Sleep&Wellness Magazine - Diabetes Issue

Biggest LoserHead Master ChefShares Recipes ToHelp With SeasonalDepression AndDiabetes

DIABETES

AmericanAssociation ForRespiratoryCare CPAP Use – Tips ForAvoiding Problems

The AmericanSleep &BreathingAcademy Why Do I Need AGood Night's sleep?

Complimentary Copy

Winter 2013 // Issue 6

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LINKED TO SLEEP APNEA By Edward Grandi

DOESSLEEP FASCINATEYOU? The need for trained sleep professionals is in highdemand across the country. More than 100 millionAmericans suffer from some form of sleep disorder;18 million Americans suffer from sleep apnea.Sleep technologists have competitive wages, andthere are job opportunities found in hospitals andsleep disorder clinics, as well as in private labs. The American Sleep and Breathing Academy offers courses needed to become a RegisteredPolysomnography Technologist. The program isdesigned to prepare students to perform, monitor,and interpret sleep studies.

Are you already a Sleep Professional?Join us every month for our Lunch Break Broadcast.The Lunch Break CEC is an hour-long broadcastwith 1 continuing education credit for all partici-pants. Every month features a different topic withspeakers that are experts in the field.

Visit our website www.americansleepandbreathingacademy.comfor more details or call 866-272-3226

CONTENTS

Winter 2013 // Issue 6

ASBA DentalDivisionWorking toImprove Safetyon America’sRoadwaysWritten By David Gergen

The A B Zzzzsof Yoga A Yogi̓ s Guideto Sound SleepWritten By Rudy Mettia

Oral ApplianceTherapyFor Sleep Apneaand SnoringWritten By Barry N. Chase,DDS, PC, D. ABDSM, D. ACDSS

10 12 20

WINTER 2013 • SLEEP & WELLNESS MAGAZINE4

Diabetes and OSAWhat is Diabetes?What is theConnection withSleep Apnea?Written By Edward Grandi

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AARCAmerican Associationfor Respiratory Care

Meditation:The AncientAntidote forModern StressWritten By Lisa Cypers Kamen, MA

CPAP Use Tips for AvoidingProblemsWritten By Karen S. Schell,DHSc, RRT-NPS, RPFT, RPSGT,AE-C, CTTS

Like Insomniacs,SAD SufferersHold UnhelpfulBeliefs About SleepWritten By Traci Pedersen

Sleep, Wellness & Health=A Recipe forWellbeingWritten By Lisa Cypers Kamen, MA

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Case StudyHow I EliminatedMy AsthmaWritten By Rick Tufts, C.N.P.

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34

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SLEEP & WELLNESS MAGAZINE • WINTER 2013 5

InfoGraphic:Sleep isAwesomeASBA Committee

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Cheryl Forberg Biggest Loser Head MasterChef shares Recipes to Helpwith Seasonal Depressionand Diabetes

38Lisa Cypers Kamen, MANew WellnessEditor

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SOMETIMES THE RESPONSIBILITIES IN DIFFERENT parts of our lives all converge onone day or one week. Recently, I found myself juggling an impossible collection of to-doitems. I was working from sun to sun—and beyond!—and I just couldn’t get everythingdone. I was feeling frantic, day after day, and the pressure was taking a toll on how I feltphysically as well. As it so happened, on one of those crazy days, Lisa Cypers Kamen’s articleon meditation came across my desk. As I read the article, I realized I really needed to slowdown and save my sanity and my health. I tried to do 10 minutes of mindful meditation, butI found I was too keyed up. Instead, I carved out a chunk of time for some moving medita-tion and took a walk. Even though the weather was blustery, it felt good to get out. I paidattention to what was around me (instead of all the things I “should have” been doing)—andI truly felt better!

Maybe meditation doesn’t sound appealing to you. How about yoga? Whether you’restressed out, sleepless, or just looking for ways to learn or make your day-to-day life better,this issue of Sleep & Wellness Magazine has something for everyone.

Did you know there’s a correlation between diabetes and sleep apnea? Both are common,and it may be more than a coincidence. If you or someone you know has diabetes (or not!),you’ll love the diabetic-friendly recipes provided in this issue. You can learn about seasonalaffective disorder and boost your mood with recipes that include specially selected ingredi-ents. Read about how one man conquered his asthma using natural remedies. See how theAmerican Sleep & Breathing Academy is working to make the roadways safer by encourag-ing compliance with sleep therapy for professional drivers who need it. Check out startlingstatistics about how getting too little sleep can truly be hazardous to your health.

Life gets crazy, it’s true. But amidst your worries, remember to take care of yourself. Prioritize,and let some things wait until tomorrow or next week. Let less-important things go if youmust. Protect your sleep, and promote your own well-being. You’ll be glad you did.

PUBLISHINGSleep & Wellness Magazine is produced, published, and distributed quarterly by The American Sleep and

Breathing Academy, LLC, Ogden, UT. The American Sleep and Breathing Academy, LLC also produces andpublishes Principles of Polysomnography, Principles of Polysomnography practice examination manual,

Principles of Polysomnography pocket guide, and other written educational materials key in the field of sleep.Entire contents copyright 2013 American Sleep and Breathing Academy, LLC all rights reserved. Reproduction

in whole or in part is prohibited. PRODUCED IN THE UNITED STATES OF AMERICA

CUSTOMER SERVICEThe American Sleep & Breathing Academy (attn) S&W Magazine Customer Care1464 East Ridgeline Drive, Suite 104Ogden, Utah 84405

PHONE: 866.227.3226 E-MAIL: [email protected] BACK ISSUES are available in digital format for 3 months after original print date online at: www.sleepandwellness.net

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Jennifer TaylorMANAGING EDITOR


F R O M T H E E D I T O R

ART DIRECTORSharon Robins

CREATIVE DIRECTORAntoni Pham

HEALTH AND WELLNESS EDITORLisa Cypers Kamen, MA

PRODUCTIONDIRECTORCarline Risser


AMERICAN SLEEP & BREATHINGACADEMY EDUCATION COMMITTEEAmber Galer BS, RRT, Primary Children'sMedical Center, USRC: Past President Archie Roberts, MDCindy Olsen, RPSGTJeanette Robins, RPSGTJessica Schweller, RRT, RN, MS, CNPKaren S. Schell, DHSc, RRT-NPS, RPFT, RPSGT,AE-C, CTTSLaree Fordyce- RPSGT, RRT, CCRP , CSEMatt CarlockRudi Ferrate, MD Seth Wallace, MDSyed I. Nabi, MDTala’at Al-Shuqairat, MD

AMERICAN SLEEP & BREATHINGACADEMY DENTAL DIVISIONDavid Gergen, Executive DirectorSteve Carstensen, PresidentRichard Drake, Vice- PresidentRandy Clare, SecretaryWayne Halstrom, Sleep DirectorElliot Alpher, Sleep DirectorSteve Marinkovich, Sleep DirectorRod Willey, Standards DirectorBrad Eli, Pain Management DirectorBrian Blevins, Pain Management DirectorHarry Sugg, Archives DirectorTara Griffin, Director

ASBA CONTRIBUTING STAFF MEMBERSAngela Kyzer Julie Thomas

CONTRIBUTING WRITERSBarry N. Chase, DDS, PC, D.ABDSM, D. ACDSSCheryl Forberg, RDEdward GrandiKaren S. Schell, DHSc, RRT-NPS, RPFT, RPSGT,AE-C, CTTSMarci WilliamsRick Tufts, C.N.P.Rudy MettiaSyed I. Nabi, M.D. Traci Pedersen

CONTRIBUTING ORGANIZATIONSAccreditation Commission for Health CareAmerican Association for Respiratory CareAmerican Sleep Apnea AssociationBreather Narcolepsy NetworkPro Player Health AllianceUniversity of PittsburghWake Up Narcolepsy

MANAGING EDITORJennifer Taylor

CONTRIBUTORS

THE STAFF

A filmmaker, positivepsychology coach,author, host of

Harvesting HappinessTalk Radio, professorand lecturer specializ-

ing in the field of sustainable happiness.Lisa’s acclaimed docu-mentary film co-pro-duced with her now

fifteen year-old daugh-ter, Kayla, “H-Factor…Where is your heart?”explores how people invaried circumstancesfind, generate and

share happiness. Lisahas also published anumber of articles andbooks entitled, GotHappiness Now?, Are

We Happy Yet?,Leadership: Helping

Others to Succeed andReintegration

Strategies, about com-bat trauma and usingpositive psychologyprinciples to create

wellness in a post-warnew normal. In addi-

tion, she is theHappiness Expert forthe Florida Department

of Citrus/ FloridaOrange Juice in its Takeon the Day campaign.

DENTAL DIVISIONEDITOR

Randy Clare

20 years of experiencein the DME and Dentalsleep medicine field.

As the SeniorConsultant,Distribution

Management atCarefusion, he is

currently working toimprove patient out-comes with improvedhome diagnostics andinnovative therapyproducts. He is theManaging Editor/co-

Founder atSleepScholar.com.Previous experienceincludes President atDDMEonline.com,Vice President USA,Canada at SleepnetCorp, and Advisory

Council at Academy ofClinical Sleep

Disorders Dentistry.

AARC SPECIAL SECTION EDITOR

Timothy R. Myers, MBA,RRT-NPS, FAARC

Associate ExecutiveDirector of BrandsManagement for theAmerican Associationfor Respiratory Care(AARC). He is a gradu-ate of Lake Erie CollegeParker MBA Programand The Ohio StateUniversity with a

Bachelor of Sciencedegree in Respiratory

Care. Previous served asAARC President for2009-2010 and wasappointed as a Trustee

of the AmericanRespiratory CareFoundation (ARCF) in 2010. He has alsoserved as Neonatal-

Pediatric Section Chair(2000-04), VP of

Internal Affairs (2005),Board of DirectorMember at-large

(2006-07) and CPGSteering CommitteeChair and liaison to

American Academy ofPediatrics Neonatal

Resuscitation SteeringCommittee (2001-08).

A R T & P R O D U C T I O N

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The agency is working on guidance tomedical examiners regarding sleepdisorders, but trucking interests insistthat a formal rule is needed to giveemployers a clear statement of theirlegal responsibilities. A spokesman forthe T&I Committee said that if themeasure passes, it will be reported tothe full House for action.

“The bill is a good government meas-ure,” said Justin Harclerode. “It doesn’taddress whether or not there shouldbe any regulation changes – it simplyrequires that any proposed regulatorychanges follow the rule-makingprocess.” The bill is likely to beapproved by the committee and takenup by the House, but it is not clear ifthe Senate will do the same, said one insider who could not speak onthe record.

ASBA members will be on the pre-ferred providers listing for the trans-portation program that was presentedto the Department of Transportationin Washington D.C. by David Gergenand Dr. Elliott Alpher.

Update, the bill passed unanimouslyin both the House and Senate andwas signed into law on October 16,2013.


ON JULY 11, 2013, SEVERAL SLEEP EXPERTS PRESENTEDNEW TECHNOLOGY THAT COULD HELP IMPROVE SAFE-TY ON AMERICA’S ROADWAYS. The experts spoke with offi-cials at the Department of Transportation in Washington,D.C. The experts included David Gergen, Executive Directorof the American Sleep and Breathing Academy DentalDivison; Dr. Elliott Alpher, a Board member of the ASBADental Division; Dr. Richard Klein, a member of ASBA; Dr. Richard Bonato, President of Braebon Corporation; andMitch Livingston, Vice President of Braebon Corporation.

Dr. Bonato and Mitch Livingston explained how a sensorimplanted into an oral appliance used to treat sleep apneacan measure usage and compliance among patients, such ascommercial truck drivers. Dr. Bonato was directly involvedin creating the micro-recorder technology, along with DonBradley and others at Braebon.

