The dangers and consequences of lack of sleep

Sleep is one of those funny things that most of us love, but we can never seem to get enough. On the one hand, anyone who is tired will tell you how much they desperately want more sleep. They might have to take naps, or just crave a decent full-night of sleep.

On the other hand, a lot of us also need down-time after work and into the evening. Maybe you have kids and you don't get time for yourself or alone time with your partner until after the kids are in bed. Maybe you take work home with you and work late, and therefore just don't get to bed early enough. Either way, we're pushing our bedtimes later, and our wake-up times aren't necessarily changing.

This balance of sleep, work, and time for yourself to decompress, can be really tough to achieve. Part of it is due to how we, as a North American society, view our daily expectations. Workplaces expect a 8-hour workday minimum, with more and more jobs requiring additional hours adding up to 60-80 hours per week. How on earth is that healthy for anyone?

Most of the research I have done in this area is eye-opening. Humans in general need a minimum of 7 hours per night. Anything less than 6.5 hours per night increases the risk of developing Alzheimer's disease, cardiovascular disease, and certain cancers such as breast cancer. (full article with references here: http://thenatpath.com/mind/sleep-deprivation-chronic-health-outcomes/)

I was reminded of these while listening to a fascinating podcast with Matthew Walker, professor of neuroscience and founder/director of the Centre for Human Sleep Science on the JRE:

(http://podcasts.joerogan.net/podcasts/matthew-walker)
I've posted a short clip below, but the full video is also found on YouTube: https://www.youtube.com/watch?v=pwaWilO_Pig

Key messages were that in addition to the number of hours of sleep needed, the quality of sleep is crucially important. That evening glass of wine might help you relax, but the alcohol is keeping your system up.

As well, sleep isn't just for rest! This isn't just about letting the body go to sleep, but allowing your brain to solidify all the connections you were trying to make from your day. This is where the saying "sleep on it" comes from. Even for students who are studying - it is more beneficial for their learning and memory to sleep, rather than to pull an all-nighter. You might think you're giving your brain extra study hours, but the connections will not be made or stay the same way if you instead got a good night of sleep.

Studies have also looked at the mental and cognitive function of school-aged children, finding that children are better able to learn when school start times are pushed back from 7/8am to 9 am or later.

And what about our doctors? The ones who pull double or triple shifts at hospitals, or who have a ridiculous number of working hours during their residency? Aren't we supposed to be superhuman and push through it? Nope! The initial regimen of pushing medical residents started with one MD: a man who was able to follow these long working hours. But it wasn't because of his "mental strength" - it was because he was accidentally addicted to cocaine! And now we use this as our standard for medical students and hospital doctors.

This type of sleep deprivation can cause major issues of impairment both on the job and while driving, being equated to the impairment of drunk driving. Falling asleep at the wheel is no joke, and it's not uncommon. That's what makes this so dangerous.

These developments in sleep science should be unnerving for a lot of us. Sleep isn't something to take for granted. These aren't extra hours to allocate to whatever activities you deem important. This is about your chronic health, and the safety of those around you. Today you might feel okay with 4-5 hours, but 10 years from now your health could be facing the consequences.

Interestingly, Walker actually addresses the "4-5 hour sleeper". He says that the percentage of human beings that can actually get away with that amount of sleep per night with no repercussions is a fraction of 1% but even that number is rounded up!

There are multiple ways to help improve sleep. Walker goes into a few of them, though what's most important is keeping a routine and removing obstacles that can keep you from good sleep:

• Have a set bedtime, set an alarm if you need to remind yourself. 
• Avoid screen time, like smartphones and computers before bed. Put a blue-light filter on your devices if you must use them. 
• Avoid eating 2 hours before bed, and alcohol about 4 hours before bed (or just avoid alcohol altogether). 
• Refrain from caffeine after noon
• Keep the bedroom dark and do not allow light in from outside. Cover up electronics that have lights on them while you sleep
• Keep your bedroom cooler at night. Use fans, A/C or lighter pyjamas if necessary. 
• Work on stress management to regulate cortisol levels. This is crucial for those who find they're waking between 2-4am. 

One of the most dangerous things that we do in a doctor's visit

After having talked to multiple people, listening to stories over the years about people going to see their doctor, I realized that there is something crucially wrong about how we approach seeing a doctor. In fact, there is something that many people are doing - probably without realizing - that is extremely dangerous to their own health.

