Turek On Men's Health » sleep

Why is Awake the New Sleep?

Paul Turek, MD — Mon, 28 Nov 2011 16:00:01 +0000

Sleeping Beauty definitely gets enough sleep (Source: Disney)

It was no surprise to me to read a recent study that showed that when Stanford men’s basketball players got more than 10 hours of sleep nightly, their on-court performance improved dramatically. They ran faster sprints, took more accurate shots and were less fatigued. Another example of more sleep translating into improved awake performance.

Facts About Sleep Deprivation

According to a recent national survey and the American Academy of Sleep Medicine, here are the current facts about sleep:

Adults should get 7-9 hours of sleep nightly.
Short sleep is defined as less than 6 hours of sleep.
Almost half (48%) of Americans say that they are not great sleepers.
More than 35% of Americans get less than 7 hours of sleep.
On average, “good” sleepers get 1-hour more sleep every night than poor sleepers.
13% say that they never get a good night’s sleep.
1 in 20 Americans have fallen asleep at the wheel while driving in the past month.
1 in 5 Americans have sex less often or have lost interest in sex because they are too sleepy.
In general, we sleep one hour less every night with each passing generation.

Sleep as Oxygen

During sleep, body temperature falls, muscles relax, the heart beats more slowly, blood pressure and pulse rate fall, and breathing slows. Clearly, sleep is more than simply rest and relaxation. It is a time of growth, recuperation and repair. Losing sleep may not physically kill you like being oxygen-deprived, but short sleep patterns are linked to depression, obesity, heart disease, loss of sex drive, attention disorders and a higher likelihood of developing a work-related disability. One Swedish study even showed that sleep deprived people look tired and less healthy and therefore less attractive to others.

Not only that, it’s not that easy to bounce back after losing sleep. The impairments caused by sleep-deprivation remain even after sleeping in for a day. Full recovery after sleep deprivation may take several nights of extended sleep.

So why does our society applaud those who stay up working all night rather than sleeping? Sleep deprivation is no badge of honor; it’s a threat to your health. Maybe this is why the Guinness Book of World Records refuses to recognize any record claims for lack of slumber. In my view, sleep ranks up there with nutrition and exercise as important pillars for a healthy, long and fulfilling life.

A Bank Account to Empty

Paul Turek, MD — Tue, 05 Jul 2011 15:15:08 +0000

Diet like you emptied your piggy bank as a kid…

“You tell me I need to lose weight. How do I do it, Doc?”
“My dear patient, it’s simple: treat your body like a bank account, but one that you should empty. Put less in and take more out.”

Obesity in America

You’ve heard the rumors; here are the facts: The United States is one of the most obese nations in the world, with 31% of Americans currently overweight. Not only that, obesity rates have tripled in the past 3 decades. The most disturbing statistic about all of this is that obese children are leading the way.

The Best Recipe for Weight Loss

Believe it or not, Americans are very motivated to lose weight. In fact, they spend $42 billion annually on weight loss foods, products, and services. Any Joe can name a half a dozen diet plans that populate the American psyche: Atkins, Pritiken, Ornish, Zone, South Beach, Jenny Craig and Weight Watchers to name a few. But do they really work?

A great study was published recently in one of medicine’s most prestigious journals that showed that no particular diet plan works better than any other to help you lose weight. In a Harvard study, 811 overweight adults were assigned to one of four diet programs that each varied carbohydrate, fat and protein content. After two years, each group had lost — and regained — about the same amount of weight regardless of the diet. I say regained because a few months off of the diet, most returned to their usual eating habits. So, despite the different diets, the same results were achieved. Conclusion: popular diet plans are largely ineffective.

Calorie and food group restricted diets are complex, stressful and lead to disappointment when goals aren’t met. Not only that, the math gets too complicated and it makes meals stressful instead of enjoyable. There must be a better way.

Five Easy Ways to Empty Your Bank Account

Give this approach a try. Knowing that the cause of obesity is relatively simple in that weight gain occurs when caloric intake exceeds caloric expenditure, try treating your body like a bank account that you want to empty and keep empty:

1. Eat less but keep it simple. Eat what you like, but first cut out snacks between meals. Then cut out dessert after dinner a couple of times a week. Then cut down on the size of one meal each day. A great way to put less into the bank account.

2. Eat food that requires work. It takes time to consume celery or an apple and requires chewing. The more you chew, the more you decrease hunger.

