Columnist and AS expert Dr. Stacy Loeb praises 'a good night's sleep'
It's almost New Year's 2024. Resolution time. Starting Jan. 1, why not get more sleep?
By Howard Wolinsky
The fifth position in a batting line-up, the “Destiny spot,” is tres important. The fifth batter is responsible for driving in any baserunners that the cleanup hitter failed to bring home.
This month, TheActiveSurveillor.com rolls out a new column featuring Dr. Stacy Loeb as our fifth batter in the AS advice line-up. She is not only a urologist but was just boarded in lifestyle medicine. Congrats, Dr. Loeb.
Send your questions about AS and urology, radiology, pathology, sexual health, and lifestyle via email to mailto:pros8canswers@gmail.com
Keep the questions short and sweet. They should be of general interest. Sign with your real name, or just initials, tell me where you live, how long you‘ve been on AS, are you seeing a private practice or university urologist, tell me how it’s going for you. Share a whimsical signature if you’re so inclined. Like ‘Butch from Idaho” or “Lost in Flossmoor.’)
Question: What’s “a good amount of sleep”? And what’s it got to do with my low-risk prostate cancer? My AS and enlarged prostate keep me up at night. Do I need help, Dr. Loeb?
Sleepy (and Snoring) in Seattle
Dr. Loeb answers:
A good amount of sleep is 7-9 hours per night. Good sleep is extremely important for everyone. Sleep disturbances are associated with a whole host of problems including depression and reductions in quality of life, an increased risk of many chronic diseases (e.g., heart disease), accidents, and injuries.
Sleep can be particularly problematic in prostate cancer. In 2022, we published a survey of patients with prostate cancer reporting very high rates of sleep disturbances: 51% reported poor quality sleep, 18% met criteria for clinical insomnia and 37% were at high risk of sleep apnea. In a separate survey we found that partners of patients with prostate cancer also have disturbingly high rates of sleeping problems.
One of the common screening tools for obstructive sleep apnea risk is called “STOP BANG,” which stands for Snoring, Tired during daytime, Observed to stop breathing, high blood pressure, Body Mass Index, age 50 and above, neck measurement of 40 inches and above, and male gender. Look online here for a screening test for sleep apnea: https://www.mdcalc.com/calc/3992/stop-bang-score-obstructive-sleep-apnea
Individuals who meet 0-2 of these criteria are considered low-risk for obstructive sleep apnea. However, if you are a male over age 50, that is already two criteria.
Therefore, the presence of any other criteria on this list would place you into at least the intermediate risk category and warrant further evaluation by a physician. Not only is obstructive sleep apnea a potentially life-threatening condition but it is also associated with a higher risk of erectile dysfunction.
Aside from obstructive sleep apnea, as described above it is common for patients with prostate cancer to suffer from poor-quality sleep. Some important tips for sleep hygiene are to keep to a stable sleep schedule (similar sleep and wake times each day), get bright light in the morning but avoid bright light and electronics at night, get physical activity (ideally earlier in the day), limit big meals and fluids within three hours of bedtime, and enhance the sleep environment (e.g., comfortable temperature and bedding).
“Stimulus control” is also important, meaning that the bed should only be used for sleeping and sex. The bed should not be associated with other activities like doing work. Meditation can also be a great way to relax before bedtime, particularly if AS is causing some anxiety.
If you have already tried these things unsuccessfully and/or poor sleep is taking a major toll, then I recommend seeing a medical or behavioral sleep specialist to do further workup and to learn about additional options such as cognitive behavioral therapy for insomnia. Sleeping medications have many health risks and are not a good long-term solution.
Dr. Stacy Loeb is a Professor of Urology and Population Health at NYU Langone Health and the Manhattan Veterans Affairs, specializing in prostate cancer. Dr. Loeb completed her urology residency training at Johns Hopkins and subsequently received a Master of Science in Comparative Effectiveness Research at NYU School of Medicine.
Dr. Loeb is an internationally recognized expert in prostate cancer with more than 340 peer-reviewed published articles and 11 book chapters. She is on the Editorial Board for the Journal of Clinical Oncology, European Urology, Urology Times, Nature Reviews Urology and Reviews in Urology. Dr Loeb authored the chapter on “Diagnosis and Staging of Prostate Cancer” for Campbell-Walsh Urology, the primary textbook used in the field of urology.
Pitch in on new database on AS-friendly docs
By Howard Wolinsky
f you’ve attended Active Surveillance support groups from AnCan, Prostate Cancer UK, Active Surveillance Patients International, and Prostate Cancer Support Canada, you may have run into my friend Mike Win, an AS patient from Denver.
( Patient Mike Win stands up for AS in his tux.)
I speak and write often with Mike. We talk philosophy (Stoicism), maths, stats, and anything else that his hungry mind comes up with. He is a diligent researcher who gladly shares his AS findings with other patients.
Mike, retired president of a Colorado-based technology company, has launched a much-needed initiative at his Website ProstateNow.org to create a database of AS-friendly urologists plus lists of uropathologists and abdominal MRI radiologists, who are experts on the prostate.
We need this data in one spot to help patients find first and second opinions. Lists like these may help patients get the right diagnosis and find the best treatment for themselves.
Mike needs your help to help us all.
If you trust and like your urologist and he or she supports AS, please share their names and locations with Mike at ProstateNOW.org@gmail.com
Likewise send the names of other experts.
Mike also includes links to support groups and events at ProstateNow.org.
Sign up early: ZERO support group on AS in March
By Howard Wolinsky
For the past three years, I have run a special Active Surveillance support group for ZERO.
Why not plan ahead and sign up now and tjoin us at 11 a.m. Eastern on Tuesday, March 12, 2024. Register in advance for this meeting:
https://us02web.zoom.us/meeting/register/tZUsfuqgrjIoG9AWf7voMhzT_UjdqbQQbQPA