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SLEEP & WELLNESS MAGAZINE // Fall 2011

The INSOMNIA Issue: - MEDICATIONS - SLEEP HYGIENE - TREATMENTS

Fall 2011 // Issue 1 Complimentary Copy

Pain Due to a Lack of Sleep What to Expect From Your Overnight Sleep Study Work Out Your Core

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Contents

The Insomnia Issue:

Fall 2011 // Issue 1

DEPARTMENTS

Q&A INSOMNIA: Interview with Dr. Andrew Mouton, Ph.D. by Cindy Olsen, RPSGT

pg 8 Food & Nutrition NEITHER FISH NOR FOWL Recipes are brought to you by the American Heart Association’s Patient Education program

FEATURES: INSOMNIA by Andrew P. Gasecki, M.D., Ph.D.

pg 16

PAIN DUE TO A LACK OF SLEEP by Daniel B. Davenport, D.C. & Shawn D. Loree, A.P.R.N.

pg 24

WHAT TO EXPECT FROM YOUR OVERNIGHT SLEEP STUDY Information provided by the American Sleep & Breathing Academy

pg 28

pg 10

Health & Wellness

CRUNCH TIME by Charles Stelk, M.P.T.

pg 22

22 5

Contributors

American Sleep & Breathing Academy Education Board Zach Andelin Alison Porter, RPSGT Cindy Olsen, RPSGT Reagan Dickson, RPSGT Syed Nabi, M.D. Paul Tehman, M.D. Managing Editor Erin Spurgeon Contributing Writers Andrew P. Gasecki M.D., Ph.D. Cindy Olsen, RPSGT Charles Stelk, P.T., M.P.T, C.S.C.S. Daniel B. Davenport, D.C. Shawn D. Loree, A.P.R.N. Creative Director Zach Andelin Graphic Design Brad Trinnaman Photography: Jed College Matt Tafoya Sales & Marketing Coordinator Kelli Adams Sales & Marketing Assistants Anthony Simon Sherry Jarvis Production Director Carline Risser Publishing Sleep & Wellness Magazine is produced, published, and distributed 4 times a year by The American Sleep and Breathing Academy LLC, 8706 South 700 East Suite #207, Sandy, Utah 84070. The American Sleep and Breathing Academy also produces and publishes Principles of Polysomnography, Principles of Polysomnography practice examination manual, Principles of Polysomnography board review flash cards, Principles of Polysomnography pocket guide, and other educational written materials key in the field of sleep. Entire contents copyright 2011 American Sleep and Breathing Academy LLC all rights reserved. Reproduction in whole or in part is prohibited. PRODUCED IN THE UNITED STATES OF AMERICA.

Fall 2011 // SLEEP & WELLNESS MAGAZINE

ere at the American Sleep and Breathing Academy, we are excited to contribute to the ever-increasing need for community and patient education regarding sleep disorders. We believe that by educating we can save lives. Our team of sleep professionals strives to stay educated and current on all advancements in treating and diagnosing sleep disorders. Furthermore, we are dedicated to bringing our readers and their families information on the importance of healthy sleep behavior. Sleep & Wellness is designed to provide well-rounded information not only about sleep, but also about exercise and healthy eating. There is an increasing trend in the media regarding car and plane accidents related to sleep deprivation. Around 37 percent or 103 million people have admitted to falling asleep at the wheel. It is estimated that 100,000 police-reported crashes were a result of fatigue. We live in very fast-paced world where frequently our sleep patterns are unhealthy and dangerous. Sleep disorders have an impact on our everyday lives and can contribute to serious mental and physical health problems. By increasing the quality of our sleep, we reduce the risk of obesity, diabetes, heart problems and depression, as well as improve the body’s ability to fight off disease. Insomnia is a very common sleep disorder in America; there is an inability to shut down, relax, sleep and maintain sleep. After several nights without sleep, your body will start to feel the effects of sleep deprivation and accidents can occur. That’s why we chose to focus on insomnia in this first edition of Sleep & Wellness. Knowing that there are solution and treatment options for insomnia, you might be able to get a good night’s sleep, or maybe even save a life. Many times people will suffer from a sleep disorder like insomnia for years and consider it normal, or part of life, without knowing there is an underlying problem that can be treated. We hope to deliver important health information to the public in an enjoyable and aesthetically pleasing way that will improve lives. We hope to improve the way people look at sleep and their personal behaviors.

~ American Sleep & Breathing Academy Education Board

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. We accept most insurance plans. Our services range from Physician Consultations, In-Lab Sleep studies, In-Home Sleep Studies, to DME home homecare. Free take-home oximetry pre-screening devices are also available in our offices; they are easy for you to pick up and use. Monthly online educational events are exclusively provided to you to keep you up to date and improve your quality of sleep. We strive to give you the most up to date information on new devices and concepts as the field develops and changes. With state of the art equipment and bedrooms designed to make you feel at home, the Sleep Institute of Utah offers a pleasant sleep experience for your sleep study. We have six convenient locations throughout the Wasatch front – call us today so you can start sleeping better tonight.

