Sleep Health Outreach! Sodalis and Baylor LEAD-LLC

Over the duration of the semester, my classmate Ashley Zapata and I have looked forward to sharing our newly gained knowledge about sleep and sleep and sleep health with the greater Baylor community and Waco.  We completed our outreach project last week, culminating in our sleep health/ sleep information presentation to the staff of Waco’s Sodalis Memory Care center.

I know that we reached many people, but we still would have loved to see our work reach the hearts and minds of many more.  I would guess that we did in fact highly impact the lives of those with whom we communicated.

How did we spread our message about the importance of sleep health?

Our main means of communication manifested in the form of hosting two presentations, one centered toward college students, followed by “the main event” – a sleep health presentation given to the staff at, again, Sodalis Memory Care – essentially a nursing home [this term is outdated] for those suffering from dementia or Alzheimer’s.

Speaking for myself, I enjoyed both presentations, especially our first one (to college students), …even though it was not the main focus of our endeavors.  I enjoyed it more than the second because I felt as if I was talking to myself and speaking directly into my own concerns at the time.  I was presenting information that would immediately and immensely impact my life.

In the first presentation, Ashley and I aimed to provide students in the Leadership Living and Learning Community at Baylor University with the tools and resources they needed to improve their sleep habits and quality over time…

Allow me to take a side-step.  The irony of our two-part sleep health outreach project is striking because we presented impactful information to students who are at arguably the most formative age of their lives – namely about the effects of sleep deprivation, i.e. its reality as a long-term determinant of Alzheimer’s disease.  I couldn’t help but at least mention to the students at the Acts 2:42 night (a weekly event in Allen and Dawson Halls – where I am employed as a Resident Assistant/ Community Leader – centered on verse 2, chapter 42, of Acts in the Bible; a verse about community) the scary potential outcome of sleep loss given our 20-30 student captive audience.  The presentation in Allen/ Dawson for students definitely made an impact as we received lots of questions after the presentation, again had high attendance, and I have since fielded more inquiring questions about the topic of sleep since the event about a month ago!

Still, the second presentation earned its own unique merits as, again, the “main event” for which we have been preparing the last few weeks as we continued to learn about age throughout the lifespan in our Science of Sleep course at Baylor University.  The content of the second presentation proved to hold equal worth to the first because of the marginalized status community for which we focused our efforts: the elderly, especially the elderly with declined mental cognitive facilities.

Since we could neither alter the sleeping environment of patients at Sodalis nor directly work with them to share information about the implications of their mental impairment on sleep, we decided to “train” the staff that works alongside them every day.  The nurse’s aides at Sodalis or other care facilities – like the one where my grandmother lives – are among the most kind-hearted, sacrificial, patient healthcare providers among us.  We hoped that they would enjoy learning some information about sleep patterns in their patients so as to better inform their service.  Additionally, we highlighted some general sleep health guidelines for the nurse’s aides themselves to employ in their own sleep routines with spouses or children at home.  The specific topics we covered will be covered in our presentation:

When we present, Ashley and I will ensure that we incorporate parts of both presentations into our course presentation about the sleep health outreach project.  I initially planned on sharing some pieces of them with you here, but I have run into some technical trouble because our visual aid for both presentations were Prezi (and Prezi is not as user friendly for remote slide manipulation as I recall!)  We will also bring the sleep bookmarks that we created when we present in class as well.

At both events, my favorite area of discussion was consistently sleep health tips and guidance (essentially the take-home message that we concluded with at the end of both presentations).  I enjoyed the discussion of sleep tips the most because I felt as if this was a portion where I could truly see concrete changes in the lives of those in attendance based on the specific guidelines given.

I so wish that more information could have been covered in both presentations and I wish that more people could have been reached!

Therefore, if I could change anything, I think it would be my communication platform for spreading this pertinent information.  Perhaps I could begin a sleep health discussion trend Facebook or start a #sleephealth hashtag on twitter?  The possibilities are endless; and I look forward to expanding my influence.

“To whom much is given, much is expected.”

