Cleveland Clinic on Affordable Care Act

Today, the 5-4 Supreme Court Ruling in favor of the “Affordable Care Act” upheld the individual health insurance mandate as tax.

The decision will require most Americans to obtain minimum health insurance coverage. CLEVELAND CLINIC President and CEO, Dr. Toby Cosgrove, says the law will ultimately change the face of healthcare.

CG: Dr. Toby Cosgrove/Cleveland Clinic

“I’m really pleased that we’ve seen the healthcare law held up. I think that what this means is that we’re moving ahead, we’re continuing on a journey of reforming healthcare in the United States . We’re addressing access for people who haven’t had access before. We’re beginning to address quality and developing a more efficient healthcare delivery system. I think one of the things I’d like to see more of however is more emphasis on wellness and reducing the incidence of chronic diseases that we see, secondary to behavior.”







CG: Dr. Toby Cosgrove/Cleveland Clinic

“We started out with a healthcare system that was really designed for the 1950’s, a different set of diseases, different things we could do for patients and a different level of sophistication that we can bring to patient’s problems. All that’s changed now. We have a bigger population. We have an older population. We have more things we can do for people. Now we have to change the system in order to accommodate those changes.”



CG: Dr. Toby Cosgrove/Cleveland Clinic

“I’m delighted we finally have a decision. It’s taken one more unknown out of the equation. For a long time we haven’t known what the rules of the game are, now we’re starting to know the rules of the game and that’s going to continue over a long period of time as we understand the law better, but we’ve got the first steps.“

7 Top Health Risks for Men Over 40


By Guest Author, , senior editor

During midlife and beyond, men’s leading causes of death include familiar standbys: heart disease, cancer, unintentional injuries, stroke, diabetes, respiratory disease, suicide, and Alzheimer’s disease.  To lessen your odds of dying from these killers, curb the critical habits that lead to them:

1.  Risk: Being single

Numerous surveys have shown that married men, especially men in their 50s, 60s, and 70s, are healthier and have lower death rates than those who never married or who are divorced or widowed.

Never-married men are three times more likely to die of cardiovascular disease, for example. After 50, divorced men’s health deteriorates rapidly compared to married men’s, found a RAND Center for the Study of Aging report.

What’s the magic in the ring? The social connectedness of marriage may lower stress levels and depression, which lead to chronic illness. (Women tend to have more social ties outside of marriage.)

Oops: Unmarried men generally have poorer health habits, too — they drink more, eat worse, get less medical care, and engage in more risky behaviors (think drugs and promiscuous sex).  Exception: It’s better to be single than in a strained relationship, probably because of the stress toll, say researchers in Student BMJ.

Silver lining: It’s never too late. Men who marry after 25 tend to live longer than those who wed young. And the longer a fellow stays married, the greater the boost to his well-being.

2.  Risk: Electronic overload

Psychologists are debating whether “Internet addiction disorder” is a legitimate diagnosis, and how much is too much, given how ubiquitous screens are in our lives. But one thing’s certain: The more time that’s spent looking at wide-screen TVs, smartphones, tablets, gaming systems, laptops, and other electronics, the less time that’s spent on more healthful pursuits, like moving your body, communing with nature, and interacting with human beings.

Social isolation raises the risk of depression and dementia. And a sedentary lifestyle — a.k.a. “sitting disease” — has been linked to heart disease, type 2 diabetes, obesity, and premature death. A 2012 Australian study of more than 220,000 adults ages 45 and up linked sitting for 11 or more hours a day with a 40 percent increased risk of death over the next three years.

Oops: Americans spend five hours in front of the TV every day, according to a 2011 JAMA study that didn’t even take all those other screens into account. More than just three hours a day ups your odds of dying of any chronic disease.

Silver lining: The Australian researchers say that getting up and moving even five minutes per hour is a “feasible goal . . . and offers many health benefits.”

3. Risk: Sloppy sunscreen use

Men over age 40 have the highest exposure to damaging UV rays, according to the Skin Cancer Foundation. Men are twice as likely as women to develop skin cancer and die from it. And 6 in 10 cases of melanoma, the deadliest skin cancer, affect white men over age 50.

More men tend to work and play sports outdoors; having shorter hair and not wearing makeup adds to the gender’s exposure. Nor are their malignancies noticed and treated early: Middle-aged and older men are the least likely group to perform self-exams or see a dermatologist, according to a 2001 American Academy of Dermatology study.

Oops: Fewer than half of adult men report using sun protection methods (sunscreen, protective clothing, shade), in contrast to 65 percent of adult women.

Silver lining: Doctors tend to detect more early melanomas in men over 65, perhaps because the older you get, the more often you see a doctor for other (nondermatological) reasons.

4. Risk: Crummy diet

Poor nutrition is linked with heart disease, diabetes, and cancer — leading causes of death in men over 40. Younger midlife men often over-rely on red meat, junk food, and fast food to fuel a busy lifestyle, which leads to excess weight, high cholesterol, hypertension, and other risk factors. Older men living alone and alcoholics are vulnerable to malnutrition, because they tend not to prepare healthy food for themselves.