What is this crazy thing I'm talking about? Neglecting to provide information. I have a spot on my intake forms that asks for all previous diagnoses and medical conditions. As a Naturopathic Doctor, I spend roughly 90 minutes with my patients on a first visit and I try to get as much information from them as possible about their health and lifestyle.

What I noticed was that most patients left this area blank. However, when I asked the right questions, I got a lot more information than a patient originally disclosed - important information that I would have otherwise been blind to. Patients lie all the time. Sometimes on purpose, but often without even realizing it.

It's easy to do. We forget about things. Or we minimize them, thinking that some small detail doesn't matter.

When we withhold information from healthcare practitioners, we interfere with them making the best and safest choice for our personal health care. This includes occupation, recent travels, if you smoke or do drugs, your FULL past medical history. Even something as small as a bug bite can have huge implications.

You might not think it's relevant that you had a concussion 10 years ago, or that you had a UTI last week that has since cleared up, but to a clinician, it can make the difference in your treatment plan. That concussion from a head injury could have led to pituitary dysfunction, messing up your hormones. Or that UTI could have been caused by sexual practices that leave you susceptible to other vaginal infections like yeast or bacterial vaginosis.

I talk about this being dangerous because it is. There are some medical conditions and lifestyles that if unknown to your doctor, could leave you with a treatment plan that can do more harm than help. Getting swelling in your legs and you didn't tell your doc that you're a flight attendant? Being prescribed a heartburn medication but forgot to tell your doc that you're a vegetarian and your B12 is already abnormally low? Heartburn meds like proton-pump inhibitors can cause a B12 deficiency. Being a flight attendant with lower leg swelling may require compression stockings at work instead of just taking a water pill/diuretic.  All of these things matter.

We need to stop being afraid of being judged. If you feel put down by your doctor, judged by them, or if they make a comment to you that makes you uncomfortable, you have every right to say something and either mend the relationship, leave and find another doctor, or report them to their regulatory college. Not all health care workers are created equally. I highly suggest finding the right health care practitioners for you, so that you can feel safe enough to disclose your personal information to them.

This is also one of the driving factors of offering complementary 15-minute consultations in my office. I think it's a fantastic idea to go "shopping" for an ND. Meet with them, see if they can help you with what your looking for. Get to know their personality, ask about their education or their other experiences. And then go with your gut. Build a relationship with your health care provider so that you feel comfortable disclosing your personal information so you can get the best care - the care that you deserve!

The Value of Naturopathic Care

I get it. We have free medical healthcare in Canada. Here in Ontario, our government pays for emergency room visits, surgeries, walk-in clinics, basic medical care, and for seniors, a HUGE portion of their prescription costs.

If you visit a walk-in clinic without your government "Health Card" and pay for services, a 10 minute visit with an MD can cost about $110. Yes, that's $11 for each minute you spend with that doctor. The doctor that must take your information, and very quickly use their clinical knowledge to figure out what (if anything) they can do for you.

As an ND, I realize that fees can be alarming if you're not used to paying for healthcare. However, the service you're receiving is much different than that of an MD, and we both paid about the same amount for our education (a 4-year undergraduate degree, plus 4 years of post-secondary medical education).

An ND (Naturopathic doctor) will:

• Spend 90 minutes with you on the first visit (This may range between 1-2 hours depending on the naturopath. My initial visits are 1.5 hours)
• Take a thorough health history including details on your: sleep, mood, energy, diet, appetite, stress, temperature, and more. 
• Whenever possible, treat the root cause, not just your symptoms. 
• Sure, we also want to give you symptom relief, but we focus on interventions or treatments that address the cause. 
•  Consider the big picture - treating you as a whole
• ND's tend to take all of you (your symptoms, your lifestyle, your views) into account when making a treatment plan. There is rarely a "one-size-fits-all" treatment. 
• Help you with positive diet choices for your specific needs
• ND's have a minimum of 4 years education in nutrition - a signifiant difference from the minimal training an MD gets. We can help you with hormone balancing, weight loss and specific diets for medical conditions such as IBD, PCOS, and weight loss. 
• We combine the medical aspect (blood work, physical exams, diagnosis) with the holistic: incorporating lifestyle choices to improve your health. For example, part of an ND's prescription might be 5 minutes of meditation, or daily puzzles for mental cognition and brain function. 
• We offer many additional services to your average medical care, including (but not limited to): IV therapy, acupuncture (based on Traditional Chinese Medicine), B12 injections, and infrared sauna treatment.
• Our goals are for you to live a healthier life, improve your feeling of wellness and allow you to age well. We want to you to optimize your health and be the best you. 

