Broken sleep is normal

I rarely sleep through the night or get the recommended eight hours. Though I fall asleep quickly and I’m in bed for eight hours, I’m only asleep for about six of those hours. I use the wakeful time to get my thinking done. Sometimes this wakeful period is productive; sometimes it’s boring. At any rate, I always feel fine the next day and don’t worry about it. I do take a ten-minute nap after lunch.

I figure that my sleep pattern is normal. When talking to friends, I’ve learned that nearly all of them have similar experiences. It turns out that the “lie down and die” model of sleep, in which we attempt to lie perfectly still for a solid eight-hour block, is a relatively new model that coincides with the industrial age. Like me, pre-industrial people experienced a similar “broken” pattern, splitting their slumber into “first” and “second” periods. Kroger Ekrich, author of At Day’s Close: Night in Times Past, says “there is every reason to believe that segmented sleep, such as many wild animals exhibit, had long been the natural pattern of our slumber before the modern age, with a provenance as old as humankind.” When you look at the conditions under which humans evolved, it doesn’t make sense that they’d basically go unconscious for eight hours in a row. There were too many pressures and predators to contend with. What’s more, some non-Western peoples, such as the !Kung hunter-gatherers in Africa or Balinese farmers in Indonesia have no specific bedtimes. Rather, they drift in and out of slumber depending on what’s happening on any given night.

In the early 1990s, Dr. Thomas Wehr at the National Institute for Mental health conducted an experiment to duplicate sleep patterns before the invention of gas or electric lights. He did this by placing volunteers in an environment lit with only natural light. After a while, his volunteers drifted into a pattern in which they slept for a few hours then awoke for a period of “meditative wakefulness” then fell back asleep again. Sounds just like me.

Of course, we do live in environments of artificial stimuli—lots of it. But we adjust. As Dr. James J. McKenna, an anthropologist who studies sleep says, “Our bodies move toward adaptation, not pathology. Given the sensory context [the stimuli of modern life] our sleep is probably appropriate to the challenge.”

Yet, we’re told that if we don’t sleep eight hours, we’re killing ourselves. Actually, just the opposite is true. Studies have shown that people who sleep between 6 and 7 hours live the longest. More than seven hours of sleep is associated with progressively increasing risk of death, especially from heart disease. Men who sleep more than eight hours a night have been found to have twice the risk of overall death and about three times the risk of dying of heart disease as those who sleep less. Yet, we worry about sleeplessness and look for remedies; exactly what the drug companies encourage.

Next week: The dangers of sleeping pills

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Mammograms: Just say no

I’ve had two or three mammograms. The last one was in 2008. I don’t remember why I quit having them. At any rate, I’m glad I did. They’re pretty useless and can be damaging.

In spite of three decades of widespread screening mammography in the US, the breast cancer rate is unchanged. In other words, the number of women who are found to have metastatic breast cancer when they first contact the health system is the same now as it was before we screened for breast cancer. As one breast cancer surgeon said, “If mammography was a treatment, we’d never do it. The effect is too small.” That is, breast cancer screening lowers breast cancer mortality on the order of one person per one thousand over ten years--essentially an insignificant number. A ten-year Canadian study of 6000,000 women, half of which were being screened and half of which were not, found that the mammogram group were just as likely to die as the non-mammogram group. So why bother? The Swiss Medical Board has suggested the screening be halted.

There are plenty of other reasons not to have mammograms, the main one being they lead to false alarms, which then lead to more testing: another mammogram, an ultrasound, an MRI, a biopsy. Among 1000 American women age fifty screened annually for a decade, somewhere between 490 and 670 will have a false alarm, and 70 to 100 will be biopsied to prove they don’t have cancer. Research has shown that the psychological effects of false alarms, such as stress and anxiety, often persist for three years. Not good for your health.

What's more, screenings find cancers that would otherwise not be found—harmless cancers that would never develop into anything serious. It’s true that there are plenty of people who think their lives were saved by screening. As Dr. Gilbert Welch says it’s entirely possible that such people “would have done just as well had their cancer been diagnosed following the appearance of signs and symptoms. It’s also possible they were overdiagnosed: the cancer was never destined to kill them or even make them sick.” Eighty percent of breast lumps are non-cancerous. Seventy percent of breast cancers are found through breast self-exams. At least 30 percent of tumors found on mammograms would go away if you did absolutely nothing. 

You can get as much radiation from one mammogram as you would from 1,000 chest X-rays. I suppose that if the radiation were seriously dangerous, the practice would be curtailed, which, of course, it hasn’t. So maybe it’s safe. But it seems creepy to me. Just leave me out of it.

