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SLEEP AND YOUR HEART

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Winter 2012 // Issue 2 Complimentary Copy

FIBROMYALGIA: WHY AM I SO TIRED? REGULATING YOUR SLEEP

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them it is time to return to their side.

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Contents

Sleep and Your Heart Issue:

Winter 2012 // Issue 2

departments

Q&A

EFFECTS OF PTSD by Dr. Paul Teman, MD

pg 7 Info Graphic YOU SNOOZE YOU LOSE by ASBA Committee

pg 12 features

FIBROMYALGIA: WHY AM I SO TIRED? by Dr. Syed I. Nabi, MD.

pg 14 REGULATING YOUR SLEEP by Cindy Altman, RPSGT, R. EEG/EP T.

pg 20

Health and Wellness

YOGA FOR MANAGING STRESS ON THE HEART by Chandra Jo Sgammato

pg 32 INTERVAL TRAINING FOR A STRONGER HEART: Interview with pro-cyclist Nicole Evans by Ja-Ann Wolsey

HEART HEALTH: Is a Good Night’s Sleep the Key? by Christine Boufis Ph.D

pg 34

pg 26

Food & Nutrition

FOOD FOR YOUR HEART WITH JOE PISCATELLA

pg 38

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Winter 2012 // SLEEP & WELLNESS MAGAZINE

Contributors

American Sleep & Breathing Academy Education Board Alison Porter, RPSGT Cindy Olsen, RPSGT Dr. Syed I. Nabi, MD Dr. Paul Tehman, MD Managing Editor Jennifer Taylor Contributing Writers Dr. Syed I. Nabi, MD Christine Boufis Ph.D Dr. Paul Tehman, MD Cindy Altman RPSGT Ja-Ann Wolsey Jo Sgammato Health and Wellness Ja-Ann Wolsey Creative Director Antoni Pham Photography Ryan Glaze Altus Photography Sales & Marketing Coordinator Kelli Adams Sales & Marketing Assistants Sherry Jarvis Angela Kyzer Production Director Carline Risser Publishing Sleep & Wellness Magazine is produced, published, and distributed quarterly by The American Sleep and Breathing Academy, LLC, 8706 South 700 East Suite #207, Sandy, Utah 84070. 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 educational written materials key in the field of sleep. Entire contents copyright 2011American Sleep and Breathing Academy, LLC all rights reserved. Reproduction in whole or in part is prohibited. PRODUCED IN THE UNITED STATES OF AMERICA.

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he American Sleep and Breathing Academy is excited to start the New Year off with a bang. Our goal is to improve patient care through education on current and relevant issues. We are dedicated to bringing our readers and their families information on the importance of healthy sleep behavior and overall wellness.

This quarter our topics of interest reveal tools and techniques that we feel are vital for improving quality of life. By practicing proper sleep hygiene, creating an environment conducive to functional sleep, you can improve your heart health, control symptoms caused by fibromyalgia, and even achieve a healthy, balanced weight. Sleep affects mental and physical well-being and is often overlooked as the cause of many health problems. When we sleep, we are essentially allowing our body’s systems to rejuvenate and repair any damage caused by the everyday stresses of life. Just like being awake, sleep is an active state that can affect your mental and physical well-being in a positive or negative way. That’s where the importance of a good night’s sleep comes in. A good night’s sleep is nature’s way to help us to cope with stress, heal from illness, and balance the body.

SLEEP & WELLNESS MAGAZINE // Winter 2012

Q&A

THE EFFECTS OF

POST-TRAUMATIC STRESS ON SLEEP By ASBA Committee

Dr. Paul Teman received his MD from the University of Minnesota. He then completed a residency in psychiatry, followed by a sleep medicine fellowship, at the Mayo Clinic College of Medicine in Rochester, MN. Dr Teman is currently the Medical Director at the Sleep Wake Center in Salt Lake City, Utah. Dr. Teman enjoys educating the community about sleep disorders and healthy sleep patterns. He currently participates in sleep medicine education at the University of Utah.

February is heart health month as well as Valentine’s Day. The heart, long ago, was recognized as the intellectual and emotional core of a human being. We now know that the emotional and intellectual aspects come from the brain, but the heart is still the mechanical core of every human being. It is the body’s driving force, the hardest working muscle in the body, providing us with the oxygen and nutrients we need to survive. The heart is what allows us to breathe and ensure oxygen is provided to all of our cells. Poor sleep habits can negatively affect the heart and, in some cases, can lead to heart disease. To learn more about the effects of sleep on the heart, see our feature article, “Sleep and Your Heart.” It is our intent to deliver important health information to the public in an enjoyable and aesthetically pleasing way that will resonate with readers and help to improve their overall approach to sleep and wellness. Questions & Comments: Please contact info@sleepandwellness.net with any topics of interest and experiences you would like to share.

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.sleepandwellness.net

Nightmares are one possible symptom of PTSD, but not all nightmares indicate PTSD. The nightmares that PTSD sufferers experience are repetitive, and the content suggests that the person is reliving a traumatic experience.

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Q&A

Q. What are the clinical definition and criteria of Post-Traumatic Stress Disorder?

Q. What are some common signs seen in someone suffering from PTSD?

A. The definition is based on criteria in the DSM 4, Diagnostic and Statistical Manual of Mental Disorders, which are considered the Bible of psychiatry.

A. They often have sleep disturbances, insomnia, heart palpitations, or difficulty getting to sleep or staying asleep. That is part of the hypervigilance. Nightmares are common. They describe feeling numb. It’s like their emotions are blunted. They may feel they are not going to live much longer. They avoid things that remind them of the event. For example people who were in combat may avoid loud noises and war movies.

The first criterion is the person has to be exposed to some type of traumatic event. Previous definitions required that a person was involved in the trauma, but the criteria have changed. The definition now states that the victim can be directly involved or be exposed to or witness the traumatic event.

Q. What is the history of identifying PTSD?

The second criterion is that the victim re-experiences the trauma in some manner, such as through intrusive recollections, memories, flashbacks, or nightmares. For example, people who survived 9/11 may suffer from PTSD. One man witnessed the buildings collapse and almost died while at an intersection in New York. Now when he comes to the intersection, his heart rate increases, he sweats, and he re-experiences the event.

A. It has been described in very old literature going back to the Greek wars. People described comrades going blind not because of physical trauma but because they experienced something so horrific that they lost their sight. People had a hard time describing mental and psychological illness back then, so they described physical terms.

The third criterion is that the victims experience increased arousal. They might have anger outbursts, be hypervigilant, or have insomnia.

PTSD has been identified by different terms. During the Civil War, they used terms such as heart sickness. During World War I, it was referred to as shell shock. During World War II, people called it combat fatigue.

Symptoms must be present daily for at least a month. Symptoms experienced for less than a month is considered acute stress disorder, which can develop into PTSD. Symptoms may surface immediately after the event, or they may be delayed for years.

Q. What are some traumatic events that can cause PTSD? A. Combat, sexual or physical assault, abuse, being held hostage, torture, accidents, or receiving a diagnosis of a life-threatening illness can all trigger PTSD if the individual feels fearful or helpless. Less commonly, PTSD may be triggered by hearing about a traumatic event or witnessing one on TV.

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Unfortunately, like many psychological illnesses, it has taken a lot of research to validate PTSD as a legitimate disorder. Soldiers with PTSD were thought to be cowards because they had no physical scars to show they were injured. Clearly psychological scars are harder to identify because you can’t feel and touch them. One thing that happened in World War II was that General George S. Patton slapped a soldier because the soldier had “combat fatigue.” General Patton was reprimanded and taken out of command because of that incident.

