Sleep&Wellness Magazine - Diabetes Issue by Sleep & Wellness

Winter 2013 // Issue 6 Complimentary Copy

DIABETES LINKED TO SLEEP APNEA

Biggest Loser Head Master Chef Shares Recipes To Help With Seasonal Depression And Diabetes

By Edward Grandi

American Association For Respiratory Care

The American Sleep & Breathing Academy

CPAP Use – Tips For Avoiding Problems

Why Do I Need A Good Night's sleep?

DOES SLEEP FASCINATE YOU?

The need for trained sleep professionals is in high demand across the country. More than 100 million Americans suffer from some form of sleep disorder; 18 million Americans suffer from sleep apnea. Sleep technologists have competitive wages, and there are job opportunities found in hospitals and sleep disorder clinics, as well as in private labs. The American Sleep and Breathing Academy offers courses needed to become a Registered Polysomnography Technologist. The program is designed to prepare students to perform, monitor, and interpret sleep studies. Are you already a Sleep Professional? Join us every month for our Lunch Break Broadcast. The Lunch Break CEC is an hour-long broadcast with 1 continuing education credit for all participants. Every month features a different topic with speakers that are experts in the field.

Visit our website

www.americansleepandbreathingacademy.com for more details or call

866-272-3226

W IN T ER 2 013 • S LE E P & W ELLNE SS MA GAZ INE

CONTENTS

Winter 2013 // Issue 6

ASBA Dental Division Working to Improve Safety on America’s Roadways

The A B Zzzzs of Yoga A Yogiʼs Guide to Sound Sleep

Oral Appliance Therapy For Sleep Apnea and Snoring

Written By Rudy Mettia

Written By Barry N. Chase, DDS, PC, D. ABDSM, D. ACDSS

Written By David Gergen

Diabetes and OSA What is Diabetes? What is the Connection with Sleep Apnea? Written By Edward Grandi

SL E E P & W E L L N E SS M AG A Z I N E â&#x20AC;˘ W I N T E R 201 3

AARC American Association for Respiratory Care

InfoGraphic: Sleep is Awesome ASBA Committee

34 Meditation: The Ancient Antidote for Modern Stress Written By Lisa Cypers Kamen, MA

CPAP Use Tips for Avoiding Problems

Sleep, Wellness & Health= A Recipe for Wellbeing

Like Insomniacs, SAD Sufferers Hold Unhelpful Beliefs About Sleep

Written By Lisa Cypers Kamen, MA

Written By Traci Pedersen

Written By Karen S. Schell, DHSc, RRT-NPS, RPFT, RPSGT, AE-C, CTTS

44 Case Study How I Eliminated My Asthma Written By Rick Tufts, C.N.P.

Lisa Cypers Kamen, MA New Wellness Editor

Cheryl Forberg Biggest Loser Head Master Chef shares Recipes to Help with Seasonal Depression and Diabetes

W IN T ER 2 013 • S LE E P & W ELLNE SS MA GAZ INE

Jennifer Taylor MANAGING EDITOR

SOMETIMES THE RESPONSIBILITIES IN DIFFERENT parts of our lives all converge on one day or one week. Recently, I found myself juggling an impossible collection of to-do items. I was working from sun to sun—and beyond!—and I just couldn’t get everything done. I was feeling frantic, day after day, and the pressure was taking a toll on how I felt physically as well. As it so happened, on one of those crazy days, Lisa Cypers Kamen’s article on meditation came across my desk. As I read the article, I realized I really needed to slow down and save my sanity and my health. I tried to do 10 minutes of mindful meditation, but I found I was too keyed up. Instead, I carved out a chunk of time for some moving meditation and took a walk. Even though the weather was blustery, it felt good to get out. I paid attention to what was around me (instead of all the things I “should have” been doing)—and I truly felt better! Maybe meditation doesn’t sound appealing to you. How about yoga? Whether you’re stressed out, sleepless, or just looking for ways to learn or make your day-to-day life better, this issue of Sleep & Wellness Magazine has something for everyone. Did you know there’s a correlation between diabetes and sleep apnea? Both are common, and it may be more than a coincidence. If you or someone you know has diabetes (or not!), you’ll love the diabetic-friendly recipes provided in this issue. You can learn about seasonal affective disorder and boost your mood with recipes that include specially selected ingredients. Read about how one man conquered his asthma using natural remedies. See how the American Sleep & Breathing Academy is working to make the roadways safer by encouraging compliance with sleep therapy for professional drivers who need it. Check out startling statistics about how getting too little sleep can truly be hazardous to your health. Life gets crazy, it’s true. But amidst your worries, remember to take care of yourself. Prioritize, and let some things wait until tomorrow or next week. Let less-important things go if you must. Protect your sleep, and promote your own well-being. You’ll be glad you did. S&W

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 2013 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

W IN T ER 2 013 • S LE E P & W ELLNE SS MA GAZ INE

AMERICAN SLEEP & BREATHING ACADEMY EDUCATION COMMITTEE

THE STAFF

HEALTH AND WELLNESS EDITOR

DENTAL DIVISION EDITOR

AARC SPECIAL SECTION EDITOR

Lisa Cypers Kamen, MA

Randy Clare

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

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.

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.

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).

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

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 Barry N. Chase, DDS, PC, D.ABDSM, D. ACDSS Cheryl Forberg, RD Edward Grandi Karen S. Schell, DHSc, RRT-NPS, RPFT, RPSGT, AE-C, CTTS Marci Williams Rick Tufts, C.N.P. Rudy Mettia Syed I. Nabi, M.D. Traci Pedersen

CONTRIBUTING ORGANIZATIONS

ART DIRECTOR

CREATIVE DIRECTOR

PRODUCTION DIRECTOR

Sharon Robins

Antoni Pham

Carline Risser

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

W IN T ER 2 013 • S LE E P & W ELLNE SS MA GAZ INE

DENTA L

ASBA DENTAL DIVISION

WORKING TO IMPROVE SAFETY ON AMERICA’S ROADWAYS

The agency is working on guidance to medical examiners regarding sleep disorders, but trucking interests insist that a formal rule is needed to give employers a clear statement of their legal responsibilities. A spokesman for the T&I Committee said that if the measure passes, it will be reported to the full House for action.

ON JULY 11, 2013, SEVERAL SLEEP EXPERTS PRESENTED NEW TECHNOLOGY THAT COULD HELP IMPROVE SAFETY ON AMERICA’S ROADWAYS. The experts spoke with officials at the Department of Transportation in Washington, D.C. The experts included David Gergen, Executive Director of the American Sleep and Breathing Academy Dental Divison; Dr. Elliott Alpher, a Board member of the ASBA Dental Division; Dr. Richard Klein, a member of ASBA; Dr. Richard Bonato, President of Braebon Corporation; and Mitch Livingston, Vice President of Braebon Corporation. Dr. Bonato and Mitch Livingston explained how a sensor implanted into an oral appliance used to treat sleep apnea can measure usage and compliance among patients, such as commercial truck drivers. Dr. Bonato was directly involved in creating the micro-recorder technology, along with Don Bradley and others at Braebon. Gergen, who has successfully helped 160 NFL players with sleep apnea, drew several comparisons between the large sizes of truck drivers and NFL football players. Gergen owns Gergen's Orthodontic Lab, which is a company that leads the country in fabrication of the Acrylic Sleep Herbst Device, the oral appliance Braebon intends to have their micro-recorder planted in. The House Transportation and Infrastructure Committee scheduled a vote on September 19, 2013, for a bill that would compel the Federal Motor Carrier Safety Administration to write a regulation covering sleep disorders rather than issue guidance that cannot be enforced. The bill that was introduced by Reps. Larry Bucshon (R-Ind.) and Daniel Lipinski (D-Ill.) says the agency must go through the rule-making process to regulate sleep disorders, including sleep apnea.

David Gergen Executive Director of the American Sleep and Breathing Academy (ASBA) Dental Division, owns Gergen’s Orthodontic Lab

“The bill is a good government measure,” said Justin Harclerode. “It doesn’t address whether or not there should be any regulation changes – it simply requires that any proposed regulatory changes follow the rule-making process.” The bill is likely to be approved by the committee and taken up by the House, but it is not clear if the Senate will do the same, said one insider who could not speak on the record. ASBA members will be on the preferred providers listing for the transportation program that was presented to the Department of Transportation in Washington D.C. by David Gergen and Dr. Elliott Alpher. Update, the bill passed unanimously in both the House and Senate and was signed into law on October 16, 2013. S&W

W IN T ER 2 013 • S LE E P & W ELLNE SS MA GAZ INE

SLEEP & WELLNESS

The A B Zzzzs of Yoga

– A YOGIʼS GUIDE TO SOUND SLEEP Written By Rudy Mettia

HAVE YOU EVER GLANCED AT THE ILLUMINATED NUMBERS ON THE CLOCK NEAR YOUR BED AND THOUGHT IN SHOCK, “ITʼS ALREADY 1:30 A.M. Crap! I have to get up at 6:30. If I can just fall asleep right now, Iʼll get five hours of rest.” As you lie restless, you try to convince yourself that you can function on five hours of sleep — yeah right! You tell yourself this again at four hours. At three hours, you know you’re in trouble, and you start to get—dare I say—agitated and angry. Lord knows that wonʼt help your cause. Sleeplessness can be caused by a lot of things. Sometimes, your mind wonʼt let up. Your might be worried and frightful or so full of joy, happiness and excitement that you canʼt slow down, much less get some shuteye. It doesnʼt matter whether youʼre thinking about a pending disaster or anticipating the best day of your life; you need your sleep, and to get it, you need to quiet that monkey mind. So how do you deal with a busy brain that wonʼt let you get to sleep? My go-to nightcap is yoga. Itʼs kind of like that warm glass of milk that helps

SL E E P & W E L L N E SS M AG A Z I N E • W I N T E R 201 3

Shoulder Stand

Pegeon Pose

you wind down and get ready for bed. One of the main reasons yoga works so well as a sleep aid is that it releases your tension. Tension is antisleep. If you practice yoga, you can learn to release that stress and also tune yourself into the habits that keep you from hitting the hay.

