sleep&wellness fall2014

COMPLIMENTARY COPY

SLEEP WELLNESSM A G A Z I N E

! N F L F O R M E R P L A Y E R S T A C K L E !

MYSTERY SLEEPER:A PILOT’S FIRST!HAND STORY // HOLISTIC SLEEP BY TODD SWICK, MD

MARTY RUSSO JOINS THE FIGHT AGAINST

SLEEP APNEA

FALL 2014 // ISSUE 8

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F O R M E R C O N G R E S S M A N

Derek Kennard COWBOYS/CARDINALS

[Center & Guard]

Mark Walczak CARDINALS/CHARGERS/COLTS

[Tight End & Long Snapper]

Mike HaynesNFL HALL OF FAMEPATRIOTS/RAIDERS

[Cornerback]

Roy Green CARDINALS/EAGLES

[Wide Receiver & Cornerback]

Dave GergenPRESIDENT PRO PLAYERS

HEALTH ALLIANCE

Visit our website www.americansleepandbreathingacademy.com for more details or call 801-410-4989

UPCOMING EVENTSSleep & Wellness 2015: A Conference for Healthcare Professionals. The conference promises to be an educational and enjoyable event and will be held in Scottsdale, Arizona, on April 9-11, 2015. On-demand Courses to prepare for your BRPT BoardsMonthly Live WebinarsScoring Workshops on-demand

Join Today! The American Sleep & Breathing Academy

is the first to offer a multi-disciplinary approach to Sleep

Medicine. We provide education for Sleep Specialists,

Medical Professionals, Dentists, Nurse Practitioners,

Physician Assistants, Respiratory Therapists, Sleep

Technologists, DME Providers and office staff. Our patient

education and public sleep and wellness campaigns will

further assist you with the patient tools you need to be a

Sleep Care Provider who leads the way with current con-

cepts in sleep medicine.This education is intended to

enhance the quality of care education for all who work

under the umbrella of the Board-certified Sleep Specialist.

F A L L 2 0 1 4 • S L E E P & W E L L N E S S M A G A Z I N E4

32 36

BY INTERVIEWS AND WRITINGS, ANDWITH PERMISSION FROM DAVE GERGEN,DEREK KENNARD AND ROY GREEN

22COVER FEATURE

SLEEP APNEA: A PROBLEMWE CAN TACKLE

ACCORDING TO A2009 STUDY BY

MAYO CLINIC, 46%OF PLAYERS IN THE

NFL AND 60% OFLINEMEN SUFFER

FROM SLEEP APNEA.

A

OZ. CANOF SODA CAN

CONTAIN:

10 teaspoons of sugar = 50 grams =200 empty calories

12

S L E E P & W E L L N E S S M A G A Z I N E • F A L L 2 0 1 4 5

12

10 Holistic Sleep TherapyINTERVIEW WITH TODD SWICK, MD WRITTEN BY JENNIFER TAYLOR

16 Lobby Like a Pro BY MARTY RUSSO, FORMER CONGRESSMAN

20 INFOGRAPHIC: You Snooze, You Lose

REGULARS6 Letter From the Editor8 Staff & Contributors

HEALTH & WELLNESS32 Understanding Sleep:

Body, Mind & SocialBY JENNIFER TAYLOR

36 Q&A with Cheryl Forberg, RD BY JENNIFER TAYLOR

46 Living Heart FoundationPromotes General Wellness BY ARCHIE ROBERTS, MD

48 A few Words From AARC DirectorsBY TOM KALLSTROM AND TIM MYERS

Sports’ Secret Weapon: SleepBY MICHAEL J. BREUS, PH.D. (THE SLEEP DOCTOR™)

28 Children and Soda BY JANET PETERSON

42 Mystery Sleeper: Part I BY LOUD U. SNORER

features

departments28 42

THE CARDIOVASCULARPROBLEMS like hyperten-sion, stroke, and heartattack that Dr. Robertstreated as a physicianare often experienced inconjunction with sleepdisorders, such as sleepapnea, often because ofobesity or large bodysize. THE REASON

GROUPS HIREprofessional

lobbyists is thatthe federal gov-erment is huge

and it’s a big jobto stay informed

on an issue.

Jennifer TaylorMANAGING EDITOR

twitter.com/SleepnWellnessfacebook.com/SleepandWellness

PUBLISHINGSLEEP & WELLNESS MAGAZINE IS PRODUCED, PUBLISHED AND DISTRIBUTED QUARTERLY BY SLEEP &WELLNESS, LLC, IN PARTNERSHIP WITH THE AMERICAN SLEEP & BREATHING ACADEMY, INC. SLEEP &WELLNESS, LLC, PUBLISHES OTHER WORKS IN PARTNERSHIP WITH THE AMERICAN SLEEP & BREATHINGACADEMY, INC. INCLUDING PRINCIPLES OF POLYSOMNOGRAPHY, PRINCIPLES OF POLYSOMNOGRAPHYPRACTICE EXAMINATION MANUAL, PRINCIPLES OF POLYSOMNOGRAPHY POCKET GUIDE, AND OTHERWRITTEN EDUCATIONAL MATERIALS KEY IN THE FIELD OF SLEEP. ENTIRE CONTENTS COPYRIGHT 2014SLEEP & WELLNESS, LLC. ALL RIGHTS RESERVED AND PROCEEDS ARE DONATED TO THE AMERICAN SLEEP &BREATHING ACADEMY, A NOT-FOR-PROFIT ORGANIZATION. REPRODUCTION IN WHOLE OR IN PART ISPROHIBITED. PRODUCED IN THE UNITED STATES OF AMERICA.

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275 West 200 North, Suite 202Lindon, UT 84042

PHONE: 801-410-4989 E-MAIL: [email protected]

BACK ISSUES are available in digital format for 3 months after original print date online at:

www.sleepandwellness.net


LETTER FROMTHE EDITOR

NAH, FALL. THERE ISSOMETHING MAGICALABOUT THE CRISP AIR,THE TURNING LEAVES—AND THE WAY PUMPKINSNEAKS INTO EVERYRECIPE.

While the return ofautumn weather, football,and pumpkins are pre-dictable, the changing sea-son also comes with somenew developments. InOctober, PBS will air aspecial on sleep apnea andthe NFL. Who saw thatcoming? NFL players areprimarily seen mainly asthe amazing athletes theyare; however, many currentand retired NFL playerssuffer from health troublethat isn’t readily apparent:sleep apnea. NFL playershave joined with the ProPlayer Health Alliance and the Living HeartFoundation to bring sleepapnea, and treatment for it,to light. Many players haveseen remarkable improve-ments in their quality oflife by having their sleepapnea treated. They wantto share what they havelearned with the public, soothers who share their

experiences with sleep apnea can find the same help the players have.Public television is a great avenue for the players and the non-profitorganizations to share their message about sleep apnea: it’s a problemwe can tackle.

To take the message from the NFL one step further, Michael J.Breus, Ph.D., (a.k.a. The Sleep Doctor) touts sleep as the new thing forimproving sports performance. Dr. Brues’ article focuses on increasedsleep more than on combating sleep disorders. It’s remarkable to seehow some additional sleep helped players of several sports improvetheir performance. Of course, if athletes improve their performance withadditional sleep, it stands to reason that all of us could benefit from alittle more shut-eye.

Tom Kallstrom and Tim Myers from the American Association forRespiratory Care (AARC) explain the role of the AARC, a brief overviewof some common respiratory conditions and the risks they pose, andtrends treatment. They tell us that respiratory therapists are beingincluded in Accountable Care Organizations, a new trend in medicalcare that could help practitioners and patients contain medical costs.

Seasons come and go, but one thing is constant: our need for sleep.The American Sleep & Breathing Academy is committed to learningabout sleep conditions, treatments and trends in the industry and shar-ing that information with as many people as possible. After all, to quoteDr. Breus, “Everything you do, you do better with a good night’s sleep.”

ART DIRECTOR

Sharon Robins

CREATIVEDIRECTORAntoni Pham

HEALTH ANDWELLNESS EDITORMichael Grandner, PhD

PRODUCTION DIRECTOR

Jeanette Robins, BS, RPSGT, RST

AMERICAN SLEEP & BREATHINGACADEMY EDUCATIONALCONTRIBUTORSTodd Swick, MDMichael Grandner, PhDRudi Ferrate, MDTim SafleySyed Nabi, MDRudy Ferrate, MDMichelle Primeau, MDArchie Roberts, MD, LHFSteven Park, MDPeter Moskovitch, MDChad Ruoff, MD

AMERICAN SLEEP & BREATHINGACADEMY DENTAL DIVISIONPresident - Dr. Bob Talley - BoardVice President - Dr. Peter Chase - DiplomateMedical Director - Dr. Rudi FerrateExecutive Director - David GergenExecutive Secretary - Randy ClareCongressional Liason - Marty RussoDr. Richard Klein - Board/DiplomateDr. Brad Eli -Board/DiplomateDr. Elliot Alpher - Board/DiplomateDr. Richard Klein - Board/DiplomateDr. Erin Elliot - Board/DiplomateDr. Harry Sugg - Board/Diplomate Dr. Paul Van Walleghem - Board/DiplomateDr. Rod Willey - Board/DiplomateDr. Steve Carstensen - Board/DiplomateDr. Jeffrey Rein - Board/DiplomateDr. Richard Drake - Board

ASBA CONTRIBUTING STAFF MEMBERSAngela KyzerJulie Thomas

CONTRIBUTING WRITERSTodd Swick, MDCongressman Marty Russo (retired)Michael Breus, MDCheryl Forberg, RD David GergenMichael Grandner, PhDArchie Roberts, MDJanet PetersonThomas Kallstrom, MBA, RRT, FAARCTimothy Myers, MBA, RRT-NPS, FAARC

CONTRIBUTING ORGANIZATIONSAccreditation Commission for Health CareAmerican Association for Respiratory CareAmerican Sleep Apnea AssociationNarcolepsy NetworkPro Player Health AllianceWake Up Narcolepsy

MANAGING EDITORJennifer Taylor

THE STAFF

Dr. Grandner is a licensedclinical psychologist, an

Instructor in theDepartment of Psychiatry,

and a member of theBehavioral Sleep Medicine

Program (BSMP), the Centerfor Sleep and Circadian

Neurobiology (CSCN), andthe Institute for

Translational Medicine andTherapeutics (ITMAT) at theUniversity of Pennsylvania.