Update: Here's the latest study (2017) that supports what I have written above.

Next week: Broken sleep is normal

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Guidelines on getting or avoiding scans

In last week’s post I mentioned that various types of scans and x-rays can be both dangerous and of no value. Of course, often they are needed for diagnostic purposes—but often they’re not. The following is a summary of what the March 15, 2015 issue of Consumer Reports offers as guidelines for making decisions about getting scans or x-rays.

Four scans you can usually skip:

•  X-rays for back pain: Back pain is usually caused by muscle damage and clears up on its own. Unless your doctor suspects a serious underlying problem such as cancer or a spinal infection, or severe nerve damage, an x-ray is not usually needed.
•  Chest x-rays before surgery: You don’t need to be “cleared” for surgery with an x-ray unless your surgery involves the heart, lungs, or part of the chest.
•  CT scans to screen for lung cancer: The test is worthwhile only for people at the highest risk of developing lung cancer, which includes current or former smokers between the ages of 55 and 80 who smoked the equivalent of a pack a day for 30 years.
•  CT scans for headaches: A CT scan for headaches is necessary only if your doctor can’t diagnose your problem based on a physical exam, which he or she almost always can. However, if your headache is sudden or explosive or accompanied by fever, seizure or vomiting, a scan is warranted—but not a CT scan, which exposes you to radiation. Get an MRI instead.

 Cancers from medical radiation can take anywhere from five to 60 years to develop. Children are particularly vulnerable to the effects of radiation. Those who had a CT scan before the age of five face a 35 percent spike in cancer risk. For every 1,000 children who have an abdominal CT scan, one will develop cancer as a result. A 2012 study that looked at almost 180,000 British children linked CT scans to higher rates of leukemia and brain cancer. Dr.Stephen J. Swensen, M.D., medical director at the Mayo Clinic in Rochester, Minnesota says, “All too often children are receiving adult-sized doses of radiation, which is many times the amount they need. The dose directly increases the risk of leukemia or a solid tumor. And that’s not regulated today.” A friend of mine developed cancer of the salivary gland which she suspects (with good evidence) was caused by X-ray treatments for acne she received as a teenager over 50 years ago.

As to X-rays on your teeth (the bitewing type), you need one only every 24 to 36 months, and you can go a decade between full-mouth x-rays.

Well, this is scary business. Best to be skeptical when it comes to getting scans.

Next week: Mammograms: Just say no

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Think twice before getting scans or x-rays

As I mentioned in an earlier post, tests such as scans are a revenue source for medical institutions and are often given needlessly. Research shows that about one-third of the scans serve little if any medical purpose. They can also be dangerous. At least two percent of all future cancers in the US—about 29,000 cases and 15,000 death per year—are a result of CT scans alone.  Dr. Stephen J. Swensen, medical director at the Mayo Clinic says, “If the scan isn’t necessary or emits the wrong dose of radiation, the risks far outweigh the benefits.”

The information in this post comes from the March, 2015 issue of Consumer Reports, which gives a detailed report on the various types of scans, their uses and dangers. I’ll give a brief summary, beginning with an explanation of each type of scan, plagiarized from the magazine:

• Ultrasound: High-frequency sound waves create echoes as they bounce off organs and tissues. The echoes are turned into images called sonograms. The images of soft tissue disease are fairly good, but not detailed. Radiation exposure: none.

• MRI: Magnetic resonance imagining uses magnets and radio waves to create images; takes from 45 minutes to two hours with patient inside a machine. Radiation exposure: none.

• Mammogram: Uses low-dose x-rays. Radiation exposure: low.

• X-Ray: emits a broad beam that passes through the body before landing on film, creating shadow-like images. Excellent for creating images of bones. Radiation exposure: minimal to medium.

• CT: computed tomography uses a pencil-thin X-ray beam to create a series of images from multiple angles, which create a 3D image. Excellent for looking at soft tissue. Radiation exposure: minimal to high.

• PET: positron emission tomography requires the patient to ingest a radioactive tracer that lands in cells, especially cancer cells, from which an image is created. Radiation exposure: medium to high.

 According to the magazine, “Just one CT scan of the abdomen and pelvis equals about 10 millisieverts, more radiation than most residents of Fukushima, Japan, absorbed after the Fukushima Daichi nuclear power plant accident in 2011” Add to that the fact that there are no federal radiation limits for any kind of imagining and no national standards for training or certifying technologists. Apparently about one-third of the scanners now used across the country won’t meet the safety features that will soon be required by the Centers for Medicare and Medicaid Services.

Next week: Guidelines on getting or avoiding scans

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.