Q. Do genetic factors make someone more likely to develop PTSD?

A. There have been studies of genetics and PTSD. The studies were of identical twins that were separated at birth; they had the same genetic makeup but were raised in different environments, so scientists could rule out environmental factors as a cause of PTSD. Research shows that if the both twins experience separate traumatic events, both are likely to experience PTSD, suggesting a genetic predisposition to the disorder. More recently there have been studies on what are called single nucleotide polymorphisms, or SNIPS. SNIPs are more common than genetic mutations, and some SNIPs may result in a predisposition to PTSD. For instance, a recent study of survivors from a mass shooting incident in Illinois found that people with a SNIP affecting the serotonin transporter gene were more likely to experience PTSD because of their lower serotonin levels. Having an underlying psychiatric illness can also make a person more likely to develop PTSD.

Q. Can heart rate be a predictor of PTSD? Measuring how a person’s heart rate responds to stress can aid in diagnosing PTSD. If a person’s heart rate stays elevated after a stressful event, it can indicate the person is predisposed to develop PTSD.

Does sleep deprivation exacerbate the symptoms of PTSD? A. Sleep deprivation does have an impact, whether it’s voluntary or caused by sleep apnea or another sleep disorder. Studies show that the treatment of sleep apnea helps daytime symptoms of PTSD as well as improving sleep.

Q. Is PTSD seen predominately in men or women? A. PTSD is more predominant in women, which is also the case for depression and other psychiatric conditions.

SLEEP & WELLNESS MAGAZINE // Winter 2012

Q. What are the physical effects of PTSD on the brain? A. Studies show that brain function is different in PTSD patients. The amygdala limbic cortex is the part of the brain that controls, drive, desire, survival, and instinct. The amygdala is very active in people with PTSD, which dampens their ability to concentrate. Instead they focus more on emotion.

Q. What is the connection between PTSD and cortisol levels? A. There is evidence that PTSD affects the hypothalamic pituitary axis, which controls the release of hormones. The stress hormone, cortisol, remains elevated in people with PTSD. The high level of this hormone means they are hyper-vigilant, in a constant “fight or flight” mode.

Q. How does PTSD impair a person’s waking life? A. PTSD can affect concentration and create the need to avoid situations that trigger flashbacks. It can affect relationships due to the detachment and numbing that accompanies PTSD. People with PTSD have trouble connecting with children and spouses. Emotionally they are stuck in the state of mind they were in during the trauma. They often turn to alcohol and drug abuse as coping mechanisms.

Q. Are there specific sleep disorders associated with PTSD? A. Insomnia is common in PTSD sufferers because their hyper-vigilance makes it difficult to fall asleep and stay asleep. There is a high risk for sleep disordered breathing. This might also be due to the increased REM sleep because during REM sleep the mind is active but the body is paralyzed. This causes the air way to relax and more likely to create an obstruction. There is no evidence that shows PTSD causes central sleep apnea.

However, some PTSD patients are treated with opioids, which can cause central sleep apnea.

Q. What are treatment options for PTSD? A. Both psychological and pharmacological treatments are helpful. The main psychotherapy is cognitive behavioral therapy, which considers ways that can change thinking and behaviors. The person identifies triggers and determines how to deal with anxious feelings. A more controversial form of treatment is to expose the person to situations that cause a physical response or flashback. The idea there is that eventually they won’t have the same response. SSRIs, or selective serotonin reuptake inhibitors, commonly known as antidepressants, are usually the most effective medications for PTSD. Other medication may include mood stabilizers, anti-psychotics, anti-hypertensive drugs, and beta blockers. Some studies suggest the treatment of sleep disordered breathing actually improves the symptoms and sleep of people who suffer from PTSD.

Q. What about nightmares and PTSD? A. For people with PTSD, sleep is more fragmented, and there is increased REM sleep, which may be connected to increased nightmares. Nightmares are one possible symptom of PTSD, but not all nightmares indicate PTSD. The nightmares that PTSD sufferers experience are repetitive, and the content suggests that the person is reliving a traumatic experience. Two types of treatment have been found to be effective in treating nightmares specifically related to PTSD. The first is a medication called prazosin, which is an anti-hypertension medication that can control the fight

or flight mechanism and enable a person to rest. The other is a psychological therapy called Image Rehearsal Therapy, or IRT. IRT is a form of cognitive behavioral therapy in which a person with PTSD is asked to think about the nightmare, and then rewrite it with a different chain of events or outcome. Having done this exercise, the person is more likely to experience the dream with their own “happy ending.”

Q. How can a sleep diary be effective in treating PTSD? A. Sleep diaries are used to document how the person who suffers with PTSD goes to bed and wakes up. Some psychologists use diaries to help monitor when people have nightmares. Diaries are a tool, not a treatment.

Q. How can family or loved ones help when dealing with PTSD? A. The main thing is recognizing that the person who is suffering is not making these symptoms up, Validation is important. Do not minimize the symptoms. It is also important not to try to get the person to talk about it if they aren’t ready and to avoid creating situations that might trigger a flashback. Putting the individual through the situation again can actually be more damaging than helpful. Instead ask how that traumatic event still affects the person today. The person can’t change the past but can learn to change his or her response to the situation.

Q. Where should someone go for help if they suspect they or someone they love is suffering from PTSD? A. Start by going to your physician. A doctor who doesn’t feel comfortable diagnosing or treating PTSD can help direct you to resources that can help. The National Alliance on Mental Illness website, www.nami.org, is also a good resource. S&W

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SPECIAL ADVERTISING SECTION

THYME HAS TRADITIONALLY BEEN USED TO ENHANCE PLEURAL ACTIVITY. IT ACTUALLY IMPROVES THE ABILITY OF THE LUNGS TO EXCHANGES CO2 FOR OXYGEN AND MAKES AN EXCELLENT CONTRIBUTION TO MAINTAINING SUFFICIENT RESPIRATORY AMPLITUDE.

The Herbal Treatment Of Sleep Apnea leep apnea is one of the most common sleep disturbance problems in America. It ruins the sleep of an estimated 25 million Americans on a regular basis. The condition prevents the sleeper from entering REM and Delta sleep causing them to become anxious, cantankerous and tired during the day. There are very serious health consequences of prolonged sleep deprivation. Additionally, due to the nature of the condition, it causes blood oxygen levels to be lower than normal for very prolonged periods of time. This is damaging to the brain and heart in particular.

Presently, there are several ways in which the problem is addressed. Some are affective while others can be painful with only little success.

CAUSE OF THE CONDITION: When we start to fall asleep, we move from a state of drowsiness into transitional sleep and begin our first “Sleep Cycle”. Stage 2 sleep is considered our baseline sleep where all three stages of sleep emerge from. When we are in our baseline sleep preparing for dreaming or REM sleep, our muscle activity is decreased. It is called “reduction of muscle tonus”. This helps to keep the dreamer from phys-

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ically acting out the movements of their dreams since the part of the brain that controls muscle activity cannot tell the difference. It is accomplished by suppressing the flow of signals from the brain along the spinal cord. Unfortunately, as we age, a couple of problems develop. The first problem is that the muscles of the soft palate in your mouth become weak. This allows the soft palate to sag. The second problem is that the communication between the diaphragm and the brain becomes somewhat obstructed. The result of this is that upon entering stage two sleep, the muscle tone holding the soft palate out of the air-way is reduced. While this is happening, the same decrease in muscle tone is reducing the signals to the diaphragm on an already obstructed communication channel. The result is that our breathing becomes shallower and shallower due to insufficient signal strength to the diaphragmatic muscles. As our breathing becomes shallower, the blood oxygen level drops. In a young and healthy individual, this would trigger a stronger and deeper breathing from the control system. In an older individual with an already restricted nervous flow to the diaphragmatic muscles, there is no trigger to breath deeper.