Oops: Until around 2000, more women were obese than men — but guys are catching up. In 2010, 35.5 percent of men were obese, up from 27.5 percent in 2000, according to the Centers for Disease Control and Prevention. (Women’s fat rates have held steady at around 37 percent.)

Silver lining: The American Dietetic Association recommends a reasonable 2,000 calories a day for men over 50 who are sedentary, up to 2,400 for those who are active. What comprises those calories is up to you.

5. Risk: Careless driving

Men generally have more car accidents than women, and men in their 50s and 60s are twice as likely as women to die in car wrecks. Unintentional injuries (of all kinds) are the top cause of death among men ages 40 to 44, the third main cause in men ages 45 to 64, and cause #8 in men 65-plus.

Oops: Among middle-aged men, fatalities are more likely to result from falling asleep at the wheel, exceeding the speed limit, getting into an accident at an intersection or on weekends after midnight — all factors that don’t have a significant effect on the injury levels of middle-aged women, according to a 2007 Purdue University study on how age and gender affect driving. Men over age 45 have more accidents on snow and ice, too.

Silver lining: Older men fare better than men under age 45 on dry roads, where younger drivers crash more (perhaps due to overconfidence, the Purdue researchers say).

6. Risk: Untreated depression

Although women are three times more likely to attempt suicide than men, men are more successful at it, according to the American Foundation for Suicide Prevention. In 2009, 79 percent of all suicides were men. Suicide rates for men spike after age 65; seven times more men over 65 commit suicide than their female peers.

More than 60 percent of all those who die by suicide have major depression. If you include alcoholics, that number rises to 75 percent. In older adults, social isolation is another key contributing factor — which is why older suicides are often widowers.

Oops: Men often equate depression with “sadness” or other emotions — and fail to realize that common warning signs of depression include fatigue or excessive sleep, agitation and restlessness, trouble concentrating, irritability, and changes in appetite or sleep.

Silver lining: Depression is treatable at any age, and most cases are responsive to treatment, according to the National Institute of Mental Health.

7.  Risk: Smoking

Sure, you’ve heard about the horrific effects of smoking before. But the older you get, the worse they become. Older smokers have sustained greater lung damage over time because they tend to have been smoking longer; they also tend to be heavier smokers.

Men over 65 who smoke are twice as likely to die of stroke. Smoking causes more than 90 percent of all cases of COPD — the fourth leading cause of death among men — and 80 to 90 percent of all lung cancer. The risks of all kinds of lung disease rise with age. Smokers develop Alzheimer’s disease, the sixth leading cause of death, far more than nonsmokers.

Oops: Older smokers are less likely than younger smokers to believe there’s a real health risk attached to cigarettes, says the American Lung Association. That means they’re less likely to try to quit.

Silver lining: No matter at what age you quit, your risk of added heart damage is halved after one year. The risks of stroke, lung disease, and cancer also drop immediately.

For More Information, please visit:









Top 10 Calcium Rich Foods May Surprise You

calcium foods

Recommended Dietary Allowances (RDA) dictate that an average adult must down anywhere between 1000mg and 1300mg of calcium daily. This number is slightly higher for lactating and pregnant women.

Sufficient amounts of calcium are required to maintain health bones and teeth as well. 99% of calcium is stored in bones and teeth with the remainder found in our blood.

The calcium found in the blood is required for muscle function, nerve transmission and hormonal secretion among other functions. These critical metabolic functions are regulated by the remaining 1% found in the blood.

Attempting to consume 1000mg of calcium daily may sound like a bit too much but, there are certain foods which can easily provide all your calcium intake requirements in a small and easily digestible serving.

While dark green leafy vegetables such as spinach are high in calcium, they are also high in oxalates, which can inhibit the absorption of several nutrients, including calcium.

If you do eat spinach, you may be better off reducing the oxalates by cooking it lightly.

Calcium rich milk


This is probably the most reliable source of calcium as well as other nutrients. A glass of skimmed milk will give you 244mg of calcium. For an afternoon snack, a small 300ml serving of milkshake will provide 387mg of calcium.

You have to make sure you keep the calories in check otherwise your endeavor for calcium rich diet may give you other problems to worry about. Milk may however, may not be the best source of calcium be for certain people.

 Those who are lactose intolerant should look for other sources to supplement this. Milk may also be high in saturated fats, which will increase the risks of getting a heart attack.

Calcium rich cheese in a window


This is a direct product that comes from the fermentation of milk. This means that it will naturally have plenty of calcium. The good thing about cheese is that only a small amount needs to be consumed to get a large chunk of your calcium RDA needs.

A small portion of fresh Parmesan cheese of about 30g will give you approximately 308mg of calcium. To get the right measurements, simply grate some cheese and scoop up 4 tablespoons of the stuff.

A slightly larger serving of cheddar cheese will give you almost the same amount of calcium. The same risks and downfalls associated with milk are applied here since cheese is simply concentrated milk.

Go easy on the cheese since it won’t make sense having the toughest bones in your funeral.

