TOP
DOCTORS
2016
by
ADJUA FISHER,
SANDY HINGSTON
&EMllY lEAMAN
7
photography by
DAN SAHINGER
styling by
DDMINIOUE BAYNES
•
Netflix, Facebook, lnstagram. Work, love, traffic, money worries ... the NBA. In keeping up with modern life, many of us-even our kids-are cheating ourselves out of the rest we need. Inside, your playbook for how to tune out and turn in FEW MONTHS BACK, there was a story in the Wall Street
Journal about the Golden State Warriors' Stephen Curry. Only
it wasn't about basketball, per se. It was about how the point
guard's remarkable performance this season has caused an
East Coast phenomenon known as "Curry insomnia." As the
article explained, those of us in the Eastern time zone tend to
fall asleep between 11:30 p.m. and midnight. Half the Warriors' games don't even
start till 10:30. NBA fans are sacrificing sleep to catch the Curry excitement- and
paying for it the next day.
A
This isn't the first time sports have cost Americans
sleep. Remember how Monday Night Football games
used to begin at nine o'clock? Now they kick off at
8:30. Why the change? "They moved it a half hour ear­
lier because the country was losing money," says Eric
Sztejman, a board-certified sleep specialist with Vir­
tua Health. "It was bright and exciting, and everybody
was staying up too late to watch it. It was affecting the
economy."
Maybe it's not sports for you. Maybe it's the temp­
tation to watch a whole season of The Walking Dead at
once. Or lying in bed and fretting over how to pay for
your kid's college. Or that caramel mocha venti latte
you had after supper, or answering emails from your
boss, or checking out Tinder or the latest version of
Mortal Kombat. We all have our excuses, but the fact
is, we're sleeping an hour to an hour and a halfless per
night than our great-grandparents did, according to
Les Szekely, a sleep specialist at Doylestown Hospi-
MAY 2016
PHILADELPH I A
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DOCTOR S
2016
tal. "Now we have electric lights, and all this electronic
distraction," says Szekely. ''We've pushed the envelope
as far as we can." Life today is crammed with a vast
menu ofbright, sparkly, fun diversions. And you know
what those diversions are doing?
They're making you fat.
Really. Talk to local sleep doctors and research­
ers, as we did for this package, and you'll come away
convinced that America's obesity problem can't be
blamed on soda (sorry, Mayor Kenney) orsoft pretzels
or even the Quesalupa- at least, not directly. When
you don't get enough sleep, your willpower erodes,
explains Sigrid Veasey, of Penn's Center for Sleep and
Circadian Neurobiology. That makes it harder to resist
Taco Bell. But even worse, lack of sleep triggers hor­
monal changes that make you crave sugar and fat and
carbs instead of healthy foods. "It's chemical," Veasey
says of our societal longing for cronuts and Big Macs.
What makes lack ofsleep insidious is that it won't
kill you tomorrow. "It's like eating, or smoking," says
David Dinges, chief of the division of sleep and chro­
nobiology at Penn Med. "No one gets obese from one
cheeseburger. No one gets lung cancer from one ciga­
rette. The effects are cumulative." Shorting ourselves
on sleep night after night adds up. And too much
weight is just the tip of the iceberg. Science has cor­
related insufficient sleep with all sorts of health woes,
from heart disease to depression to cancer to stroke
to the permanent loss of brain cells, not to mention
thousands oftraffic accidents a year. And our children,
with high-def TVs and iPads in their bedrooms and
iPhones in their pockets? While grown-ups manifest
lack of sleep by getting, well, sleepy, kids get wild and
belligerent and loud. In fact, says Veasey, they exhib-
In America, we're used to
wearing ourlack ofsleep
as a badge ofpride- a
holdover from ourPuritan
past when inactivity
equaled laziness.
it all the symptoms of that other epidemic of modern
life,ADHD.
Unconvinced? Listen to this. Dominic Valentino,
a sleep medicine and critical care doctor with Mer­
cy Health, designed a little experiment to study the
effects of sleep on patients in the ICU. His wild idea:
to let them snooze without having nurses pop in con­
stantly to check their vital signs. "When I first pro­
posed it,'' he says, "the nurses were taken aback. They
were used to being in the room with the patients."
But when those patients w ere monitored remotely
from the nurses' station and allowed to sleep undis­
turbed from midnight to 4:30 a.m., their stays in the
ICU were cut by an average of 4.4 days. And they aver­
aged about two fewer days of delirium as measured by
the Confusion Assessment Method for the ICU, which
monitors level of alertness, ability to focus, ability to
follow and repeat directions and the like. The results
were so startling that Mercy Health implemented the
protocol in all its hospitals.
That's the power ofsleep.
In America, we're used to wearing our lack of sleep
as a badge of pride- a holdover from our Puritan past,
when inactivity equaled laziness. Wall Street moguls
boast of getting by on just four hours of shut-eye.
Meantime, pro athletes and reality stars and pop sing­
e rs tweet and Instagram evidence of their all-night
debauchery. Staying up late feels deliciously naughty,
even ifyou're only watching one more episode ofLaw
& Order. But the experts we spoke with say that's start­
ing to change as research reveals more of the dangers
ofcutting slumber short.
"It's becoming a lifestyle matter," says Dinges.
"We're prioritizing it. More scientists are interested
in it. The U.S. government has panels on nutrition and
exercise. We need to have sleep as the third compo­
nent of the triad."
Incidentally, hardly any of the doctors we spoke
with started out to practice sleep medicine. What
attracted them to it, they say, was the dramatic- the
downright miraculous- differe nce they saw proper
sleep make. "You can fix people," says Joanne Getsy,
medical director of the Drexel Sleep Center. "It's not
just giving them a little more time or making them a
little bit better. You can.fix them!"