When the blood oxygen level gets low enough and the carbon dioxide level gets high enough, the brain intervenes and tells the body to take a large breath. This causes a lot of pressure and literally sucks the saggingsoft palate into the airway. This obstructs the airflow and causes a loud “SNORT” and wakes you up. Most times, you won’t wake up completely and are not aware that it happened and return to sleep. Then it starts over again; it can occur as often as every minute or so.

THE SOLUTION: If your breathing was sufficient, then you would not make a deep breath, suck your soft palate into the airway and snort, disturbing your sleep. The solution is to increase the ability of the brain to communicate with the diaphragm so that you breathe regularly throughout the night. This can be solved with the most dramatic impact by the administration of just a few common herbs. Lobellia, when used in small doses, acts as a respiratory stimulant. It has been used for thousands of years to treat respiratory conditions. This herb, when taken before bed, can actually increase the quiescent level of respiration sufficiently so as to avert the dangerous drop in blood oxygen

level that occurs upon muscular inhibition. It can maintain deep steady breathing throughout sleep. Since it can have some un-settling effect on the stomach, it should be used in conjunction with Meadowsweet to eliminate any slight nauseous feeling. Thyme has traditionally been used to enhance pleural activity. It actually improves the ability of the lungs to exchanges CO2 for oxygen and makes an excellent contribution to maintaining sufficient respiratory amplitude. To round out the combination, Chamomile aids the subject in relaxing and Cramp Bark helps the upper trapezius muscles to relax. This bouquet of herbs enhances respiration relaxes muscles that restrict nervous flow, increases drowsiness, and protects the stomach lining. It represents a holistic natural solution to sleep apnea. It is non-habit forming and no-preconditioning is required. S&W

The information contained in this article is for informational purposes only, and may not apply to your situation. Statements and opinions expressed herein are those of the authors; and not those of the American Sleep and Breathing Academy.

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Info Graphic

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SLEEP & WELLNESS MAGAZINE // Winter 2012

By Dr. Syed I. Nabi, MD.

ALTHOUGH THE DIAGNOSTIC CRITERIA FOR FM IS BASED ON THE IDENTIFICATION OF 11 OUT OF 18 TENDER POINTS SPREAD THROUGHOUT THE BODY, OVER 90% OF FM PATIENTS HAVE A TRIAD OF SLEEP, FATIGUE AND PAIN, AND THE DIAGNOSIS IS COMMONLY MISSED BY PHYSICIANS UPON INITIAL PRESENTATION.

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ome of the most dreaded patients in any primary care facility are the ones that present with chronic pain. It is a recognized source of anxiety and stress among health care providers when these patients appear on the schedule, from the front desk office staff to physicians. The patient in pain is often a frequent, frustrated visitor; for patients with chronic pain and fatigue, there is no clear-cut blueprint for primary care providers to follow. Identifying the source of the pain and treating it is often a challenge for even the best physicians.

Patients with Fibromyalgia (FM) often present with a constellation of symptoms that include fatigue, numbness, tingling, headaches, weakness, insomnia, and sleepiness. This myriad of ailments may cause patients to hop from one provider to other in hopes of finding their knight in shining armor who will ease their suffering. What they don’t realize is each of their symptoms in and of itself can require a full 30 to 40 minutes of evaluation and discussion. To discuss all their symptoms, diagnose all the problems, and make an effective plan, all in one tiny appointment slot, is a bold undertaking. Sometimes a provider scrambles to simply get the patient out the door with a remedy that might work. With all their distinct symptoms that need individualized attention, no two patients with Fibromyalgia are alike. Each patient with FM suffers with her own set of symptoms, medical problems, genetics and family history, psychological disorders, social factors, access to health care, etc. Each patient needs individualized attention and a plan tailored to

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Multiple factors affect sleep in FM patients. Genes and environmental factors affect how FM symptoms present and how patients respond to therapy. Several neurochemicals, especially serotonin and adrenaline, have also been noted to play a significant role in sleep, pain, and mood.

SLEEP & WELLNESS MAGAZINE // Winter 2012

DISORDERS THAT DISRUPT SLEEP, SUCH AS OBSTRUCTIVE SLEEP APNEA (OSA) CAN CONTRIBUTE SIGNIFICANTLY TO SYMPTOMS OF FM. his or her situation to get the best outcome. Although the diagnostic criteria for FM is based on the identification of 11 out of 18 tender points spread throughout the body, over 90% of FM patients have a triad of sleep, fatigue and pain, and the diagnosis is commonly missed by physicians upon initial presentation. Sleep is always affected someone is in pain, and patients with FM are no different. Poor sleep quality and perception of poor sleep adds to the misery of patients with FM who are already struggling with pain and fatigue. Symptoms generally include trouble falling and staying asleep, waking up frequently at night, non-restorative sleep, daytime fatigue and excessive sleepiness. Some patients have excessive preoccupation about their lack of sleep. FM patients often comment, “If I could only get a few hours of sleep at night, and would be fine,” or “I have not slept in ages.” Symptoms of poor sleep, in addition to pain and fatigue, are another management challenge for most physicians. Consequently, these patients are often referred to a sleep

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clinic. Whether sleep ailments are caused by pain or vice versa is debatable, but both must be addressed before a patient will feel better. Multiple factors affect sleep in FM patients. Genes and environmental factors affect how FM symptoms present and how patients respond to therapy. Several neurochemicals, especially serotonin and adrenaline, have also been noted to play a significant role in sleep, pain, and mood. Receptors in the skin, neurons that communicate messages between the peripheral and central nervous systems, complex brain processes, and interplay of hormones and immune system all have a hand in how the individual is affected. Female relatives of FM patients tend to have more tenderness than male relatives, suggesting there is also a genetic component. FM patients have also been observed to have different levels of cortisol, a stress hormone which is produced by adrenal glands. The brain and adrenal glands regulate cortisol differently during wake and sleep, so the variation in cortisol levels suggests a physiologic component to sleep disorders in FM patients.

During a polysomnogram, a patient sleeps in a lab with wires hooked to their scalp, face, chest, abdomen, and extremities, so at technician can monitor the patient’s sleep overnight.

As a patient with FM is evaluated, he or she undergoes a battery of blood work, testing, screening, physical examinations, and trial and error of different medicines. Often a polysomnogram, or an overnight sleep study, is done to study the patient’s sleep patterns. During a polysomnogram, a patient sleeps in a lab with wires hooked to their scalp, face, chest,

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OBSTRUCTIVE SLEEP APNEA

abdomen, and extremities, so a technician can monitor the patient’s sleep overnight. A sleep study measures the breathing pattern, heart rate, EKG, oxygen, and limb movements and their relationship with brain waves. A polysomnogram enables the technician to study the quality of sleep and look for problems like obstructive sleep apnea or periodic limb movement that can result in poor sleep. Armed with this information, a sleep center can help patients with FM improve their quality of sleep and help alleviate some, if not all of their symptoms. The brain goes through transitions during sleep, which can be measured during a sleep study from the electrodes on the patient’s scalp. Sleep is divided into different stages based on this electrical wave form activity. Brain waves range from fast or alpha waves, to very slow delta waves, which reflect deep sleep. Stage 1, during which alpha waves are predominant, is considered the transition from being awake to sleep. Stage 2, forms the bulk of the sleep. Deep sleep occurs during Stage 3. Stage 3 sleep has been noted to have the most restorative effect. As we age, Stage 3 sleep is reduced. Interestingly, in patients with FM the alpha waves usually seen during Stage 1 sleep are seen in excess, sometimes even “riding’’ on the delta wave during what should be deep sleep. In fact, higher levels of these aberrant alpha waves correspond to higher levels of pain in FM patients. Sleep researchers speculate that in these patients the brain is not completely transitioned into deep sleep, leading to non-restorative sleep and symptoms associated with it. Disorders that disrupt sleep, such as Obstructive Sleep Apnea (OSA) can contribute significantly to symptoms of FM.

