Brush Your Teeth and Stay Awake

The typical bedtime routine is “brush your teeth and go to bed.”  Unfortunately, the act of brushing my teeth is too invigorating for me to do right before bedtime.  Sometimes I’d skip brushing my teeth at night because I felt it would ruin my sleep cycle.

At first I figured that the problem was with the mint flavor of the toothpaste.  So I bought and used bubblegum-flavored toothpaste.  Alas I still felt revived after using it.  And this was very disappointing because I spent a long time to find toothpaste that’s not minty.

Then I figured the effect was because the water was so cold.  The bathroom is located a bit far from the water heater, and I’m too impatient and too much of a cheapskate to keep the hot water valve open to purge the cold water in that line.  So then I decided to brush my teeth at the kitchen sink, which is right over the water heater and next to the dishwasher.  It was easy to get warm water to rinse my mouth out with.  But then I realized what the real problem is.

The real problem is that the sensation of the nylon bristles rubbing against my gums drives away stupor.  So even eliminating toothpaste and cold water doesn’t help.  The problem remains with the very act of brushing!

But I do wonder why we have an over abundance of mint-flavored toothpaste.  Is it to counteract a sense of nausea?  Or to ensure fresh breath?

Maybe I'm not the only adult that relies on children's toothpaste.  Could this be an untapped market?

Moon Phase and Its Effect on Sleep

The article Evidence that the Lunar Cycle Influences Human Sleep was published six years ago, but I only just became aware of it today.  Nevertheless, I suspected as much.

I was diagnosed with Sleep Apnea in 2006.  But lately I feel there's more to my sleep disturbances than just cessation of breath.  Some days I wake up after a mere four hours unable to get back to sleep.  Other nights I'll sleep for six hours.

So I think it's ridiculous that health insurance companies will limit coverage for a sleep study to a single one-night study over the member's lifetime.  How can a single study capture all the variations in someone's sleep patterns?

Maybe this study and others like it will motivate The National Sleep Foundation to advocate for policy change.

Wednesday Weigh-In 20151104

I've been so tired lately that I fall asleep at work now. Before the switch back to Standard Time, I thought sleep was brought on by a post-lunch drop in blood sugar. But this week I actually fell asleep before lunch. Plus, my sleep is deeper than ever. I used to sleep light enough so that if my cubicle neighbor returned back to his desk, I'd wake up and pretend to be functional. But recently I woke up and noticed that he had returned without my noticing.

I do have an appointment with a new sleep doctor this month. So hopefully all I need is an adjustment to my CPAP machine's pressure setting.

Waist = 41.0"
Height = 5' 9"

References:

1. Wikipedia BMI page
2. Tanita Scale with Body Fat monitor
3. Javascript must be enabled to view the data.

Quirky in the Bedroom

Whoa, did I just title this "Quirky in the Bedroom?"  What was I thinking?

But it's true that my biggest quirk happens in the bedroom.  Umm, let me rephrase that.  My quirkiest behavior... -- no that's not gonna come out right, either.

Well, it has to do with the way I sleep.  Yes, sleep, or were you thinking of something else?

I already wrote about my "Hernia Rock" several days ago.  This is a warm stone I place on myself before I go to sleep.  But I do an even quirkier thing than that.

Here it is: I cover myself completely, from head to toe, when I lie down to sleep.  The sheet and comforter cover me from the foot end of the bed all the way up to my neck.  But I also cover my face with a black T-shirt.  I do this to block out all light from landing on my body.

You might wonder two things.  First you might wonder "Why can't you just turn off the lights -- isn't that dark enough?"  No it is not dark enough.  One of the windows is a large bow window.  Getting a room-darkening shade for that window is very impractical.  On nights when the moon is anywhere near to full, the room can be too bright.  Besides, skin can react to even tiny amounts of light.

The second thing you might wonder is, "How do you manage to breathe?"  That's good question.  But long-time readers will know (or may recall) that I have sleep apnea, so I wear a CPAP mask when I sleep.  This machine ensures that I have access to air, and the mask itself keeps the T-shirt from lying directly on my face.

