Blog | Friday, September 28, 2012

One more monitor


At about 3:30 p.m., I sat down in my family room, raised my feet onto an ottoman, and conked out until 5:00 p.m. with a copy of a medical journal in my lap. My wife nudged me on her way out to meet a friend for dinner.

When I'm sleepy, my first reflex is to check my continuous glucose monitor for a high blood sugar level. Nope. 95 and steady. As they say on the beer commercial: "It don't get any better than this." I also wear (as in attached to my body, not my clothing) an insulin pump and a heart monitor. Neither of those could offer help in this situation. So I turned to my newest monitoring system: LARK (See Wired's "How Lark Went From Idea to Apple Store in One Year').

My wife and I often drive up to Los Angeles for the day, a 300-mile round trip. Lately, especially on our return trips to Escondido, I've been almost nodding off at the wheel. A lot more serious than falling asleep in my family room!! On these occasions, my wife is not so gentle in rousing me. In June, she'd had enough and marched me down to the local Apple store to purchase a specialty device called LARK. According to the accompanying app on my iPhone, my "time asleep needs work", meaning I should be averaging 8 hours of sleep per night, but I'm only getting 6. LARK suggested I go to sleep earlier and at the same time each night.

Because she is hearing impaired and doesn't pick up many audible wake-up alarms, Dee Dee bought LARK primarily for the wristband which pulsates at a scheduled time. While I also use this new silent alarm system, I am more interested in the objective data the accompanying app provides about my sleep patterns. Using this data, I'm alerted to possible corrective actions I can take to improve performance throughout the day. I can also share this data wirelessly via Facebook or Twitter.
Coincidentally, in June, when I bought the device, Dr. George Sledge authored an article on sleep ("Perchance to Dream", Oncology Times, June 25, 2012, pg. 28), and a second article entitled "Decoding the Science of Sleep" appeared in the Wall Street Journal, August 4-5, 2012, pp. 1-2. Both document how common sleep disorders are.

To illustrate, the annual number of prescriptions written for sleeping meds last year was about 60 million. And studies have demonstrated that these pills don't work. Unfortunately, they can impair short-term memory so that people believe they slept better than they actually did. So poor sleep habits "can also be a data problem" in that the medicated individual can't really remember how well or poorly they slept. Devices like LARK can collect this information for us, and supply analysis for possible solutions.

Before you can designate something as abnormal, it has to deviate from what is considered normal. A. Roger Ekirch, a Virginia Tech history professor, spent 20 years researching sleep and provides the seminal work defining "normal sleep." He found that, until about 200 years ago, our normal sleep pattern was divided into two phases: the "first sleep" started just after sunset and lasted until just after midnight, when the person would wake up for about an hour, then fall back into the "second sleep" ending with the rising sun. The time between the two episodes of sleep was spent reading, praying, contemplating dreams or having sex. This normal sleep pattern was totally altered by Thomas Edison and the electric light. The result is that about 20% of our general population has some type of sleep disorder. We've become a "wired and tired" society.

Dr. Sledge estimates that 45% of cancer patients have insomnia. Some are afraid to fall asleep as they might not wake up ("somniphobia"). Sleep disorders tend to be intertwined with other problems, especially fatigue, depression, and pain, "making it hard to tease out cause and effect."

For example, I saw a patient today with multiple myeloma who said his main complaint was fatigue. On further questioning, he was taking longer naps during the day because he didn't sleep well at night, sometimes taking an Ambien. When this didn't help, his primary care physician tried Lunesta, which didn't work at all. Turns out he wasn't sleeping because his Velcade-induced neuropathy only bothered him at night. Fortunately, this patient has a good memory and an attentive wife, who happens to be a nurse. So we were able to figure out the problem without a device like LARK. But most situations are not this straight-forward, and data-driven solutions can be quite beneficial.

This post by Richard Just, MD, ACP Member, originally appeared at JustOncology.com, a joint publication of Richard Just, MD, aka @chemosabe1 on Twitter and Gregg Masters, MPH, aka @2healthguru on Twitter. Dr. Just has 36 years in clinical practice of hematology and medical oncology.