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IS A CONDITION IN WHICH THE AIRWAY EITHER COMPLETELY OR PARTIALLY COLLAPSES, LEADING TO THE TEMPORARY CESSATION OF BREATHING.

Obstructive Sleep Apnea is a condition in which the airway either completely or partially collapses, leading to the temporary cessation of breathing. As we fall asleep, muscles of our body relax, and we lose control of voluntary muscles from head to toe. Muscles in the airway relax as well, leading to the narrowing of the airway. If the airway is narrowed too much, or closed completely because of OSA, the brain signals the patient that she is strangling, disrupting the continuity of sleep. When it happens frequently night after night, over a period of time, patients with OSA develop symptoms of sleep deprivation, which include fatigue, excessive daytime sleepiness, trouble falling or staying asleep, and a decreased threshold for pain—all of which are common in FM patients. If OSA is contributing to FM symptoms, treating OSA will also relieve many FM symptoms. A sleep center can create a sleep plan for patients with OSA. Patients with FM would be wise to consider a sleep study as a part of their treatment. The information gathered during the sleep study can help the patient and doctors understand some of the symptoms the patient is experiencing and treat them. Establishing sound sleep goes a long way toward the treatment of Fibromyalgia. S&W

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SLEEP & WELLNESS MAGAZINE // Winter 2012

REGULATING YOUR SLEEP By Cindy Altman, RPSGT, R. EEG/EP T.

MOST ADULTS WHO AVERAGE 7.5-8 HOURS OF SLEEP A NIGHT REPORT FEELING RESTED AND ALERT.

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t a time when electronic media is everywhere, products and services are available 24 hours a day, and life in general is packed with one activity after another, people are not getting the sleep they require. According to a Sleep in America® poll released by the National Sleep Foundation in March 2011, 43% of Americans between 13 and 64 years of age rarely or never get a good night of sleep, and 63% said they needed more sleep than they were getting during the week.

Getting enough sleep, and good quality sleep, is critical to a person’s well-being. The need for sleep varies from one person to another and is influenced by genetics, age, and one’s sleep habits. Sufficient sleep is defined as the amount of sleep a person needs to wake up spontaneously, without an alarm clock or other stimulation, feeling refreshed and alert for the day. Most adults who average 7.5-8 hours of sleep a night report feeling rested and alert.

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ADULTS WHO CONSISTENTLY GET 6 OR FEWER HOURS OF SLEEP A NIGHT GENERALLY EXPERIENCE SYMPTOMS OF INADEQUATE SLEEP.

ADULTS ARE SLEEPING LESS Over the years, the amount of time adults sleep each night has decreased, while the amount of sleep needed has not. The average amount of sleep per night reported by adults in the 1950’s was 8.5 hours, compared to 7.5 hours today. This reduction in sleep time over the years is most likely self-imposed and related to increasing work hours, busy family life, expanding technologies, and 24-hour availability of many products and services. The biological need for sleep has not changed; however, the importance we place on it has. Adequate sleep, no matter what our age, improves alertness, mood, and the ability to perform both basic and complex tasks. In contrast, inadequate sleep results in daytime sleepiness, memory problems, difficulty performing tasks, irritability, and poor attention. Over time people can become tolerant of the effects of inadequate sleep, and

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unfortunately sleep loss may become accepted as the norm. To compensate, people may use stimulants such as coffee to wake up or keep going during the day; they may fall asleep when inactive or become dependent on daily naps. Adults who consistently get 6 or fewer hours of sleep a night generally experience symptoms of inadequate sleep. Insufficient sleep can lead to problems with work and family relationships, as well as an increase in motor vehicle or serious workrelated accidents. Research has shown that even partial sleep loss over time can worsen or increase the risk for heart disease, high blood pressure, coronary artery disease, diabetes, obesity, and immune system disorders.

HOW TO SOLVE SLEEP PROBLEMS To determine whether sleep problems are due to bad habits or a more serious sleep disorder, it’s important to first evaluate sleep

Tips for Good Sleep Hygiene 01

Make sleep a priority. Sleep is as important as diet and exercise, and necessary for both physical and mental wellbeing. Determine your daily sleep need and meet this sleep requirement on a regular basis.

Maintain an active, mentally stimulating lifestyle. Research shows that people who have strong social relationships and are mentally challenged rate their sleep as good to excellent, and feel more rested and energized during the day.

Go to bed and wake up about the same time each day, even on weekends or days off. Regular sleep times help set the wake/sleep clock in the brain and promote wake during the day and sleep at night.

Establish a relaxing bedtime routine such as reading a book or listening to soothing music. Watching TV before bedtime may help some people fall asleep, but it can cause others to become more alert. Allow time to wind down and relax, thereby reducing stress and anxiety. Avoid working, paying bills, playing video games, or problem-solving before going to bed.

Make sure the bedroom is quiet and comfortable. It should be free of distractions and noises, such as traffic sounds and equipment motors and lights. Pets should not sleep in the same bed. There should be minimal light in the room, and if a nightlight is used it should be low intensity. Consider blackout curtains, eye shades, ear plugs, "white noise" machines, humidifiers, fans or other devices to counteract the effects of sleep distractions that cannot be eliminated.

Keep the bedroom cool. A cool room promotes a low body temperature, which is associated with an increase in sleepiness and restful sleep.

Avoid bright lights in the evening and during the night. Bright lights trigger an awakening response in the brain. Consider dimming room lights close to bedtime. Stay away from computer screens as they emit ambient light.

Sleep on a comfortable, supportive mattress and pillows. Most mattresses should be replaced within 10 years. Make the bed and bedroom attractive and inviting for sleep, free of objects that could get in the way when moving around the room at night. Don’t turn on bright lights during the night; use a low level flashlight or nightlight if you need to move around in the dark.

practices, also known as sleep hygiene. If sleep problems do not improve with good sleep hygiene, or are present for more than three months, it is time to consult a sleep medicine doctor. Sleep/wake disorders that can affect sleep and daytime performance include obstructive sleep apnea, restless leg syndrome, periodic limb movements in sleep, narcolepsy, insomnia, and even nightmares. There are also psychological and medical disorders that can interfere with sleep, including pulmonary disease, diabetes, thyroid disorders, esophageal reflux, fibromyalgia, obesity, menopause, pain, depression, and anxiety. And there are medications that can delay, increase, or disrupt sleep. Most sleep problems can be identified, corrected, or treated, leading to restful and restorative sleep and optimal daytime functioning.

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Winter 2012 // SLEEP & WELLNESS MAGAZINE

MPACT. MAKE ONE.

Caffeine remains in the body on average four hours, but this time varies greatly. Some people are affected by caffeine for up to 12 hours.

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Use the bedroom for only sleep and intimate relations. Ideally, remove work materials, computers, televisions, and other distractions from the bedroom. If the bedroom clock makes you anxious about getting up in the morning, move the clock to a location that’s not visible from the bed. Avoid performing activities in the bedroom that cause anxiety and prevent sleep. Finish eating at least two hours before bedtime, yet don’t go to bed on an empty stomach. Avoid heavy meals, spicy foods, and too many liquids close to bedtime. Eating or drinking close to bedtime may make you uncomfortable and cause indigestion or frequent trips to the bathroom. Hunger at bedtime may keep you from falling asleep.

