Our WHY/ Approach
I often tell my patients that I am going to be their coach, their fan and their cheerleader (without the pom-poms), but they are the players on the field.
It is you who has to put in the hard work, you that wants to get better. I provide you direction and roadmap. As the saying goes, ‘We are flooded with information, but thirsting for wisdom.’
STEP #1: My first task is to understand your goals.
STEP #2: You also need guidance about the role your sleep has on brain health, mental health, general health, sports and cognitive performance.
STEP #3: I help you understand all the factors sabotaging your sleep.
STEP #4: I will equip you with the tools you need to improve your sleep and succeed.
STEP #5: I will be your personal sleep coach, working with you to overcome barriers, and guide you to the finish line.
THE NUTS AND BOLTS:
What you have here is Dr Creado's 'Pyramid of Sleep Performance'.
Level I of the pyramid is where I identify Sleep Saboteurs: concussions, specific sleep disorders, mental health disorders, pain, alcohol and other substance use, medical conditions, medications that impact sleep and performance), etc.
LEVEL II of the pyramid involves initial baseline measurement of sleep, as well as tracking of sleep over time. We may use: sleep diaries, biomarkers (hormones, neurotransmitters, etc.), imaging, wearable sleep trackers, sleep testing and technologies to diagnose sleep disorders, athlete-specific sleep screening tools.
We can also link these sleep trackers to performance metrics and brain functioning.
LEVEL III of the pyramid addresses: evidence-based sleep practices to synchronize your circadian and homeostatic rhythms. This includes strategies for setting up a sleep-healthy lifestyle, the ‘ toolkit’ or your sleep performance pack!
We may evaluate and modify: bedroom environment, lifestyle factors (including diet, supplements, exercise, medications and more), develop specific sleep habits to synchronize your circadian and homeostatic sleep rhythms, find ways to reduce arousal (anxiety), and identify and defeat sleep-sabotaging thoughts.
LEVEL IV of the pyramid or the pyramidion (the name of the capstone of a pyramid) is the pinnacle of sleep performance: This is where the science of sleep becomes an art. Where normalization is transcended, and optimization is the norm.
This can include understanding and organizing your sleep rhythms, training and its impact on sleep, and how to ‘bank’ sleep with strategic napping and sleep extension, as well as chronocoaching to mitigate jet lag.
These tools may include:
1. Sleep promoting strategies (light blocking, arousal reduction strategies, nutraceuticals/ supplements, medications (only when absolutely necessary).
2. Alertness promoting strategies [caffeine, nutraceuticals/ supplements, light therapy, timed training, strategic napping, sleep extension, impact of your chronotype (morning birds versus night owls) on performance, how to adjust your sleep rhythms].
3. Travel strategies: Addressing the impact of travel on performance (within and in different time zones), and developing specific strategies to shift your sleep rhythm, so that no matter when or how long you travel, you can compete at your biological peak!
Dr Creado has a custom-built, proprietary formula that is uniquely his intellectual property.
‘This wonderful human has been a key player in helping me crack the code on jet lag! THANK YOU DR SHANE!’ LeAnn Rimes
Every sleep problem is multi-factorial , and our duty is to identify as many contributing factors as we can, and mitigate those as far as possible.
Remember, if we only think about possible outcomes from doing something (for example, a recommended intervention l ike going to bed only when sleepy), it is only a 50% analysis. The other 50% to think about is the outcomes of not doing something (for example, clock watching when you are struggling to fall asleep).
I use the marginal gains approach: If there are 10 different factors sabotaging your sleep by 5%, mitigating them wil l improve your sleep by 50%.
I do not look at insomnia as a lack of sleep, but rather, a preponderance of wakefulness of the brain. Similar to darkness not actually being darkness, but actually the absence of light.
It is not enough to look for a problem after it arises, or treat it with just one medication after another.
It is about looking at ALL the underlying factors that impact a certain problem.
For example, if you have a headache, an aspirin may help. But if your headache is a symptom of bacterial meningitis, you could die.
My approach, is a personalized sleep approach, a precise and effective sleep OPTIMIZATION program for the individual. One size does NOT fit all.
The initial sleep optimization plan will be updated and adjusted , based on the data we receive from measurement tools ( of both sleep and performance), current stressors, schedule and timing of play, timings and duration of travel, current mental state, current injury status, medications/ supplements being taken, and many other factors.
LET’S DO THIS!
THE NEED for Athlete Sleep Optimization
Sleep is one of the core pillars of athletic performance.
Sleep, like physical training, needs to be prescribed, personalized, practiced and optimized.
It astounds me that when it comes to the pillars of performance: mental conditioning, physical conditioning, nutrition and sleep, sleep seems to be the neglected step-child in most cases.