Office: 866-22-sleep Fax: 866-716-6117 www.sleepiu.com

CUSTOMER SERVICE The American Sleep & Breathing Academy (attn) S&W Magazine Customer Care, 8706 South 700 East Suite 207, Sandy, Utah 84070 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.americansleepandbreathingacademy.com

South Ogden

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Tooele

1464 East Ridgeline Dr. Suite 104 South Ogden, Ut 84405

5323 Woodrow Street Suite 205 Murray, Ut 84107

8706 South 700 East Suite 207 Sandy, Ut 84070

552 East 1400 South Orem, Ut 84097

2376 North 400 East Suite 201 Tooele, Ut 84074

Lindon 275 West 200 North Suite 230 7 Lindon, Ut 84042

Fall 2011 // SLEEP & WELLNESS MAGAZINE

SLEEP & WELLNESS MAGAZINE // Fall 2011

Q. As an expert in the field, how do you define insomnia? A. I see insomnia not so much as a diagnosis as I do a symptom. Insomnia is a complaint of inadequate or poor quality of sleep. Q. How can one recognize insomnia – what are the common symptoms? A. Insomnia can cause a difficulty in falling asleep or a difficulty in maintaining sleep. It can cause early awakenings in the morning, or simply be a lack of feeling refreshed in the morning. To be classified as insomnia, there must be an impairment of daytime functioning. Q. What is the most common type of insomnia that you see? A. Often people can fall asleep without difficulty but are then unable to maintain sleep. This inability to maintain sleep is the most common insomnia complaint I see.

INSOMNIA By Cindy Olsen, RPSGT

Dr. Andrew Mouton, Ph.D., is a licensed clinical psychologist in Illinois and serves as a diplomat with the American Board of Sleep Medicine and with the American Academy of Sleep Medicine. A certified behavior sleep medicine expert, Dr. Mouton here addresses some common questions about insomnia. Dr. Mouton currently serves on the medical staff at the Center for Sleep Medicine in Illinois.

Q. So, what are the common causes for insomnia? A. Stress is an obviously huge contributor to insomnia, as well as other mental health conditions. If these issues are too overwhelming, counseling may be needed to help the individual learn coping and stress management skills. Another obvious contributor is medical conditions, including other sleep disorders and pain. Sleep schedules and poor sleep hygiene can lead to insomnia, as can many medications and chemicals. Q. What are the treatment options available to people experiencing insomnia? A. Medication is a common treatment. Medication can prove to be very helpful in initiating sleep, but medications can lose their effectiveness and can have many side effects. Cognitive Behavioral Treatment for Insomnia (CBT-I) is another treatment option. Q. What does CBT-I include? A. Cognitive Behavioral Treatment for Insomnia is a set of interventions directed at the behaviors, cognitions and physiological arousals that maintain insomnia. CBT-I targets the conditioned arousal.

Q&A

Q. What can I do to start sleeping better? A. You can start by creating an evening ritual, just like you did when you were a kid. Hot shower, read a book – a relaxing routine that happens every night will trigger the nervous system to facilitate sleep onset. Another thing that can be helpful is to change your beliefs about sleep. Q. That’s interesting. What is an example of a “belief” about sleep that might be problematic or incorrect? A. A common one that I see is the belief that you should fall asleep within just a couple of minutes of retiring to bed. Taking 15-20 minutes to fall asleep is completely normal; in fact, falling asleep in less than five minutes can be an indicator of sleep problems. People also tend to believe that once you fall asleep you should stay asleep the remainder of the night. This is unrealistic. It is normal for people to wake during the night and then return to sleep. Night awakenings only become a problem when you cannot return to sleep and the awakening causes you to wake un-refreshed in the morning.

and as you do your sleep time should increase. You should limit your activity in bed to sleep and intimacy. Talking on the phone, watching television, working and reading should all be done before getting into bed. This helps you to associate the bed with sleep. Q. Is there anything else that helps one associate the bed with sleep? A. Simply put, if you’re not asleep, don’t be in bed. If you climb into bed and lay there for 20 minutes and can’t sleep, get up. Go to another room; keep the lights dim and the activity calming, then return to bed when you feel sleepy. Similarly, if you wake in the night and cannot return to sleep within 15-20 minutes, get up. If you are only in bed when you are sleeping, you will begin to associate the bed with sleep and your sleep quality will improve.

