEL OF SLEEP MEDICINE The biopsychosocial model of medicine promotes the notion that wellness is tied not only to biological factors but also psychological and social elements. Dr. Grandner believes the discipline of sleep medicine is best explained using a biopsychosocial model.

That is, sleep can be best understood by investigating a person’s body and mind and the social aspects of his life.

• Body body structure, heart rate, body temperature, circadian rhythms

• Psychological stress, mental activity, mood, attitudes, beliefs

• Social family, friends, work, routines

Michael A. Grandner, PhD

GETTING OPTIMAL SLEEP Typically people feel most rested and function best when they sleep 78 hours each night. Dr. Grandner advised, “It should take you a few minutes to fall asleep when you go to bed. If you fall asleep immediately when your head hits the pillow, you either aren’t getting enough sleep or you’re going to bed too late.”

Research shows that people sleep best when it’s dark, slightly cool, and when they are comfortable. Even a little bit of light at night can disrupt biological rhythms, so you should keep your room slightly cool and as dark as feasibly possible.

Our bodies run on biological clocks known as circadian rhythms.

Every morning this internal clock is reset by bright daylight. Our clocks can get messed up when we don’t get enough light during the day (such as during a long, northern winter) or when we get too much light at night (such as when we watch TV or use digital devices in the evening). If your biological clock isn’t in sync with your daily schedule, you may feel groggy or even depressed, but you can reset your clock by exposing yourself to bright light in the morning. You can even adjust your biological clock by up to an hour a day, training yourself to be alert earlier in the morning and go to bed earlier in the evening, by using light therapy.

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Many people suffer from insomnia. That is, they either have a hard time falling asleep or they wake up in the night and have a hard time falling back asleep.

Dr. Grandner said while many things can cause insomnia—illness, job stress, a family crisis—the initial cause of insomnia has little to do with long-term insomnia.

That is, the original cause of insomnia usually goes away, but the insomnia persists. Why is that? When people first experience insomnia, they spend extra time in bed, hoping to get some extra sleep. But instead of sleeping, they spend a lot of time in bed, awake, doing

other things. They program their minds to stay awake in bed. Then, no matter how tired they are, they just can’t sleep well. To resolve long-term insomnia, people need to reprogram their minds by using the bed only for sleeping. That means if you wake up in the night, you get out of bed and do something for a little while and then go back to bed to sleep. It seems counterintuitive, but it works.

You should sleep in your bed, and your bed should be for sleep and sex only. A lot of people use their beds for other activities, like work, reading, watching TV, playing video games, and talking.

In general, the more “People who are sleep-deprived don’t think as clearly,

t hey a re n ot as abl e to m ake s o und d ec is io ns,

and they are more emotionally fragile.”

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UNDERSTANDING SLEEP: BODY, MIND & SOCIAL

H time you spend in bed doing things that are not sleep, the harder it will be to sleep when you’re trying to.

Of course, if there’s a readily identifiable reason why you’re up at night, you must address that issue directly. Biological, psychological, and social aspects of your life affect your sleep. For example, if you’re angry, you’re going to have a difficult time falling asleep. Don’t go to bed angry; work through what you can before you go to bed. Give yourself permission to let things go for the night; chances are you aren’t at your mental sharpest right before bed. In the morning, often things will look better or make more sense or you’ll be able to see a solution you couldn’t see the night before.

EMOTIONS & MEMORY Sleep serves some very important functions in terms of emotional regulation, so sleeping on your problems is genuinely helpful much of the time.

People who are sleepdeprived don’t think as clearly, they are not as able to make sound decisions, and they are more emotionally fragile. They are more prone to mood swings and do not derive as much pleasure from the things they would enjoy if they weren’t tired.

Brain research has shown that the areas of the brain that control memory and emotion are right next to each other. Memory is profoundly affected by emotions because emotions signal to our minds what is important. You may not remember what you ate

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“Memory is profoundly affected by emotions because emotions signal to our minds what is important.”

for breakfast last Tuesday, yet you remember what you ate for breakfast the day your mother passed away years ago; that’s because your mother’s death was a powerful emotional experience, so the memory is preserved in vivid detail. The intensity of the emotion surrounding different events affects how well you remember them more than whether the events were positive or negative. Even more profound, it has been determined that if you are able to change your feelings about an event, you will also change your memories of that event. In effect, you can “spin” your own history.