Exercise regularly. Research shows that people who exercise regularly fall asleep and maintain sleep better at night. Be sure to complete workouts at least three hours before bedtime. Exercising right before bed can increase alertness and cause body temperature to rise, delaying sleep.

Avoid nicotine products, which are stimulants. When used close to bedtime, they can increase alertness, delay sleepiness, and reduce the quality of sleep.

24 www.sleepandwellness.net

Avoid caffeine and other similar stimulants for 6 - 8 hours before bedtime. They can keep you awake or interfere with sleep at night. Coffee, tea, colas, energy drinks, and chocolates contain caffeine. Caffeine remains in the body on average four hours, but this time varies greatly. Some people are affected by caffeine for up to 12 hours.

Avoid alcohol before bedtime. While it may make you sleepy initially, it is a stimulant and can lead to disrupted sleep later in the night.

Get out of bed if you are not sleepy within 30 minutes. Do something relaxing in dim light until you are sleepy. Do not turn on bright lights or sit in front of a computer screen. If you can’t sleep or wake up because of worries, keep a notepad at the bedside and write down your problems. Create a plan to address problems the next day, and then forget about them until the morning. If you are unable to avoid tension and stress, it may be helpful to learn relaxation therapy from a trained professional.

Don’t nap during the day. Napping can reduce the need for sleep at night. If you must take naps, do so before 3 pm, and keep nap times short (close to 30 minutes).

Simply put: enough sleep – and proper sleep hygiene – are critical to maintaining a happy, healthy and productive lifestyle. Cindy Altman, RPSGT, R. EEG/EP T. is President-Elect of the Board of Registered Polysomnographic Technologists (BRPT) and is the Technical Director at Creighton University Sleep Disorders Center in Omaha, NE. She has more than 30 years experience in neurodiagnostic and sleep technology, and throughout her career has held both clinical and administrative positions at Creighton University Medical Center in Omaha, NE. Altman has served on the boards of the American Society of Electroneurodiagnostic Technologists (ASET), the American Board of Registration of Electroencephalographic and Evoked Potential Technologists (ABRET), and the Joint Review Committee for Education in Electroneurodiagnostic Technology (JRC-END). S&W

Winter 2012 // SLEEP & WELLNESS MAGAZINE

SLEEP & WELLNESS MAGAZINE // Winter 2012

HEART HEALTH: Is a Good Night’s Sleep the Key? By Christine Boufis, Ph.D

“Sleep deficiency increases the risk of cardiovascular complications including heart disease, high blood pressure, stroke, and arrhythmias. In turn, heart disease itself can produce sleep disturbances and induce sleep apnea, so it’s kind of a vicious circle.”

THOSE WHO SLEPT LESS THAN 6 HOURS PER NIGHT HAD A 48% GREATER CHANCE OF DEVELOPING AND DYING FROM CORONARY HEART DISEASE (CHD) AND 15% CHANCE OF DEVELOPING OR DYING FROM A STROKE.

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Did you know that we now sleep 1-2 hours less per night than people did 50 years ago? In fact, more than 30% of Americans ages 30-64 report getting less than 6 hours sleep per night. Increased work hours, stress, and the siren call of electronic devices are no doubt to blame.[1][2] And while lack of sleep can affect everything from job performance to your mood, the effects of sleep deprivation are also seen internally: research shows that inadequate sleep can detrimentally affect cardiovascular health, leading to increased risk of heart attacks, stroke, and even death.[3][4][5] “All of us are concerned that sleep deprivation ultimately will contribute to an increasing epidemic of cardiovascular disease,” says Prediman K. Shah, MD, Director of the Division of Cardiology and of the Oppenheimer Atherosclerosis Research Center at Cedars-Sinai Medical Center in Los Angeles. A June 2011 review of almost 475,000 participants in 15 studies, published in the European Heart Journal, found that those who slept less than 6 hours per night had a 48% greater chance of developing and dying from coronary heart disease (CHD) and 15% chance of developing or dying from a stroke. “That’s pretty astounding, if you think about it,” says Dr. Shah. [3]

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Winter 2012 // SLEEP & WELLNESS MAGAZINE

SLEEP & WELLNESS MAGAZINE // Winter 2012

Men and women who averaged less than 6 hours of sleep per night had higher amounts of coronary plaque – a precursor to heart disease – compared to those who slept 6 or 7 hours per night.

15 MILLION AMERICANS HAVE SLEEP APNEA, AND MORE THAN 85% OF PEOPLE WITH OSA ARE NOT DIAGNOSED.

Researchers found that sleeping one extra hour per night decreased the buildup of coronary plaque by 33%.

Interestingly, too much sleep – usually beyond 8 or 9 hours a night – was also associated with increased cardiovascular risk: long sleepers had a 38% increased risk of developing or dying from CHD and a 65% great risk of developing or dying from a stroke. “Both short and long duration of sleep are predicators, or markers, of cardiovascular outcomes,” researchers concluded. [3] But the big question is how or why does short sleep affect the heart? “It’s a two-way connection,” explains Dr. Shah. “Sleep deficiency increases the risk of cardiovascular complications including heart disease, high blood pressure, stroke, and arrhythmias. In turn, heart disease itself can produce sleep disturbances and induce sleep apnea, so it’s kind of a vicious circle.” One disease, nocturnal angina, where people wake up feeling a squeezing or pressure in their chest due to decreased blood flow to the heart, can most often be controlled by medications or by bypass surgery or angioplasty,” says Dr. Shah. “We don’t see it that often anymore because we have effective treatments available – ways of improving blood flow to the heart.” But while the association between shortened sleep and increased risk of cardiovascular disease has been seen in several studies, the cause and effect mechanism – if there is one – is not completely understood. A 2008 study published in JAMA by Diane Lauderdale, PhD, professor of epidemiology in the Department of Health Studies at the University of Chicago, et al, found that men and women who averaged less than 6 hours of sleep per night had higher amounts of coro-

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nary plaque – a precursor to heart disease – compared to those who slept 6 or 7 hours per night. In fact, the researchers found that sleeping one extra hour per night decreased the buildup of coronary plaque by 33%. Coronary plaque is the buildup of cholesterol and calcium in the lining of the arteries of the heart,” explains Dr. Shah, and “that could lead to a heart attack.”[4] Researchers were unable to pinpoint a causal mechanism for the buildup, but there are several theories. “One hypothesis is that lack of sleep induces a pro-inflammatory state in the body – especially if lack of sleep is associated with sleep apnea,” says Dr. Shah.[6] Another theory is that blood pressure, which usually falls at night, does not decrease enough in the short sleepers, which in turn can lead to elevated levels of cortisol, a stress hormone. [7]

“The association is not entirely clear,” explains Dr. Shah. “There’s even an idea that too much sleep may be a consequence of heart disease, but you cannot distinguish cause and effect. All you can do is show an association.” What is clearer is the relationship between sleep apnea and hypertension. People with obstructive sleep apnea (OSA) experience a constricting or closing of their airways while they sleep; they snore heavily and may wake up dozens of times a night gasping for air. With sleep apnea, the sympathetic nervous system – or fight or flight response -- is activated; your body produces adrenaline, “which induces inflammation, which can then lead to high blood pressure, possibly even diabetes and obesity,” says Dr. Shah. Indeed, OSA has also been associated not only with hypertension, but also heart failure, stroke, and arrhythmias.[8][9]

“Basically sleep apnea induces hypertension and taxes the sleeping heart, which is being challenged to get more oxygen,” says Susan Zafarlotfi, clinical director of the Institute for Sleep-Wake Disorders at Hackensack University Medical Center in New Jersey. Studies show that 15 million Americans have sleep apnea, and more than 85% of people with OSA are not diagnosed. [8] In addition, “One in three people who have high blood pressure have sleep apnea,” says Dr. Shah. “And one in two people with type II diabetes also have sleep apnea.”