Research Internship Day @ Baylor: Discovering Your Passion

I attended a portion of the Research Internship Day held in the Baylor Sciences Building last Friday, November 18th.  Unfortunately, my schedule permitted me to attend only Mericyn and Rachel's breakout session about their work with Dr. Scullin in the sleep lab, held directly before Dr. Scullin's main presentation.

Mericyn and Rachel provided an overview of the study performed in the lab last year with interior design students, the same study that Dr. Scullin explained in class.  The study used personal diary-like self-report measures as well as actigraphy to observe the effects of total sleep time and sleep patterns on creativity in interior design students.  The study's "punch-line," or take-home-message, can be described by the following directional statement:

Get more sleep, better yet more consistent sleep, if you want to think creatively and effectively.

The students also briefly highlighted their study currently underway involving the effects of sleep (i.e. sleep loss or poor sleep quality) on efficient cognitive processing -- specifically, the cognitive skills needed to solve economics problems on assessments.  This study struck me as one that I think will shed a lot of light on the effects of sleep health [deprivation] on academic performance.  As a sleep-deprived Baylor undergraduate, pursuing a challenging major, I look forward to hearing about this study's findings and implications for my academic success.

Additionally, I found Dr. Scullin’s lecture about discovering and pursuing your academic (then career) passion to be very informative and enlightening.  The insight he provided I think will prove to be useful for all those in attendance.  Therefore, I will discuss his main points here in an effort to provide the general public with some of the same helpful guidance:

Firstly, to successfully discover and know your career calling, one must adhere to two principles:

1)      You must find a great mentor.

a.      Someone who will build you up but challenge you

b.     Someone who cares deeply for your success

c.      Someone with whom you can be vulnerable and vice versa

2)     You must dream big, fail often, and persevere.

a.      You must dream outside-of-the-box; and when your ideas are shot down, the critiques you receive must not deter you from your ambitions but inspire you to be better.

b.     You must respond to every piece of negative feedback you receive and improve your idea based on that feedback.

c.      And then you must never give up but rather continue to persevere until you reach your goals – and then continue learning!

When discussing these steps, Dr. Scullin explained, for example, how studying prospective memory (remembering to do something in the future) lead him to study sleep and memory consolidation – sleep science being his true passion.  He also met his wife in the first lab he where he worked, a place for developing later academic pursuits.  Hence, he was able to complete the impossible task of weaving his career passions and academic pursuits (i.e. “work life”) with his “personal life” (love, marriage, friendship).  In other words, Dr. Scullin found work-life co-inherence rather than work-life balance: the much more complicated but rewarding avenue to take.

This way, when one lets his/ her work inform life decisions and practices, and conversely allows life experience to inform work [they are integrated], he/ she can find a lot more value in both than if they had to remain ‘separate but equal’.

I enjoyed hearing Dr. Scullin’s thoughts as I am willing to consider any advice that will inform my quality of life in the very demanding and busy healthcare career field.  Still a rewarding professional pursuit, I look forward to serving others in healthcare and hope that my love for people will inform my service to their well-being.

Lastly, I have been coming to learn that I cannot serve others well if I am firstly not whole.  So, I am glad to say that my sleep habits have been steadily improving!  I have been going to bed and waking up at roughly the same times every night/morning…even though I am still averaging less than 7.5 hours of sleep daily, I am taking baby steps to improve my sleep health!

Nature vs Nurture in Sleep

(Above: an illustrator's depiction of an American man arguing with a Chinese man.)

Have you heard of the “nature versus nurture” argument?  Probably.  The science says that most of ‘us’ (our personality and overall health predispositions) is controlled by nature, i.e. genetics, and that a smaller portion is influenced by nurture: the environment we live in, our friends, family, income, education, etc.  While it is true that a lot of our health predispositions are controlled by genetics, we have the power to control our wellness.  One of the areas where “nurture” has a lot, maybe almost all, control of our wellness is sleep health.

