iOS app Android app More

Featuring fresh takes and real-time analysis from HuffPost's signature lineup of contributors
Qanta Ahmed, MD

GET UPDATES FROM Qanta Ahmed, MD
 

Be Your Own Sleep Specialist: Sleep Medicine And The Self-Care Movement

Posted: 02/02/10 09:10 AM ET

Americans are sleeping poorly. Some estimates indicate up to a 100 million of us experience sleeping problems. Depending on how that is defined, up to 48 percent percent of the population may experience insomnia.

This current state of the economy has been particularly detrimental for sound sleep. The National Sleep Foundation's 2009 Sleep in America Poll showed 31 percent of Americans were experiencing insomnia directly as a result of the economic downturn, and these findings resonate with what has been unfolding right here on Huffington Post.

Since Arianna Huffington launched the 2010 Sleep Challenge, we are seeing a flurry of activity as readers discover some of the secrets to improving sleep, sharing many of their concerns. It's enormously heartening to see this information shared on a broader platform. Finally, I think to myself, reinforcements have arrived!

I remember the moment I decided to become a sleep specialist. I was sitting in the opening lecture at The School of Sleep Medicine in Palo Alto on a beautiful Californian spring morning. I was transfixed as I listened to the speaker -- Dr. Sharon Keenan.

In that first lecture, she warned us of the mantle we were at that moment assuming. As sleep specialists, she taught us, we are fully committed to becoming life-long educators, not just for our patients but to every aspect our society at large. Ours is a mission of public health service and it's something I think about every day.

As a result of this philosophy my mentor instilled in me, every patient whom I see leaves with basic, and eventually (after subsequent visits) advanced knowledge about sleep in general as well as more specific information about their diagnosis. At the outset, I ask them to become a conduit, a portal, to share their new knowledge, whether with their children and other family members or at their workplace, or with their employers. If we are to have any chance of pulling back from our destructive national culture of Sleep Machismo, a culture which is bringing this country to its knees in terms of both performance deficits at work and fueling the fire under the most extraordinary obesity pandemic we are now witnessing, we must all become sleep specialists.

In October 2009 I attended my annual professional meeting in San Diego, California, where the American College of Chest Physicians held congress. (Many sleep disorders specialists are also Chest Physicians, or 'pulmonologists' by way of the relationship between sleep and breathing disorders, especially in one of the most common problems we treat: obstructive sleep apnea syndrome). At this meeting, we listened to a most extraordinary lecture given by Dr. Jay Sanders. In his keynote address, Dr. Sanders, the President and CEO of Global Telemedicine Group made an observation which struck me as profound. I have been sharing it with my patients ever since. He observed medicine is changing in every dimension. Its time to realize: in the future patients will be their own healthcare providers.

What did he mean by that? To me, this means patients increasingly will benefit from learning as much as they can about their conditions in order to best manage their own illness or symptom in partnership with their physician. Physicians, whether we like it or not will have to come to terms with an increasingly informed patient, which ultimately demands us become better clinicians. Managing sleep disorders ultimately requires a lot of education, both of the patient and of the referring clinician, the patient's employer and workplace. The more you know, the better you sleep.

Perhaps this self-caring approach is best captured in the philosophy of a new device which first surfaced in the market in the summer of 2009. I read about it last July in the New York Times. The Zeo is a portable, at-home device, designed for the consumer (not as a prescribed medical technology) which nonetheless measures sleep architecture surprisingly well. Let me repeat that: surprisingly well. It can tell you quite literally the shape of your sleep. The device looks a lot like a clock radio and wirelessly communicates with a headband which is worn on the forehead. During sleep, sensors in the headband record and transmit the kinds of brain waves, or EEG data which are emitted during sleep. In the morning, the data can be downloaded with a USB adapter to display graphically the amount of 'light' sleep and deeper, slow wave sleep and finally dream sleep that you experienced that night.

What could be the value in that, you might ask. Well, certain behaviors promote certain kinds of sleep. For instance, that alcoholic drink one partakes of on a Friday night --y ou will be surprised to see -- can initially trigger some deep sleep and then promptly lead to lots of nighttime disruptions which can be measured. Or let's say one exercises, like I do, spinning at SoulCycle a few times a week. Those days, my recordings will show me higher percentages of slow wave sleep, explaining why I feel refreshed and invigorated the next day. Maybe looking at these changing graphs will add to my motivations to SoulCycle more often.

The applications for home measurement of sleep patterns are tremendous. At the moment, I evaluate patients, study them in American Academy Accredited sleep laboratory in a costly and labor intensive procedure and then I see the patients at appointments thereafter. My expert education and various targeted interventions depend on their implementation only based on how well the patient listens to what I say, how well I explain my treatment plan. I only get to find out how my patient does some weeks later. If the patient could somehow, become engaged in the mystery of seeing his or her sleep change architecturally in real-time, so-to-speak, the potential impact of the behavioral change might actually be amplified.

I see this often when I explain patient's performances when showing them their CPAP compliance reports or detailed National Sleep Foundation sleep logs. Using these tools the patient feels more like an active partner in this process rather than merely a passive vessel to receive instruction. Its more fun for me too, as the patient gets to see our recommendations in action. Very often my patients and I take decisions together. I use that very terminology in my conversations and my medical records and I believe my patients do better when they are participants in my decision-making. Self-care measurements allow patients to follow their own progress to behavioral changes while they implement them at home, a kind of living, dynamic sleep diary.