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Winter 2012 // SLEEP & WELLNESS MAGAZINE

IT’S VERY IMPORTANT IF SOMEONE HABITUALLY SNORES, TO HAVE THAT SNORING CHECKED WITH A SLEEP SPECIALIST. “That’s why it’s very important if someone habitually snores, to have that snoring checked with a sleep specialist,” says Dr. Zafarlotfi. “You cannot guess during the day if someone has sleep apnea,” she adds. You need to be evaluated in a sleep laboratory by a sleep specialist who will monitor and measure nighttime heart rate, oxygenation, movement, and breathing to get the proper diagnosis. And contrary to stereotype, “OSA doesn’t only affect overweight men but also women (particularly menopausal women) and even children,” says Dr. Zafarlotfi. And once a diagnosis is made by a sleep specialist, OSA can be treated by weight loss, or a mandibular device, or in severe cases, a continuous positive airway (CPAP) machine. “Sleep apnea is a correctable problem,” says Dr. Shah, “and it’s important to seek treatment not only for heart health but also fixing the problem can lead to improved quality of life,” he adds. So can sleeping more be protective for your heart? “That study has not been done,” says Dr. Shah. Yet the evidence seems to point in that direction. “In general, good sleep habits are very important for someone who wants to prevent heart disease, or for someone who currently has heart disease,” says Dr. Zafarlotfi. “So they really have to pay attention to how they sleep, how well they sleep, and if they’re getting sufficient sleep.” “Everyone needs to make time for sleep,” agrees Dr. Shah. Going to bed every night at the same time, waking up at roughly the same time (even on weekends and days off), avoiding caffeine and alcohol 4 hours before bed, creating a soothing, tranquil bedroom, and avoiding stimulating television or computer use before bed can help foster good sleep hygiene habits. Dr. Zafarlotfi also recommends that you go to bed only when you’re drowsy, avoid being in bed for anything but sex or sleeping, and write your worries or anxieties down so you don’t take them to bed with you. “Inadequate sleep is like a credit card,” says Dr. Zafarlotfi. “You keep adding debt, and eventually you need to pay it.” Getting a good night’s rest, possibly with the help of a sleep specialist, can mean avoiding that debt. And that may protect your heart. S&W

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Sources [1] Eve Van Cauter, Karine Spiegel, Esra Tasali, Rachel Leproult. “Metabolic consequences of sleep and sleep loss.” Sleep Medicine 9 Suppl. 1 (2008) S23–S28 www.elsevier.com/locate/sleep [2] Brindle RC, Conklin SM. “Daytime Sleep Accelerates Cardiovascular Recovery after Psychological Stress.” Int J Behav Med. 2011 Feb 26. www.ncbi.nlm.nih.gov/pubmed/21359666 [3] Francesco P. Cappuccio, Daniel Cooper, Lanfranco D’Elia, Pasquale Strazzullo,,and Michelle A. Miller. “Sleep Duration predicts cardiovascular outcomes: a systematic review and metaanalysis of prospective studies.” European Heart Journal. Feb 7 (2011). www.ncbi.nlm.nih.gov/pubmed/21300732 [4] Christopher Ryan King, BS, Kristen L. Knutson, PhD, Paul J. Rathouz, PhD Steve Sidney, MD, MPH, Kiang Liu, PhD, and Diane S. Lauderdale, PhD. “Short Sleep Duration and Incident Coronary Artery Calcification.” JAMA. 2008 Dec 24;300(24):2859-66. www.ncbi.nlm.nih.gov/pubmed?term=lauderdale sleep calcification [5] Mullington JM, Haack M, Toth M, Serrador JM, Meier-Ewert HK. “Cardiovascular, inflammatory, and metabolic consequences of sleep deprivation.” Prog Cardiovasc Dis. 2009 Jan-Feb; 51(4):294-302. www.ncbi.nlm.nih.gov/pubmed/19110131 [6] Van Leeuwen WM, Lehto M, Karisola P, Lindholm H, Luukkonen R, Sallinen M, Härmä M, Porkka-Heiskanen T, Alenius H “Sleep restriction increases the risk of developing cardiovascular diseases by augmenting proinflammatory responses through IL17 and CRP.” PLoS One. 2009;4(2):e4589. Epub 2009 Feb 25. www.ncbi.nlm.nih.gov/pubmed/19240794 [7] Knutson KL, Van Cauter E, Rathouz PJ, Yan LL, Hulley SB, Liu K, Lauderdale DS. Association between sleep and blood pressure in midlife: the CARDIA sleep study. Arch Intern Med. 2009 Jun 8;169(11):1055-61. www.ncbi.nlm.nih.gov/pubmed/19506175 [8] Virend K. Somers, MD, DPhil, FAHA, FACC, Chair, David P. White, MD, Co-Chair, Raouf Amin, MD, Co-Chair, William T. Abraham, MD, FAHA, FACC, Fernando Costa, MD, FAHA, Antonio Culebras, MD, FAHA, Stephen Daniels, MD, PhD, FAHA, John S. Floras, MD, DPhil, FAHA, FACC, Carl E. Hunt, MD, Lyle J. Olson, MD, FACC, Thomas G. Pickering, MD, DPhil, FAHA, Richard Russell, MD, FAHA, FACC, Mary Woo, RN, PhD, FAHA and Terry Young, PhD. “Sleep Apnea and Cardiovascular Disease.” J Am Coll Cardiology, 2008; 52:686-717. www.content.onlinejacc.org/cgi/content/full/j.jacc.2008.05.002 [9] Robert Wolk, MD, PhD; Tomas Kara, MD; Virend K. Somers, MD, PhD. “Sleep-Disordered Breathing and Cardiovascular Disease.” Circulation. 2003; 108: 9-12 www.circ.ahajournals.org/content/108/1/9.full

Winter 2012 // SLEEP & WELLNESS MAGAZINE

Health and Wellness

yoga for Managing Stress on the Heart By Chandra Jo Sgammato Photography Altus Photography

STANDING WARRIOR POSE

SEATED FORWARD BEND

ALTERNATE-NOSTRIL BREATHING

A gentle yoga practice is a major part of Dr. Dean Ornish’s program for reversing heart disease. The program has proven so effective that many private insurance companies and Medicare now cover it. In yoga poses you stretch, fold, and bend the body while breathing deeply. This increases blood circulation to your internal organs. The act of deep breathing ensures that your blood is rich with oxygen.

Here are yoga poses and breathing practices people of every age, size, and fitness level can safely and easily perform. Make each pose comfortable, steady, and never strain.

OXYGEN IS SO IMPORTANT TO YOUR OVERALL HEALTH AND WELL BEING THAT TAKING TIME FOR BREATHING PRACTICES ON YOUR OWN IS TIME WELL SPENT.

Standing Warrior Pose: Stand with the legs hip-width apart. Bring your arms up to shoulder height. Turn your right foot out and left foot slightly in. Bend your right knee so it is directly over the ankle. Lengthen up through the spine, then turn your head and look out past the fingers of your right hand. Relax your shoulders and breathe. Hold for 30 to 45 seconds, then repeat on the left side. Seated Forward Bend: Sit on your mat with legs extended. Adjust your hips until you are sitting on your sitz bone. Inhale and stretch your arms overhead. Then hinge forward from the hips as you exhale and lengthen forward only as far as comfortable. Relax your shoulders, elbows and wrists and rest your hands outside the legs. Relax and breathe. Hold for 45 seconds to one minute. Legs up the Wall: Lie on the floor and place your hips sideways against the wall. Then turn and lift your legs. Be sure your hips are touching the wall. Bring the arms out to your sides, palms facing up. Have your head on the floor with space beneath your neck. Relax the body and breathe deeply. Practice for up to ten minutes or more. Deep Three-Part Yogic Breathing: Sitting on the floor cross-legged, with legs extended, or even in a straight-back chair; lengthen your spine and relax your shoulders. Inhale;

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DEEP THREE-PART YOGIC BREATHING

veryone who can stretch and breathe can practice yoga and experience the many benefits of this ancient science, including lower heart rate and blood pressure, a calm state of mind, and a better night’s sleep.