He completed an APAinternship with the

Behavioral Medicine serviceat the San Diego VA

Healthcare System andOutpatient Psychiatric

Services at UCSD. He thenwent on to complete an

AASM-accredited BehavioralSleep Medicine Fellowship

at the University ofPennsylvania, which was

part of a larger postdoctoralfellowship at the CSCN. Hehas published over 40 arti-

cles on issues relating tosleep and health appearingin journals including SLEEP,Appetite, Sleep Medicine,and JAMA. He currently

serves on the Mental HealthTask force of the NCAA. Dr.Grandner maintains leader-

ship positions with theAmerican Academy of Sleep

Medicine, Sleep ResearchSociety, and Society of

Behavioral Sleep Medicine,and he is the outgoing

President of thePennsylvania Sleep Society.

DENTAL DIVISIONEDITOR

Rudi Ferrate, MD

Dr. Rudi Ferrate MD,FAAFP, DABSM, is theMedical Director for

Sleep Alternatives SaltLake in South Jordan,

Utah and for In MotionHealth and Wellness inPhoenix, Arizona. His

private practice is in theSalt Lake Valley and isfocused on IntegrativeMedicine and Wellness.From very early on in his

career he understoodthat anyone’s knowl-

edge is quickly outdat-ed, that medicine is awonderful yet highly

complex science that isconstantly upgradingand that the differentorgan, emotional and

biological systems inter-play in ways we are just

beginning to under-stand. For this reasonhe has been dedicatedto continued studies in

the fields and specialtiespertaining to healthy

aging and wellness. Hispractice includes

healthy aging, hormonebalance, weight loss,sleep disorders and

nutrition. His goal is tofind ways to permit thebody to utilize its ownhealing processes anddiminish the need for

synthetic pharmaceuti-cal treatment.

AARC SPECIAL SECTION EDITOR

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

Associate ExecutiveDirector of Brands

Management for theAmerican Associationfor Respiratory Care

(AARC). He is a graduateof Lake Erie CollegeParker MBA Programand The Ohio State

University with aBachelor of Science

degree in RespiratoryCare. Previous served as

AARC President for2009-2010 and was

appointed as a Trusteeof the AmericanRespiratory Care

Foundation (ARCF) in 2010. He has alsoserved as Neonatal-

Pediatric Section Chair(2000-04), VP of

Internal Affairs (2005),Board of Director

Member at-large (2006-07) and CPG SteeringCommittee Chair and

liaison to AmericanAcademy of PediatricsNeonatal Resuscitation

Steering Committee(2001-08).

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

F A L L 2 0 1 4 • S L E E P & W E L L N E S S M A G A Z I N E8CONTRIBUTORS

CPAP ASSISTANCE PROGRAM (CAP)Help us save lives! CAP provides a CPAP package to patients whootherwise would not be able to afford this vital and life savingequipment.

THREE EASY WAYS TO CONTACT US: WWW.SLEEPAPNEA.ORG1

[email protected]

888-293-36503

SLEEP & WELLNESS

FOR PHYSICIANS, PA'S, NURSE PRACTITIONERS,TECHNOLOGISTS, THERAPISTS OR ANY HEALTHCARE

PROFESSIONAL WHO TREAT SLEEP!RELATED DISOR!DERS AS A PART OF THEIR PRACTICE. ESTIMATED 17

CREDITS AWARDED FOR EACH SPECIALTY.

Featured Symposiums:

• Sleep Apnea • Circadian Rhythm Disorder • Behavioral Sleep• Hypersomnia

Featured Workshops:

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C O N F E R E N C E


HOLISTIC SLEEPTHERAPY THE FIELD OF SLEEP MEDICINE IS NEW AND IS RAPIDLY CHANGING. SLEEP

AND WAKEFULNESS ARE FUNCTIONS THAT ARE CONTROLLED BY THE BRAINVIA NEURAL PATHWAYS MEDIATED BY A VAST ARRAY OF NEUROCHEMICALS.IT HAS BEEN SHOWN THAT A DECREASE OR ABSENCE OF CERTAIN OF THESECHEMICALS DIRECTLY LEADS TO SPECIFIC SLEEP DISORDERS, WHEREAS ANEXCESS AMOUNT OF THESE NEUROCHEMICALS CAN BE EQUALLY PROBLEM-ATIC IN TERMS OF DISRUPTION OF NORMAL SLEEP AND WAKEFULNESS.

BY JENNIFER TAYLOR✒

N


quences such as excessive daytime sleepiness,loss of concentration and impaired motor reflexes,leading to an increase in depression, anxiety,physical illnesses and motor vehicle accidents.There is clearly an interaction between sleep andmood disorders. What is not clear is the exactcause and effect. Does impaired or fragmentedsleep lead to depression, or does depression causepoor sleep? Treatments that improve sleep havebeen shown to improve depression, and viceversa, so it can be helpful to consider both condi-tions before treating either.

While medication can provide significant ben-efits for people with sleep disorders, there is meritto a form of treatment known as cognitive behav-ioral therapy for insomnia (CBT-I). CBT-I is aninteractive and collaborative process that gradual-ly changes the patient’s lifestyle and habits result-ing in improved quality and quantity of sleep.Studies have shown that CBT-I is as effective aspharmaceutical therapy for insomnia; in manycases, CBT-I is more effective. CBT-I has long-term applicability in that an individual who com-pletes CBT-I is armed with an understanding ofhow different behaviors—such as sleep patterns,alcohol consumption, medication, job stress, andso forth—can affect the quantity and quality ofsleep. Further, the patient knows how to adaptbehavior to improve sleep.

While medication can provide a “quick fix,”individuals with sleep disorders would benefit byconsidering holistic treatments as a viable, long-term solution.

Dr. Todd Swick

This article waswritten using infor-

mation from aninterview with

Dr. Todd Swick. Dr. Swick is a

board-certifiedneurologist, sleep

specialist, andassistant clinical

professor of neu-rology at the

University of TexasMedical School at

Houston.

S&W

“While medication can provide a “quick fix,”individuals with sleep disorders would benefit by considering

holistic treatments as a viable, long-term solution.”

The ability to treat sleep and wake disorders can andshould rely on the basic prem-ise of medicine: “First do noharm!” If a disorder can bemanaged without introducinga drug or other external com-pound, more natural remediesshould be tried first. As such,holistic treatments for sleepdisorders are gaining in popu-larity. Because sleep affectsour daytime functioning, anddaytime functioning affects thequality and quantity of ournocturnal sleep, it seems rea-sonable to treat sleep disorderpatients as a whole, looking atall aspects of their lives andlooking at ways to changehabits and diet that can affectnocturnal sleep as a first step.Prescribing medication, whichoften treats limited symptomswhile leaving the root cause ofsleep trouble unresolved, istypically a short-term remedy;in fact, medication can causeeven more serious, long-termproblems.

Holistic treatments takeinto account not only sleeppatterns but also a person’slifestyle, including work,school, interpersonal relation-ships, and social issues.Holistic treatments alsoinvolve evaluating physicalqualities that might not seemimmediately tied to sleep, suchas weight, diet, level of physi-cal activity, and stress.

Conditions such as insom-nia and sleep apnea don’t justaffect night time sleep; thereare significant daytime conse-


SPORTS’SECRETWEAPON: WEAPON: SPORTS’ SECRET

SLEESLEEP


C O N T I N U E D H

BY MICHAEL J. BREUS, PH.D. (THE SLEEP DOCTOR™)

✒

THE SEARCH FORPERFORMANCEENHANCEMENT

LEADS SOME ATH-LETES TO TURNSOME PRETTY

DARK CORNERS.IT’S A SHAME, ANDNOT JUST BECAUSEDOPING IS DANGER-

OUS, UNETHICAL,AND FREQUENTLY

ILLEGAL. IT’S ALSOA SHAME BECAUSE

ATHLETES AT ALLLEVELS OF PLAY

HAVE ACCESS TO APOWERFUL TOOL

TO IMPROVE THEIRPERFORMANCE,

ONE THAT WON’TBREAK ANY LAWSOR PUT ANYONE’SHEALTH AT RISK.

SLEEPSLEEP


WHAT’S THISWONDER DRUG?

SLEEP. There’s been a welcomeuptick in the attention paidby the media and athleticprofessionals to the benefitsof sleep for competitive ath-letes, and to the researchthat shows just how sleepcan improve physical per-formance in sports. The NYJets brought sleep special-ists into the locker room,signaling their intention touse sleep as part of theirtraining strategy. At theother end of the spectrum, Iwas disappointed to readthat Manchester United isaddressing its players’ sleepproblems by issuing sleep-ing pills. This strategy—andthe coach’s seemingly cava-lier attitude toward med-icating players for sleep—isnot what I recommend whenI suggest that athletes andcoaches pay more attentionto sleep.

In recent years, StanfordUniversity’s Center forSleep Sciences andMedicine has been at theleading edge of examiningthe sleep-sport performanceconnection. Researchersthere have conducted stud-ies with several groups ofStanford student-athletes,examining the effects ofextended sleep on athleticperformance.

CONTINUEDH

HERE’S A SAMPLING OF THEIR RESULTS, WHICH SHOWIMPROVEMENTS ACROSS A VARIETY OF SPORTS:

SWIMMINGFive members of theStanford men’s andwomen’s swimmingteams increasedtheir sleep goal to10 hours per nightfor a period of 6-7weeks. This led toimprovements inspeed, reactiontime, turn times andkick strokes.Swimmers shavedan average of .51seconds off a 15-meter sprint, theyleft the blocks .15seconds faster,shaved .10 secondsoff their averageturn time, andadded an average of5 kicks to theirstroke frequency.Out of the water,swimmers reportedreductions in theirlevels of daytimesleepiness,improvements totheir mood, moreenergy and lessfatigue.

TENNISResearchers askedfive members of thewomen’s tennisteam to increasetheir sleep goal to10 hours per nightfor 5-6 weeks.Players improvedtheir sprint times,dropping from anaverage of 19.12 to17.56 seconds. Theyalso increased theirserve accuracy,going from an aver-age of 12.6 validserves to 15.61.