You don’t want to give your blood, sweat and tears to train the hardest, only to have sub-optimal sleep be your kryptonite.
Sleep optimization is the last frontier in peak athletic performance.
For athletes, the consultation includes: investigating where your sleep is falling off, and ways to strategically use all the evidence-based tools to boost your sleep quality (including thought and behavioral strategies, supplements, nutrition, strategic napping, training schedules and travel strategies). By perfecting these strategies, your athletic performance will be improved.
“We’re teaching our players: Sleep is a weapon.” Sam Ramsden, Director of Player Health and Performance, Seattle Seahawks
The prevalence of sleep problems in athletes:
Collegiate athletes: Data pooled from Project REST (Recovery Enhancement and Sleep Training), the NCAA (National Collegiate Athletic Association), the NCAA Inter-Association Task Force on Sleep and Wellness, the NCAA GOALS (Growth, Opportunities, Aspirations and Learning of Students survey), PAC12 (Pacific-12 Conference), ACHA (the American College Health Association) show that:
- In a 2018 study of 628 collegiate athletes from 29 varsity teams, 42% experienced poor sleep quality and 51% reported high levels of excessive daytime sleepiness.
- Sleep is the #1 thing their athletic time commitments keep them from doing.
- Sleep symptoms (especially insomnia) lead to an increased likelihood of lower GPA (Grade Point Average) and significantly higher risk for academic failure (GPA <2.0).
Professional athletes:
Studies estimate the prevalence of sleep disturbances in athletes ranges from 13% to 70%. There are hundreds of studies that have looked at sleep problems in specific sports, specific nations, different levels of sport, different leagues, which all show that the prevalence of sleep problems in athletes, and the psychiatric problems that go along with them, cannot be ignored any more.
Factors contributing to sleep problems in athletes:
1. Lifestyle factors: Physical and mental demands, training and competition schedules, social and media appearances, sponsors and advertisements, electronic media devices, and many others.
2. Type of Sport: Intensity of training, body-type impact on sleep, seasons of play, etc.
3. Training type (aesthetic coordination vs speed vs strength vs endurance).
4. Time of training and individual chronotype. [the time of day a person prefers to sleep]
5. Individual athletes attitudes about sleep
6. Seasons of play: Several studies show that pre-season, off-season and in-season sleep and performance vary greatly.
7. Travel: short-haul travel (travel fatigue, timing, duration, type of travel, frequency) and long-haul travel (time zones) can both disrupt sleep.
8. Sleep Environment: traveling for games and training.
The impact of sub-optimal sleep on performance:
The evidence shows that poor sleep directly impacts:
· Inflammation,
· Immunity
· Hormone balance (lower growth hormone, testosterone, leptin; and higher cortisol, ghrelin).
· RER (respiratory exchange ratio)
· Concussion risk and recovery,
· Mental and practical errors.
· Reaction times,
· Accuracy,
· Sprint times,
· Shooting accuracy in basketball (9.2%),
· Tennis serving speed and accuracy (20-40%)
· Swimming start times (17%)
· Circadian misalignment (peak performance, related to early vs late risers differs by up to 26%).
· Hand-eye coordination,
· Emotional resilience (think squabbles with team mates and coaching staff),
· Memory (limiting your ability to think about and execute your game plan).
· Worse pain tolerance,
· Increased injury rates
· Slower recovery and prolonged rehabilitation after injuries
· Impaired recovery from a single HIIT session,
· Reduced PPO (peak power output),
· Reduced motivation to train,
· Decreased maximal jump performance,
· Increased joint coordination variability (which predisposes an athlete to injury, because of faulty technique),
· Negative effect on the continuous kicking test (soccer),
· Steeper learning curves,
· Perceived increased training load,
· Poorer concentration and sustained attention,
· Maximal isometric strength,
· Lower psychological resilience,
· Difficult team dynamics,
· Slower muscle recovery,
· Lower muscle glycogen,
· Poor glucose metabolism,
· Shortened playing careers
EVERYBODY'S NEED for personalized sleep strategies and the disease burden!
Disease burden:
Sleep problems are a major DIRECT, but crucially MODIFIABLE risk factor for the leading causes of mortality in the world (USA ANNUAL numbers given):
Top 9 leading causes of death in USA:
- Cost of COPD/ lung disease: COPD is costly with almost $50 billion in direct costs annually.
- Cost of diabetes: 26% increase from $245 billion in 2012 to $327 billion in 2017 (includes $237 billion in direct medical costs and $90 billion in reduced productivity).
- Cost of obesity: Estimated to be $147 billion. If obesity rates continue on their current track, medical costs associated with obesity are estimated to increase by $48 - $66 billion per year in the U.S.
