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5/27/20

Is Your Sleep as Good as It Can Be?

Sleep is restorative. Cellular repair, cleansing processes, wound healing, fighting off bacterial and viral infections, consolidation of memories, problem solving, emotional processing, are just some of the processes that kick up in overdrive while asleep.

Less than 1% of us can get away with sleeping fewer than 5 hours per night. For the rest of us, young and old alike, 8 hours per night seems to be the sweet spot of quantity of sleep needed. Together with the appropriate quantity of sleep, the appropriate quality of sleep is also important for passing through all the stages of sleep. If you have sleep apnea for instance, you may be waking up dozens of times throughout the night, which results in sleep of very poor quality, although sufficient quantity.

Poor sleep quality, or too little (less than 6 hours per night) or too much (more than 9 hours per night) sleep can result in diabetes, Alzheimer’s disease, poor emotional balance and poor motor learning.

Our sleep cycles are approximately 90 minutes. The first kind of sleep is non-REM (non-rapid eye movement), which has four stages with increasingly deeper sleep and slowing down of brain wave frequency. Non-REM sleep is followed by REM sleep, the time when we typically dream.

So how do you know you are getting enough sleep? If you cannot wake up in the morning without an alarm or you feel sleepy before lunch, either you are not getting enough sleep or your circadian rhythm is altered.

With aging, the slow-wave sleep stage of non-REM sleep is reduced. Early night REM sleep increases. Restless leg syndrome causes interruption of sleep. Disordered breathing, including sleep apnea is also common. Sleep disturbance in the elderly causes memory loss and physical and psychiatric illnesses, including depression, neurodegeneration and mortality.

In aging women, menopausal symptoms like night sweats and hot flashes cause sleep disturbances that can last 7 years or more.

Hormone replacement therapy, among other benefits, improves sleep.

In aging men, hormone replacement therapy can also have a beneficial impact on sleep quality and duration.

I hope that even this necessarily short analysis of the importance of sleep convinced you. Let’s all be honest with ourselves: how many of us actually get good, restorative sleep?

This blog is not going to get into the weeds of treatment for sleep disorders. We will have other dedicated blogs for that. Instead, this blog is about an exciting new addition to our Precision Medicine evaluation and treatment.

This week, we are launching our new Sleep Matters program. Why? Because sleep is an essential part of health. It is an essential metric to be measured and analyzed as part of our Anthropometric Analysis (remember the ABCs of Precision Medicine?) and it ties very nicely into our Cognitive evaluation.

Now, our other leading principle is to make being healthy affordable. Money should not be a barrier to entry into the world of prevention medicine. Traditionally, sleep studies require the patient to spend at least one night in a sleep study facility, hooked to numerous wires, in a foreign, strange environment. For that privilege, you are charged between $4000-8000!

We have a much simpler and affordable strategy: first, you fill out a page-long screening form; second, if you are at risk, we provide you with a disposable device that you take home with you, connect to you smartphone, and wear for one night while you sleep in your own room, in your own bed, with your own pillow/dog/cat/etc. Third, we download the data from your phone, and it is read by a Board-certified Sleep Medicine physician; Fourth, you follow up with us, discuss the results, and, depending on the severity of your problem, we refer you for the appropriate treatment, ranging from a simple mouth device, to a continuous positive air pressure (CPAP) device or even a consultation for surgery if needed.

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The cost? Maximum $250 out of pocket. We will work with all insurance carriers, including Medicare to cover the rest of the cost.

This strategy will be intuitive to anybody who has had a wearable device - Apple watch, Garmin devices, FitBit, Whoop, Oura rings, etc. It will require no expertise on your part and will provide at least 90% of the data available from those $4-8000 sleep studies.

I believe this is a big step toward health and wellness, especially for our patients who are in pain. We know how chronic pain, opioid use, etc, can disrupt sleep and how lack of sleep can exacerbate painful symptoms.

We attach the screening page. If you are interested, print it, fill it out and send it to us: take a picture of it and email it to us, or fax it, scan it, heck, even put it in the mail!

If you are not ready now, no pressure: we will be asking you about your sleep a lot more, now that we have palpable, affordable, proven treatments.

Link to Sleep Assessment Form

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