Whether what's keeping you awake is a fussy baby,
a jammed-up schedule, a spouse who snores or the
lonely misery of insomnia, this guide is full ofways for
you to get fixed. - s.11.
SEE OUR ANNUA L LI ST OF THE BEST PHYSICIANS IN THE REGION, STARTING ON PAGE 101.
92
PH I LAD E LPHIA
1bisls
Your
Wake-Up
Call
25 questions: Philly's top experts share the secrets to a great night's sleep 1
Wbydowesleep?
~ Surpris ingly, nobody knows. "If I did, I'd be
n ch and famous," laughs David Dinges, chief
of Penn Med's division of sleep and chronobiology.
He adds that whatever sleep's functions might be, it
evolved because our planet has light and dark cycles
every day: "Evolutionarily, it was adaptive to be out
and about in one phase or the other. All animals func­
tion according to circadian rhythms, and sleep is a
manifestation of that."
That doesn't mean there aren't theories of course·
this is science! Richard Friedenheim, medical direc~
tor of Abington-Jefferson Health's sleep disorders
centers, ticks off four: the restorative theory ("Sleep
restores and revitalizes the body, so you wake up
r:freshed"); the energy-conservation theory ("At
mght, when there a re fewer threats, you consume
less energy so you can hold it over to when there are
gre~ter threats during the day''); the inactivity theory
(animals evolved to be most active in whichever halfof
the cy~Ie n~aximizes their survival); and the memory­
consohdatJon theory (the sensory input from dreams
stimulates neurons and synapses to help you learn).
Whatever its purpose, says Dinges, scientists have
established that nearly all complex life-forms sleep.
How they sleep can differ. Dolphins, for example, can
go for weeks with half the brain asleep and the other
half awake, regularly switching the two sides off and
on and seemingly maintaining constant vigilance.
2
Whathappemifldon'tsleep?
C> On the most basic level, says Friedenheim,
"The drive to sleep is as strong as the drive to
breathe." Scientists have shown that ifyou keep rats
from sleeping, they die in a matter ofweeks: "You can
MAY 20 16
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P HI LA DELPH IA
93
I
feed them and feed them, but their temperature reg­
ulation goes down, their fur gets crunched up"-and
they expire. People suffer as well. Studies have shown
lack of sleep affects human metabolism, inflamma­
tion, heart health, cognitive effects, mood, even appe­
tite (by increasing-ack!-the longing for sugar and
carbs). "The immune system is perturbed," says Sigrid
Veasey, of Penn Med's Center for Sleep and Circadian
Neurobiology. And her research shows that ch ron ­
ic sleep deprivation destroys neurons in the brain­
permanently. That's not to mention the thousands of
car accidents caused by nodding off at the wheel.
3
Okay, so how little sleep
can I get away with?
e That depends on your personal biochemis­
try. Human sleep needs, says Friedenheim, fall along a
U-shaped curve. On one end are people who need very
little sleep-say, four to six hours a n ight. On the other
end are those who need 10 or more for optimal mood
and pe1formance. Interestingly, "Mortality increases
on both ends of the curve," notes Friedenheim. Get­
ting too much sleep can be hazardous to your health,
too. The Centers for Disease Control and Prevention
have decreed that at least seven hours is optimal­
and that a third of the country regularly gets less than
seven hours' sleep. In case you're wondering, Penn
researchers say work is the number one reason peo­
ple cut back on sleep.
4
Ionly getsix hours ofsleep on
weekdays, but I get eight hours on
weekends. Won't that make up for it?
e Um. No. There's a ton ofresearch to prove it. "Ifyou
go two or three days on short sleep," says Eric Sztej­
man, a pulmonologist with Virtua Health System,
"you can be restored after one night of extra sleep
and fee l rested. But the literature doesn't support
going an entire week and catching up on t he week­
end." You should establish bedtime rituals, according
to our experts: "The brain is more inclined to sleep
when given cues," says David Greenspan, a psychia­
trist at Einstein Medical Center. "Going to sleep and
getting up at the same time seven days a week helps
dramatically." If that sounds too draconian, Thanuja
Hamilton, a sleep doctor in South Jersey, says you can
cheat occasionally-"but only by one hour." So much
for those Netflix marathons.
Older people sleep more
than youngpeople, right?
5
e You probably know about REM and non­
REM sleep, but sleep scientists further refine those
stages. Non-REM 1, says Friedenheim, is a light, tran­
sitional sleep that's skimpy in babies and much more
frequent when you're older. Non-REM 3 is the deep,
highly restorative sleep that toddlers luxuriate in but
94
PH lL A D ELP HlA
MAY 20 16
Howcanl
•
convmce
mybosstbat
middayaaps
areagood
idea?
-
YAWN
JAWN
How much sleep
American adults
get each night:
12%
•••••
23%
••••••
5 HOURS OR LESS
6 HOURS
30%
•••••••
7 HOURS
II
28%
••••••••
4%
•••••••••
3%
••••••••••
8 HOURS
9 H OUR S
-
10 HOURS OR MORE
that tapers off as we age. That's because of deterio­
ration in our sleep-wake neurons as we grow older,
Veasey says, causing "a loss of the ability of the whole
brain to be connected and to get deep sleep." Nala­
ka Gooneratne, a Penn Med associate professor who
studies sleep in the elder ly, says science doesn't yet
know what drives t he change. He does note that old­
er adults have more opportunities for daytime sleep:
"The consequences aren't the same for them as if
you fall asleep in a bus in ess meeting. The bound­
ary between daytime sleep and nighttime sleep gets
more blurred." Studies also show that people who
complain of difficu lty sleeping frequently report they
get less sleep than they actually do. When it comes to
older friends and family, says Gooneratne, "The main
thing to be worried about is a change in patterns." If
Mom always got seven hours of sleep but suddenly
needs nine or is nodding off at lunchtime frequent­
ly, she should see a doctor: "There's something else
going on that needs to be addressed."