Say you want to get to sleep by 10 p.m. By 7 p.m., stop taking in stimulants like coffee, alcoholic beverages and sugar. Also steer clear of heavy meals. Kill the TV by 8:30 p.m. I know Breaking Bad and Dexter come on at 9, but you got TIVO, don’t you? Keep your tube time to the daytime.

But yoga doesn’t just hush that monkey mind; it also triggers the parasympathetic — “rest and digest” — system in the same way that a few ZZZs do. By jump-starting parasympathetic activities like energy conservation, digestion and slowing of your heart rate, yoga can help you get ready for that much-needed shuteye. Studies have even shown yoga helps decrease insomnia.

Once the TV, laptop, tablet and phone are all dark, break out your yoga mat. Now, start the 90minute advanced Astanga series. Just kidding! Relax. You’re just going to do about 15 minutes of gentle forward bends, seated and supine postures, all with deep breaths designed to illicit the relaxation response in your mind. Whereas backbends are exhilarating and standing poses are powerful, the gentle poses in this sleep routine make you do what gravity wants you to do anyway: move without exerting a ton of effort. Free your mind, and much needed sleep will come.

Ready to start using yoga as your sleep aid? First, you need a plan, a ritual. Here’s what works for me:

CONTINUED >>

W IN T ER 2 013 • S LE E P & W ELLNE SS MA GAZ INE

SLEEP & WELLNESS

Here’s the yoga:

Stand with your feet hips distance apart at the back end of your mat, with your hands resting on your hips.

Take a deep inhale and on the exhale, hinge at the hips and fall forward into a forward bend. Your knees should be softly bent to support your lower back and hamstrings.

Take 10 breaths with your head hanging with gravity. Imagine all the busyness dumping out and dissolving into the floor while you empty your mind and melt your body.

From your forward bend, walk your hands out into downward facing dog.

Take 5 to 8 breaths, not working too hard. You’re doing this just to take the edge off and burn any excess energy that may be keeping you from sleeping. You’re not trying to get stronger or fitter in this practice; you’re trying to relax.

From down dog, drop to your knees and take child pose for 10 soft breaths. Feel your body soften and your mind start to surrender.

As you come out of child pose, find your way into a seated posture. Bring the soles of your feet together in a Baddha Konasana (cobbler) pose and gently drift into a forward bend. Take a few deep breaths.

After cobbler posture, release both legs straight out in front of you for a long-held forward fold, 10 breaths at least.

Move into a supported shoulder stand with a bolster. Better yet, move to the wall so you can stay for 10 breaths without working too hard. Lowering from shoulder stand, take a gentle leg across body twist on both sides.

10 Find your way to savasana (corpse) pose. Here is the one time falling asleep in savsana is not a bad ending. Stay in corpse pose until you feel ready for sleep. 11 Move slowly off your mat. If you’re not quite ready for bed, have a bed time tea and spend 5 to 10 minutes in meditation. Whatever you do, please don’t turn the gadgets back on; you’re free, for now.

Practice that easy routine every night, and youʼll be the next Rip Van Winkle — minus the bad hair and the 20 years of hibernation in the woods, that is. S&W

Forward Fold

Child Pose

Dancer Pose

Warrior Pose

Reverse Warrior

Sunbird Pose

Don’t let the handlebar mustache and rugged exterior fool you: Rudy Mettia is one of the most dynamic, dedicated yoga instructors you could meet. Drawing from decades of personal exploration and extensive physical training, Rudy teaches a power yoga-based practice that both challenges and heals his students — all while using his signature wit and southern drawl to make yoga approachable to novices and experts alike. Rudy founded the Yoga Allianceapproved Power Yoga 360 Teacher Training method. He is also an adjunct faculty member at the Kripalu Center for Yoga & Health and the resident Yoga Specialist for Harvesting Happiness for Heroes, an organization that helps returning veterans and their families overcome reintegration struggles such as PTSD. An E-RYT 500 certified instructor, Rudy has spent more than 10,000 hours instructing yoga students of all experience levels and recently released a DVD series, Yoga Warrior 365, that makes yoga mastery accessible to yogis in the comfort of their own homes. To learn more, visit www.RudyMettia.com.

ų 6/((3 $:$5(1(66 7285 ų

A grass-roots, cross-country ‘movement’ bringing education and FREE clinics to the people. Our goal is to raise awareness of the connection between sleep and good health. Join the movement today! Register online at DreamsWithHope.com

6SRQVRUHG E\

® &3$3 0DVN /LQHUV Let

yourself dream again...

Comfort / Stop leaks / Prevent skin irritation / Promotes compliance

7R OHDUQ PRUH YLVLW RemZzzs.com or call 877.473.6999

W IN T ER 2 013 • S LE E P & W ELLNE SS MA GAZ INE

DIABETES DIABETES IS SERIOUS AND HIGHLY PREVALENT. ACCORDING TO THE AMERICAN DIABETES ASSOCIATION’S 2011 FACT SHEET, 25.8 MILLION CHILDREN AND ADULTS IN THE UNITED STATES – 8.3% OF THE POPULATION—HAVE TYPE 2 DIABETES; 1.9 MILLION NEW CASES OF DIABETES WERE DIAGNOSED IN 2010. THE COMPLICATIONS OF DIABETES ARE SERIOUS; THEY INCLUDE HEART DISEASE, STROKE, HIGH BLOOD PRESSURE, BLINDNESS, KIDNEY DISEASE, NERVOUS SYSTEM DISEASE (NEUROPATHY) AND AMPUTATION. THE ECONOMIC CONSEQUENCES ARE STAGGERING AS WELL: $245 BILLION IN 2012, INCLUDING $176 BILLION IN DIRECT MEDICAL COSTS AND $69 BILLION IN REDUCED PRODUCTIVITY. CONTINUED >>

SL E E P & W E L L N E SS M AG A Z I N E • W I N T E R 201 3

S AND OSA

“

Diabetes is a condition that results in excess sugar, or glucose, in the blood caused by damage to the cells that produce insulin.

W IN T ER 2 013 • S LE E P & W ELLNE SS MA GAZ INE

DIABETES AND OSA

Edward Grandi serves as the Executive Director of the American Sleep Apnea Association. He is a resource to the media on the prevalence of sleep apnea and diagnostic and treatment options available to address the condition. He is a nationally and internationally invited speaker on the field of sleep medicine.

WHAT IS DIABETES? Diabetes is a condition that results in excess sugar, or glucose, in the blood caused by damage to the cells that produce insulin. Insulin is a naturally occurring hormone that regulates how the body processes carbohydrates and fat. Glucose is like the gasoline that makes an automobile run. Insulin causes the liver, muscles and fat tissue to absorb glucose. Insulin protects the body by preventing excess glucose in the blood stream, which is dangerous. Unlike flooding the engine with too much gasoline, the presence of excess glucose in the bloodstream can lead to death. There are several types of diabetes. Type 1, also known as juvenile diabetes, occurs when the body does not have the cells responsible for producing insulin. Type 1 diabetes is usually the result of an autoimmune disorder wherein the body turns on itself, damaging or destroying the cells that produce insulin. This type of diabetes can be managed by replacing the insulin using injections or an insulin pump. Type 2 diabetes is more common and develops as a result of insulin resistance, a condition in which the body fails to use insulin properly to regulate glucose in the blood. Type 2 diabetes occurs mainly in adults, so it is sometimes known as adult-onset diabetes. However, the incidence of type 2 diabetes in children is increasing with the rate of childhood obesity. Mild cases of type 2 diabetes can be managed by changes in diet; more serious cases are managed with prescribed drugs. A third type of diabetes, gestational diabetes, sometimes occurs in pregnant women. Gestational diabetes can have negative effects on the unborn child as well as the mother. In some cases, a mother with gestational diabetes develops type 2 diabetes after her pregnancy.

WHAT IS THE CONNECTION WITH SLEEP APNEA? Sleep apnea is also a chronic medical condition. It results in sleep fragmentation and sleep deprivation from frequent pauses in breathing during sleep and subsequent arousals when breathing restarts. Like diabetes, sleep apnea is highly prevalent, with as much as 16% of the adult population suffering from

“

THE BENEFITS OF TREATING SLEEP APNEA INCLUDE IMPROVED DAYTIME FUNCTIONING AND BLOOD PRESSURE, AND—ACCORDING TO RECENT STUDIES – REDUCED INSULIN RESISTANCE.

“

Obstructive sleep apnea (OSA)

some form of the condition. Like diabetes, the consequences of untreated sleep apnea are serious and potentially life-threatening. Sleep apnea can be successfully treated, depending on the severity, by using a variety of different therapies including weight loss, modifying sleep position, an oral appliance, and devices that create positive airway pressure. The benefits of treating sleep apnea include improved daytime functioning and blood pressure, and—according to recent studies – reduced insulin resistance. The connection between the two conditions has been the subject of much interest in the medical research community. While researchers are reluctant to suggest that one causes the other, they feel there is a strong association between the two diseases. The association is so strong that the International Diabetes Federation and the American Academy of Sleep Medicine believe that people with either condition should be tested for the other. The importance of healthy sleep cannot be underestimated. Medical research shows that the lack of healthy sleep contributes to a number of serious medical conditions, like diabetes. There is promising evidence that restoring healthy sleep by treating a common sleep disorder— obstructive sleep apnea—can have a positive impact on insulin resistance. It is also possible that individuals can prevent or reduce the possibility of diseases like diabetes by establishing healthy sleep at an early age and maintaining good sleep habits throughout their lives. S&W

Snuggle Eye Pillow

SnuggleSoaps SnuggleGear Snuggle Buckwheat Pillow

SnuggleStraps

SnuggleScents

Breeze/Swift SnuggleHose

Every hose should have a

SnuggleHose!

SnuggleHoses are the ORIGINAL fleece hose covers for cpap hoses. They decrease condensation and prevent â&#x20AC;&#x153;rainoutâ&#x20AC;?. They look great, feel great & improve the quality of sleep. Hypoallergenic - machine washable - Earth friendly - available in many colors.