Gergen, who has successfully helped 160 NFL players withsleep apnea, drew several comparisons between the large sizesof truck drivers and NFL football players. Gergen ownsGergen's Orthodontic Lab, which is a company that leads thecountry in fabrication of the Acrylic Sleep Herbst Device, theoral appliance Braebon intends to have their micro-recorderplanted in.

The House Transportation and Infrastructure Committeescheduled a vote on September 19, 2013, for a bill that wouldcompel the Federal Motor Carrier Safety Administration towrite a regulation covering sleep disorders rather than issueguidance that cannot be enforced. The bill that was intro-duced by Reps. Larry Bucshon (R-Ind.) and Daniel Lipinski(D-Ill.) says the agency must go through the rule-makingprocess to regulate sleep disorders, including sleep apnea.

ASBA DENTAL DIVISION

WORKING TO IMPROVESAFETY ON AMERICA’S

ROADWAYS

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D E N T A L

David GergenExecutive

Director of theAmerican Sleepand BreathingAcademy (ASBA)Dental Division,owns Gergen’sOrthodontic Lab


HAVE YOU EVER GLANCED AT THE ILLUMINATED NUMBERS ONTHE CLOCK NEAR YOUR BED AND THOUGHT IN SHOCK, “ITʼSALREADY 1:30 A.M. Crap! I have to get up at 6:30. If I can just fall asleepright now, Iʼll get five hours of rest.”

As you lie restless, you try to convince yourself that you can function onfive hours of sleep — yeah right! You tell yourself this again at four hours.At three hours, you know you’re in trouble, and you start to get—dare Isay—agitated and angry. Lord knows that wonʼt help your cause.

Sleeplessness can be caused by a lot of things. Sometimes, your mindwonʼt let up. Your might be worried and frightful or so full of joy, happi-ness and excitement that you canʼt slow down, much less get some shut-eye. It doesnʼt matter whether youʼre thinking about a pending disasteror anticipating the best day of your life; you need your sleep, and to getit, you need to quiet that monkey mind.

So how do you deal with a busy brain that wonʼt let you get to sleep? Mygo-to nightcap is yoga. Itʼs kind of like that warm glass of milk that helps

The A B Zzzzs of Yoga

– A YOGIʼS GUIDETO SOUND SLEEP

S L E E P & W E L L N E S S

Written By Rudy Mettia


you wind down and get ready for bed. One of themain reasons yoga works so well as a sleep aid isthat it releases your tension. Tension is anti-sleep. If you practice yoga, you can learn torelease that stress and also tune yourself into thehabits that keep you from hitting the hay.

But yoga doesn’t just hush that monkey mind; italso triggers the parasympathetic — “rest anddigest” — system in the same way that a few ZZZsdo. By jump-starting parasympathetic activitieslike energy conservation, digestion and slowingof your heart rate, yoga can help you get readyfor that much-needed shuteye. Studies haveeven shown yoga helps decrease insomnia.

Ready to start using yoga as your sleep aid? First,you need a plan, a ritual. Here’s what works forme:

Say you want to get to sleep by 10 p.m. By 7 p.m.,stop taking in stimulants like coffee, alcoholicbeverages and sugar. Also steer clear of heavymeals. Kill the TV by 8:30 p.m. I know BreakingBad and Dexter come on at 9, but you got TIVO,don’t you? Keep your tube time to the daytime.

Once the TV, laptop, tablet and phone are alldark, break out your yoga mat. Now, start the 90-minute advanced Astanga series. Just kidding!Relax. You’re just going to do about 15 minutes ofgentle forward bends, seated and supine pos-tures, all with deep breaths designed to illicit therelaxation response in your mind. Whereas back-bends are exhilarating and standing poses arepowerful, the gentle poses in this sleep routinemake you do what gravity wants you to do any-way: move without exerting a ton of effort. Freeyour mind, and much needed sleep will come.

Shoulder Stand Pegeon Pose

CONTINUED >>

Stand with your feet hips distance 1apart at the back end of your mat, with your hands resting on your hips.

Take a deep inhale and on the exhale,2hinge at the hips and fall forward intoa forward bend. Your knees should be softly bent to support your lower back and hamstrings.

Take 10 breaths with your head 3hanging with gravity. Imagine all the busyness dumping out and dissolving into the floor while you empty your mind and melt your body.

From your forward bend, walk 4your hands out into downward facing dog.

Take 5 to 8 breaths, not working 5too hard. You’re doing this just to take the edge off and burn any excess energy that may be keep-ing you from sleeping. You’re not trying to get stronger or fitter in this practice; you’re trying to relax.

From down dog, drop to your knees 6and take child pose for 10 soft breaths. Feel your body soften and your mind start to surrender.

As you come out of child pose, find 7your way into a seated posture. Bringthe soles of your feet together in a Baddha Konasana (cobbler) pose and gently drift into a forward bend. Takea few deep breaths.

After cobbler posture, release both 8legs straight out in front of you for a long-held forward fold, 10 breaths at least.

Move into a supported shoulder 9stand with a bolster. Better yet, moveto the wall so you can stay for 10 breaths without working too hard. Lowering from shoulder stand, take a gentle leg across body twist on both sides.

Find your way to savasana (corpse) 10pose. Here is the one time falling asleep in savsana is not a bad ending.Stay in corpse pose until you feel ready for sleep.

Move slowly off your mat. If you’re 11not quite ready for bed, have a bedtime tea and spend 5 to 10 minutes inmeditation. Whatever you do, please don’t turn the gadgets back on; you’re free, for now.


Practice that easy routine every night, andyouʼll be the next Rip Van Winkle — minusthe bad hair and the 20 years of hiberna-tion in the woods, that is.

Here’s the yoga:

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Sunbird Pose

Reverse Warrior

Warrior Pose

Dancer Pose

Child Pose

Forward Fold


Don’t let the handlebar mustache and rugged exteri-or fool you: Rudy Mettia is one of the most dynamic,dedicated yoga instructors you could meet. Drawingfrom decades of personal exploration and extensivephysical training, Rudy teaches a power yoga-basedpractice that both challenges and heals his students— all while using his signature wit and southerndrawl to make yoga approachable to novices andexperts alike. Rudy founded the Yoga Alliance-approved Power Yoga 360 Teacher Trainingmethod. He is also an adjunct faculty member at theKripalu Center for Yoga & Health and the residentYoga Specialist for Harvesting Happiness for Heroes,an organization that helps returning veterans andtheir families overcome reintegration struggles suchas PTSD. An E-RYT 500 certified instructor, Rudy hasspent more than 10,000 hours instructing yoga stu-dents of all experience levels and recently released aDVD series, Yoga Warrior 365, that makes yoga mas-tery accessible to yogis in the comfort of their ownhomes. To learn more, visit www.RudyMettia.com.

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DIABETES ANDOSADIABETES IS SERIOUS AND HIGHLY PREVALENT. ACCORDINGTO THE AMERICAN DIABETES ASSOCIATION’S 2011 FACTSHEET, 25.8 MILLION CHILDREN AND ADULTS IN THEUNITED STATES – 8.3% OF THE POPULATION—HAVE TYPE 2DIABETES; 1.9 MILLION NEW CASES OF DIABETES WEREDIAGNOSED IN 2010.

THE COMPLICATIONS OF DIABETES ARE SERIOUS; THEYINCLUDE HEART DISEASE, STROKE, HIGH BLOOD PRESSURE,BLINDNESS, KIDNEY DISEASE, NERVOUS SYSTEM DISEASE(NEUROPATHY) AND AMPUTATION. THE ECONOMIC CON-SEQUENCES ARE STAGGERING AS WELL: $245 BILLION IN2012, INCLUDING $176 BILLION IN DIRECT MEDICAL COSTSAND $69 BILLION IN REDUCED PRODUCTIVITY.


CONTINUED >>

B Y E D W A R D G R A N D I

DIABETES ANDOSA


“Diabetes is a condition that results in excesssugar, or glucose, in the blood caused by damage tothe cells that produce insulin.

“

B Y E D W A R D G R A N D I


DIABETES ANDOSA

WHAT IS DIABETES?Diabetes is a condition that results in excess sugar, orglucose, in the blood caused by damage to the cells thatproduce insulin. Insulin is a naturally occurring hor-mone that regulates how the body processes carbohy-drates and fat. Glucose is like the gasoline that makes anautomobile run. Insulin causes the liver, muscles andfat tissue to absorb glucose. Insulin protects the body bypreventing excess glucose in the blood stream, which isdangerous. Unlike flooding the engine with too muchgasoline, the presence of excess glucose in the blood-stream can lead to death.

There are several types of diabetes. Type 1, also knownas juvenile diabetes, occurs when the body does nothave the cells responsible for producing insulin. Type 1diabetes is usually the result of an autoimmune disor-der wherein the body turns on itself, damaging ordestroying the cells that produce insulin. This type ofdiabetes can be managed by replacing the insulin usinginjections or an insulin pump.

Type 2 diabetes is more common and develops as aresult of insulin resistance, a condition in which thebody fails to use insulin properly to regulate glucose inthe blood. Type 2 diabetes occurs mainly in adults, so itis sometimes known as adult-onset diabetes. However,the incidence of type 2 diabetes in children is increas-ing with the rate of childhood obesity. Mild cases oftype 2 diabetes can be managed by changes in diet;more serious cases are managed with prescribed drugs.

A third type of diabetes, gestational diabetes, some-times occurs in pregnant women. Gestational diabetescan have negative effects on the unborn child as well asthe mother. In some cases, a mother with gestationaldiabetes develops type 2 diabetes after her pregnancy.

WHAT IS THE CONNECTION WITHSLEEP APNEA?Sleep apnea is also a chronic medical condition. Itresults in sleep fragmentation and sleep deprivationfrom frequent pauses in breathing during sleep andsubsequent arousals when breathing restarts.

Like diabetes, sleep apnea is highly prevalent, with asmuch as 16% of the adult population suffering from

THE BENEFITSOF TREATINGSLEEP APNEAINCLUDEIMPROVEDDAYTIMEFUNCTIONINGAND BLOODPRESSURE,AND—ACCORD-ING TO RECENTSTUDIES –REDUCEDINSULINRESISTANCE.

“

“Obstructivesleep apnea

(OSA)

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some form of the condition. Like dia-betes, the consequences of untreatedsleep apnea are serious and potential-ly life-threatening.

Sleep apnea can be successfully treat-ed, depending on the severity, byusing a variety of different therapiesincluding weight loss, modifyingsleep position, an oral appliance, anddevices that create positive airwaypressure.

The benefits of treating sleep apneainclude improved daytime function-ing and blood pressure, and—accord-ing to recent studies – reducedinsulin resistance.

The connection between the twoconditions has been the subject ofmuch interest in the medical researchcommunity. While researchers arereluctant to suggest that one causesthe other, they feel there is a strongassociation between the two diseases.The association is so strong that theInternational Diabetes Federationand the American Academy of SleepMedicine believe that people witheither condition should be tested forthe other.

The importance of healthy sleep can-not be underestimated. Medicalresearch shows that the lack ofhealthy sleep contributes to a numberof serious medical conditions, likediabetes. There is promising evidencethat restoring healthy sleep by treat-ing a common sleep disorder—obstructive sleep apnea—can have apositive impact on insulin resistance.

It is also possible that individuals canprevent or reduce the possibility ofdiseases like diabetes by establishinghealthy sleep at an early age and maintaining good sleep habitsthroughout their lives.

Edward Grandi serves as the Executive Director of theAmerican Sleep Apnea Association. He is a resource tothe media on the prevalence of sleep apnea and diag-nostic and treatment options available to address thecondition. He is a nationally and internationally invitedspeaker on the field of sleep medicine.