PROCESSING INFORMATION AT NIGHT How do emotions and memory relate to sleep? What really happens when we “sleep on it”?

During the day, you take in information during every moment. You do things, you hear things, you learn things, you feel things. By the end of the day, you can be overwhelmed with data. That’s one of the reasons why it’s not best to make important decisions at night before bed. While you sleep, your brain processes the information it has taken in during the day. It determines what is important and what things mean. Some of this data processing manifests itself as dreams, which you may or may not remember upon awakening in the morning. Often, you’ll find that something that stymied you at night before you went to bed makes sense to you

in the morning. Your mind has processed that information and knows what to do with it.

Dr. Grandner is a licensed clinical psychologist and Instructor in the Department of Psychiatry. He has published over 40 articles on issues relating to sleep and health appearing in journals including SLEEP, Appetite, Sleep Medicine, and JAMA. He currently serves on the Mental Health Task force of the NCAA. Dr. Grandner maintains leadership positions with the American Academy of Sleep Medicine, Sleep Research Society, and Society of Behavioral Sleep Medicine, and he is the outgoing President of the Pennsylvania Sleep Society.

HOW DOES IT ALL FIT TOGETHER? Sleep is essential—and complex—because it affects and is affected by every part of our lives. When you work with a person on improving his sleep, you are dealing with every part of his life: how he feels physically and emotionally, what he can do, his worries and fears, even what is important to him. That is why there is no “one size fits all” solution for sleep problems and why it’s important to consider biopsychosocial elements that take in the broad view and treat the whole person.

Sleep medicine is a field that bridges the gap between traditional medicine and wellness.

Sleep, like diet, is truly a pillar of health. Emerging solutions for sleep disorders, which often take into consideration multiple aspects of a person’s life, have a great impact on overall health and well-being. S&W

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Q&A

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WITH CHERYL FORBERG, RD

A REPRESENTATIVE FROM THE AMERICAN SLEEP & BREATHING ACADEMY [ASBA] TALKED WITH CHERYL FORBERG, RD AT THE SLEEP & WELLNESS 2014 CONFERENCE IN MAY. CHERYL FORBERG, RD IS AN AWARD-WINNING CHEF AND A NEW YORK TIMES BESTSELLING AUTHOR. SINCE 2004, FORBERG HAS BEEN THE NUTRITIONIST FOR THE NBC HIT SHOW, THE BIGGEST LOSER. SHE WAS ALSO NAMED AS ONE OF THE TOP 100 MOST INFLUENTIAL PEOPLE IN HEALTH AND FITNESS. CHERYL FORBERG WAS PLEASED TO SHARE SOME OF HER EXPERIENCES AND INSIGHTS FOR SLEEP & WELLNESS MAGAZINE.

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“...often people skip meals, which promotes weight gain, not weight loss.

I t’s co unt er i ntu iti ve, but o nc e we sk ip a me a l,

particularly breakfast, we lose sight of our hunger cues.

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Q&A WITH CHERYL FORBERG, RD

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ASBA: PLEASE GIVE A SHORT SUMMARY OF HOW YOUR CAREER EVOLVED. CHERYL FORBERG: My career originated from my

training as a professional chef, which is my first love. I started to cook for private clients who had dietary restrictions. I felt I could go a lot further with my cooking if I understood the physiology of why people needed to eat a certain way, so I went back to school and got my nutrition degree and RD [registered dietician] credential. That training enabled me to go beyond the kitchen and to do more teaching and approach my work from a lifestyle vantage point that includes elements of nutrition, exercise, and general wellness.