Q. What are some other common misconceptions about sleep? A. Many people also believe that you need eight hours of uninterrupted sleep each night and less than that means they have insomnia. In reality, we each require a different amount of sleep, and where eight hours may be the average, it is not necessary for us all. We each need just the amount of sleep it takes to wake up in the morning refreshed and have the ability to function throughout our day. Often, people lie in bed awake trying to sleep, but can’t. For many people the bed begins to be associated with wake instead of sleep, and then the insomnia increases. Q. How can people who have come to associate the bed with wakefulness change that perception and begin associating the bed with sleep again? A. It may be helpful to keep a sleep diary and track how many hours each night you are actually sleeping. Then restrict your “in bed” time to the amount of time you have actually been sleeping. You can gradually increase your “in bed” time, 9

Fall 2011 // SLEEP & WELLNESS MAGAZINE

Food & Nutrition

COOK’S TIP: Dry-roasting nuts brings out their flavor. Put the nuts in a single layer in an ungreased skillet. Dry-roast over medium heat for about 4 minutes, or until just fragrant, stirring frequently and watching carefully so they don’t burn. Remove the skillet from the burner, so the nuts don’t continue to cook.

NEITHER FISH NOR FOWL

When your grocery shopping moves outdoors to roadside produce stands and parking lot farmers’ markets, these recipes will get you from farm to table in a jiffy.

LEMON GREEN BEANS WITH PARSLEY AND ALMONDS

1 teaspoon fresh lemon juice 1 /8 teaspoon pepper

Ingredients

Serves 4; ½ cup per serving The lively taste of lemon and the wonderful crunch of dry-roasted almonds add the perfect accents to fresh green beans.

In a large saucepan, steam the beans for 10 minutes, or until tender-crisp. Transfer to a serving bowl. Sprinkle with the remaining ingredients. Stir gently to coat. Serve immediately for the best texture.

Ingredients

Nutrition Analysis

8 ounces fresh green beans, trimmed, cut into 1½- to 2-inch pieces (about 2 cups) 2 tablespoons sliced almonds, dry-roasted 1 tablespoon finely snipped fresh parsley ½ teaspoon grated lemon zest 10

SLEEP & WELLNESS MAGAZINE // Fall 2011

Directions

(per serving) Calories 35 Total Fat 1.5g Saturated Fat 0.0g Trans Fat 0.0g Polyunsaturated Fat 0.5g Monounsaturated Fat 1.0g Cholesterol 0mg

Sodium 4mg Carbohydrates 5g Fiber 2g Sugars 1g Protein 2g

Dietary Exchanges 1 vegetable ½ fat

LETTUCE-WRAP TACOS WITH BLACK BEANS AND CORN Serves 4; 2 tacos per serving These tacos don’t require any cooking, which makes it easy for you to put together a quick lunch and be on your way.

1 cup canned no-salt-added black beans, rinsed and drained ½ cup frozen whole-kernel corn, thawed 1 small Italian plum (Roma) tomato, diced ½ small avocado, diced 2 tablespoons fresh cilantro 1 tablespoon fresh lemon juice ½ teaspoon chili powder 8 Bibb lettuce leaves ½ cup shredded low-fat Monterey Jack cheese ½ cup salsa (lowest sodium available)

Directions

In a small bowl, stir together the beans, corn, tomato, avo-

cado, cilantro, lemon juice and chili powder. Spoon ¼ cup bean mixture into the center of each lettuce cup. Top with the Monterey Jack and salsa. For tacos, fold the sides of the lettuce over the filling. For burritos, roll the lettuce to enclose the filling, tucking the ends in. Secure each burrito with a toothpick.

Nutrition Analysis

(per serving) Calories 170 Total Fat 6.5g Saturated Fat 2.5g Trans Fat 0.0g Polyunsaturated Fat 0.5g Monounsaturated Fat 3.0g Cholesterol 9mg

Sodium 202mg Carbohydrates 20g Fiber 5g Sugars 5g Protein 9g

CHILLED ASIAN ASPARAGUS SPEARS Serves 4; about 6 asparagus spears per serving A cool and tangy change from the usual cooked asparagus, this dish is perfect as a complement to an entrée or as an elegant party appetizer.

2 tablespoons finely chopped green onion 1 tablespoon white vinegar 1 tablespoon honey 2 teaspoons fresh orange juice 2 teaspoons soy sauce (lowest sodium available) 2 large garlic cloves, minced 1 teaspoon toasted sesame oil 1 teaspoon Worcestershire sauce (lowest sodium available) 1 teaspoon sesame seeds plus 1 teaspoon sesame seeds, divided use ½ teaspoon crushed red pepper flakes

Ingredients

1 pound fresh asparagus spears (about 24), trimmed 11

Food & Nutrition

Fall 2011 // SLEEP & WELLNESS MAGAZINE

SLEEP & WELLNESS MAGAZINE // Fall 2011

Directions

FARMER’S In a skillet large enough to al- MARKET OMELETS low you to lay the asparagus flat, bring 2 inches of water to a boil over high heat. Add the asparagus, arranging the spears in a single layer. Cook for 2 minutes. Using tongs, immediately plunge the asparagus into a large bowl of ice water to stop the cooking process. Let soak for 2 to 3 minutes. Spread paper towels on a flat surface. Dry the asparagus well on the paper towels. Meanwhile, in a small bowl, whisk together the remaining ingredients except 1 teaspoon of the sesame seeds. Pour into a large, shallow casserole dish. Add the asparagus, turning several times to coat. Cover and refrigerate for 4 to 24 hours. COOK’S TIP: You might wonder why the marinade ingredients are combined in one bowl, only to be transferred to a casserole dish in the very next step. It’s because the amount of marinade is fairly small, so it’s easier to combine thoroughly in a smaller container. The marinade is also ideal with other vegetables, such as mushrooms, green beans and broccoli.