7
My husband is a night owl. Is
there any hopefor turning
him into an earlyriser?
e
Maybe. Your propensity toward "eveningness" or
"morningness" (the terms sleep experts use for night
owls and early risers) is partly determined by your
genes- specifically, mutations in the biological clock
genes that govern these rhythms. But it's not all about
wiring: Your husband's late-night tendencies have
been cemented by outside factors, from his upbring­
ing (Did he have a late-working parent he stayed up
to see?) to his caffeine habits (Does he drink espresso
after dinner?) to his light exposure (Does he get too
much light at night and not enough in the morning?).
So while he (and you) can't do anything about his
genetic code, you can adjust some of the external [-+]
f) Tzythis: A 2010 study found that naps canboost alertness and improve
cognitive function-effects that last for hours after even a short stint of
sleep. Studies have also found that the ideal time to nap is early afternoon-think
post-.lunch- so you won't have trouble sleeping later at night. IdeallY, you'll
restnct!ourmidday snooze to between 15 and 30 minutes-just enough time to
enter a.hght phase ofsleep and refresh your brain, but not so long that you wake
up feelm~ groggy. Most sleep experts sayoccasional alertness-boosting naps are
okaY, but ifyou're making them a daily habit, you probably aren't getting enough
sleep at night.
factors to better sync up his clock with yours.
Karl Doghramji, director of J efferson's Sleep Dis­
orders Center, says your husband should conform to
regular bedtimes and wake times, even on weekends.
Take baby steps: Have him set his alarm earlier by 15
or 30 minutes each day until he reaches the ideal ris­
ing hour. And make sure he gets plenty ofbright light
during the first hour of his day. "Brigh t ligh t in the
morning is an important signal to the body to re-sync
its rhythm;' says Doghramji. On the flip side, have him
limit his exposure to light in the evenings- including
iPhones and other blue-light-emitting devices (see
question 22)- especially in the hour before bedtime.
Doghramji says it will take concerted, consistent effort
to make the switch to morningness, but your husband
should notice a difference-more alertness in the
morning, feeling tired earlier in the evening- over the
course ofa few weeks.
My 10-month-old 1tW won't sleep
8
throueh the ni&ht. I'm at my wit's end. Should I let her cry It out? This is one of the most hotly debated topics in
infant sleep. In one camp are those who argue that
allowing a baby to cry herself to sleep causes undue
mental and physical stress, leading to elevated blood
pressure, erratic breathing, a compromised digestive
system, and even changes in brain chemistry. They
also point to the pote ntial for long-term e motional,
developmental and behavioral damage, and worry that
cry-it-out techniques diminish the bond between baby
and parent.
"I've found no evidence for any of these claims,"
says Marsha Weinraub, a developmental psycholo­
gist and psychology department chair at Temple Uni­
versity, who's been studying sleep in young children
since 1989. In 2012, she published a study, based on
data from more than 1,200 infants, showing that on
average, a third of six-month-old babies wake up
every nigh t of the week, but that this slowly decreas­
es to one night a week by 24 months. These night­
wakers tend tobe generally fussy, are more often male,
are more likely to be breastfeeding, and have mothers
who are very sensitive to their rhythms and needs.
"These mothers hear their babies cry and immedi­
ately go pick them up," Weinraub says. "Their babies
aren't given the chance to learn how to fall asleep on
their own, which is likely why sleep problems persist."
She argues that he r findings support parenting prac­
tices that encourage children to learn to go back to
sleep on their own- without nursing or being held.
But make no mistake: Weinraub and others in her
camp don't condone putting your daughter in her crib
at bedtime, closing the door, and not returning until
morning no matter how hard or long she cries. "A par­
ent needs to make sure the baby isn't hurt or in dan­
ger, so look in on her and then go out;' she says. Her
C)
96
PHILADELPH I A
MAY 2 016
What's die latest I
can get away with
drinking my afternoon
cup ofcoffee without
tossing and turning
come bedtime?
A
V
Good news, Starbucks addicts: Caffeine has a
half-life of anywhere between two and seven
hours, depending on how you metabolize it, says
Penn Merl's David Dinges. "The rate at which you
metabolize caffeine is genetically determined;' he
explains, and you probably already know how sen­
sitive (or not) you are to a caffeine jolt. A good rule
of thumb, says Fredric Jaffe, director at Temple's
Sleep Center at Oaks, is to cut yourself off at least
three hours before bed, to give the caffeine effect
adequate time to run its course.
~··
Everything
You Think
You Know
About Sleep
Is Wrong
l$'1i=UJ
Once a baby
issleep­
trained,
that's that.
" We all sleep in cycles that
are woven together in pat­
terns." says Andrea Elovson. a
Wyndmoor-based child sleep
coach. Between sleep cycles
are short phases. called partial
arousals. during which we
become wakeful. Adults tran­
sition seamlessly from one
sleep cycle t o t he next : babies
aren't so good at this. which is
why many of them have to be
taught how to put themselves
back to sleep. But once a baby
learns. that's not the end of
the line: "Brain development.
travel. visitors. growth spurts.
teet hing-t hese things will
send your kid 's sleep into
a spiral." explains Elovson.