Oxygen is so important to your overall health and well being that taking time for breathing practices on your own is time well spent.

LEGS UP THE WALL

SLEEP & WELLNESS MAGAZINE // Winter 2012

expanding the abdomen, ribcage, and chest. Exhale; relaxing the chest, contracting the ribcage, and softening the abdomen. Repeat several times. This deep full breathing brings up to seven times more oxygen into the body than normal, shallow breathing. Practice for three to five minutes to nurture and heal every organ and cell in the body. Alternate-Nostril Breathing: Make a gentle fist with the right hand and then release the thumb and the last two fingers. Bring the fist toward the face with the palm facing in. Inhale through both nostrils, then cover the right nostril with the thumb and exhale through the left. Now inhale through the left nostril, close it with the last two fingers, release the thumb and exhale through the right. Continue with this pattern: exhale and inhale on the same side, then switch. Use the deep three-part breath and keep the breath smooth and silent. This breathing practice calms the central nervous system and keeps the mind present and steady. Practice for three to five minutes; afterwards sit for one more minute observing how you feel. These yoga practices will almost instantly make you feel better and over time you’ll look forward to including them in your health and fitness regime every day. S&W

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Winter 2012 // SLEEP & WELLNESS MAGAZINE

Health and Wellness

INTERVAL TRAINING FOR A STRONGER HEART: By Ja-Ann Wolsey Photography Ryan Glaze

Interview with pro-cyclist Nicole Evans

earch Nicole Evens on the USA Cycling website (www.usacycling.org), and the list begins. Her national feats include her seventh place overall finish in the 2006 Cascade Cycling Classic. That accomplishment caught the attention of Team Lipton, who recruited her—and so began her professional cycling career. With a tenth place overall finish in Tour of the Gila, she was also a fierce competitor against Olympic medalist Clara Hues and Giro D’Italia Feminine Champion Mara Abbot. One of many notable achievements during that race was placing fifth in stage one, a 73.1-mile segment with an exhaustive hill climb. Nicole currently races for team Primal Map-My-Ride. She has worked hard and has had an amazing year.

I welcomed an opportunity to get some insight on Nicole’s life, her career, and her advice on how to keep fit and healthy.

SLEEP & WELLNESS MAGAZINE // Winter 2012

Q. You’ve always been an athlete, but not a cyclist. What other sports did you participate in growing up? A. Growing up I did cross-country and track. I’ve always loved hiking, but running was my passion. Those activities helped me to develop a really good cardiovascular base, and this has enabled me to become competitive in cycling. Q. So do you think that a person’s cardiovascular base can be established at a younger age and retained throughout life? A. Yes. It’s like building a foundation for your home; the bigger your foundation, the more you have to work with later on. You can have a naturally athletic heart, or you can build one at any age. Q. You have won a lot of climbing races and hilly stages of races. Climbing requires a lot of interval anaerobic and aerobic shifts. What kind of training did you do to prepare for this? A. Well, it’s about strengthening the heart so that you can increase the efficiency of blood being pumped to the extremities. Interval training provides an intense way to improve the heart’s strength. By increasing and decreasing your heart rate through intervals, you train the body to recover faster and more efficiently from stress. Q. If someone wanted to begin a heartstrengthening interval training program, where would they start? A. It’s a good idea to establish a base before you begin. Often, people get over-ambitious the first week, and they go out and overexert themselves. To start building a base, begin by doing 20-60 minutes of continuous activity, three to five days a week. As you feel that you’re getting in better shape, increase your frequency and duration. Do activities you enjoy because if you like them, and do a variety, you’re more likely going to stick with them. After you have a stronger base, maybe after one to two weeks of base training, begin doing interval training. Depending on the

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shape you’re in, the length of time you have your heart rate in higher and lower zones will vary. Do a lap around a 400-meter track, then do the next at a little faster pace. Then follow with a lap at a slow recovery jog. Remember, the more you do intervals, the stronger you will get. Eventually you will be able to shorten recovery time and lengthen the high intensity interval time. Q. So how would someone calculate his or her heart rate to know if they are in the right zone during interval training? A. I use a heart rate monitor, but you can stop and take a 15-second pulse check too. First you determine your maximum heart rate, which is 220 minus your age. Next you need to establish your target heart rate. Usually when you are working out, you’ll get your greatest benefit from staying at 65-85 percent of your maximum heart rate. This zone is referred to as you target zone. To calculate your target heart rate, multiply your maximum heart rate by 65.

220 - (age) x .65 = target zone heart rate Q. During interval training, should the heart rate be above your target zone? A. Not always. Sometimes you may want to do an interval at 65 percent and sometimes at 85 percent. The American Heart Association advises: if you feel faint, dizzy, or short of breath, you should stop the activity and consult a physician. It is great to get advice from someone like Nicole Evans, who has achieved so much as an athlete. She wisely points out the need to develop a strong base fitness level before jumping into more demanding workouts, so you won’t burn out. Then, as you develop that base fitness, you are prepared to do more rigorous interval training. We all know it’s wise to strengthen our hearts. This is just one set of ideas that could help us achieve that goal. S&W

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Winter 2012 // SLEEP & WELLNESS MAGAZINE

SLEEP & WELLNESS MAGAZINE // Winter 2012

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. (USD) is a JCAHO accredited and Medicare certified sleep diagnostic company. USD provides comprehensive diagnostic sleep testing and treatment in our state-of-the-art 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. UNITED SLEEP DIAGNOSTICS, INC 2241A N. University Dr. Pembroke Pines, FL 33024 Phone: 954-442-8694 Fax: 954-442-8695

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

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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.

MNAP DIAGNOSTIC CENTER 9908 E. Roosevelt Blvd. Philadelphia, PA 19115 Phone: 215-464-3300 ext.1345 Fax: 215-464-0835

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

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The sleep specialists at The Houston Sleep Center diagnose and treat people who have a wide range of sleep disorders.

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. Sleep well. ove life.

We offer three locations for your convenience. MEMORIAL 7500 San Felipe, Suite 550 Houston, TX 77063 Phone: 713-827-8896

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Board of Registered The Polysomnographic Technologists (BRPT) administers the Registered Polysomnographic Technologist (RPSGT) and the Certified Polysomnographic Technician (CPSGT) exams based on best credentialing practices, which measure the knowledge, skills and abilities of technologists and technicians in the field of sleep medicine. The BRPT fosters ethical practices and requires the continued competence of those who successfully complete the RPSGT and the CPSGT exams.

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We are fully AASM accredited 6bedroom Sleep Disorders Center with additional OCST accreditation. We are also Center-member 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

Winter 2012 // SLEEP & WELLNESS MAGAZINE

Food & Nutrition

SLEEP & WELLNESS MAGAZINE // Winter 2012

FRENCH LENTIL SOUP

40 CLOVES OF GARLIC CHICKEN

HOMEMADE CHICKEN BROTH

FOOD FOR YOUR HEART WITH JOE PISCATELLA FRENCH LENTIL SOUP Serves 6 Lentils require no presoaking and are an easy first step toward including heart-healthy plant proteins in your meals. We found that French lentils hold their shape better than the regular varieties; they’re available in specialty food stores or by mail order.