COOK’S TIP: Although these omelets are delicious with basil, feel free to use a different fresh herb or combine several for even more variety.

COOK’S TIP: If the Italian cheese blend isn’t available, you can use low-fat mozzarella cheese. You’ll miss out on a pleasant smoky flavor, however.

To serve, discard the marinade. Arrange the asparagus on a platter. Garnish with the remaining 1 teaspoon sesame seeds.

Nutrition Analysis

(per serving) Calories 65 Total Fat 2.0g Saturated Fat 0.5g Trans Fat 0.0g Polyunsaturated Fat 1.0g Monounsaturated Fat 1.0g Cholesterol 0mg Sodium 70mg Carbohydrates 10g Fiber 3g Sugars 7g Protein 3g Dietary Exchanges ½ carbohydrate ½ fat

Dietary Exchanges ½ carbohydrate ½ fat

Serves 4; ½ omelet per serving Brighten up your breakfast, lunch, or dinner menu with these flavorful omelets, full of fresh vegetables and fragrant basil.

Ingredients

1 tablespoon plus 1 teaspoon canola or corn oil 1 cup grape tomatoes, halved (about 5 ounces) 1 cup baby spinach (about 1 ounce) 2 cups egg substitute ¼ cup fat-free milk 4 medium green onions, chopped ¼ cup chopped fresh basil 2 ounces fat-free feta cheese, crumbled

Directions

In a medium nonstick skillet, heat 2 teaspoons oil over medium heat, swirling to coat the bottom. Cook the tomatoes and spinach for 2 to 3 minutes, or until the tomatoes are slightly softened, stirring constantly. Transfer to a plate. Cover with aluminum foil to keep warm.

omelet to the edge. Cook for 1 to 2 minutes, or until no longer moist. With the skillet still on the burner, spoon half the tomato mixture over half the omelet. Top the tomato mixture, in order, with half the basil and half the feta. Remove from the heat. Fold the other half of the omelet over the filling. Cut the omelet in half crosswise. Transfer to plates. Cover with aluminum foil to keep warm. Using the remaining ingredients, make and fill a second omelet.

Nutrition Analysis

(per serving) Calories 146 Total Fat 5.0g Saturated Fat 0.5g Trans Fat 0.0g Polyunsaturated Fat 1.5g Monounsaturated Fat 3.0g Cholesterol 0mg Sodium 496mg Carbohydrates 9g Fiber 2g Sugars 6g Protein 16g

Dietary Exchanges 2 lean meat 2 vegetable

MARINATED In a small bowl, beat half the VEGETABLE SALAD

Set Aside

egg substitute and half the milk together with a fork. Stir in half the green onions.

Wipe the same skillet with paper towels, being careful to avoid burning your fingers. Add 1 teaspoon oil, swirling to coat the bottom. Place over medium heat. Pour in the egg substitute mixture, swirling to cover the bottom. Cook for 2 minutes without stirring. Using a rubber scraper, gently spread the uncooked part of the moist

Serves 4; ½ cup per serving The vibrant colors and flavors of this salad add pizzazz to any meal.

Salad

1 cup grape tomatoes, halved ½ cup chopped unpeeled cucumber (English, or hot house, preferred) ¼ cup chopped red bell pepper ¼ cup chopped red onion

¼ cup chopped fresh basil ¼ cup shredded reduced-fat four-cheese Italian blend

Dressing

2 tablespoons plain rice vinegar 1½ teaspoons sugar ½ teaspoon olive oil (extra-virgin preferred) 1 small garlic clove, minced

Directions

In a medium bowl, stir together the salad ingredients. In a small bowl, whisk together the dressing ingredients. Pour over the salad. Toss lightly to coat. For peak flavor, cover and refrigerate for 30 minutes to 1 hour before serving.

Nutrition Analysis

(per serving) Calories 54 Total Fat 2.0g Saturated Fat 0.5g Trans Fat 0.0g Polyunsaturated Fat 0.0g Monounsaturated Fat 0.5g Cholesterol 3mg Sodium 62mg Carbohydrates 7g Fiber 1g Sugars 4g Protein 3g

Dietary Exchanges free

These recipes are brought to you by the American Heart Association’s Patient Education program. Recipe copyright © 2009 by the American Heart Association. Look for other delicious recipes in American Heart Association cookbooks, available from booksellers everywhere, and at heart.org/recipes. Photography Zach Andelin

