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Weight, what does sleep have to do with it, have to do with it?!?!?!?!


More than 78 million adults (or 35.7%) and more than 12.5 million children (or 16.9%) in the U.S. are classified as obese. By increasing the risk for cardiovascular diseases, Type 2 diabetes and most cancers, obesity contributes to 1 in 10 deaths, making it the second leading cause of preventable death in the U.S. Obese individuals with diabetes or high blood pressure have a 26% greater risk of death than healthy-weight individuals.

You know that old song, “the thigh bone is connected to the leg bone”. Well, with sleep, “the sleep bone is connected to the weight bone”, so to speak.  Interruptions in sleep may contribute to hormonal changes and fatigue, which may result in less exercise, increased appetite, insulin resistance and diabetes.

Body Mass Index (BMI) is calculated from a person’s weight and height and correlates to measures of body fat. A BMI of greater than 30 is considered obese. Two thirds of people with obstructive sleep apnea (a sleep disorder characterized by loud snoring with repetitive blockage of the upper airway causing arousals from sleep) are obese. Interestingly, neck circumference (your shirt collar size) is associated with obesity and appears to be a risk factor for obstructive sleep apnea (greater than 16 inches for women and greater than 17 inches for men). Losing 10-20% of total body weight can improve the severity of underlying obstructive sleep apnea

Here’s an interesting tidbit. Did you know the timing of food intake, in relation to our internal body clock and the time we sleep, can predict weight gain and weight loss? In an experiment where mice were forced to eat only during the day, the reverse of their normal nighttime eating habits, the mice gained two and a half times more weight, even when their caloric intake remained unchanged. The message to us as humans:  “If you eat earlier and don’t graze with food and snacks after dinner, you’ll be more likely to lose weight”.   Even the timing of when you go to sleep can affect weight. Studies have shown that even changing your sleep schedule on the weekends, the way many of us do by shifting to a later sleep time on a Friday and Saturday night, can contribute to obesity. Not getting enough sleep can contribute to weight gain. A sleepy brain appears to not only respond more strongly to junk food, but also has less ability fight the impulse to eat more, less healthy foods. Remarkable as well is the observation that sleep disturbances in children with sleep apnea my lead to either weight gain or even a “failure to thrive” with actual weight loss.  

Medical research has recently discovered specific hormones which effect weight and appetite. Leptin comes from adipose cells (fat cells) and normally signals satiety = “makes you feel full”.  Ghrelin is another hormone (from the GI digestive tract), which signals increased appetite, tells you to “eat more”.  Stanford University and the University of Wisconsin looked at about 1,000 volunteers who reported the number of hours they slept each night. Doctors then measured their levels of ghrelin and leptin and charted their weight. The result: those who slept less than eight hours a night not only had lower levels of leptin (felt less satiety or less full) withhigher levels of ghrelin (increased appetite), but they also had a higher level of body fat. What’s more, the level of body fat seemed to correlate with their sleep patterns. Specifically, those who slept the fewest hours per night weighed the most.

Parasomnias are sleep disorders defined as “undesirable physical events or experiences occurring during or around sleep”. The typical example is sleepwalking. Well, there exists a phenomenon known as aSleep Related Eating Disorder” characterized by episodes of involuntary eating and drinking during arousals from sleep with no memory of the events.”  We believe this may be a variant of sleep walking and is more common in women than men. It can occur during any time in the sleep cycle with people often eating peculiar forms or combinations of food. The good news is it’s often very treatable.

Dr. Matthew P. Walker, professor of psychology and neuroscience at the University of California, Berkeley seems to have summed it up quite well when he stated,

“It is increasingly clear from the medical literature that there is not a single tissue in the body that is not beneficially affected by improved sleep.  It’s the single most effective thing people can do every day to reset their brain and body health.”


-Dr. Timothy L. Grant, M.D., F.A.A.S.M.

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Is Sleep The New Sex? No, No, No, It’s Much More Important!


Some of us take sleep for granted, those who claim they fall asleep like a baby “as soon as their head hits the pillow”.  I remember my grandfather informing the rest of the family of how he only needed 3-4 hours of sleep and could function “just fine”. However, he was always the one napping on the couch or slumped in a chair snoozing during a family get together. Interestingly, to us as sleep specialists, falling asleep immediately as you lay down for the night, or dozing off inadvertently during the day may be a sign of sleep deprivation. In fact, the most common cause of daytime sleepiness it just not getting enough sleep at night.

Famous politicians have long boasted on how little sleep they needed. Most humans need 7.5-8 hours of sleep to awaken on their own feeling refreshed and alert. Only a very small percentage of the population is what we call “short sleepers” and can function well with 5 hours or less of sleep. If you looked up sleep in the dictionary you’d see it is defined as “a condition in which the eyes are usually closed and there is little or no consciousness”.  We now know the brain can be even more active in sleep than when awake. It uses more oxygen during the deepest stages of sleep than when you’re sitting at your desk working. Some mammals including dolphins and whales can sleep with only one side of the brain and be awake on the other side of the brain.  You’d think that would be nice if we could do it although if our bosses found out, they might just make us work a longer shift.

