A Rocket Scientist Explains How a Sleep Study Can Change Your Life

Once upon a time, before medical science started nosing around your bedroom, snoring was a nocturnal annoyance and little more. Sawing logs in the wee hours, while the bane of spouses and significant others, wasn’t a health concern – just cause for housemates to wear ear plugs.

But over the last couple of decades, science has pulled the covers off snoring, revealing that in many cases—far more than anyone expected—it’s not only irritating, but the symptom of a potentially lethal condition known as sleep apnea. People suffering from this condition experience limited breathing multiple times during the night, depriving their brain of oxygen and consequently increasing blood pressure and putting enormous strain on their organs, most notably their heart.

Studies linking sleep apnea to heart disease have been adding up, and the evidence is pointing to one inescapable conclusion: snoring could be your body’s alarm letting you know that something is wrong along the vital brain-heart highway. The best way to find out for sure is undergoing a sleep study.

Does it take a rocket scientist to explain what a sleep study is and why it’s important?  Probably not, but that didn’t stop me from finding one. John Cunningham is a Registered Polysomnographic Technologist (RPSGT) who runs sleep studies for Total Sleep Management, Inc. In a previous life, he was, in fact, a rocket scientist, but over the course of time his engineering interests turned from the aeronautic to the biologic.

John ran a sleep study I took part in not too long ago, and is a walking wealth of knowledge on all things sleep. He graciously agreed to answer a few questions about what happens during a sleep study, what anyone thinking of having one can expect, and why doing it could improve your health and your life.

David: First, tell us what we’re all wondering – do sleep techs laugh at what people do during the night?

John: You know, sleep is such a personal thing. Inherently personal. You’ve slept all your life without wires or a mask on your face. For some people coming to the lab is the first night they will spend away from their spouse in 20 years. No joke. Some people are creeped out by the cameras. They are being watched! But the truth is we are not staring at you all night. The cameras are just a tool and nothing to be worried about. So I’m not going to say we don’t sometimes see something funny when running the tape, but no, rest easy. We’re not laughing.

Ok a few basics. If you snore, do you definitely have sleep apnea?

No. People can snore for many reasons, including anything from allergies to loose skin in the back of their throat. Snoring is a potential symptom of apnea but not an absolute one.  It’s important, though, to tell your doctor if you snore because it could be the starting place to eventually diagnose apnea.

And sleep apnea occurs when someone stops breathing while asleep?

They don’t necessarily stop breathing altogether, but someone with apnea will experience limited breathing multiple times during any given night. That’s one of the main things we track during the study using polysomnography, the comprehensive diagnostic tool that shows us all the biophysical changes your body undergoes while you are asleep. Some people will experience limited breathing hundreds of times, and that’s extremely dangerous because oxygen flow is reduced each time. The chief mechanism by which apnea damages your body is oxygen crashing hard and fast in your blood.  You can still breathe in many cases, but not enough air gets through your partially or totally collapsed throat muscles.

So is apnea a disease?  

Apnea is a structural problem—not a disease or chemical imbalance—which is why you can’t treat it with a pill. As you relax in sleep, your throat and chest muscles relax (so you don’t act out your dreams – but that’s another topic). Your throat is pitted against gravity, which is why the primary cause of apnea is age; the older we get the looser our muscles become. Because your throat and chest muscles partially or fully collapse, your breath decreases significantly. In the majority of apnea cases, your chest muscles are still trying to take in air, but you can’t get enough air to pass through and your blood-oxygen level crashes rapidly. That’s when the damage begins.

And what can happen if someone doesn’t have their sleep apnea treated?

The connection between apnea and cardiovascular disease is very strong. Your blood pressure increases and you are at far greater risk of stroke with untreated apnea. You’ll also suffer from sleep deprivation, which has a number of negative consequences, including fatigue, mental exhaustion and reduced immune system response. Aside from dire health concerns, quality of life is simply lower with apnea. Plus, your snoring is probably annoying people you live with, but that’s not necessarily a health concern, unless they get really angry.

Give us a general sense of what someone can expect when their doctor orders up a sleep study and they arrive at your lab.