Our emergency medical system and public health is an absolute necessity for our healthcare, but there are times when conventional medicine doesn't have the answers, or there are no other treatments that can be offered. But there are more options available. There are always alternative treatments, whether it be from an ND, and osteopath, a chiropractor, or other practitioner.

Paying for your health now is like paying for a healthier future; paying for the tools to manage stress or anxiety; paying for someone to truly listen to you - and to everything on your list; paying now, so you don't pay in body pains and illness later. It's an investment in you. 

Using your voice in medical/healthcare situations

I'm about to share a personal story with you. It might seem like a little too much information, but I'm doing so for an important reason. Today's post is about the importance of using your voice with anyone giving you medical attention (doctor, nurse, technician, etc) and standing up for yourself.

I recently have been experiencing abnormal cyclical pelvic pain. Knowing I needed a requisition for imaging and labs (blood work), I made an appointment with a medical doctor (MD). She was extremely nice, asked all the "red flag" questions and agreed that imaging would be necessary.

One quick thing I will bring up though is how Ontario's medical system - although effective at screening for emergencies - was disappointing. As a naturopathic doctor (ND) I've become accustomed to spending great amounts of time with my patients. And when it comes to female reproductive health my screening goes beyond the basics and into a full history with details on everything including family history, age of menarche (first period), history of symptoms, and flow assessment (colour, clotting, volume) and so much more. My time in this particular visit was limited. I felt like I kept cutting the MD off because I had additional information that I thought she would find helpful.

I guess it's a moot point because having the imaging and testing done was the most important thing to me. I just found it was really difficult to be heard in such a short amount of time. Where this would be more troubling for me is if I was counting on the MD for treatment. Depending on my results, I'll likely get stuck in a one-size-fits-all model, be prescribed hormone replacement (birth control pill) and that will be it (luckily I know I have so many other options!) unless a referral to gynaecologist/specialist is warranted.

Again, a moot point, I got what I needed and went and had both a pelvic and trans-vaginal ultrasound done. Upon doing the pelvic ultrasound the technician mentioned he could see a cyst. I told him another technician found something similar about a year ago but said it was just the remnants from a ruptured follicle (from ovulation). He said, no, that's not what this is. He continued to tell me that this is likely what's been causing my pain, and asked if I still wanted to do the trans-vaginal ultrasound.

Hold up right there. Red flag #1: I have no idea if this guy was a doctor. I'm almost certain he was only a technician. He has a requisition from an MD requesting both types of imaging be done and now he's asking me if I want to have one of them done - based on what he thinks is causing my pain? How many other people have been asked a similar question and have said "Oh, if you think that's what's going on, then maybe I should save myself the inconvenience and not go through with the trans-vaginal exam."? I was floored. So I stood my ground, "No, I'd like to have it done as well. I need to rule out other issues and pathologies that might also be going on."

Although he maintained professionalism during this next part of the exam, his communication was terrible. Again, lucky, being an ND and a previous gynaecological model for medical students, I've had a lot of experience with pelvic examinations and having to communicate direction and instructions.

I knew there was a problem when his initial attempt on placement of the ultrasound wand was way off. I thought, Okay, he's a technician who does this for a living. He must understand female anatomy and know how to troubleshoot in order to obtain the necessary images. So I offered direction and used anatomical description and direction to help him out. Red Flag #2: this guy doesn't know what "anterior" means... at all.

So as I'm describing how he needs to shift the position of the ultrasound wand, I realize he truly doesn't understand and now I'm very much uncomfortable and almost in pain, so I intervened, and changed the placement of the ultrasound wand myself.

Again I wondered, If this was anyone else on the table, would they have spoken up? How long would they have put up with this ... 'misdirection' before saying something? If I had been a teen, I probably wouldn't have said anything because you always think that grown-ups in the medical field know everything, Maybe that's how they do it? I don't know!

This isn't going to happen in every case, but there are lots of people in the medical field who have less experience, terrible communication skills and lack a good bedside manner. It's not everyone but it can happen anywhere.

My point is, no matter who is treating you or giving you medical attention, don't be afraid to use your voice. Speak up and stand up for yourself. If you want something, ask for it. If you feel pressured into a decision, ask about the risks and benefits of ALL available options. If something doesn't sit right in your gut, trust your judgement. And don't ever feel like you're a burden just because your doctor or technician is rushing you. That's them rushing - their issue - you pay for healthcare through your taxes, so make sure you're getting what you need.