Ingredients 1 cup French lentils 1 tablespoon olive oil 2 cups chopped yellow onion 3 cloves garlic, chopped 1 cup chopped white portion of leek

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2 cups diced carrots 8 cups chicken broth, preferable homemade (see chicken broth recipe in this section) ¼ teaspoon coarse salt ¾ teaspoon black pepper 1 tablespoon fresh lemon thyme leaves or ½ teaspoon dried ½ teaspoon cumin 1 8-ounce can tomato sauce ¼ cup tomato paste

Directions Place lentils in a large bowl and cover with 2 cups of boiling water. Let stand 15 minutes. Drain. Heat olive oil in a nonstick skillet. Add onion, garlic, and leeks; sauté 10 minutes over medium heat. Add carrots; sauté ten minutes longer.

In a stockpot, combine broth, salt, pepper, thyme and cumin. Bring to a boil. Add lentils, tomato sauce and tomato paste, and sautéed vegetables; bring to a second boil. Reduce heat and simmer, uncovered, 1 hour, or until lentils are tender.

Nutrition Analysis (per serving) Calories: 304 Protein: 17 g Sodium: 804 mg Carbohydrates: 47 g Cholesterol: 3 mg Total Fat: 5 g Saturated Fat: 0 g Dietary Fiber: 18 g

HOMEMADE CHICKEN BROTH Makes 5 to 6 quarts (1-cup servings)

Ingredients 1 4-pound, cut up, plus 2 whole chicken breasts 1 large onion, peeled and quartered 2 carrots, peeled 2 garlic cloves, peeled 1 tablespoon chopped fresh basil or ½ teaspoon dried 2 to 2 ½ tablespoons coarse salt or to taste ½ teaspoon pepper 6 quarts cold water or enough to cover chicken

Directions

Nutrition Analysis

Place chicken in a 10-quart stockpot. Add water. Add onions, carrots, garlic, basil, salt, pepper and water. Heat gradually just to boiling, but do not allow to boil (boiling makes broth cloudy). Reduce heat and simmer 3 hours, or until chicken falls easily away from the bone. Strain stock; discard bones and vegetables. Refrigerate broth overnight. Use a slotted spoon to skim off fat that rises to the top. Return broth to stockpot. Simmer, uncovered, 1 hour, or until broth is reduced by about a third. Test seasonings; sparingly add more salt if needed. Use broth at once or store in a refrigerator or freezer for later use.

(per serving) Calories: 33 Protein: 4 g Sodium: 275 mg Carbohydrates: 0 g Cholesterol: 2 mg Total Fat: 1 g Saturated Fat: 0 g Dietary Fiber: 0 g

40 CLOVES OF GARLIC CHICKEN 6 servings

Ingredients 1 ½ teaspoons extra-virgin olive oil 3 whole skinned and boned chicken breasts, halved 40 garlic cloves (about 4 heads), unpeeled 1 ¼ cups dry white wine

1 tablespoon chopped fresh rosemary 1 tablespoon chopped fresh thyme ¼ cup fresh chopped flat-leaf parsley pinch of course salt pinch freshly ground black pepper 6 ¼ inch slices Tuscan style bread Heat oil in a nonstick skillet. Add chicken and cook over medium-high heat 4-5 minutes. Turn chicken, add garlic and cook 4 to 5 minutes longer, or until garlic begins to brown. Transfer chicken and garlic to an ovenproof baking dish and set aside. Pour wine into a skillet to deglaze the pan; add rosemary and thyme and pour mixture over

chicken. Cover tightly with foil. Bake at 350 for 30 to 45 minutes, or until chicken is done. Sprinkle with parsley. Season with salt and pepper. Set aside. In a pre-heated broiler, toast Tuscan bread slices until golden brown on each side. Pass bread for dipping with chicken and garlic sauce.

Nutrition Analysis (per serving) Calories: 223 Protein: 23 g Sodium: 236 mg Carbohydrates: 18 g Cholesterol: 49 mg Total Fat: 3 g Saturated Fat: 1 g Dietary Fiber: 1 g

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Winter 2012 // SLEEP & WELLNESS MAGAZINE

Food & Nutrition

JOSEPH C. PISCATELLA www.JoePiscatella.com

TUSCAN BEAN SALAD

Joe Piscatella is one of the nation’s foremost authorities on the link between lifestyle habits and cardiac health. In his seminars, which have been called "a force for positive change" by TIME magazine, he teaches how to live a healthier, better-balanced life in our stressful modern society. Joe knows the science of healthy living. More importantly, he understands the practical application of that science. His experience of undergoing coronary bypass surgery at age 32, and subsequently managing heart disease successfully for over 34 years, gives him a practical perspective that audiences appreciate. He is one of the longest-lived survivors of cardiac bypass in the world.

LEMON VINAIGRETTE

TUSCAN BEAN SALAD

LEMON VINAIGRETTE

Serves 8

Makes 7 tablespoons

Ingredients

3 15-ounce cans cannellini beans, drained and rinsed 7 tablespoons Lemon Vinaigrette (see recipe in this section) 1 ½ cups coarsely chopped red onion 2 Large ripe tomatoes coarsely chopped ½ cup chopped celery ¾ cup coarsely chopped fresh flat-leafed parsley

2 garlic cloves, minces 3 tablespoons fresh lemon juice ¼ cup extra virgin olive oil ¾ teaspoons coarse salt ¼ teaspoons freshly ground black pepper Combine all ingredients in a jar with a lid. Shake until well blended.

Directions Arrange beans in a shallow salad bowl and toss with 2 tablespoons of the lemon vinaigrette. Chill. Just before serving, toss beans with onion, tomatoes, celery, parsley and remaining 5 tablespoons of the vinaigrette.

Nutrition Analysis

(per serving) Calories: 245 Protein: 12 g Sodium: 167 mg Carbohydrates: 34 mg Cholesterol: 0 mg Total Fat: 8 g Saturated Fat: 1 g Dietary Fiber: 9 g

(per tablespoon) Calories: 71 Protein: trace Sodium: 206 mg Carbohydrates: 1 g Cholesterol: 0 mg Total Fat: 8 g Saturated Fat: 1 g Dietary Fiber: 0 g

40 www.sleepandwellness.net

President of the Institute for Fitness and Health, he lectures extensively to a variety of clients, including Fortune 1000 companies, professional associations and medical organizations. He consults on employee wellness to Boeing, Raytheon, Exxon, Sprint, the Federal Reserve Bank and the U.S. Naval War College. Over 2 million people have attended his seminars. He is the author of 12 best-selling books including Don't Eat Your Heart Out, Take A Load Off Your Heart, The Road to A Healthy Heart Runs Through the Kitchen and Positive Mind, Healthy Heart. His newest is Prevent, Halt and Reverse Heart Disease. Mr. Piscatella has hosted three PBS television specials, is a frequent guest on television and radio programs, including CNN, The Today Show, Fox News and Good Morning America, and is a guest expert for lifestyle and heart health on WebMD. Mr. Piscatella designs and manages corporate and community health initiatives. In one program, 650 people lost 4,200 pounds. He is a member of the Legislative Task Force on Youth Health, a group that has instituted a “healthy lunch” program at eight elementary schools in Washington State. He is the only non-medical member of the National Institutes of Health Cardiac Rehabilitation Expert Panel charged with developing clinical practice guidelines for physicians. Says William C. Roberts, MD, Editor-in-Chief of The American Journal of Cardiology, "Joe Piscatella knows more about healthy living and the health impact of our lifestyle choices on heart-health than anyone I know." S&W

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