This quirk, of course, creeps out my wife.  It makes her feel like she's sleeping next to a corpse.  It doesn't help that I have poor circulation in my extremities, so I'm cold to the touch.

Still want more quirks?  This is one of the better ones.  But I'll add a few others before Dec 1.

How to Maintain Brain Function

The current issue of Neurology Now magazine includes an article on how to maintain cognitive function.  "Staying Sharp: What you do during your free time could help save your brain" lists the following "brain-boosting activities":

• Learn A Second Language
• Become A Social Butterfly
• Play Music
• Exercise

The article also claims that heart-protective measures may also protect the brain.  For example, it recommends:

• Don't smoke.
• Sleep 7–8 hours a night.
• Keep your blood pressure and cholesterol levels in check.
• Eat a low-fat, healthy diet.
• Get plenty of exercise.
• Maintain a healthy weight.
• Limit alcohol consumption.
• Get blood sugar levels (and diabetes, if you have it) under control.

Yes, cholesterol is still a villain, despite assertions from both cardiologists and neurologists that high blood sugar causes damage, and it's the cholesterol that aids in the repair of that damage.

The biggest payoff is to stimulate your intellect while elevating your blood flow.  Learn to dance or practice martial arts for example.  I try to meditate while I walk, or walk mindfully.

Wednesday Weigh-In 20140821

I've been plagued by allergy symptoms lately. This happens to me toward the end of every summer when the nights get cool. The nasal congestion makes it difficult for me to use the CPAP machine effectively. I've had to leave the mask off a few nights and breathe through my mouth! I'm now aware of some instances when I wake up because of breathing obstruction.

Waist = 40"
Height = 5' 9"

References:

1. Wikipedia BMI page
2. Tanita Scale with Body Fat monitor
3. Javascript must be enabled to view the data.

Sleep Well For a Healthy Brain

The latest issue of Neurology Now features an article on the importance of sleep for maintaining a healthy brain, "Sleep Well: Could getting more high-quality sleep protect the brain?".  It is during sleep when the brain cells get rid of waste products.  The article includes tips to ensure you get more sleep.

The same issue lists the following resources that you can use to improve your sleep:

• NINDS Fact Sheet on normal and disordered sleep.
• The American Academy of Neurology's brochure "Sleep Disorders".
• American Sleep Apnea Association.
• National Sleep Foundation.

It's ironic that I'm staying up late in order to bring this information to you.

Good night!

Distractions in my Day-to-Day Routine

[Written two and a half years ago for a course on Concentration]

For this assignment, take stock of your day to day routine. In doing so, jot down what your routine is on most days. Then think about what type of distractions you often encounter. Write your list of distractions and come up with ways that you can try to address them. Submit your list and of distractions and possible ways you can address them to the instructor.

My typical week day involves getting ready for work at home, driving to work, working, driving back home, ending the day at home.

