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Heat Waves: The Hidden Dangers

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By Patricia Fennell and Stephen Leon

When a summer heat wave settles over us like an oppressive shroud, we know what we can expect from the headlines. There will be warnings to stay inside in air conditioning, stay hydrated, and keep physical exertion to a minimum. There will be reports of hospitals taking in victims of heat stroke and heat exhaustion, and worse, grim stories of heat-related deaths.

We can also expect a spike in certain types of crimes, regardless of whether they make the headlines. Statistically, we know that some categories of crime do not fluctuate with the air temperature—but we also know that extreme heat does correlate with spikes in physical assault in general, and domestic violence in particular.

Anecdotally, we also know to expect increased incidents of road rage, and more arguments and fights on the street, in bars, and in the kitchens and back bedrooms across from your own rear window. Oh, and we’re sure to see a sampling of Ten Ways to Beat the Heat stories, some of which may be more useful than others, although these lists sometimes carry roughly the same depth and gravity as household redecorating tips.

Beyond the headlines, heat waves affect all of us in ways that are both obvious and unseen—and potentially dangerous. And if extreme heat poses health risks to relatively healthy people, those risks are much more pronounced among the most vulnerable populations: the old, the young, and the chronically ill.

We’re all familiar with the term “seasonal affective disorder,” which refers primarily to symptoms that appear with the onset of winter, including depression, low energy, appetite loss, inadequate sleep, loss of interest in usually enjoyable activities, and so forth. While the causes of SAD are not fully understood, it is generally thought that the reduction in daily sunlight—and with it, the disruption of the internal body clock, and changes in the levels of brain chemicals—is a significant factor.

Some people, however, are more prone to “reverse seasonal affective disorder,” which switches the timing of the symptoms to the onset of summer. And people who don’t do so well with the heat and long days are going to be that much more affected by a heat wave. So are the vulnerable groups generally, especially the chronically ill, who make up over half the population—and are among the most susceptible to the risks of extreme heat, which can both exacerbate their symptoms and even worsen the underlying conditions.

It’s the Inflammation

Although extreme heat can harm us mentally and physically in a number of ways, the biggest culprit is inflammation, which can present in many different forms and affect everything from cognition to digestion to balance to your ability to get a good night’s sleep. And inflammation can cause pain wherever in the body it occurs.

How can we manage inflammation during a heat wave?

  • Stay hydrated—and limit things that dehydrate you, like caffeine and alcohol.
  • Exercise moderation, and employ sensible practices with sleep, food, hygiene, etc.
  • Try not to have big stress-inducing conversations. This isn’t the best time to pick an unnecessary fight with your spouse or make a life-changing decision like moving or changing jobs.
  • Consider looking at an anti-inflammatory diet. Google it and read up. An anti-inflammatory diet can help anybody—it doesn’t matter who you are or whether you have chronic illness.
  • Stick to your structures and routines. Prepare ahead of time: gas up the car, make sure you have your basic provisions, get enough cash out of the ATM. Whatever you do for a snowstorm, do for a heat wave.
  • Stay cool. This is why God made air conditioning. But don’t go to extremes–find the right temperature setting for your body. Set to the highest temperature that still keeps you cool. Draw the blinds.

Vulnerability Times Seven

Extreme heat, and the inflammation it causes, also affects us in more specific ways that relate to seven “functional capacities”* we all share: fatigue, pain, sleep, cognition, ambulation, mood, and gut. These capacities are negatively affected by a heat wave, and that goes for everyone—but especially the young, the old, and the chronically ill.

  • Fatigue may have little or nothing to do with the amount of sleep you get. You can have physical, mental, or emotional fatigue regardless of your sleep patterns—and inflammation affects fatigue too.
  • Inflammation can bring on pain anywhere in your body. And when the barometric pressure changes, that creates swelling—in the joints, in the gut, and elsewhere.
  • Heat waves disturb normal sleep patterns. The extra light in summer already affects circadian rhythms, and heat waves occur during the maximum light periods. Heat, humidity, and the inflammation they cause exacerbate the disruption.
  • As for cognition, there is some science to back up the popular understanding that people don’t think as well in the heat. People have more trouble finding words, focusing, what we might call “staying on point.” And it affects the short-term memory. You can’t find the car. People also are more prone to make careless (and potentially deadly) mistakes while driving.
  • Ambulation is affected by many things, notably, the inner ear. As we age, balance becomes more of an issue. Heat and inflammation can throw off balance, which affects walking and other types of movement, including going up and down stairs.
  • Heat waves affect mood. In extreme heat and humidity, all of these functions can act upon each other negatively. And regardless of or in addition to these factors, the brain experiences inflammation on its own. All of this makes us irritable. We’re hot and uncomfortable, and we’re not thinking well.
  • The gut is already having an inflammatory response, and the heat makes us want to eat less. We change our diet, not necessarily for the better, and we move and exercise less—all of which is a recipe for digestion problems.