Fall 2011 // SLEEP & WELLNESS MAGAZINE

SLEEP & WELLNESS MAGAZINE // Fall 2011

INSOMNIA An introduction to the ailment and common treatments By Andrew P. Gasecki, M.D., Ph.D. Photography Jed College

nsomnia is defined as a difficulty with sleep initiation or maintenance, despite adequate sleep opportunity. In the general population, about one-third of adults have one or more episodes of insomnia each year, and about two-thirds of adults with insomnia are seen in primary care and psychiatric clinics. Insomnia becomes more com-

mon with age, afflicting up to 50 percent of adults 65 years or older. Thus, it is one of the most common complaints doctors receive, and is commonly associated with medical, neurological, pulmonary and psychiatric disorders. Patients with insomnia may complain of fatigue; malaise; attention, concentration or memory impairment; social disfunc-

tion; poor school performance; mood disturbance; irritability; daytime sleepiness; reduction in motivation or energy; proneness for errors; accidents at work or while driving; tension; headaches or gastrointestinal symptoms. Insomnia is a risk factor for depression, anxiety or substance abuse, and is associated with increased medical care utilization and absenteeism from work.

Fall 2011 // SLEEP & WELLNESS MAGAZINE

SLEEP & WELLNESS MAGAZINE // Fall 2011

COMMON CULPRITS IN INSOMNIA IF YOU OR SOMEONE YOU KNOW IS CURRENTLY EXPERIENCING INSOMNIA, MORE THAN 30 SLEEP DISTURBANCE SUBTYPES MAY BE CONTRIBUTING TO THE CONDITION. THESE INCLUDE:

UNDERSTANDING INSOMNIA

THE VAST MAJORITY OF ALL INSOMNIA CONDITIONS ARE SHORT-TERM, OR ACUTE 18

Insomnia is a disorder of increased arousal. It may be related to more than 30 sleep disturbance subtypes, including stress-related, caffeine overuse, mood disorders, medications (including overuse of hypnotics, stimulants or alcohol), circadian rhythm disorders, sleep disorders, neurologic disorders or other medical illnesses. Many medications may cause insomnia, including antidepressants (fluoxetine, bupropion), anticonvulsants (lamotrigine), stimulants (caffeine, dextroamphetamine, methylphenidate), blood pressure medicines (beta-blockers and diuretics), pulmonary medicines (albuterol, salmeterol, theophylline), corticosteroids (prednisone) and decongestants (pseudoephedrine). Nicotine may also cause insomnia among smokers. If no known cause of insomnia is established, insomnia is defined as idiopathic or primary.

Fall 2011 // SLEEP & WELLNESS MAGAZINE

SLEEP & WELLNESS MAGAZINE // Fall 2011

OPTIONS FOR TREATING INSOMNIA WITHOUT MEDICATION Keep consistent bedtime hours and routines, with a set time for going to sleep and waking up each day, aiming for at least eight hours of sleep per night. Eliminate bedroom distractions. This means turn off the TV, and minimize other intruding noise or light in the bedroom. Even the sound of a snoring spouse or noisy street can interrupt healthy sleep. Lying awake and watching the clock at night may create anxiety about lost sleep and reinforce patterns of awakening. One may think, “I always wake up at 2 a.m.” and thus reinforce the behavior. Instead, if you don’t fall asleep after 20 minutes, go into another room and engage in a relaxing activity while sitting until you are ready to sleep. Practice pre-sleep rituals. Engaging in a relaxing activity, such as a warm bath, before going to bed can facilitate sleepiness. Avoid TV, phone calls, reading or computer use for at least 30 minutes before bedtime.

Recognition of the factors contributing to insomnia is the key in establishing a therapeutic plan. Treatment of insomnia due to medical, neurologic, psychiatric and drug-related illnesses should be directed at the correction of the underlying cause. For example, specific treatment of restless legs syndrome, sleep apnea, anxiety or pulmonary disease may alleviate sleep complaints without having to use hypnotic agents. In cases of drug misuse, discontinuation of the offending drug may yield similar benefits. The vast majority of all insomnia conditions are short-term, or acute, typically associated with an identifiable stressor, and usually lasting a few days to a few weeks. Examples include interpersonal relationship problems, occupational stress, personal losses, diagnosis of a new medical condition, or moving to a new location. Sleep education, sleep hygiene advice and/or a trial of short-term hypnotic may be helpful, followed by supervised withdrawal and reevaluation after the stress-inducing event has abated.

TREATING INSOMNIA Nonpharmacologic treatment of insomnia includes sleep hygiene, which, in layman’s terms, consists of adjusting one’s sleeping en20

vironment and changing potentially disruptive pre-sleep behaviors. When undergoing this nonpharmacologic treatment, a patient will be asked to go to bed and wake up at set times, with a goal of at least eight hours per night; to keep the bedroom dark and quiet; and avoid activities such as reading in bed. Relaxing bedtime routines have also been found to be beneficial. It’s important to note that, in addition to bedtime routines, daytime habits and activities can also be culprits in insomnia. Common daylight-hours contributors to insomnia include napping, use of caffeine within 10 hours of bedtime, or use of nicotine within a few hours of bedtime. If insomnia persists after making these environmental changes, sleep hygiene may need to be supplemented with other treatments. Behavioral therapies, also known as cognitive behavioral therapies, with a trained psychologist may provide long-term benefits without the side effects associated with pharmacotherapy. Stimulus control therapy, consisting of regular wake up time every morning (regardless how much sleep was obtained), going to another room if unable to fall asleep within 20 minutes, avoidance of engaging in any stimulating activity in bed, and avoidance of daytime napping, can also be beneficial. Relaxation techniques may

include muscle relaxation, to reduce physical tension, and meditation. Other techniques for insomnia may include sleep restriction and paradoxical intention, usually offered by behavioral sleep specialists.