Yoghurt is calcium ei


This is an easy one, definitely one of the most popular snacks out there. Also being a child of milk, calcium and fats are plenty to be found in every sip.

A cup of frozen yogurt is all that’s needed to get your 300mg of calcium. And ¾ cup of plain or flavored yogurt will also give you the same amount.

You should know the amount of carbohydrates that they contain is high as well. The low-fat brands of yogurt will provide a smaller amount of calcium for the same size serving.

These are the ones you should go for, as the low percentage of saturated fats will be music to your heart. Avoid full fat yogurt if you can or try taking smaller servings of it.

Pudding is an easy source of calcium


Being a favorite meal for just about anyone, it also comes packed with healthy nutrients especially calcium. The puddings made from milk are both high in nutrients and delicious to eat, a rare combination indeed.

Instant pudding or those made from rice may seem like an unlikely source of calcium but one 250ml cup will give your body around 300mg of calcium.

The unfortunate thing is that lactose intolerant people will miss out on the health benefits. Other puddings made from almond milk or soymilk may not contain as much in the way of calcium but, they still make a tasty treat.

Healthy fish


It seems that there is no known nutrient on earth that can’t be found in fish. This food is not only the best source of omega fats and oils as well as proteins, but it has sufficient amounts of calcium in it too.

Not all fish however have this attribute. Saltwater fish will have higher a mineral content thanks to their environment. For instance a 100g portion of tinned sardines in oil will give you a whopping 500mg of calcium.

If you don’t quite like the flavor of sardines, then a similar portion of fried whitebait will give you 688mg of calcium. Fresh water fish is just as good if not better.

They actually have a higher mineral content than their saltwater counterparts so that they can take in water through osmosis to regulate various bodily functions.


Fruit:  Figs & Apricots

These are already the best source of essential vitamins and some minerals. They may not have significant amounts of calcium like milk-based products, but they have enough to supplement the other sources.

Ready to eat figs surprisingly have a high amount of calcium. One fig will give you almost 130mg of calcium.

These are fresh figs however, not the disgusting dried up stuff that is usually offered. Raw apricots, which have been de-stoned, are also a good source of calcium. 4 of them will give you 117mg of calcium.

These sources of protein are preferred by vegans and lactose intolerant people.


Beans and Vegetables

Soybeans are currently the best source of vegetable protein. It is estimated that the quality of protein is similar to those from meat products. Two cups of cooked soybeans at dinner is enough to provide 300mg of calcium.

You can also opt for tofu if the beans give you gas. Taking around ½ to 1 cup of tofu, either firm or regular, will give you approximately the same amount.

Pairing up a cup of cooked collard greens with your soya beans for supper will be a great combination. Collectively you will get about 600mg of calcium from that simple and cheap dish.

You can also add broccoli to get some extra calcium. A cup of it provides close to 60mg of calcium. It may not be much but it will reduce any deficits that you have left at the end of the day.

orange juice

Drinks:  Orange, Grapefruit, Soy

There are a variety of calcium-fortified drinks that you can pick up to get your daily supply. A cup of orange or grapefruit juice will give you roughly 300mg of calcium and you will be well on your way to acquire your RDA requirements.

Such drinks are best used as a supplement and not as the chief source of calcium. This is because they are modified to contain more calcium and are suited for those who are constantly on the move.

There are also very nutritious soy beverages that contain high amounts of calcium. Generally, such drinks are a better option than fizzy drinks that are full of empty calories.

Breads and cereals both have calcium

Breads and Grains

Even though they are not a high source for calcium, they will act as a good pairing with other sources of this nutrient. A slice of whole-meal bread may only give you 30mg of calcium, but it will pair well with that glass of skimmed milk in the morning.

White bread is usually a no go zone because it has been refined giving it an abundance of carbohydrates. Nevertheless, a slice of it will give you about 53mg of calcium.

Breads and grains are rich in other nutrients but you should be careful since they are full of calories. A full portion of pasta will provide 85mg of calcium.

The best way to start your day however is by having a bowl of calcium-fortified cereal. Total Cereal makes such a cereal. It gives well over 1000mg of calcium when consumed with milk. There are other brands to choose from which are rich in this essential nutrient.


Snacks and Treats

There are other foods that don’t generally fall in a particular category but are still high in calcium. Ice cream for instance is one such product. Half a cup of light ice cream will provide some 200mg of calcium.

Pizza is also a great source of calcium. A medium sized cheese and tomato pizza has an astounding 873mg of calcium.
One of these for lunch coupled with a glass of calcium fortified orange juice will give you all the calcium you need to keep your bones healthy. This might be a good thing to try once a week.

The only thing that one has to remember is not to over do it.

Just because you have had meals which have less than the recommended amount, doesn’t mean that you will have frail bones. Most people never adhere to these guidelines and have lived long and healthy lives. Besides, anything taken in excess is usually not good for you.

If you are unable, for some reason, to get the required amount of calcium, there are a lot of mineral supplements that will give you all the nutrition you need. You should however not substitute these small pills for your meals. Calcium rich foods are always the best source for your calcium needs.


