Sleep


Swallowing – Episode 112

 

A young child with no shirt and light brown hair against a blue sky is swallowing gulps of orange juice from a clear plastic bottle.

The 3 Phases of Swallowing

Oral Phase

This phase includes chewing and saliva mixing with the food to form a bolus (a little glob of mashed up food). Then the tongue moves the bolus towards the back of the mouth.  The tongue starts by pressing against the hard palate behind the front teeth.  Then the sides of the tongue raise up to also press against the hard palate inside the teeth.  At this point, the bolus has nowhere to go except towards the back of the throat.

Pharyngeal Phase

The vocal folds in the larynx close to keep food out. The larynx also moves up as the epiglottis covers it to seal off the airway. Then the soft palate and uvula move up and close off the nasal passage  So now there is only one way out.

Esophageal Phase

The bolus moves into the esophagus (because it is the only open path). The esophageal muscles contract from top to bottom (this waving, rhythmic muscle movement is called peristalsis) to push the bolus into the stomach.

Swallowing Reflex

There are sensory receptors in the pharynx and tongue that receive touch signals.  When they are touched by a bolus, the signals are sent to the brain stem and the return signal results in involuntary and automatic movements of the larynx and epiglottis.  This is a good thing since swallowing is a very rhythmic process and you want food and drink to continue going in the correct direction.

This reflex cannot be triggered by sticking your finger in your throat.  You are more likely to trigger a gag reflex that way.  The voluntary steps of swallowing must be initiated before the involuntary portion of the process takes over.

Weird Swallowing Scenarios

How do you swallow with your mouth open?

At the dentist, you are usually laying in the chair on your back and facing the ceiling.  There are at least three tools and two hands in your mouth.  Things in your mouth trigger saliva production.  Also, generally one of the tools the dentist is using is emitting water.  The natural reflex when you have to hold your mouth open for a long time is to bring the back of the tongue and the soft palate together.  This seals off the throat and allows you to still breathe through your nose.  The liquid in your mouth plus gravity creates a puddle at the seal of your tongue and soft palate.  Because the touch sensors to trigger your swallowing reflex are also in this area, it is likely you begin to panic because if they don’t hurry and use the suctioning straw to remove the liquid, you’re going to swallow!

Do you swallow in your sleep?

A study was done to find that the only times you swallow while sleeping is during arousal and during REM.  My logical deduction regarding why is that when you’re aroused or in one of the more shallow phases of sleep, that is when you can voluntarily move – roll over, adjust the bedding, and swallow.  During REM sleep, most people will experience sleep paralysis, so whatever exciting things are happening in their brain, the body is not likely to act it out.  Because the brain cannot tell if a dream is real or imaginary, the feeling solicited can trigger hormones secretions and saliva production. Increased saliva, just like in the dentist scenario, can trigger swallowing.

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Nose Anatomy [Show Notes]

Nose Basics

Your nose is responsible for breathing and smelling.  These things work better when it isn’t stopped up.

The part of your nose that you can see and touch is cartilage covered in skin.  There is bone above it, beside your nose, below it, and right in the middle (inside your head).  Part of the cartilage is stiff and hold shape, other parts of cartilage are soft for flexibility.

The nasal root (the bone that extends between your eyes) connected to the bridge of your nose (which is made of cartilage).  The tip is also called the lobe.  The wings are on each side of your nose that you can flare.  The nostrils is actually the holes.

There are 4 main sinus cavities

  1. Frontal sinuses = in your forehead, between your eyebrows
  2. Maxillary sinuses = run under your eyes, behind your cheeks
  3. Ethmoid sinus = right between your eyes, in the middle of your head, connected to your tear ducts
  4. Sphenoid sinus = under your sphenoid bone (in the middle of your head)

The sinus cavities are lined with mucous membranes that keep them moist and have lots of blood flow to them.  Their job is to warm and moisten the air you breathe in your nose before it goes into the lungs.  Your lungs don’t like cold air.

Mouth breathing is not very efficient. This is true in athletics as well as sleep.   But breathing out through your mouth can be useful because you can get a large amount of air out rather quickly and the lungs empty better.

You have a fast-flow and a slow-flow nostril – this has to help you perceive smell.  Sometimes almost as good as dogs.