3. Replace energy drinks with water. Energy drinks have way too many unfilling calories.

4. Although you exercise for your heart, and you at to lose weight, exercise is a great way to help empty the bank account. Go for a 20-minute walk after lunch.

5. Get more sleep: Poor or too little sleep impairs hormones (ghrelin and leptin) that regulate hunger (gherlin) and satisfaction (leptin). Less sleep means less satisfaction with food and more uncontrolled hunger. Try to sleep 30 minutes more nightly than you do now.

I explained this recipe for weight control to a banker one day in the office and he listened intently. He then went home, made a series of small changes in his diet and lifestyle as suggested here. Being the typical number-oriented male that he is, he brought a plot of his weight over the next 4 months to show me. He had lost 30 pounds; about 1-2 pounds a week, and felt great. No fancy diet plan. Just plain ol’ economics: buy low and sell high.

The Google Wrap (Up)

Paul Turek, MD — Sat, 18 Jun 2011 16:06:40 +0000

Google: Feels like college all over again…

Got a slice of Google life this week with a lecture and lunch on the Googleplex campus. Here’s the Google wrap up. Now, this is a company with great ingredients for a healthy work life: Yoga and massage classes, personal trainers, free bicycles, three squares a day, an on-site doctor, haircuts, car washes, dry cleaning, rubber exercise balls everywhere, and health and wellness lectures at lunch. In the words of CEO Eric Schmidt “The goal is to strip away everything that gets in our employees’ way.” Nothing like the corporate America of yesteryear. Truly, a very tasty wrap.

The Guy’s Guide to Maintaining Sexual Health Talk

My talk was well attended and, as far as I could tell, no one fell asleep. Maybe it’s because I kept up the pace. Or, maybe the young Googlers were riveted by my relatively disruptive philosophy how best to identify and care for men’s sexual health issues. If you just can’t wait for the YouTube video to be posted on Google Health in a week or two, here’s the meat of it:

Young men are medically underserved in America.
One problem that contributes to this is that their care is fragmented and reductionist in nature since it is provided by various doctors.
One helpful solution would be to train more men’s health specialists who “own” all aspects of young men’s health.
Another problem is that men do not have biological reminders, or biomarkers, of their health, unlike the menstrual cycle in women.
Importantly, sexual health issues such as low sex drive, erectile dysfunction and infertility are intimately relatedto overall health. Examples:
- Men with erectile function are twice as likely to have heart attacks later in life.
- Men who are infertile are 2 to 3 times more likely to get testis and prostate cancer, respectively, later in life.
Maintaining good overall health is a great way of optimizing sexual health. The reverse is also true.
Sexual health issues should therefore be considered natural biomarkers of overall health for men.
If we educate men about such natural biomarkers, then they may assume more “ownership” of their health and live healthier, productive and maybe longer lives.

Googlers Care

I have to admit the Googlers surprised me, right off the bat, at start of the talk. Watch the YouTube video and you’ll see. Not surprisingly, when I asked the audience how many of them get regular oil changes for their cars (not knowing that Google provides this service for them), most of them raised their hands. However, when I asked how many of them had been to a doctor in the past year for a personal checkup…again the majority raised their hands. More than I had ever seen among young men. This is a good sign, to see men taking equally good care of their bodies and their cars. I see this as a powerful first step for men to achieve “ownership” of their personal health and wouldn’t you know it, Googlers are leading the way. Happy Father’s Day.

The Talk:

Video -

Slides -
The Guy’s Guide To Maintaining Sexual Health By Paul J. Turek, MD

View more presentations from Dr. Paul Turek | The Turek Clinic

He’s Gotta Have It

Paul Turek, MD — Sat, 14 May 2011 14:54:07 +0000

Maybe a few oysters would help…

What is that urban legend? An 18-year old teenager thinks about sex every 3 minutes. And that’s while he’s awake. Ah, those were the days. Now that you are older, more serious, possibly more responsible, maybe partnered, and may even have little ones, you may have nowhere near this frequency of sexual thoughts. Haven’t you wondered about why things may have changed (or not!) as you age? Do you need to eat more oysters?

What is Libido?

The desire to have sex is called libido. It is considered by many to be an “instinctual” and “primitive biological urge” and by others as an “existential need.” Libido levels differ widely among individuals, but are pretty characteristic for an individual, similar to handwriting style. After all, we are creatures of habit. Having said that, libido can also vary from day to day, and even by the hour, in any individual. Importantly, libido doesn’t correlate with normal or high levels of the male hormone testosterone, but can fall with low hormone levels.