According to “Sleep Medicine” by Mindell et. al., one’s culture plays a large role in bedtime, waketime, sleep quality, efficiency, etc.  To study the correlation between culture and sleep, parents/ caregivers from primarily “Western” homes (i.e. Australia, USA, United Kingdom, etc.) and parents from primarily “Eastern” (think Japan, Malaysia, China, etc.) answered an infant-sleep questionnaire online.  The questionarre included questions about bedtime routine, sleeping arrangements, infant daytime and nighttime sleep patterns, and sleep-related behaviors.

The article notes that this study was the only cross-cultural study of its kind to examine the effects of culture on infant and toddler sleep.  The large and varied sample size of this study allows it to be used for powerful analyses of the considered phenomena.

Most intriguing, the researchers found that total sleep time varied across cultures by about 101 minutes!  Bedtime routines were also found to be unique and more disassociated than I would imagine (children in traditionally Eastern countries like China receiving less sleep than American children, for example).  Children in Eastern countries are more likely to bed share but less likely to have a strictly enforced nighttime daily routine.  I also note that parents in Eastern countries tend to report more sleep problems than Western parents (51.9% versus 26.3%).

These findings surprise me while simultaneously managing to not surprise me at all.  I have visited China, Beijing to be exact – the bustling capital of the nation, mind you – and stayed with a host family whose daughter was probably sleep-deprived because of the rigorous academic environment she has been raised in.  *Side note: I visited my senior year of high school, 4 years ago, and get to see her this winter!*  I am not surprised by the differences found in that these populations have very fast-paced societies like ours but I also feel that to a certain degree, most nations in the “East” value health more and would therefore work to address it.

Lastly, I have been sleeping well the last few nights, and I am grateful to feel rested!

This week, I commented on Sahar Bradham's and Matt Sutton's blogs.

The Reality of Fake Illness: Restless Leg Syndrome

Have you ever visited your physician for sickness just to be prescribed a medication before you were actually examined?  The article “Giving Legs to Restless Legs: A Case Study of How the Media Helps Make People Sick” by Steven Woloshin and Lisa Schwartz gives readers an insight into that same phenomenon of the doctor who prescribes before she or he diagnoses, but on a much larger scale.  The article’s authors claim that pharmaceutical companies largely aim to make money and have financial success, not to treat the health ailments of their customers, and that the media backs such behavior, termed “disease mongering.”

The rhetoric used in the article to characterize this phenomenon involves a comparison between the presentation of “information” versus the media’s presenting of “infomercials,” here specifically, about ‘restless legs.’  According to webMD,  “people with restless leg syndrome have uncomfortable sensations in their legs (and sometimes arms or other parts of the body) and an irresistible urge to move their legs to relieve the sensations. The condition causes an uncomfortable, "itchy," "pins and needles," or "creepy crawly" feeling in the legs. The sensations are usually worse at rest, especially when lying or sitting.”

Additionally, the article lists the following as criteria for having restless leg syndrome:

1.  An urge to move the legs due to an unpleasant feeling in the legs.

2.  Onset or worsening of symptoms when at rest or not moving around frequently.

3.  Partial or complete relief by movement (e.g. walking) for as long as the movement continues.

4.  Symptoms that occur primarily at night and that can interfere with sleep or rest.

RLS (Restless Leg Syndrome) affects about 10% of Americans (more females than males).  It is considered a sleep disorder because its symptoms tend to impact sleep:

Now then…I have undoubtedly experienced days and nights of immense restlessness during which I would probably have reported feelings of ‘tingliness’ or itchiness in my legs, and even would have probably conceded an inability to totally rest as I my legs continued to move.  However, I agree with the authors’ shared lack of confidence in the science used to cite many of these such [very] common yet somehow unknown clinical ailments.

For example, the 10% estimate I mentioned above (from the trusted website WebMD!), according to the article, came from a study that used only a single question to diagnose restless legs syndrome rather than the clinical diagnostic criteria.  A diagnosis based on only a single question begs for refute.