Calcium Super Food Komatsuna Greens

komatsuna greensOne of best non-dairy calcium sources in the world is a vegetable called komatsuna. Komatsuna, while a traditional food in Japan, has boomed in recent years because of it’s relatively high calcium content.

Komatsuna greens, in fact, have 4 to 5 times more calcium than spinach., and possible better bioavailability. They are also loaded with potassium and beta carotene.

Best of all, they are as easy to eat as spinach. When young, they can be eaten raw, in salads or the like. When more mature, they take on a kale like appearance (the plant is a member of the turnip family) with prominent white veins and a thick stem, and are better cooked as you would cabbage or kale.

 In most cases, any recipe that uses spinach will accept young komatsuna, as in the picture, as a calcium packed substitute. Many people will in fact think it is spinach.

It’s near impossible to buy in America, but easy to grow. It likes warm climates, and will thrive in the Southeastern USA. Also know as Japanese Mustard Spinach, seeds can be acquired from any number of online seed shops.

For recipes, be creative. The spaghetti dish below is made with komatsuna.

komatsuna spaghetti

Calcium Supplements and Heart Attacks


Calcium Supplements and Milk - Choose the Milk

In a disturbing study, it was revealed that subjects who took calcium supplements appeared to be twice as likely to suffer hearts attacks as those who took no supplements.

This has been reported by all the usual media outlets, and this site always leans toward favoring calcium from natural food sources rather than from pills.

Still, for a more balanced look at this issue, we need go no farther than the National Health Service in the UK. Their website provides a very balanced picture of the story. For example…

These headlines are based on the findings of a large German study that looked at the association between calcium intake and incidents of heart attack, strokes and deaths from cardiovascular disease over a period of 11 years.
Calcium supplements are often given to elderly people and women who have gone through the menopause, in an effort to keep their bones healthy.
Researchers found no link between the amount of calcium in people’s diet and their risk of stroke or cardiovascular deaths. However, people using calcium supplements as their only form of supplement had more than twice the risk of heart attack compared with people who didn’t take any vitamin supplements.

Note first that they said there is no link between the amount of calcium in ones diet and heart attacks. This is about supplements, not calcium rich foods.

Also, this seems confined to comparing those who take calcium and no other supplements with those who take no supplements at all. It could be supplement usage that’s the issue here. More…

The researchers believed that people who take supplements may be generally less healthy than those who don’t (assuming they take supplements for a health reason) so they tried to adjust for other risk factors such as smoking habits and exercise levels.

However, it is unlikely they adjusted for all the influencing factors and so we still cannot be certain that calcium supplements increase heart attacks.
Previous research based on stronger study designs has also supported a link between calcium supplements and heart disease. If you are considering taking calcium supplements, you need to base your decision on your own circumstances, balancing the benefits with the potential risks.
Do not be alarmed by the media headlines. If you have been prescribed calcium supplements do not stop taking your medication. Speak to your doctor if you have particular concerns.

Again, good advice. But the waters are muddy. On to the conclusion of the NHS:

This large prospective cohort study following more than 23,000 German adults over 11 years showed that those regularly taking only calcium supplements were at a higher risk of heart attack compared with those not taking supplements.

This study has many strengths, including its large size and its prospective nature over a relatively long period of 11 years.

However, while this study does highlight an association, it doesn’t prove that calcium supplementation causes more heart attacks. There are potentially other factors, some measured in the study and some not, which could influence the link between calcium supplementation and incidence of heart attack.

For example, compared with non-users, the study reported that those taking calcium supplements only were more likely to:

  • be older
  • be less well-educated
  • have smoked for longer

These are all factors that could contribute to poorer heart health. However, the people taking calcium supplements only were also more likely to be:

  • women
  • physically active
  • a healthy weight

These are all factors that promote good heart health. This contradiction highlights that there can be many fundamental differences between people who use calcium supplements and those who don’t. Not all of these differences will have been taken into account in the statistical analyses of the results and so some uncertainty remains as to how strong the association is.

However, there have been several randomised controlled trials of calcium supplements and their effect on heart disease, which have shown similar results to the current study. Taken together, these studies strengthen the link between calcium supplements and heart disease. But supplements are often taken for good reasons and so it is important for health professionals to help to determine whether the potential risks of taking calcium supplements outweigh the benefits for each individual.

If you have been prescribed calcium supplements, don’t be alarmed by the headlines. Don’t stop taking your medication, but speak to your doctor if you have particular concerns.

Or just take the advice of Linda Russel, a nutritionist quoted in USA today:

“Walk into any drugstore and these calcium supplements just jump off the shelves at you. But by taking foods high in calcium four times a day, you should get all that you need.”

All About Sleep Apnea






“There is, throughout the night, a collapse of the upper airway. So, essentially you stop breathing multiple times, while you’re sleeping, even if you’re not aware of it.”




Dr. Charles Bae says, “Depending on how serious the sleep apnea is that would determine when you need the machine, but it really, oftentimes, doesn’t matter. Someone with severe sleep apnea may not be sleepy, but they definitely need the machine. Someone with mild sleep apnea may be super sleepy, so certainly, that would be the time to consider it.”


