I am no fan of Daylight Saving Time

A man with sleep apnea using a CPAP machine. (iStockphoto)
A man with sleep apnea using a CPAP machine. (iStockphoto)

As a person who believes in getting enough sleep each night, I find Daylight Saving Time (DST) a nuisance. This disturbs my sleep rhythm for the next several months. Then I have to change the clocks again.

If I don’t like this then I can move to Saskatchewan or Hawaii, American Samoa, Guam, Puerto Rico, the Virgin Islands or Arizona where there is no such thing as DST. People are happy there. Having no DST has not ruined their economy.

The question is: Would you like one extra hour of sleep or sunlight?

The idea of DST is to have people up and about during the longer daylight hours, to save energy and increase productivity. In 2005, U.S. Congress and subsequently other countries expanded daylight savings time, by shifting its start to the second Sunday in March and its end to the first Sunday in November.

Has DST increased productivity? Has it improved people’s health and wealth? Have we saved any energy? Are we doing better than people in Saskatchewan or other places where there is no DST?

The DST began in Europe to conserve fuel during World War I. Since then it has gone through several changes. U.S. Congress passed the Uniform Time Act of 1966, which declared that DST be observed from the last Sunday in April to the last Sunday in October. Some exemptions were allowed. This has now changed to March and November.

In recent years several studies have suggested that daylight saving time doesn’t actually save energy – and might even result in a net loss. Studies have found that the practice of DST reduced lighting and electricity consumption in the evening but increased energy use in the dark mornings. So there is no gain as such.

As you may expect there are other studies which do show energy gains. The U.S. Department of Energy asserts that springing forward does save energy. Extended DST saved 1.3 terawatt hours of electricity. That figure suggests that DST reduces annual U.S. electricity consumption by 0.03 per cent and overall energy consumption by 0.02 per cent. While those percentages seem small, they could represent significant savings because of the enormous total energy use.

Does DST affect your health?

DST is supposed to boost your health by encouraging active lifestyles. Advocates of DST say that television watching is substantially reduced and outdoor behaviours like jogging, walking, or going to the park are substantially increased.

But others warn of ill effects. Some studies show that our circadian body clocks – set by light and darkness – never adjust to gaining an “extra” hour of sunlight to the end of the day during DST. This results in drastically decreased productivity, decreased quality of life, and increasing susceptibility to illness. People are generally more tired during the months of DST.

One expert says that one of the reasons why so many people in the developed world are chronically overtired is that they suffer from “social jet lag.” In other words, their optimal circadian sleep periods are out of whack with their actual sleep schedules. Shifting daylight from morning to evening only increases this lag.

A 2008 study in the New England Journal of Medicine concluded that, at least in Sweden, heart attack risks go up in the days just after the spring time change. The most likely explanation to the findings are disturbed sleep and disruption of biological rhythms.

DST clock shifts present other challenges. They complicate timekeeping, and can disrupt meetings, travel, billing, record keeping, medical devices, heavy equipment, etc. Software can often adjust computer clocks automatically, but this can be limited and error-prone, particularly when DST protocols are changed.

I am not sure what the majority of the people think about DST, but I find changing my circadian cycle and my clocks twice a year is annoying, to put it mildly. Anyway, the sun is shining and we have an extra hour to enjoy the evenings. So, lets get out and have fun.

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Alhambra – an Arabian Palace in Granada, Spain

View of Alhambra at sunset, Granada, Spain. (iStockphoto)
View of Alhambra at sunset, Granada, Spain. (iStockphoto)

Alhambra Entrance
Alhambra Entrance

Alhambra by Day
Alhambra by Day

Alhambra by Night
Alhambra by Night

Alhambra Gardens
Alhambra Gardens

Alhambra Interior
Alhambra Interior

Noorali with Alhambra and Granada in the Background
Noorali with Alhambra and Granada in the Background

View of Granada from Alhambra
View of Granada from Alhambra

When you travel through Spain, you find each city has beautiful historical and cultural monuments and architectural gems of immense significance. During our tour, the one place which stood out the most was the world-famous Alhambra in Granada, Spain.

To understand and enjoy the beauty and majesty of Alhambra, one has to understand the complicated history of Granada and Spain. There was a time when Muslims, Jews and Christians lived in harmony. That was a long time ago. But that is a historical fact.