The cartilage of your ears and nose never stop growing through your life.

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Eye Conditions 4 [Show Notes]

Eye Conditions (not) in ABC Order

Dry eye

48% of Americans over age 18 complain of dry eyes.  Caused by environment, genetics, health conditions, eye procedures, medications.

There are 2 reasons for dry eye:

  1. Inflammation blocks the free flow of fluid through the eye.
  2. Tear duct insufficiency – the ducts and glands don’t produce adequate moisture for the eye (can be solved by a tear duct stent)

If a medication dries up another part of your body, then it has the potential to dry out your eyes (antihistamines, medications for overactive bladder) – these medications can also lead to constipation. Many of the common diseases that many Americans deal with can cause dry eye – hypertension (high blood pressure), diabetes, obesity.

They light from electronic devices tricks your eyes into not blinking as often, therefore your eyes can dry out more easily (blinking is your eyes’ remoisturizing process).  The solution is to give your eyes long breaks from electronic light , especially late at night before sleeping.

Air conditions in hotels can make your eyes feel dry because they work to remove excess humidity from the air.

Hormones, whether in pregnancy, menopause, or during the use of prescription birth control products, can cause changes in the moisture content of your eyes.

The Solution: eye drops (either OTC or Rx)

Presbyopia

It means “old or elderly vision”.
Presby = elders
Presbyterian church = the church’s decision-maker was a group of people called Elders

This seems to happen somewhere around age 40.  The lens of your eye loses some of its flexibility.  The lens has to be really curved to see up close, and then flattens out a bit to see far away.  So, if the flexibility decreases, it means it can’t curve up enough to clearly see things up close.

The solution: wear reading glasses.

Stye

It’s an infected oil duct or hair follicle.  Looks like a zit.  **DO NOT TRY TO POP A STYE LIKE A ZIT!!**  They will usually clear out on their own in 6-7 days.  Not too troublesome other than being sore, swollen, and not pleasant to look at.

The Solution: warm compress for 15-20 min, then take a shower or wash your face, then leave it alone!  Can use drops or an ointment to help lubricate the eye.  Worst cases will require antibiotic drops or ointment from the doctor.

Corneal dystrophy

A genetic condition that causes the accumulation of protein material build up in the layers of the cornea (recap: cornea = the very front layer of your eye that starts to focus the light into the eye).  If this fluid gets cloudy with junk, then your vision gets blurry. No other symptoms really except worsening vision.  A surgical procedure can be used to clear out the cloudy liquid, but no cure.

This can lead to corneal erosion (where the layers of the cornea begin to separate = painful). Corneal erosion has to be corrected by surgery.  Erosion can also be a result of eye injury – either instant trauma or more gradual like an unhealed corneal abrasion (which can lead to ulceration and eventually erosion).

Take care of your eyes and treat them nicely!

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Special Episode #4: Life & Blood Sugar [Show Notes]

For someone with diabetes, everything they do in life affects their blood sugar.  They could be eating 100% right and taking their medicine 100% right, and something would cause the blood sugar to be off.

Exercise

It is well-accepted that exercise is good for you.  Your body will store extra sugar as a large molecule called Glycogen.  Imagine a line of kindergarteners hold hands trying to make it through the museum, Glycogen is just a bunch of glucoses holding hands.  When you’re not eating, your body will snip off a glucose at a time as it needs it.  The liver stores and directs the glycogen most of the time.  Your skeletal muscles also store some glycogen, because when they do work (i.e. exercise), it takes too long for the liver to snip off glucose from glycogen and send it to them.  

After exercise, the body replenishes the muscles’ glycogen stores.  This can cause the blood sugar level to drop, for someone with diabetes, this can be dangerous because they can’t “untake” medicine.  When protein and carbohydrates are eaten together, before or after exercise, the blood sugar changes can happen more slowly – the nutrient absorption in the gut causes a “traffic jam” of sorts.

Sleep

Certain metabolism processes happen only when you sleep.    Some people with diabetes wake up with really high blood sugar, others wake up with really low blood sugar.  Sleep is not restful and restorative if the blood sugar is out of balance, but also if sleep is not restful, then blood sugar levels can be jacked up – not just in the morning, but for the rest of the day.