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D E N T A L

ORAL APPLIANCETHERAPYFOR SLEEP APNEA AND SNORING

Written By Barry N. Chase, DDS, PC, D. ABDSM, D.ACSDD


A ROMANTIC STORY: Steve M., a hand-some young man of 42, healthy and ingood physical condition, came into ouroffice seeking treatment for his loudsnoring and moderate case of obstructivesleep apnea. As a consequence of hissnoring, he slept in another bedroom, ashis wife was unable to sleep while hesnored. He used a CPAP, a machine thatutilizes continuous positive airway pres-sure delivered via a tube and mask on theface covering the mouth and nose, whichblows the apnea obstruction open.Although the CPAP reduced his snoringand sleep apnea, Steve had to sleep on hisback and because the machine madenoise, he was still unable to sleep with hiswife. After the insertion of an oral appli-ance to treat his sleep apnea, Steve nolonger snored. He said, “Not only can Isleep with my wife, we can snuggle and Ican hold her in my arms all night.”

AN ENCOURAGING STORY: Ronald T. isa 37-year-old elementary school princi-pal. He was somewhat overweight, con-stantly tired (even though he slept 8-10hours each night), irritable and unable toget up in the morning to go to work. Notgood for an elementary school principalto be tired, irritable and late for work.Ronald tried the CPAP therapy and wasunable to get used to it. He said it madehim feel extremely claustrophobic, andalthough he tried smaller masks and nasalpillows, he felt that the CPAP was notworking for him. He came to our officeand received an oral appliance for hismoderate case of sleep apnea. Ronaldimmediately got the deep and REM (rapideye movement) sleep he needed. Hebegan to sleep only 7 hours, wakingrefreshed and energetic at 5 a.m. Whatwas he to do for two hours before schoolstarted? The only place he thought of thatwould be open at that hour of the morn-ing was an exercise gym. He joined.Within four weeks, he lost weight, boughta new wardrobe, and got a “cool” haircut.He came back to the office for a follow-up visit, and we barely recognized him. Ithas been over a year since Ronald hasbeen wearing his oral appliance, and he’sstill thin, energetic and “cool.”

A HEARTWARMING STORY: Richard S. is 20 years old and has mild autism.He was very overweight, angry, depressed, and behaviorally unpredictableand erratic. Richard was confined to the house and unable to participate inany community activities because of his outbursts and occasional violence.He suffered from extremely severe sleep apnea. He lives with his mother andgrandmother, who sleep on the second floor of their house while Richardsleeps on the first floor. Richard’s snoring was so loud that it penetrated theentire house, keeping his mother and grandmother awake. They were alsoangry, depressed and irritable. Not a happy household. After several monthsof wearing an oral appliance for his sleep apnea, Richard’s behavior and gen-eral demeanor changed for the better, as did his mother and grandmother’s.Richard is now enrolled in a life skills program, is losing weight, and has dis-covered that he loves bowling. He also loves shaking hands and makes apoint of shaking my hand before and after each visit. He said he has a girl-friend in the life skills class; he hasn’t told her yet, but he does shake herhand as often as he can.

A SAD STORY: John B. was a 78-year-old man with a history of cardiovas-cular disease, having had arterial bypass surgery. He suffered from highblood pressure and high cholesterol. He was diagnosed with obstructivesleep apnea, was CPAP intolerant, and had impressions for an oral appliancetaken. The day of his appointment to have his appliance inserted, his wifecalled to say the John would not be keeping his appointment. She said hehad difficulty breathing during the night, stopped breathing several timesdue to his sleep apnea and was snoring loudly. At 4:00 in the morning, Johndied of a heart attack.

Oral Appliance Therapy (OAT) is recommended by the Academy ofSleep Medicine (ASM) as the first line of treatment for obstructive sleepapnea (OSA) for mild to moderate cases and for patients with severesleep apnea who have tried CPAP and are intolerant.

CAUSES OF OBSTRUCTIVE SLEEP APNEA

A Collapsed AirwayHave you ever tried to suck through a paper straw that was wet andsoggy? If so, you know that the straw collapsed, especially as you triedto suck harder. Well, that’s what happens to the airway when you havesleep apnea, especially in older people. The airway (pharynx) is sur-rounded and supported by muscles. When a person inhales, the chestexpands and the stomach presses the diaphragm downward, creatingnegative pressure in the lungs and airway. The muscles surroundingthe pharynx keep the airway from collapsing by holding the walls of thepharynx rigid. However, if the muscles are weak and the airway is nar-row (which is often the case with overweight patients), the negativepressure will cause the airway to collapse, like the soggy straw.

An oral appliance is a removable device, worn while sleeping on theupper and lower teeth to hold the lower jaw forward. It keeps the airwayopen all night to reduce or eliminate sleep apnea and snoring. As thelower jaw is moved forward, the pharynx is maintained in an open pos-

•••••

•••••

CONTINUED >>

ture. When negative pressure is createdduring respiration, the airway does notcollapse, and the patient does not stopbreathing during sleep or gasp uponawakening. OAT does not cure sleepapnea and only works when the patientis wearing the oral appliance.

Physical Characteristics of the JawsThe second major cause of sleep apneais the obstruction of the airway due tothe tongue falling back while sleeping.This is a condition that affects somepeople because of the physical charac-teristics of their jaws.

True or False:

1. Breastfeeding an infant leads to proper development of the upper and lower jaws and reduces the risk of sleep apnea.

2. Bottle feeding an infant contributes to sleep apnea during adulthood.

3. Orthodontic treatment can lead to sleep apnea in an adult.

4. Humans are the only mammals that have sleep apnea.

5. Sleep apnea is related to speech.

The answer to all the questions is true.

When an infant is born, the upper jaw(maxilla) and lower jaw (mandible) needto grow both in a front to back (horizon-tal) and side to side (lateral) direction.

However, there are competing forces. Themuscles of the face, particularly the mus-cles of the lips and cheeks, want to con-strict the growth from the outside in,while the tongue pushes the jaws fromthe inside out, horizontally and vertically.

During breastfeeding an infant grabsthe nipple between tip of the tongue andthe upper lip. This causes the tongue tomove upward and forward to put inter-nal pressure against the roof of themouth (hard palate) and help it developwith the proper width. When the motherfeeds the baby with a bottle, the largenipple of the bottle depresses the tongueonto the floor of the mouth and pushes itdeeper into the throat. When this happens, the muscles of the lips andcheeks put external force on the jawsand restrict the growth laterally.Consequently, in individuals who werebottle fed, the jaws may be too narrowand the tongue has no place to go exceptbackward into the pharynx. The maxillais long and narrow, while the mandibleis too short. The child is unable to get hislips together to swallow properly, whichresults in mouth breathing, an open bite,a lisp or other speech impediment, andcrowding of the teeth. The characteris-tics of the jaws can also contribute tosleep apnea.

When we go to sleep, we pass throughsleep stages: first stage I and 2 light sleep,then stage 3 deep sleep (also referred to

as Delta or slow wave sleep), and finallyREM (Rapid Eye Movement or dreaming)sleep. During deep and REM sleep, themuscles of the body relax to the point ofbeing catatonic, including the musclesof the head and neck. The jaw relaxesand the tongue falls back and mayobstruct the airway, causing a sleepapnea event. The apnea events lastsbetween 10 to over 90 seconds, duringwhich the oxygen in the blood falls, usu-ally from the normal of the mid 90th per-centile to into the 70th, 60th or even 50thpercentile. Low blood oxygen levels havevery negative medical consequencesand can even be fatal.

Any factor that restricts the developmentof the maxilla and mandible can lead tosleep apnea. It is not uncommon for anorthodontist to recommend the extrac-tion of permanent teeth to correct severetooth crowding. The potential is thatwhen teeth are extracted the remainingteeth are retracted and moved backwardinto the mouth. The teeth line upstraight, but this backward position ofthe teeth also moves the tongue back-ward and can contribute to sleep apneawhen the patient becomes an adult.

Human evolution may also contribute tosleep apnea. Almost all mammals havetheir jaws forward relative to the rest oftheir faces. This puts the tongue in frontof the airway. As human beings evolvedwith larger brains and more upright


D E N T A L

Oral ApplianceTherapy (OAT)

SLEEP APNEAEVENTS LASTSBETWEEN 10 TOOVER 90 SECONDS,DURING WHICH THEOXYGEN IN THEBLOOD FALLS, USU-ALLY FROM THENORMAL OF THEMID 90TH PER-CENTILE TO INTOTHE 70TH, 60TH OREVEN 50TH PER-CENTILE.

“

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posture, their jaws got smaller. Humansare able to communicate as we dobecause of our anatomy, which alsoincludes having the base of the tongueover the vocal cords at the level of theepiglottis. The downside of this humanevolution is that as a person drifts intodeep and REM sleep, his tongue mayblock his airway.

Today dentists see more impacted teethand more congenitally missing teeth.This is an indicator that human jaws arecontinuing to get smaller. Consequently,future generations may be more proneto sleep apnea.

DIAGNOSING OBSTRUCTIVESLEEP APNEA (OSA)OSA can be diagnosed during a sleepstudy ordered by a physician. This sleepstudy is called a Polysomnography(PSG) or attended in-lab study. Thesleep study can be done in a sleep cen-ter, where the patient sleeps overnightattached to wires that send data to acomputer. The data is then compiled ina report, which can be sent to the doc-tor. It is also possible to do an accuratesleep study in a patient’s home. Thepatient brings the equipment homeinstead of having the study done by aspecialist in a sleep center.

If a patient is diagnosed with OSA afterhaving had a sleep study, his physicianwill recommend therapy to remedy theproblem. The most common treatmentsare CPAP or an oral appliance.

TREATING OSA WITH ORALAPPLIANCESIf you are diagnosed with OSA andchoose to pursue Oral ApplianceTherapy, you should find a dentisttrained in OAT for sleep breathing disor-ders and Temporal Mandibular JointDysfunction (TMJ). The dentist shouldalso be familiar with the protocols andguidelines recommended by theAcademy of Dental Sleep Medicine(AADSM). Sleep apnea is a condition thatcan lead to serious medical problemsand can even be fatal. Make sure you areputting your health, and life, in thehands of a qualified dentist.

Ask the dentist:

Are you trained in OAT for snoring•and sleep apnea?

Do you use only FDA-approved •appliances?

Are the appliances you make custom•made, utilizing custom impressions?

Are the appliances adjustable •(titratable)?

Do you work with physicians who•diagnose sleep apnea?

Do you recommend a sleep study•after the OAT has begun, to monitormedical data for improvement?

How do you manage TMJ symptoms•that may surface after OAT is begun?

Do you participate with medical•insurance and file my insuranceclaim for me?

Are you a Medicare provider for OAT?•

Does your treatment include follow-•up adjustment appointments afterthe appliance is inserted?

Does the appliance come with a war-•ranty if it should break or needrepair?

Do you follow the protocols outlined•by the AADSM?

There are many oral appliances tochoose from. Make sure the one you getis FDA approved. The appliance selectedshould be based on the severity of yoursleep apnea, your dental and cranio-facial (skull) anatomy, the condition ofyour teeth, any pre-existing TMJ dys-function, and the data gathered duringthe sleep study.

The data the dentist should consider fromthe sleep study for OAT selection are:

The apnea-hypopnea index (AHI) –•the severity of your apnea; mild,moderate or severe

The number of arousals and other•indicators for upper respiratory disturbance

Oxygen desaturation – the percent •of oxygen in the blood (Normal is 92-98%.)

The Oxygen Nadir – the lowest the•oxygen saturation level (Below 80%can be dangerous.)

Snoring events by number and •loudness

MEDICAL EXPECTATIONS FORTHE ORAL APPLIANCEMany patients ask, “Why did my physi-cian have me try CPAP before the oralappliance?” CPAP is more effectivewhen it can be used comfortably all

night and with the correct pressure. CPAP can reduce the severity of sleepapnea to an AHI of 5 or even to 0. Oralappliances, which are more limited by apatient’s anatomy, are generally not aseffective. However, when CPAP is not aworkable solution, an oral appliance isan excellent alternative. It can reducesleep apnea to a level that will notthreaten the patient’s life, and it canreduce the symptoms of daytime sleepi-ness, morning headaches, and snoring.