Why and When to Evaluate Libido?

Low sex drive is most commonly due to stress, and stress comes in many forms: financial, physical, travel (circadian) and emotional. The reason is pretty clear, as I have noted before. Think of yourself as a caveman, which we were not so long ago. Being anxious or worried puts your nervous system into a primitive “fight-or-flight” response and buries the sex drive. Relaxation though, stimulates the “rest and restore” nervous system and allows the sexual appetite to bloom. For a robust libido, you need energy, relaxation, and time. So get some sleep, reduce your stress and you might find that you feel 18 years old again.

But what if your sex drive has been workable and stable for years, thank you very much, but recently has taken a nosedive. In this case, the low libido might in fact be a symptom of an underlying organic disorder and should not be ignored. Below is a list of medical conditions that cross my mind in a patient with new onset of decreased sexual desire:

Acute stress                                      Erectile dysfunction
Depression                                        Peyronie disease (penile curvature)
Sleep apnea/disorders                        Diabetes mellitus
Low testosterone                               Malnutrition
Hyperprolactinemia                             Medications (5-alpha reductase inhibitors, opiates)
Hypothyroidism                                 Cancer
Anemia                                             Drug abuse

The changing nature of relationships also affects libido, but this may not be an organic problem. One way I make this distinction is to decide whether the overall pattern or frequency of sexual activity (i.e. the event, either with a partner or with self-stimulation) has changed. If not, then desire may be intact. Yup, believe it or not, good, old fashioned medical intuition figures highly in the decision to evaluate a man for loss of sexual drive. And Robert Byrne may have actually gotten it right when he said: “Anybody who believes that the way to a man’s heart is through his stomach flunked geography.”

Royal Advice for the Ages

Paul Turek, MD — Sat, 30 Apr 2011 17:10:40 +0000

Prince William's personal royal crest.

Dear Duke and Duchess of Cambridge,

I watched your lovely wedding at Westminster Abbey this week. So sorry that I couldn’t make it to the Abbey for the ceremony, but I had to operate that day (and you didn’t actually invite me). All is forgiven, as I was privileged enough to watch the marriage (from the streets) of Lady Diana and Prince Charles some 30 years ago when I was in London as a college student doing research at St. George’s Hospital. It must have been a great affair and it looked like you both enjoyed yourselves immensely.

I know that it’s early in your relationship, but sooner or later you will look in each others’ eyes (or be told by the Queen) and say “it’s time to start a family.” Best be prepared as it’s gonna happen…to keep the lineage going and all that.

For this reason, I’m be happy to offer you some royal advice on this matter. No, don’t bother to thank me; it’s my pleasure to help out. Here are 10 tips for successful family building that I have handed out countless times to couples trying to conceive and it’s worked well for them. Feel free to tuck it away in your nightstand until the time comes or “ring me up” anytime you like:

Duchess Catherine, although you looked fabulous in that wedding dress, you really must put on a stone or two (a few pounds) of weight. Being too thin or too heavy reduces chances of conception. Aim for a body mass index of 19-25.
Duke William, spend a little less time with your buddies at the Mahiki or Pig’s Ear tavern and painting the town red; too much sauce (alcohol), fags (cigarettes) and fries (even with vinegar) are poisonous for sperm. Like I always say: All things in moderation; treat your body like a temple.
On that note, the “bangers and beans” served for breakfast at Bucky Palace do not constitute a good antioxidant diet for either of you. Take my advice and start on the Paleo diet, rich in fruits, vegetables and nuts along with occasional bison, boar or elk meat from the palace grounds at Balmoral.
Better yet, head south to the Mediterranean and eat like they do, as they have the single best antioxidant diet for a healthy heart and good fertility.
Surely it must be stressful to be a royal. And believe me, stress wreaks havoc on fertility as well as your relationship. How will you achieve that necessary balance in your lives? Avoiding the paparazzi is one way. Regular exercise, yoga, acupuncture and massage are others. Wouldn’t surprise me at all to learn that your level-headed grandmother isn’t doing something like this in her antechamber.
Duke William, stay out of hot baths, tubs, and saunas as these will drop your sperm count like a lead balloon. Showers are fine, especially gold plated ones.
Duchess Catherine, I know that you know that timing is everything. Well, it is also true of conception. Use basal body temperatures or ovulation predictor kits to let you know when to flash that great smile at the Duke.
Duke William, trying to conceive is like hunting. You need to know when to fire and when to reload the gun. Every other day is optimal for baby-making.
Duchess Catherine, consider cutting out the caffeinated coffee at the Ritz, as excess coffee consumption reduces fertility. I’ll get back to you about the tea there as it goes so well with the crumpets and finger sandwiches.
And both of you, get enough rest! For a good sex life, you need energy, you need to relax, and you need time. Remember that the mind is the largest sexual organ and it controls your “mojo” as Mr. Powers put it, so take care of it. Hit the kill switch on the TV and computer earlier in the evening. Turn off Facebook and face each other. Simply sleep; the sex will follow.

