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Sleep Interview with Dr. Dan Barone, Part III

During Lisa Mercurio's interview with Dr. Dan Barone, the good sleep doctor said, "I would hope that the need for sleep becomes as prevalent as the knowledge that smoking is bad for you.  This is my hope for the future."  During National Sleep Awareness Week, we close this three part interview by saying we couldn't agree more.  "Insomnia be gone.  Amen."

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LM: So here’s a funny question for you and that is whether or not insomnia, because it’s so suggestive, can it be contagious?  Have you seen this amongst husbands and wives?


DB: I haven’t seen that kind of situation but I will see the partner say, “I’m not sleeping well now.  My sleep is disrupted because my husband or wife’s sleep is disrupted."


LM:  Can insomnia be hereditary?


DB: Absolutely.  People who have chronic insomnia can be predisposed to some mood disorder or, other things that are inheritable.  Everything in medicine is nature versus nurture.  You may have this predisposition to have insomnia or depression.  For example, if event X happens in your life (say a divorce or death in the family), then you might suddenly start doing something to perpetuate that predisposition.  You’re depressed and staying in bed and breaking your old sleep schedule and now you have insomnia.


LM: So sad when death of a partner or loved one starts this cycle.  Let's return for a moment to the good sleep doctor, Dan Barone...why did you become a sleep doctor?


DB: You can fix people’s problems. There’s nothing I enjoy more.


LM:  I’d like to hear about this.  When they come in and say I’m not sleeping – whatever the level of dysfunction – do you look at them and say, "I’m going to make it better?"


DB: Absolutely!  Let me go back in time for a minute.  As a neurologist, a lot of what we see  are devastating and not fixable problems.  MS.  Strokes.  Parkinson’s.  They can’t be fixed.  However – when I started learning about sleep and getting into it and making my own way, I realized, that whatever the problem is, there typically is a solution.  If the person can buy into the improved sleep regimen, the medication and following through with it, that for me is what it’s really all about.  Nothing makes me happier in this life than having a patient come back to say, “thank you I’m a different person now.”


DB: Now what’s my individual success?  In general, people get better – not always to the degree that they want but in most cases it can be solved.   It’s not permanent.  If the body is working properly, it can be fixed.


LM:  This is really comforting at a time when sleep is not a prized part of our lifestyle and it gives the Bedtime Network community a lot of hope regardless of whether or not they are good sleepers.  So now, how about a question or two about how the sleep doctor sleeps.  What’s your favorite sleep ritual?


DB:  I like to read before bed with a book light.  I try to avoid reading in bed, for all the reasons I’ve mentioned, but I will read books that put me at ease.  Right now, I’m reading, “Tuesdays with Morrie,” or, I tend to favor sports books.  In general, I won’t read anything text-heavy.  No mysteries or thrillers.   I tell my patients, if you wake up in the middle of the night, read something boring like “Better Homes and Gardens.”  Do not read “50 Shades of Grey.”


LM: Though that book made for lots of happy men and couples this summer.  What would you say your sleep profile is:  Morning glory?  Night owl?  Sleeping Beauty?  Vampire?


Dan:  I’m probably more of a night owl, but I’m also a morning person.  I’m somewhere in the middle.  12-1 am.  I’m a bit of a night owl…


LM: Ahhh.  I think men can stay awake until one in the morning more easily than women these days.


DB: I don’t think that’s a gender-specific trait, but it might be more anecdotal on your part.


LM: Yes.  You’re probably right.  We’re speaking to the 40-plus year old woman that’s multi-tasking between home and family and she is often my friend.  She cannot stay awake past midnight, most of the time!  With that in mind,  dan you give me an idea about what is in the future of sleep medicine?


DB: As far as sleep apnea treatments are concerned, there are a lot of things on the horizon.  One is an implantable hypoglossal nerve stimulator, an alternative to CPAP.  We didn’t speak about CPAP much, but it is the treatment of choice for sleep apnea, though there are other modalities out there.  This new device is implantable into the chest wall, similar to a pacemaker.  When someone is trying to breathe in at nighttime, it senses that and it sends a message to the tongue muscle and it tells the tongue to get pushed forward thereby keeping the air passage in the back of the throat open.


LM:  Wow.  That sounds amazing, but how does the implant affect the user during the day?  Does it make your tongue come thrusting out randomly?


DB:  It is actually remotely activated right before bedtime!  You don’t turn it on until you’re ready to go to bed.  It’s probably about a year or so away.


LM:  That’s a very exciting breakthrough for people not wanting to be chained to their nighttime gear which I understand can be cumbersome and annoying to some apnea sufferers.


DB:  That’s right.  Also, there was a recent article in the New York Times about some findings published in the journal, “Sleep.”  After looking at twenty patients with insomnia, they found that one of the major reasons these people are waking up in the night is due to respiratory disturbances of some kind, whether or not they were classified as apneas.  This is actually a game changer.  So overall, I would say that the two biggest areas of research in the coming years are likely to be sleep apnea and insomnia.  These are the overwhelming issues and the majority of cases that we see in the practice.


LM: On a positive note, one thing I’ve gathered from you, and that I know will be a relief for many people to read and hear, is that insomnia doesn’t have to be permanent.


DB:  Yes.  That’s true.  It tends to wax and wane, but if you can set yourself up by following a protocol in the best way you can, when it does tend to wane, you can hopefully catch it and keep the new, good habits going.


LM: Now for you, dear doctor, what would you personally hope for the future of sleep?


DB: Since sleep is a young area of science, as time goes on, I’d like to see it recognized more and more in the public eye, in the education of doctors and medical schools, so that real people become more cognizant of how important sleep is, not only for day- to-day health, but for the chronic problems it can yield: diabetes, high blood pressure, heart issues.  I would hope that that the need for sleep becomes as prevalent as the knowledge that smoking is bad for you.  This is my hope for the future.


LM:  In the end, it’s as simple or as complicated as, “did you get a good night’s sleep.”

Thank you so much for this interview.  I think we’ve got a lot of useful information and we’re looking forward to sharing your wealth of knowledge with everyone.


Dr. Daniel Barone is currently an Assistant Professor of Neurology at Weill Cornell Medical College and an Assistant Attending Neurologist at New York-Presbyterian/Weill Cornell Medical Center.  He sees patients primarily at the Weill Cornell Medical College Center of Sleep Medicine and specializes in the evaluation and management of patients with all forms of sleep disorders including sleep apnea, restless leg syndrome, insomnia, and narcolepsy.  He is certified by the American Board of Psychiatry and Neurology as well as the American Academy of Slep Medicine and is a member of the American Academy of Neurology and the American Academy of Sleep Medicine.  He was recently honored as a Consumer's Research Council of America's "Top Physician" in Sleep Medicine for 2012.