SnuggleHose, LLC | 459 East 1300 South | Salt Lake City, UT 84115 Phone: (801) 217-3437 | Fax: (801) 820-5720 | www.snugglehose.com

W IN T ER 2 013 • S LE E P & W ELLNE SS MA GAZ INE

DENTA L

ORAL APPLIANCE THERAPY FOR SLEEP APNEA AND SNORING

Written By Barry N. Chase, DDS, PC, D. ABDSM, D.ACSDD

SL E E P & W E L L N E SS M AG A Z I N E • W I N T E R 201 3

A ROMANTIC STORY: Steve M., a handsome young man of 42, healthy and in good physical condition, came into our office seeking treatment for his loud snoring and moderate case of obstructive sleep apnea. As a consequence of his snoring, he slept in another bedroom, as his wife was unable to sleep while he snored. He used a CPAP, a machine that utilizes continuous positive airway pressure delivered via a tube and mask on the face covering the mouth and nose, which blows the apnea obstruction open. Although the CPAP reduced his snoring and sleep apnea, Steve had to sleep on his back and because the machine made noise, he was still unable to sleep with his wife. After the insertion of an oral appliance to treat his sleep apnea, Steve no longer snored. He said, “Not only can I sleep with my wife, we can snuggle and I can hold her in my arms all night.”

•••••

AN ENCOURAGING STORY: Ronald T. is a 37-year-old elementary school principal. He was somewhat overweight, constantly tired (even though he slept 8-10 hours each night), irritable and unable to get up in the morning to go to work. Not good for an elementary school principal to be tired, irritable and late for work. Ronald tried the CPAP therapy and was unable to get used to it. He said it made him feel extremely claustrophobic, and although he tried smaller masks and nasal pillows, he felt that the CPAP was not working for him. He came to our office and received an oral appliance for his moderate case of sleep apnea. Ronald immediately got the deep and REM (rapid eye movement) sleep he needed. He began to sleep only 7 hours, waking refreshed and energetic at 5 a.m. What was he to do for two hours before school started? The only place he thought of that would be open at that hour of the morning was an exercise gym. He joined. Within four weeks, he lost weight, bought a new wardrobe, and got a “cool” haircut. He came back to the office for a followup visit, and we barely recognized him. It has been over a year since Ronald has been wearing his oral appliance, and he’s still thin, energetic and “cool.”

A HEARTWARMING STORY: Richard S. is 20 years old and has mild autism. He was very overweight, angry, depressed, and behaviorally unpredictable and erratic. Richard was confined to the house and unable to participate in any community activities because of his outbursts and occasional violence. He suffered from extremely severe sleep apnea. He lives with his mother and grandmother, who sleep on the second floor of their house while Richard sleeps on the first floor. Richard’s snoring was so loud that it penetrated the entire house, keeping his mother and grandmother awake. They were also angry, depressed and irritable. Not a happy household. After several months of wearing an oral appliance for his sleep apnea, Richard’s behavior and general demeanor changed for the better, as did his mother and grandmother’s. Richard is now enrolled in a life skills program, is losing weight, and has discovered that he loves bowling. He also loves shaking hands and makes a point of shaking my hand before and after each visit. He said he has a girlfriend in the life skills class; he hasn’t told her yet, but he does shake her hand as often as he can.

•••••

A SAD STORY: John B. was a 78-year-old man with a history of cardiovascular disease, having had arterial bypass surgery. He suffered from high blood pressure and high cholesterol. He was diagnosed with obstructive sleep apnea, was CPAP intolerant, and had impressions for an oral appliance taken. The day of his appointment to have his appliance inserted, his wife called to say the John would not be keeping his appointment. She said he had difficulty breathing during the night, stopped breathing several times due to his sleep apnea and was snoring loudly. At 4:00 in the morning, John died of a heart attack.

Oral Appliance Therapy (OAT) is recommended by the Academy of Sleep Medicine (ASM) as the first line of treatment for obstructive sleep apnea (OSA) for mild to moderate cases and for patients with severe sleep apnea who have tried CPAP and are intolerant.

CAUSES OF OBSTRUCTIVE SLEEP APNEA A Collapsed Airway Have you ever tried to suck through a paper straw that was wet and soggy? If so, you know that the straw collapsed, especially as you tried to suck harder. Well, that’s what happens to the airway when you have sleep apnea, especially in older people. The airway (pharynx) is surrounded and supported by muscles. When a person inhales, the chest expands and the stomach presses the diaphragm downward, creating negative pressure in the lungs and airway. The muscles surrounding the pharynx keep the airway from collapsing by holding the walls of the pharynx rigid. However, if the muscles are weak and the airway is narrow (which is often the case with overweight patients), the negative pressure will cause the airway to collapse, like the soggy straw. An oral appliance is a removable device, worn while sleeping on the upper and lower teeth to hold the lower jaw forward. It keeps the airway open all night to reduce or eliminate sleep apnea and snoring. As the lower jaw is moved forward, the pharynx is maintained in an open pos-

CONTINUED >>

W IN T ER 2 013 • S LE E P & W ELLNE SS MA GAZ INE

DENTAL

“

SLEEP APNEA EVENTS LASTS BETWEEN 10 TO OVER 90 SECONDS, DURING WHICH THE OXYGEN IN THE BLOOD FALLS, USUALLY FROM THE NORMAL OF THE MID 90TH PERCENTILE TO INTO THE 70TH, 60TH OR EVEN 50TH PERCENTILE.

“

Oral Appliance Therapy (OAT)

ture. When negative pressure is created during respiration, the airway does not collapse, and the patient does not stop breathing during sleep or gasp upon awakening. OAT does not cure sleep apnea and only works when the patient is wearing the oral appliance.

Physical Characteristics of the Jaws The second major cause of sleep apnea is the obstruction of the airway due to the tongue falling back while sleeping. This is a condition that affects some people because of the physical characteristics of their jaws. True or False: 1. Breastfeeding an infant leads to proper development of the upper and lower jaws and reduces the risk of sleep apnea. 2. Bottle feeding an infant contributes to sleep apnea during adulthood. 3. Orthodontic treatment can lead to sleep apnea in an adult. 4. Humans are the only mammals that have sleep apnea. 5. Sleep apnea is related to speech.

The answer to all the questions is true. When an infant is born, the upper jaw (maxilla) and lower jaw (mandible) need to grow both in a front to back (horizontal) and side to side (lateral) direction.

However, there are competing forces. The muscles of the face, particularly the muscles of the lips and cheeks, want to constrict the growth from the outside in, while the tongue pushes the jaws from the inside out, horizontally and vertically. During breastfeeding an infant grabs the nipple between tip of the tongue and the upper lip. This causes the tongue to move upward and forward to put internal pressure against the roof of the mouth (hard palate) and help it develop with the proper width. When the mother feeds the baby with a bottle, the large nipple of the bottle depresses the tongue onto the floor of the mouth and pushes it deeper into the throat. When this happens, the muscles of the lips and cheeks put external force on the jaws and restrict the growth laterally. Consequently, in individuals who were bottle fed, the jaws may be too narrow and the tongue has no place to go except backward into the pharynx. The maxilla is long and narrow, while the mandible is too short. The child is unable to get his lips together to swallow properly, which results in mouth breathing, an open bite, a lisp or other speech impediment, and crowding of the teeth. The characteristics of the jaws can also contribute to sleep apnea. When we go to sleep, we pass through sleep stages: first stage I and 2 light sleep, then stage 3 deep sleep (also referred to

as Delta or slow wave sleep), and finally REM (Rapid Eye Movement or dreaming) sleep. During deep and REM sleep, the muscles of the body relax to the point of being catatonic, including the muscles of the head and neck. The jaw relaxes and the tongue falls back and may obstruct the airway, causing a sleep apnea event. The apnea events lasts between 10 to over 90 seconds, during which the oxygen in the blood falls, usually from the normal of the mid 90th percentile to into the 70th, 60th or even 50th percentile. Low blood oxygen levels have very negative medical consequences and can even be fatal. Any factor that restricts the development of the maxilla and mandible can lead to sleep apnea. It is not uncommon for an orthodontist to recommend the extraction of permanent teeth to correct severe tooth crowding. The potential is that when teeth are extracted the remaining teeth are retracted and moved backward into the mouth. The teeth line up straight, but this backward position of the teeth also moves the tongue backward and can contribute to sleep apnea when the patient becomes an adult. Human evolution may also contribute to sleep apnea. Almost all mammals have their jaws forward relative to the rest of their faces. This puts the tongue in front of the airway. As human beings evolved with larger brains and more upright

SL E E P & W E L L N E SS M AG A Z I N E • W I N T E R 201 3

posture, their jaws got smaller. Humans are able to communicate as we do because of our anatomy, which also includes having the base of the tongue over the vocal cords at the level of the epiglottis. The downside of this human evolution is that as a person drifts into deep and REM sleep, his tongue may block his airway. Today dentists see more impacted teeth and more congenitally missing teeth. This is an indicator that human jaws are continuing to get smaller. Consequently, future generations may be more prone to sleep apnea.

• Do you use only FDA-approved appliances? • Are the appliances you make custom made, utilizing custom impressions? • Are the appliances adjustable (titratable)? • Do you work with physicians who diagnose sleep apnea? • Do you recommend a sleep study after the OAT has begun, to monitor medical data for improvement? • How do you manage TMJ symptoms that may surface after OAT is begun? • Do you participate with medical insurance and file my insurance claim for me? • Are you a Medicare provider for OAT?

DIAGNOSING OBSTRUCTIVE SLEEP APNEA (OSA) OSA can be diagnosed during a sleep study ordered by a physician. This sleep study is called a Polysomnography (PSG) or attended in-lab study. The sleep study can be done in a sleep center, where the patient sleeps overnight attached to wires that send data to a computer. The data is then compiled in a report, which can be sent to the doctor. It is also possible to do an accurate sleep study in a patient’s home. The patient brings the equipment home instead of having the study done by a specialist in a sleep center. If a patient is diagnosed with OSA after having had a sleep study, his physician will recommend therapy to remedy the problem. The most common treatments are CPAP or an oral appliance.

TREATING OSA WITH ORAL APPLIANCES If you are diagnosed with OSA and choose to pursue Oral Appliance Therapy, you should find a dentist trained in OAT for sleep breathing disorders and Temporal Mandibular Joint Dysfunction (TMJ). The dentist should also be familiar with the protocols and guidelines recommended by the Academy of Dental Sleep Medicine (AADSM). Sleep apnea is a condition that can lead to serious medical problems and can even be fatal. Make sure you are putting your health, and life, in the hands of a qualified dentist. Ask the dentist: • Are you trained in OAT for snoring and sleep apnea?