Make It Easy on Yourself

You can manage your functional capacities during a heat wave without overwhelming yourself. Think about which capacities typically are your problem areas. Rank them, and work on one or two at a time. For example:

Sleep: Try to create a reasonable sleep schedule. Give yourself time to rest. Keep your room dark. Avoid overhead lighting. Give your brain the message that it’s time to wind down.

Cognition: Avoid mental activities that strain your brain. Minimize distractions so your brain can do the work it has to and then rest. Work for 40 minutes and then take a break. Calm your neurology.

Mood: Manage your mood by expecting the things that are likely to happen, so they won’t throttle you. Expect people to cut your off in traffic. Expect people to be cranky. Expect that you will be more emotional. If you’re vulnerable (and aren’t we all) to feeling low or anxious or unsettled, expect it and be ready to manage it.

*Fennell, P.A. (2012). The Chronic Illness Workbook: Strategies and Solutions for Taking Back Your Life. Third Edition. Albany, NY: Albany Health Management Publishing.

This post also appears on the website for Albany Health Management Associates, Inc.

Copyright 2018, Patricia Fennell and Stephen Leon

 

The Doctor of Drowsy

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In his new book, local author and sleep researcher Paul Glovinsky says the solution to insomnia may have more to do with getting sleepy than trying to fall asleep

By Stephen Leon

Dr. Paul Glovinsky calls it his “Alice in Wonderland” moment. A graduate student studying neurophysiology at the City University of New York, he was doing grad work at Montefiore Hospital in the late 1970s when, during a lunch break, he became fascinated with a wide door bearing the sign “Laboratory of Human Chronophysiology.”

“I opened it, and I went in, and met people working there,” Glovinsky recalls of his first peek into the world of circadian cycles and sleep science. “It was the excitement of a new field. Everyone I was talking to, it was a feeling of exploration. People had a sense that they were in a special place.”

And they were: the field of sleep research was about to experience exponential growth. Prior to this era, there had been some clinical studies (REM sleep was defined and linked to dreams by researchers in 1953), but the field—led by pioneers William Dement and Michael Jouvet—was still young. “There were many people studying circadian rhythms, but mainly in animal models,” Glovinsky says.

The sleep center at Montefiore was one of only two in the country at the time (the other was at Stanford University); today, in Glovinsky’s estimation, “there are probably over a thousand.”

Glovinsky, who was born and raised in the Detroit area and graduated from Yale University, received his Ph.D. from CUNY and wrote his dissertation on sleep. Today, he is a leading expert on the subject: along with his longtime colleague Arthur Spielman, Glovinsky wrote The Insomnia Answer: A Personalized Program for Identifying and Overcoming the Three Types of Insomnia (Penguin, 2006), and You Are Getting Sleepy: Lifestyle-Based Solutions for Insomnia (Diversion, 2017).

With The Insomnia Answer—widely respected among Spielman and Glovinsky’s peers, and influential in subsequent treatment of insomnia—the authors introduced three distinct sets of factors associated with insomnia: predisposing, precipitating, and perpetuating. “Predisposing” refers to characteristics people are born with; “precipitating” factors are stressful life changes including divorce, job loss, and the death of a loved one; and “perpetuating” factors are the maladjusted behaviors people employ to compensate for sleeping poorly. While the stress of precipitating factors is likely to recede over time, or go away altogether with a new job or spouse, the perpetuating behaviors often remain.

“The 3P behavioral model,” wrote reviewers Frank M. Ralls and Swala K. Abrams in the Journal of Clinical Sleep Medicine, “is beautifully explained and serves to logically demonstrate to the readers how insomnia occurs acutely and how it may become chronic and self-perpetuating.”