Sleep is to humans what gas is to a car, what water is to plants, it fuels the brain. During sleep we shuffle and sort out our memories and recharge the brain and its important functions. Sleep recharges our batteries. Sleep deprivation can have the same effect on brain function as driving when you’re drunk. It can slow down your reflexes, promote poor decision making, and increase the chances of reckless and unsafe decision making. Just ask a rat if sleep is important. Indeed, if you deprive a rat of sleep for a month or so, they will perish and die. Let’s give thanks we are not rats. However, you cannot underestimate the importance of sleep.

Oh, don’t get me wrong. Sex can be rejuvenating. But just talk to the young couple whose newborn has kept them up for weeks and months on end. What would they wish for on a vacation? Well, I can’t speak for others although a great night’s sleep might just be the new sex for them. So just lean your head back on that chair and ponder, “Is sleep the new sex, or nay I say it, even more important!”

-Timothy L. Grant, M.D. – Neurologist and Sleep Specialist

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Better Sleep: Insomnia

Insomnia as a condition characterized by any combination of difficulty falling asleep, staying asleep, or awakening too early in the morning and feeling unrefreshed.  According to the National Sleep Foundation, almost half of adult Americans reports they experienced difficulty falling asleep at one point in their lives.  Insomnia is the most common sleep disorder, affecting about 12% of the population at any given time, or about 32 million people.  More women than men are affected.  Older adults become less efficient with her sleep and can experience more frequent insomnia.  Transient, or short-term insomnia, can often be treated quite easily or may resolve spontaneously on its own.  Chronic, or long-lasting insomnia, is often more difficult to resolve.  It is often associated with many other medical and psychological illnesses, including depression.  It can also occur in patients with other sleep disorders such as restless leg syndrome, sleep apnea, (difficulty breathing during sleep with associated snoring), and narcolepsy (an illness associated with excessive daytime sleepiness).

Symptoms of insomnia may include anxiety, fatigue, difficulty concentrating, drowsiness, forgetfulness, irritability, headache, low energy, weight gain and increased blood pressure. Often, treatment entails simply embracing better sleep hygiene, or better sleep habits.  Often, only a brief course of over-the-counter or prescription medication is necessary.  For chronic insomnia, the best treatment is often a combination of medications and cognitive behavioral therapy (relaxation techniques and reinforcement of better sleep habits).  A sleep specialist can advise what is best for your individual case, including the risks and rationale of various medications and supplementations.

In order to ensure good sleep, it is important to have good sleep habits.  Often simple changes in your daily routine can improve your sleep.

Here are a few simple tips:

•           Avoid caffeine within 10 hours of bedtime.  Avoid alcohol and smoking, especially one or 2 hours before bedtime.

•           Exercise regularly.  Strenuous exercise should be avoided 3 hours before bedtime.

•           Don’t take naps, or limit them to 30 min.

•           Establish pre-sleep rituals, like a warm bath or reading.

•           Go to sleep only when you are sleepy and use your bed for sleep only, not as an office or place to watch television.

•           Get up about the same time every day, regardless of when you fall asleep.

•           If you can’t sleep, don’t stay in bed fretting.  After 10-15 min., go to another room and read until you feel sleepy.

Contact your physician if you:

•           Remain unable to fall asleep.

•           Can’t stay asleep.

•           Sleep at night but consistently feel sleepy during the day. You may have a separate medical problem that is preventing normal sleep patterns.

-Dr. Tim Grant M.D. – Neurologist and Sleep Specialist

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The Secret Link Between Snoring and Fatigue



Snoring is portrayed as the sign of a sound sleeper – we can see it in the movies, in cartoon characters and even children’s books. However the snoring sleeper may not be catching z’s all that soundly – no pun intended. In reality the sound of snoring may be an indication of an obstruction to the flow of air during inspiration. Several intensities of this obstruction exist – from mild to severe – with the severe from carrying the diagnosis of OSA – or obstructive sleep apnea. It is not an easy diagnosis to make, as usually the subjects of this condition are not truly aware of its occurrence – sleepers are typically not aroused by the sound of the snoring to recognize – it is usually a question best reserved for the other party sharing the bed with the snorer. Obstructive sleep apnea is not a benign condition however… During the night, patients with OSA may have such significant limitation to the flow of air into their airways that they stop breathing altogether, at which point they are literally started partially awake by their nervous system trying to regain some air flow, after which they again dose back off and the cycle repeats. In fact, this vicious cycle usually happens hundreds if not thousands of times through the night, essentially continuously disrupting the quality of the snorer’s sleep. Because they spend the whole night in a state of recurrent agitation due to inability to breathe properly – all without being fully aware of it – people with obstructive sleep apnea are usually very tired during the day and tend to dose off easily while waiting for the bus, after meals, while watching tv, and unfortunately also driving. OSA can also contribute to elevations in blood pressure, weight gain and obesity, uncontrolled blood sugars and heart disease. So if you know anyone who snores who is always tired – recommend that they ask their doctor to be tested for obstructive sleep apnea – it’s a simple test that may make their life significantly better.