• Does your treatment include followup adjustment appointments after the appliance is inserted? • Does the appliance come with a warranty if it should break or need repair? • Do you follow the protocols outlined by the AADSM? There are many oral appliances to choose from. Make sure the one you get is FDA approved. The appliance selected should be based on the severity of your sleep apnea, your dental and craniofacial (skull) anatomy, the condition of your teeth, any pre-existing TMJ dysfunction, and the data gathered during the sleep study. The data the dentist should consider from the sleep study for OAT selection are: • The apnea-hypopnea index (AHI) – the severity of your apnea; mild, moderate or severe • The number of arousals and other indicators for upper respiratory disturbance

night and with the correct pressure. CPAP can reduce the severity of sleep apnea to an AHI of 5 or even to 0. Oral appliances, which are more limited by a patient’s anatomy, are generally not as effective. However, when CPAP is not a workable solution, an oral appliance is an excellent alternative. It can reduce sleep apnea to a level that will not threaten the patient’s life, and it can reduce the symptoms of daytime sleepiness, morning headaches, and snoring. There is hope! That is the message of the oral appliance. If you cannot tolerate CPAP, that doesn’t mean that sleep apnea will ruin and endanger your life. An oral appliance can save your life or save your marriage (by eliminating snoring). The oral appliance is successful because patients wear it all night. They put it in when they go to bed and wear it until they awaken. During the hours we sleep, we go through sleep stages. Most of the deep sleep is in the first half of the sleep hours, and REM sleep is mostly in the second half of our sleep. Many patients take the CPAP off when they wake to use the bathroom, then return to bed and are too tired to replace the CPAP. It’s easy to wear the oral appliance all night, which assures that the patient will get the maximum benefit of therapy and achieve the results they want. A properly constructed oral appliance is comfortable, easy to wear all night, effective, and will not aggravate TMJ. The cost should be covered by medical insurance. If you have sleep apnea or excessive snoring, or if you are undiagnosed and have excessive daytime sleepiness and other symptoms of sleep apnea, consult your physician or dentist and ask if an oral appliance is right for you. S&W

• Oxygen desaturation – the percent of oxygen in the blood (Normal is 92-98%.) • The Oxygen Nadir – the lowest the oxygen saturation level (Below 80% can be dangerous.) • Snoring events by number and loudness

MEDICAL EXPECTATIONS FOR THE ORAL APPLIANCE Many patients ask, “Why did my physician have me try CPAP before the oral appliance?” CPAP is more effective when it can be used comfortably all

ABOUT THE AUTHOR Barry N. Chase, DDS, PC, D. ABDSM, D.ACSDD is the owner of Chase Dental SleepCare™ and Chase Dental Care, PLLC; Melville, Long Island and Manhattan, NY, a private practice dedicated to dental sleep medicine. He is on the advisory boards of the Polysomnography and Respiratory Care programs at Stony Brook University in Long Island, NY, and the Scientific Advisory Board of SleepUp Corp. in Tel Aviv, Israel. He is an adjunct professor of Dental Sleep Medicine at Stony Brook University and practices dental sleep medicine at St. Joseph’s Hospital Sleep Center in Bethpage, NY. www.chasedentalsleepcare.com/practice

W IN T ER 2 013 • S LE E P & W ELLNE SS MA GAZ INE

INFOGRAPHIC

SL E E P & W E L L N E SS M AG A Z I N E • W I N T E R 201 3

INFOGRAPHIC

40 35 30 25 20 15 10 5 0

DANGEROUSLY LOW 1 HOUR

80 70 60 50 40 30 20 10 0

2 HOURS

3 HOURS

4 HOURS

5 HOURS

6 HOURS

7 HOURS

8 HOURS

9 HOURS

> 10 HOURS

W IN T ER 2 013 â&#x20AC;˘ S LE E P & W ELLNE SS MA GAZ INE

INFOGRAPHIC

LOOKING PRETTY Have sleep apnea treated to improve facial appearance and look more alert, youthful & attractive.

Adequate sleep is shown to improve a vast array of quality of life elements, ranging from health, intelligence in kids, increased productivity at work, improved cardio & brain execution, hence improving our overall well-being & health.

This infographic designed by FFunction for Zeo www.myzeo.com

SL E E P & W E L L N E SS M AG A Z I N E • W I N T E R 201 3

BREATH

AMERICAN ASSOCIATION FOR RESPIRATORY CARE 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-forprofit 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.

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. S&W

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

W IN T ER 2 013 â&#x20AC;˘ S LE E P & W ELLNE SS MA GAZ INE

BREATH

- CPAP USE TIPS FOR AVOIDING PROBLEMS From the American Association for Respiratory Care Written By Karen S. Schell, DHSc, RRT-NPS, RPFT, RPSGT, AE-C, CTTS

SLEEP IS AN ESSENTIAL COMPONENT OF HEALTH. There is strong evidence that insufficient sleep has an effect on numerous health conditions. Obstructive Sleep Apnea (OSA) as a chronic disease, left untreated, can have major health consequences. For those individuals diagnosed with OSA, treatment is available. Continuous positive airway pressure (CPAP) therapy can effectively treat OSA. Deciding to use CPAP therapy is a major step to sleeping better and living a healthier life. Patients, despite the benefits of CPAP therapy, have limited success in adapting the nightly use of CPAP therapy. Many patients are resistant to wearing a mask at night and CPAP can interfere with sleep. Numerous problems exist and can be frustrating to CPAP users, which can ultimately decrease the willingness to continue use. Side effects and other problems usually are minor and they can be treated or easily fixed. Early education by the clinician about CPAP therapy can help gain patient acceptance. The goal is to keep it simple and not overload the patient. Clear understanding of health behaviors for chronic illnesses, such as OSA, is necessary in planning

SL E E P & W E L L N E SS M AG A Z I N E • W I N T E R 201 3

“

CPAP therapy requires a long-term commitment to improve sleep and health. It is important to identify and address side effects and problems quickly and communicate them to the health care team and the CPAP equipment provider. Working closely with the health care team and equipment provider gives the opportunity to be successful at adjusting the machine and avoiding frustration during the initial period of adjustment. It may take up to four to six weeks to get used to CPAP therapy. Consistency and continued usage makes it easier to adjust to the treatment and receive the maximum health benefit. Asking questions when first starting to wear CPAP is key to success. Talk with the sleep specialist about how to handle follow-up questions. They can answer some questions, but the home equipment provider may need to address others. CPAP therapy is a longterm treatment. Achieving the full benefits of CPAP requires knowing how to maintain the machine, identifying risks, and getting ongoing care. It is sometimes difficult for patients to see the benefits of nightly use of CPAP and often the side effects and problems associated with

“

programs that will be successful. Chronic disease management can help patients improve health, maintain current health, reduce risks, and manage chronic conditions (National Cancer Institute [NCI], 2005). Several models exist to change behavior of individuals. It is important for providers to: (a) identify patient knowledge weaknesses, (b) to strengthen patient knowledge of the disease process, and (c) teach the patient self-management skills. Addressing the patient’s understanding of the disease process, signs and symptoms, causes, and treatment can improve their ability to manage the disease at home. Individual education and identifying intervention points for changing individual behavior and the social environment can help improve and maintain health, reduce risk, and manage the disease.

CPAP use can cause the CPAP machine never to be used. The side effects can include nasal drying, increased congestion, sneezing, rhinorrehea, sinusitis, conjunctivitis, claustrophobia, pressure sores on the bridge of the nose, difficulty exhaling, allergic reaction to the materials in the mask, air swallowing with gastric distension, machine noise, and skin creases the next morning. These side effects can often be avoidable with behavioral therapy, patient education, CPAP application, and follow-up with troubleshooting and early intervention correcting the problem. Communication, including sharing feelings, fears, and discomforts can improve the use of CPAP therapy.

TIPS FOR AVOIDING PROBLEMS Early and ongoing education should include all parties involved including provider, patient, and spouse. All must understand the health issues related to OSA and how CPAP therapy can help with many of the problems the patient is experiencing. Education should cover advantages and disadvantages of treatment and the positive effects on sleep quality, health, mood, and alertness. Questions should be encouraged and answered honestly. Continued education should address specific problems with possible solutions. Once the patient agrees to a trial of CPAP, the next challenge is getting them to wear it. CPAP only works if it is being used. Problems may arise with initiation of CPAP. These problems and their causes should be addressed quickly with possible solutions. Identifying and addressing problems will improve the ability to adjust to CPAP. Choosing the right device is key to successful use. There are many options for delivery systems. Education and understanding the devices should be addressed before determining which one will benefit the patient the most. The mask or nasal pillows must be the correct size. There are several mask types and sizes and patients should be given the option that works best for their lifestyle and tolerance. Long-term support should be available for troubleshooting and replacement of equipment. Changes in the patient's condition should be communicated to all parties and may warrant a change in CPAP pressure and/or mask fit. CONTINUED >>

W IN T ER 2 013 • S LE E P & W ELLNE SS MA GAZ INE

BREATH

“

Traveling to more than 5,000 feet above sea level may require adjusting CPAP pressure setting in order to get the correct amount of pressure / air.