They aren’t going to encounter anything alarming—a typical doctor’s office setting with rooms in the back—but everyone arrives with questions, which is of course natural. My explanation from when they come through the door right into and including the hook-up stage of the study—when we place wires on their body—has been honed by answering patients varied questions and concerns over the years I’ve been doing this. When I’m in the zone (and I’m not always there, but when I am), everything I say while hooking them up is to answer questions before they ask them. And by the way, it’s worth mentioning that the rooms patients sleep in are rather nice, like a decent hotel room – not a sterile, clinical cell that some people envision.

So the tech’s first job is to read people when they walk in and try to anticipate their concerns.

Yes, because contrary to the obvious assumption, my job is art. This is not research, strictly speaking; it’s human diagnostics, which always contains an element of the emotional, the erratic, the unpredictable. In short, the human.

With so much in the news lately about the dangers of apnea, are you finding people more informed when they arrive at the lab?

I’ve found that people have heard about it in general terms, but most of their practical information about apnea and its medical solutions come from the sleep technician.  Apnea is rising for two main reasons: age and weight. Arguably, more people over 50 are overweight than ever before. So amidst growing concerns about obesity, there’s no question that more information about the warning signs of snoring and the dangers of apnea is out there, but the technical specifics usually don’t hit home until someone comes to the lab.

How do you put someone as ease who seems a bit freaked out by the prospect of being hooked up to wires and sleeping in a strange place with cameras running all night?

Much like special effects in movies, a good tech can tailor and weave solutions to the subtle, often unspoken human needs of the patient without them even knowing it. The less they notice it, the better the movie, so to speak. All the while, I’m spouting beneficial technobabble, cleaning, scrubbing and slapping on pieces of technology to create the perfect sleep cyborg for analysis.

Sleep cyborg?

Just a term I use for describing what someone looks like once we have the technology hooked up, and to underscore the point that you can’t forget, no matter how much technology is layered on, that this is a human. And it’s the human who follows through on treatment. Actually, better stated: it’s the human with the unanswered questions and the unaddressed fears that doesn’t follow through with the treatment.

And if someone is diagnosed with sleep apnea, the treatment is a CPAP mask, correct?

CPAP is the gold standard solution. There are a few other options, but they are about 50/50 in effectiveness—surgery and mouth pieces. These remedies can become ineffective over time.  CPAP can change with you as your body changes (essentially by increasing the air pressure of the device), which is what makes it the preferred standard.

Many of the concerns I try to answer are about the possibility of having to wear a CPAP mask (which stands for Continuous Positive Airway Pressure) if the diagnosis is apnea. The reality is wearing the mask is going to feel weird. Anyone who tells you differently is lying. But it’s totally do-able, and with time it will become normal. Most importantly, will it help? Without a doubt. I genuinely believe CPAP helps people live better, longer lives.

I often tell patients the facts about wearing a CPAP straight up, and getting the simple facts out in the open can be very helpful. I often notice people will then lower their shoulders a bit and hit me with their more personal concerns, their real worries, almost as if I have given them permission to vent their anxieties.  I wear a CPAP mask myself and have been in the exact same chair they are in, having the same electrodes placed on my slightly itchy, recently scrubbed skin and had to wash the white goopy paste out of my hair the next morning.

What’s the most important thing someone facing having to wear a CPAP should keep in mind?

It’s simply this: find a mask that you like. From a technical point of view, whether a mask is big or small, they both do the exact same thing. A patient needs to find a mask that is comfortable. My technical opinion on this point doesn’t matter – the truth is, if you like it, you’ll wear it. If you don’t like it, you won’t wear it, even if I tell you otherwise. It will be that dress behind that “gorgeous” polka dot number that a clerk sold you on but that you secretly don’t believe makes you look good. Same with the CPAP mask. If it fits well and you like it, ditch the polka dots and choose the lowcut tye-dye.

Ok, so let’s say someone undergoes a sleep study and is diagnosed with apnea. They select their CPAP mask. Then what?

Well first off, be realistic. It will take you two months to get used to it. You’ll try it, you’ll hate it, it’ll be weird, then it’ll be great, then you’ll hate it again.  It’s ok. This is all normal.  You may experience some nasal swelling, but it’s temporary so don’t worry. You may wake up some mornings with the mask across the room. Again, normal, don’t be discouraged.