English: The Cycle of Obstructive Sleep Apnea ...
English: The Cycle of Obstructive Sleep Apnea – OSA (Photo credit: Wikipedia)


The Center for Minimally Invasive and Robotic Surgery at The Mount Sinai Medical Center—a pioneer in robotic surgery—now offers a procedure to patients with sleep apnea, whose obstructive breathing prevents them from sleeping normally.

Mount Sinai is one of only a few programs in the world to use transoral robotic surgery (TORS) to remove excess tissue or fix a collapsed airway that causes sleep apnea.

Through the robotic procedure, a laser removes the extra tissue in the throat that contributes to the airway obstruction in sleep apnea patients.

Patients typically return home the next day, and are back to work in 10 days, sleeping and breathing normally.

During sleep apnea, a person’s breathing is blocked and then restored when the brain sends a signal that awakens the patient to a lighter level of sleep.

This process can happen hundreds of times each night, leaving the patient exhausted during the day and at risk for many health complications, including cardiovascular disease and hypertension.

Many patients opt for a treatment called continuous positive airway pressure (CPAP), delivered through a mask that the patient wears at night to force his or her airway open for the duration of sleep.

However, some feel the mask hinders their quality of life, and look for better options.

“Over time many patients grow frustrated with CPAP or stop using the device, causing their sleep apnea to return and leaving them anxious for a better solution,” said Fred Lin, MD, Assistant Professor of Otolaryngology and Director of the Mount Sinai Sleep Surgery Center.

 “In the past, surgery had been a last resort. Now, using robotic surgery, we can remove the tissue that contributes to the airway blockage in a brief procedure with no external incisions and have patients home the next day, sleeping healthfully.”

During the robotic procedure, a surgeon sits at a console directly controlling a robotic arm that extends a small surgical instrument through the patient’s mouth. Using a high-powered 3-D camera, he or she has a clear view of the surgical field.

The previous surgical technique was less precise and potentially less effective because the surgeon was only able to use one hand, and had limited maneuverability.

“Mount Sinai is one of the original adopters of robotic surgery and we have seen first-hand the dramatic quality of life improvements it provides our head and neck cancer patients,” said Eric Genden, MD, Professor and Chair of Otolaryngology, Mount Sinai School of Medicine.


There are three types of respiratory events:

  • Obstructive apnea—caused by a temporary, partial, or complete blockage of the airway
  • Central apnea—caused by a temporary failure to make an effort to breathe
  • Mixed apnea—combination of the first two types

Risk Factors

These factors increase your chance of developing sleep apnea. Tell your doctor if you have any of these risk factors:

  • Sex: male
  • Overweight
  • Large neck circumference
  • Age: middle to older age
  • Family history of apnea
  • Structural abnormalities of the nose, throat, or other part of the respiratory tract. Examples include:
  • Hypothyroidism
  • Medicines: sedatives and sleeping aids
  • Alcohol consumption
  • Smoking


Symptoms include:

  • Fatigue and sleepiness during waking hours
  • Loud snoring
  • Breathing that stops during the night (noticed by the partner)
  • Repeated waking at night
  • Unrefreshing sleep
  • Morning headaches
  • Poor concentration or problems with memory
  • Irritability or short temper

People with chronic untreated sleep apnea may be at risk for:


An overnight sleep study is used to help diagnose sleep apnea.

Overnight Sleep Study (Polysomnography)

This testhelps detect the presence and severity of sleep apnea. During sleep, it measures your:

  • Eye and muscle movements
  • Brain activity ( electroencephalogram)
  • Heart rate
  • Breathing (pattern and depth)
  • Percent saturation of your red blood cells with oxygen

Other Studies

In addition to sleep studies, your doctor may order:


There are a number of treatment options for sleep apnea, including:

Behavioral Therapy

  • Lose weight if you are overweight.
  • Avoid using sedatives, sleeping pills, alcohol, and nicotine, which tend to make the condition worse.
  • Try sleeping on your side instead of your back.
  • Place pillows strategically so you are as comfortable as possible.
  • For daytime sleepiness, practice safety measures, such as avoiding driving or operating potentially hazardous equipment.

Mechanical Therapy

Continuous positive airway pressure (CPAP) entails wearing a mask over your nose and/or mouth during sleep. An air blower forces enough constant and continuous air through your air passages to prevent the tissues from collapsing and blocking the airway. In some cases, dental appliances that help keep the tongue or jaw in a more forward position may help.


In some cases, surgery may be recommended. It is most often beneficial in pediatric patients.

Types of surgery that may be done to treat severe cases of sleep apnea include:

  • Uvulopalatopharyngoplasty—The doctor removes excess soft tissue from the nose and/or throat.
  • Maxillomandibular advancement—The jawbone is repositioned forward.
  • Tracheotomy—For life-threatening cases of sleep apnea, an opening is made in the windpipe to allow for normal breathing.

Bariatric surgery may help with weight loss in some people who are obese. This surgery may reduce many of the complications that are related to obesity, including sleep apnea.