Nasal irritation/congestion/rhinorrhea can be caused by dry air, chronic rhinitis, or nasal allergies. Possible solutions include heated humidification, nasal decongestants, nasal steroids, or antihistamines. Dry throat or mouth can be caused by dry air or mouth leak. This could be resolved by heated humidification, chin strap, or a full-face mask. Nasal congestion and high airway pressure can cause painful pressure in ears. Verifying and decreasing positive airway pressure (PAP) level or nasal decongestants/nasal steroids may be effective in decreasing the pain. Decreasing PAP can also prevent air swallowing which may cause gastric bloating or chest discomfort. Poor mask fitting and anxiety may cause claustrophobia, nasal pressure sores and air leaks. Readjusting headgear, changing mask size or style, skin protection and reassessment of patient education on mask fit may resolve the problem. Improper mask size or style and headgear may cause mask leak, which may lead to eye irritation. Assessing patient education and mask fit may quickly address these problems. Adjusting headgear or mask size and style may eliminate skin creases. Skin irritation from the mask or headgear may require using nasal pillows or lowering the temperature on the humidifier. Most CPAP machines are fairly quiet but if noise is a bother, checking the air filter to make sure the machine is working properly, using earplugs, a white noise sound machine, or placing the machine on the floor and slightly under the bed may be helpful in dampening the sound. If snoring continues on CPAP therapy, check the pressure and consult your physician. Other factors affecting increased snoring may be alcohol consumption, sedation, or increased weight. If surgery is scheduled, the CPAP unit should be taken to the hospital and make sure all medical staff is aware of your OSA. If traveling, the CPAP equipment should go with you and make sure to bring extension cord, fuses, and any electrical requirements including converter or adapter for a foreign country. Traveling to more than 5,000 feet above sea level may require adjusting CPAP pressure setting in order to get the correct amount of pressure / air. The CPAP provider should help you adjust the pressure. Remember to reset the pressure to the original settings once returning home.

“

Masks, tubing, and headgear should be cleaned once a week. Check and replace the filters for the unit and humidifier. The provider on a regular basis should replace these. If you are having recurring symptoms, the equipment should be checked out and pressures verified by the provider.

OSA is usually a lifelong condition. Active follow-up care is very important in sticking with the therapy. Every visit should include discussion of any problems encountered and finding solutions. Any symptoms, changes in weight, equipment performance, and mask fit should be reviewed. Patients need to know up front that CPAP therapy is challenging and there will be an adjustment period. Making sure the facts are known and what to expect will help with CPAP therapy success. Patients can deal with the initiation and adjustment period if they understand the therapy. Written instructions are important for the patient, caregiver, and family. Thorough explanation can improve the understanding and can improve compliance. Emphasize the positives. Regular follow-ups are essential, along with clinical assessment, review of the patient's response to CPAP, adverse effects, and any limitations or problems. Layers of information are necessary for CPAP use with ongoing education, written instructions, demonstration of equipment, troubleshooting of concerns and problems. Changes of symptoms, medical conditions, weight, and device usage are important information to be shared with the clinician and equipment provider. Each patient is different and taking the time to assess their particular needs can individualize the treatment necessary for improving patient function and symptoms. Communication is the key to improving the treatment of each individual. Changing an individual’s health practices involves identifying intervention points for promoting health. Individual characteristics that influence behavior such as: (a) knowledge, (b) attitudes, (c) beliefs, and (d) personality traits can influence how the patient understands and communicates understanding of the disease process. Involving family, friends, and their peers provide social identity and support (NCI, 2005). Each can influence the patient health behavior and improve CPAP compliance for the patient. S&W

REFERENCES American Academy of Sleep Medicine (2006). Sleep apnea takes your breath away...CPAP gives it back. Retrieved from: www.sleepeducation.com Bollig, S., (2010). Encouraging CPAP adherence: It is everyone's job, Respiratory Care 2010, 55(9), 1230-1239. Chokroverty, S., (2012), About Sleep Apnea, Questions and Answers. Sudbury, Massachuesetts: Jones and Hamilton, Ontario: BC, Bartlett Publishers. National Cancer Institute. (2005). Theory at a glance, a guide for health promotion practice second edition. (NIH Publication No. 05-3896). USA: Department of Health and Human Services. National Heart Lung and Blood Institute, National Institute of Health What is CPAP? Retrieved from: http://www.nhlbi.nih.gov/health/health-topics/topics/cpap Pruitt, B. (2010-2011), Top 10 practices to increase CPAP compliance. Retrieved from: http://riversidemed.net/top-10-practices-to-increase-cpap-compliance/

SL E E P & W E L L N E SS M AG A Z I N E • W I N T E R 201 3

SLEEP & WELLNESS

LISA CYPERS KAMEN, MA SLEEP & WELLNESS MAGAZINE WELCOMES OUR NEW WELLNESS EDITOR 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 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. Lisa’s written work is featured on blogs for the Huffington Post, PositivelyPositive.com and InspireMeToday.com and she is a TEDx community event speaker. In addition, she is the Happiness Expert for the Florida Department of Citrus/ Florida Orange Juice in its Take on the Day campaign. Harvesting Happiness for Heroes™ is a 501(c)(3) nonprofit corporation that delivers stigma-free integrated combat trauma recovery services to warriors and their loved ones. Modalities include

scientifically proven strengths based Positive Psychology coaching and interdisciplinary tools such as film, yoga, meditation, art and creative writing designed to mindfully empower the client to achieve increased self-mastery, self-esteem and reclaim her/his life. HH4Heroes focuses on the balance of mind, body and emotion resulting in greater overall wellbeing and the transformation of Post-Traumatic Stress (PTS) into Post-Traumatic Growth (PTG). HH4Heroes offers retreat workshops, one-on-one coaching, Battle Buddy programs, as well as our new R.E.B.O.O.T Online virtual community coaching classrooms designed to reach underserved areas. In addition, HH4Heroes deploys Return to Duty™ civilian and corporate training to help welcome a warrior home and into the community and workplace. Lisa is committed to teaching Happiness is an inside job™ and helping others end their needless suffering through intentionally cultivating greater joy. S&W www.HH4Heroes.org www.HarvestingHappiness.com www.HarvestingHappinessTalkRadio.com Facebook: Harvesting Happiness Twitter: @LisaKamen

W IN T ER 2 013 • S LE E P & W ELLNE SS MA GAZ INE

“

I've always envied people who sleep easily. Their brains must be cleaner, the floorboards of the skull well swept, all the little monsters closed up in a steamer trunk at the foot of the bed. ― David Benioff, City of Thieves

“

SL E E P & W E L L N E SS M AG A Z I N E • W I N T E R 201 3

SLEEP & WELLNESS

SLEEP, WELLNESS & HEALTH = A RECIPE FOR WELLBEING Written By Lisa Cypers Kamen, MA

SLEEP IS FAVORITE HOBBY OF MINE. I love to sleep. In fact, good sleep makes me really happy. Not only does it make me happy but I know a solid night (or stretch) of delicious sleep makes me healthier, more focused and able to take on the day, come what may. And I also know that sleep (or lack of it) can be an anxiety-producing devil that taunts and haunts our personal happiness. You might ask where I am going with this. Fair enough. I am a happiness and wellbeing expert. I began my first career as an architectural designer creating physical real estate. I went back to school in mid-life to become a psychologist: a person who helps organize mental space. Along the way, I discovered that the pathway to optimal wellbeing (code name: happiness) is not found on a single road of talk-therapy or prescribed living but through a series of intersecting and parallel life trails called integrated health and wellness. It is through my work as an applied positive psychology coach, author, documentary filmmaker, lecturer and radio show host that I am able to help others weave a roadmap for their own sustainable wellbeing and greater overall life-satisfaction. Creating a happy life is all about creating a balanced life. Happiness is not a destination but a natural byproduct of a journey. You may be thinking that I am a little crazy and simplistic in my views, but stay with me here as I elaborate.

Let’s take a look at automobiles as a metaphor for our bodies. Most of us take loving care of our cars. We gas, wash and service them to be road ready and perform optimally. The same theory must apply to our bodies for them to function properly. For our “machines” to work properly, we must feed, care, clean and keep the mental, physical and emotional spaces within them in tip-top shape.

“People say, 'I'm going to sleep now,' as if it were nothing. But it's really a bizarre activity. 'For the next several hours, while the sun is gone, I'm going to become unconscious, temporarily losing command over everything I know and understand. When the sun returns, I will resume my life.'

Therein lies the challenge. How do we create a “to-do” list for our own personal wellness? Life is filled with realities such as work, family, money stress, health challenges and serious issues; these produce anxiety, dampen our happiness, and take a toll on our health at all levels. The first place we tend to compromise is on ourselves. We give up the walk we enjoy or eat the calorieladen fried comfort food we crave because it seems faster, easier and more satisfying. At the same time, we are busy multi-tasking to create space in our already overloaded schedules for the “to-do” items that scream the loudest for our attention. The result is overload and burnout that compromises our health and happiness.

If you didn't know what sleep was, and you had only seen it in a science fiction movie, you would think it was weird and tell all your friends about the movie you'd seen.

In reality, we our doing ourselves a huge disservice when we don’t mind our magnificent bodies that serve us beautifully in so many ways, even when all the parts are not working perfectly. And this is my great and exciting challenge as the new health and wellness editor at Sleep and Wellness Magazine: to bring you the best and brightest science, technology and strategies that open pathways to integrated wellbeing through optimizing our brains and bodies. Each issue will contain psychosocial education, delicious food and nutrition tips (along with easy-toprepare recipes), and as mental and physical practices to reduce stress, promote relaxation and improve overall health. S&W

They had these people, you know? And they would walk around all day and be OK. And then, once a day, usually after dark, they would lie down on these special platforms and become unconscious. They would stop functioning almost completely, except deep in their minds they would have adventures and experiences that were completely impossible in real life. As they lay there, completely vulnerable to their enemies, their only movements were to occasionally shift from one position to another; or, if one of the 'mind adventures' got too real, they would sit up and scream and be glad they weren't unconscious anymore. Then they would drink a lot of coffee.' So, next time you see someone sleeping, make believe you're in a science fiction movie. And whisper, “The creature is regenerating itself.”

To your health and wellbeing,

Lisa

-George Carlin, Brain Droppings

W IN T ER 2 013 • S LE E P & W ELLNE SS MA GAZ INE

SLEEP & WELLNESS

MEDITATION: THE ANCIENT ANTIDOTE FOR MODERN STRESS Written By Lisa Cypers Kamen, MA

THE BEST WEAPON TO COMBAT STRESS, TRAUMA AND SUFFERING IS TO IMPROVE RESILIENCY.

SL E E P & W E L L N E SS M AG A Z I N E • W I N T E R 201 3

Meditation slows the production of cortisol, the stress hormone. In addition, it retards aging in the brain and improves mental acuity and creativity.