On the plus side, the snoring will disappear. That’s huge for most people. And you’ll likely experience REM rebound, because you’ll begin enjoying deeper REM sleep. When you have apnea and stop breathing several times throughout the night, your sleep is fragmented, and good, solid REM is hard to come by. With the CPAP mask, that will change and you may find yourself dreaming for the first time in a long time.

What's the big takeaway you'd like to leave with readers of this interview?

Don't fear the sleep lab.  Seriously, if you snore, tell your doctor and if he or she suggests going to a sleep lab to check for apnea, go ahead and do it. We're going to take good care of you and the results could change your life.

10 Reasons Why We Struggle With Creativity

“There is always room, if only in one’s own soul, to create a spot of Paradise, crazy though it may sound.”

--Henry Miller, Preface to Stand Still Like the Hummingbird

“I tell you: one must still have chaos in oneself, to give birth to a dancing star.”

--Frederick Nietzsche, Thus Spake Zarathustra

“The fact that order and creativity are complementary has been basic to man's cultural development; for he has to internalize order to be able to give external form to his creativity.”

--Lewis Mumford, The Myth of the Machine

Anyone who says “I don’t have a creative bone in my body” is seriously underestimating their skeleton.  More to the point, they are drastically undervaluing their brain.

My contention in this article is that creativity is an integral part of being human, and to deny its expression is like denying the expression of other crucial human elements that we intuitively realize we'd be miserable without. How about a life without sex, to use one bare-knuckled example? Creativity is no less a part of who and what we are. What follows are 10 reasons why we frequently struggle to get into a creative space, along with suggestions on how to get there.

1. Your brain is always putting out fires.

Cognitive science research tells us that our brains are equipped with sensitive threat-alert systems (of which the amygdala is a significant part), and these systems are older than we are, evolutionarily speaking. In our brains, the limbic system--home of the well-known fight or flight response--is ready to click on with a micro seconds's notice. That's a good thing. The problem is that it's ready to click on with a micro second's notice. As with many paradoxes within our brains, the good is also the bad depending on context. Because we are so neurobiologically predisposed to looking for the next fire, it's challenging to carve out a "safe space" for creativity.

What can we do about that?  The video at the end of this article, featuring the inestimable creative genius John Cleese, offers some quality suggestions.

2. Chunks of time are hard to come by.

Even when we can outwit our brain's threat-alert system, it's still difficult to find what the late, great management philosopher Peter Drucker advised we must find to be effective in any capacity: "chunks of time."  Spurts of time riddled with interruptions aren't conducive to creativity because each time our focus is wrecked, we struggle to get back to the point we'd reached in our creative "flow" (a term coined by psychologist Mihaly Csikszentmihalyi).  Creativity isn't like restarting a blu ray disk and picking up exactly where we left off. A great deal of energy went into getting to that place, and we must expend more energy to get into it again.

Cleese's video also offers suggestions for this problem, but in short -- we must set firm, impenetrable parameters for being creative. If you think you'll need two solid hours to get there, then make those two hours nonnegotiable.

3. The "self-efficacy" problem.

Pioneering psychologist Albert Bandura devoted a large part of his expansive career to figuring out how people can develop a necessary sense of self-efficacy--the outcome when accomplishment yields compounding confidence in one's abilities. The irony that Bandura uncovered is that we only get there when we've experienced enough failure to demonstrate the difficulty of our eventual accomplishment. Another way to say that is -- if it were easy, none of us would have a problem. But creativity isn't easy, and we're going to stomach failure--probably more than we think--before achieving something that starts depositing confidence in our cerebral bank accounts.

The thing to remember is that confidence compounds with time, and most people give up before they start earning a return on their investment.

4. The "governing scenes" problem. 

Two more great psychologists, Silvan S. Tomkins and Gershen Kaufman, devoted much of their careers to figuring out why shame wields so much power in our mental lives.  Tomkins (who is the father of "Affect Theory" and "Script Theory") coined the term "governing scripts," and Kaufman built on his work, later coining the term "governing scenes," which are the mental images of past experience that our brains conjure when we come across a "trigger" for that experience.

The tricky part is that our brains conjure governing scenes automatically--they arise from the unconscious. So when we experience a creative failure, our brains toss out vivid images--not just vague memories, but "scenes"--of past failures.  Kaufman saw this as the pivotal dynamic that makes shame such a potent emotion -- it's not just an externally triggered feeling, but also an internal saboteur.