There is hope! That is the message of theoral appliance. If you cannot tolerateCPAP, that doesn’t mean that sleep apneawill ruin and endanger your life. An oralappliance can save your life or save yourmarriage (by eliminating snoring).

The oral appliance is successful becausepatients wear it all night. They put it inwhen they go to bed and wear it untilthey awaken. During the hours we sleep,we go through sleep stages. Most of thedeep sleep is in the first half of the sleephours, and REM sleep is mostly in thesecond half of our sleep. Many patientstake the CPAP off when they wake to usethe bathroom, then return to bed and aretoo tired to replace the CPAP. It’s easy towear the oral appliance all night, whichassures that the patient will get the max-imum benefit of therapy and achieve theresults they want.

A properly constructed oral appliance iscomfortable, easy to wear all night, effec-tive, and will not aggravate TMJ. The costshould be covered by medical insurance.

If you have sleep apnea or excessivesnoring, or if you are undiagnosed andhave excessive daytime sleepiness andother symptoms of sleep apnea, consultyour physician or dentist and ask if anoral appliance is right for you.

ABOUT THE AUTHOR

Barry N. Chase, DDS, PC, D. ABDSM, D.ACSDDis the owner of Chase Dental SleepCare™ andChase Dental Care, PLLC; Melville, Long Islandand Manhattan, NY, a private practice dedicat-ed to dental sleep medicine. He is on the advisory boards of the Polysomnography andRespiratory Care programs at Stony BrookUniversity in Long Island, NY, and the ScientificAdvisory Board of SleepUp Corp. in Tel Aviv,Israel. He is an adjunct professor of DentalSleep Medicine at Stony Brook University andpractices dental sleep medicine at St. Joseph’sHospital Sleep Center in Bethpage, NY.www.chasedentalsleepcare.com/practice

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LOOKING PRETTY

Have sleep apnea treated to improve facial appearance

and look more alert, youthful & attractive.

Adequate sleep is shown to improve a vast array of quality of life elements, ranging from health, intelligence in kids, increased productivity at work, improved cardio & brain execution, hence improving our overall well-being & health.

WINTER 2013 • SLEEP & WELLNESS MAGAZINE26I N F O G R A P H I C

This infographic designed by FFunction for Zeo www.myzeo.com

Background: Founded in 1947, the AARC is a not-for-profit professional association with more than 52,000members worldwide. Our primary membership consistsof respiratory therapists, allied health practitioners whoare trained at the 2- and 4-year college level to assistphysicians in the care of patients with lung disorders andother conditions. Respiratory therapists can be found inall areas of health care, including hospitals, home care,nursing homes, and physicians’ offices—in short, any-where patients are being treated for lung diseases.

AARC Congress: The four-day AARC Congress is thepremier educational event in the respiratory care profes-sion. Every year, the meeting brings together more than6,000 respiratory therapists and other health profession-als from around the world, who gather to hear the latestdevelopments in respiratory care.

Education: In addition to the AARC Congress, theAssociation develops and conducts a plethora of meetings, educational courses, and symposia through-out the year to provide members with opportunities toearn Continuing Respiratory Care Education (CRCE™)credits. The newest additions to the AARC’s educationline-up are online. The Association also presents regularwebcasts featuring leading speakers and topics in respi-ratory care, which are archived for viewing any time atWebcast Central.

Advocacy: The AARC interacts with local, state, and fed-eral government on public policies that affect ourpatients and our members. From Medicare and Medicaidreimbursement issues to health-care reform proposals,the AARC keeps Congress, state, and local policymakersup-to-date on the issues that are important to patientcare and respiratory practice.

Publications: The Association publishes a peer-reviewedjournal, RESPIRATORY CARE, and a news and featuremagazine, AARC Times. The foremost scientific journalin the respiratory care profession, RESPIRATORY CARE islisted in Index Medicus and features original researchand case reports on topics such as chest radiographs,pulmonary function tests, and blood gas analyses. AARCT¦mes is the profession’s leading general interest publi-cation, containing management tips, human-interestfeatures, profiles of respiratory care leaders, and more.Both are now available online as well.

Contact Information: For more information, please contact us via e-mail, phone, or regular mail:

American Association for Respiratory Care 9425 N.MacArthur Blvd. Suite 100 Irving, TX 75063-4706. Phone:(972) 243-2272 Fax: (972) 484-2720 E-mail: [email protected]

AMERICAN ASSOCIATION FOR RESPIRATORY CARE

The American Association for Respiratory Care (AARC) is the leading national and international pro-fessional association for respiratory care. The AARC encourages and promotes professional excel-lence, advances the science and practice of respiratory care, and serves as an advocate for patientsand their families, the public, the profession and the respiratory therapist.

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B R E A T HSLEEP & WELLNESS MAGAZINE • WINTER 2013 27


SLEEP IS AN ESSENTIAL COMPONENT OF HEALTH. There is strong evidencethat insufficient sleep has an effect on numerous health conditions.Obstructive Sleep Apnea (OSA) as a chronic disease, left untreated, can havemajor health consequences. For those individuals diagnosed with OSA, treat-ment is available. Continuous positive airway pressure (CPAP) therapy caneffectively treat OSA. Deciding to use CPAP therapy is a major step to sleepingbetter and living a healthier life. Patients, despite the benefits of CPAP therapy,have limited success in adapting the nightly use of CPAP therapy. Manypatients are resistant to wearing a mask at night and CPAP can interfere withsleep. Numerous problems exist and can be frustrating to CPAP users, whichcan ultimately decrease the willingness to continue use. Side effects and otherproblems usually are minor and they can be treated or easily fixed. Early edu-cation by the clinician about CPAP therapy can help gain patient acceptance.The goal is to keep it simple and not overload the patient. Clear understandingof health behaviors for chronic illnesses, such as OSA, is necessary in planning

B R E A T H

- CPAP USE - TIPS FOR AVOIDING

PROBLEMSFrom the American Association

for Respiratory Care Written By Karen S. Schell, DHSc, RRT-NPS, RPFT, RPSGT, AE-C, CTTS


programs that will be successful. Chronicdisease management can help patientsimprove health, maintain current health,reduce risks, and manage chronic conditions(National Cancer Institute [NCI], 2005).Several models exist to change behavior ofindividuals. It is important for providers to:(a) identify patient knowledge weaknesses,(b) to strengthen patient knowledge of thedisease process, and (c) teach the patientself-management skills. Addressing thepatient’s understanding of the diseaseprocess, signs and symptoms, causes, andtreatment can improve their ability to man-age the disease at home. Individual educationand identifying intervention points forchanging individual behavior and the socialenvironment can help improve and maintainhealth, reduce risk, and manage the disease.

CPAP therapy requires a long-term commit-ment to improve sleep and health. It is impor-tant to identify and address side effects andproblems quickly and communicate them tothe health care team and the CPAP equipmentprovider. Working closely with the health careteam and equipment provider gives theopportunity to be successful at adjusting themachine and avoiding frustration during theinitial period of adjustment. It may take up tofour to six weeks to get used to CPAP therapy.Consistency and continued usage makes iteasier to adjust to the treatment and receivethe maximum health benefit.

Asking questions when first starting to wearCPAP is key to success. Talk with the sleepspecialist about how to handle follow-upquestions. They can answer some questions,but the home equipment provider may needto address others. CPAP therapy is a long-term treatment. Achieving the full benefits ofCPAP requires knowing how to maintain themachine, identifying risks, and getting ongo-ing care.

It is sometimes difficult for patients to see thebenefits of nightly use of CPAP and often theside effects and problems associated with

CPAP use can cause the CPAP machinenever to be used. The side effects caninclude nasal drying, increased conges-tion, sneezing, rhinorrehea, sinusitis,conjunctivitis, claustrophobia, pressuresores on the bridge of the nose, difficultyexhaling, allergic reaction to the materialsin the mask, air swallowing with gastricdistension, machine noise, and skincreases the next morning. These side effects can often be avoidablewith behavioral therapy, patient education, CPAP application, and fol-low-up with troubleshooting and early intervention correcting theproblem. Communication, including sharing feelings, fears, and dis-comforts can improve the use of CPAP therapy.

TIPS FOR AVOIDING PROBLEMSEarly and ongoing education should include all parties involvedincluding provider, patient, and spouse. All must understand thehealth issues related to OSA and how CPAP therapy can help withmany of the problems the patient is experiencing. Education shouldcover advantages and disadvantages of treatment and the positiveeffects on sleep quality, health, mood, and alertness. Questions shouldbe encouraged and answered honestly. Continued education shouldaddress specific problems with possible solutions. Once the patientagrees to a trial of CPAP, the next challenge is getting them to wear it.CPAP only works if it is being used.

Problems may arise with initiation of CPAP. These problems and theircauses should be addressed quickly with possible solutions.Identifying and addressing problems will improve the ability to adjustto CPAP.

Choosing the right device is key to successful use. There are manyoptions for delivery systems. Education and understanding thedevices should be addressed before determining which one will ben-efit the patient the most. The mask or nasal pillows must be the correctsize. There are several mask types and sizes and patients should begiven the option that works best for their lifestyle and tolerance.Long-term support should be available for troubleshooting andreplacement of equipment. Changes in the patient's condition shouldbe communicated to all parties and may warrant a change in CPAPpressure and/or mask fit.

CONTINUED >>

“Nasal irritation/congestion/rhinorrhea can be caused bydry air, chronic rhinitis, ornasal allergies. Possiblesolutions include heatedhumidification, nasal decon-gestants, nasal steroids, orantihistamines.

“

Nasal irritation/congestion/rhinorrhea can be caused by dryair, chronic rhinitis, or nasal allergies. Possible solutionsinclude heated humidification, nasal decongestants, nasalsteroids, or antihistamines. Dry throat or mouth can be causedby dry air or mouth leak. This could be resolved by heatedhumidification, chin strap, or a full-face mask. Nasal conges-tion and high airway pressure can cause painful pressure inears. Verifying and decreasing positive airway pressure (PAP)level or nasal decongestants/nasal steroids may be effective indecreasing the pain. Decreasing PAP can also prevent air swal-lowing which may cause gastric bloating or chest discomfort.Poor mask fitting and anxiety may cause claustrophobia, nasalpressure sores and air leaks. Readjusting headgear, changingmask size or style, skin protection and reassessment of patienteducation on mask fit may resolve the problem. Improper masksize or style and headgear may cause mask leak, which may leadto eye irritation. Assessing patient education and mask fit mayquickly address these problems. Adjusting headgear or masksize and style may eliminate skin creases. Skin irritation fromthe mask or headgear may require using nasal pillows or lower-ing the temperature on the humidifier. Most CPAP machinesare fairly quiet but if noise is a bother, checking the air filter tomake sure the machine is working properly, using earplugs, awhite noise sound machine, or placing the machine on thefloor and slightly under the bed may be helpful in dampeningthe sound. If snoring continues on CPAP therapy, check thepressure and consult your physician. Other factors affectingincreased snoring may be alcohol consumption, sedation, orincreased weight.

If surgery is scheduled, the CPAP unit should be taken to thehospital and make sure all medical staff is aware of your OSA. Iftraveling, the CPAP equipment should go with you and makesure to bring extension cord, fuses, and any electrical require-ments including converter or adapter for a foreign country.Traveling to more than 5,000 feet above sea level may requireadjusting CPAP pressure setting in order to get the correctamount of pressure / air. The CPAP provider should help youadjust the pressure. Remember to reset the pressure to the orig-inal settings once returning home.