When I'm at home, I'm distracted by

1. The needs of my wife and daughter. Even if they don't interrupt, I expect them to, so I don't get deeply involved in any activity until they're out of the house or in bed. I get our daughter ready to school. Even though she's a teenager, I want to be involved. Otherwise she'll probably make herself a breakfast of three Hershey Kisses and go out into 30F weather wearing just a flimsy sweatshirt and jeans. I can make my own breakfast while making something for our daughter. I can find out if things are going well for her at school during breakfast or while waiting with her at the bus stop.
2. The cuteness of our pets (or the damage they do). I'm either fawning over our cats, or cleaning up after them. Sometimes I take a quick break to pet one of them. Or I protect my meal from the fat one who's always hungry. Once in a while I'll take out the camera to take a picture, even if it will make me late for work. When I take the dog outside, he wants to play outside for a while. When I'm outside with the dog, I can let him roll around on the ground while I pick up branches from the lawn or get the newspaper. I want him to be happy. He's a good dog, and he's getting old, so I'm willing to spend time with him. I can keep the hungry cat away from our meals by spraying him with a water bottle. I do some pet photography as a hobby, and this year's Christmas card resulted from taking a picture of a cat that posed under the tree. So even though I'm distracted, I can make something good come from it.
3. Things that are out-of-place and need picking up or straightening. I'll walk from the bathroom to the kitchen and notice a candy wrapper on the living room floor. Or I'll go into the laundry room (which doubles as an overflow pantry) to get more tea and notice that the clothes need to be transferred into the dryer. So I'll do that and forget about the tea. I'm trying to condition our daughter to pick up things that are out-of-place. When I do notice a chore that needs completing, I can ignore it if it's not an emergency.
4. A news story on the radio. I can't seem to listen to the radio while doing something. So if there's something I want to hear, I usually stop what I'm doing to listen. I can turn the radio on just for the five minutes of important news I need and then turn it off when it's over. I don't need to listen to the banter and trivia.
5. Thoughts. I always have an inner dialog (or music) going on in my head. I'm meditating more and trying to stay mindful.

While driving, I can be distracted by

1. Scenery. I love nature and photography, and I drive through a rural area alongside a river. I can drive slowly when there isn't much traffic and still take in some scenery.
2. Radio. Since I'm a visual thinker, it can be dangerous for me to listen to music or talk radio while driving in heavy traffic. I can drive slowly when there isn't much traffic and enjoy the radio. When driving in traffic or on unfamiliar roads, I turn off the radio.
3. Passengers. This is the same as having the radio on. But I can't turn them off. I don't respond to passengers when driving in traffic or on unfamiliar roads.
4. Thoughts (particularly what I have planned for the day). Again, I drive slowly. But I find that the process of driving a normal speed keeps me from thinking, and I focus better on driving.

At work, distractions include:

1. E-mail. I tend to keep the e-mail client open and check it whenever I get a new message notification. When I need to focus, I do close the e-mail client.
2. Phone calls. When I really need to focus, I unplug the phone. Activating the "Do Not Disturb" function doesn't help -- it still beeps to indicate that someone is trying to call.
3. In-person interruptions. I'm one of those folks that seems to know a lot about everything, so when a "new guy" is stymied, he'll come to me. I can ask him to come back later, or promise that I'll get back to him within 15 minutes, which can give me enough time to reach a good breaking point in my work. Sometimes just a look of intensity can dissuade someone from interrupting. This does not work for the boss, though.
4. Noisy co-workers. The guy next to me not only talks loud on the phone, but he uses speaker phone, too. Earplugs, headphones?
5. "What if" thoughts (work related). The work I do often involves solving problems. Sometimes I'll come up with an idea for a problem that I'm not currently working on. Or I'll learn about a new tool that might be helpful later. Rather than stop my current task to explore the new idea or tool, I'll use my new capture tool to record a brief note about the thought and then return to my task.
6. Thoughts (not related to work). There's a lot going on in my personal life: family & pet issues, volunteer activities, car and home maintenance, finances. I can use the capture tool to record notes about these thoughts, too, so that I can let go of them more easily.
7. Muscle stiffness and other physical discomfort. Some days I just can't seem to sit because my legs ache. Also, I've found if I don't eat well, I'll feel gnawing hunger pains or experience dizziness. If I eat too much or the wrong foods, I can feel bloated or foggy. I can stick to my diet and avoid empty foods or those that I can't tolerate. I can get plenty of sleep the night before and take breaks to walk and drink water. I can do office yoga.

My CPAP Breathing Machine

This is a continuation of The Sleep Study...

Not long after the sleep study, the respiratory therapist showed up at my home for a morning appointment.   This was the exciting day I would start using my CPAP machine, which was programmed to inflate my airway with enough pressure to keep it open all night long.  Tonight would be the first of many nights in my own bed without sleep apnea.

"Jenny" introduced the machine to me -- a ResMed S8 Escape.  She explained the one and only setting that I could adjust -- the ramp-up time to full pressure.  It also came with a humidifier, but since it was August, we decided to leave it unconnected.