BASKETBALLFor 5-7 weeks, 11members of the uni-versity’s basketballteam extended theirnightly sleep to 10hours. As a result,shooting accuracyamong the playersimproved signifi-cantly: Free throwshooting improved9%, and three-pointshooting 9.2%.

FOOTBALLSeven players on theStanford footballteam spent 7-8weeks attempting tosleep for 10 hoursper night. Theirextended sleepresulted in improve-ments to their 20-yard shuttle—aver-age time decreasedto 4.61 secondsfrom 4.71—and totheir 40-yard dash,which dropped toan average of 4.89from 4.99 seconds.(Both the shuttleand the dash areamong the drillsconducted at theNFL ScoutingCombine.) Playersalso reportedimprovements totheir daytime energylevels and mood,and reduced day-time fatigue.

“SLEEPPROMOTESMUSCLERECOVERY.SLEEP IS ACRITICALTIME FORCELLREGENERA!TION ANDREPAIR INTHE BODY.”

SPORTS’ SECRET WEAPON: SLEEP


Sensing a pattern? Extending sleeptimes translated into significantimprovements to critical game-dayskills. Worth noting: not all athletesacross these studies actually slept for10 hours per night, but attempting tosleep for 10 hours per night got themadditional sleep compared to theirregular routine. According toresearchers, many of these athletescame to their sleep-sport studiesalready sleep deprived.

And that gets to the flipside of theadvantages that additional sleep cangive to athletes. Sleep deficiency caninhibit performance. Research showslack of sleep can also affect thelongevity of players’ careers. Tworecent studies investigated the rela-tionship between sleep and careerduration and stability among NFLplayers and MLB players. The NFLstudy looked at 55 players from acrossthe league. Those who reported high-er levels of daytime sleepiness were

less likely to remain with the teamthat drafted them than those playerswho reported lower levels of daytimetiredness. And MLB players whoreported higher levels of daytimetiredness had attrition rates far high-er than league averages.

There’s also evidence that sleepcan increase the risk of injury amongathletes. In this study of teenage stu-dent-athletes, those who slept at leasteight hours per night were 68 percentless likely to injure themselves play-ing sports than those who slept lessthan eight hours nightly. Researchersexamined the sleep patterns andsports-related injuries of 112 male andfemale athletes from grades 7-12.They discovered that sleep and agewere the most significant factors inassessing injury risk. (In addition tobeing more injury-prone when shorton sleep, students were also morelikely to injure themselves as theymoved to higher grade levels.)

The cognitive benefits of sleeptranslate onto the field. Memory,learning, reaction time andfocus: sleep is critical to thebrain’s ability to perform thesemental tasks efficiently and well.The brain uses sleep to consoli-date memory into longer-termknowledge, clearing the area ofthe brain used for short-termmemory in preparation toabsorb new information. Duringsleep, the brain also works toprioritize the information itthinks will be important in thefuture. Sleep deprivation haswell-studied negative effects onreaction times—and even a sin-gle night of sleep deprivationcan slow quick response times.

Sleep promotes musclerecovery. Sleep is a critical timefor cell regeneration and repairin the body. During non-REMstages of sleep, cell division andregeneration actually becomesmore active than during wakinghours. Insufficient sleep, on theother hand, hinders musclerecovery.

Sleep is a stress reducer.Sleep and stress have a tangledrelationship—and both are dan-gerous to healthy immune function when we don’t getenough (sleep), or have toomuch (stress). Stress can inter-fere with sleep. This studyranked worry as the most com-mon cause of sleeplessnessamong adults 34-79, but lack ofsleep can also affect mood andmake us more susceptible tostress and anxiety.

Is sleep the next big thing in sports? I’d say it’s more than earned its shot in the bigshow.

Dr. Michael J. Breus

This article was originally published on www.theinsomniablog.comon November 19, 2012, where you can see details of the researchfor this article. You can read more of Dr. Brues’ insights on his website, www.thesleepdoctor.com, or by following him on Twitter@thesleepdoctor.

SLEEP? SO WHAT’S BEHINDTHE PERFORMANCEBOOST FROM

S&W


LOBBY

“The reason groups hire professional lobbyistsis that the federal government is huge and it's a bigjob to stay informed on an issue.”


I FIRST BECAME AWARE OF THE WIDE-RANGING IMPACT OF SLEEP DISORDERS WHILEBEING TREATED WITH ORAL APPLIANCE THERAPY BY DR. ELLIOTT ALPHER OF THEALPHER CENTER IN WASHINGTON, D.C. WHILE I WAS BEING FITTED FOR THIS NEW TECH-NOLOGY FOR SLEEP APNEA, DR. ALPHER GAVE ME A RUNDOWN OF ALL THE WAYS THEFEDERAL GOVERNMENT WAS GETTING INVOLVED IN REGULATING SLEEP DISORDERS. THEU.S. DEPARTMENT OF TRANSPORTATION WAS LOOKING AT THE TRUCKING INDUSTRYAND HOW SLEEP IMPACTS SAFETY ON OUR ROADS. THE NATIONAL TRANSPORTATIONSAFETY BOARD WAS INVESTIGATING AIRLINE AND TRAIN ACCIDENTS TO DETERMINE IFFATIGUE DUE TO LACK OF SLEEP PLAYED A ROLE.

DR. ALPHER HAD A MISSION TO GET THE LATEST SCIENCE ON TREATING SLEEP DISOR-DERS INTO THE HANDS OF FEDERAL POLICYMAKERS SO THAT THEIR DECISIONS COULDBE MADE BASED ON FACTS AND NEW CUTTING EDGE TECHNOLOGY.

N

LIKE A PRO

C O N T I N U E D H

BY MARTY RUSSO, FORMER CONGRESSMAN✒

The advantage you have is that you care aboutsleep and want the government to make smart deci-sions when making policy. That’s worth all youreffort. You may save a life.

Marty Russo,Former

Congressman

A native of Chicago,Former CongressmanMarty Russo has spent

a career navigatingthe maze of federal

institutions inWashington, D.C.

First elected toCongress at the ageof 30, Marty servedhis constituents for

nine terms alongsidelegendary

Congressional leadersand Presidents fromboth political parties.Marty believes in tak-ing an active role to

make our governmentand country a betterplace. As part of acapstone to a suc-

cessful career as a toplobbyist, he speaks toaudiences about howto have more influ-ence so your voice

can be heard to makea difference inWashington.

S&W

I spent 18 years of mycareer in Congress and thepast 22 years as a lobbyist,and I had no idea that sleepissues were so hot at the fed-eral level. I dug a little deeperand discovered that theVeterans Administration isvery concerned about sleepfor returning veterans whoexperience PTSD. The Centerfor Medicare Services is look-ing closely at how to reducethe high cost of treatinghealth issues that result fromsleep disorders and fatigue. Infact, throughout the federalgovernment there are manyagencies that are waking upto sleep disorders.

What does this mean forsleep specialists? I can tellyou from years inWashington, D.C., that whenthe federal government startsinvestigating an issue, thepeople who care about thatissue need to be ready. Afamous saying is, "If you'renot at the table, you're on themenu." This means that thesleep community needs to getactive and take its seat at thetable so that federal actionswill help the cause, not hurt it.

As a Democrat, I think thegovernment has a role inhelping people. But as a lob-byist I know that federal poli-cymakers often do not havethe information they need tomake good decisions. As alobbyist, I was frequentlyhired to help a business digout of a hole created by theunintended consequences of a federal action.

Whether you are a sleepexpert or just a person whohas learned first-hand thedangers of sleep disorders,my message is, "Get involved.You can make a difference."


Scout. Research what is happening in the feder-•al agencies and who in the sleep community isalready involved. Who agrees with you? Who isopposed? Where are good sources of informa-tion?

Team up. Professional lobbyists don't go it•alone. They build up a groundswell of supportfrom stakeholders. Talk to colleagues, profes-sional medical and dental academies, tradeassociations, local officials, healthcare leaders,and people who care. Tell them your missionand ask for help in getting your message out.

Train. Develop your message points in a clear,•easy to digest format, and keep your teaminformed. Meet with your member of Congress.Send your materials ahead of time (one-pagesummary with technical documentation asneeded). Educate the Congressman on sleepdisorders in a brief, focused meeting. Let him orher know that you are available as a resource.Send updates on scientific advances and federalactivity. I tell people that developing an ongoingrelationship with your Congressman andCongressional staff before you ask for help isthe single best action you can take.

Play Defense. Educate regulators before they•act. Comment on a proposed policy. Write a let-ter. Make sure there is an abundance of goodinformation in the right hands so that whensomeone puts the regulatory ball in play, yourmessage is already ingrained in the system.

Play Offense. Sometimes agencies get it wrong.•When the Federal Aviation Administration issueda policy on pilot fatigue that caught the sleepcommunity off guard, there was so muchuproar that the policy was reversed within aweek. When you hear of movement takingplace, deploy your team, get your message out,contact your Congressman and have your voiceheard.

Stay in the game. Most important, stay•involved. It takes time and effort to move theball up the field. Don’t expect a score every timeyou touch the ball. The reason groups hire pro-fessional lobbyists is that the federal govern-ment is huge and it's a big job to stay informedon an issue and then know when, where, andhow to make your move.

