More Insomnia...

More musings on insomnia. Have today seen a lady whose usual sleep time is 3am. She feels this is by choice. However she's had OSA sypmtoms for years (since she got over 300lbs) and her primary doctor, a sympathetic individual, prescribed provigil 200mg 2 tabs daily when she told the doctor she couldn't afford to see a Sleep Specialist or have a sleep test. Several years ago. I'm sure the drug has cost more than the sleep test would have by now, and it has no indication for use as faux treatment for OSA, but done is done. Unfortunately the lady decided to split the dose and take one in the am and one in the pm. Since it has a long half life, and basically lasts about 12 hours, her bedtime has been delayed. Now she gets up at 10-11am. If she's happy with that, no problem. Still at risk for stroke, car accident, heart attack, heart failure, atrial fibrillation etc. due to the untreated OSA. So now she will be doing that sleep test, and we can find out why she was so sleepy to start with, and then we will treat it. She probably won't need the Provigil.

Sleepless in Missouri

Sleepiness only wins if you let it.
And we should.


- Posted using BlogPress from my iPhone

Location:Farmhouse

I spoke today with a very nice lady who has struggled with insomnia for years, knows she is hooked on sleeping pills, and has OSA but is finding her CPAP use limited by the time she spends awake at night, tossing and turning. Turns out she is drinking at least 24 ounces of caffeine every morning, which she didn't think was a problem because she USED to drink a whole pot of coffee daily and because she doesn't drink any later in the day. I explained the concept of a "half life" to her, and how only half of the caffeine is gone every 10 hours. 400mg of caffeine at 8am results in 200mg of caffeine floating around at 6pm and 100mg of caffeine still there at 4am. Caffeinated 24 hours per day.
And doing your ironing at 2am or watching TV at 3am does not help. The term we use to describe activities that help sleep (and do not hinder it) is "sleep hygiene"; not a lovely term but managing your sleep hygiene means better sleep. Regular bed times and rise times, skipping caffeine and alcohol and antihistamines, de-stressing before bedtime, avoiding light/exercise/mental activity in the middle of the night are all pro-sleep activities.

Time

Have noticed a curious thing about time. When I am seeing a patient, they never check their watch to see if they are over their alloted time. Our appointment slots are 15' apart but it takes 10' to check in (longer if you didn't fill out the 5 page history we need to do a good job for you), it takes 20' at least to do pulmonary function tests (longer if you can barely climb in & out of the booth or totter down the hall to the testing), and 10-40 minutes of interview time with my nurse taking history details before I even come in the room. Then I take 10-40 minutes per patient. Whatever is needed. Not 15 minutes. The whole thing can easily run 2 hours, especially for new patients. Many people are annoyed that they are "waiting" for me even when they have been busy the entire time, yet they don't exactly get up and rush out so the next person doesn't have to wait. I have to apologize for spending time with my patients. Constantly. Wish I could book one per hour but since so many cancel or fail to show up, we'd be out of business if I did that-and nobody would be seen. Yesterday a lady booked an appt. New patient who wanted a consultation, and left minutes after arriving because she'd booked another appt. 60 minutes after ours and couldn't "wait". This is not fast food.
Maybe we should book desk appts and pulmonary function appts. separately. Then doctor.


- Posted using BlogPress from my iPhone

Extremely busy week at work, but worse this week-spending week of vacation time taking another Board exam...

where I've been....

It turns out, I'm far more likely to write for 30 seconds on Facebook and post pics than actually Blog. But is will use this when less pressed for time. Stay tuned.

more sleep stuff

bizarre coincidence, have a second patient who has chronic sleepiness and has a vagal nerve stimulator implant, this time for seizure control. Interested to see on sleep test whether the VNS is disturbing his sleep every few seconds when it goes off, like my other patient. Surely someone else has noticed this. Test pending.