Stress

The hormones that are triggered by stress – even something as basic as adrenaline, can cause the body to respond to insulin and glucose differently.  

Sickness

Your body is going to responds things differently when the immune system is in high gear – that includes insulin, glucose, the food you eat.  An infection requires an antibiotic because you are infected with a bacteria.  Bacteria are living organisms.  Living organisms consume energy sources and produce waste.  This can affect the sugar levels in your bloodstream.  You’re immune system doing work also burns sugar.

Allergies

Works about the same as sickness.  Your immune system is actively trying to protect you from something (allergens) and so it responds differently.

Smoking

If you smoke, STOP!  The nicotine and other chemicals make you more resistant to insulin.  This is most troublesome in Type 2 Diabetes.

Hormones

Especially for women, hormone cycles can affect sensitivity to insulin differently during different times of the month.  Adrenaline can override almost any response to any previous hormone response.

Life is hard

Life with diabetes is super hard.  Diabetes and other chronic diseases are silent and it doesn’t show on the outside at first sight.  Extend grace, extend compassion.

The Nashville chapter of JDRF is having their annual One Walk on September 24th. Friend of the show and previous guest, Rachel Mayo has been #T1D for over 10 years and she is passionate about the cutting edge research and support JDRF provides for people and their families. Her goal is for her team to raise $5000, you can contribute!

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It’s All About Sleep

Angry grizzly bear meme, "Tumor Necrosis Factor be like You started goofing off today? I will kill you!" This happens in your sleep.

Gotta Breath While You Sleep

Apnea = stopped breathing

Types of sleep apnea

When you metabolize the fat stores when you’re losing weight, the main by-product of that process is carbon dioxide.  You breathe away your fat!!

Getting better sleep can be the trick to untangling the knot of many health problems.

Medication can make apnea worse.  So can other things too.

Caffeine helps you stay awake (read and listen here).  Sunlight does much more for you in helping you wake up (as little as 15 minutes of sunlight a day).

Light Makes a Difference

Sun comes up –> serotonin –> happy, awake, productive
Sun goes down –> melatonin replaces serotonin –> sleep

Sunrise clocks

People who work third shift have to use a lot of tricks for making daytime to feel like night so you can sleep.

Can’t just supplement serotonin because a lot of biologicals don’t survive the digestive and absorption process to get used by the body.

Electronic curfews are a good idea.

Blue blocking glasses

Light that helps us see is actually a combination of different colors of light (based on their wavelength).  The blue wavelength of light is what stimulates our eyes. So, if you have to do work at night, blocking that stimulating light can help you sleep once work is over.

Working third-shift is now considered a carcinogen.

Tumor Necrosis Factor (TNF) runs while you’re sleeping.

*Links in this post are affiliate links*

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Sleep Aids [Show Notes]

Who needs help falling asleep?  *raises hand*

WARNING: Do not mix any sleep aids with alcohol – compounded drowsiness, depressed breathing or depressed heart rate

Sleep Aids

  1.  Melatonin – the chemical your brain makes when it’s dark.  Electronic light can interfere with your natural production of melatonin after the sun goes down.
  2. Valerian Root – claims to promote calming and relaxation
  3. 1st Generation Antihistamines – Diphenhydramine (Benadryl) or Doxylamine (Unisom; also in NyQuil).  They have natural drowsy side effect, so using for the purpose of that side effect is a common practice.
  4. Rozerem – stimulates melatonin production in your brain
  5. Hypnotics – Ambien (zolpidem), Lunesta (eszopiclone). They seduce your brain to sleep in an unnatural way, thus they have high risk side effects (vivid dreams, sleep driving/walking/eating) and a high risk of dependence.  The side effects are due to the fact that the medications may get you to a deeper level of sleep before the rest of your body is prepared.  Your body has a natural paralysis process to ensure you don’t act out dreams in the REM cycle, but if your brain reaches REM before your body is paralyzed, you may do crazy things!
  6. Benzodiazepines – generic names end in -lam or -pam.  Also have a risk of dependence and side effects (mainly “hangover” effect).
  7. Tricyclic Antidepressants – a symptom of depression is sleeping too much, but insomnia can be a symptom of depression.  Also, insomnia can make you feel depressed – it’s a vicious cycle.  In small doses, they work to help rebalance the brain chemicals and reset the sleep-wake cycle.