ALERT! ATTENTION, ALL READERS! STRESS IS A WORLDWIDE MODERN EPIDEMIC. It has been said that stress is the number one cause of “dis-ease” and illness. Stress can cause serious physical symptoms such as elevated blood pressure and glucose level, increased heart rate, compromised immune system, agitated nervous system, bodily inflammation, sleep, and appetite disorders. It can also hinder optimal brain functioning. Stress starts in the mind and then permeates the rest of the body. But that’s not all. The negative byproducts of stress also include anxiety, anger, frustration, negative emotion, depression, impulsive behaviors, and relationship problems. Bottom-line: stress kills! Stress kills our bodies, hearts, minds and spirits. It is a gift of life we wish we never unwrapped. Unfortunately, we are control freaks that cannot really control very much: not our partners nor our children nor world affairs. Yet there is great news here. The one thing we can learn to control is our mind. It’s true. We can learn to quiet our minds, reduce stress and ease the anxiety that erodes our wellbeing. In fact, there is a no-cost, drug-free, painless, simple and portable tool available to us at anytime to help soothe our inner savage beast. It’s called meditation.

“

hypnosis, mind control, a New Age vision quest, nor a religion. Meditation reduces stress, so you can deal with your life from a calm and pragmatic place. Many people report they feel a sense of connectedness or spiritual wellness when they meditate. The Benefits of Meditation: Meditation can reverse the stress response by filtering and reducing the mental overload that contributes to stress by helping us better manage our emotions, fostering: • Increased self-awareness • Increased positive emotions • Focus on the present • Effective stress management During meditation, blood pressure normalizes; heart rate and breathing slow down, immune system and brain function improve. Meditation slows the production of cortisol, the stress hormone. In addition, it retards aging in the brain and improves mental acuity and creativity. Scientific research validates the health benefits of meditation, showing that meditation can help the body repair itself while managing conditions that are exacerbated by stress such as:

• Allergies • Anxiety disorders • Asthma • Binge eating

You might think meditation is a throwback to bell-bottomed, psychedelic, hippy-filled days gone by. Perhaps your vision of this includes bald men in saffron robes chanting by the River Ganges in India. Meditation is a highly effective ancient practice of peaceful repose designed to empty the mind and allow the body to rest and repair from the hustle and bustle of life.

• Cancer

The very act of living generates stress, but not all stress is bad. A small amount of stress, such as the kind that accompanies a new project, can actually be stimulating and good. But adding health challenges, traumatic events or financial worry and you may go into stress overload; your ability to cope disintegrates.

• Sleep disorders

The best weapon to combat stress, trauma and suffering is to improve resiliency. And one of the best ways to improve resiliency is through meditation. Meditation is the ancient antidote for stressful modern life. Meditation is not

• Depression • Diabetes • Fatigue • Heart disease • High blood pressure • Pain

• Substance abuse

HOW IT WORKS: Curious? Go ahead…take meditation for a simple test drive. To start, set aside 10 uninterrupted minutes to explore one of the styles below. Allow yourself to sit comfortably and undistracted by people, animals and electronics. Remember, this is a relaxing gift you are giving yourself to release stress and recharge your batteries. As you become more comfortable with meditating you can increase to 20 minutes, ideally twice a day. CONTINUED >>

W IN T ER 2 013 • S LE E P & W ELLNE SS MA GAZ INE

SLEEP & WELLNESS

“

TRAINING YOUR MIND TO HANDLE STRESS MORE PRODUCTIVELY IS A GREAT DOSE OF PREVENTATIVE MEDICINE FOR ANYONE, AT ANY AGE, IN ANY CONDITION.

TYPES OF MEDITATION: There are several kinds of meditation, some with fancy names and labels. They all achieve the same goal: to relax the brain, the body and the breath. They are all designed to release tension while creating awareness of the present moment. When we focus solely on the present moment, we cannot stress about the past or worry about the future. The only place we can be is right here, right now. Here are a few of the most simple and easy ways to practice meditation: 1 Breathing Plain & Simple: You’ve got this. You already know how to breathe. The next step is to pay attention to the in breath and the out breath. Allow your attention to be focused on your breathing; how it sounds and how it feels. With each breath, you are inhaling relaxation and exhaling stress. As your mind strays, refocus it on the breath. Voila! 2 Mindful Meditation: This is the art of paying attention without thinking. Notice the raw sensations that surround you. Listen to the sounds around you, discovering layers of sound in your environment and within your body such as the birds chirping, a passing car, your breath, the sound of your heart beating. Observe how you are feeling and what you are feeling. Is your body beginning to let go?Are your shoulders relaxing? Did your headache go away? What about the temperature in the room? Is it cool or warm? Does your chair feel soft or hard? How does your skin feel when it meets the air? This awareness creates presence. 3 Guided Meditation: Guided meditation is a relaxing listening journey that is guided by a facilitator with words, imagery and sometimes music or sound. You can try a session for free by accessing the link at the end of this article.

Lisa Robyn Deutsch

“

Allow your body to sink into your seat and gently close your eyes. Your legs should be uncrossed, feet grounded to the floor and your hands relaxed in your lap. While the practice is simple, it may not be easy to simply allow yourself to “be” for 10 minutes. You will have random thoughts that float in and out. This is normal. Just allow the thoughts to roll in and roll out much like the waves in the ocean. Simply observe and witness what comes up during the process. The idea is to empty the mind and restore the body during this brief period of stillness.

4 Mantra-Based Meditation: A mantra is nothing more than a contemplative word, phrase or prayer that is softly or silently repeated. It is not meant to be the focus of your meditation but a touchstone for attention when the mind begins to wander. And it will wander, guaranteed. Allow the repeated rhythm of the mantra to gently lull you into an eased state. 5 Moving Meditation: Moving meditation involves doing an activity that induces a “flow” state where you become unaware of time, space and outside circumstance. You become completely entranced by the activity at hand that produces a relaxation response. The activities you engage in can be as varied as walking, cycling, gardening, painting, yoga dancing, cooking and sports. In summary, stress is one of the most under-valued issues taxing our health and wellbeing. An integrated approach to good self-care is essential to our health and must include proper diet, exercise, sleep and stress management. Training your mind to handle stress more productively is a great dose of preventative medicine for anyone, at any age, in any condition. Meditation is one of the most efficient and scientifically proven methods of stress reduction that has no negative side effects and does not negatively interact with any medications. So go ahead; be kind and gentle with yourself and meditate. With a little practice, it will become a permanent, welcomed, happy-making habit.

CREATING CALM CHALLENGE: We are offering a complimentary brief guided meditation to all magazine readers. To access our Mindful Meditative Moments series, visit http://www.youtube.com/watch?v=iGsclpKHOI&feature=em-upload_owner or scan QR below. If you enjoy the meditation, you can sign up to receive an additional six free Mindful Meditative Moments delivered daily to your computer. These are roughly three minutes each and offer a “stay-cation” at the click of a button. No reservations or travel required. S&W

SCAN TO WATCH VIDEO >

One of the nation’s leading advisors on health and nutrition, Cheryl Forberg is a James Beard award-winning chef and one of the few professional chefs in the country who is also a registered dietitian. She strongly believes you don’t have to sacrifice flavor to eat well and that eating well can change your life. She is the chef and nutritionist for NBC’s “The Biggest Loser” and has written multiple bestselling cookbooks for the hit television show. Her latest book is “Flavor First: Cut Calories and Boost Flavor” (Rodale). To learn more, visit www.CherylForberg.com.

SLEEP & WELLNESS

BIGGEST LOSER

HEAD MASTER CHEF

SHARES RECIPES TO HELP WITH SEASONAL DEPRESSION AND DIABETES

WE ALL KNOW THAT GETTING ENOUGH SLEEP IS IMPORTANT. Sleep deprivation can have many undesirable consequences, including decreased alertness, impaired memory and cognitive ability, poor quality of life, and decreased reaction time, which may lead to occupational or automobile accidents. Chronic sleep deprivation can also have serious effects on your long-term health, including increased risk of obesity and diabetes. But does poor sleep or sleep deprivation cause obesity and/or diabetes, or does being obese or having diabetes lead to poor sleep? Just like the classic question— “Which came first, the chicken or the egg?”—the answer is actually both. Studies have found that the less you sleep, the higher risk you have of being overweight. And being overweight increases your risk of developing type 2 diabetes. Several studies have shown that sleep deprivation actually resembles insulin resistance1. There is also a link between diabetes and sleep apnea, which is a sleep disorder that disrupts your sleep due to pauses in breathing.

1 http://www.mayoclinic.com/health/sleep-anddiabetes/MY01597 2 “Acute sleep deprivation increases food purchasing in men.” Colin D. Chapman, Emil K. Nilsson, Victor C. Nilsson, Jonathan Cedernaes, Frida H. Rangtell, Heike Vogel, Suzanne L. Dickson, Jan-Erik Broman, Pleunie L. Hogenkamp, Helgi B. Schioth, and Christian Benedict. Obesity; (DOI: 10.1002/oby.20579). URL: http://doi.wiley.com/10.1002/oby.20579 3 http://diabetes.niddk.nih.gov/dm/pubs/preventionprogram/index.aspx

Researchers in Sweden found that after one night of total sleep deprivation, subjects were more likely to purchase more food (and more calories) than those subject that were not sleep deprived. The researchers hypothesize that sleep deprivation impacts hunger and decision making when purchasing food2. So, what can you do nutritionally to help you get a better night’s sleep? Here are a few tips: 1. If you need to lose weight, do so with help from your doctor, registered dietitian, and/or trainer. Getting to your ideal weight may eliminate your diabetes. 2. Get enough exercise. Check with your doctor to get recommendations on what kind of exercise and how much is good for you. 3. Eat properly throughout the day to keep your blood sugar under control. When blood sugar is too high, your kidneys have to work hard to filter it all, which may lead to extra trips to the bathroom in the middle of the night. Eating six small meals and snacks throughout the day is a good idea. Also, include a lean protein in each meal or snack along with some carbohydrates to help regulate your blood sugar. 4. Don’t go to bed either stuffed or hungry. 5. Avoid caffeine in the afternoon and evening. Caffeine is a stimulant and can take many hours to wear off. 6. Avoid alcohol (one glass of red wine is OK and is actually heart healthy). Although alcohol may make you feel sleepy at first, it disrupts your sleep pattern later in the night. 7. Consider taking melatonin. Melatonin is a natural hormone found in your body, and researchers have found that it naturally peaks at night. Studies suggest that melatonin supplementation may be effective for shortening the amount of time it takes you to fall asleep (by about 12 minutes) and may be more helpful the older you get. Check with your doctor before taking any supplements. If you are at risk for diabetes, here’s the good news: Lifestyle changes can have a powerful influence in staving off the disease. In fact, a major NIH study found that people can cut their risk of developing diabetes by 58 percent!3 Diet and lifestyle changes are essential for diabetes prevention. Even if you already have diabetes, the strategies outlined above can help limit the damage, reverse the disease’s progress, and lessen the severity of symptoms. Making small changes to your lifestyle and eating habits can have a big impact on your sleep, health and weight over the long run. If you have diabetes, controlling your blood sugar levels is important. If you have type 2 diabetes, losing weight can do wonders! A strategy that works well is to split up your caloric intake evenly throughout the day. For example, if you are eating 1500 calories per day you can divide up your meals and snacks as follows: Breakfast Morning snack Lunch Mid-day snack Dinner Late snack

300 calories 200 calories 300 calories 200 calories 300 calories 200 calories

Here are three diabetes-friendly family dinner recipes that were created by me and some of the Biggest Loser contestants:

SL E E P & W E L L N E SS M AG A Z I N E • W I N T E R 201 3

PORK TENDERLOIN WITH WARM ASIAN SLAW 4 Cilantro-crusted pork tenderloin is full of flavor. Paired with a zesty Asian slaw, this dish is a delicious twist on the same old pork tenderloin.