- Cost of heart disease: The American Heart Association estimated that medical costs and productivity losses of cardiovascular disease (CVD) are expected to grow from $555 billion in 2015 to $1.1 trillion in 2030.
- Cost of drowsy driving: The National Highway Traffic Safety Administration (NHTSA) estimates conservatively that each year drowsy drivers are responsible for at least 100,000 automobile crashes, 71,000 injuries. It is estimated that 80,000 drivers fall asleep at the wheel every day, 10% of them run off the road, and every two minutes, one of them crashes, thus around 8000 fatal crashes are caused by drowsy driving every year in the US. The Governors Highway Safety Association released a report that estimated the societal costs of drowsy driving crashes total $109 billion annually.
- Cost of cancer: Increased from $157 billion in 2010 to $208.9 billion in 2020.
- Cost of dementia: In 2021, the estimated cost was $355 billion, including $239 billion in Medicare and Medicaid payments combined. In 2050, Alzheimer's is projected to cost more than $1.1 trillion (in 2021 dollars).
- Cost of cerebrovascular disease: In 2012, it was $105 billion (total direct annual stroke-related medical costs and real indirect annual costs attributable to lost productivity). Overall, total annual costs of stroke are projected to increase to $240.67 billion by 2030, an increase of 129%.
- Cost of respiratory disease: Annual expenditures for US workers totaled $7 billion for asthma care and $5 billion for chronic obstructive pulmonary disease (COPD) care between 2011 and 2015, according to the CDC. A pair of Harvard economists (David Cutler and Lawrence Summers) estimated that the coronavirus pandemic would cost the US at least $16 trillion by the fall of 2021 (assuming it ended by then, and not taking into account variants, more testing, boosters and novel therapeutics). Sleep deficits have been associated with 3x increased risk of symptoms of RNA viruses, 70% reduction in functioning of natural killer cells (first like defense against viruses), and sleep apnea has been associated with an increased risk of getting infected with COVID-19, as well as doubling the risk of hospitalization once infected.
Impact of poor sleep on overall health:
1. Hormone Imbalance:
· Men who sleep five hours a night on average, have significantly smaller testicles than those who sleep seven hours or more. One study showed that when healthy young men get five hours of sleep every night for a week, their testosterone levels drop by 10-15%.
· We see equivalent drops in female reproductive health caused by a lack of sleep, linking it with early menopause.
· Less deep sleep results in less growth hormone, which is crucial for growth in children; and in adults; increased production and reduced breakdown of proteins, muscle growth, repair of damage, recovery after a game or after an injury, and bone building.
· Sleep deprivation can lead to more cortisol production, which can worsen stress, accelerate muscle breakdown, and further contribute to insomnia/ excessive wakefulness, setting up a bad feedback loop.
· The global hormone replacement therapy market size was USD 13.40 billion in 2020. The market is projected to grow from USD 14.17 billion in 2021 to USD 21.49 billion in 2028 at a CAGR of 6.1% in the 2021-2028 period.
2. Increased Inflammation: Sleep loss is known to activate mediators and markers of inflammation and cell damage.
3. Premature aging: Independent studies have found an association between sleep deprivation and shortened telomeres (the endcaps of DNA) in children, as well as healthy adult males (with sleep apnea, which reduces sleep quality), as well as those with short sleep duration.
4. Gene Activity: In healthy adults limited to six hours of sleep a night for one week, 711 genes were distorted in their activity. The genes that were switched off by a lack of sleep were genes associated with the immune system (which indicated an increased risk of infection). In contrast, those genes whose activity levels were increased by way of a lack of sleep were genes associated with the promotion of tumors, long-term inflammation, stress, and—as a result—cardiovascular disease, atherosclerosis, stroke, dementia and other conditions directly associated with inflammation.
5. Infections and Immunity: Even a small loss of sleep has been shown to impair immune function. In one study, those who slept less than seven hours were almost three times more likely to develop a cold than those who slept eight hours or more.
6. Cancer: In a study where participants were restricted to four hours of sleep for a single night, there was a 70% drop in natural killer cell activity. These cells play a critical role in immunity, especially in fighting tumor cells and virally infected cells.
7. Poor Sleep Can Make You Fat: Short sleep duration is one of the strongest risk factors for obesity. In one massive review study, children and adults with short sleep duration were 89% and 55% more likely to become obese, respectively.
8. Heart Disease:
· Poor sleepers have a greater risk of heart disease and stroke. A review of 15 studies found that short sleepers are at far greater risk of heart disease or stroke than those who sleep seven to eight hours per night.
· Daylight Saving Time: In the spring, when we lose one hour of sleep, we see a subsequent 24% increase in heart attacks that following day. In the fall, when we gain an hour of sleep, we see a 21% reduction in heart attacks.