ASBA: CAN YOU TELL US A LITTLE BIT ABOUT YOUR ROLE AS THE NUTRITIONIST FOR THE BIGGEST LOSER TV PROGRAM? CHERYL FORBERG: Sure. I’ve been with the show for 10 years, and we’re in the middle of filming our 16th season. (NBC started filming two seasons of The Biggest Loser per year when it became a popular show.) I design the eating plan for the contestants. Over the years, I’ve worked with hundreds of contestants, introducing them to a new style of eating. I don’t like to use the word ‘diet’ because a diet is temporary. On The Biggest Loser, we address the contestants’ entire lifestyle, not just what they eat. Our integrated approach addresses psychology and emotional eating, exercise and nutrition. The show employs experts in all areas on a medical team, and we’re constantly in communication with each other to make sure that each of our contestants is getting the optimal care in all areas.

“Many people have a long-term habit of emotional eating

that has contributed to weight gain and overall health issues.

Emotional eaters need to address the psychological aspect of eating.”

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ASBA: ASBA’S MISSION IS TO HELP PEOPLE IMPROVE BOTH SLEEP AND WELLNESS. HOW DO YOU FEEL YOUR WORK FITS WITH OUR MISSION? CHERYL FORBERG: I was pleased to participate

in the Sleep & Wellness conference because it included health professionals from different fields, working together, which is really the optimal approach to preventive health and lifestyle improvements. Nutrition is one important part of a healthy lifestyle, but you can’t ignore other areas like fitness and restful sleep and still maintain optimal health.

ASBA: LET’S TALK ABOUT THE RELATIONSHIP BETWEEN FOOD AND A GOOD NIGHT’S SLEEP. CHERYL FORBERG: The title of my talk at the

Sleep & Wellness conference was “Eat Your Way to Zzzz’s,” but I added a little subtitle because I didn’t want people to think there’s a food cure for sleeping disorders because there isn’t. However, the way we eat definitely contributes to our sleep and to our wellness. It’s really important that we eat at different times throughout the day because our blood sugar affects sleep. The amount and quality of the calories that we eat contributes as well.

Through working with The Biggest Loser, I have found that having a healthy weight is very important to having optimal sleep.

ASBA: PLEASE COMMENT ON HOW THE QUALITY OF FOOD IS AS IMPORTANT AS THE CALORIES IT CONTAINS. THERE’S A DIFFERENCE BETWEEN 500 CALORIES OF JUNK FOOD AND 500 CALORIES OF HEALTHY FOOD. CHERYL FORBERG: Healthy foods have a higher

nutrient density than junk food. If you eat 10 calories of a tomato, for example, and 10 calories of a soft drink, you’re getting a lot more “nutrient bang” for the tomato calories. My approach is that the quality of the calories we consume should be our principal focus. I truly believe if we focused on high-quality calories—such as lean proteins, whole grains, good fats—and eliminated many of the salty, fatty foods that are contributing to the obesity in this country, the quantity of the calories we consume would really take care of itself. We’d be naturally satisfied with the high amounts CONTINUED

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CONTINUED

Q&A WITH CHERYL FORBERG, RD

H take the time to plan our menus.

That’s what has kind of gotten us into this mess. It’s important to take time and think about what you’re going to eat, and where you’re going to eat it.

Otherwise you might wind up as so many people do: eating in the car, eating at your desk, eating standing up, choosing to dine at which ever drive-thru has the shortest line. A comprehensive approach to wellness requires that we step back a little bit, slow down, and prioritize things like meals. If we don’t take care of ourselves, we’re not going to be healthy enough to take care of anybody else in our family, so good choices about where and how we eat (as well as what we eat) are key.

of fiber, water, and nutrients that are found in those healthy foods.

ASBA: LET’S TALK ABOUT THE ENVIRONMENT IN WHICH WE CONSUME OUR FOOD"OUR RELATIONSHIP WITH FOOD"AND HOW THAT AFFECTS OUR WELLNESS. CHERYL FORBERG: It’s really important for all of us

to try to slow down a little bit. We’re all so busy, and often people skip meals, which promotes weight gain, not weight loss. It’s counterintuitive, but once we skip a meal, particularly breakfast, we lose sight of our hunger cues. By the time we eat lunch, we’re so hungry that we usually eat too much, too fast, and we choose the wrong things.