side effects. Atypical antipsychotic agents, such as quetiapine (Seroquel), olanzapine (Zyprexa) and risperidone are used with increased frequency, but patients are at risk for significant weight gain, diabetes and neurological complications.

All patients with insomnia should receive nonpharmacologic treatment options, whereas the choice of pharmacotherapy should be based on patient preference after discussing risk and benefits of available medications. Currently available medicines for insomnia include benzodiazepines (e.g. temazepam), which are indicated only for short-term use. Chronic use is discouraged because of the potential for tolerance, abuse and dependence. In contrast, the newer generation hypnotic agents (nonbenzodiazepines), such as zolpidem (Ambien) or eszopiclone (Lunesta) have been tested in longer-term studies, without evidence of rebound insomnia, when taken at recommended doses. However, amnesia, sleepdriving, sleep-eating, sleepwalking or confusion may occur with the use of these medications. Ramelteon (Rozerem), a melatonin receptor agonist, on the other hand, has no known major risks.

Antihistamines (usually diphenhydramine) are over-the-counter agents, which may be very effective for insomnia, but the tolerance may develop after only few days. Also, daytime sedation may not be well tolerated. Melatonin acts as a hypnotic or sleep-promoting agent, although little data is available and long-term effects are unknown.

Other medicines used for insomnia are not FDAapproved. These include trazodone and tricyclics (amitryptyline and doxepin), which are the most widely used medicines for insomnia because of the low cost, despite their unfavorable cardiovascular

It’s important to note that, in addition to bedtime routines, daytime habits and activities can also be culprits in insomnia.

THE BOTTOM LINE In summary, insomnia is a common condition, resulting in various symptoms, and is associated with many medical, psychiatric, neurological and pulmonary conditions. Recognition of the underlying illness(es) is crucial to identifying the proper treatment options. Nonpharmacological treatment may provide long-term benefits, without side effects associated with pharmacotherapy. When necessary, medicines for insomnia may be utilized, depending on the patient preference and characteristics. As with any other condition, it is best to consult with your doctor for the treatment that is right for you.

Fall 2011 // SLEEP & WELLNESS MAGAZINE

Health & Wellness

SLEEP & WELLNESS MAGAZINE // Fall 2011

RAISE THE ROOF

PLANKS Maintain this position for 10-60 seconds and repeat three times.

By Charles Stelk, MPT Illustration Bradley Trinnaman hether it’s for an off-season vacation to someplace sunny or a post-holiday binge recovery, chances are it’s crunch time. (Yes, I mean the exercise.)

When most of us think of our core muscles, we think of the picture perfect “six pack” abs. But as nice and desirable as a six pack may be, your core is more than just the abdominal set; and believe it or not, its value extends far beyond aesthetics. Your core is everything except your arms and legs. It is your body’s center of gravity and where all movement begins. Having a strong core contrib-

HIGH FIVES

utes in stabilization, strength, power, efficient acceleration, deceleration and even injury prevention. Your core is the center and support for a stable, strong structure: your body. A few of my favorite movements for strengthening the core muscles are planks, “raise the roof” and high fives. Before starting any movements, first draw in your abs; you can do this by pulling your belly button toward your spine without holding your breath. Doing this several times throughout the day can be an exercise on its own.

PLANKS

RAISE THE ROOF

Planks aid in the development of the rectus abdominis, external and internal obliques. It is a full-body isolation hold and also aids in strengthening arms, shoulders, back, glutes and legs.

When “raising the roof,” you are work- High fives aid in the development of ing your internal oblique and trans- the hip flexors, obliques and rectus verse abdominals. abdominis muscles, which are all part of your core. 1. Lie on your back with your feet straight up towards the roof. Hands 1. Lie on your back with knees bent can be at your sides or under your hips. and feet on the ground. Anchor a resistance band and hold handles in 2. Pull your belly button towards the one hand.

1. Lean on your elbows with palms facing down, shoulder width apart, and toes on the ground with the body extended. Without arching your back, keep a neutral spine and face the floor to prevent tension in your neck. 2. Maintain this position for 10-60 seconds, and repeat three times. You can also drop your knees if needed to build up strength.

ground and then “raise the roof” with your feet by pushing your hips towards the ceiling. Make sure you press straight up and not over your head. Keep upper body flat on the ground. Repeat 15 reps, three or four times.