Only used in central apnea, acetazolamide (Diamox) may help improve the ability to regulate breathing. Overall, there is not a lot of evidence to support the use of medicines to treat sleep apnea.

Supplemental oxygen may be given if blood levels of oxygen fall too low during sleep, even after opening the airway.


You may be able to prevent the onset of sleep apnea by maintaining a healthy weight . Avoid alcohol, nicotine, and sedatives, which may contribute to airway obstruction.


American Academy of Sleep Medicine

American Sleep Apnea Association

National Sleep Foundation


Canadian Lung Association

Canadian Sleep Society


American Academy of Sleep Medicine. The International Classification of Sleep Disorders. 2nd ed. Westchester, IL; American Academy of Sleep Medicine; 2005.

American Sleep Apnea Association website. Available at: Accessed July 9, 2009.

Smith I, Lasserson TJ, Wright J. Drug therapy for obstructive sleep apnea. Cochrane Database Syst Rev. 2006;19:CD003002.

Obstructive sleep apnea. DynaMed website. Available at: Accessed October 22, 2007.

Kushida CA, Littner MR, Hirshkowitz M, et al. Practice parameters for the use of continuous and bilevel positive airway pressure devices to treat adults with sleep-related breathing disorders. Sleep. 2006;29:375-380.

Littner MR, Kushida C, Wise M, et al. Practice parameters for clinical use of the multiple sleep latency test and the maintenance of wakefulness test. Sleep. 2005;28:113-121.

Morgenthaler TI, Kapen S, Lee-Chiong T, et al. Practice parameters for the medical therapy of obstructive sleep apnea. Sleep. 2006;29:1031-1035.

Pack AI, Maislin G. Who should get treated for sleep apnea? Ann Intern Med. 2001;134:1065-1067.

Sleep apnea: treatment and drugs. Mayo Clinic website. Available at: Updated June 29, 2010. Accessed April 4, 2011.

Last reviewed September 2011 by Marjorie Bunch, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

Copyright © 2012 EBSCO Publishing. All rights reserved.

 “This minimally invasive procedure has the potential to fundamentally change the treatment paradigm for people battling sleep apnea.”

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Twitter: @mountsinainyc

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Sleep Paralysis: Can’t Scream or Move Nightmare

Cope with Sleep Paralysis

Sleep paralysis is a condition where people are paralyzed at the onset of sleep or upon waking. It is a disorienting condition that may also proffer vivid and terrifying hallucinations. Here are some steps to help you identify and cope with sleep paralysis.

Recognize the Symptoms


    Learn to recognize the symptoms. Sleep paralysis can affect you in many different ways. There are, however, some commonalities that people experience, including[1]:

    An inability to move the trunk or limbs at the beginning of sleep or upon awakening 
    • Brief episodes of partial or complete skeletal muscleparalysis
    • Visual and auditory hallucinations(people often sense an evil presence, or feel a phantom touch, or hear an unidentifiable noise in the room)
    • A sense of breathlessness (or chest pressure)
    • Confusion
    • Helplessness
    • Fear

What to Do During Sleep Paralysis


    Focus on body movement. You may find that you are able to move a part of your body (often your toes, fingers, or tongue) to force yourself to a fully waking state. [2]


    Focus on eye movement. Your ability to open your eyes and look around is generally not hindered by sleep paralysis. Some people recommend rapidly moving their eyes back and forth to break the paralyzed state.[2]


    Focus on breathing. Controlled breathing can be an excellent relaxation technique. Knowing some breathing techniques in advance may help you regain control during a sleep paralysis episode.



    Imagine yourself moving. Some people intentionally induce a sleep-paralysis state to induce what they believe to be out-of-body experiences. Imagining oneself moving effortlessly from the body may be a pleasant alternative to sleep paralysis.[2]


Treating the Symptoms


    Sleep regularly. Sleep paralysis is thought to happen when the sleeper enters the REM-sleep state prematurely.[2] Since this is more likely to occur when a person is sleep-deprived, maintaining a regular healthy sleep pattern and getting enough sleep can significantly reduce the likelihood of sleep paralysis episodes.[3] If you suffer from insomnia, train yourself to fall asleep more easily.

  2. “Sleeping on my side worked for me.” -Maria

    Sleep on your side. About 60% of sleep paralysis episodes reportedly occur when the sleeper lies on his or her back; to break this habit, sew a pocket or pin a sock to the back of your nightshirt and insert a tennis ball or two.[2]



    Exercise regularly.[3] You don’t have to go to the gym. Simply introduce a low-impact exercise regimen to your day. Taking a walk in the morning, for example, is a good idea.


    Eat healthy. Nothing is more important than what you put inside your body. Cut out the things that will affect your sleep, such as caffeine, alcohol, and sweets.


    Relax. Stress interrupts normal sleep cycles, which can greatly contribute to the likelihood of sleep paralysis.[2] There are many things you can do to help you calm down, such as meditating, listening to music, and playing with a pet. Decide what works best for you.


    See a doctor. When episodes occur once a week for 6 months, it’s time to consult with your personal health care provider.