She also fitted me for a mask -- the Fisher Paykel FlexiFit.  It felt like the same one that I wore during the sleep study, designed to fit over the nose only.  She explained how to put it on and take it off, as well as how to adjust the Velcro straps to make it tighter or looser.  It felt snug but not uncomfortable, at least for the 30 seconds I had it on for.  And when she started up the machine, it made an airtight seal.


Now I realize it may seem odd that this woman was at my home helping me with a device that I would use while in bed.  So let me pause here to explain that we were seated at the kitchen table, both fully clothed, and my wife was puttering about in the background.


I slept very well that night, despite looking like I had an alien attached to my face, and despite the purr of the novel machine and the Darth-Vadar-like sound of my own breathing.  I felt somewhat refreshed the next morning.  However, I was bothered by the sore spot on the bridge of my nose where the mask was the most snug.  The area was bright red with a few yellow oozing pimples.

"That's a nasty staph infection you got," my wife said.  "You better call the doctor and get some antibiotic."

"Nawh, I'll just wash it and put some ointment on it."

"Don't fool around!  If that gets into your eye you could go blind!" she replied, in a tone that was far from reassuring.

I did not call the doctor right away, but I did call the CPAP machine supplier.  I had read all the literature.  The mask was supposed to come with two seals, but I had only one, which was marked "small."  The other seal, which I did not have, would have been marked "medium."  So I explained the problem of the staph infection and the missing seal.  They promised to send a new seal out to me in the mail.

The literature also directed the patient to wash the mask with warm soap and water between each use and let it air dry.  It's very likely that the mask was contaminated with some bacteria either from Jenny or myself or from whoever placed the mask components into the kit.  Or the bacteria may have been present on my face.  In fact we're covered with all sorts of bacteria just waiting for a break in the skin in order gain a foothold and multiply.

The infection only got worse, so I went in to see the doctor the very next day.  I started on a course of oral antibiotics and kept it covered with a topical, over-the-counter ointment.

Eventually the infection cleared up and the new, medium-sized seal arrived.  I washed everything thoroughly.  At bedtime I carefully readjusted the Velcro to achieve the minimum tightness that would prevent air from escaping.  As well, I turned off the ramp feature.  I found that I could set the fit too loose and sometimes not realize it until after the machine reached full pressure.  It was better for me to start the machine off at the final pressure and then adjust the mask.

I never could get the larger seal to fit properly.  During the night the mask would shift slightly and allow air to escape, usually near one of my eyes.  Every time I'd try the small seal, I get the sore, red mark. So I settled on the medium seal.  However, I should've requested another brand or style of mask.  As I lie on my back, I like to arrange the hose so that it goes straight from the mask under the covers to my belly button, and I hold it in place with my two hands as if clutching a teddy bear to my chest.  This keeps the mask from shifting too much.


After a few months I stopped washing the mask and went a long time nearly without incident.  The incident occurred when we went on vacation to Mount Pocono.  I brought the CPAP machine and mask with me.  In the act of packing and unpacking, the mask probably got contaminated because after the first night in the hotel, I had that infection again.  I wound up calling my doctor from afar.  But because it was the weekend, I spoke with the doctor on call and had to explain the whole business with the mask and the infection.  No problem.  He called the prescription in to the nearby (and ubiquitous) CVS pharmacy, with which I had an account in my home state.  They had all my records stored electronically, even my insurance information.  So I bought the antibiotic, plus some ointment and bandages for the rest of the vacation.

This vacation-infection scenario played out once again.  Then I got smart and decided to wash the mask while on vacation with it.


Anyway, I really like the CPAP machine despite its imperfections.  I have been wearing it for about six and a half years every night for the entire night except when I was too congested to breathe through my nose.  It, along with my special diet, has made a big improvement in my life.