HERE ARE SOME FOOTBALL ANALOGIES TOINSPIRE YOU TO RUN OUT ONTO THE FIELDAND MOVE THE BALL FORWARD ON SLEEPDISORDER AWARENESS:

LOBBY LIKE A PRO

CONTINUEDH

20 F A L L 2 0 1 4 • S L E E P & W E L L N E S S M A G A Z I N E

I N F O G R A P H I C


Roy Green CARDINALS/EAGLES

[Wide Receiver & Cornerback]

Dave GergenPRESIDENT PRO PLAYERS

HEALTH ALLIANCE

Mike HaynesNFL HALL OF FAMEPATRIOTS/RAIDERS

[Cornerback]

Derek Kennard COWBOYS/CARDINALS

[Center & Guard]


A P R O B L E M W E C A N T A C K L E

Mark Walczak CARDINALS/CHARGERS/COLTS

[Tight End & Long Snapper]

C O N T I N U E D H

THE PRO PLAYER HEALTH ALLIANCE (PPHA) IS A GROUP OFFORMER NFL FOOTBALL PLAYERS WHO HAVE BANDEDTOGETHER WITH DAVID GERGEN, A DENTAL LAB TECHNI-CIAN IN PHOENIX, ARIZONA, WHO SPECIALIZES IN TREATINGSLEEP APNEA. DAVID GERGEN INITIALLY APPROACHEDDEREK KENNARD, A FORMER NFL GUARD, WHEN KENNARDWAS DOING A COACHES CLINIC AT ARIZONA STATEUNIVERSITY. GERGEN TOLD KENNARD HE HAD THE SLEEPAPNEA LOOK—RACCOON EYES—AND THAT, TOGETHERWITH HIS HIS RASPY VOICE, SUGGESTED THAT HE’D EITHERBEEN UP ALL NIGHT YELLING AT SOMEONE OR HE HADSLEEP APNEA. HE ENCOURAGED KENNARD TO BE TESTED.KENNARD UNDERWENT A HOME SLEEP STUDY, WAS DIAG-NOSED WITH SLEEP APNEA, AND WAS SUBSEQUENTLY FITTED WITH A SPECIALIZED DENTAL DEVICE THAT COM-PLETELY CHANGED THE QUALITY OF HIS LIFE.

BY INTERVIEWS AND WRITINGS, AND WITH PERMISSIONFROM DAVE GERGEN, DEREK KENNARD AND ROY GREEN

✒


The concept of jaw position as a fundamentalpiece of sports performance is not new. Dr.Harold Gelb introduced this concept in his early

work in the 1970s. The culmination of his work inimproved performance was the 2000 BaltimoreRavens who triumphed over the New York Giants towin Super Bowl XXXV. Every player on the teamwore a custom oral appliance that positioned the jawin Dr. Gelb’s Jaw position called the Gelb 4/7 posi-tion. Since that time, professional sportsmen all overthe world have been adopting a daytime mouthguard to protect them from injury and improve theirperformance.

In recent years, awareness of the potentially life-threatening effects of obstructive sleep apnea (OSA)has begun to rise, but there’s still widespread confu-sion about who can be affected by the disorder. Mostof those who are aware of the dangers of OSA believethat it affects only overweight and unhealthy people.In fact, even some of the best athletes in the worldsuffer the consequences of OSA, especially playersin the National Football League. According to a 2009study by Mayo Clinic, 46% of players in the NFL and60% of linemen suffer from sleep apnea. The problemis endemic and has even affected draft results. Forexample, sleep apnea took a toll on the 2007 #1 NFLdraft pick JaMarcus Russell, who played for theOakland Raiders.

HISTORY OF PRO PLAYER HEALTH ALLIANCEDavid Gergen rolled out of bed on December 4, 1982,and had his career “aha” moment. Gergen knew hewas going to be an orthodontic technician, and heknew he was going to help people all over the coun-try. Since then, he has built one of America’s mostsuccessful dental labs in Phoenix, Arizona, revolu-tionized the sleep industry through oral appliancesand special programs, and was once voted top dentallaboratory technician in the country.

Derek Kennard had been seeing a doctor abouthis sleep trouble twice a year for eight years but hadbeen unable to reach a resolution. He’d reached theuncomfortable conclusion that sleep apnea wassomething he’d just have to live with. Unfortunately,there was a much more difficult lesson about sleepapnea in store for him. When his younger brother,

Donald, passed away from cardiacarrest brought about, in part, bysleep apnea, Kennard felt a newurgency to find a solution to hisproblem and was receptive whenDavid Gergen approached him atthe clinic.

Mark Walczak, a former tightend for the Phoenix Chargers, alsofaced health trouble associatedwith sleep apnea and achievedgood results with a dental device.

The players’ friends could seehow much Kennard’s andWalczak’s lives improved.Another former teammate, RoyGreen, who also had problemswith his health, was intriguedenough to ask and pursue a solu-tion—and Kennard, Walczak,Green, and Gergen realized theirsleep stories and solutions weresomething worth sharing. Theyformed the Pro Player HealthAlliance with the goal of helpingother NFL players.

After noticing NFL playersseeking treatment for theirobstructive sleep apnea, Gergendecided there was an urgent needto spread awareness of the disor-der throughout the United States.His response was to form ProPlayer Health Alliance (PPHA),which brings current and formerprofessional football players todifferent communities throughoutthe U.S. to promote awareness ofsleep apnea. “Pro Player HealthAlliance was created to treat thesleep health needs of retired NFLplayers,” explains Gergen, “whileat the same time raising aware-ness of sleep apnea as a silentkiller.”

PPHA events have reachedthousands of people and have the

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“WEREACHEDOUT TOOTHERPLAYERSWE’DPLAYEDWITH, ANDAGAINST,THENATIONALFOOTBALLLEAGUE,AND THEPLAYERSUNION,AND WESTARTEDTESTINGPLAYERS.”

SLEEP APNEA: A PROBLEM WE CAN TACKLE


potential to reach many more, poten-tially the entire NFL fan base. Thebeauty of PPHA’s efforts is that theybenefit everyone involved: the publicmeets their sports heroes whilebecoming informed on the life-threatening risks of sleep apnea;players receive treatment for thisdebilitating condition, which meansbetter athletic performance andmore exciting games; dental practi-tioners, especially those who helphost PPHA events, are able to attractattention and patients to their sleeppractices; and dental sleep appliancelabs like Gergen’s are able to conductmore research and develop improvedoral appliance solutions.

“We reached out to other playerswe’d played with, and against, theNational Football League, and theplayers union, and we started testingplayers,” Green said.

The Pro Player Health Alliancehas tested over 200 former and cur-rent NFL players and has seen greatresults. Roy Green said, “We heardstories that were so unbelievable.Lives were changing. We decided toreach out to our communities, toeveryone we know. We know this issaving lives. This is helping so manypeople. It’s just become a passion of

ours, so that’s what we do now. We’refeeling so much better, and we knowso many people are unaware that it issleep apnea that they’re sufferingfrom. Just a simple test and a simpleappliance can change lives.”

Along with Kennard, Walczak,and Green, Eric Dickerson, MikeHaynes, and Larry Fitzgerald Jr.,other NFL greats like Warren Moon,Marcus Allen, Dave Krieg, NesbyGlasgow, OJ Anderson, Bart Oats,Carl Eller, Preston Pearson, J.T.Smith, Lincoln Kennedy, Ed “TooTall” Jones, Isiah Robertson, ChuckForeman, and Nick Lowery, have allalso received oral appliance sleepapnea treatment and subsequentlyteamed up with PPHA. Together,these players have visited schools,held meet-the-players events forfans, and even hosted golf-tourna-ments to spread a simple message:get diagnosed for sleep apnea, gettreated, and get a good night’s sleep.As Derek Kennard explains, “Youcan’t put a price on a good night’ssleep.”

Eric Dickerson, another HeismanTrophy winner and NFL Hall ofFamer, also suffered from terriblemorning headaches and neededextensive dentistry due to sleep

apnea. However, Dickerson issleeping better than ever afterreceiving treatment for hisOSA by Dr. Harry Sugg, inDallas, Texas. Dr. Sugg placedDickerson in a Gergen’sOrthodontic Lab Herbst appli-ance for night-time use and aGelb Splint to prevent over-closing for daytime use.

Tony Dorsett, a formerHeisman Trophy winner andNFL Hall of Famer, claimed hewas “snoring like a freighttrain” before being diagnosedwith sleep apnea. Then hereceived his dental sleep device,a Herbst appliance custom fitby Gergen’s Orthodontic Lab.Now that he breathes well while he sleeps, he proudlyboasts, “Superman ain’t gotnothing on me.”

Members of the Pro PlayerHealth Alliance travel aroundthe country promoting sleepwellness and they are sur-prised by how few people knowabout sleep apnea, the nega-tive effects it can have, andhow easy it can be to treat.They have seen some of theirformer heroes limping around,not feeling well. When ques-tioned, these guys invariablysay something about theirpoor quality of sleep. With aproper diagnosis and treat-ment, these guys who thoughtthey were on the back nine,without much to look forwardto, are active again and enthu-siastic about life.

The bottom line is thatsleep apnea is a problem wecan tackle!

What’s next? In addition tocontinuing to promote aware-ness and treatment for sleepapnea with the PPHA, recently,Gergen has been working withNFL Hall of Famer MikeHaynes and NFL All-Pro Derek

Roy Green

C O N T I N U E D H

Kennard, who are both active in the POP Warnercommunities. Together, they are working on a newappliance that could potentially reduce concussionsand improve performance on the playing field.

SPOTLIGHT ON PRO PLAYER HEALTH ALLIANCE FOUNDER:DAVE GERGENIn a 2012 dental conference in Las Vegas, Dr. Gelbpaid Gergen a high compliment, saying, “DavidGergen is the finest technician ever to live. He isheads and tails above the competition.” Gergen washonoring Dr. Gelb for his 65th year in dentistry atthe presentation, and Dr. Gelb mentioned, “Thereare two legends in this room.”

Sleep medicine specialist Rudi M. Ferrate, MD,DABSM, complimented David Gergen for hisstrength of character, his passion for excellence,and his desire to help as many people as possible,adding, “He could easily sit back and enjoy thefruits of his business, but instead he spends histime and resources promoting education andawareness of sleep disorders. He is single-handedlythe most important force bringing sleep physiciansand sleep dentists together and now is using his

skills and reputation tobring everyone else onboard—from legislatorsto sports legends.”

DENTAL DEVICES HELPMORE THAN JUST FOOTBALLPLAYERS…. For more than 20 years inPhoenix, Gergen spentthe fall coaching POPWarner football and highschool football. Most ofthe important lessons ofhis life were learnedeither watching footballlegends, creating chal-lenges for himself on thefield, or teaching childrenthe values of courage andteamwork on the field. Itcomes as no surprise thatGergen, father of ninechildren, would focus agood deal of his profes-sional life on helping chil-dren achieve their goals.Gergen is a certified den-tal technician, and somewould say a master tech-nician that children andadults have relied on forexcellent results.

