Liquid Lightning Bolts: Energy Beverages, The Promises, Hype and Truth

If your car were making noises or running slowly you could go to a trusted mechanic and have it repaired properly so it would run well for a long time.  However, you could also go to the auto-parts store and spend $19.99 on a product with a name like "Octane-Insane Booster", pour it into your gas tank and see if it solves your problem.  You would probably find that you had wasted 20 bucks and decide to get and oil change and a tune up. 

If your body feels tired and is moving slowly, you can rest, eat well, take care of yourself properly, or there are cans and bottles of products that promise to rev you up and keep you fully functional even though your body is clearly telling you that you need rest and care. 

Let's review some of these products. 

Sport drinks like Gatorade and Powerade are marketed primarily as products that rehydrate.  They suggest that they replace carbohydrates, electrolytes, as well as missing water.  They do not suggest that the user will not need to sleep or will have more energy other than feeling better for being hydrated. 

True energy drinks like "Red Bull", "Rockstar", "Monster", "Full Throttle", and "5 Hour Energy" all derive their energy delivery from caffeine.  With the exception of "5 Hour Energy" there is also a significant amount of carbohydrate.  That means the "energy" is a sugar rush and a "sugar rush" tends to have a quick onset, last a short time and then end with a dull, slow feeling. 

Each of the energy drinks add 10 - 20 dietary supplements in form of vitamins and herbs with unproven effects.  Some of the ingredients could cause dehydration which could be detrimental to someone participating in athletic or heavy physical activity.  There is no clearly stated advantage to most of these ingredients other than a vague "energy" claim without any data to support the claims.  

Energy drinks are probably not significantly dangerous, but it is probably better to work toward getting adequate rest, addressing sleep problems and then forcing alerness won't be necessary. 



Darius Zoroufy, M.D.



Reference: 
Higgins, John P, et al, "Energy Beverages:  Content and Safety", Mayo Clin Proc, Nov 2010; 85(11)1033-1041.

Sleep Apnea is Associated with Heart Disease in Large University of Wisconsin Study

When a study follows a particular demographic or statistical group, that study can be considered a cohort study. One carefully followed group is the Wisconsin Sleep Cohort. The Department of Medicine, and the University of Wisconsin has been following this cohort for over 20 years. I was fortunate to attend my residency at the University of Wisconsin and to meet some of the researchers who are still actively involved in this project.

[“Sleep Disordered Breathing and Mortality: Eighteen-Year Follow-up of the Wisconsin Sleep Cohort”, Young, Terry PhD, et al., Department of Population Health Sciences and Department of Medicine, University of Wisconsin-Madison, Madison, WI. SLEEP, Vol 31, No. 8, 2008.]

When the researchers wrote their 18^th year report and released it to SLEEP Journal it was released for expedited publication. The cohort sample includes 1522 adults assessed at baseline for sleep disordered breathing/sleep apnea and stratified as mild, moderate, and severe sleep apnea. All-cause mortality risk was adjusted for confounding factors such as age, gender, weight (body mass index), other disease states, etc that could have affected the results.

The researchers found startling results. People with severe untreated sleep apnea had a 3.8 times greater chance of dying than the baseline population without sleep apnea. They also had a 5.2 times greater chance of dying of cardiovascular disease. These people did not necessarily have current cardiovascular disease or other cardiovascular risk factors.

Moderate sleep apnea conveyed an overall 1.7 times greater risk. Mild sleep apnea conveyed a 1.4 times greater risk.

These findings were significant and were consistent with other important studies like the Sleep Heart Health Study.

Patients at the Swedish Sleep Medicine Associates Clinics get a thorough evaluation. If they are found to have sleep apnea they are advised to get treatment and to consistently adhere to their treatment plan in order to eliminate symptoms of sleep apnea such as daytime sleepiness, snoring, loss of mental acuity. They are also told that treating sleep apnea also has the critically important role of reducing cardiovascular risk.