HIGH FIVES

2. Isolate arm straight towards the ceiling as if there were a cast on your shoulder. Then give yourself a “high five” by crunching your abs towards your knee, bringing ribs to the hips and raising your shoulder blades off the ground. Repeat 15 crunches on each side, three times.

One more little tip to engage core strength and balance is to simply lift a leg. Seriously, though, without compensating form, stand on one foot by raising one leg and do a set of curls, side lateral raises or any other upper body movement. These, among other motions, depend heavily on the central support of your body. Whatever motion you choose to do, remember that regular strengthening of the core will ensure your body continues to support you well for years to come.

Fall 2011 // SLEEP & WELLNESS MAGAZINE

SLEEP & WELLNESS MAGAZINE // Fall 2011

YOUR PAIN MAY BE LINKED TO LACK OF SLEEP By Daniel B. Davenport, D.C. & Shawn D. Loree, A.P.R.N. Photography Matt Tafoya

Fall 2011 // SLEEP & WELLNESS MAGAZINE

SLEEP & WELLNESS MAGAZINE // Fall 2011

Sleep is essential for our bodies. Not getting enough sleep has numerous costs that affect your body and your overall health. If you don’t sleep, your body cannot heal from illness or injury. A study by University of Chicago professor of medicine Dr. Eve Van Cauter illustrates this case.

THE MOST COMMON SLEEP DISORDER IS INSUFFICIENT SLEEP. PEOPLE COME IN AND SAY THEY’RE SLEEPY. IT’S BECAUSE THEY’RE NOT GETTING ENOUGH SLEEP.

THE CASE FOR A GOOD NIGHT’S SLEEP

n her research, Dr. Van Cauter found that just six days of sleep restriction to four hours of sleep per night caused reduced levels of the stress hormone cortisol in subjects. Cortisol, a naturally occurring hormone, normally surges just before waking from a good night’s sleep, energizing people for the day’s demands. For subjects in the study, however, reduced sleep resulted in a lower production of growth hormone after less than a week. As a necessary part of repairing damaged tissue and helping muscles grow, growth hormone is crucial to the human body and is largely secreted during the night’s first round of deep sleep. If inadequate sleep is obtained, damaged tissues may go unrepaired and muscles may weaken, directly causing pain. In addition, growth hormone deficiency leads to exhaustion, poor concentration, depression and lowered ability to perform physical activities. Another factor that contributes to pain from a lack of quality sleep is found in the body’s own inflammatory response. Lack of sleep leads to an alteration of the immune system physiology and the body reacts by increasing the inflammatory tone, which then leads to pain. Dr. Michael Irwin, professor and director of the Cousins Center for Psychoneuroimmunology at the Semel Institute for Neuroscience and Human Behavior at UCLA states, “The studies show that even a modest loss of sleep for a single night increases inflammation, which is a key factor in the onset of cardiovascular disease and autoimmune disorders.”

Sleep expert Dr. Dennis Nicholson concurs, and adds that lack of sleep (and the resulting ailments it can trigger) affects a significant number of people struggling from sleeping disorders. “The most common sleep disorder is insufficient sleep,” says Nicholson, director of the Pomona Valley Hospital Medical Center’s Sleep Disorders Denter. “People come in and say they’re sleepy. It’s because they’re not getting enough sleep.” The connection seems like a no-brainer, but many people don’t see it, he says. They want a sleep study and a pill.

DECREASING PAIN THROUGH SUFFICIENT SLEEP

So, what is the appropriate amount of sleep? Researchers say that without 7-8 hours of deep un-

interrupted sleep, you may be causing your pain to increase. Most people will say, “I can make it up over the weekend.” However, David Dinges, chief of the division of sleep and chronobiology at the University of Pennsylvania School of Medicine reports, “Our early data show that after a week of four hours of sleep a night, you need nine to 10 hours on the weekend to have any hope of recovery.”

sleep and consult with a physician if necessary. Sufficient sleep can play a crucial role in both reducing pain and conserving your health for years to come. Dr. Daniel B. Davenport and Shawn D. Loree, A.P.R.N., are providers with the Utah Pain Relief Institute based in Salt Lake City.

In conclusion, studies are continuing to identify the effects a lack of quality sleep can play on human physiology. Everyone already understands that a lack of sleep can make one feel awful; but there is research which now supports that “awful” can lead to a delay of healing and cause disease. If you are currently experiencing pain, evaluate your ability to achieve a good night’s 27

Fall 2011 // SLEEP & WELLNESS MAGAZINE

WHAT TO EXPECT FROM YOUR OVERNIGHT SLEEP STUDY

Information provided by the American Sleep & Breathing Academy

pon arriving at the Sleep Institute, the night technicians will introduce themselves and ask you to fill out some paperwork. This paperwork will take about 20 minutes to complete and gives the lab vital information for the technician and the sleep doctor concerning your medical history. The technician will then answer any questions and show you to the room you’ll be sleeping in. Today’s sleep labs are comfortably designed with private rooms to accommodate adults as well as children. The technician will instruct you to change into your night clothes and make preparations for bed such as brushing your teeth and using the restroom. 28