Patricia Fennell, who founded Albany Health Management Associates, Inc., and has worked with Glovinsky at the intersection of sleep disorders and chronic illness, adds that “precipitating factors can include a car accident, a fall, or even a severe flu. A kid comes home for Thanksgiving. It’s flu season; she gets sick. She goes back to school and she gets seriously ill. It turns out, an acute autoimmune disease has been triggered. It affects her sleep. She has pain, which also affects her sleep. She has to take new medication, which also can affect her sleep. And thus, a likely precipitating factor, the flu, produced a sleep disorder and the autoimmune condition.”

“You do not have to have a chronic disease to have a sleep disorder. But show me somebody who has chronic disease, and I’ll show you somebody who probably has sleep issues.”

With You Are Getting Sleepy, Spielman and Glovinsky turned their attention away from the perpetuating factors they had covered so well (along with other subsequent researchers) in The Insomnia Answer, and trained their sights on predisposing factors they considered less well-covered, including chronic conditions such as depression, anxiety, circadian rhythm disorder, and hyperarousal, any of which can sap a person’s energy during their waking hours and throw off their sleep cycles. (To that list, Fennell would add chronic diseases such as multiple sclerosis, arthritis, cancer, diabetes, and heart disease.)

In clinical trials, Spielman and Glovinsky had come to a new conclusion: some patients were focusing too much on getting to sleep and not enough on getting sleepy.

“Sleepiness–that’s my new hook here,” Glovinsky says. “It’s a common result of an experience with insomnia or chronic sleeplessness that people become more attuned to the question of whether they’re going to sleep or not,” and they make too much of an effort to try to figure it out. “The paradox is that the more you make an effort to sleep, the less likely you will get to sleep.”

People who aren’t getting enough sleep at night often get sleepy at other times of the day, when it interferes with work or family or the general quality of their life. So Glovinsky and Spielman shifted their focus to “trying to get people sleepy at the right time and place. There are things you can do to promote sleepiness.” And recognizing that there is no one-size-fits-all answer to insomnia, they wrote and organized You Are Getting Sleepy in a way that encourages readers to jump around and look for strategies that fit their personal experiences.

Before they began writing, the authors knew their clinical work was opening up new ground to cover in a book, but they faced an ominous new obstacle: Spielman was diagnosed with cancer and began to undergo chemotherapy. In 2014, while Glovinsky was on vacation, he was dogged by the realization that the clock was ticking, and called Spielman from Greece to insist that they had to get to work on it as soon as possible. Spielman, whom Glovinsky considered the originator of many of the concepts they developed together, contributed to the project until he died in 2015.

Although Glovinsky was more the writer of the pair, he now had to face the loss of his trusted colleague and sounding board. “That was difficult. It took a year before I picked it up again. Writing was not the issue. But in 30 years, I always had him to bring things to me.”

Glovinsky, who lives in Columbia County and New York City with his wife of 35 years, Maureen (with whom he has three grown sons), finished the book in 2016, and it was released this year by Diversion.

Glovinsky met his two most influential lifelong colleagues—Spielman and Aaron Sher—on the same day in 1979 while doing his graduate work at CUNY. Today, Glovinsky practices psychology at the St. Peter’s Sleep Center in Albany, where Sher was medical director until his recent retirement. Glovinsky also was, for many years, an adjunct professor of psychology at the Graduate Center at CUNY in New York City, where Spielman taught until his death.

Insomnia and associated problems affect more than 10 percent of the population, Glovinsky says. And people who rely on sleeping pills to solve the problem tend to believe that only the pills can cure the insomnia, which he argues is not productive in the long run. “My thrust in writing the book is that sleep is in you,” he says. “Ultimately, you have to believe you can sleep again.”

Looking back at the day he decided to push open the mysterious door at Montefiore Hospital, Glovinsky marvels at how well that fateful impulse played out.

“Sleep, it turns out, is intimately related to just about everything that happens in waking life. It effects our cells, organs, systems, behaviors, moods, thoughts, and social roles. Few of us had any inkling of this range back in the 1970s, as we were making career choices. We have been astounded by new discoveries concerning sleep in every year since. That’s why, I think, my walking through that Alice in Wonderland door at Montefiore turned out to be such a serendipitous choice.”

@Copyright 2017 Stephen Leon

stephenleon7@gmail.com