I believe patients with access to their sleep pattern recordings will feel more educated about their sleep and therefore, critical to sleep wellness, much more in control. This fascinates me, especially since subjective sleep quality is a central goal in managing any sleep patient, particularly so in the most challenging of our populations, the insomnia patient. By giving the insomnia patient a sense of control over their sleep, a new sense of clarity, we begin the critical process of decatastrophization, dismantling a set of beliefs which can, if left unattended, ultimately perpetuate insomnia. Of all my consultations, I spend the most energy teaching my patients to regain control over their sleep schedule so they feel less powerless over their sleep opportunities and ultimately can begin to feel more hopeful, optimistic and realistic about what they can do to begin to improve their relationship to sleep.

So, will we all become sleep specialists? Will we think about sleep, as we do exercise and nutrition? How often have you sat down at a restaurant and discussed your calorie intake, or your alcohol consumption, or when you last exercised? Did you ever discuss how you need to curtail the evening early because you have acquired a cumulative sleep debt that week? Or that you are concerned your sleep hygiene is not what it could be? Sleep is finally, finally coming into focus as an equally critical component in the triumvirate of 21st century wellness: exercise, nutrition and sleep.

Sleep is fundamentally essential to health and wellness. Yet sleep has not registered on the American cultural radar the way diet and exercise have penetrated our psyche. We all need to work to change this. And the first step towards this is by becoming more informed through introspection and self-examination. Ask yourself: What priority do I place on my sleep, and on that of my family, my children? Time will tell whether millions of Americans choose to learn how to monitor and interpret their sleep patterns, choosing to make healthy adjustments in behavior or whether remaining entrenched in the current culture which makes us irritable, fat and sleepy.

I hope Americans make the right choice. In fact, my patients are my best instructors. Because of them, I have every confidence that Americans can accomplish anything they set their mind to. After all, we made New York City smokefree and the rest of the country followed suit. We enforced seat belt laws, helping it become a global standard. Our EMS approaches lead the world. Our management of critical illness and trauma is unparalleled and oft emulated the world over. In this era of torturous healthcare debate, we forget the many, many successes which have underpinned American Medicine for so long.

We innovate cutting edge medical advances every day, setting standards for the rest of the world to follow. But for this can-do capability to influence how America sleeps, we first have a few critical steps to pursue, and urgently so. We must assess our current model of sleep medicine, how it has evolved and where it needs to go.

Beginning in the early part of the 20th century, leapfrogging into an accepted medical science in the 1950s and finally being offered in 1973 as a valid discipline advocated by Stanford University, American Sleep Medicine has become a multibillion dollar profit-centered behemoth business.

While we have confidently declared an epidemic of sleep disorders, as a field, we remain too focused on what I call 'the Sleep Center as Diagnostic Temple model'. Our field is currently deeply distorted, centered on investigative diagnostic tools. We are a nation of 300 million, yet at last count there were only an estimated 1.1 million sleep laboratory beds throughout the country, far less than the 100 million patients reportedly impacted. Of course, not all sleep patients need a sleep laboratory visit, but this paradox places our field in a strange position, both declaring an epidemic while we limit access to vital, expensive diagnostic centers.

For sure, I would like to see more colleagues join me in our field. And indeed the costly tools at our disposal generate precious information about my patients when we study them in the laboratory beds of American Academy of Sleep Medicine Accredited Sleep Centers. These studies are invaluable to advancing understanding and prescribing highly specialized treatment strategies which I use them every day to help many, many patients successfully get better. But while this focus on the center, the laboratory, the discipline has been intense, a second focus has been deeply lacking.

Where is the investment in deploying the patient himself or herself as a means of behavioral modification, the patient as a vector for his own change, the patient as a factor in tackling this vast challenge of getting America to sleep better? When we partner with patients, our benefit can be amplified and magnified in a way that will impact our societies seismically.

As an informed nation, we will ensure that every professional driver in the United States is automatically evaluated for a sleep disorder and educated about the risks of sleep deprivation. Amazingly, this still doesn't happen. While we have blasted through legislation on driving and texting within a decade of texting becoming widespread, legislation on driving and sleepiness is severely lacking and flawed despite the invention of the first gasoline engine in 1893 and almost 100 years of driving! An informed public can change this. As an informed nation, we can move school start times to later in the day and enhance our childrens performance in education, strengthening the building blocks for our global future. As an informed nation, we can improve driving culture.

New York City is noted for endemic speeding as published in the recent report "Terminal Velocity" likely a function of our sleep-deprived, disinhibited frontal-release characteristics which expose themselves behind the wheel as road rage. As an informed nation, we can teach our employers that every corporation needs a corporate sleep policy of safety and health. As an informed nation, we can finally address the impact of long work days and poor eating choices, breaking the cycle of weight gain. As an informed nation, we can protect our shift-workers who perform our most vital services, our firemen, our police force, our aviation colleagues, our nurses, our doctors, our military. As an informed nation, we can address the myriad ways sleep disorders are affecting every level of our society. Sleep physicians cannot accomplish any of this without an informed patient and public base.

I have long been aware that as a field we need to step back from carefully corralling our expertise, detaching ourselves from being centered on worshiping at the altar of reimbursement and act not from this position of fear and protectionism but instead from a position of sharing empowerment. If we are truly going to change how our nation sleeps, it will take more than an 'Academic Body', it will take EVERY BODY.

Products such as the imaginative Zeo will play a key role in raising the national consciousness of a fundamental principle: the more America knows, the better America sleeps. Take it from a militant sleep fundamentalist: its time to get the Self Care Sleep Movement in gear. There is not a moment to lose as we bring America to a healthier, more enriching snooze.

 
 
 

Follow Qanta Ahmed, MD on Twitter: www.twitter.com/MissDiagnosis