Masks, tubing, and headgear should be cleaned once a week.Check and replace the filters for the unit and humidifier. Theprovider on a regular basis should replace these. If you are hav-ing recurring symptoms, the equipment should be checked outand pressures verified by the provider.

OSA is usually a lifelong condition. Active follow-up care is veryimportant in sticking with the therapy. Every visit shouldinclude discussion of any problems encountered and findingsolutions. Any symptoms, changes in weight, equipment per-formance, and mask fit should be reviewed. Patients need toknow up front that CPAP therapy is challenging and there willbe an adjustment period. Making sure the facts are known andwhat to expect will help with CPAP therapy success. Patientscan deal with the initiation and adjustment period if theyunderstand the therapy. Written instructions are important forthe patient, caregiver, and family. Thorough explanation canimprove the understanding and can improve compliance.Emphasize the positives. Regular follow-ups are essential, alongwith clinical assessment, review of the patient's response toCPAP, adverse effects, and any limitations or problems.

Layers of information are necessary for CPAP use with ongoingeducation, written instructions, demonstration of equipment,troubleshooting of concerns and problems. Changes of symp-toms, medical conditions, weight, and device usage are impor-tant information to be shared with the clinician and equipmentprovider. Each patient is different and taking the time to assesstheir particular needs can individualize the treatment necessaryfor improving patient function and symptoms.

Communication is the key to improving the treatment of each individual. Changing an individual’s health practices involves identifying intervention points for promoting health.Individual characteristics that influence behavior such as:(a) knowledge, (b) attitudes, (c) beliefs, and (d) personalitytraits can influence how the patient understands and commu-nicates understanding of the disease process. Involving family,friends, and their peers provide social identity and support(NCI, 2005). Each can influence the patient health behavior andimprove CPAP compliance for the patient. S&W


Traveling to more than 5,000 feet above sea levelmay require adjusting CPAP pressure setting in orderto get the correct amount of pressure / air.

““

REFERENCES

American Academy of Sleep Medicine (2006). Sleep apnea takes your breath away...CPAPgives it back. Retrieved from: www.sleepeducation.com

Bollig, S., (2010). Encouraging CPAP adherence: It is everyone's job, Respiratory Care2010, 55(9), 1230-1239.

Chokroverty, S., (2012), About Sleep Apnea, Questions and Answers. Sudbury,Massachuesetts: Jones and Hamilton, Ontario: BC, Bartlett Publishers.

National Cancer Institute. (2005). Theory at a glance, a guide for health promotion prac-tice second edition. (NIH Publication No. 05-3896). USA: Department of Health andHuman Services.

National Heart Lung and Blood Institute, National Institute of Health What is CPAP?Retrieved from: http://www.nhlbi.nih.gov/health/health-topics/topics/cpap

Pruitt, B. (2010-2011), Top 10 practices to increase CPAP compliance. Retrieved from:http://riversidemed.net/top-10-practices-to-increase-cpap-compliance/

B R E A T H

LISA CYPERS KAMEN IS A FILMMAKER, POSITIVEPSYCHOLOGY COACH, AUTHOR, HOST OFHARVESTING HAPPINESS TALK RADIO, PROFES-SOR AND LECTURER SPECIALIZING IN THE FIELDOF SUSTAINABLE HAPPINESS. She is widely recog-nized as an expert on the subject. Lisa’s acclaimeddocumentary film co-produced with her now fifteen year-old daughter, Kayla, “H-Factor…Whereis your heart?” explores how people in varied circumstances find, generate and share happiness.In addition to her film on happiness, Lisa has alsopublished a number of articles and books entitled,Got Happiness Now?, Are We Happy Yet?,Leadership: Helping Others to Succeed andReintegration Strategies, about combat trauma andusing positive psychology principles to create well-ness in a post-war new normal. Lisa’s written workis featured on blogs for the Huffington Post,PositivelyPositive.com and InspireMeToday.comand she is a TEDx community event speaker. Inaddition, she is the Happiness Expert for the FloridaDepartment of Citrus/ Florida Orange Juice in itsTake on the Day campaign.

Harvesting Happiness for Heroes™ is a 501(c)(3)nonprofit corporation that delivers stigma-freeintegrated combat trauma recovery services towarriors and their loved ones. Modalities include

scientifically proven strengths based PositivePsychology coaching and interdisciplinary toolssuch as film, yoga, meditation, art and creativewriting designed to mindfully empower the clientto achieve increased self-mastery, self-esteem andreclaim her/his life. HH4Heroes focuses on the balance of mind, body and emotion resulting in greater overall wellbeing and the transformationof Post-Traumatic Stress (PTS) into Post-TraumaticGrowth (PTG). HH4Heroes offers retreat workshops, one-on-one coaching, Battle Buddyprograms, as well as our new R.E.B.O.O.T Onlinevirtual community coaching classrooms designedto reach underserved areas. In addition,HH4Heroes deploys Return to Duty™ civilian andcorporate training to help welcome a warrior homeand into the community and workplace.

Lisa is committed to teaching Happiness is an insidejob™ and helping others end their needless suffer-ing through intentionally cultivating greater joy.

www.HH4Heroes.orgwww.HarvestingHappiness.comwww.HarvestingHappinessTalkRadio.com

Facebook: Harvesting HappinessTwitter: @LisaKamen

SLEEP & WELLNESS MAGAZINE • WINTER 2013 31S L E E P & W E L L N E S S

LISA CYPERS KAMEN, MASLEEP & WELLNESS MAGAZINE WELCOMES

OUR NEW WELLNESS EDITOR

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“ I've always envied people who sleep easily. Their brains must be cleaner,the floorboards of the skull well swept, all the little monsters closedup in a steamer trunk at the foot of the bed.

― David Benioff, City of Thieves

“


Let’s take a look at automobiles as ametaphor for our bodies. Most of ustake loving care of our cars. We gas,wash and service them to be road readyand perform optimally. The same theo-ry must apply to our bodies for them tofunction properly. For our “machines”to work properly, we must feed, care,clean and keep the mental, physical and emotional spaces within them intip-top shape.

Therein lies the challenge. How do wecreate a “to-do” list for our own person-al wellness? Life is filled with realitiessuch as work, family, money stress,health challenges and serious issues;these produce anxiety, dampen ourhappiness, and take a toll on our healthat all levels. The first place we tend tocompromise is on ourselves. We giveup the walk we enjoy or eat the calorie-laden fried comfort food we cravebecause it seems faster, easier and moresatisfying. At the same time, we arebusy multi-tasking to create space inour already overloaded schedules forthe “to-do” items that scream the loud-est for our attention. The result is over-load and burnout that compromises ourhealth and happiness.

In reality, we our doing ourselves ahuge disservice when we don’t mindour magnificent bodies that serve usbeautifully in so many ways, even whenall the parts are not working perfectly.

And this is my great and exciting chal-lenge as the new health and wellnesseditor at Sleep and Wellness Magazine:to bring you the best and brightest science, technology and strategies thatopen pathways to integrated wellbeingthrough optimizing our brains andbodies. Each issue will contain psy-chosocial education, delicious foodand nutrition tips (along with easy-to-prepare recipes), and as mental andphysical practices to reduce stress, promote relaxation and improve over-all health.

To your health and wellbeing,

Lisa

SLEEP,WELLNESS & HEALTH =A RECIPEFORWELLBEINGWritten By Lisa Cypers Kamen, MA


“People say, 'I'm goingto sleep now,' as if itwere nothing. But it'sreally a bizarre activity.'For the next severalhours, while the sun isgone, I'm going tobecome unconscious,temporarily losingcommand over every-thing I know andunderstand. When thesun returns, I willresume my life.'

If you didn't knowwhat sleep was, andyou had only seen it ina science fictionmovie, you wouldthink it was weird andtell all your friendsabout the movie you'dseen.

They had these people,you know? And theywould walk around allday and be OK. Andthen, once a day, usu-ally after dark, theywould lie down onthese special platformsand become uncon-scious. They wouldstop functioningalmost completely,except deep in theirminds they would haveadventures and experi-ences that were com-pletely impossible inreal life. As they laythere, completely vul-nerable to their ene-mies, their only move-ments were to occa-sionally shift from oneposition to another; or,if one of the 'mindadventures' got tooreal, they would sit upand scream and beglad they weren'tunconscious anymore.Then they would drinka lot of coffee.'

So, next time you seesomeone sleeping,make believe you're ina science fictionmovie. And whisper,“The creature is regen-erating itself.”

-George Carlin, BrainDroppings

SLEEP IS FAVORITE HOBBY OF MINE. I loveto sleep. In fact, good sleep makes me reallyhappy. Not only does it make me happy but Iknow a solid night (or stretch) of delicioussleep makes me healthier, more focused andable to take on the day, come what may. AndI also know that sleep (or lack of it) can be ananxiety-producing devil that taunts andhaunts our personal happiness.

You might ask where I am going with this.Fair enough.

I am a happiness and wellbeing expert. Ibegan my first career as an architecturaldesigner creating physical real estate. I wentback to school in mid-life to become a psy-chologist: a person who helps organize men-tal space. Along the way, I discovered that thepathway to optimal wellbeing (code name:happiness) is not found on a single road oftalk-therapy or prescribed living but througha series of intersecting and parallel life trailscalled integrated health and wellness.

It is through my work as an applied positivepsychology coach, author, documentaryfilmmaker, lecturer and radio show host thatI am able to help others weave a roadmap fortheir own sustainable wellbeing and greateroverall life-satisfaction. Creating a happy life is all about creating a balanced life.Happiness is not a destination but a naturalbyproduct of a journey. You may be thinkingthat I am a little crazy and simplistic in myviews, but stay with me here as I elaborate.

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MEDITATION: THE ANCIENT ANTIDOTE FOR MODERN STRESS


THE BESTWEAPON TOCOMBATSTRESS, TRAUMAAND SUFFERINGIS TO IMPROVERESILIENCY.

Written By Lisa Cypers Kamen, MA


ALERT! ATTENTION, ALL READERS! STRESSIS A WORLDWIDE MODERN EPIDEMIC. Ithas been said that stress is the number onecause of “dis-ease” and illness. Stress cancause serious physical symptoms such as ele-vated blood pressure and glucose level,increased heart rate, compromised immunesystem, agitated nervous system, bodilyinflammation, sleep, and appetite disorders. Itcan also hinder optimal brain functioning.Stress starts in the mind and then permeatesthe rest of the body.

But that’s not all. The negative byproducts ofstress also include anxiety, anger, frustration,negative emotion, depression, impulsivebehaviors, and relationship problems.Bottom-line: stress kills! Stress kills our bodies,hearts, minds and spirits. It is a gift of life wewish we never unwrapped.

Unfortunately, we are control freaks that can-not really control very much: not our partnersnor our children nor world affairs. Yet there isgreat news here. The one thing we can learn tocontrol is our mind. It’s true. We can learn toquiet our minds, reduce stress and ease theanxiety that erodes our wellbeing. In fact,there is a no-cost, drug-free, painless, simpleand portable tool available to us at anytime tohelp soothe our inner savage beast. It’s calledmeditation.

You might think meditation is a throwback tobell-bottomed, psychedelic, hippy-filled daysgone by. Perhaps your vision of this includesbald men in saffron robes chanting by theRiver Ganges in India. Meditation is a highlyeffective ancient practice of peaceful reposedesigned to empty the mind and allow thebody to rest and repair from the hustle andbustle of life.

The very act of living generates stress, but notall stress is bad. A small amount of stress, suchas the kind that accompanies a new project,can actually be stimulating and good. Butadding health challenges, traumatic events orfinancial worry and you may go into stressoverload; your ability to cope disintegrates.