Darius Zoroufy

Children with Sleep Apnea have Higher Blood Pressures

Many of you have already learned about increased cardiovascular disease risk markers in patients with uncontrolled sleep apnea. When I speak with patients, they often seem to take on an opinion that the cardiovascular risk issues are have more to do with older adults and people who already have significant heart disease. Patients in their 20’s, 30’s, 40’s and even 50’s sometimes seem disinterested in the cardiac effects of sleep disordered breathing, as if they are too young to be affected by sleep related breathing affects on the heart.

In the article by Marilisa Montesano, M.D. and her colleagues at The Pediatric Department “La Sapienza” University, Il Faculty, Medicine, Rome, Italy in SLEEP (Vol 33, No. 10, Oct. 1, 2010, pp. 1349-1355.) In the study children ages 7 – 14 underwent overnight sleep studies. 18 had obstructive sleep apnea and 25 were in the control group.

The investigative group did many sophisticated analyses leading to many surprising results. One of the most significant was that children have markedly greater blood pressure if they have sleep apnea compared to those who do not.

	Obstructive Sleep Apnea Group	Control Group
Systolic Blood Pressure	111.7 mm Hg	100.5 mmHg
Diastolic Blood Pressure	64.7 mm Hg	57.7 mmHg
Heart Rate	77.0/min	67.5/min
Apnea/Hypopnea Index	5.3/hour	0.3/hour

Statistical analysis showed a clear and direct relationship between the AHI (Apnea-Hypopnea Index: the number of apneas and hypopneas per hour) and cardiovascular parameters in these children.

It is evident that there are already cardiovascular changes in children who are suffering from obstructive sleep apnea. We must take the cardiovascular effects of sleep apnea very seriously in every sleep apnea patient and make sure we are fully managing sleep apnea in every single patient to the best of our ability.

Darius Zoroufy, M.D.

Late Night is Better for Rest and Less Effective for Work

Many studies have demonstrated that sleep quality has a close relationship with memory and mental performance. In fact, many of us have recognized in our own lives that our memory and recall are not as sharp when we are sleep deprived compared to times when we are well rested. In this month’s journal SLEEP (Vol 33, No. 10, Oct. 1, 2010) another study and associated editorial were published on this very subject. (“A Time for Learning and a Time for Sleep: The Effect of Sleep Deprivation on Contextual Fear Conditioning at Different times of the Day” Roeline Hagewoud, et al, pp 1315-1322)

This study showed that rats demonstrated reduced learning when allowed to sleep less following a learning stimulus when compared with rats which had the opportunity to sleep amounts consistent with the normal rat sleep cycle. The researchers concluded that not only was the amount of sleep deprivation a significant factor, but the timing of sleep deprivation (deprived during normal sleep hours) that affected learning and the consolidation of memories. It appears that each stage of sleep may have a layering effect in the production of long term, integrated memories.

A corollary of the study is that late night work is not nearly as productive as we tend to think it is. It is far better to put work away at bedtime, get adequate, restorative sleep and start fresh in the morning.

The age-old question “How much sleep do I need may be a much more complicated question that it initially seems but the answer definitely requires getting a full night of sleep on a consistent schedule. Adults should be getting to bed by 10-11 p.m. and sleeping 8 hours. Children have varying sleep schedule requirements depending on their ages. However, essentially all children should be in bed going to sleep at least by 9 p.m. and most school aged children should be getting 9-10 hours of sleep/night. If you or the children are too tired to wake up easily, you are probably not getting enough sleep.

Sleep well and have a good day.

Darius Zoroufy, M.D.

Sleep Apnea Screening is Necessary Before Surgery

For patients undergoing surgery, unidentified Obstructive Sleep Apnea is associated with increased risk of complications. Untreated sleep apnea patients are at greater risk of cardiovascular disease, type II diabetes, and premature death. During October 16-20, 2010 the annual meeting of the American Society of Anesthesiologists two similar studies were presented regarding screening presurgical patients for sleep apnea. The patients who screened positive for sleep apnea could be definitively diagnosed and treated and/or monitored more carefully during their time in surgical care.

One study used a comprehensive home sleep study or a full in-laboratory study. 819 patients were enrolled and a stunning 536 patients, 2/3 of the total (65.4%) tested positive for sleep apnea. Of these 85.5% of the patients with severe sleep apnea were not identified by the surgeons and 47% of the severe sleep apnea patients were not identified by the anesthesiologists based on clinical assessment alone.

