Rabbott Tracks: August 2015

Six months into my 3^rd year rotations and I continue to be amazed everyday with the unique ability of most humans to work through and ignore obvious physiologic signals trying to say that enough is enough, you need some rest! The current culture within Western medicine is centered around strength and fortitude, and more often than not, I hear individuals feeling the need to “brag” about the number of hours that they have been continuously awake, functioning, and “performing” the necessary medical tasks required. Despite the work hour restrictions placed on resident physicians, the truth is they work long hours on irregular cycles, and inevitably, share amongst other residents/interns, a periodized schedule of night shifts. Throw in the fact that the hospital is by no means a stress-free environment and one can quickly see that modern health care, as is carried out in most academic medical centers, is made for anything but health. Perpetuating the perception that working more means you are a better physician or that acknowledging fatigue and distress simply means your are too weak for this job is only doing the health care industry more harm. Stepping down from the soap box, I hope this evolving insight will provide a little context for the main topic of this post: SLEEP!

The realization that sleep is an absolutely essential component of health is nothing new. I love hearing the hard charger’s mantra “I’ll sleep when I’m dead,” because the reality is, acute sleep deprivation WILL KILL YOU before dehydration or malnutrition stop your organs in their tracks. To put it in another way, you can survive longer without food and water (considering you are not completely exposed in Death Valley during the summer months) than you can without sleep. For years, epidemiologists have been tracking, though numerous retrospective and cohort studies, the strong associations between sleep deprivation and shift work to nearly every pathologic disease process including: metabolic disturbance, cardiovascular disease and even cancer. So we know we need sleep to be healthy, but why suddenly does it seem like every holistic, functional and traditionally trained family doctor is urging his or her patients to make sleep a number one priority? Just as with most pathologic “disease” treatment within the current system, there isn’t a problem worth treating until it is incredibly DISABLING or LARGE ENOUGH to warrant the serious interventions we have studied and KNOW to be effective. As far as sleep is concerned, Americans have gradually been sleeping less over the past 50 years, such that, as a whole, we are now sleeping between 1.5-2 hours LESS every day. When you consider that the average individual needs from 7-9 hours per night, 2 hours of lost sleep from the average of 8 hours is a 25% reduction. That might not seem like a lot, but the scary reality is that due to the nature of our sleep cycles, cutting hours of sleep isn’t as simple as first grade subtraction. One may disproportionately lose a greater fraction of restorative, deep, slow wave sleep in addition to compromising REM sleep, and establish irregular intervals of early stage 1 and 2 sleep. While this post is not meant to focus on the scientific and technical aspects of sleep, I do want to make it clear that when it comes to sleep 8-2 ≠6.

So yes, since chronic disease is disabling millions of Americans and we are now aware that most Americans are sleeping significantly less than they should, sleep has become a problem worth treating. And of course, what do we turn to when it comes to treating insomnia or poor sleep: PILLS. Doctor Kirk Parksley has become one of the most prominent researchers, clinicians and advocates for recognizing insomnia and poor sleep as one of if not THE most important public health concern facing our nation- even more than the DIABESTIY EPIDEMIC that seems to get more media attention than the NFL in April. Poor jokes aside, the treatment of choice for insomnia and disturbed sleep is a class of drugs affectionately called the “Z drugs.” Structurally similar to the anti-anxiety/sedative drugs known as benzodiazepines, the “Z-compounds” which include: Ambien, Sonata and Lunesta are more selective for certain receptors such that they induce more sustained “sedation/hypnosis” than the traditional anxiolytic medications. Parsley comments; however, that the “sleep” induced by these “Z compounds” is entirely anything but actual sleep. The brain wave patterns (EEG) and overall polysomnography observed for people using these drugs resembles that of an unconscious zombie knocked out with a sledgehammer. The normal sleep architecture and pattern is non-existent and the idea of actually getting restorative slow wave sleep is entirely fictitious. To make matters worse, due to their chemical and structural “differences” from the benzodiazepine drugs, the “Z compounds” are considered to have no potential for dependence, abuse or addiction. If you ask Dr. Parsley or other clinicians specializing within the field of sleep medicine, they would laugh you off of the face of the Earth if you believed the chemists and pharmaceutical companies explanation of the drug's mechanism of action, risks and benefits. Working within the field of military medicine, and more specifically with the Navy Seals, Dr. Parsley has commented in numerous blog posts, videos and podcasts the struggle to get soldiers off of their absurdly high routine dosages of ibuprofen, acetaminophen and Ambien. I have provided links to some of his best articles, his current sleep promoting supplement and a TedTalk regarding this growing problem below.

1. Sleep Cocktails: http://www.sleepcocktails.com/

2. How we are wired to sleep; Part 1 of 3: http://robbwolf.com/2015/06/01/how-we-are-wired-to-sleep-and-why-we-have-sleep-problems/

3. America’s Biggest Problem: https://video.search.yahoo.com/video/play;_ylt=A2KLqIIBB9lVGEAAvnEsnIlQ;_ylu=X3oDMTByZWc0dGJtBHNlYwNzcgRzbGsDdmlkBHZ0aWQDBGdwb3MDMQ--?p=Ted+Talk+Kirk+parsley&vid=2f2c30842bea0c0d6bd16679473cbf33&turl=http%3A%2F%2Ftse2.mm.bing.net%2Fth%3Fid%3DWN.A4obMSH3byr2mf3zehcCeg%26pid%3D15.1%26h%3D168%26w%3D300%26c%3D7%26rs%3D1&rurl=https%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3D7s9C_8-OoxI&tit=America%26%2339%3Bs+biggest+problem+|+Kirk+Parsley+|+TEDxReno&c=0&h=168&w=300&l=1042&sigr=11bsa82ov&sigt=11n4t4ags&sigi=12lumiqq9&age=1410188665&fr2=p%3As%2Cv%3Av&fr=yhs-mozilla-002&hsimp=yhs-002&hspart=mozilla&tt=b

So now that we know that these medications are clearly not the answer, what exactly should the average American focus on to improve their sleep? Rather than try to re-invent the wheel, I will provide you with links to some of the best resources, education, advice and programs for improving sleep. Obviously, there are hundreds of ways to go about improving sleep hygiene from modifying your daily habits to taking supplements, and I have tried to provide a selection of resources from some of the best practitioners and researchers currently available across this spectrum. In my next post I will share my own experience and experiment with sleep during a few weeks of night shift work during my pediatric and obstetric rotations. Enjoy the reading and watching, but more importantly get some better sleep!

Reference and Resources

1. Sleep Habits for Shift Workers

“Surviving the Night Shift” Nom Nom Paleo: http://nomnompaleo.com/post/55156756199/surviving-the-night-shift

2. Sustainable Behavior and Habit Change

“Dan’s Plan” Dan Pardi

https://www.dansplan.com/company/company-information/our-team

3. Alternative Medication for Insomnia

“Sleep Cocktails” Dr. Kirk Parsley and Robb Wolf

http://www.sleepcocktails.com/pages/product

4. Understanding Sleep

“How Much Sleep Do You Need?” Guest Post by Dan Pardi- Chris Kresser’s Revolutionary Health

http://chriskresser.com/how-much-sleep-do-you-need