The best weapon to combat stress, trauma andsuffering is to improve resiliency. And one ofthe best ways to improve resiliency is throughmeditation. Meditation is the ancient antidotefor stressful modern life. Meditation is not

hypnosis, mind control, a New Age vision quest, nor a religion.Meditation reduces stress, so you can deal with your life from acalm and pragmatic place. Many people report they feel a senseof connectedness or spiritual wellness when they meditate.

The Benefits of Meditation: Meditation can reverse the stressresponse by filtering and reducing the mental overload thatcontributes to stress by helping us better manage our emotions,fostering:

Increased self-awareness•

Increased positive emotions•

Focus on the present•

Effective stress management•

During meditation, blood pressure normalizes; heart rate andbreathing slow down, immune system and brain functionimprove. Meditation slows the production of cortisol, the stresshormone. In addition, it retards aging in the brain andimproves mental acuity and creativity.

Scientific research validates the health benefits of meditation,showing that meditation can help the body repair itself whilemanaging conditions that are exacerbated by stress such as:

Allergies•

Anxiety disorders•

Asthma•

Binge eating•

Cancer•

Depression•

Diabetes•

Fatigue•

Heart disease•

High blood pressure•

Pain•

Sleep disorders•

Substance abuse•

HOW IT WORKS:Curious? Go ahead…take meditation for a simple test drive. Tostart, set aside 10 uninterrupted minutes to explore one of thestyles below. Allow yourself to sit comfortably and undistractedby people, animals and electronics. Remember, this is a relaxinggift you are giving yourself to release stress and recharge yourbatteries. As you become more comfortable with meditatingyou can increase to 20 minutes, ideally twice a day.

““ Meditation slows the production of cortisol, the stresshormone. In addition, it retards aging in the brain andimproves mental acuity and creativity.

CONTINUED >>

Allow your body to sink into yourseat and gently close your eyes.Your legs should be uncrossed, feetgrounded to the floor and yourhands relaxed in your lap. Whilethe practice is simple, it may not beeasy to simply allow yourself to “be”for 10 minutes. You will have random thoughts that float in andout. This is normal. Just allow the thoughts to roll in and roll outmuch like the waves in the ocean. Simply observe and witnesswhat comes up during the process. The idea is to empty themind and restore the body during this brief period of stillness.

TYPES OF MEDITATION:There are several kinds of meditation, some with fancy namesand labels. They all achieve the same goal: to relax the brain, thebody and the breath. They are all designed to release tensionwhile creating awareness of the present moment. When wefocus solely on the present moment, we cannot stress about thepast or worry about the future. The only place we can be is righthere, right now. Here are a few of the most simple and easyways to practice meditation:

Breathing Plain & Simple: You’ve got this. You already1know how to breathe. The next step is to pay attention tothe in breath and the out breath. Allow your attention to befocused on your breathing; how it sounds and how it feels.With each breath, you are inhaling relaxation and exhalingstress. As your mind strays, refocus it on the breath. Voila!

Mindful Meditation: This is the art of paying attention2without thinking. Notice the raw sensations that surroundyou. Listen to the sounds around you, discovering layers ofsound in your environment and within your body such asthe birds chirping, a passing car, your breath, the sound ofyour heart beating. Observe how you are feeling and whatyou are feeling. Is your body beginning to let go?Are yourshoulders relaxing? Did your headache go away? Whatabout the temperature in the room? Is it cool or warm?Does your chair feel soft or hard? How does your skin feelwhen it meets the air? This awareness creates presence.

Guided Meditation: Guided meditation is a relaxing listen-3ing journey that is guided by a facilitator with words,imagery and sometimes music or sound. You can try a ses-sion for free by accessing the link at the end of this article.

Mantra-Based Meditation: A mantra is nothing more than4a contemplative word, phrase or prayer that is softly orsilently repeated. It is not meant to be the focus of yourmeditation but a touchstone for attention when the mindbegins to wander. And it will wander, guaranteed. Allowthe repeated rhythm of the mantra to gently lull you intoan eased state.

Moving Meditation: Moving meditation involves doing an5activity that induces a “flow” state where you becomeunaware of time, space and outside circumstance. Youbecome completely entranced by the activity at hand thatproduces a relaxation response. The activities you engagein can be as varied as walking, cycling, gardening, paint-ing, yoga dancing, cooking and sports.

In summary, stress is one of the most under-valued issues tax-ing our health and wellbeing. An integrated approach to goodself-care is essential to our health and must include properdiet, exercise, sleep and stress management. Training yourmind to handle stress more productively is a great dose of pre-ventative medicine for anyone, at any age, in any condition.Meditation is one of the most efficient and scientificallyproven methods of stress reduction that has no negative sideeffects and does not negatively interact with any medications.So go ahead; be kind and gentle with yourself and meditate.With a little practice, it will become a permanent, welcomed,happy-making habit.

CREATING CALM CHALLENGE:We are offering a complimentary brief guided meditation to all magazine readers. To access our Mindful Meditative Moments series, visit http://www.youtube.com/watch?v=-iGsclpKHOI&feature=em-upload_owner or scan QR below.If you enjoy the meditation, you can sign up to receive an addi-tional six free Mindful Meditative Moments delivered daily toyour computer. These are roughly three minutes each and offera “stay-cation” at the click of a button. No reservations or travelrequired. S&W


TRAINING YOUR MINDTO HANDLE STRESSMORE PRODUCTIVELYIS A GREAT DOSE OFPREVENTATIVE MEDI-CINE FOR ANYONE, ATANY AGE, IN ANY CON-DITION.

“

“Lisa Robyn Deutsch


SCAN TO WATCH VIDEO >

WE ALL KNOW THAT GETTINGENOUGH SLEEP IS IMPORTANT.Sleep deprivation can have many undesirable consequences,including decreased alertness,impaired memory and cognitiveability, poor quality of life, anddecreased reaction time, whichmay lead to occupational or auto-mobile accidents. Chronic sleepdeprivation can also have seriouseffects on your long-term health,including increased risk of obesi-ty and diabetes.

But does poor sleep or sleep depri-vation cause obesity and/or dia-betes, or does being obese or hav-ing diabetes lead to poor sleep?Just like the classic question—“Which came first, the chicken orthe egg?”—the answer is actuallyboth. Studies have found that theless you sleep, the higher risk youhave of being overweight. Andbeing overweight increases yourrisk of developing type 2 diabetes.Several studies have shown thatsleep deprivation actually resem-bles insulin resistance1. There isalso a link between diabetes andsleep apnea, which is a sleep dis-order that disrupts your sleep dueto pauses in breathing.

Researchers in Sweden found that after one night of total sleep deprivation, subjects were more likely to purchase more food (and more calories) than thosesubject that were not sleep deprived. The researchers hypothesize that sleep deprivation impacts hunger and decision making when purchasing food2.

So, what can you do nutritionally to help you get a better night’s sleep? Here area few tips:

1. If you need to lose weight, do so with help from your doctor, regis-tered dietitian, and/or trainer. Getting to your ideal weight may eliminateyour diabetes.

2. Get enough exercise. Check with your doctor to get recommenda-tions on what kind of exercise and how much is good for you.

3. Eat properly throughout the day to keep your blood sugar under con-trol. When blood sugar is too high, your kidneys have to work hard to fil-ter it all, which may lead to extra trips to the bathroom in the middle ofthe night. Eating six small meals and snacks throughout the day is a goodidea. Also, include a lean protein in each meal or snack along with somecarbohydrates to help regulate your blood sugar.

4. Don’t go to bed either stuffed or hungry.

5. Avoid caffeine in the afternoon and evening. Caffeine is a stimulantand can take many hours to wear off.

6. Avoid alcohol (one glass of red wine is OK and is actually hearthealthy). Although alcohol may make you feel sleepy at first, it disruptsyour sleep pattern later in the night.

7. Consider taking melatonin. Melatonin is a natural hormone found inyour body, and researchers have found that it naturally peaks at night.Studies suggest that melatonin supplementation may be effective forshortening the amount of time it takes you to fall asleep (by about 12minutes) and may be more helpful the older you get. Check with yourdoctor before taking any supplements.

If you are at risk for diabetes, here’s the good news: Lifestyle changes canhave a powerful influence in staving off the disease. In fact, a major NIHstudy found that people can cut their risk of developing diabetes by 58 percent!3 Diet and lifestyle changes are essential for diabetes prevention.Even if you already have diabetes, the strategies outlined above can helplimit the damage, reverse the disease’s progress, and lessen the severity of symptoms.

Making small changes to your lifestyle and eating habits can have a bigimpact on your sleep, health and weight over the long run. If you have diabetes, controlling your blood sugar levels is important. If you havetype 2 diabetes, losing weight can do wonders!

A strategy that works well is to split up your caloric intake evenlythroughout the day. For example, if you are eating 1500 calories per dayyou can divide up your meals and snacks as follows:

Breakfast 300 caloriesMorning snack 200 caloriesLunch 300 caloriesMid-day snack 200 caloriesDinner 300 caloriesLate snack 200 calories

Here are three diabetes-friendly family dinner recipes that were created by meand some of the Biggest Loser contestants:

HEADMASTERCHEFSHARES RECIPES TOHELP WITH SEASONALDEPRESSION ANDDIABETES

BIGGEST LOSER S L E E P & W E L L N E S S

1 http://www.mayoclinic.com/health/sleep-and-diabetes/MY01597

2 “Acute sleep deprivation increases food purchasing in men.”Colin D. Chapman, Emil K. Nilsson, Victor C. Nilsson,Jonathan Cedernaes, Frida H. Rangtell, Heike Vogel, SuzanneL. Dickson, Jan-Erik Broman, Pleunie L. Hogenkamp, Helgi B.Schioth, and Christian Benedict. Obesity; (DOI:10.1002/oby.20579).URL: http://doi.wiley.com/10.1002/oby.20579

3 http://diabetes.niddk.nih.gov/dm/pubs/preventionpro-gram/index.aspx

One of the nation’s leading advisors on health and nutrition, Cheryl Forberg is a James Beardaward-winning chef and one of the few professional chefs in the country who is also a registereddietitian. She strongly believes you don’t have to sacrifice flavor to eat well and that eating wellcan change your life. She is the chef and nutritionist for NBC’s “The Biggest Loser” and has writtenmultiple bestselling cookbooks for the hit television show. Her latest book is “Flavor First: CutCalories and Boost Flavor” (Rodale). To learn more, visit www.CherylForberg.com.


Slaw2 teaspoons olive oil•1 medium yellow onion, finely chopped•1 tablespoon minced garlic•1 tablespoon chopped, peeled fresh ginger•3 cups finely shredded green cabbage•1⁄2 cup grated carrot•1⁄3 cup chopped cilantro, without stems•1 tablespoon low-sodium soy sauce•Salt to taste•

Pork4 (4-ounce) pieces lean pork tenderloin•1⁄4 teaspoon salt•1⁄8 teaspoon ground black pepper•1-1⁄2 tablespoons chopped cilantro +•cilantro sprigs as garnish1 teaspoon olive oil•

To make the slaw: In a large skillet, heat 2teaspoons of olive oil over medium-highheat. Add the onion and cook for about 2minutes, until softened but not colored. Addthe garlic and ginger and cook for 1 minutelonger. Add the cabbage and stir-fry forabout 2 minutes longer.

Remove the pan from the heat. Add the car-rot, 1⁄3 cup chopped cilantro, and soy sauce.Stir until combined. Season with salt, ifdesired. There should be about 2 cups ofslaw. Keep warm.

To prepare the pork: Place the pork ten-derloin between two sheets of heavy-dutyplastic wrap. With a meat mallet or rollingpin, pound each piece to an even 1⁄4" thick-

ness. Sprinkle with the salt and pepper.Dredge the pork in the chopped cilantro,pressing to make the leaves stick.

In a large nonstick skillet, heat the oil overmedium-high heat. Add the pork to the panand cook 2 or 3 minutes per side, untilopaque throughout and tender.

