Transcript Jack Lessenberry, Wayne State University, August 25, 2016

Sleep Medicine and Lifestyle
Medicine: Common Ground
Mark G. Goetting, MD
Bronson Sleep Health
Kalamazoo, MI
I have the following relationships with entities producing, marketing, re-selling,
or distributing health care goods or services consumed by, or used on, patients.
Type of Potential Conflict
Details of Potential Conflict
Grant/Research Support
Jazz Pharmaceuticals, Inspire Medical, Luitpold
Consultant
Speakers’ Bureaus
Financial support
Other
The material presented in this lecture has no relationship with any of these potential conflicts.
Case Review
A 53 year old man was admitted with severe chest pain. His
cardiac ischemia was reversed by medication without permanent
damage.
Risk factors identified during evaluation were smoking,
hypertension, obesity, dyslipidemia, diabetes, sedentary lifestyle,
shift work with sleep insufficiency, and probable OSA.
All of these were addressed in his discharge planning.
Is It Possible That:
• We got it mostly wrong?
• We’re missing the obvious?
• 40 Percent of Americans Will Develop
Diabetes
• CDC Projects Rates for black women and
Hispanics even higher at 50 percent
Back in the early 1990s, I talked to Kevorkian one
night when he was briefly ensconced in the Oakland
County jail. I asked him if he ever thought physicianassisted suicide would be fully legal.
“Oh yes,” he told me. “But not for the right reason.
You’re a baby boomer, right? There are 75 million of
you, far more than the next generation. “Do you
think they are going to keep you artificially alive on
machines at their expense?”
Jack Lessenberry, Wayne State University, August
25, 2016
What Is Our Mission?
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Increase the quantity of life
Increase the quality of life
Relieve suffering
Maximize human potential
Six Realms Of Lifestyle Medicine
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Fingers
Food
Feet
Sleep
Loneliness
Stress
Cynicism vs. Skepticism
Fingers
Food
Why Is Food So Hard To Figure?
Cat
Dog Food
Dog
Turtle Food
Turtle
Cat Food
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Genetics
Culture
Internal environment (microbiota)
External environment
Food availability and convenience
Food qualities
Feet
• Exercise effects
• Sedentary effects
Non-Exercise Activity
Sleep
• Health effects
• Social/economic problems
– Absenteeism
– Presenteeism
Sleep and Cancer
• Healthy sleep duration and quality
– Enhanced DNA repair
– Increased helpful cytokines IL-1, IL-2, and TNF-α
• Unhealthy sleep duration and quality
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↓melatonin
Immunosuppression
↑ cancer stimulating IL-10
Gene transcription dysfunction
Aberrant DNA methylation
Loneliness
Cole and colleagues found 14 older adults
who differed significantly in their subjective
reports of isolation
• 8 people who consistently reported social
connectedness (over 4 years)
• 6 people who consistently reported social
isolation (over 4 years)
• Then they scanned their DNA, their entire genome
(~23,000 genes)
• Brute-force examination found ~200 genes that
showed clear, systematic differences in gene
expression between the “lonely” and ”connected”
people
Each row is a person, each column is a gene.
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Red = high expression
Black = intermediate expression
Green = low expression
Cole SW, Hawkley LC, Arevalo JM, Sung CY, Rose RM, Cacioppo JT. (2007) Social
regulation of gene expression in human leukocytes. Genome Biology, 8(9): R189.
Immune response
Inflammation
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Immunoglobulin G production
 Our most common
antibodies
Type 1 interferon arrival
response
 Regulate our immune system
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Heart disease
Rheumatoid
arthritis
Cancer
Cole SW, Hawkley LC, Arevalo JM, Sung CY, Rose RM, Cacioppo JT. (2007) Social
regulation of gene expression in human leukocytes. Genome Biology, 8(9): R189.
Stress
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Prayer
Meditation
Tai Chi
Other
Relaxation Response
Patient Education
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Inform
Educate
Advise
Lecture
Warn
Preach
Case Review
A 53 year old man was admitted with severe chest pain. His
cardiac ischemia was reversed by medication without permanent
damage.
Risk factors identified during evaluation were smoking,
hypertension, obesity, dyslipidemia, diabetes, sedentary lifestyle,
shift work with sleep insufficiency, and probable OSA.
All of these were addressed in his discharge planning.
What enables people to make
sustainable changes in their lives?
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Fun
Freedom
Pleasure
Love
• Will power = failure
Consideration of Future Consequences
Motivational Interviewing
• Individual centered
• Directive
• Enhances intrinsic motivation by exploring and
resolving ambivalence
Cultural Rehab
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All facets of healthy lifestyle begin before birth
Fostered in our schools
Honored in our society
Needs to be fulfilling and enjoyable
Sleep Medicine and Lifestyle
Medicine: Common Ground
Mark G. Goetting, MD
Bronson Sleep Health
Kalamazoo, MI