Granada has a population of around 250,000.

The Moors (Muslim inhabitants of al-Andalus and North Africa) ruled Spain, Portugal and North Africa for about 800 years. Spain was re-conquered by the Catholic monarchs from the Moors and the conquest was completed in 1492.

A complete tour of the monument may take anywhere from four to eight hours depending on your mobility, the weather and how much time you want to spend in each area. There is much to see, learn and enjoy. My advice would be to buy your ticket in advance online (www.alhambra-patronato.es) and get there early by 8 a.m.

Alhambra is a 9th century Arabian palace. The palaces of Alhambra were originally built by Ismael I for judicial administration. It was modified by Mohamed III in the 13th century to be used as his private residence. From the 13th century to the 15th century, Alhambra had been a palace, a citadel, a fortress and home of the Nasrid sultans. It also housed high government officials, servants of the court and elite soldiers.

The name Alhambra (an Arabic word) means “the red one” or “red castle” and refers to the color of the mountain on which it is built overlooking Granada on the southeastern border of the city. From Alhambra, one can have a beautiful wide view of the city and plain of Granada.

After the Christian conquest of Granada in 1492, Alhambra suffered neglect and mutilation. But it was soon realized that Alhambra is a rare natural beauty and the buildings were extensively restored after 1828 and are still well maintained. Alhambra has become the best conserved ancient Arabian palace.

Alhambra covers an area of about 35 acres (142,000 m²). It has fortified walls and is guarded by thirteen towers. Alhambra is divided into four main areas: the Palaces, Alcazaba (the military area), Medina (the city) and Generalife (agricultural estate).

Entry to Nasrid Palaces is strictly limited to the times indicated on the ticket. If you miss your turn you will not be allowed to see these Palaces. Only 300 people are allowed in each half-hour. You have to be in the building within half-an-hour of the assigned time. Once you are in you can stay as long as you want.

Historians believe that Alhambra is a true expression of the once flourishing Moorish civilization and is the finest example of its architecture in Spain. In a short article it is hard to describe in detail the four main areas of Alhambra. But each area is worth seeing.

The halls and chambers of the Palaces are surrounded by a series of open courts. The interior of the building has many magnificent examples of honeycomb vaulting. The walls and ceilings are decorated with geometric ornamentation of minute detail and intricacy. The work is beautifully done with outstanding skill in marble, alabaster, glazed tile, and carved plaster.

There are number of beautiful gardens. There are places to rest, eat and relax. Once you are in you can stay as long as you want. You can visit Alhambra by night as well. After a visit the beauty and history of Alhambra will be hard to forget.

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Colonoscopy – A Dreaded Test Prevents Deaths

Colonoscopy cartoon. (Hemera)
Colonoscopy cartoon. (Hemera)

Dr. Bharwani demonstrating the use of flexible sigmoidoscope - checks left side of the colon for average risk patient.
Dr. Bharwani demonstrating the use of flexible sigmoidoscope – checks left side of the colon for average risk patient.

Rightly so, the media immediately picked up the conclusions of a recent study (Colonoscopic Polypectomy and Long-Term Prevention of Colorectal-Cancer Deaths) published in the New England Journal of Medicine (February 23, 2012).

Among 2602 patients who had adenomas (pre-malignant polyps) removed during participation in the study, after a median of 15.8 years, had 53 per cent reduction in death from colorectal cancer.

This indeed is an important conclusion. As New York Times (February 22/12) said, “Although many people have assumed that colonoscopy must save lives because it is so often recommended, strong evidence has been lacking until now.” This study has some limitations in that it was not a double blind or randomized trial.

The Times article also says, “The new study did not compare colonoscopy with other ways of screening for colorectal cancer and so does not fully resolve a longstanding medical debate about which method is best. Tests other than colonoscopy look for blood in the stool or use different techniques to examine the intestine. All the tests are unpleasant, and people are often reluctant to have them.”

In fact, a study from Spain found that when people were offered a stool test, only 34.2 per cent took it. The figure for colonoscopy was even worse: 24.6 per cent.