It’s really important to take the time and plan ahead. That’s much easier said than done with all the crazy schedules that people have. So often we don’t take the time to shop, and we certainly don’t

ASBA: LET’S TALK ABOUT THE RELA! TIONSHIP BETWEEN STRESS, ANXIETY, DEPRESSION AND EATING. CHERYL FORBERG: All of us are

emotional eaters, but some of us do a little more emotional eating than others. Sometimes we eat when we’re sad, when we’re tired, when we’re depressed, when we’re anxious—and we might not even be hungry. Emotional eating is when you’re eating and you’re not hungry; you know it, and you do it anyway. To compound the problem, emotional eaters generally choose unhealthy foods. When you’re stressed out or tired and going for a snack, you’ll rarely choose a salad with dressing on the side. The chocolate and fried comfort foods you choose instead aren’t really comforting to your body or your health.

Many people have a long-term habit of emotional eating that has contributed to weight gain and overall health issues. Emotional eaters need to address the psychological aspect of eating.

S L E E P & W E L L N E S S M A G A Z I N E • FA L L 2 0 1 4

in conjunction with changing your eating patterns for weight loss.” “...so it’s important to do proper exercise

ASBA: IN YOUR EXPERIENCE, WHAT HAS BEEN THE MOST EFFECTIVE SYSTEM FOR YOU TO HELP PEOPLE CHANGE NOT JUST THEIR DIET BUT THEIR LIFESTYLE? CHERYL FORBERG: I prefer to work

as part of a team. On The Biggest Loser, every day I work with the psychologists, the trainers, the medics, and the physician. In my private practice, I always work with a local trainer and also consult with a psychologist for some of my clients. Coordinating with other experts really improves the results of my work.

Even though nutrition is really important, if you only change the way and amount of food that you eat, you lose weight by losing fat and muscle. And you don’t want to lose muscle; you want to increase your muscle mass.

Muscle helps you to be more flexible and increases your metabolism, so it’s important to do proper exercise in conjunction with changing your eating patterns for weight loss.

ASBA: TELL US A LITTLE BIT ABOUT YOUR NEW COOKBOOK, FLAVOR FIRST, WHICH DEBUTED AT THE SLEEP & WELLNESS 2014 CONFERENCE. CHERYL FORBERG: Flavor First is a culmination of all the things I’ve learned from working with The Biggest Loser show for 10 years.

The cast members on the show personify overweight America.

We are so in love with our condiments. We love our ranch dressing, we love our ketchup, we love our sauces (especially cheese sauce)—and these things have really gotten us into trouble.

Most of us have such good intentions. When we’re trying to stay on a healthy plan, we go out to lunch and order a salad, but then we drown it in dressing. I wanted to help people choose the right ingredients and allow condiments and cheese to be part of the picture. The cookbook includes some sauces, vinaigrettes and marinades that are made with high quality ingredients and do not contain excess amounts of salt, sugar, and unhealthy fats. That’s a big part of the book, but I also kept in mind that most of us are pretty busy. The recipes included in the book are fairly simple, and the ingredients are things you can find without a hassle. Most of the people I work with don’t all have access to high-end health food stores and obscure ingredients.

Fortunately, you don’t need those things to prepare healthy, delicious food.

ASBA: WHAT DOES COOKING LOOK LIKE AT YOUR HOUSE? CHERYL FORBERG: We like to cook a lot of

international foods. Our dinner parties usually have a global theme. My boyfriend likes to make sushi. I enjoy Italian food, so I might teach my friends how to make pasta. Another time we might have an East Indian menu.

We live on a farm. I have a 3,000 square foot garden, and I enjoy picking my dinner. What’s in season in my garden usually dictates what we’re eating. I’m hoping that eventually we’ll be able to get almost all of our food from the back yard. In addition to my garden, I have 12 chickens. I just love having fresh eggs. A vineyard is also in the plans at our house, so soon we’ll even be making our own wine.

ASBA: IS PICKING YOUR DINNER EVEN A POSSIBILITY FOR MOST OF US? CHERYL FORBERG: I think a lot of

people are trying to go back to living off the land. Even if you live in town, sometimes it’s all right to have a few laying hens. If you live in an apartment or a big city, you can still have a few pots of herbs on the balcony or in your kitchen. I highly recommend growing a little bit of what you eat. You can’t beat it for cost and freshness and excellent taste.