What can we do about that?  Look to Albert Bandura's discoveries (#3 above) and get back to the hard work of overcoming, and overcoming, and, oh yeah, overcoming. In other words, don't quit, because in all likelihood you are giving up far too early.

5. The functionary temptation.

"So, what are you going to do with that?"  Tough question to answer for anyone trying to be creative, because there probably isn't an answer. What we seem to have a hard time getting our arms around is the fact that there also doesn't need to be an answer.  What would a world driven by purely functionary concerns look like?  Is that a world you'd want to live in?

The answer to this one is self-evident: stop asking the functionary question about everything in your life, or others' lives. The question itself is designed to drain creativity from your bones.

6. Fear of disruption.

Getting into creative flow can disrupt your life. Henry Miller referred to this disruption in Sexus with the pregnant term “primal flux.” It's a hard fact to handle, but the truth is that creativity isn't all sweetness and light -- it's a volatile, disruptive force that can shatter presumptions, undermine expectations, and dismantle unquestioned standards.  That's part of what makes it a frightening prospect for our threat-sensitive brains (see #1).

What can we do about that? Decide how much creativity your life can handle -- more precisely, how much you are willing to handle.

7. Misunderstanding the "background noise" dimension of creativity. 

For some reason we think that to be creative means constantly creating something tangible, but that's not how creativity works.  Much of the creative process goes on in the background of your conscious mind space and emerges in conscious flurries.  As discussed in #2, we need chunks of time to create something tangible, but leading up to those chunks of time is an enormous amount of background processing. This is also why #8 that follows is so important.

8. Opportunities slip through the cracks.

You know the old story about how writers keep a notebook by their beds in case they have an idea in the middle of the night?  There's only two things untrue about that story -- it's not just writers who do it (or at least it's not just writers who should do it) and it's not just in the middle of the night that a notebook or something to scribble on is invaluable to capture rapidly evaporating thoughts.  Those thoughts are creative opportunities, any one of which can open doors to new thoughts, fresh ideas, and untapped creative energy.

Easy fix for this one: get a notebook and a pen, and get ready.

9. It’s easier to get numb.

Irony of ironies, the same incredible organ in our heads that allows us to be creative is also perilously prone to brain-numbing distractions. Sure, those can be chemical distractions--drugs, alcohol, etc--but in this case I mean just the regular old "plug-in drugs" like TV (using the term coined by author Marie Winn).  The problem with TV, of course, isn't TV, it's the hours upon hours that it draws us in. At the very least, at that level it's a time sink that makes finding those essential chunks of time even harder. At worst, it's a brain backwater--a complacency refuge from the challenge of creativity.

What to do?  Regulate time. Distractions aren't the problem; it's our unregulated devotion to them that doesn't allow creativity to spark.

10. Limited exposure to the creativity of others. 

I'm a firm believer that creative inspiration isn't all about originality; it's more about being driven by the creative achievements of others. After reading a great novel, creative energy swirls in the brain like a newly spawned tornado. After watching an incredible movie, mental wormholes open to challenging ideas and possibilities. Same goes for museums and galleries and concerts and even electronics shows. It doesn't matter where the ideas originate -- it matters where they take you.  To the extent that we limit our exposure to an array of creative ideas (and focus instead on just one source; TV, for example), we limit our creative potential.

The solution: get up, get out, and get exposed.

And now for a final word from one of my favorite creative masters, John Cleese.

Results of My Kratom Experiment

This post is a follow-up to an article I wrote on Forbes entitled, The Kratom Experiment Begins.

First, I should explain why I am publishing this piece here instead of Forbes.  When I wrote the original piece, I mentioned that I would be using Lucky Kratom brand capsules for the evaluation. This set off a cascade of comments and emails telling me that I was making a mistake limiting myself to that brand, for a variety of reasons.

At the same time, several Kratom distributors contacted me offering free samples to use during my evaluation.  I decided to accept samples from three of these companies:

Mayan Kratom

Nutmeg Kratom

Online Kratom

Because I accepted these free samples, I felt it was no longer ethical to write the follow-up article on Forbes -- a venue for which I am paid to write.  Instead I chose to move the follow-up here, to The Daily Brain, a blog I own and derive exactly zero compensation from.