To serve: Place the pork on individual serv-ing plates and top with 1⁄4 of the Asian Slaw.Garnish with a sprig of cilantro, if desired.

Makes 4 servings per serving: 200 calories,2 g protein, 8 g carbohydrates (4 g sugars), 7 g fat (2 g saturated), 75 mg cholesterol, 2 gfiber, 210 mg sodium

PORK TENDERLOIN WITH WARM ASIAN SLAW 4Cilantro-crusted pork tenderloin is full of flavor. Paired with a zesty Asian slaw,

this dish is a delicious twist on the same old pork tenderloin.

4 Recipe and photo reprinted from: The Biggest Loser: 6 Weeks to a Healthier You: Lose Weight and Get Healthy For Life! by Cheryl Forberg, RD. Biggest Loser Experts and Cast Copyright © 2005. Permission granted byRodale, Inc., Emmaus, PA 18098. Available wherever books are sold or directly from the publisher by calling (800) 848-4735 or visit their website at www.rodalestore.com.

Directions2 tablespoons Dijon mustard•4 (4-ounce) boneless, skinless chicken•breasts, trimmed of fat and butterflied4 slices low-sodium ham•4 slices 2% Swiss or low-fat provolone•cheeseSalt and ground black pepper to taste•1 teaspoon fresh rosemary, chopped•1⁄4 cup fat–free, low-sodium chicken broth•

Spread the Dijon mustard evenly inside ofthe 4 pieces of chicken breast. In a smallnonstick skillet set over medium heat,quickly sear the slices of ham for about 30seconds on each side. Place the ham on oneside of each piece of chicken. Place 1 sliceof cheese folded in half over the top of theham. Fold over the butterflied chickenbreast to create a pocket. Tuck in thecheese to be sure it’s well concealed.Season each breast with salt, pepper, androsemary.

Lightly coat a skillet with cooking oil spray.Gently place each breast in the pan. Cookon medium to low heat for 6 to 8 minutes,

until golden brown—then turn over thebreasts and brown the other side. Once thechicken is fully cooked, remove it from thepan momentarily and drain any excessgrease from the skillet. Return the skillet tothe heat, add the broth, then place thechicken in the broth. Simmer for 3 or 4 min-utes. Serve immediately.

Makes 4 servings per serving: 220 calories,37 g protein, 2 g carbohydrates (0 g sugars),7 g fat (3 g saturated), 85 mg cholesterol, 0g fiber, 460 mg sodium.


ED & HEBA’S BLUE-Ribbon Chicken 5One night, when Season 6 Finalist Heba Salama was craving something Italian and her husband, Ed Brantley, was in the mood for the flavor rosemary, they put their heads together and came

up with this tasty dish. They already had all of the ingredients in the refrigerator!



Directions1 teaspoons sesame, canola, or olive oil•8 ounces lean pork tenderloin (or skinless•chicken breast or lean flank steak), diced1⁄2 cup fat-free, low-sodium chicken broth,•divided1⁄2 medium red onion, thinly sliced•2 tablespoons finely chopped shallots•2 tablespoons finely chopped ginger•2 tablespoons low-sodium soy sauce•1 tablespoon dark molasses•1 tablespoon Szechuan seasoning (see note)•1 cup cooked wild rice or brown rice•2 cups steamed broccoli•1 teaspoon toasted sesame seeds and 2•tablespoons chopped cilantro

In a nonstick skillet, heat the oil over medi-um-high heat. Add the pork and cookquickly until lightly browned but not fullcooked. Remove the meat from the pan andset aside. Add half the broth to the skilletand then add the onion, shallots, and ginger.Simmer for a few minutes, until softened.Add the remaining broth and the soy sauce,molasses, and seasoning. Bring the mixtureto a simmer and return the meat to the skil-let. Simmer for a couple minutes longer,until the meat is just cooked through. Serveover hot rice with broccoli. Garnish withsesame seeds and cilantro.

Note: Szechuan seasoning usually containsa combination of chile peppers, garlic, gin-ger, and Chinese spices. You can make yourown blend with 1⁄2 teaspoon garlic powder,1⁄2 teaspoon red chili flakes, 1 teaspoonground mustard, and 1 teaspoon groundcoriander.

Makes 2 (11⁄4-cup) servings per serving:360 calories, 34 g protein, 40 g carbohy-drates (11 g sugars), 8 g fat (2 g saturated),75 mg cholesterol, 7 g fiber, 610 mg sodium


SIZZLING GINGER PORK 6Though he usually loved to cook his family’s Italian recipes at the ranch, Season 9’s MichaelVentrella concocted this creation one night when I was there cooking with the contestants.It reminded him of a dish at his favorite Chinese restaurant. Michael used chicken, but you

can use turkey or, as in this case, lean pork tenderloin.


LIKE INSOMNIACS,

SAD SUFFERERSHOLDUNHELPFULBELIEFSABOUT SLEEP


Because they struggle with depression, individuals withSAD,like those with insomnia, may spend more time in bedbut not actually sleeping.

““

Written By Traci Pedersen Associate News EditorReviewed by John M. Grohol, Psy.D. on June 29, 2013


INDIVIDUALS WITH SEASONAL AFFEC-TIVE DISORDER (SAD) — a winterdepression linked to loss of motivationand interest in daily activities—tend tohave misconceptions about their ownsleeping habits, similar to those of insom-niacs, according to researchers at theUniversity of Pittsburgh.

The findings may lead to new treatmentsfor seasonal affective disorder that aresimilar to treatments for insomnia.

The researchers wanted to know whyindividuals with seasonal affective disor-der incorrectly reported that they sleptfour more hours a night in the winter,according to a previously published sleepstudy by the University of California,Berkeley.

“We wondered if this misreporting was aresult of depression symptoms, likefatigue and low motivation, promptingpeople to spend more time in bed,” saidKathryn Roecklein, Ph.D., primary inves-tigator and assistant professor in theDepartment of Psychology. “And peoplewith seasonal affective disorder havedepression approximately five months a year, most years. This puts a signifi-cant strain on a person’s work life andhome life.”

The research team interviewed 147 adults (ages 18 to 65) livingin the Pittsburgh metropolitan area during the winters of 2011and 2012. Data was collected through self-reported question-naires and structured clinical interviews in which participantswere asked questions such as the following:

• In the past month, have you been sleeping more than usual?

• How many hours, on average, have you been sleeping in the past month?

• How does that compare to your normal sleep duration during the summer?

To understand participants’ ideas about sleep, researchersasked the participants to respond to statements such as “I needat least 8 hours of sleep to function the next day” and “Insomniais dangerous for health” on a scale from 0 to 7, where 7 means“strongly agree” and 0 means “disagree completely.”

The findings showed that the misconceptions about sleep heldby SAD sufferers were similar to the “unhelpful beliefs” or per-sonal misconceptions about sleep that insomniacs often report.

Because they struggle with depression, individuals with SAD,like those with insomnia, may spend more time in bed but notactually sleeping, leading to misconceptions about how muchthey sleep.

These misconceptions, said Roecklein, play a significant role insleep cognition for those with SAD.

“We predict that about 750,000 people in the Pittsburgh metroarea suffer from seasonal affective disorder, making this animportant issue for our community and the economic strengthand vitality of our city,” said Roecklein. “If we can properly treatthis disorder, we can significantly lower the number of suffer-ers in our city.”

The researchers believe that psychotherapy could help managethese unhelpful beliefs about sleep and could lead to improvedtreatments for seasonal affective disorder.

Roecklin noted that one of the most effective insomnia treat-ments is cognitive behavioral therapy for insomnia (known asCBT-I), which is designed to help people take control of theirthinking as a way to improve their sleep habits as well as theirmood, behavior, and emotions.

...ONE OF THE MOSTEFFECTIVE INSOM-NIA TREATMENTSIS COGNITIVEBEHAVIORAL THER-APY FOR INSOMNIA(KNOWN AS CBT-I).

“

“ S&W

http://psychcentral.com/news/2013/06/30/like-insomniacs-sad-sufferers-hold-unhelpful-beliefs-about-sleep/56616.html

IN MAY OF 1976, I WOKE UP ONE MORNING TODISCOVER I HAD HAY FEVER, A SIGN I NOWKNOW MEANT THAT MY IMMUNE SYSTEM WASBREAKING DOWN. For the next few years, my aller-gies would appear every May like clockwork. Ithought it was something I would just have to acceptand live with, but years later I realized I was wrong.My allergies took on a new dimension in 1983 whenI developed a condition called candida – a bacterialgrowth in my gastrointestinal tract. To bring it undercontrol, I adopted a special diet that consisted ofavoiding fermented foods and foods high in whitesugar, white flour and dairy. Unfortunately, the can-dida suppressed my immune system even more,which caused me to develop asthma at the age of 32.

I began to follow the same regimen as most peoplesuffering from asthma. I avoided anything that could

cause an allergic reaction, including spring grass,trees, dust mites, laughing (no joke), dog dander andvigorous exercise – especially in cold weather. Theselast two issues were troublesome because I had a dogthat I was not about to give up and I was an avid run-ner. My immune system was further compromisedby the fact that I had been suffering from chronicinsomnia for seven years. Getting insufficient sleepwas leaving me exhausted.

A year later, I was controlling my asthma with thefrequent use of puffers – one to open up the airwaysand another to break down mucus in my lungs.These were the only options presented to me at thetime and, while I was thankful they were available, Iwas disappointed because doctors told me that Icould only control the symptoms of asthma, neveractually eliminate the condition.


C A S E S T U D Y

ASTHMAHOW I ELIMINATED MY

Written By Rick Tufts, C.N.P.

During this time, I had to go to Boston for a businesstrip. Before I left, my asthma was particularly bad butI foolishly decided to fly anyway, disregarding mycondition. During the plane’s descent into Boston, Iexperienced a serious asthma attack. It was, by far,the most terrifying experience of my life. I was gasp-ing for every breath I could drag into my lungs, andmy puffer was having no effect whatsoever. Therewas nothing anyone could do until I was off theplane. Within 12 hours of landing in Boston, my fam-ily checked me into a hospital, where I stayed forover four days with a mask over my face pumpingmedication into my lungs so I could breathe. Evenwith such drastic measures, it took two days beforemy breathing started to normalize. After four days, I was released from hospital and, following a fewdays of recuperation with my family, I flew back to Toronto.

Breathing is something we all take for grantedbecause it happens so effortlessly. But as any asth-matic can tell you, a severe asthma attack can leaveyou struggling for every breath and make you awareof the fragility of life. I knew I had to find a better wayto deal with my asthma. It was devastating my life,and it was getting worse.

A friend suggested I talk to a medical doctor who waspracticing alternative medicine at the time. I wasdesperate to help my asthma and allergies, so Idecided to see the holistic doctor. The doctor per-

IF I WANTED TOELIMINATE MY

ASTHMA, I WOULDHAVE TO STOP CON-

SUMING DAIRYPRODUCTS MADE

FROM COW’S MILK,SUCH AS MILK AND

CHEESE, ALTHOUGHNON-FLAVORED,

ORGANIC YOGURTWAS FINE.

“

“

CONTINUED >>


NormalBrochialTube

InflamedBrochial

Tube of anAsthmatic

formed acupuncture on me for 20 minutes and, 10 minutesafter that, every allergy symptom I had been feeling was gone. Icouldn’t believe it. I remained symptom-free for the rest of May.Although my asthma wasn’t eliminated, the worst was over. Istill had to use my puffer before I went for a run but, except forthat, I was basically symptom-free.

The following spring, my symptoms returned. I went back tothe same doctor who again used acupuncture, but it didn’t helpthis time. On my second trip to his office, he recommended aseries of ozone treatments – a treatment that remains contro-versial to this day. It works by increasing the oxygen level inthe blood, making it very difficult for viruses and bacteria tosurvive. After six treatments over three weeks, my asthma sub-sided dramatically.