How is it that a syndrome (not a disease, mind you, but simply a set of unexplained correlated symptoms) can be clinically diagnosed so easily?  It cannot – which is why the promotion of RLS in the media is in fact “disease mongering.”

Still, instead of highlighting the misfortune we experience in this persistent and unfair reality, presented in other health areas of health concern [Eh-hem, excuse me, I am looking at you, ADHD over-diagnosis], I offer a few solutions to curb the problem:

The following suggestions to information outlets aim to counteract the three common malpractices of media that contribute to disease mongering, as named by the article, i.e. exaggerating disease prevalence, encouraging more {too much} diagnosis, and suggesting that all disease should be treated.  My thoughts…

1.   Fact-check the information you spout before you present it as truth.  Perhaps do so by monitoring the sources used, comparing the information found in one to the same information search in another source.

2.   Encourage less diagnosis.  The American people lead busy, stressful lives – they have enough ailments that result from their demanding schedules as it is.  Do encourage strict diagnostic procedures on the part of physicians.

3.   Not all diseases need treatment.  Patients can sometimes return from a period of sickness just by practicing rest, self-care, proper nutrition, and healthy sleep.  Encourage holistic health instead of promoting primarily medication, as medicines often can have side effects that outweigh potential therapeutic benefits.

Lastly, I offer that since I have been consistently sleeping 7-9 hours/ night the last several nights, I have not experienced phenomena like RLS as a result of stress or fatigue.  When I am very sleep deprived, having also engaged in a lot of physical and mental activity, I do sometimes get RLS-like symptoms.  This anecdotal evidence should give weight then to the idea that RLS, perhaps like ADHD is prevalent because it is over diagnosed and undervalued in real cases.

Snoring: Funny Annoyance or Serious Problem?

If you have been keeping up with me, you know I would claim that sleep deprivation is the "root of all evil" for many accidents or otherwise negative events in American society.  One form of usually unknown, and often untreated sleep deprivation is sleep apnea.  Sleep apnea is defined, according to webMD, as "a sleep disorder that occurs when a person's breathing is interrupted during sleep."  In other words, those with sleep apnea are those who snore.  Annoying?  Yes.  Unhealthy?  Yes.  Dangerous?  Yes.  Of course you will be sleep deprived if your sleep is interrupted because you cannot breathe!  And you cannot be blamed for a slow reaction time during an accident when you are not alert.

The article by "The Association Between Sleep Apnea and the Risk of Traffic Accidents" by J. Teran-Santos, A. Jimenez, J. Cordero-Guevara, and the Cooperative Group Burgos-Santander explores a study correlating, as alluded to in its title, sleep apnea to traffic accidents.  We already know that sleep deprivation is directly correlated with the occurrence of traffic accidents, so it is not surprising then that sleep apnea could cause car accidents: patients who experience sleep apnea are in fact quite sleep-deprived, usually without knowing it.

For this group's study, participants answered several questionnaires:

-about their health history

-traffic accident history (as it relates to how drowsy they were at the time and causes of this drowsiness)

-daytime sleepiness as measured by the Epworth Sleepiness Scale (8 item questionnaire designed to illuminate the probability of responders are to fall asleep in various common daytime situations)

The researchers also used polysomnography (means of recording the brain's electrical activity and body's movements during sleep) as an experimental data measure.

Dr. Teran-Santos and the rest of the research team analyzed the results of 254 subjects, a little more than half of them being controls (not diagnosed with sleep apnea) while the rest were experimentally dependent participants.  The results, as already mentioned, showed a significant association between a patients presenting with sleep apnea and traffic accidents, those diagnosed having a larger total number of accidents historically than those characterized as a healthy and free of sleep apnea or related problems.  Granted, because only questionnaire reporting was used to qualify the details of reported accidents, recall bias could skew the accuracy of participants’ answers.  Serious accidents involving multiple vehicles or instances of running off the road were excluded from the study.  Consequently, the authors reported that – even more alarming than the data’s proof of a general sleep apnea-accident correlation – a stronger correlation is likely present.  Lethal accidents often involve sleep deprivation or drowsiness.  Therefore, it remains probable that many such tragedies are caused by sleep apnea, especially in the case of someone who is not diagnosed or untreated.