I am grateful to each of the companies that supplied samples, because they enabled me to conduct a much more thorough evaluation than would have been possible with only one brand (Lucky Kratom – a product I paid for myself, I should add).

Having said that, I will not be comparing products from different companies in this post. That was never my intention. Rather, I will simply provide you with my personal experience with the products in general. 

The two forms of Kratom I experimented with were powder and capsules. I also experimented with a variety of strains and “fusions” of different strains and extracts.  Generally speaking, I took Kratom in the morning, usually mixed with a small amount of orange juice. 

I did not experience a tremendous difference between strains, although the fusions that contained extracts were consistently more potent. Because the extracts lead to quicker tolerance, I spaced out my usage and tried to stick to regular strains most of the time.  I especially liked Bali, Maeng Da and Green Thai. 

Now for the effects.

My overall takeaway is that Kratom has a two-tiered effect. Initially it provides a burst of energy very similar to a strong cup of coffee.  Unlike coffee, however, the energy I derived from Kratom was longer-lasting and level.  My experience with coffee is that the initial burst is strong but it tapers and descends rapidly, leading to the well-known caffeine crash. The energy from Kratom, on the other hand, would often last for three or four hours, but was subtle enough that at no point did I feel like I was jumping out of my skin. I also did not experience an energy crash with any of the Kratom products I sampled. 

The second-tier effect was relaxing, but fell short of being sedating. I never felt sleepy while taking Kratom, but I did experience a level relaxation that was pleasant, and balanced out the initial energy-boosting effects nicely. 

As to side effects, I can’t say that I experienced any worth noting. A few times I noticed that my eyes were bloodshot after I used a fusion containing an extract, but that was not a consistent side effect and it never obscured my vision, nor did it seem related to any other drawbacks. 

As to the difference between capsules and powder, I noticed that the powder worked faster, but the capsules seemed to be generally as effective, though with somewhat delayed effects. That makes perfect sense since it takes the stomach a bit longer to break down the gelatin containing the powder. 

My biggest concern with most of the products I sampled is that it’s not easy to nail down the specific amount to take. I used “bakers spoons” that indicated how many grams a spoonful contained, but I’d strongly recommend anyone who wants to take the product long-term to invest in a decent-quality digital kitchen scale. I am indebted to several people who have sold Kratom for years for offering free advice on how to arrive at the correct amount for my body type (I'm six feet, 225 lbs with an athletic build). 

In my case, about three grams was adequate to induce an effect, but I have been told by several regular Kratom users that amounts vary greatly by person.  I can’t make any recommendations on the “right” amount to use. I simply experimented with amounts (guided by the advice I mentioned) until I found one that worked well for me. 

My overall comment on Kratom is that it’s a lot like good coffee, but with a more even, long-lasting energy effect, and a much more pleasant “finish.” 

As to the results of stopping usage, I can tell you without hyperbole that getting off coffee is a far worse experience than getting off Kratom. I was able to stop taking Kratom for three days and at most I experienced a bit of sluggishness that wore off in a day or so.  Withdrawal from coffee, for me, includes at minimum two days of excruciating headaches that make me want to rip trees from the ground and toss them through store windows (something I've never actually done, mind you). Suffice to say, caffeine withdrawal is significantly worse than Kratom withdrawal, if it can even be called "withdrawal." There's no comparison whatsoever. 

Having now experienced the product myself for a number of weeks, I can see no reason why it should be banned, or on what basis such a product would be banned if people can walk into a typical coffee shop and buy an enormous cup of an addictive substance that’s arguably more potent than any Kratom available anywhere.

If you have any questions about my experience or would simply like to discuss further, please feel free to email me: 

disalvowrites [at] gmail.com

You can also leave a comment on this post. 

*A note on quoting from or reprinting/reposting this piece: overall I am flexible on reposts, but please contact me ahead of time by email to let me know when and where you'd like to repost. Thanks in advance.  

Kratom Results are Coming

For anyone visiting this site looking for the follow-up to my Forbes article, "The Kratom Experiment Begins," please stay tuned.  The follow-up will be published here by April 5th.  Thanks! 

How to End the Growing Problem of Water Poverty at a Glance

Infographic supplied by Water for People