• • • • • • • • •

Slaw 2 teaspoons olive oil 1 medium yellow onion, finely chopped 1 tablespoon minced garlic 1 tablespoon chopped, peeled fresh ginger 3 cups finely shredded green cabbage 1⁄2 cup grated carrot 1⁄3 cup chopped cilantro, without stems 1 tablespoon low-sodium soy sauce Salt to taste

Pork 4 (4-ounce) pieces lean pork tenderloin 1⁄4 teaspoon salt 1⁄8 teaspoon ground black pepper 1-1⁄2 tablespoons chopped cilantro + cilantro sprigs as garnish • 1 teaspoon olive oil

• • • •

To make the slaw: In a large skillet, heat 2 teaspoons of olive oil over medium-high heat. Add the onion and cook for about 2 minutes, until softened but not colored. Add the garlic and ginger and cook for 1 minute longer. Add the cabbage and stir-fry for about 2 minutes longer. Remove the pan from the heat. Add the carrot, 1⁄3 cup chopped cilantro, and soy sauce. Stir until combined. Season with salt, if desired. There should be about 2 cups of slaw. Keep warm. To prepare the pork: Place the pork tenderloin between two sheets of heavy-duty plastic wrap. With a meat mallet or rolling pin, pound each piece to an even 1⁄4" thick-

ness. Sprinkle with the salt and pepper. Dredge the pork in the chopped cilantro, pressing to make the leaves stick. In a large nonstick skillet, heat the oil over medium-high heat. Add the pork to the pan and cook 2 or 3 minutes per side, until opaque throughout and tender. To serve: Place the pork on individual serving plates and top with 1⁄4 of the Asian Slaw. Garnish with a sprig of cilantro, if desired. Makes 4 servings per serving: 200 calories, 2 g protein, 8 g carbohydrates (4 g sugars), 7 g fat (2 g saturated), 75 mg cholesterol, 2 g fiber, 210 mg sodium

4 Recipe and photo reprinted from: The Biggest Loser: 6 Weeks to a Healthier You: Lose Weight and Get Healthy For Life! by Cheryl Forberg, RD. Biggest Loser Experts and Cast Copyright © 2005. Permission granted by Rodale, Inc., Emmaus, PA 18098. Available wherever books are sold or directly from the publisher by calling (800) 848-4735 or visit their website at www.rodalestore.com.

W IN T ER 2 013 • S LE E P & W ELLNE SS MA GAZ INE

ED & HEBA’S BLUE-Ribbon Chicken 5 One night, when Season 6 Finalist Heba Salama was craving something Italian and her husband, Ed Brantley, was in the mood for the flavor rosemary, they put their heads together and came up with this tasty dish. They already had all of the ingredients in the refrigerator!

Directions • 2 tablespoons Dijon mustard • 4 (4-ounce) boneless, skinless chicken breasts, trimmed of fat and butterflied • 4 slices low-sodium ham • 4 slices 2% Swiss or low-fat provolone cheese • Salt and ground black pepper to taste • 1 teaspoon fresh rosemary, chopped • 1⁄4 cup fat–free, low-sodium chicken broth

Spread the Dijon mustard evenly inside of the 4 pieces of chicken breast. In a small nonstick skillet set over medium heat, quickly sear the slices of ham for about 30 seconds on each side. Place the ham on one side of each piece of chicken. Place 1 slice of cheese folded in half over the top of the ham. Fold over the butterflied chicken breast to create a pocket. Tuck in the cheese to be sure it’s well concealed. Season each breast with salt, pepper, and rosemary.

until golden brown—then turn over the breasts and brown the other side. Once the chicken is fully cooked, remove it from the pan momentarily and drain any excess grease from the skillet. Return the skillet to the heat, add the broth, then place the chicken in the broth. Simmer for 3 or 4 minutes. Serve immediately. Makes 4 servings per serving: 220 calories, 37 g protein, 2 g carbohydrates (0 g sugars), 7 g fat (3 g saturated), 85 mg cholesterol, 0 g fiber, 460 mg sodium.

Lightly coat a skillet with cooking oil spray. Gently place each breast in the pan. Cook on medium to low heat for 6 to 8 minutes,

5 Recipe and photo reprinted from: The Biggest Loser: 6 Weeks to a Healthier You: Lose Weight and Get Healthy For Life! by Cheryl Forberg, RD. Biggest Loser Experts and Cast Copyright © 2005. Permission granted by Rodale, Inc., Emmaus, PA 18098. Available wherever books are sold or directly from the publisher by calling (800) 848-4735 or visit their website at www.rodalestore.com.

SL E E P & W E L L N E SS M AG A Z I N E • W I N T E R 201 3

SIZZLING GINGER PORK 6 Though he usually loved to cook his family’s Italian recipes at the ranch, Season 9’s Michael Ventrella concocted this creation one night when I was there cooking with the contestants. It reminded him of a dish at his favorite Chinese restaurant. Michael used chicken, but you can use turkey or, as in this case, lean pork tenderloin.

Directions • 1 teaspoons sesame, canola, or olive oil • 8 ounces lean pork tenderloin (or skinless chicken breast or lean flank steak), diced • 1⁄2 cup fat-free, low-sodium chicken broth, divided • 1⁄2 medium red onion, thinly sliced • 2 tablespoons finely chopped shallots • 2 tablespoons finely chopped ginger • 2 tablespoons low-sodium soy sauce • 1 tablespoon dark molasses • 1 tablespoon Szechuan seasoning (see note) • 1 cup cooked wild rice or brown rice • 2 cups steamed broccoli • 1 teaspoon toasted sesame seeds and 2 tablespoons chopped cilantro

In a nonstick skillet, heat the oil over medium-high heat. Add the pork and cook quickly until lightly browned but not full cooked. Remove the meat from the pan and set aside. Add half the broth to the skillet and then add the onion, shallots, and ginger. Simmer for a few minutes, until softened. Add the remaining broth and the soy sauce, molasses, and seasoning. Bring the mixture to a simmer and return the meat to the skillet. Simmer for a couple minutes longer, until the meat is just cooked through. Serve over hot rice with broccoli. Garnish with sesame seeds and cilantro.

Note: Szechuan seasoning usually contains a combination of chile peppers, garlic, ginger, and Chinese spices. You can make your own blend with 1⁄2 teaspoon garlic powder, 1⁄2 teaspoon red chili flakes, 1 teaspoon ground mustard, and 1 teaspoon ground coriander. Makes 2 (11⁄4-cup) servings per serving: 360 calories, 34 g protein, 40 g carbohydrates (11 g sugars), 8 g fat (2 g saturated), 75 mg cholesterol, 7 g fiber, 610 mg sodium

6 Recipe and photo reprinted from: The Biggest Loser: 6 Weeks to a Healthier You: Lose Weight and Get Healthy For Life! by Cheryl Forberg, RD. Biggest Loser Experts and Cast Copyright © 2005. Permission granted by Rodale, Inc., Emmaus, PA 18098. Available wherever books are sold or directly from the publisher by calling (800) 848-4735 or visit their website at www.rodalestore.com.

W IN T ER 2 013 • S LE E P & W ELLNE SS MA GAZ INE

“

Because they struggle with depression, individuals with SAD, like those with insomnia, may spend more time in bed but not actually sleeping.

SLEEP & WELLNESS

LIKE INSOMNIACS,

SAD

SUFFERERS HOLD UNHELPFUL BELIEFS ABOUT SLEEP Written By Traci Pedersen Associate News Editor Reviewed by John M. Grohol, Psy.D. on June 29, 2013

“

SL E E P & W E L L N E SS M AG A Z I N E • W I N T E R 201 3

INDIVIDUALS WITH SEASONAL AFFECTIVE DISORDER (SAD) — a winter depression linked to loss of motivation and interest in daily activities—tend to have misconceptions about their own sleeping habits, similar to those of insomniacs, according to researchers at the University of Pittsburgh. The findings may lead to new treatments for seasonal affective disorder that are similar to treatments for insomnia. The researchers wanted to know why individuals with seasonal affective disorder incorrectly reported that they slept four more hours a night in the winter, according to a previously published sleep study by the University of California, Berkeley. “We wondered if this misreporting was a result of depression symptoms, like fatigue and low motivation, prompting people to spend more time in bed,” said Kathryn Roecklein, Ph.D., primary investigator and assistant professor in the Department of Psychology. “And people with seasonal affective disorder have depression approximately five months a year, most years. This puts a significant strain on a person’s work life and home life.”