The Sleep Study

I had complained to my doctor about sleepiness at my previous wellness exam.  He recommended a sleep study for sleep apnea.  I declined.  I would have to stay overnight at the city hospital.  But at the next visit when we discussed the topic, I decided to go through with it.

Even before the doctor mentioned sleep apnea, I was pretty sure I had it.  Ever since I could remember, I would wake up groggy and somewhat out of breath.  I've had a few dreams in which I was holding my breath underwater and then I'd wake up gasping for air.  And my wife would wake me to complain that I was snoring very loudly and "snort like a gunshot."

And I remember that when I was on pain meds after sinus surgery, I would realize I had stopped breathing while drifting off to sleep.  When I mentioned this to the ENT surgeon at a followup visit, he dismissed my complaint as just a vivid imagination.

But I declined the initial sleep study referral because the only solution is either surgery, an oral appliance, or a machine that forces air into your nose (a CPAP machine).  None of these options appealed to me.  But I reconsidered because the study itself wouldn't cost anything, and the solution would be partially covered.  The main reason I reconsidered was because my wife made me do it.

I had a private room at the hospital with its own bathroom.  I changed into my PJs.  The technician suggested that I relax a bit and watch some TV.  Then when I was ready to go to bed, I should let him know so that he could attach electrodes to my body.

I don't watch TV.  I usually read before I go to bed, but I had forgotten to bring a book.  But I did find a TV channel that played relaxing music.  It didn't really matter because at that point in my life I was so thoroughly tired all the time that I could fall asleep quickly nearly anywhere, even standing in a line at a bank.  I went through the motions of a pre-bedtime ritual only for appearances sake -- I felt that the technician expected me to watch TV before going to bed.

After a short while, I was in bed, and the technician was attaching electrodes to my scalp, wrists and ankles, and attached a pulse oximeter to my finger.  He explained that the doctor ordered a "split" sleep study.  In this type of study, the first half would include just a monitoring phase.  If during this phase I should stop breathing, the technician would wake me and attach a CPAP machine to me.

I fell asleep right away, despite all the wires attached to me.  And then right away, inexplicably, the technician woke me up.  "What's going on?  Why'd you wake me up?" I asked a bit crossly.

"You have the worst sleep apena I've ever seen.  You really surprised me.  When you first walked in, I didn't think you'd have it.  Most of the folks who have sleep apnea are very overweight.  Boy was I wrong!"

He placed a special mask over my nose and explained that it would keep my airway open using air pressure, which he'd adjust remotely.  He'd be able to determine an optimum pressure that would be programmed into my own machine once I got it.

The next time I woke up, it was morning.  I actually felt refreshed.  It was amazing!  It was still early as I drove home.  Traffic was light, and I had the whole day ahead of me.  I had the euphoric sense that infinite possibilities were within reach.

The story continues here with My CPAP Breathing Machine.

Wednesday Weigh-In 20121113

I have no dream to report today, even though I remember snippets of a very complicated dream. One problem was that the dog was making noise. In fact he was doing that vigorous type of shaking that dogs do after they come out of the water. Repeatedly. Even though he had no collar on, the slapping of his ears made a huge racket at 1am. So I got up and grumpily escorted him to his crate where he stayed until morning.

Sleep and weight gain are inter-related by way of energy. When I don't sleep well, my energy level drops, and I'm tempted to "use" coffee and high-carb foods as stimulation. Note the use of the term "use" -- the same word that's sometimes followed by the word "drugs" when referring to recreational or addictive abuse of a substance.

Waist = 37.0"
Height = 5' 9"

References:

1. Wikipedia BMI page
2. Tanita Scale with Body Fat monitor
3. Javascript must be enabled to view the data.

Notes From the "Good Night" Book

Excerpts from "Good night : the sleep doctor's 4-week program to better sleep and better health," by Michael Breus...