THE ROLE OF NUTRITIONMy doctor then made the first nutritional recommendation Ihad ever heard for asthma. If I wanted to eliminate my asthma,I would have to stop consuming dairy products made fromcow’s milk, such as milk and cheese, although non-flavored,organic yogurt was fine. Until that point, I had been consuming

1 to 2 quarts of milk per day for most of my life. I loved it, and itwas a staple of my diet; nonetheless, I immediately eliminateddairy products from my diet. Over a period of months, my asth-ma gradually improved.

For the first time since I developed asthma, I was beginning tounderstand that I could improve my condition, primarilythrough nutrition. I also began to wonder what other changeswould help eliminate my symptoms. While I never reallybelieved I could eliminate my asthma completely (since I wastold this by doctors), I started to read everything I could onnutrition, especially as it pertained to asthma. I learned thatasthma is primarily the result of the asthmatic’s immune sys-tem being severely weakened. The immune system can be com-promised by eating too much processed food (foods high inwhite sugar, white flour, dairy, etc.) and not enough whole, nat-ural foods like vegetables, fruits, whole grains and legumes.When poorly nourished, our body will break down one way oranother. In my case, it happened to be asthma. With other peo-ple, it could be cancer, arthritis, eczema, or any one of a numberof conditions. I also learned how the nutritional value of ourfood supply has been severely compromised and, as a result,conventional fruits and vegetables today have a fraction of thenutritional value they had a number of years ago. This hasfuelled the demand for more organic produce as well as vitaminand mineral supplements to optimize our nutrient intake.

From approximately 1985 to 1995, I experienced gradualimprovements in my asthma as I improved my diet. The monthof May continued to be my bad time, as the trees and grassescame into season and their impact was dramatic enough thatnot even my puffers would allow me to run outdoors during thisperiod. Then I was introduced to the wonders of juicing. I dis-covered that by juicing and drinking raw, organic juice everyday, my spring allergies disappeared—allergies that had beenwith me for almost 20 years! As a result, not only could I runoutside, I could run without my puffer. My lungs would be a lit-tle tight for the first mile and then they would open up and befine for the rest of my run. However, during cold weather, Iwould still have to use my puffer. This experience made memuch more aware of the importance of the immune system andour ability to strengthen it through nutrition.

By early 1996, I felt I had done as much as I could with my asth-ma. The only time I needed the puffer was when I ran in coldweather. And then I made two changes simultaneously. I startedusing better quality vitamin supplements, including vitaminsC, B-complex, beta carotene and a multivitamin. I also begantaking psyllium as a fiber supplement. Within six weeks of mak-ing these changes I discovered, in the cold weather of February,that I could run as fast as I wanted without the use of a puffer.My asthma was completely gone. It was a day that completed a15-year journey of recovery. Had I known then what I knownow, I may have been able to eliminate my asthma in threemonths or less.

By 1997 I had become quite passionate about the power ofnutrition, and I decided to pursue it as a career. I gave up a salesand marketing career to study nutrition at The Institute ofHolistic Nutrition in Toronto. Upon graduation, I discoveredthat I still had lessons to learn about asthma.

In May of 1998, my spring allergies came back, quickly followedby asthma. I was dumbfounded that this could happen, but Ithen realized I must have changed something in my diet thathad weakened my immune system. I reviewed the last year andrealized the only major change I had made was the introductionof soy milk into my diet. When I stopped drinking it, my asthmastarted to disappear and within three weeks, it was completelygone. I went on to discover that soy milk has to be pasteurized(cooked) even more than cow’s milk to be sold at retail. Theresult is a food that is almost devoid of live enzymes and, as aresult, is very hard for the body to process and digest. Soy milkshould be consumed in limited quantities only – especially bythose suffering from respiratory problems.

My asthma came back in 1999 and, again, I had to figure outwhere I had gone wrong. I discovered that some of the carrots Ihad been juicing had traces of mold to which I was quite allergic.Within two weeks of discontinuing their use, my asthma disap-peared again. These experiences taught me a valuable lesson.Asthma can return, but only if you become careless and dosomething that compromises your immune system. Since thattime, I have helped a number of people eliminate their asthma.While not everyone’s situation is exactly the same, there are cer-tain fundamental issues that must be considered and addressed.Could all sufferers eliminate their asthma? I suspect most could,but only if they are willing to make changes in their lifestyle,especially in respect to nutrition and exercise. That is very diffi-cult for most people to do but can be very rewarding. S&W


C A S E S T U D YI went on to discover that soy milk hasto be pasteurized (cooked) even more thancow’s milk to be sold at retail.

““


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United Sleep Diagnostics, Inc2241A N. University Dr.Pembroke Pines, FL 33024Phone: 954-442-8694Fax: 954-442-8695www.unitedsleepdiagnostics.com

St. Patrick Hospital Sleep Center isaccredited by the American Academy ofSleep Medicine. We have two Board certi-fied Sleep Physicians and a team of RPSGT,RRT, R.EEG T., CRTT, and LPN staff. We arelocated between Glacier and YellowstoneParks in Missoula, a major medical hub inwestern Montana.

Our 4 bed sleep lab, and full neurodiag-nostics dept., are here to serve the needsof our community and surrounding area.

St. Patrick HospitalSleep Center/Neurodiagnostics ServicesMissoula, MT 59802406-329-5650www.saintpatrick.org

As a comprehensive center, The SleepDisorders Center of GwinnettPulmonary Group deals with the diagno-sis and treatment of all sleep disorders.The most common disorders areObstructive Sleep Apnea Syndrome,Narcolepsy, Periodic Limb MovementDisorder, Restless Legs Syndrome, andInsomnia. Please contact us anytime! Welook forward to hearing from you.

Gwinnet Sleep Center631 Professional Dr., Suite 350Lawrenceville, Ga 30046Phone: 678-942-5982Fax: 770-623-1485www.gwinnettsleep.com

MNAP Sleep Disorders Center bringstogether Board-Certified Sleep Specialistsand staff to diagnose problems in an advanced, 4-room, sleep center. While patients sleep, PolysomnographicTechnologists observe the sleep patternsin a separate room. Brain activity, breath-ing patterns, muscle activity, and heart-beat are monitored. MNAP Sleep DisordersCenter can improve patients' health andquality of life by diagnosing a full range ofdisturbances.

MNAP Diagnostic Center9908 E. Roosevelt Blvd.Philadelphia, PA 19115Phone: 215-464-3300 ext.1345Fax: 215-464-0835www.mnap.com

The Sleep Institute of Utah and its teamof Board Certified Sleep Specialists,Registered Sleep Technicians, andRespiratory Therapists are here to takecare of all of your sleep disorders. Ourservices are range from PhysicianConsultations, In-Lab Sleep studies, In-Home Sleep Studies, to DME homecare.We have six convenient locations through-out the Wasatch front – call us today soyou can start sleeping better tonight.

Sleep Institute of UtahPhone: 866-716-6117Fax: 866-719-6117www.sleepiu.com


S L E E P S P E C I A L I S T I N Y OUR A R E A , G U I DNG YOU TO B E T T E R S L E E P

St. Vincent Hospital’s Regional SleepDisorders Center is accredited by theAmerican Academy of Sleep Medicine(AASM). The Center provides a full range ofdiagnostic and treatment procedures fordisorders of sleep and maintaining wake-fulness for both children and adults.

St. Vincent Regional Sleep Disorders Center1821 S Webster AveGreen Bay, WI 54301Phone: 920-431-3053Richard Potts DO, FCCP,FAASM- Medical DirectorMarla Van Lanen RRT RPSGT, [email protected]

Central Washington Sleep DiagnosticCenter is a specialized medical facility. Ittreats all varieties of sleep disorders in adultsand children, including but not limited to,insomnia, narcolepsy, obstructive sleepapnea, and complex sleep apnea, all withthe goal of getting people rested, healthyand back to a normal, productive life.Accepting most Insurance and Medicare.

Eric Haeger, MDBoard Certified Sleep MedicineCentral Washington Sleep Diagnostics Center410 Washington StWenatchee, WA 9880Phone: 509-663-1578www.cwsleepcenter.com

THE SLEEP CORNER

A speciality medical practice devoted toSleep Medicine, Neurology, and ClinicalResearch Trials. We offer three convenientlocations in the Greater Houston area.

Cypress • Katy • Memorial

"Improving the Quality of your Life byImproving the Quality of your Sleep"

Houston Sleep & Neurology Consultants

Todd J. Swick, MD, ABSM,Medical DirectorHouston, Texas713-465-9282 www.houstonsleepcenter.comwww.toddswickmd.com

Roper St. Francis Health Sleep Center islocated in Charleston, South Carolina.We are a 10-bed Sleep Center testing atvarious facilities within the Roper St.Francis Healthcare System. Our RoperHospital Sleep Center in downtownCharleston is accredited by the AASM,recently receiving reaccreditation for 20years now. We have 9 board-certifiedsleep specialists with our Center and allRPSGTs on our clinical staff.

Roper Hospital843-724-2000316 Calhoun StreetCharleston, SC 29401 www.ropersaintfrancis.com

We are fully AASM accredited 6-bedroomSleep Disorders Center with additionalOCST accreditation. We are also Center-member of National Sleep Foundation. Weoffer unsurpassed patient access andcomfort, state-of the art diagnostic andtreatment resources and professionalservices provided by the board certifiedsleep specialists.

BMC SleepDisorders Center165 Tor CourtPittsfield, MA 01201Phone: 413-447-2701Fax: 413-447-2101www.berkshirehealthsystems.org

Athens Center for Sleep Disorders pro-vides a comfortable and convenient alter-native to hospital-based sleep studies. Weprovide an environment that is soothingand inviting, with comfortable amenitiesand friendly, welcoming faces.

Athens Center for Sleep Disorders is thefirst sleep disorders center in HendersonCounty to be eligible for accreditation bythe American Academy of Sleep Medicine.

Athens Center704 South PalestineAthens, TX 75751Phone: 903-675-1717or e-mail: [email protected]: 903-675-3338www.athenssleepcenter.com

Gergens Ortho and Sleep Appliance Labis family owned and has serviced theUnited States since 1985. Based out ofPhoenix, we employ over 45 tech andsupport personnel. We fabricate ortho,pedo, TMJ and Sleep Apnea appliancesWe have built our reputation on greatquality, customer service, and havingknowledgeable technicians. Our cus-tomers from across the United Statesshare a common characteristic: Theygenuinely care about their patients andwant them to have the finest dental appli-ances available.

1745 W. Deer Valley RoadBuilding 1, Suite 112Phoenix, AZ 85027

Houston Sleep& Neurology Consultants

Chase Dental SleepCare is a treatment-oriented facility, which concentrates onsleep apnea, snoring and sleep breathingdisorders. There are several convenientlocations for patients to visit. Each prac-tice is equipped with state of the art tech-nology, knowledgeable staff and Dentiststhat treat all patients with above standardcare. If you or someone you know suffersfrom Sleep Apnea or Snoring, or cannottolerate their CPAP machine, please callto schedule a free consultation.

Chase Dental Sleepcare Headquarters324 South Service Road, suite 116Melville, New York 11747Tel: 631 393 6888www.ChaseDentalSleepCare.com

Most sleep problems can be treated andsome even cured with expert evaluationand appropriate treatment. The SleepDisorders Center at McKay-Dee Hospitalutilizes the latest technology in diagnosingand treating sleep/wake disorders.

Talk with your doctor, or call (801) 387-2700 to schedule an appointment and getmore information.

Sleep CenterMcKay-Dee Hospital Center4401 Harrison Blvd.Ogden, UT 84403Phone: 801-387-2700www.intermountainhealthcare.org/hospitals/mckaydee/services/sleep-center

Documents

Sleep&Wellness Magazine - Diabetes Issue