It’s so gratifying that I think everyone should give it a try. S&W

Hungry for more? You can find recipes, wellness and cooking tips, and even photos and other information about contestants on The Biggest Loser at Cheryl Forberg’s web site, www.cherylforberg.com.

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PART 1

This is the first in a series of articles. It chronicles the real-life experiences of a man with sleep apnea. The mystery sleeper’s identity will be revealed in the final installment of the series.

MOST OF MY LIFE I HAVE BEEN A BIG PERSON. FIRST A BIG KID, THEN A LARGE ADULT. IT WORKED WELL ON THE PLAYGROUND, IN SPORTS, AND THEN IN COLLEGE. I STARTED A PROFESSIONAL LIFE, PAID MY TAXES—FOR THE MOST PART, JUST BECAME A RESPECTABLE MEMBER OF SOCIETY.

S L E E P & W E L L N E S S M A G A Z I N E • FA L L 2 0 1 4

✒ BY

LOUD U. SNORER

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SOMEWHERE ALONG THE WAY, PEOPLE STARTED COMMENTING ON MY NIGHTTIME RUCKUS. I wasn’t aware of it at first because, of course, I was asleep. But the complaints became louder and more frequent. They were often directed at my wife, who would hear things such as, “How do you sleep at night with that racket?” My wife was nice at first. She put up with it. I would occasionally get a jab in the ribs that would abruptly bring me out of whatever sleep I was enjoying to hear, “Quit snoring!” Do you think any of us who snore can stop just because someone asks us to?

CONTINUED

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Mys t e r y S l e e p e r

CONTINUED

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So this has been my life and my marriage for the past 25 years. Yes, I know I snore, but I don’t know what to do about it.

My parents have been using these machines for ten years now. I just kind of looked at them with disdain. “Not me,” I said. “I will never use a CPAP machine. That’s the silliest thing I have ever seen. It’s just another fad, along with chin supports, aromas, and whatever else they sell at carnivals to stop snoring.

I used to tell people I just do not need much sleep. I had seen a reporter mention that Bill Clinton only slept a couple of hours a night. Thomas Edison only slept a couple of hours a night. I figured I was one of the lucky ones who only required a couple of hours of sleep at night.

While I thought sleeping just a little at night was all right, sleeping during the day was an issue. I would fall asleep as soon as I sat down.

Forget watching a movie. I remember often going to a movie with my kids and not getting through the previews.

I’d wake up at the end of the movie. “At least it was a dollar movie,” I would comment.

Later, I went back to school to get my doctorate.

School meant long hours of class, study, and writing that dissertation. I did not have time to sleep. However, one day I was driving home from classes and felt my head bob.

Where was I? Had I been asleep, and if so, for how long?

I could have hit someone or

PART 1

This is the first in a series of articles. It chronicles the real-life experiences of a man with sleep apnea. The mystery sleeper’s identity will be revealed in the final installment of the series.

I real“ ized I had to

deal with my sleep problem— and soon.

I would force myself to get more sleep, I promised.”

even killed someone. That was unacceptable. I realized I had to deal with my sleep problem—and soon. I would force myself to get more sleep, I promised.

For the next year, I really did try to get more sleep.

But though I slept more, I did not feel rested. In fact, I was still nodding off in movies and whenever I had a quiet moment. I realized I was suffering from sleep apnea. By this time, the science was there: apnea is bad. Heart disease, diabetes, and so many of the diseases often attributed to aging also can be associated with sleep apnea.

After accepting that I had sleep apnea, I had to decide what to do about it.

It’s important to note that I make my living flying airplanes. I have been doing it for many years, and I am not about to give it up. Pilots have to pass a medical exam; if they have a medical issue, they must disclose it. Pilots who have medical issues that can affect the safety of passengers are grounded. For me, that was a big reason to avoid being diagnosed with sleep apnea!

I figured the bottom line was, I was not getting enough sleep. I resigned myself to using a CPAP machine. I thought I’d just go buy one. Then I learned that’s not possible. A person needs to have a medical exam, be diagnosed with sleep apnea officially, and then get a prescription before he can buy a CPAP machine.