30,000 Foot (Cloud) Thoughts

Paul Turek, MD — Sun, 30 Jan 2011 02:44:35 +0000

Having your head in the clouds could be good for healthcare…

Do you find it hard to think at 30,000 feet if you are not on an airplane? “Think broadly and ambitiously and leave your pet projects at the door.” That was our charge as invited guests of the National Institutes of Health (NIH) this week for their visioning process for the future of healthcare in America.

A Vision of Health

The think tank session that I led during the meeting responded beautifully. In an effort to inform the government’s vision of healthcare in the next decade, we dreamed of developing “natural biomarkers” of health. In a surge of group think, we first defined these as common, observable and characteristic biological indicators of health states such as the menstrual cycle, the semen analysis or trends in bodyweight.

Similar to the warning lights on the car dashboard, we then postulated that natural biomarkers could be used to accurately predict future health states. Acting on changes to these common, easily observable and natural indicators could open up unimaginable opportunities for preventative health and early disease detection down the line. And not only in America, but on a global scale. I think the Feds liked this one.

Your Health Care Diary

And my group of thinkers flew even higher. An even better proposal was to create a “Personal Health Diary” for each citizen on an NIH-served, on-line communication platform. Similar to how Facebook connects friends, this web-based platform would connect the public and the government to improve healthcare. How? It would:

Encourage citizens to notify and update the NIH of their personal health status over time. (Tweet to NIH: “Dr said I wz cured of cancer today”).
Serve as a line of communication for the government to notify individuals about public health issues before they happen (Tweet from NIH: “Flu in yr zp code nxt wk”).
Provide a rich database of longitudinal health data on the population for unprecedented discovery in medical research.

With this proposal, we flew so high, we made it to the moon. Technology conceived in the clouds. And what kept us in the air after the meeting ended was the idea that by connecting the government directly to citizens, each and every one of us could make a difference and improve healthcare in America. Easily the healthiest social network you will ever join.

Through the Looking-Glass

Paul Turek, MD — Sun, 23 Jan 2011 17:17:44 +0000

Mirror, mirror on the wall…

They called again and want to talk. Similar to a strict parent who gives you little clue as to where they stand, the National Institutes of Health (NIH) wants to have a conversation. I said: “Yes, absolutely.”

The NIH is nation’s power player in healthcare research. In 2010 it spent $32 billion or about $100 per American citizen forging new research paths, describing and curing disease, informing and transforming health care and keeping academic centers financially afloat. It is a model of healthcare research worldwide.

They want me to lead a think tank session next week in Washington D.C. at the NICHD headquarters. In the dead of winter, they are crystallizing plans to roll out a comprehensive new vision for reproductive health in America. This vision will lead to a white paper statement and guide the government’s research agenda for years to come. I am honored to attend.

Leading a session of experts from around the country, I will guide discussion of how reproductive health is a window to overall health, a topic upon which I have often reflected both here and in the published literature.

In preparation for this innovative meeting, I made a list of all of the medical conditions or illnesses that have been linked to male infertility or erectile dysfunction, either causally or by association. I also included conditions linked to having a past history of either of these sexual health disorders. What frightened me is that the list is 40 conditions long! Everything from diabetes to dyslipidemia, hypertension to heart disease, from tobacco use to sexually transmitted disease, and from chromosomal disorders to cancer. This list is extensive, sobering and reaffirms my deeply held belief that sexual health is a “window” into men’s overall health. Not only do male sexual health disorders coexist with many other medical conditions, but they also predict the future occurrence of even more.

So I will be showing up in Washington with my sleeves rolled up and ready to clean the sullied panes of the looking-glass, and hoping to clarify a new vision of men’s health.