Parents may need to re-teach
their kids how to get over the
arousals anytime t heir sleep
get s thrown out of whack.
ltiriUOI
illustrations by
CHI BIRMINGHAM
Awarm
glass ofmilk
before bed will help you sleep.
The theory here hinges_on tryptophan- yup. t he same sleep-inducing amino acid found
nod off after a Thanksgiving feast. Althou h
t ryptophan is indeed found in protein-rich foods like milk, t urkey and even chickeng
a 2003 study out_of MIT found that the ot her amino acids present in them actuall/
decrea~e the ability of tryptophan to reach your brain. And without entering your brain.
good ol _tryptophan cant work its sleepy-time magic. So while drinking warm milk · ht
be relaxing. the milk itself isn't going to help you fall asleep faster.
m,g
in t urkey that i:nany believe makes them
Hitting
the snooze
button three
times before
actually
getting out
ofbedisa
smartway
to wakeup.
"Anything that wakes you up
before you have to get out
of bed is a bad idea." says
Penn's Richard Schwab. Think
of it this way: You're robbing
yourself of precious m inutes
that could be spent sleeping.
meaning you're disturbing
your shut-eye for no good rea­
son. And dozing from alarm to
alarm is doing nothing to help
you ease into your morning.
says Schwab: "You're much
better off setting the alarm
for the last possible second
and knowing that you can't
snooze."
19.136 individuals from 15
states and found that 3.6
IXtiUQJ
All coffee
is created
equal.
I
If you're worried about your
afternoon joe affecting your
sleep, be smart ab out the
brew you reach for. "There
are a lot of variants associat·
ed with what you're drinking
when you're talking about
coffee," Dinges says. One of
the biggies: the amount of
caffeine in the blend. " Most
people think an espresso has
all the caffeine in it. but really.
you get a much larger dose
from a breakfa st blend ."
I
1he main reason
people today aren't
getting enough
sleep is the Internet.
Not true. David Dinges at Penn wanted to find out wh_a t people
trade for sleep. His colleague. Mathias Basner. examineddthe!
overnment's economic time surveys. in which thousan so
g eo le break down how t hey spend every minute of their days ..
~he~esult? "Work is the number one reason p_eople_reduce their
..
D.
"That's true even at the b1ll1ona1re level.
.. A d
sleep says 1nges.
wher~ you couldn't possibly spend all the money you have. n
it's also t rue at the other end of t he spectrum. wher~.you h~ve a
Theres no
day laborer who's working two jobs to make money. _
question that time is money." Dinges says. "and that influences
Onlykids
sleepwalk.
Not true. A 2012 study out of
Stanford found that around
8.4 m i/lion U.S. adults are
prone to sleepwalking.
Researchers used data from
a represen tative sample of
percent reported sleep·
walking at least once in
the previous year. with one
percent saying they sleep·
walk at least t wice a month.
This meant. the researchers wrote. "that sleepwalk ing is much more prevalent in adults than previously appreciated." Yawning
means
you're tired.
More likely. it means you're
hot. In 2014. researchers in
Vienna took a deep dive into
yawns and found that they
seem to help regulate brain
temperature and aren't
directly caused by how tired
you are. In their study. the
biggest predictor for yawn·
ing wasn't the amount o_f
sleep subjects got the night
before. but rather tempera·
ture: a hotter room yielded
yawns. Another reason you
yawn? Because it really is
contagious: about half of
adults yawn after seeing
someone else do so.
Sleep
induced by
sleeping
pills is the
same as
natural
sleep.
Some components are
similar. says Sigrid Veasey
of Penn. but research shows
they're not equivalent. In
studies where patients were
given sleeping pills. slept.
and then com pleted learn·
ing tests, they didn' t show
the same improvement as
patients who slept without
the pharmaceutical help.
itVii=AI
Ifyou can't
sleep,do
something
active, to get
tired.
13
14
What's the best thinl
to w ear to bed?
0 "If a child's daytime functioning is good, then he's
getting the sleep he needs," says Jennifer Marriner,
an advanced-practice nurse who specializes in sleep
at Nemours/ Alfred I. duPont Hospital fo r Children.
Unlike adults, who will sometimes push themselves to
the limit with too little sleep, kids won't fight sleep and
will get the rest their bodies need one way or another.
If your child is alert, attentive, and able to stay awake
during his waking hours, his sleeping habits are just
fine, even if they seem inconsistent to you.
Wrong again. "If you wake up
in the night and have trouble
going back to sleep,'' says
Donald M. Sesso of Chest·
nut Hill Hospital's sleep med
department. "go into a d ark·
ened. quiet room and read a
book. Don't make a meal or
go on t he computer. Don' t
do stimulating things."
11
My six-year-old can only fall asleep at night ifmusic ii on in her room. Bad idea? 0 Experts say sleep associations, like allowing your
child to listen to bedtime music, aren't going to cause
any sort ofdevelopmental damage or significant sleep
issues down the line, and she'll eventually grow out
of it. But if an association is particularly disruptive­
for instance, if a child insists on being driven around
in the car in order to fall asleep- it needs to be dealt
with. "Parents must remember that they are altering
patterns that are fiercely defended by the child," says
Aaron Chidekel, chief of pediatric pulmonology and a
sleep expert at Nemours. You can go cold turkey, but a
gentler approach might be to ease into the transition
by putting a time limit on the association: only 10 min­
utes of driving the first night, then five minutes the
next, etc. You can count o n some tears and perhaps a
few sleepless nights, but Chidekel says to stick to your
guns. And know this: Most associations can be undone
in a matter ofdays.
Taking a warm shower
or bath right before bed
will help you fall asleep.