Are you kidding? Clearly everyone, including yours truly, can see or hear that I am suffering from sleep apnea. S&W

YOU CAN READ MORE OF THE MYSTERY SLEEPER’S STORY IN THE NEXT EDITION OF SLEEP & WELLNESS MAGAZINE.

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N LIVING HEART

“The cardiovascular problems like hypertension, stroke, and heart attack

are often experienced in conjunction with sleep disorders , such as sleep apnea, often associated with obesity or large body size.”

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FOUNDATION

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PROMOTES GENERAL WELLNESS

DR. ARCHIE ROBERTS, FORMER CARDIAC SURGEON, NFL PLAYER AND CHIEF MEDICAL OFFICER AND PRESIDENT OF THE PRO-PLAYER HEALTH ALLIANCE, FOUNDED THE LIVING HEART FOUNDATION IN 2001 TO PROMOTE CARDIOVASCULAR HEALTH AND WELLNESS AMONG ATHLETES AND UNDERSERVED POPULATIONS, YOUNG AND OLD. SINCE ITS FOUNDING, THE FOUNDATION HAS SHOWN SPECIAL INTEREST IN THE HEALTH OF PROFESSIONAL ATHLETES, PARTICULARLY NFL FOOTBALL PLAYERS.

✒ BY

ARCHIE ROBERTS, MD

Dr. Roberts was motivated to create the foundation because he’s passionate about health and wellness. At one point in his career, Dr. Roberts suffered a mini-stroke while delivering a lecture to a large group of doctors. He knew that others shared his experience with garbled speech, weakness in his arm, and the subsequent treatments and carotid artery surgery, and he wanted to help people avoid those experiences if he could.

Dr. Roberts was heavily involved in sports throughout his life, with his athletics culminating in a career as a NFL quarterback for the Cleveland Browns and the Miami Dolphins. It is believed that he is the only NFL player to play football and graduate from medical school in 4 consecutive years.

However, even in his youth, he planned to become a physician. Later, he recognized that as a doctor he could promote lifestyle choices that would lead to increased health for athletes—and for the general population, since many of us struggle with the same the health challenges athletes face.

NFL athletes are often afflicted with hypertension, sleep apnea, and metabolic syndrome. When they find solutions for these problems, they are happy to share them with other peo-

ple who face the same symptoms.

Choosing active and retired NFL players to serve as spokesmen has been especially helpful for the Living Heart Foundation. While many of us are affected by health challenges, lots of us “check out” when our doctors explain treatment options and lifestyle choices that could help us.

When NFL players team up with medical professionals to share health messages, they reach a broader, more engaged, audience.

The cardiovascular problems like hypertension, stroke, and heart attack that Dr. Roberts treated as a physician are often experienced in conjunction with sleep disorders, such as sleep apnea, often associated with obesity or large body size. Dr. Roberts and the Living Heart Foundation promote general wellness, which integrates healthy sleep with other beneficial lifestyle choices. The foundation benefits from the input of everyday people and a variety of experts that include doctors, dentists, health care professionals, and technicians—people who are interested in a good night’s sleep and are willing to approach treatment options across a range of disciplines. S&W

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A FEW WORDS FROM AARC EXECUTIVE OFFICE ✒ BY

N

TOM KALLSTROM AND TIM MYERS

TOM KALLSTROM MBA, RRT, FAARC IS THE EXECUTIVE DIRECTOR AND CEO OF THE AMERICAN ASSOCIATION FOR RESPIRATORY CARE (AARC). TIM MYERS MBA, RRT-NPS, FAARC IS AN ASSOCIATE EXECUTIVE DIRECTOR WITH THE AARC. THE AARC AND THE AMERICAN SLEEP & BREATHING ACADEMY (ASBA) HAVE COLLABORATED EXTENSIVELY OVER THE PAST YEAR TO PROMOTE PATIENT AND CAREGIVER EDUCATION AND MULTIDISCIPLINARY COLLABORATIVE CARE FOR PATIENTS WITH BREATHING DISORDERS, PARTICULARLY DISORDERS THAT RELATE TO SLEEP. KALLSTROM AND MYERS RECENTLY SHARED A FEW OF THEIR THOUGHTS REGARDING THE RESPIRATORY PROFESSION AND THE DIAGNOSIS AND MANAGEMENT OF SLEEP DISORDER BREATHING FOR SLEEP & WELLNESS MAGAZINE READERS.