Music to Our Ears

Paul Turek, MD — Sun, 08 Nov 2009 18:08:05 +0000

Miles and Microsurgery: it doesn't get any better.

For as long we have pounded drums and plucked strings, listening to music has affected people’s sense of well-being, lifting and consoling their spirits, inducing calm and tranquility, or the trance of dance. I have listened to the sounds of classical jazz during microsurgery operations throughout my professional career as a surgeon. Coltrane, Miles, Evans, Djavan, Caetano Veloso and all the greats sweetly waft in the operating suite and overcome the din of devices within the room. Does music in the operating room lead to less wasted and more fluid surgical motion, and therefore faster procedures and better patient outcomes? Who knows. But as the background makes the painting, the music may make the maestro.

A recent study suggests that listening to music in surgery may also benefit patients. Maybe this is why oral surgeons and dentists offer earphones and video glasses to their patients. Anything is better than listening to the whine of the drill during a root canal. The effect of music on cortical, limbic or higher brain centers has previously been studied in patients undergoing brain surgery. These centers control feeling, thoughts and memory. In this recent research, a neurosurgeon studied the effect of different kinds of music on deeper portions of the brain, located in the thalamus. This region is responsible for sensation, motor function, consciousness, sleep and alertness. This study of music and Parkinson’s patients is quite different from what Oliver Sacks describes in his book Musicophilia, in which music therapy is used to increase the mobility and responsiveness of Parkinson’s patients.

According to this new study in awake patients undergoing surgery for Parkinson disease, music slowed the neuronal firings deep within the brain. As a consequence, patients became physically more relaxed, calm and even slept during their surgery. And pure melodic music appeared to be the most soothing to most patients.

So music in the operating room may make more sense than we think. In addition to helping the surgeon with his surgery, it may reduce patient anxiety. This in turn, could shorten operative times, reduce the need for anesthetic medication, and lead to quicker patient recovery and shorter hospital stays. In a word, more music, less pills.

No Sex? Get Some Sleep!

No Sex? Get Some Sleep!

Paul Turek, MD — Fri, 01 May 2009 22:50:15 +0000

The Exquisite Woman Right Next to You..

As a men’s health specialist, I get to hear a lot of things that men wouldn’t tell their best friends. And a very common occurrence is their confession that they have lost some of their sex drive. “My partner is great and I used to want sex ALL the time, now it barely enters my mind” is what I hear most.

The first thing to realize is that if you do not have the sex drive that you had when you were 18 years old, maybe its because you aren’t 18 anymore. Maybe the 10 to 20 years of aging that has occurred since then has taken a small toll. You are now older and wiser, having survived wars, financial distress and maybe even children, and you could be a bit less frisky as a result.

That reminds me of two memorable patients who represent different ends of this spectrum. Both in their late 30’s, one answered my survey question about how often they have sex by writing “twice daily, every day” and the other wrote “by appointment only.” This just goes to show that we are all built differently and we all age differently. Neither is really clinically out of the normal range. Blame comments in the locker room, Hollywood films, or Internet porn, but men often feel like their sex drive should not change with age. Tough for men to talk about and therefore tough for them to gauge. However, it is well understood by sex therapists that men aren’t always in the mood. Sometimes the History Channel looks way better.

It may not be for any lack of love or Barry White records. However, if it has been several weeks since you last took your wristwatch off, so to speak, then the real issue behind your lack of sex drive may be your level of sleeplessness and stress. If you aren’t well rested, you probably aren’t feeling too frisky. You’re probably cranky. Believe it or not, this is a very common reason why sex lives are compromised. Being anxious puts your nervous system, once part of the animal kingdom, into a primitive “fight-or-flight” response, and buries the sex drive. Relaxation though, stimulate several appetites, including degustory and sexual.

For a robust sex life, both of you need energy, relaxation, and time. The mind is the largest sexual organ, and turning off the amygdala, the portion of your brain that handles fear and worry, will allow that quiet, sensitive part of your brain that handles sex drive to kick into gear. Think seriously about turning off the TV or computer earlier in the evening, and swap out dozing in front of the TV for more restful sleep in bed. Think hard about improving how much quality rest you actually get, not necessarily to have more sex, but simply to sleep; the sex will follow. Make dates with your partner so you can focus solely on each other and forget the usual distractions. Take her to a funny movie, and laugh (or cry) together. But make the time, make it important, and catch some zzzs. Revving up your sex life can be as simple as that.

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