Where do we go from here?

I suggest simply more education and prevention efforts from the medical community.  I would like to practice medicine one day.  Having the knowledge that I have gained from this course “in my pocket,” I will use it to educate my patients and encourage holistic health as much as possible.  Maybe I will not have to send them to a pulmonologist for “snoring problems.”  Hopefully they will be physically fit enough that their airways are free from obstruction, in bed and in waking, allowing for efficient and quality nightly sleep…and a better marriage?  A well-rested (with uninterrupted sleep) spouse is a happy spouse right?  I would hope so!

I have been sleep-deprived recently but luckily I breathe well when I sleep, and seem to sleep efficiently, almost never waking up during the night.  I also have not recently had to drive anywhere farther than a 15-minute trip in Waco, so I have not tested my drowsiness on the road (a good thing!)  I hope to again improve my nightly sleep routine and overall sleep health after I finish a paper I have due tomorrow…

This week I commented on Andrew Hughes’ and Nicole Massamillo’s blogs.

Have you ever been caught sneaking a late-night snack? At least you (hopefully) can control your bad habit!

Have you ever been caught sneaking a -- usually unhealthy -- midnight snack?  Probably.  Did you know that eating that snack probably was not the wisest move?  Probably.  Did you remember eating it and feel guilty about it in the morning?  Probably.  Did you do the same thing the following night?  Probably not.  You are Squidward.

 

Imagine if you were unconsciously sneaking midnight snacks on a daily basis, and I don't mean "guilty pleasures like chips or cookies.  I mean sandwiches filled with sugar, soap, or dog food.  Those diagnosed with Nocturnal Sleep-Related Eating Disorder experience bizarre, sometimes nightly, eating binges characterized by the unconscious consumption of comfort food.  According to the scholarly article "Zolpidem Induced Nocturnal Sleep-Related Eating Disorder (NSRED) in a Male Patient," written by Amit Dang, Gaurav Garg, and Padmanabh V. Rataboli, a man being treated for short-term insomnia presented with NSRED.  His symptoms manifested in his ability to safely exit his home, walk to his own nearby store, and single-handedly unlock the door -- all without any signs of awareness of these actions.  Soon thereafter, his family discovered him consuming candy in the store almost 2 km away from their home.

How is this possible?

For his insomnia, the man’s healthcare provider prescribed Zolpidem tartrate, a short-acting hypnotic (often used to treat insomnia characterized by difficulty in falling asleep, i.e. long SOL, or sleep onset latency).  A well-intentioned directional choice for his care regardless of such side-effects, the patient was in fact diagnosed with drug-induced NSRED.

How can he be helped?

As a result of the guilt, sadness, and embarrassment that fills NSRED patients when loved ones or friends inform them of their habits and behavior, such patients often experience depression.  A common treatment for depression then is the use of SSRI drugs: drugs that extend the activity of “happy”, “feel-good” neurotransmitters in neuron communication via the synapse…a welcome correlation, SSRIs are beneficial to NSRED patients too.  Other clinical treatments include anticonvulsant drug therapy, stress management, gastric bypass surgery, counseling, and removal of caffeine/ alcohol from patients’ diets.

Honestly, I found this information to be both appalling and disturbing.  It seems almost as if Nocturnal Sleep-Related Eating Disorder cannot be a real condition.  I am impressed to know that someone can exit his/ her house, walk or drive to another location, and make and consume food – safely – all without any knowledge of doing so.  It is a dangerous ability to carry.  Thankfully, I am not an insomniac and sleep pretty well on a nightly basis.  I cannot imagine having exhausting sleep problems, just to receive information that a drug like Zolpidem tartrate is my only hope for improvement.  I cannot imagine the reality of the picture indicated above.