The research team interviewed 147 adults (ages 18 to 65) living in the Pittsburgh metropolitan area during the winters of 2011 and 2012. Data was collected through self-reported questionnaires and structured clinical interviews in which participants were asked questions such as the following: • In the past month, have you been sleeping more than usual? • How many hours, on average, have you been sleeping in the past month? • How does that compare to your normal sleep duration during the summer? To understand participants’ ideas about sleep, researchers asked the participants to respond to statements such as “I need at least 8 hours of sleep to function the next day” and “Insomnia is dangerous for health” on a scale from 0 to 7, where 7 means “strongly agree” and 0 means “disagree completely.” The findings showed that the misconceptions about sleep held by SAD sufferers were similar to the “unhelpful beliefs” or personal misconceptions about sleep that insomniacs often report. Because they struggle with depression, individuals with SAD, like those with insomnia, may spend more time in bed but not actually sleeping, leading to misconceptions about how much they sleep. These misconceptions, said Roecklein, play a significant role in sleep cognition for those with SAD. “We predict that about 750,000 people in the Pittsburgh metro area suffer from seasonal affective disorder, making this an important issue for our community and the economic strength and vitality of our city,” said Roecklein. “If we can properly treat this disorder, we can significantly lower the number of sufferers in our city.”

“

...ONE OF THE MOST EFFECTIVE INSOMNIA TREATMENTS IS COGNITIVE BEHAVIORAL THERAPY FOR INSOMNIA (KNOWN AS CBT-I).

The researchers believe that psychotherapy could help manage these unhelpful beliefs about sleep and could lead to improved treatments for seasonal affective disorder. Roecklin noted that one of the most effective insomnia treatments is cognitive behavioral therapy for insomnia (known as CBT-I), which is designed to help people take control of their thinking as a way to improve their sleep habits as well as their mood, behavior, and emotions. S&W

“

http://psychcentral.com/news/2013/06/30/like-insomniacs-sad-sufferers-hold-unhelpful-beliefs-about-sleep/56616.html

W IN T ER 2 013 • S LE E P & W ELLNE SS MA GAZ INE

CASE STUDY

HOW I ELIMINATED MY

ASTHMA Written By Rick Tufts, C.N.P.

IN MAY OF 1976, I WOKE UP ONE MORNING TO DISCOVER I HAD HAY FEVER, A SIGN I NOW KNOW MEANT THAT MY IMMUNE SYSTEM WAS BREAKING DOWN. For the next few years, my allergies would appear every May like clockwork. I thought it was something I would just have to accept and live with, but years later I realized I was wrong. My allergies took on a new dimension in 1983 when I developed a condition called candida – a bacterial growth in my gastrointestinal tract. To bring it under control, I adopted a special diet that consisted of avoiding fermented foods and foods high in white sugar, white flour and dairy. Unfortunately, the candida suppressed my immune system even more, which caused me to develop asthma at the age of 32. I began to follow the same regimen as most people suffering from asthma. I avoided anything that could

cause an allergic reaction, including spring grass, trees, dust mites, laughing (no joke), dog dander and vigorous exercise – especially in cold weather. These last two issues were troublesome because I had a dog that I was not about to give up and I was an avid runner. My immune system was further compromised by the fact that I had been suffering from chronic insomnia for seven years. Getting insufficient sleep was leaving me exhausted. A year later, I was controlling my asthma with the frequent use of puffers – one to open up the airways and another to break down mucus in my lungs. These were the only options presented to me at the time and, while I was thankful they were available, I was disappointed because doctors told me that I could only control the symptoms of asthma, never actually eliminate the condition.

SL E E P & W E L L N E SS M AG A Z I N E • W I N T E R 201 3

“

IF I WANTED TO ELIMINATE MY ASTHMA, I WOULD HAVE TO STOP CONSUMING DAIRY PRODUCTS MADE FROM COW’S MILK, SUCH AS MILK AND CHEESE, ALTHOUGH NON-FLAVORED, ORGANIC YOGURT WAS FINE.

“

During this time, I had to go to Boston for a business trip. Before I left, my asthma was particularly bad but I foolishly decided to fly anyway, disregarding my condition. During the plane’s descent into Boston, I experienced a serious asthma attack. It was, by far, the most terrifying experience of my life. I was gasping for every breath I could drag into my lungs, and my puffer was having no effect whatsoever. There was nothing anyone could do until I was off the plane. Within 12 hours of landing in Boston, my family checked me into a hospital, where I stayed for over four days with a mask over my face pumping medication into my lungs so I could breathe. Even with such drastic measures, it took two days before my breathing started to normalize. After four days, I was released from hospital and, following a few days of recuperation with my family, I flew back to Toronto.

Normal Brochial Tube

Inflamed Brochial Tube of an Asthmatic

Breathing is something we all take for granted because it happens so effortlessly. But as any asthmatic can tell you, a severe asthma attack can leave you struggling for every breath and make you aware of the fragility of life. I knew I had to find a better way to deal with my asthma. It was devastating my life, and it was getting worse. A friend suggested I talk to a medical doctor who was practicing alternative medicine at the time. I was desperate to help my asthma and allergies, so I decided to see the holistic doctor. The doctor perCONTINUED >>

W IN T ER 2 013 • S LE E P & W ELLNE SS MA GAZ INE

CASE STUDY

“

I went on to discover that soy milk has to be pasteurized (cooked) even more than cow’s milk to be sold at retail.

formed acupuncture on me for 20 minutes and, 10 minutes after that, every allergy symptom I had been feeling was gone. I couldn’t believe it. I remained symptom-free for the rest of May. Although my asthma wasn’t eliminated, the worst was over. I still had to use my puffer before I went for a run but, except for that, I was basically symptom-free. The following spring, my symptoms returned. I went back to the same doctor who again used acupuncture, but it didn’t help this time. On my second trip to his office, he recommended a series of ozone treatments – a treatment that remains controversial to this day. It works by increasing the oxygen level in the blood, making it very difficult for viruses and bacteria to survive. After six treatments over three weeks, my asthma subsided dramatically.

THE ROLE OF NUTRITION My doctor then made the first nutritional recommendation I had ever heard for asthma. If I wanted to eliminate my asthma, I would have to stop consuming dairy products made from cow’s milk, such as milk and cheese, although non-flavored, organic yogurt was fine. Until that point, I had been consuming

“

From approximately 1985 to 1995, I experienced gradual improvements in my asthma as I improved my diet. The month of May continued to be my bad time, as the trees and grasses came into season and their impact was dramatic enough that not even my puffers would allow me to run outdoors during this period. Then I was introduced to the wonders of juicing. I discovered that by juicing and drinking raw, organic juice every day, my spring allergies disappeared—allergies that had been with me for almost 20 years! As a result, not only could I run outside, I could run without my puffer. My lungs would be a little tight for the first mile and then they would open up and be fine for the rest of my run. However, during cold weather, I would still have to use my puffer. This experience made me much more aware of the importance of the immune system and our ability to strengthen it through nutrition. By early 1996, I felt I had done as much as I could with my asthma. The only time I needed the puffer was when I ran in cold weather. And then I made two changes simultaneously. I started using better quality vitamin supplements, including vitamins C, B-complex, beta carotene and a multivitamin. I also began taking psyllium as a fiber supplement. Within six weeks of making these changes I discovered, in the cold weather of February, that I could run as fast as I wanted without the use of a puffer. My asthma was completely gone. It was a day that completed a 15-year journey of recovery. Had I known then what I know now, I may have been able to eliminate my asthma in three months or less. By 1997 I had become quite passionate about the power of nutrition, and I decided to pursue it as a career. I gave up a sales and marketing career to study nutrition at The Institute of Holistic Nutrition in Toronto. Upon graduation, I discovered that I still had lessons to learn about asthma.

1 to 2 quarts of milk per day for most of my life. I loved it, and it was a staple of my diet; nonetheless, I immediately eliminated dairy products from my diet. Over a period of months, my asthma gradually improved. For the first time since I developed asthma, I was beginning to understand that I could improve my condition, primarily through nutrition. I also began to wonder what other changes would help eliminate my symptoms. While I never really believed I could eliminate my asthma completely (since I was told this by doctors), I started to read everything I could on nutrition, especially as it pertained to asthma. I learned that asthma is primarily the result of the asthmatic’s immune system being severely weakened. The immune system can be compromised by eating too much processed food (foods high in white sugar, white flour, dairy, etc.) and not enough whole, natural foods like vegetables, fruits, whole grains and legumes. When poorly nourished, our body will break down one way or another. In my case, it happened to be asthma. With other people, it could be cancer, arthritis, eczema, or any one of a number of conditions. I also learned how the nutritional value of our food supply has been severely compromised and, as a result, conventional fruits and vegetables today have a fraction of the nutritional value they had a number of years ago. This has fuelled the demand for more organic produce as well as vitamin and mineral supplements to optimize our nutrient intake.

In May of 1998, my spring allergies came back, quickly followed by asthma. I was dumbfounded that this could happen, but I then realized I must have changed something in my diet that had weakened my immune system. I reviewed the last year and realized the only major change I had made was the introduction of soy milk into my diet. When I stopped drinking it, my asthma started to disappear and within three weeks, it was completely gone. I went on to discover that soy milk has to be pasteurized (cooked) even more than cow’s milk to be sold at retail. The result is a food that is almost devoid of live enzymes and, as a result, is very hard for the body to process and digest. Soy milk should be consumed in limited quantities only – especially by those suffering from respiratory problems. My asthma came back in 1999 and, again, I had to figure out where I had gone wrong. I discovered that some of the carrots I had been juicing had traces of mold to which I was quite allergic. Within two weeks of discontinuing their use, my asthma disappeared again. These experiences taught me a valuable lesson. Asthma can return, but only if you become careless and do something that compromises your immune system. Since that time, I have helped a number of people eliminate their asthma. While not everyone’s situation is exactly the same, there are certain fundamental issues that must be considered and addressed. Could all sufferers eliminate their asthma? I suspect most could, but only if they are willing to make changes in their lifestyle, especially in respect to nutrition and exercise. That is very difficult for most people to do but can be very rewarding. S&W

W IN T ER 2 013 • S LE E P & W ELLNE SS MA GAZ INE

THE SLEEP CORNER

SLEEP SPECIALIST IN YOUR AREA, GUIDNG 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

THE SLEEP CORNER

SL E E P & W E L L N E SS M AG A Z I N E • W I N T E R 201 3

SLEEP SPECIALIST IN YOUR AREA, GUIDNG 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

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