HELPING CHILDREN BREATHBETTER:In his professional life,Gergen worked tostraighten teeth for cos-metic reasons, and to helpcreate functional oralstructures for patientswith severe trauma ordevelopmental issues.Recently, some of hisattention has turned tothe effects of poor jawposition on children. “Asmall airway often forceschildren to breathethrough their mouth andposture their head for-ward resulting in rounded


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SLEEP APNEA: A PROBLEM WE CAN TACKLE

Mike Haynes“ACCORDING TOA STUDY BY THEUNIVERSITY OFPENNSYLVANIASPONSORED BYTHE FMCSAAND THEAMERICANTRUCKINGASSOCIATION,28% OFTRUCKERSHAVE MILDTO SEVERECASES OFSLEEPAPNEA. THISIS ANALARMINGNUMBER,CONSIDERINGTHAT THEREARE OVER 3MILLIONTRUCKERS ONAMERICANHIGHWAYS.”


shoulders and back prob-lems,” explains Gergen.“Continuing this positionover many years will createpermanent changes in pos-ture. Poor breathing habitscan result in heart and lungproblems in later life.”

After 30 years of estab-lishing better jaw and toothfunction through orthodon-tics, Gergen decided to focuson the airway. His pediatricsleep appliance, Gergen’sBionator, is a direct result ofhis experience and experi-mentation. Gergen is eager todemonstrate to physiciansand the public that oral appli-ances are an effective solu-tion for sleep and airwayproblems.

Gergen’s Bionator is wornon the child’s upper andlower teeth, and gives den-tists an opportunity to guidethe growth of patients’ teeth—more importantly, the jaw andthe airway. Expansion of theupper jaw will create moreroom for the tongue to pos-

ture forward and open the air-way.

“The simple shape andconstruction of the lowerappliance will help stage thegrowth of the child’s teeth,allowing the dentist to con-trol the growth rates of theteeth for maximum cosmeticand palliative effect,” saidGergen. “One of the bestparts of the treatment is thatwhile growth is being con-trolled, the jaw is held slightlyforward, creating an open air-way that produces better anddeeper sleep patterns.”Children undergoing stan-dard orthodontic care havenoticed their grades improve,sometimes dramatically. Inthe past, this improvementhas been attributed toimproved self-image or agrowth spurt. Today, expertshave measured the improvedsleep patterns and theincrease in airway size thatcomes from a better jaw posi-tion. These patients breathebetter at night, and wake upmore able to deal with thedemands of the day.

Professional Drivers:According to a study by theUniversity of Pennsylvaniasponsored by the FMCSA andthe American TruckingAssociation, 28% of truckershave mild to severe cases ofsleep apnea. This is an alarm-ing number, considering thatthere are over 3 million truck-ers on American highways. In 2013, Gergen appearedbefore the Department ofTransportation to requestthat an assessment for sleepapnea be required for com-mercial truck drivers. OnOctober 17, 2013, H.R. 3095,which sets standards for theevaluation of truck drivers forsleep apnea, was signed intolaw. Also in 2013, on behalf of

the entire dental sleep community, DavidGergen testified before the Department ofTransportation to request that dentists be ableto order home sleep tests for their patients.Increased testing may help reverse the trend ofundiagnosed sleep apnea.

Dental Education: In August 2011, Gergen’sfirst sleep training program was presented to agroup of 25 doctors in Sonoma, California, andGergen’s Orthodontic Lab team and trainingprograms have gotten better since then. Theymaximize on their experience, developing spe-cialties as educators and covering topics thor-oughly in their seminars and meetings. Theywere selected by Henry Schein to participate intheir dental sleep apnea programs. Their semi-nars emphasize long-term education and self-developing practices.

Dr. Archie Roberts, retired NFL player andfounder of the Living Heart Foundation and NFLHOPE program, has been one of the Gergenteam’s keynote speakers. Roberts established astrong correlation between OSA and heart dis-ease in the general population. He asked Gergento be the sleep apnea director in the HOPE pro-gram that the Living Heart Foundation launchedat the Mayo Clinic in Scottsdale, Arizona.

David Gergen serves the dental sleep community as the Executive Director of theASBA Dental Division. The ASBA DentalDivision is a for profit group that has partneredwith the not for profit American Sleep &Breathing Academy. For more information visit www.americansleepandbreathingacademy.comand click on Dental Division.

This article is for informational and commercial pur-poses about the Pro Player Health Alliance and theHerbst oral appliance. Views set out are those of theauthors and do not necessarily reflect the official opin-ion of the Sleep & Wellness Magazine.

S&W


SODA CONSUMPTION HAS INCREASED DRAMATICALLYSINCE THE 1960S, MIRRORING THE INCREASED RATES OFOBESITY. IT IS ESTIMATED THAT 95 PERCENT OFAMERICANS DRINK SODA AT SOME POINT DURING THEYEAR AND MORE THAN 50 PERCENT DRINK ONE OR MORESODAS EVERY DAY. BOYS ARE MORE LIKELY TO DRINKSODA AT A YOUNGER AGE WITH OVER 70 PERCENT OFTHEM CONSUMING ONE OR MORE SODA PER DAY. THESESTATISTICS ARE FOR SODA ALONE! IF YOU TAKE IN TOACCOUNT ALL SUGARY DRINKS (SWEETENED JUICES,LEMONADES AND ICE TEAS) THE AMOUNT OF ADDEDSUGAR CONSUMED DAILY GREATLY INCREASES. ADDEDSUGAR INTAKE DURING CHILDHOOD INCREASES THE RISKOF HEALTH ISSUES LATER IN LIFE.

children

malibu chronicle

C O N T I N U E D H

sodaBY JANET PETERSON✒


INABILITY TO CONCENTRATE

SLEEP DISORDERS

HEART BURNAND STOMACH

ACHES

PANCREATIC CANCER

HEART DISEASE

TYPE 2 DIABETES

OVERWEIGHT AND OBESITY

METABOLIC SYNDROME

WEAK OR BRITTLEBONES

STROKE

TOOTH DECAYPERIODONTAL

DISEASE AND GINGIVITIS

LEARNINGDISORDERS

THEHEALTHRISKS OFSODA


• soda lacks gOOd nutrition Food and drink are classified as nutrientdense--lots of good quality nutrients and nota lot of calories-- and energy dense--very lit-tle nutritious value with lots of calories, inother words “empty calories.” Soda andother high sugar drinks are classified asenergy dense, loaded with empty calories.The average 12 ounce soda has more than 10teaspoons of sugar (50 grams) which isequivalent to 200 empty calories. That is alot of extra sugar, not to mention calories inone’s diet, particularly for a child. The cur-rent recommendation for sugar consump-tion per day for children is 10 teaspoons (50grams) for girls and 15 (75 grams) for boysand no more. Most children meet or exceed

c h i l d r e n a n d s o d a

A

OZ. CANOF SODA CAN

CONTAIN:

10 teaspoons of sugar = 50 grams =200 empty calories

12

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“WITH EVERYSINGLE SERVINGOF SODA YOURCHILD CON-SUMES THEIR RISK OFBEINGOVER-WEIGHTOR OBESEINCREASES BY60 PER-CENT!”


titian at Central Washington University. Low dairyconsumption is associated with reduced calciumintakes, resulting in weak bones and teeth.

• The importance of role modelingA majority of soda consumption occurs in the home--not when the kids are at school or out and about. Infact, only 1.4 percent of all sodas consumed by chil-dren are done so in schools. So where are kids get-ting all this soda from? Mostly, their parents are pro-viding the sugar-laden drinks. Parental role model-

ing has a large influence on the dietary (and otherlifestyle) choices children make. If you drink soda,then it is very likely that your children will as well.One of the first steps you can do to reduce yourchild’s soda consumption is to not purchase or drinksoda in the home. This will provide health benefitsfor the whole family.

• If I can’t drink soda, what can I drink? Is there anything that children can drink that is con-sidered healthy? The answer is a resounding yes!Pure and simple the answer is water: Noncarbonated,unflavored, tap water is the best option. Sure, theoccasional glass of fruit juice is ok, as long as thecalories are accounted for, but most of your dailyfluid intake should come from water. Not happy withthat answer? Some other alternatives to soda that arelow in calorie and noncarbonated include unsweet-ened or diluted fruit juices, flavored waters andunsweetened (decaffeinated) iced tea. S&W

“A MAJORITY OFSODA CONSUMPTIONOCCURS IN THEHOME--NOT WHENTHE KIDS ARE ATSCHOOL OR OUT ANDABOUT. IN FACT, ONLY1.4 PERCENT OF ALLSODAS CONSUMED BYCHILDREN ARE DONESO IN SCHOOLS.”

the recommended sugar intake simplythrough what they eat in their regular diet.The additional sugar intake from beveragessuch as soda or other sweetened drinks canbe detrimental to your child’s health.

• Health and soda consumptionPerhaps the most urgent concern for ourchildren is the contribution of soda to theoverweight and obesity epidemic. Withevery single serving of soda your child con-sumes their risk of being overweight orobese increases by 60 percent! Most peopledrink soda in addition to eating all the calo-ries they require in a day. Any excess calo-ries consumed-- more than you are burningduring the day--from any source (protein,fat or carbohydrate, i.e. sugar) will be storedas fat. Most experts argue that drinkingexcess calories from soda in combinationwith a sedentary lifestyle is a major contrib-utor to becoming obese.

Obesity is not the only soda-relatedhealth concern: soda consumption has beenlinked to type 2 diabetes, tooth decay, weakbones, digestive issues, inability to concen-trate, pancreatic cancer, sleep disorders andlearning problems. “One of the issues I’veseen with drinking soda is that children maybe replacing a glass of milk (or dairy prod-ucts) with the soda,” says Kelly Pritchett,Ph.D., assistant professor and registered die-

32

BIOPSYCHOSOCIALMODEL OF SLEEPMEDICINE

The biopsychosocialmodel of medicine pro-motes the notion thatwellness is tied notonly to biological fac-tors but also psycho-logical and social ele-ments. Dr. Grandnerbelieves the disciplineof sleep medicine isbest explained using abiopsychosocial model.That is, sleep can bebest understood byinvestigating a per-son’s body and mindand the social aspectsof his life.

