Six months into my 3rd 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/
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
3.
Alternative Medication for Insomnia
“Sleep
Cocktails” Dr. Kirk Parsley and Robb Wolf
4.
Understanding Sleep
“How Much Sleep
Do You Need?” Guest Post by Dan Pardi- Chris Kresser’s Revolutionary Health
5. Sleep Hygiene
“Sleep” Guest Post by Evan Bran-
Paleo Mom
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