In a second study a questionnaire followed by an overnight oxygen recorder screened for possible sleep apnea. Although this protocol did not diagnose sleep apnea, it identified patients at greater risk for sleep apnea and therefore at greater risk for surgical complications. 367 patients patients completed the study. It was concluded that simply performing the questionnaire followed by the overnight oxygen overnight screening test identified greater than 90% of the cases of sleep apnea.

The doctors could send the patients for full diagnostic sleep testing to reduce the surgical risks.

In our practice we routinely evaluate and treat patients before surgery. Since surgery often requires a specific time frame, we work closely with the surgical team, cardiology team, or other procedural team to integrate with their surgical schedules. As a result our services are often requested to assist patients in pre-operative evaluation. We use comprehensive questionnaires, home screening tests when appropriate, and state of the art full diagnostic sleep testing to assess patients

When speaking with your surgeon, cardiologist, or other physician prior to a surgery or significant procedure, ask for a referral to  Sleep Medicine for a pre-operative assessment for Obstructive sleep apnea.

Darius Zoroufy

Aerobic Exercise Relieves Insomnia

Insomnia is a common problem of sleep leaving millions awake for hours at night. Many interventions are tried, some successfully, some without success. Often the most effective techniques over the long term are behavioral techniques such as consistent bedtime, relaxing nighttime routine without work and stimulating media, etc.

Regular aerobic exercise during the day improves nighttime sleep quality as well. A study from Northwestern Medicine reported in Sleep Review in the October 27, 2010 issue included 23 sedentary insomniac women who were enrolled in a 30-40 min/day stationary bicycle or treadmill program 4 days per week for 16 weeks. A control group had 45 minuted meetings instead of exercise.

Both groups had exercise about good sleep behaviors.

Exercise improved self-reported sleep quality in the exercise group with participants no longer describing themselves as poor sleepers. They described fewer depressive symptoms and less daytime sleepiness as well. These improvements were not seen in the control group.

For those suffering from insomnia, regular aerobic exercise is an effective intervention. Consistently applying an exercise regime may be one of the most helpful tools for treating insomnia.

Darius Zoroufy, M.D.

A clean mask every day makes CPAP a much better experience

Mask Care Advice From Dr. Zoroufy

Every day I hear complaints about how the mask does not seal correctly, slides to one side in the night, needs to be put on so tightly it is painful and a long list of other complaints.

I ask, quite innocently, "How often do you wash your mask?"

I get answers like, "I try to do it once a week." If they try to do it once a week that means they are probably not succeeding to do it that often. I will even get answers like, "I was supposed to wash that thing? It looks fine to me."

Keeping mask or nasal pillows and headgear is not only hygienic and will help prolong the life of your mask, it will also help your mask seal better against your skin. The problem is that adding another long procedure to your daily routine is not likely to be welcome. Some of the official instructions recommend filling the sink and using dish soap and soaking in an undertaking lasting 15 precious minutes as you are trying to get yourself and possibly your children out the door on time on a busy morning.

Here is a much easier technique that works well and leaves your mask smelling nice at the end of the day.

When your morning alarm rings and you remove your mask, disconnect it from the tubing and shuffle to the bathroom where you hang the mask in the shower. Do not take the mask apart.

When you take your shower the steps of washing the mask are as follows:

1. Hold the mask and headgear in the water until it is all wet.
2. Use a small amount of liquid soap or shampoo to wash all surfaces and headgear. Key word: "small" amount. If you use too much you will be rinsing soap out for a long time. Remember, you will be doing this every day, so it will not be that dirty. Avoid expecially greasy, slimy soaps or they will build up on your mask. The whole process should take only a few minutes. If you spend more than 5 minutes, you are taking too long.
3. Rinse your mask.
4. Shake it out and hang it up
5. Get your mask the next night. It should be dry or nearly dry.
6. *** As a courtesy, tell others in the household you will be leaving your mask in the shower.
7. Once a week take the tube into the shower, wash it and hang it with a similar procedure.
8. The CPAP machine itself does NOT get washed in the shower.

I hope this advice makes your CPAP use better and easier.

Darius Zoroufy, M.D.