One thing most physicians agree is that it is important to get some type of screening test for colorectal cancer starting at age 50. Research indicates that not every polyp turns into cancer, but that nearly every colorectal tumor starts out as an adenomatous polyp. In the general population this type of polyp is found in about 15 per cent of women and 25 per cent of men.

So, not every 50 year old and older is at risk of having colorectal cancer. Some are at average risk, some are at moderate risk and some are at high risk. It all depends on your personal and family history.

Not all doctors who do colonoscopies are good at finding polyps. Studies have shown that polyps in the right side of the colon are more often missed than on the left side.

Good news is, colonoscopy does not have to be done every year. If there are no polyps, it is recommended just once every 10 years. People with polyps are usually told to have the test every three to five years depending on the size and kind of polyp.

Colonoscopy should be used judiciously. It is invasive and expensive. It carries small risks of bleeding or perforation of the intestine. It requires sedation, a day off work, and patients must take strong, foul-tasting laxatives to clean out the intestines.

Dr. Winawer, one of the authors of the new study is quoted in the Times article saying, “Any screening is better than none. The best test is the one that gets done, and that gets done well.”

So, what are you waiting for. Talk to your doctor about your risk (average, moderate, high), your options, the advantages and disadvantages of each test and go for it. It may save your life.

Honey, where is my bottle of laxative…I said laxative not a bottle of wine.

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There Isn’t One Best Treatment for Sleep Apnea

A man with sleep apnea using a CPAP machine. (iStockphoto)
A man with sleep apnea using a CPAP machine. (iStockphoto)

Noorali demonstrating CPAP

There are two main goals to be achieved when it comes to treating sleep apnea. First, to establish adequate ventilation. When you stop breathing your ventilation system stops. Second, to make sure your body gets enough oxygen.

There are three ways to treat the problem. Each treatment method has advantages and disadvantages. The treatment involves behaviour modification, medical treatment and sometimes surgical treatment.

For mild cases of sleep apnea, the treatment often starts with behavioural therapy. Counselling for behavioural changes includes losing weight and avoidance of alcohol, sleeping pills and sedatives. These pills relax throat muscles, contributing to the collapse of the airway at night.

Most patients snore sleeping on their back. These patients should be asked to train themselves to sleep exclusively on their side. One way to do this is by sewing three or four tennis balls at the back of an old shirt. Wear the shirt when you go to bed and you will never sleep again on your back. It will be painful. It works and it is cheap. This can prevent the tongue and palate from falling backwards in the throat and blocking the airway.

The medical management of sleep apnea uses continuous positive airway pressure (CPAP) or dental appliance.

For moderate to severe sleep apnea, the most common treatment is the use of a CPAP. CPAP is delivered through a mask to be worn when a sleep.

CPAP keeps the patient’s airway open during sleep by means of a flow of pressurized air into the throat. The patient wears a plastic facial mask (see picture), which is connected by a flexible tube to a small bedside machine. The CPAP machine generates the required air pressure to keep the patient’s airways open during sleep. The machine can humidify the air and keep it warm.

CPAP therapy is extremely effective in reducing the episodes of apnea. But some patients find it uncomfortable. The mask is not easy to fit your face and it is not easy to sleep with. One study demonstrated 46 per cent of patients used CPAP for more than four hours per night for more than 70 per cent of the observed nights. Others have adapted to CPAP quite nicely. Some studies have shown improved survival in patients who use CPAP.

Oral dental appliance has been promoted as a useful alternative to CPAP. It is a custom-made mouthpiece that shifts the lower jaw forward, opening up the airway. There are a variety of appliances. The appliances are worn only during sleep and are generally well tolerated. Not all patients have clinically proven response. It is considered as a second line of treatment compared to CPAP.

Surgical treatment for snoring and obstructive sleep apnea has become quite popular. Probably due to the inconvenience of CPAP and oral appliance. Surgery is considered if only other methods fail. Several surgical procedures are available, each one with advantages and disadvantages. These procedures are done by Otolaryngologists (specialists in ear, nose and throat surgeries).

There isn’t one solution to the problem of snoring and obstructive sleep apnea. Weigh your options carefully. Have yourself checked out at a sleep clinic and talk to a specialist in sleep disorders. Until then happy snoring.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!