I our body's signals that it's t im e for sleep is a drop in body
te:;e(ature, so taking a wa;: ~:; :aet~f ~gb;~~;i~~tbbe~~~~e:ee:.
1D
Is there a bestposition for sleep?
sleepfnehabits are all over
the map. How do I know
if he's getting enough sleep?
it\1UOUI
0
"It's like speeding in a car at night," explains Dinges.
"You're not going to crash every time, but you're
increasing your risk of something going wrong." And
if you down a few glasses of wine at dinner (see ques­
tion 24 for more about wine and sleep), you may
require more trips to the bathroom in the middle of
the night- another roadblock to good sleep.
My tbree-year-old's
how people sleep."
l&tidCJ!i
rule of thumb: When you hear your baby start to cry,
let her go for about five minutes before checking on
her. Then leave and give it another five minutes, and
repeat until she goes back to sleep. Gradually lengthen
the time between check-ins over a few days. With con­
sistency, your baby should learn to put herself back to
sleep after a few nights.
:f
actually atbadd 11.dt eyao. us.;;beefter off t aking a cold shower before hitting
you can s an ,
,
) t ake it
th h
Or if a hot shower is a must (we don t blame you ,
at ~e:J·go'minutes before bedtime. to let your body temperature
12
WW eatm, a bigmeal late in the
evenm,screwwith my sleep?
0 If there's anything a good night's sleep
depends on, it's routine, experts say. So the main risk
with a late-night feast is that you may be cutting into
your usual bedtime, which can throw your sleep rou­
tine out of whack. And if you're constantly moving
mealtimes around, you may really begin to mess with
your shut-eye, David Dinges says.
Then there's the whole digestion thing. If you eat
something that disagrees with your stomach before
hitting the sack, you can forget about sleeping well.
-
Y AWN
JAWN
Amount of time
each night that
kids spend in
deep sleep
Amount of time
eachnight that
adults spend in
deep sleep
-
0 Sleep position is all about personal pref­
erence. "There's no evidence that says sleep­
ing on your back, stomach or side is more beneficial,"
Fredric Jaffe of Temple says. That is, unless you're
pregnant or have back pain: Pregnant women are bet­
ter off sleeping on their left sides, so the womb doesn't
rest on the vena cava, a large vein that delivers blood
to the heart. And anyone on a quest t o ease back pain
should try side-sleeping, too; it takes some pressure
off the spine.
0 There's no one-size-fits-all approach
when it comes to apparel (or lack thereof) for sleep,
but temperature is a consideration. Jaffe says the ide­
al temperature for sleep is between 68 and 72 degrees,
depending on the person. So dress appropriately.
15
I put on a bit ofwinte r
weight, and I've noticed
I don't sleep as soundly.
Couldthese things be related?
0 A recen t animal study out of Penn's Perelman
School of Medicine suggests that even small changes
in weight can impact sleep patterns-for better if you
drop afewpounds,forworse if the number on the scale
shoots up. Isaac Perron, a Penn neuroscience PhD can­
didate and lead author of the study, explains that when
mice were switched from a healthy diet to one high in
fat for just a week, they showed the same poor sleep_
patterns as mice who'd been fe d a high-fat diet for
much longer, including increased wake fragmentation
(the undesirable habit ofdozing off during the day).
The thing is, when mice are tired during the day,
they sleep. Humans, on the other hand, try to power
through, loading up on La Colombe lattes and sugary
scones, which can further screw with sleep and cre­
ate an ongoing cycle of poor sleep patterns. The good
news is, mice who switched from a high-fat diet to a
healthy one and slimmed down a bit quickly exhibited
healthy sleep patterns again. So, yes, ditching your win­
ter weight could help you snooze better.
16
WWdofneyoga
improve my sleep?
0 A study out of Penn's Perelman School of
Medicine exan1ined the sleep patterns and physical
come back down.
MAY 2 016
PH I LADELP H IA
97
activity habits of more than 400,000 adults and found
that those who regularly participated in activities like
biking, running, weight lifting, Pilates, yoga, golfing
and even gardening were more likely to get the recom­
mended seven hours of sleep on a regular basis than
adults who didn't.
Just don't make it an evening power-yoga class
if you're hoping to turn in- and fall asleep-earlier.
When you exercise, your body releases adrenaline, so
some people need a few hours to wind down after a
workout before they hit the sheets.
17
MydoctorprescribedsleeplagpWs,
but I'm scared ofthe side effects.
What other options do I have?
0 If you can't sleep, you're in good company. A recent
survey showed that 27 percent of U.S. adults have
trouble falling or staying asleep most nights, and 68
percent have trouble at least once a week. The prob­
lem with older sleeping pills like some benzodiaze­
pines wasn't just that they were addictive, according
to Karl Doghramji of Jefferson: "A tolerance devel­
ops, they don't work as well, and you get 'rebound
insomnia' when you go off them." Some newer drugs
aren't addictive. But those taking prescription sleep­
ing pills are still twice as likely to be in auto accidents
as non-users, and the FDA has cut the recommended
dosage for some pills in half. That's the bad news. The
really bad news is that sleeping pills are shockingly
ineffective. The newest, Belsomra, got users to sleep
just six minutes faster and for 16 minutes longer per
night than placebos in testing by Consumer Reports,
and the older ones, like zolpidem and benzos, weren't
much better. The main effect the pills have, some doc­
tors say, is that they make you less likely to remember
being awake.