I am intrigued by the NSRED phenomenon and will more seek literature about it.  I also would like to see more correlative studies between depression treatments and NSRED treatments.  I see it as a potential chicken-egg dilemma…does NSRED cause the need for depression-treating drugs or does the treatment of depression require medication like Zolpidem tartrate to combat its negative manifestations?

Which came first, the chicken or the egg?

Traumatic Events Could be Affecting Your Sleep

What were you doing on 9.11.2001.?  If you are a member of Dr. Scullin's The Science of Sleep Course, you probably are not older than 22 years old and in fact are likely younger than that...I was in first grade, Mrs. Flusche's class, and had no concept of what was happening other than my observation of the distressed expression on my teacher's face.  Mrs. Flusche was a "smiley," gregarious, middle-aged woman, who -- looking back -- really loved her job.  I remember seeing her leave the room for a minute then returning with a totally different demeanor.  To a first grader, the look was simply one of sadness; little did I know exactly how serious the situation was for the United States.  I remember her stating plainly "there are some bad guys doing bad things..."  I wonder how my sleep was that night?  Probably unaffected as I was unaware of the true gravity of events that day.  Here I examine a review article titled “Sleep Disturbances in the Wake of Traumatic Events” by Dr. Peretz Lavie.

According to Dr. Lavie, traumatic events can and do indeed cause sleep disturbances as such symptoms characterize PTSD.  Unfortunately, physicians diagnose veterans and those who have experienced traumatic, life threatening events like 9/11 too often for a sleep health expert's comfort.  Examples of PTSD patients named in the article include Japanese imprisonment survivor as well as Holocaust survivors.  Two subjective sleep-related aspects are included for diagnostic guidance in the DSM-IV (psychological Diagnostic and Statistical Manual IV): the reported re-experiencing of the traumatic events in the form of nightmares (1), and difficulty in initiating and maintaining sleep (2).  Dr.  Lavie notes that sleep disturbances can occur even in the clinical absence of PTSD.  Objective findings include severely disturbed patterns, longer sleep onset latency (SOL, a measure of the amount of time one requires to fall asleep), shorter total sleep duration/ time (TST), and recurrent awakenings during REM sleep (Lavie, 2001).   Interestingly, increased frequency of rapid eye movements and muscle twitches during REM are noted in patients with PTSD, as well as increased rates of gross body movements and periodic leg movements (associated with subjectively characterized “light” sleep).

How are we to react to these findings?  Let us note that sleep disturbances are both common and considered normal in the immediate aftermath of a traumatic event.  Additionally, in many cases, sleep problems indicate the presence of other health problems instead of being side effects of an issue already present (i.e. a PTSD diagnosis).  Behavioral and pharmacologic interventions both prove to be helpful in managing sleep problems, especially those that stem from PTSD or other trauma-related problems.  Specific interventions mentioned by Dr. Lavie range from progressive muscle relaxation and stimulus control to sleep restriction and paradoxical intention (engaging in feared behaviors).

I enjoyed the information synthesized and provided in the article but I look forward to more research into the area of PTSD and traumatic events as they relate to maintenance of sleep health.  I know that my sleep quality is poor simply when I am stressed, let alone that I cannot imagine being in a constant state of stress, as is the case with PTSD.  Fortunately, I have never experienced a true life-threatening event so I cannot offer accurate personal experiences related to this topic.  However, again, I can in fact relate to a feeling of chronic stress…I am looking at you, finals week.  Therefore, when I imagine the adverse effects of PTSD on sleep quality, I am not surprised that those who suffer from the disorder have poor sleep.  Since so many of us are affected by PTSD, or have valued loved ones who suffer from it, can we work to improve the resources available for those with PTSD to improve sleep health?  We can.  Let’s move forward with more research in this area because we already know the impact that chronic sleep deprivation has on a person…let us not exaggerate these effects by combining sleep debt with the already taxing symptoms of PTSD.

See my blogs titled “You are NOT superhuman.  Get some sleep.” And “Should we rename sick days to ‘I need sleep’ days?” for more information on sleep deprivation.

This week I commented on Christy Ramirez’s and Taylor Phillip’s blogs.