BODY, MIND &SOCIAL

BY JENNIFER TAYLOR✒

UNDERSTAND ING S LEEP :

GETTING OPTIMAL SLEEP

Typically people feel most restedand function best when they sleep 7-8 hours each night. Dr. Grandneradvised, “It should take you a fewminutes to fall asleep when you goto bed. If you fall asleep immediatelywhen your head hits the pillow, youeither aren’t getting enough sleep oryou’re going to bed too late.”

Research shows that people sleepbest when it’s dark, slightly cool, andwhen they are comfortable. Even alittle bit of light at night can disruptbiological rhythms, so you shouldkeep your room slightly cool and asdark as feasibly possible.

Our bodies run on biologicalclocks known as circadian rhythms.Every morning this internal clock isreset by bright daylight. Our clockscan get messed up when we don’tget enough light during the day(such as during a long, northern win-ter) or when we get too much lightat night (such as when we watch TVor use digital devices in theevening). If your biological clockisn’t in sync with your daily sched-ule, you may feel groggy or evendepressed, but you can reset yourclock by exposing yourself to brightlight in the morning. You can evenadjust your biological clock by up toan hour a day, training yourself to bealert earlier in the morning and go tobed earlier in the evening, by usinglight therapy.

DR. MICHAEL GRANDNERIS A RESEARCH PSY-CHOLOGIST AT THEUNIVERSITY OFPENNSYLVANIA. THE PRI-MARY FOCUS OF HISRESEARCH IS TYPICALSLEEP PATTERNS ANDHABITS AND HOW THEYRELATE TO HEALTH OUT-COMES. THIS ARTICLE ISBASED ON A DISCUSSIONWITH DR. GRANDNERAND A MEMBER OF THEAMERICAN SLEEP &BREATHING ACADEMY.

F A L L 2 0 1 4 • S L E E P & W E L L N E S S M A G A Z I N E

Michael A. Grandner, PhD

Psychological •stress, mentalactivity, mood,attitudes, beliefs

Body•body structure,heart rate, bodytemperature,circadianrhythms

Social•family, friends,work, routines


Many people suffer from insomnia. That is, theyeither have a hard time falling asleep or they wake upin the night and have a hard time falling back asleep.Dr. Grandner said while many things can cause insom-nia—illness, job stress, a family crisis—the initial causeof insomnia has little to do with long-term insomnia.That is, the original cause of insomnia usually goesaway, but the insomnia persists. Why is that? Whenpeople first experience insomnia, they spend extra timein bed, hoping to get some extra sleep. But instead ofsleeping, they spend a lot of time in bed, awake, doing

other things. They program their minds to stay awakein bed. Then, no matter how tired they are, they justcan’t sleep well. To resolve long-term insomnia, peopleneed to reprogram their minds by using the bed onlyfor sleeping. That means if you wake up in the night,you get out of bed and do something for a little whileand then go back to bed to sleep. It seems counterintu-itive, but it works.

You should sleep in your bed, and your bed shouldbe for sleep and sex only. A lot of people use theirbeds for other activities, like work, reading, watching

TV, playing videogames, and talking.In general, the more

C O N T I N U E D H

they are not as able to make sound decisions,and they are more emotionally fragile.”

“People who are sleep-deprived don’t think as clearly,

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34 F A L L 2 0 1 4 • S L E E P & W E L L N E S S M A G A Z I N E

UNDERSTANDING SLEEP: BODY, MIND & SOCIAL

time you spend in bed doingthings that are not sleep, theharder it will be to sleep whenyou’re trying to.

Of course, if there’s a readilyidentifiable reason why you’re upat night, you must address thatissue directly. Biological, psycho-logical, and social aspects ofyour life affect your sleep. Forexample, if you’re angry, you’regoing to have a difficult timefalling asleep. Don’t go to bedangry; work through what youcan before you go to bed. Giveyourself permission to let thingsgo for the night; chances are youaren’t at your mental sharpestright before bed. In the morning,often things will look better ormake more sense or you’ll beable to see a solution youcouldn’t see the night before.

EMOTIONS & MEMORY

Sleep serves some very impor-tant functions in terms of emo-tional regulation, so sleeping on your problems is genuinelyhelpful much of the time.

People who are sleep-deprived don’t think as clearly,they are not as able to makesound decisions, and they aremore emotionally fragile. Theyare more prone to mood swingsand do not derive as much pleas-ure from the things they wouldenjoy if they weren’t tired.

Brain research has shown thatthe areas of the brain that controlmemory and emotion are rightnext to each other. Memory isprofoundly affected by emotionsbecause emotions signal to ourminds what is important. Youmay not remember what you ate

in the morning. Your mind hasprocessed that information andknows what to do with it.

HOW DOES IT ALL FIT TOGETHER?

Sleep is essential—and com-plex—because it affects and isaffected by every part of ourlives. When you work with aperson on improving his sleep,you are dealing with every partof his life: how he feels physical-ly and emotionally, what he cando, his worries and fears, evenwhat is important to him. Thatis why there is no “one size fitsall” solution for sleep problemsand why it’s important to con-sider biopsychosocial elementsthat take in the broad view andtreat the whole person.

Sleep medicine is a field thatbridges the gap between tradi-tional medicine and wellness.Sleep, like diet, is truly a pillarof health. Emerging solutionsfor sleep disorders, which oftentake into consideration multipleaspects of a person’s life, have agreat impact on overall healthand well-being.

Dr. Grandner is alicensed clinical

psychologist andInstructor in theDepartment of

Psychiatry. He haspublished over 40articles on issuesrelating to sleep

and healthappearing in jour-

nals includingSLEEP, Appetite,Sleep Medicine,and JAMA. He

currently serveson the Mental

Health Task forceof the NCAA. Dr.Grandner main-tains leadership

positions with theAmerican

Academy of SleepMedicine, Sleep

Research Society,and Society of

Behavioral SleepMedicine, and heis the outgoingPresident of the

PennsylvaniaSleep Society.


for breakfast last Tuesday, yetyou remember what you ate forbreakfast the day your motherpassed away years ago; that’sbecause your mother’s deathwas a powerful emotional expe-rience, so the memory is pre-served in vivid detail. The inten-sity of the emotion surroundingdifferent events affects how wellyou remember them more thanwhether the events were posi-tive or negative. Even more pro-found, it has been determinedthat if you are able to changeyour feelings about an event,you will also change your mem-ories of that event. In effect, youcan “spin” your own history.

PROCESSING INFORMATION AT NIGHT

How do emotions and memoryrelate to sleep? What really hap-pens when we “sleep on it”?

During the day, you take ininformation during everymoment. You do things, youhear things, you learn things,you feel things. By the end ofthe day, you can be over-whelmed with data. That’s oneof the reasons why it’s not bestto make important decisions atnight before bed. While yousleep, your brain processes theinformation it has taken in dur-ing the day. It determines whatis important and what thingsmean. Some of this data pro-cessing manifests itself asdreams, which you may or maynot remember upon awakeningin the morning. Often, you’llfind that something thatstymied you at night before youwent to bed makes sense to you

“Memory is profoundlyaffected by emotionsbecause emotions sig-nal to our minds whatis important.”

S&W

A REPRESENTATIVE FROM THE AMERICAN SLEEP & BREATHINGACADEMY [ASBA] TALKED WITH CHERYL FORBERG, RD AT THESLEEP & WELLNESS 2014 CONFERENCE IN MAY. CHERYLFORBERG, RD IS AN AWARD-WINNINGCHEF AND A NEW YORK TIMES BEST-SELLING AUTHOR. SINCE 2004,FORBERG HAS BEEN THE NUTRITIONISTFOR THE NBC HIT SHOW, THE BIGGESTLOSER. SHE WAS ALSO NAMED AS ONEOF THE TOP 100 MOST INFLUENTIALPEOPLE IN HEALTH AND FITNESS.CHERYL FORBERG WAS PLEASED TOSHARE SOME OF HER EXPERIENCESAND INSIGHTS FOR SLEEP & WELLNESSMAGAZINE.


Q&AC O N T I N U E D H

WITH C H E R Y L F O R B E R G , R D


It’s counterintuitive, but once we skip a meal, particularly breakfast, we lose sight of our hunger cues.

“...often people skip meals, which promotes weight gain, not weight loss.

ASBA: PLEASE GIVE A SHORT SUMMARY OF HOWYOUR CAREER EVOLVED.CHERYL FORBERG: My career originated from mytraining as a professional chef, which is myfirst love. I started to cook for private clientswho had dietary restrictions. I felt I could go alot further with my cooking if I understood thephysiology of why people needed to eat a cer-tain way, so I went back to school and got mynutrition degree and RD [registered dietician]credential. That training enabled me to gobeyond the kitchen and to do more teachingand approach my work from a lifestyle van-tage point that includes elements of nutrition,exercise, and general wellness.

ASBA: CAN YOU TELL US A LITTLE BIT ABOUT YOURROLE AS THE NUTRITIONIST FOR THE BIGGEST LOSERTV PROGRAM?CHERYL FORBERG: Sure. I’ve been with the showfor 10 years, and we’re in the middle of film-ing our 16th season. (NBC started filming twoseasons of The Biggest Loser per year when itbecame a popular show.) I design the eatingplan for the contestants. Over the years, I’veworked with hundreds of contestants, intro-ducing them to a new style of eating. I don’tlike to use the word ‘diet’ because a diet istemporary. On The Biggest Loser, we addressthe contestants’ entire lifestyle, not just whatthey eat. Our integrated approach addressespsychology and emotional eating, exerciseand nutrition. The show employs experts inall areas on a medical team, and we’re con-stantly in communication with each other tomake sure that each of our contestants is get-ting the optimal care in all areas.

Q&A WITH CHERYL FORBERG, RD

CONTINUEDH

that has contributed to weight gain and overall health issues. “Many people have a long-term habit of emotional eating

Emotional eaters need to address the psychological aspect of eating.”


ASBA: ASBA’S MISSION IS TO HELP PEOPLEIMPROVE BOTH SLEEP AND WELLNESS. HOW DOYOU FEEL YOUR WORK FITS WITH OUR MISSION?CHERYL FORBERG: I was pleased to participatein the Sleep & Wellness conference because itincluded health professionals from differentfields, working together, which is really theoptimal approach to preventive health andlifestyle improvements. Nutrition is oneimportant part of a healthy lifestyle, but youcan’t ignore other areas like fitness and restfulsleep and still maintain optimal health.