Where to Start

Use as natural a solution as possible that is effective.  Physiological and neurological issues can lead to chronic insomnia that is not corrected by the most natural solutions, thus pharmaceuticals are needed – and that’s nothing to be ashamed of!

Sunlight stimulates your eyes and tells your brain to make serotonin.  When the light is gone, and that stimulation stops, serotonin stops and melatonin replaces it.  This is how we functioned and planned our days back in the “old days”.

Summertime brings on long days and lots of sunlight.  Thus we may not sleep as long because the long daylight hours keep us awake.  But this can also be the issue in the winter and for people who experience SAD (Seasonal Affective Disorder) – the shorter daylight doesn’t allow sufficient serotonin to be produced and we actually feel sad.

Analyzing your sleep patterns and knowing your options will allow you to have a productive conversation with your doctor – different medications are used depending on if you have trouble falling asleep or waking up halfway through sleep or both.

Audience Question

*Melatonin in nursing:  your natural melatonin gets in breast milk and is thought to help baby’s sleep cycle (especially early on when baby’s sleep-wake cycle may be backwards because that’s how they rolled in the womb).  Thus, if your natural melatonin gets into breast milk, then supplemented melatonin will get there too.  The rationale is that if you’re not sleeping (despite the exhaustion of having a new baby), then you may not be making enough natural melatonin.  If you’re going to take melatonin while breastfeeding, LOW dose is key to ensure the excess isn’t deposited in the breast milk to pass on to baby – 3 mg seems to be the highest recommended, and I agree.  PLEASE do your own research and discuss it with a medical professional you trust rather than just taking my word for it!*

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Sleep Hygiene

A Definition

Sleep Hygiene: how conducive your night time and bedtime habits are for restful sleep on a regular basis

Your body performs important processes while you sleep.

Risk of disease is increased when you don’t get enough sleep.  Heart disease, diabetes, and stroke, just to name a few.

4 Areas of Sleep Hygiene

  1. Environment
    • dark (all of our light-emitting toys are bad for our sleep) – your body makes serotonin stimulated by light, and then melatonin when the light is gone.
    • temperature – your body sleeps well when it’s cool, kind of like hibernation. Gotta get past REM sleep because REM sleep is not restful sleep
  2. Habits
    • no naps – recovery processes can be inefficient
    • exercise (vigorous exercise during the day; slow & calming exercise late at night)
    • getting adequate natural light – so your brain isn’t confused about which chemical it needs to make
    • consistent routine – your brain likes predictable patterns
  3. Consumption
    • stimulants – caffeine, nicotine
    • alcohol – initially makes you sleepy, but can disrupt sleep when the liver finishes processing it into sugar
    • large meals – can cause indigestion which can disrupt sleep
    • drastic dietary changes – fluctuating amounts of sugar in the blood stream or digestive discomfort
  4. Mindset
    • bed is for sleep – not a place for work or studying or eating
    • avoid emotional stress – positive (i.e. excitement) or negative (i.e. anger)

Tidbits

CPAP machine – helps in sleep apnea, which is wear the body doesn’t get enough oxygen during sleep.  Oxygen is needed for all sorts of processes.  If the body can’t get the oxygen, then it probably isn’t using the nutrients and energy sources available, and it can lead to feeling awful, even after a night of sleep.

Nothing good comes from a lack of sleep.

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Thrive with sleep [Show Notes]

3 Areas Thrive When You Sleep

1. Productivity 

  • Memory
  • Attention span
  • Creativity

2. Health

  • Decreased risk for cardiac disease
  • Inflammatory chemicals are cleansed out
  • Weight management – certain metabolism processes only happen while you’re sleeping
  • Tissues heal and rebuild
  • Reaction time improves

3. Emotions

  • Stress hormones are removed from your system
  • Gives your serotonin production a break, so you get a fresh supply in the morning (Serotonin is your happy chemical)

The Bottom Line

The cells in your brain (neurons) run on electricity (aka the flow of positive and negative charges).  Sleep allows the electricity to reset, so it’s really to flow quickly and efficiently the next morning.  You live longer when you get enough sleep.

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