Once you are ready for bed, the technician will begin the electrode application. Before applying the electrodes, the technician will locate and scrub each area with a light exfoliate to clean the surface of the skin. Once the sites have all been prepped, electrodes will then be placed on the head, face and body. You will have special designed belts placed snuggly, yet comfortably, around your chest and tummy. Airflow sensors, similar to an oxygen cannula, will be put in place. Once all electrodes and sensor devices have been put in place, the technician will help you into bed. The technician will want to check that all signals are being picked up properly, so you will be asked to do a series of simple exercises such as blink, look up and down, wiggle your

SLEEP & WELLNESS MAGAZINE // Fall 2011

toes, hold your breath, etc., to verify each signal.

daytime activities, and greatly influence your overall health.

Once the hook-up is complete, you may watch television or read until it is time for the study to begin. Many people are nervous that they may have to use the restroom in the night; this is very common and is not a problem. The sleep technician will be monitoring you and is there to assist you as needed.

How can i sleep with all these things on me? Surprisingly, most people sleep fairly well in the sleep lab. The sensors are attached in such a manner allowing you to turn and move during sleep. Generally, you will not be aware of the wires during most of the night. Our staff makes every effort to try to make the lab feel as much like home as possible.

As the technician monitors your sleep, he or she may find that it is necessary to initiate Continuous Positive Airway Pressure (PAP) therapy. PAP therapy is not oxygen and should not be confused with oxygen; however, oxygen may be added to the PAP therapy if needed. To initiate the PAP therapy, you will be fitted with a comfortable mask that is placed on the face. Pressurized air is administered through the mask to hold your airway open, so that you may breathe freely and unobstructed. The amount of pressure this takes varies with each person. The sleep technician will adjust the pressure throughout the night to find your optimal setting. If the technician does not find it necessary to initiate PAP therapy, they will continue to monitor you throughout the night. The data that is collected will be reviewed by a boardcertified sleep physician who will make a proper recommendation. Often the patient will need to return for a full night of PAP therapy.

FREQUENTLY ASKED QUESTIONS Why record all these things? Your body functions differently during sleep than during wake. Interrupted sleep can disturb

What if I don’t sleep well in the lab? If you do not sleep well in the lab, the study is still not a waste of time. There are many things that can be determined about your sleep based on recordings from just a short sleep period. What is CPAP? CPAP (Continuous Positive Airway Pressure) is the treatment of choice for obstructive sleep apnea. If you have been referred to the lab for a CPAP titration study, you will have all the normal sensors placed on you, as well as a mask connected to a machine that pumps pressurized air into the mask to help you breathe. If you continue having difficulty breathing during your sleep, the technician will slowly increase the air pressure to help open your airway and allow you to breathe normally. What is the difference between a baseline study, a CPAP titration, and a splitnight study? A baseline study is a diagnostic test. If this is your first visit to the lab, you will more than likely have a baseline study performed. During this study, your sleep is simply monitored during the night by the sensors previously mentioned. No

forms of treatment are given, with the exception of oxygen when needed. A CPAP titration is a therapeutic study. If you have been referred for a CPAP titration, you have already been diagnosed with obstructive sleep apnea syndrome, and now need treatment. CPAP will be applied in addition to the normal sensors. A split-night study is a combination of the two studies, in which the first half of the night is diagnostic, and CPAP is tried during the second half of the night. This procedure is not as common as performing the Baseline and CPAP studies on separate nights. What is a multiple sleep latency test (MSLT)? If you have been referred for an MSLT, you will be staying during the night and the following day. The MSLT begins with an overnight baseline study to rule out many possible sleep disorders. Once these are ruled out, you will take five 20-minute naps during the day, approximately two hours apart from each other. During these naps we record how long on average it takes you to fall asleep and if you enter REM sleep quickly. If staying for an MSLT, you should bring entertainment (books, movies, etc.) for the periods in between naps, as well as a lunch and any snacks you may want.

Apnea (the Greek word meaning “without breathing”) is a condition in which the airway collapses with temporary absence or complete cessation of breathing and can happen several time during sleep. In severe cases, this can occur up to or greater than 100 times per hour. High blood pressure, stroke, heart attack, and/or abnormal heart rhythms are some of the disorders sleep apnea has been shown to be responsible for. Some symptoms of obstructive sleep apnea include daytime sleepiness and fatigue, loud and irregular snoring, morning headaches, poor concentration, frequent nighttime urination and obesity. Sleep apnea can also contribute to or cause the following medical conditions and problems: • Fatal heart attacks • Coronary-artery disease • Respiratory failure • Impotence • Lack of energy • Diabetes • Anxiety and depression • Auto and/or work related accidents

By reviewing some sleep basics with you, our hope is that we are conveying the simplicity of any sleep study as well as opening the door for you to receive proper treatment after having been diagnosed with any type of sleep disorder. Photography Zach Andelin

SLEEP & WELLNESS MAGAZINE // SPRING 2011

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