ASBA: LET’S TALK ABOUT THE RELATIONSHIPBETWEEN FOOD AND A GOOD NIGHT’S SLEEP.CHERYL FORBERG: The title of my talk at theSleep & Wellness conference was “Eat YourWay to Zzzz’s,” but I added a little subtitlebecause I didn’t want people to think there’s afood cure for sleeping disorders because thereisn’t. However, the way we eat definitely con-tributes to our sleep and to our wellness. It’sreally important that we eat at different timesthroughout the day because our blood sugaraffects sleep. The amount and quality of thecalories that we eat contributes as well.Through working with The Biggest Loser, Ihave found that having a healthy weight isvery important to having optimal sleep.

ASBA: PLEASE COMMENT ON HOW THE QUALITY OF FOOD IS AS IMPORTANT AS THE CALORIES IT CONTAINS. THERE’S A DIFFERENCE BETWEEN 500CALORIES OF JUNK FOOD AND 500 CALORIES OFHEALTHY FOOD.CHERYL FORBERG: Healthy foods have a highernutrient density than junk food. If you eat 10calories of a tomato, for example, and 10 calo-ries of a soft drink, you’re getting a lot more“nutrient bang” for the tomato calories. Myapproach is that the quality of the calories weconsume should be our principal focus. I trulybelieve if we focused on high-quality calo-ries—such as lean proteins, whole grains,good fats—and eliminated many of the salty,fatty foods that are contributing to the obesityin this country, the quantity of the calories weconsume would really take care of itself. We’dbe naturally satisfied with the high amounts

C O N T I N U E D H


of fiber, water, and nutrients that are found inthose healthy foods.

ASBA: LET’S TALK ABOUT THE ENVIRONMENT IN WHICHWE CONSUME OUR FOOD"OUR RELATIONSHIP WITHFOOD"AND HOW THAT AFFECTS OUR WELLNESS.CHERYL FORBERG: It’s really important for all of usto try to slow down a little bit. We’re all so busy,and often people skip meals, which promotesweight gain, not weight loss. It’s counterintuitive,but once we skip a meal, particularly breakfast, welose sight of our hunger cues. By the time we eatlunch, we’re so hungry that we usually eat toomuch, too fast, and we choose the wrong things.It’s really important to take the time and planahead. That’s much easier said than done with allthe crazy schedules that people have. So often wedon’t take the time to shop, and we certainly don’t

take the time to plan our menus.That’s what has kind of gottenus into this mess. It’s importantto take time and think aboutwhat you’re going to eat, andwhere you’re going to eat it.Otherwise you might wind up asso many people do: eating in thecar, eating at your desk, eatingstanding up, choosing to dine atwhich ever drive-thru has theshortest line. A comprehensiveapproach to wellness requiresthat we step back a little bit,slow down, and prioritize thingslike meals. If we don’t take careof ourselves, we’re not going tobe healthy enough to take careof anybody else in our family, sogood choices about where andhow we eat (as well as what weeat) are key.

ASBA: LET’S TALK ABOUT THE RELA!TIONSHIP BETWEEN STRESS, ANXIETY, DEPRESSION AND EATING.CHERYL FORBERG: All of us are

emotional eaters, but some of us do a little more emotional eating than others. Sometimes we eatwhen we’re sad, when we’re tired, when we’redepressed, when we’re anxious—and we mightnot even be hungry. Emotional eating is whenyou’re eating and you’re not hungry; you know it,and you do it anyway. To compound the problem,emotional eaters generally choose unhealthyfoods. When you’re stressed out or tired andgoing for a snack, you’ll rarely choose a saladwith dressing on the side. The chocolate andfried comfort foods you choose instead aren’treally comforting to your body or your health.Many people have a long-term habit of emotionaleating that has contributed to weight gain andoverall health issues. Emotional eaters need toaddress the psychological aspect of eating.


Q&A WITH CHERYL FORBERG, RD

CONTINUEDH

ASBA: IN YOUR EXPERIENCE, WHATHAS BEEN THE MOST EFFECTIVE SYSTEM FOR YOU TO HELP PEOPLECHANGE NOT JUST THEIR DIET BUTTHEIR LIFESTYLE?CHERYL FORBERG: I prefer to workas part of a team. On The BiggestLoser, every day I work with thepsychologists, the trainers, themedics, and the physician. In my private practice, I alwayswork with a local trainer and alsoconsult with a psychologist forsome of my clients. Coordinatingwith other experts reallyimproves the results of my work.Even though nutrition is reallyimportant, if you only change theway and amount of food that youeat, you lose weight by losing fatand muscle. And you don’t wantto lose muscle; you want toincrease your muscle mass.Muscle helps you to be moreflexible and increases yourmetabolism, so it’s important todo proper exercise in conjunc-tion with changing your eatingpatterns for weight loss.

ASBA: TELL US A LITTLEBIT ABOUT YOUR NEWCOOKBOOK, FLAVORFIRST, WHICH DEBUTEDAT THE SLEEP &WELLNESS 2014 CONFERENCE.CHERYL FORBERG:Flavor First is a cul-mination of all thethings I’ve learnedfrom working withThe Biggest Losershow for 10 years.

The cast members on the showpersonify overweight America.We are so in love with our condi-ments. We love our ranch dress-ing, we love our ketchup, we loveour sauces (especially cheesesauce)—and these things havereally gotten us into trouble.Most of us have such good inten-tions. When we’re trying to stayon a healthy plan, we go out tolunch and order a salad, but thenwe drown it in dressing. I wantedto help people choose the rightingredients and allow condi-ments and cheese to be part ofthe picture. The cookbookincludes some sauces, vinai-grettes and marinades that aremade with high quality ingredi-ents and do not contain excessamounts of salt, sugar, andunhealthy fats. That’s a big partof the book, but I also kept inmind that most of us are prettybusy. The recipes included in thebook are fairly simple, and theingredients are things you canfind without a hassle. Most of the

people I work withdon’t all have accessto high-end healthfood stores andobscure ingredients.Fortunately, you don’tneed those things toprepare healthy, deli-cious food.

ASBA: WHAT DOESCOOKING LOOK LIKE ATYOUR HOUSE?CHERYL FORBERG: Welike to cook a lot of

international foods. Our dinnerparties usually have a globaltheme. My boyfriend likes tomake sushi. I enjoy Italian food,so I might teach my friends howto make pasta. Another time wemight have an East Indian menu.We live on a farm. I have a 3,000square foot garden, and I enjoypicking my dinner. What’s inseason in my garden usually dic-tates what we’re eating. I’m hop-ing that eventually we’ll be ableto get almost all of our food fromthe back yard. In addition to mygarden, I have 12 chickens. I justlove having fresh eggs. A vine-yard is also in the plans at ourhouse, so soon we’ll even bemaking our own wine.

ASBA: IS PICKING YOUR DINNER EVENA POSSIBILITY FOR MOST OF US?CHERYL FORBERG: I think a lot ofpeople are trying to go back toliving off the land. Even if youlive in town, sometimes it’s allright to have a few laying hens. Ifyou live in an apartment or a bigcity, you can still have a few potsof herbs on the balcony or inyour kitchen. I highly recom-mend growing a little bit of whatyou eat. You can’t beat it for costand freshness and excellent taste.It’s so gratifying that I thinkeveryone should give it a try.

Hungry for more? You can findrecipes, wellness and cooking tips,and even photos and other informa-tion about contestants on TheBiggest Loser at Cheryl Forberg’sweb site, www.cherylforberg.com.


“...so it’s important to do proper exercise in conjunction withchanging your eating patterns for weight loss.”

S&W

F A L L 2 0 1 4 • S L E E P & W E L L N E S S M A G A Z I N E42 This is the first in a series of articles. It chronicles the real-life experiencesof a man with sleep apnea. The mystery sleeper’s identity will be revealed inthe final installment of the series.

PART1

MOST OF MY LIFE I HAVE BEEN A BIG PERSON. FIRST A BIG KID, THEN A LARGEADULT. IT WORKED WELL ON THE PLAYGROUND, IN SPORTS, AND THEN IN COLLEGE. I STARTED A PROFESSIONAL LIFE, PAID MY TAXES—FOR THE MOST PART, JUSTBECAME A RESPECTABLE MEMBER OF SOCIETY.


BY LOUD U. SNORER✒ SOMEWHERE ALONG THE WAY, PEOPLESTARTED COMMENTING ON MY NIGHTTIMERUCKUS. I wasn’t aware of it at first because, ofcourse, I was asleep. But the complaintsbecame louder and more frequent. They wereoften directed at my wife, who would hearthings such as, “How do you sleep at nightwith that racket?” My wife was nice at first. Sheput up with it. I would occasionally get a jab inthe ribs that would abruptly bring me out ofwhatever sleep I was enjoying to hear, “Quitsnoring!” Do you think any of us who snorecan stop just because someone asks us to?

C O N T I N U E D H

So this has been my lifeand my marriage for the past25 years. Yes, I know I snore,but I don’t know what to doabout it.

My parents have beenusing these machines for tenyears now. I just kind of lookedat them with disdain. “Notme,” I said. “I will never use aCPAP machine. That’s the silli-est thing I have ever seen. It’sjust another fad, along withchin supports, aromas, andwhatever else they sell at car-nivals to stop snoring.

I used to tell people I justdo not need much sleep. I hadseen a reporter mention thatBill Clinton only slept a cou-ple of hours a night. ThomasEdison only slept a couple ofhours a night. I figured I wasone of the lucky ones whoonly required a couple ofhours of sleep at night.

While I thought sleepingjust a little at night was allright, sleeping during the daywas an issue. I would fallasleep as soon as I sat down.Forget watching a movie. Iremember often going to amovie with my kids and notgetting through the previews.I’d wake up at the end of themovie. “At least it was a dollarmovie,” I would comment.