So what's a tosser-and-turner to do? Cognitive
behavioral therapy for insomnia, or CBT-I, can be
more effective than pills, says Michael Perlis, director
ofPenn's Behavioral Sleep Medicine Program. Fifty to
70 percent ofthose who complete it get at least 50 per­
cent better-"In otherwords, if you're normally awake
for 60 minutes trying to get to sleep, it's down to 30
minutes in two to eight weeks." And half ofthose who
respond go on to full recovery, where they're asleep
every night in 15 minutes or so. If that sounds like
bliss, be forewarned: CBT-I isn't easy or fun. "It gets
harder before it gets better," says Perlis. "But people
come to us who've had insomnia for 10 years and want
an instant cure. You've put up with this for 10 years,
and you can't suffer for a week or two?''
That said, Einstein's David Greenspan notes that
there are good reasons why people have trouble sleep­
ing from time to time- a job loss, a death in the fam­
ily, other crises. It's okay to take pills briefly to get you
over a bout of insomnia. It's when your sleeplessness
becomes chronic that you want to try CBT-I.
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18
What aboutthe over-the­
counter stuff? Does it work?
19
My husband says I snorea loL But I'm in goodshape. Could
Ihave sleep apnea anyway?
C> The reason most over-the-counter sleep­
ing pills make you drowsy is that they contain the
antihistamine diphenhydramine- yup, the same
active ingredient as Benadryl. In addition to prevent­
ing allergy symptoms, this chemical compound keeps
your body's naturally occurring histamines from regu­
lating sleep and wakefulness, and disrupting that pro­
cess causes drowsiness. The good news is, your body
won't build up a tolerance to them. But sleep aids do
come with a host ofpossible side effects, including dry
mouth, constipation, dizziness and more. Plus, the
older you get, the more sensitive you become to those
side effects- and the side effects become more pro­
nounced. "OTC sleep aids are not the cleanest medica­
tions," says Catherine Riley, a pulmonary, critical care
and sleep medicine specialist at Bryn Mawr Hospital.
"I've seen patients who have real issues with not being
able to urinate." Riley says ifpatients insist on trying
OTC meds, she recommends they do so for no more
than a few days, and never with additional sedatives,
including alcohol and pain meds.
0 F irst off, the problem isn't snoring, which is com­
People using
over-the­
counter sleep
aids who take
them for a year
or more
mon in men and more common in both genders as
we age (because the muscles of the throat, like all
our other muscles, get floppy). The problem is that
people with sleep apnea stop breathing, which is [~ ]
-
My boyfriend
got me a wear­
able sleep
tracker for my
birthday. Do
these things
actually work?
A "There haven't been studies to show
. - , these devices do what they promise," says
Richard Schwab, co-director of the Penn Sleep
Center. "This is a case of technology outpacing the
science." In fact, a review of sleep trackers in the Jour­
nalofClinicalSleep Medicine last December concluded
that "lack ofvalidation studies and FDA approval for many
[consumer sleep technologies] is a concern.'' The problem,
says Schwab, is that most products on the market use an accel­
erometer to detect movement, then draw conclusions about your
sleep pattems based on how much (or little) you move. These devices
assume thata lack ofbig movement indicates sleep and that intermit­
tentmicro-movem.ents indicate which stage of sleep you're in. Unfor­
tunately, there's no data to ,show they do this with any sort ofaccuracy.
In fact, Schwab and other sleep experts worry that wearable trackers
ma actually cause more sleep problems than they solve, ifthey make
m;ein your way orfeel uncomfortable. Says Schwab, "The question
es: Does the device disturb your sleep more than it's helping it?''
measured on a scale of how many times it happens
per hour of sleep. (Below five is normal; above 30 is
severe.) And while it's true that the classic body type
for apnea is that of a football lineman (as it happens,
Temple is screening its offensive and defensive lines
for the problem), lots ofsufferers are slim. It has to do
with your facial bone structure, how wide your airway
is, the size ofyour tonsils, soft palate, uvula ... Samuel
Krachman, a professor at Temple Lung Center, says a
quarter of all sleep apnea is strictly positional: "You
can normalize these patients' sleep if you get them
off their backs." He's had success treating them with
what amounts to a hard-foam-filled backpack: "It's
simple and elegant."
There are also implantable devices that stimu­
late the nerve that moves the tongue as you sleep, to
open up the airway; Maurits Boon, an otolaryngolo­
gist at Jefferson, calls this a "game-changer." (One
such device is called Inspire; you may have heard it
advertised.) Robert McCoy, a dentist who works with
Crozer-Keystone's sleep clinic, has crafted dental
appliances that adjust a patient's jaw to keep the air­
way open, and is "really excited" about newer appli­
ances that stimulate stem cells in the jawbone to
actually rebuild and reshape it. There's also bariatric
surgery, for those whose apnea is tied to weight; Rich­
ard Friedenheim estimates that about one in four bar­
iatric patients get offtheir CPAP (for"continuous pos­
itive airwaypressure'') machines.
But the CPAP is still the gold standard-"the one
thing that always works," says Joanne Getsy, medi­
cal director of the Drexel Sleep Center. Alas, as many
as halfof patients don't use it every night, like they're
supposed to. "We can make it work," she promises.
"We have hundreds of different masks. Our techni­
cians work with you to figure out the perfect one.
Then you go home and use it''-and ifyou don't like it,
they try again.
But please, please, our sleep experts say:Get tested
for apnea if you (or your sleeping partner) think you
might have it. (Such testing can now be done at home,
in your own bed.) "Reggie White died ofsleep apnea,"
says Ahmed Soliman, director of the Voice, Airway &
Swallowing Center at Temple. "Most deaths in sleep
are from sleep apnea." Besides; adds Getsy, while
nobody wants to wear a mask, plenty of people do so:
"The difference is how much better they feel when
they're awake-like they can conquer the world."
21
Sometimes I reallybeUeve my six­
month-old sets biller overnipt.