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-Dr. Olga Kromo M.D – Rheumatologist

The Most Common Disease Your Doctor Has Never Heard Of

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Restless leg syndrome (RLS) is a disorder characterized by:

•             A disagreeable, uncomfortable sensation in the legs, accompanied by

•             An irresistible urge to move the legs, which is

•             Worse at night and when lying down, with the

•             Discomfort eased with movement, stretching, or walking.

RLS effects about 8-10% of Americans.  Although the symptoms can occur at any time during the 24 hour day, they are typically most troublesome at night, when the person becomes inactive and lies down to sleep.  The usual causes unknown, although it can occur in association with other medical conditions such as iron or vitamin deficiency, kidney disease, arthritis, pregnancy, diabetes, nerve damage, and Parkinson’s disease.  The disorder often appears to be more common in females and becomes more common as people become older.

The symptoms of RLS include sensations deep inside the legs, often described as:

  • Creepy–crawly
  • Pulling
  • Itching
  • Jittery
  • Burning
  • Ants crawling
  • Elvis legs
  • Bubbling water
  • Tugging
  • Painful
  • Prickling
  • Heeby  jeebies

Although in years past this disorder was often not fully recognized until 10-15 years after symptom onset, the medical community is now much more aware of RLS and able to offer an appropriate diagnosis and treatment regimen. Therapy often consists of conservative measures such as warm baths, massage, moderate exercise, along with avoidance of caffeine and certain medications which may worsen the symptoms.  Generally, good sleep hygiene (sleep habits) is appropriate.  Treatment of the underlying medical condition may also be warranted.  Also, prescription medications maybe indicated.  Your sleep specialist will be able to determine which treatment option is best for you, to finally let those Elvis legs go to sleep.

-Dr. Tim Grant M.D. – Neurologist and Sleep Specialist

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“Laugh and the world laughs with you. Snore and you sleep alone.”

Image courtesy Tobyotter  via Flickr

Image courtesy Tobyotter via Flickr

Sleep Apnea and Snoring.

Anthony Burgess, an English writer and composer, summed it up quite clearly in the above quote.  Although, it has long been the subject of jokes as well as an annoyance to many a bed partner, loud snoring can be a signal that something is seriously wrong with your breathing during sleep. Snoring is a sign that the airway is not fully open.  The distinctive sound comes from efforts to force air within the narrowed passageway of either the upper airway (your nose) or your pharynx (the back of the throat).

An estimated 10-30% of adults snore. It can be seen in both men and women of all sizes and shapes. For most of them, snoring has no serious medical consequences.  However, loud habitual snoring can be the first indication of much more serious disorder: obstructive sleep apnea.  People with sleep apnea don’t breathe properly during sleep.  They don’t get enough air and oxygen, and their sleep is poor as the brain keeps arousing him to a lighter stages of sleep, to allow them to start breathing normally again.  This can prevent the deep sleep we need to awakening feeling refreshed.  Sleep apnea can lead to daytime sleepiness and can trigger high blood pressure, heart disease, heart attack, and stroke.  It can put your at higher risk for diabetes and depression as well.

People with sleep apnea may have trouble concentrating and can become unusually forgetful, irritable, anxious or depressed.  They may also complain of insomnia symptoms, morning headaches, as well as sexual dysfunction.  Sleep apnea can even be seen in children who may erroneously be labeled slow or lazy in school.

General measures for the treatment of sleep apnea include:

•           Normalize weight.  Even a weight loss of 10-20% of your body weight may significantly improve the symptoms of obstructive sleep apnea.

•           Avoid alcohol and nicotine.

•           Avoid certain sleeping pills that suppress breathing at night.

•           Consider medications to relieve nasal congestion.

Specific treatments for sleep apnea include:

•           Continuous positive airway pressure (CPAP, pronounced SEE-pap).  CPAP is the most common form of treatment for obstructive sleep apnea.  In this highly effective therapy, a gentle flow of air is delivered through the nostrils to keep the airway open during sleep.

•           Oral appliances address sleep apnea by devices that open the airway by bringing the jaw, tongue, and/or soft palate forward.  They are best obtained and individually fitted by dentist with specialty training and sleep disorders.

•           Surgery may address physical abnormalities that interfere with breathing during sleep, including tonsils or adenoids  (this is common in children) and malformations of the jaw or soft palate.  Surgical intervention is usually pursued only after an initial trial with CPAP.

•           Nasal expiratory resistance valves (a bandaid type adhesive valve replaced nightly over the nostrils) have shown variable efficacy.

•           A new pacemaker device is under investigation which stimulates a nerve in the jaw, helping to keep the airway open.

Fortunately, sleep specialists are now able to detect and diagnose nighttime breathing disorders.  Proper treatment can not only bring your bedpartner back into your bedroom, it canprevent or reverse the potentially life-threatening consequences of sleep apnea.  When treatment is effective, patient sleep more soundly through the night, awaken feeling more refreshed, and experienced less daytime drowsiness.  They are also, subsequently, at less risk for associated medical illnesses.

Dr. Tim Grant M.D. – Neurologist and Sleep Specialist

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