Later, I went back toschool to get my doctorate.School meant long hours ofclass, study, and writing thatdissertation. I did not havetime to sleep. However, oneday I was driving home fromclasses and felt my head bob.Where was I? Had I beenasleep, and if so, for how long?I could have hit someone or

even killed someone. That was unacceptable. I realizedI had to deal with my sleep problem—and soon. I wouldforce myself to get more sleep, I promised.

For the next year, I really did try to get more sleep.But though I slept more, I did not feel rested. In fact, Iwas still nodding off in movies and whenever I had aquiet moment. I realized I was suffering from sleepapnea. By this time, the science was there: apnea isbad. Heart disease, diabetes, and so many of the dis-eases often attributed to aging also can be associatedwith sleep apnea.

After accepting that I had sleep apnea, I had todecide what to do about it.

It’s important to note that I make my living flyingairplanes. I have been doing it for many years, and I am not about to give it up. Pilots have to pass a medical exam; if they have a medical issue, they mustdisclose it. Pilots who have medical issues that canaffect the safety of passengers are grounded. For me,that was a big reason to avoid being diagnosed withsleep apnea!

I figured the bottom line was, I was not gettingenough sleep. I resigned myself to using a CPAPmachine. I thought I’d just go buy one. Then I learnedthat’s not possible. A person needs to have a medicalexam, be diagnosed with sleep apnea officially, andthen get a prescription before he can buy a CPAPmachine.

Are you kidding? Clearly everyone, includingyours truly, can see or hear that I am suffering fromsleep apnea. S&W

I real-ized I

had todeal withmy sleepproblem—and soon.I wouldforcemyself toget moresleep, Ipromised.”

“Mys t e r y S l e e p e r


YOU CANREAD MOREOF THEMYSTERYSLEEPER’SSTORY INTHE NEXTEDITION OFSLEEP &WELLNESSMAGAZINE.

This is the first in a series of articles. It chronicles the real-life experiencesof a man with sleep apnea. The mystery sleeper’s identity will be revealed inthe final installment of the series.

PART1

CONTINUEDH


are often experienced in conjunction with sleep disorders,such as sleep apnea, often associated with obesity

or large body size.”

“The cardiovascular problems like hypertension, stroke, and heart attack

NLIVING HEART


Dr. Roberts was motivated to createthe foundation because he’s passion-ate about health and wellness. At onepoint in his career, Dr. Roberts suf-fered a mini-stroke while delivering alecture to a large group of doctors. Heknew that others shared his experi-ence with garbled speech, weakness inhis arm, and the subsequent treat-ments and carotid artery surgery, andhe wanted to help people avoid thoseexperiences if he could.

Dr. Roberts was heavily involvedin sports throughout his life, with hisathletics culminating in a career as aNFL quarterback for the ClevelandBrowns and the Miami Dolphins. It isbelieved that he is the only NFL play-er to play football and graduate frommedical school in 4 consecutive years.However, even in his youth, heplanned to become a physician. Later,he recognized that as a doctor hecould promote lifestyle choices thatwould lead to increased health forathletes—and for the general popula-tion, since many of us struggle withthe same the health challenges ath-letes face.

NFL athletes are often afflictedwith hypertension, sleep apnea, andmetabolic syndrome. When they findsolutions for these problems, they arehappy to share them with other peo-

ple who face the same symptoms.Choosing active and retired NFLplayers to serve as spokesmen hasbeen especially helpful for the LivingHeart Foundation. While many of usare affected by health challenges, lotsof us “check out” when our doctorsexplain treatment options andlifestyle choices that could help us.When NFL players team up with med-ical professionals to share health mes-sages, they reach a broader, moreengaged, audience.

The cardiovascular problems likehypertension, stroke, and heart attackthat Dr. Roberts treated as a physi-cian are often experienced in con-junction with sleep disorders, such assleep apnea, often associated withobesity or large body size. Dr. Robertsand the Living Heart Foundation pro-mote general wellness, which inte-grates healthy sleep with other bene-ficial lifestyle choices. The foundationbenefits from the input of everydaypeople and a variety of experts thatinclude doctors, dentists, health careprofessionals, and technicians—peo-ple who are interested in a goodnight’s sleep and are willing toapproach treatment options across arange of disciplines. S&W

FOUNDATION

BY ARCHIE ROBERTS, MD ✒

DR. ARCHIE ROBERTS, FORMER CARDIAC SURGEON, NFL PLAYER ANDCHIEF MEDICAL OFFICER AND PRESIDENT OF THE PRO-PLAYERHEALTH ALLIANCE, FOUNDED THE LIVING HEART FOUNDATION IN2001 TO PROMOTE CARDIOVASCULAR HEALTH AND WELLNESSAMONG ATHLETES AND UNDERSERVED POPULATIONS, YOUNG ANDOLD. SINCE ITS FOUNDING, THE FOUNDATION HAS SHOWN SPECIALINTEREST IN THE HEALTH OF PROFESSIONAL ATHLETES, PARTICULAR-LY NFL FOOTBALL PLAYERS.

P ROMOTES GENERAL WEL LNESS

48

ROLEOFTHEAARC

WHAT ARE RESPIRA!TORY CONDITIONS,AND WHAT RISKS DOTHEY POSE?

TOM KALLSTROM MBA, RRT, FAARC IS THE EXECUTIVE DIRECTOR AND CEO OFTHE AMERICAN ASSOCIATION FOR RESPIRATORY CARE (AARC). TIM MYERS MBA,RRT-NPS, FAARC IS AN ASSOCIATE EXECUTIVE DIRECTOR WITH THE AARC. THEAARC AND THE AMERICAN SLEEP & BREATHING ACADEMY (ASBA) HAVE COLLABO-RATED EXTENSIVELY OVER THE PAST YEAR TO PROMOTE PATIENT AND CAREGIVEREDUCATION AND MULTIDISCIPLINARY COLLABORATIVE CARE FOR PATIENTS WITHBREATHING DISORDERS, PARTICULARLY DISORDERS THAT RELATE TO SLEEP.KALLSTROM AND MYERS RECENTLY SHARED A FEW OF THEIR THOUGHTS REGARD-ING THE RESPIRATORY PROFESSION AND THE DIAGNOSIS AND MANAGEMENT OFSLEEP DISORDER BREATHING FOR SLEEP & WELLNESS MAGAZINE READERS.

BY TOM KALLSTROM AND TIM MYERS ✒

Encourages and•promotes profes-sional excellencewhile serving as aresource forpatients, govern-ment agencies,and nationalinstitutions aboutrespiratory healthissues

Advocates for•patients and theirfamilies with res-piratory condi-tions

Advances the sci-•ence and practicefor respiratorytherapists

F A L L 2 0 1 4 • S L E E P & W E L L N E S S M A G A Z I N E

A FEW WORDS FROMAARC EXECUTIVE OFFICE

1. 2.

N

Some commonly known respiratory disordersare asthma, obstructive sleep apnea, chronicobstructive pulmonary disorder (COPD), emphy-sema, pneumonia, tuberculosis and bronchitis.

It’s important for people who suspect theyhave an acute or chronic respiratory conditionto meet with their physician and get an accuratediagnosis and proper, ongoing treatment.Patients with undiagnosed respiratory condi-tions, such as sleep apnea, may suffer from day-time sleepiness, which not only degrades theirquality of life but also puts them and others indanger if they drive or operate machinery. It’sestimated that drowsy drivers cause thousandsof fatalities every year in the U.S. People whowork long or late shifts or work in high-stresspositions may also make critical mistakes thatendanger themselves and others when theydon’t get enough sleep.

Patients with respiratory conditions alsohave an increased risk of developing other acuteor chronic health issues, such as diabetes orcardiovascular problems. Somatic heart diseasehas been identified as a possible risk of havingundiagnosed sleep apnea, for instance.


WHAT IS THEBEST WAY TO TREATRESPIRATORYCONDITIONS?The best treatments forrespiratory conditionsaddress overall wellnessinstead of just treating thesymptoms of the condi-tion. Treatment caninclude traditional medi-cine, the use of supportiveequipment like a CPAPmachine, dental devices,diets and exercise forweight loss, and improvedsleep habits.

Coordinated, interdis-ciplinary care is a key fea-ture of Accountable CareOrganizations (ACO’s),which have a growingpresence in the healthcarearena; they represent ashift in healthcare fromtreating disease to pro-moting wellness.Currently, ACO’s aregroups of hospitals, doc-tors , and other healthcarespecialists who jointogether to provide carefor chronically ill patients.Patients and healthcareproviders benefit fromACO’s because theyimprove the overall qualityof care while reducingcosts. ACO’s are alsounique in that they providea financial incentive forhealthcare providers tocoordinate care andreduce costs for patients,whereas traditional med-ical systems pay providersa fee for services rendered.The AARC has been instru-mental in recommendingthat respiratory therapistsbe included in ACO’s tohelp patients with respira-tory disorders.

TOM’STIPSFOR

BETTERSLEEP

Manage stress by designating•times for different activities.

Don’t eat late at night.•

Avoid alcohol at night.•

Read a book before bed.•

Go to bed at the same time•every day.

TIM’STIPSFOR

BETTERSLEEP

Find a good work-life •balance.

Stick to a routine.•

Eat healthy meals.•

Exercise.•

Maintain these good habits•even when you travel.

3.

Educational Material

RESPIRATORY CARE – a scientific journal that deals withthe subject area of the same name, and thus publishesarticles pertaining to disorders affecting the cardiorespira-tory system, including their pathogenesis, pathophysiolo-gy, manifestations, diagnostic assessment, monitoring,prevention, and management.

The Clinician’s Guide to PAP Adherence – a guide forclinicians that includes information about positive pres-sure device compliance and best practices for treatmentin a user-friendly Q&A format

AARC U- The AARC University is the AARC’s official edu-cational portal, allowing participants to access education-al content, earn continuing respiratory care educationcredits, and expand their ability to provide excellentpatient care.

Web sites maintained by reputable sources: CDC.gov,www.nih.gov, AARC.org, www.yourlunghealth.org

S&W

Circadian SleepDisorders Network

TO OUR SPONSORSA T T H E 2 0 1 4 C O N F E R E N C E

This conference was supported, in part, by an educational grant from Jazz Pharmaceuticals in accordance with the ACCME standards for commercial support.

BROUGHT TO YOU BY:

in collaboration with: YOUR SLEEP STICKER HERE

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