I assume I'm crazy, rilbt?
C) Maybe not. It's long been known that human
growth hormone is secreted during sleep in babies
and adults alike. That's likely why kids sleep more
than adults-they have a lot more growing to do.
What's interesting is that babies don't grow at an even
100
PHILADELPHIA
MAY 2016
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Americans who
say they get
enough sleep
regularly
.~mericans who
say they don't
-
pace, and that messes with their sleep patterns. A
2011 study found that periods in which babies slept
more than usual corresponded with growth spurts
and increases in bodyweight and fat. In fact, for each
additional nap they took, the babies in the study were
43 percent more likely to experience a growth spurt.
So if your baby is logging more sleep than usual­
the study found that during a growth spurt, the aver­
age was three additional naps and 4.5 hours of extra
sleep per day over two days-your baby really could be
getting bigger before your eyes.
22
I read on my iPad every
nilbt when I'm in bed. ls this
messina with my sleep?
C) A 2015 study found that using blue-light-emitting
devices before bed prolongs the time it takes to fal l
asleep, suppresses melatonin levels, reduces REM
sleep and diminishes alertness the following morning.
But Virtua's Eric Sztejman thinks there could
be more going on here, too: "We tend to hold these
screens, especially phones, closer to our eyes than
regular printed books;' he says, which could make the
effects of the bright light more pronounced. There
are also the behavioral effects of seeing Great-Aunt
Bertha proselytizing about Donald Trump as you
scroll through Facebook: You get agitated, your heart
begins to race, the adrenaline surges. "All of a sudden
you're stimulated again, and you're going to have trou­
ble falling asleep," Sztejman says.
Ideally, you should lay off your devices for at least
an hour before bedtime. But if you simply can't pull
the plug, Sztejman recommends dimming the screen
brightness or changing the background to a dark­
er color. You can also get a screen cover that blocks
the blue light. Or, if you have an iPhone, iPad or iPod
touch with the just-released iOS 9.3 operating system,
you can turn on Night Shift mode, a new setting that
automatically changes your display to emit warmer
colors in the evening.
Are fancy beds
worth the money?
23
C) "No mattress will magically help you
sleep better," says Main Line Health's Catherine
Riley. The exception is for people who snore; they can
benefit from an adjustable bed that puts the body in
a tilted position, since sleeping upright blunts gravi­
ty's pull on the airway and makes it easier to breathe.
But for the rest of us, the goal should simply be to
create a sleep environment that's quiet, comfortable
and relaxing, and free from too much stimulation.
If you're used to falling asleep with the TV on-a no­
no thanks to all that super-stimulating blue light-a
white noise machine is a better choice; it gives your
ears something to tune into without perking up your
brain via your eyes.
24
TOP
DOCTORS
=-~r:!f:erore
bedhelp me sleep?
C) Sipping a glass ofwine as you wind down might
not put you to sleep, but if it helps you to relax
(relaxation is sleep's best fri end!), it won't hurt.
Downing four glasses, on the other hand, isn't a
good idea, according to Fredric Jaffe. Alcohol has
sedative effects, so drinking a lot can knock you
out. But when those effects wear off in the mid­
dle of the night, that disrupts your sleep. Add this
to the fact that having four glasses of wine most
likely means you're going to bed later than usual­
screwing with sleep's other best friend, rout ine­
and you've got plenty ofreasons to stick to a single
nightcap.
And to answer the question you've secretly been
asking yourself: No, a puff of marijuana prpbably
isn't the answer, either. A 2014 study out of Penn's
Perelman School ofMedicine linked marijuana use
to poorersleep quality. (We were surprised, too.)
25
Do supplements and natural
remedies reallyhelp you
sleep? Are theysafe?
C> The sleep-supplement aisle at CVS is kind of
like the Wild West: The products aren't regulat­
ed by the FDA, so really, anything goes. As Fred­
ric Jaffe explains, "There's no standardization in
terms ofdosage, preparation or delivery," and most
supplements and natural remedies haven't been
extensively studied. This isn't to say they don't
ever work-you just need to be wary.
Many herbal supplements, like valerian root
and chamomile, which is oftenfound in sleepytime
teas, work the same way big-name prescription
sleep aids do: They decrease anxiety and help you
relax, making sleep easier to come by. The upside,
anecdotally, is that they don't leave you with that
drowsy next-day hangover feeling. But while they
might help youfall asleep, they won't necessarily
help you stay asleep.
Then there's melatonin. It's a hormone your
body naturally releases in the evening to prep
you for sleep by drowning out your wakefulness
signal; for most people, the signal peaks around 8
p.m. Taking a melatonin supplement in the eve­
ning adds to your body's natural supply, which, as
Jaffe puts it, can help to "throw a blanket on the
underlying biological rhythm telling you to stay
awake." But be warned: Dosage amounts in com­
mercially available melatonin supplements are all
over the map-a 2005 meta-analysis conduct ed
by researchers at MIT found you may only need
a tenth of the standard dosage to get melatonin's
restful effects-so it's worth checking with your
doctor before you start taking one.