Further Preemptive Treatments


    Talk about it with your friends. It’s much easier to deal with a medical condition when you know you’re not the only one. You might be surprised to learn that someone you know has gone through something similar.


    Keep a log. Track the details of the experience, the time, your sleep pattern, sleeping position, mental/emotional state before and after you were paralyzed, and if you were paralyzed while falling asleep or upon waking up. This can all be useful information, especially if you decide to a see a doctor about the condition.


    Identify the triggers. Sleep paralysis can be triggered by a variety of situations. For example, some researchers have found that it can be caused by the position you fall asleep in. These researchers recommend sleeping in any position other than your back. It can also be caused by certain sedatives or pain medication. Switching medications can eliminate the problem.



    Avoid the triggers. After identifying your personal triggers, do your best to avoid them. This will significantly reduce the chances of experiencing sleep paralysis.



  • Avoid caffeine 5 hours before sleep.
  • Sleep paralysis can be terrifying but it isn’t dangerous or harmful.
  • Consider having your doctor administer a sleep study diagnosis. With proper treatment of a diagnosed sleep apnea condition, the sleep paralysis may subside and/or disappear.
  • If you feel an episode coming on at night, try sitting up and staring at a bright light for a minute or two.
  • If you experience disassociation (“out of body” feelings), try to “feel” the texture of your sheets, clothes, or furniture around you. It’s easier to wake up if you focus on one of your senses. Alternately, ignore the sense of paralysis, and allow yourself to follow the “out of body” feelings; you can turn an unpleasant surprise into an enjoyable lucid dream, which you may be able to control. Try visiting friends or pleasant spots you have visited. No harm can come to you, so don’t be afraid.
  • Sleep paralysis is a very common medical phenomenon. Do not worry about the supernatural or spiritual implications of such an episode.
  • You might find yourself still dreaming while experiencing paralysis. This is the time when sleep paralysis is most confusing. For example, you might awaken to see the outlines of your bedroom, but at the same time you might see an intruder in your dream. These sorts of dreams are common in conjunction with sleep paralysis, and they are known to be exceptionally frightening.
  • You might feel the urge to break free of the paralysis by trying to sit up or moving a lot. Doing this can often cause you to be paralyzed further and the pressure to increase. The best way is to simply relax and recognize that you are in no danger and the feeling will soon pass.

Sources and Citations

  1. Guardian article on sleep paralysis
  2. 2.0 2.1 2.2 2.3 2.4 2.5 University of Waterloo resources on sleep paralysis – this site also has an ongoing study on sleep paralysis where you can contribute your experiences
  3. 3.0 3.1 Sleep Paralysis Information Service

Tips on Adding Healthy Fruit to Your Meals

Breakfast: Use these easy, fun tips to help you eat a colorful variety of fruits and vegetables every day!

Stir low-fat or fat-free granola into a bowl of low-fat or fat-free yogurt. Top with sliced apples or berries. bowl of granola with fruit and yogurt
half an orange Have fruit as a mid-morning snack.
Add strawberries, blueberries, or bananas to your waffles, pancakes, cereal, oatmeal, or toast. bowl of cereal with bananas
Top toasted whole-grain bread with peanut butter and sliced bananas.
Add vegetables like bell peppers, broccoli, spinach, mushrooms or tomatoes to your egg or egg white omelet.
Canned, dried, and frozen fruits and vegetables are also good options. Look for fruit without added sugar or syrups and vegetables without added salt, butter, or cream sauces.
 Strawberry Yogurt Shake

1/2 cup unsweetened pineapple juice
3/4 cup plain low fat yogurt
1-1/2 cups frozen, unsweetened strawberries

Add ingredients, in order listed, to blender container. Puree at medium speed, until thick and smooth.

image of an apple


Friday Fireside Chat: Dr. Booker, founder, OnPulse

Today, I’m talking to Dr. Corenthian “Corey” Booker.

Corey Booker, not to be confused with the mayor of Newark, is a physician. He received his undergraduate degree in Neurobiology and Physiology at the University of Maryland College, and his medical degree from Creighton University.

Thanks for talking to MedCrunch. What is OnPulse?

OnPulse is a new healthcare product designed to get you, the patient, on the same page as anyone involved in your healthcare. It’s an online environment allowing providers to communicate to one another and their patients. Not only physicians, but staff members –anyone who owns a piece of patient care. With instant online access through the product’s patient profile, connected health teams can view and share relevant information, no matter what EMR they use, or whether they’re at the office, at home or on the road.

Who should use OnPulse?

Any healthcare provider who is currently communicating by email or any specialist trying to manage a large team with email should love OnPulse. Also, any patient who emails their provider should use OnPulse.

How do patients access OnPulse?

It’s web based now (mobile app will be available this summer), so they would log on at and enter a username and login. Right now, it is by Invitation Only. You can request an invitation at our website. We will release it to more people next month. It can be accessed on iPads and will eventually be available on mobile phones.

What makes OnPulse different from anything else out there?

