Director, Emergency Services, Bikur Cholim Hospital
I get asked questions about sleep very often. The most
common question -- asked once again by a correspondent in
Ramot -- is can sleep be banked -- i.e. can you make a
deficit and then make it all up by sleeping a lot? The
answer, I am sad to say, is no. People who stay up all night
need more than one day to return to normal. Lack of sleep
lowers the body's resistance. And in the 7 Dec. 04 issue of
the Annals of Internal Medicine there is an article
that lack of sleep can lead to obesity.
Nevertheless, there is a clear demarcation of when one needs
to sleep and when one is sleeping for enjoyment. You should
be able to tell the difference. If you cannot get up on time
or cannot stay awake during the day, you are probably not
sleeping enough. Never get behind the wheel of a car if you
haven't slept enough. You endanger many people's lives.
Counting sheep does not help induce sleep, but relaxation
does. Warm milk helps little, if at all. The British
Medical Journal discussed jet lag at length, one and a
half years ago. Your best bet is to try to get onto local
times as soon as possible. Avoid daytime napping. Realize
that the older you are, the more time you will need. Going
West is harder.
Caffeine is a drug and is addictive. Safety depends on how
much you are used to it. Seasoned coffee drinkers can drink
massive amounts. I avoid all caffeine. I just do not like
addictions. Do not forget that caffeine will make you go to
the bathroom. It is a diuretic and it will speed up your
heart. Those with atrial fibrillation should avoid caffeine.
Caffeine is not a good idea to use to keep yourself awake
when you are sleep deprived.
How can doctors keep track of all the side effects of
medications? While a computer can help, most physicians keep
track by using only a group of medications with which they
are familiar and comfortable. By doing this and recalling
side effects of classes of medications instead of individual
ones, you can pretty much stay on the safe side.
I was again asked about Glaxo's sponsorship of this column.
I avoid all interactions with drug companies during my
regular work. I do not accept pens or other trinkets, nor do
I talk to the representatives. Glaxo for this column is the
only time I have compromised on these principles, and the
reason is twofold: First, without their support, the column
could not continue. If a private sponsor would come forth,
no problem -- but this hasn't happened. Second, Glaxo's
products are rarely used in emergency medicine, so I feel it
will have less effect on my own practice. The only ones
relevant to emergency medicine are Ventolin, which is the
standard anyway, and their antibiotics, which I do use when
indicated. Otherwise, Sertide, Valtrex, the dermatology
products, the vaccines, Zyban, Seroxat, Requip and Avodart
have no use in emergency medicine. Write me in care of the
Yated.
A message from GlaxoSmithKline, sponsor of this
column. Zyban does help in one addiction: smoking. The
studies are quite impressive. Smoking is a disgusting and
life-threatening habit, so use Zyban and quit for good.