2016
Our all-new list: the 786 best
physicians in the Philadelphia region,
as chosen by their peers
................. ........ .. .......... .......... .... ..... ......... ......... .... .... .. ....... ........ ......... ·· ······· ··· ADDICTION PSYCHIATRY
Jeffrey D. Bedrick, Hahnemann/
Drexel. 215·248·6848.Sp:Addiction/
substance abuse, personalitydisor·
ders.psychiatry·adult
*Kyle M. Kampman, HUP, 215·
222·3200.Sp: Addiction/substance
abuse,cocaine addiction.opiate
addiction,alcoholabuse
ADOLESCENT MEDICINE
Christopher V. Chambers,
Jefferson, 215·955-7190.Sp:Mela·
bolicsyndrome, sexually lransmitted
diseases
Lori B. Feldman-Winter,Cooper,
856-751·9339.Sp:Nutrition, ealing
disorders,prevenlivemedicine,ado·
lescent behavior·highrisk
Janice K. HIiiman, HUP, 610·902·
2450. Sp: Eating disorders
Rima H. Himelstein, Crozer·
Chester, 610·490·1755. Sp:Ado·
lescentgynecology. sexualhealth,
depression
John R. Cohn,Jefferson, 215·923·
7685.Sp:Allergy, cough·chronic,
voice disordersand allergies, occupa·
tionallungdisease
Rebecka Peebles, CHOP. 215·590·
3537. Sp:Weightmanagement.eat·
ing disorders
Philip D. Fleekop,Abington,
215·659·5480.Sp: Allergicrhini·
tis.asthma.food anddrug allergy.
insect allergy
Nadja G. Peter, St. Chris/Drexel.
215·427-3650.Sp:Menstrualdisor·
ders.chronic illness,reproductive
health.familyplanning
Gall B. Slap, CHOP. 215·590·5868.
Eugene A. Gatti, Virtua Voorhees,
856·988·0570.Sp: Asthma,immune
deficiency,insect stingallergy,drug
allergies
EvaJakabovlcs, Doylestown.215·
230-7476.Sp:Asthma,immunology.
clinicaltrials
ALLERGY AND
IMMUNOLOGY
Andrea J. Apter, HUP, 215·662·
2775.Sp:Asthma. allergicrhinitis,
sinusitis,drug allergy
Eric W. Bantz, VirtuaBurlington.
609·953·7500. Sp:Asthma andalier·
gy,pediatric allergy and immunology,
lood and drug allergy,allergicrhinitis
Thomas E. Klein, DelawareCounty.
610-789·1313.Sp:Allergy,asthma
andimmunology
Norman L. Koven,Ariafrankford.
215·676·0999. Sp:Nasalallergy,
sinusitis.asthma.foodallergy
CONT INUED ON PAGE 145
.
HOSPITAL ABBREVIATION INDEX
Abington: Abington Memorial Hospital;Arla Bucks: AriaHealth-Bucks County Campus: ArJaFrankford: AriaHealth·
fran.kford Campus; A~la !orresdale: Aria Heallh·Torresdale Campus; AtlantlCare Atlantic City: AtlanliCare Regional
M.ed1calC~nter·AtlantlcCity: AtlantlCare Pomona: AtlantiCare RegionalMedicalCenter-Pomona: Brandywlne:Brandy·
wme Hospital:Bryn Mawr: Bryn MawrHospital;Capital Health Hopewell:Capital Health Medical Center·Hopewell; Ches·
ter County: Chester Counly Hospital: Chestnut HIii:ChestnutHill Hospital: CHOP: Children's Hospital of Philadelphia;
ChrisUana: Chnst1anaHospital; Cooper: Cooper University Hospital; Crozer-Chester: Crozer-Chester Medical Center;
CTCA atEastern:CTCAat EastemRegionalMedicalCenter;Deborah: Deborah Heartand LungCenter; Delaware County:
DelawareCountyMemorial Hospital; Doylestown: Doylestown Hospital; Einstein: EinsteinMedical Center Einste in
Montgomery: EinsteinMedicalCenterMontgomery: Fox Chase: FoxChase CancerCenter; Hahnemann/ Ore~el: Hahn­
emann University Hospital;Holy Redeemer:HolyRedeemer Hospitaland MedicalCenter; HUP: Hospital of the University
of Penns~lvanla·UPHS; lnsplra Elmer: lnsplraMedicalCenter Elmer; lnsplraVineland: lnspiraMedicalCenter Vineland;
lnspl~aWoodbury: lnspiraMedical Center Woodbury;Jeanes:Jeanes Hospital;Jefferson: Thomas Jefferson University
Hospital; Kennedy Washington: Kennedy University Hospital-Washington Townsh ip: Lankenau: LankenauHospital;
Lansdale: La~.sd~leHospi~al·AbingtonHealth;LourdesCa mden: Ourl adyofLourdes MedicalCenter·Camden; Magee:
Magee Rehabi11tahon Hosp,tal: Mercy Fitzgerald:MercyFitzgeraldHospital; MossRehab: MossRehab:Nemours/duPont:
Nemours/ Afire~ I.~uPont Hospital for Children; Paoli: Paoli Hospital;Pennsylvania:PennsylvaniaHospital·UPHS: Phoe·
nlxvllle: P~oemxv1lle Hospital; Presbyterian: PennPresbyterianMedical Center-UPHS; Riddle: RiddleHospital; Shore:
Shore.MedrcalCenter;Shrlners:Shriners HospitalsforChildren·Philadelphia; St, Chris/Drexel:St Christopher's Hospital
for Children:St. Francis: St. FrancisHospital-Wilmington:St. Mary: St. MaryMedicalCenter-Langhorne, PA: Suburban:
Suburb_anCom.munity ~ospital; Temple: TempleUniversity Hospital; Union: Union Hospit al; Vfrtua Burlington: Virtua
Me~nal Hosp1tal-8urlmgto~;VirtuaMarfton: Vtrtua West JerseyHospital-Marlton; Vlrtua Voorhees: VirtuaWest Jersey
Hospital-Voorhees; WIiis: WIiisEye Hospital; Wilmington: WilmingtonHospital·Christiana Care
'Not acceptingnew patients at this time
MAY 2016
PHILADELPHIA
101,