9. Diabetes Risk: In the general population, those sleeping less than six hours per night have repeatedly been shown to be at increased risk for type 2 diabetes. In a study of healthy young men, restricting sleep to four hours per night for six nights in a row caused symptoms of pre-diabetes.
10. Dementia: Chronic sleep deprivation contributes to cognitive decline and
even dementia. If you are in a contact sport, the additional risk of repeated
blows to the head compounds the risk of dementia.
11. Academic/ professional performance: 40-percent deficit in the ability of
the brain to make new memories without sleep. On average, each additional
day per week a student reports experiencing sleep problems, raises the
probability of dropping a course by 10%.
12. Life span: Evidence from epidemiological studies across millions of
individuals conclude that the shorter your sleep, the shorter your life.
Short sleep predicts early mortality (all causes).
In other words, POOR SLEEP LITERALLY KILLS YOU.
Academic and work performance
We believe that improving the quality of your workers sleep will not only improve their overall health, but the quality of their work, relationships and team dynamics. Our mission is to make sleep awareness and healthy sleep training as ubiquitous as sexual harassment training and wellness benefits.
The impact of sleep problems on academic performance:
• Among respondents in a 2009 ACHA-NCHA survey, sleep disturbances independently predicted poor academic performance, on par with high-risk drinking in its association with GPA and course completion.
• On average, each additional day per week a student reported experiencing sleep problems, raised the probability of dropping a course by 10%.
• Cost of HS/ college dropouts in the US: An estimated $3.8 billion is lost each year as a result of college dropouts.
The impact of sleep problems on workplace productivity and performance:
• World Sleep Day Society relayed that 46% of the world’s sleep-deprived individuals frequently miss work or commit more mistakes in the office compared to the 15% who get sufficient sleep.
• The Better Sleep Council estimates that sleep deprivation costs US businesses over $150 billion per year in lost work performance alone.
• Cost of workplace compensation: The total cost of work injuries in the US in 2019 was $171.0 billion. This figure included wage and productivity losses of $53.9 billion, medical expenses of $35.5 billion, and administrative expenses of $59.7 billion.
• A study released in 2018 by Dutch researchers looking at data from 1435 people with insomnia indicated that they were 56% more likely to have impaired work performance.
• In the UK, Hult International Business School’s Professor Vicki Culpin led a study that linked sleep deprivation to poor performance which showed that all the major aspects of cognitive functioning were highly impacted by sleep loss (executive control functions of decision-making, creativity, processing, adaptability, learning and control of emotions, among others).
• Reducing your nighttime sleep by as little as 1.5 hours for just one night can result in a reduction of daytime alertness by as much as 32 percent.
The impact of sleep problems on workplace safety:
Some of the biggest disasters in the world have been linked to sleep deprivation, such as the Challenger shuttle disaster, the Exxon Valdez oil spill, the Three Mile Island disaster, Chernobyl.
It is estimated that every year, 6400 fatal accidents in the USA are because of sleep deprivation.
Reducing your nighttime sleep by as little as 1.5 hours for just one night could result in a reduction of daytime alertness by as much as 32 percent. Excessive sleepiness also contributes to a greater than twofold higher risk of sustaining an occupational injury.
Some of the biggest names in business understand that happy, well-rested workers are going to get more done and do their jobs better.
These companies have addressed the sleep needs of their employees with sleep pods, nap rooms and quiet rooms. They include Google, Cisco, Procter and Gamble, Huffington Post, Nike, Ben & Jerry’s, New York Times, Zappos, Hearst, Newsweek, Time Warner, Yarde Metals, Rodale, Pizza Hut and more.
The healthcare industry is one of the worst affected:
MEDICAL ERRORS are the third-leading cause of death in US!
A recent Johns Hopkins study claims more than 250,000 people in the U.S. die every year from medical errors. Other reports claim the numbers to be as high as 440,000.
Sleep deprivation leads to impaired physicians. Just as you would never sign up to be treated by a drunk surgeon, you should have the right to be treated by a well-rested doctor.
Cost of medical errors:
• House staff make 33% more serious errors and 5 times as many diagnostic errors when working shifts longer than 16 hours.
• Harvard professor Dr. Charles A. Czeisler conducted a study on sleep deficit in hospital interns who had been scheduled to work for at least 24 consecutive hours. They found that:
• Their odds of stabbing themselves with a needle or scalpel increased 61%,
• Their risk of crashing a motor vehicle increased 168%,
• Their risk of a near miss increased 460%.
• When on-call residents work overnight (compared to those who work a 16-hour shift!) they have:
• Twice as many attention failures,
• Commit 36 percent more serious medical errors,
• Report 300 percent more medical errors that lead to death.
• The Institute of Medicine has estimated that medical errors cost $17 billion to $29 billion per year in the US alone.