1.

ROLE OF THE AARC • Encourages and promotes professional excellence while serving as a resource for patients, government agencies, and national institutions about respiratory health issues • Advocates for patients and their families with respiratory conditions • Advances the science and practice for respiratory therapists

2.

WHAT ARE RESPIRA! TORY CONDITIONS, AND WHAT RISKS DO THEY POSE? Some commonly known respiratory disorders are asthma, obstructive sleep apnea, chronic obstructive pulmonary disorder (COPD), emphysema, pneumonia, tuberculosis and bronchitis.

It’s important for people who suspect they have an acute or chronic respiratory condition to meet with their physician and get an accurate diagnosis and proper, ongoing treatment.

Patients with undiagnosed respiratory conditions, such as sleep apnea, may suffer from daytime sleepiness, which not only degrades their quality of life but also puts them and others in danger if they drive or operate machinery. It’s estimated that drowsy drivers cause thousands of fatalities every year in the U.S. People who work long or late shifts or work in high-stress positions may also make critical mistakes that endanger themselves and others when they don’t get enough sleep.

Patients with respiratory conditions also have an increased risk of developing other acute or chronic health issues, such as diabetes or cardiovascular problems. Somatic heart disease has been identified as a possible risk of having undiagnosed sleep apnea, for instance.

S L E E P & W E L L N E S S M A G A Z I N E • FA L L 2 0 1 4

3.

WHAT IS THE BEST WAY TO TREAT RESPIRATORY CONDITIONS? The best treatments for respiratory conditions address overall wellness instead of just treating the symptoms of the condition. Treatment can include traditional medicine, the use of supportive equipment like a CPAP machine, dental devices, diets and exercise for weight loss, and improved sleep habits.

Coordinated, interdisciplinary care is a key feature of Accountable Care Organizations (ACO’s), which have a growing presence in the healthcare arena; they represent a shift in healthcare from treating disease to promoting wellness.

Currently, ACO’s are groups of hospitals, doctors , and other healthcare specialists who join together to provide care for chronically ill patients.

Patients and healthcare providers benefit from ACO’s because they improve the overall quality of care while reducing costs. ACO’s are also unique in that they provide a financial incentive for healthcare providers to coordinate care and reduce costs for patients, whereas traditional medical systems pay providers a fee for services rendered.

The AARC has been instrumental in recommending that respiratory therapists be included in ACO’s to help patients with respiratory disorders. S&W

TOM’S TIPS FOR BETTER SLEEP

TIM’S TIPS FOR BETTER SLEEP

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• Manage stress by designating times for different activities.

• Don’t eat late at night.

• Avoid alcohol at night.

• Read a book before bed.

• Go to bed at the same time every day.

• Find a good work-life balance.

• Stick to a routine.

• Eat healthy meals.

• Exercise.

• Maintain these good habits even when you travel.

Educational Material RESPIRATORY CARE – a scientific journal that deals with the subject area of the same name, and thus publishes articles pertaining to disorders affecting the cardiorespiratory system, including their pathogenesis, pathophysiology, manifestations, diagnostic assessment, monitoring, prevention, and management.

The Clinician’s Guide to PAP Adherence – a guide for clinicians that includes information about positive pressure device compliance and best practices for treatment in a user-friendly Q&A format AARC U- The AARC University is the AARC’s official educational portal, allowing participants to access educational content, earn continuing respiratory care education credits, and expand their ability to provide excellent patient care.

Web sites maintained by reputable sources: CDC.gov, www.nih.gov, AARC.org, www.yourlunghealth.org

TO OUR SPONSORS AT THE 2014 CONFERENCE

Circadian Sleep Disorders Network

This conference was supported, in part, by an educational grant from Jazz Pharmaceuticals in accordance with the ACCME standards for commercial support.

BROUGHT TO YOU BY:

in collaboration with:

YOUR SLEEP STICKER HERE