What makes OnPulse different is we allow the individuals who have an account to own their information. The difference is whenever you stop receiving care somewhere and close an account, you no longer have access to that information. With OnPulse, if you end a relationship with a doctor or provider, you own your information and you can share it with another provider anywhere or anytime you want or the next time you need to access care you can share it with that provider. As a system, multiple providers from different organizations can communicate. It’s based on 4 things: 1. Simplicity. 2. Access. 3. Peace of Mind. 4. On-line teams communicating in one place.

What regulations exist concerning ownership of patient health information?

Multiple state statutes, regulations, and cases govern the ownership of health information and the information contained in medical records. The classic statement of the rule concerning ownership of medical records is that the provider owns the medical records maintained by the provider, subject to the patient’s rights in the information contained in the record.

But,under the federal Health Insurance Portability and Accountability Act (HIPAA), every person “has a right of access to inspect and obtain a copy of protected health information.” The Meaningful Use regulations require that outpatient providers give patients clinical summaries within three business days for at least half of all office visits, if requested. Hospitals have to provide an electronic copy of discharge instructions upon request.

The stage two meaningful use places a much greater emphasis on patient engagement and set high standards for making data electronically available to patients. Physicians should think about these requirements as they work to implement a new EHR system. The new rules state that a professional must make electronic records available to 50 percent of their patients. Furthermore, 10 percent of a physician’s patients must actually view and download these records.

Should people be concerned about privacy?

As a patient no one knows you have an OnPulse account unless you tell them. Under HIPPA they allow providers to do what they currently do and allow them to invite other providers to the health team. Everyone on the team knows who has access to information. The system is only transparent to those using it.

When did you develop the idea for OnPulse?
I was exposed to communication in our healthcare system during my first summer of medical school. Writing HEDIS measures for the National Committee for Quality Assurance (NCQA), as a Washington Health Policy Fellow intern, taught me that our system was fragmented.

My understanding of communication in healthcare matured in residency when I became responsible for confused patients, busy consultants and returning phone calls to referring doctors for unreceived faxes, but I didn’t do anything about it until my fellowship. As a resident, you learn to communicate with everyone involved, you manage the communication with among your resident colleagues, consultants, patients and the people who are training you. As a resident, you learn to communicate with everyone involved, you manage the communication with among your resident colleagues, consultants, patients and the people who are training you. As a resident I saw, how our means of communication can fail the provider team and the patient. I didn’t know what to do about it at the time.

Within the first six months of my fellowship, I had a patient who looked at me with tears because she had suffered financially, physically and emotionally –she said, ‘I thought you guys were all communicating.’ That was it. I realized that all the faxes, phone calls and emails had failed her and so did our team, despite our best intentions.

Mostly, I learned even more about communicating in healthcare when I became a patient after I ruptured both of my patellar tendons, which connects your knee cap to your lower legs. I realized how difficult it is to navigate healthcare and to have a choice. I also learned how difficult it was for all of the providers to communicate as they are trying to help you reach a certain outcome, especially when they are not in the same organization. For instance I had an orthopedic surgeon and two physical therapist all in different places. This experience really informed how important the asset a patient was to the health team and really improved the system.

How does a patient get started using it?

The patient can either be invited by their provider or they can open their own account. Adding providers is simple. We recommend they that they invite providers that they have an established relationship with, especially an electronic one. If they have multiple providers helping them on a single issue they can suggest to their primary provider to form a health team in OnPulse. Then, you’re able to exchange messages, create a task and share files. Whenever information is requested by you –you receive a text or email alert that something is available to you.

OnPulse spans the communication needs for across sickness, wellness and fitness . For example, some patients even use it to communicate with their fitness trainer, keeping track of a daily routine, and keeping all their health information in one place.

[click  image below to enlarge]

Are there any costs involved for the patient or the provider?

It is free to an individual patients and individual providers. No fee for individual users either patients or doctors. There are subscription payments as a practice to include your business for independent practices or hospitals.

What are the benefits of using OnPulse?

Medical practices can share vital information with other providers and their mutual patients in an easily accessible, unified place. It gives providers and patients secure access to the entire team of healthcare providers. It gives both peace of mind that what they send is actually received by the right person. It helps streamline communication. And it provides personalized communication with everyone. And it’s free to an individual patient and individual provider to use.

Where do you envision OnPulse in 5 years?

My vision for it is to become the healthcare communication environment of choice for all providers and patients. OnPulse, the new on-line healthcare communication environment for patients and providers.

How did medicine and entrepreneurship meet?

My background is medicine with a consistent thread of entrepreneurship. During my fellowship I completed the masters program in clinical informatics at the Duke University’s Fuqua School of Business to better understand how to apply my ideas to clinical medicine. Prior to this time I dabbled in buying and selling houses, creating an online stationary company for my creative wife Kathy and forming a mobile application development company, but by far (besides my kids) OnPulse is the thing that wakes me up and takes me to bed.

“I believe in better communication in healthcare. That’s why I developed OnPulse, where everyone can easily contribute to the personalized best care for the patient and the patient will own 100 percent of their records, and be able to share them accordingly with their health team of choice.” ~ Corey Booker, MD/founder, OnPulse

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For More Information visit


If you have any questions for Dr. Booker, feel free to ask them below.