Much of how you feel -- tired, ravenous, full, excited, thirsty, hot, cold, stressed-out -- is due to hormones getting secreted and having an impact on your mind and body. Because your metabolism is the sum of all chemical and physical changes that take place within your body, enabling its continued growth and function, your metabolism is at the mercy of these chemicals 24/7. Two hormones in particular tell you whether you're hungry or full, and whether or not you'd prefer the chocolate cake to the cottage cheese. If you're wondering whether you can control any of these hormones so you'll start craving celery and be sickened by dessert, read on.

The two digestive hormones that hold the remote control to your feelings of hunger and appetite are ghrelin and leptin. As with many hormones, these two are paired together but have opposing functions. One gives the green light that says Go and the other emits the red light that says Stop. Grelin (your "Go" hormone) gets secreted by the stomach when it's empty and increases your appetite. It sends a message to your brain that says, "I'm hungry. Feed me." When your stomach is full, the other hormone -- leptin -- sends your brain the message that says, "Stop eating. I'm done." You can thank your fat cells for sending leptin out, allowing you to push away from the table. So how do these hormones tie in to sleep?

Inadequate sleep creates an imbalance of both ghrelin and leptin. One study at the University of Chicago in 2004 showed that when people were allowed just four hours of sleep a night for two nights, they suffered a 20% drop in leptin and an increase in ghrelin. These sleep-deprived participants had a 24 percent increase in hunger and a 23 percent increase in appetite. Hunger is the feeling of wanting to eat and your appetite is the physical need to eat until full. (Think of hunger as the sensation that precedes eating.) If your brain isn't getting the message that you are full, you keep eating and eating and eating.

Sleep loss, in a sense, disconnects your brain from your stomach. Have you heard of "mindless eating"? Not only is the act of eating unconscious, but you also have a hard time controlling what you eat. The Chicago study also found that participants' appetite for calorie-dense, high-carbohydrate foods like sweets, salty snacks, and starchy foods increased by 33 to 45 percent when they slept only four hours a night.

 - page 126

...sleep loss appears to interfere with the metabolism of carbohydrates, which, in turn, leads to more fat storage and a propensity to become overweight, if not outright obese.  When sleep deprived, your body's ability to use glucose for energy drops about 30 percent.  And when the body cannot use glucose effectively, it stays in the blood and increases your risk for type-2 diabetes.  Even one week of sleep deprivation can cause a temporary diabetic effect!  How scary is that?  Of course, the sugar can't linger in the blood forever.  Such an elevated blood sugar level promotes the overproduction of insulin -- also a hormone -- which then tucks away that unused energy in the form of fat.  What's more, every time your body overproduces insulin, you become susceptible to so-called insulin resistance, at which point you can develop diabetes and no longer metabolize carbohydrates correctly.  By then, your attempts to stay lean and healthy are all the more difficult.

... growth hormone, or simply GH ... is a powerful anti-obesity hormone that decreases the rate at which your cells utilize carbohydrates and increases the rate at which they use fats (all good for weight loss).  As soon as you hit deep sleep, about thirty to forty minutes after you first close your eyes, and then several more times throughout the night in your sleep cycle, your pituitary gland releases high levels of GH -- the most it's going to secrete in twenty-four hours.

- page 130

Your Sleep Has Been Delayed

"Your sleep has been delayed." Imagine hearing that as if it were announced in an airport. That's how I'm imagining it, anyway.

I'd be sleeping now. But an hour and a half ago my wife told me that she was having trouble swallowing. Turns out she just took a new-to-her med, Trazodone, to help her sleep through the night. The idea here is that maybe her extreme fatigue is due to her inability to get a full night's sleep.

Ironically, one of Trazodone's more common side effects is dry mouth, which is also a huge problem for folks with Sjögren’s Syndrome, which she may (or may not) have. And excessive dry mouth can lead to difficulty swallowing.

Another thing that can cause difficulty swallowing is swelling of the throat due to an allergic reaction, which, as you might imagine, requires immediate medical attention. My experience is that it's easier to seek immediate medical attention when you're awake.

Hence, the delayed sleep and a time-wasting post about it.

Anyway, she's sleeping now. I don't have to check on her breathing -- the snoring says it all.

Good night!