Will Fitbit Replace the Sleep Test for $120?

Fitbit.  Several patients have shown me Fitbit graphs on their cell phones, of their sleep. It graphed  heart rate, respiration, motion, and rated sleep as light, medium, or deep. That is basically a sleep test for $120, instead of for $1200. It is sleep in the natural setting of the patient, rather than in a laboratory with wires plugged to the wall, and on  a strange bed.

To get refreshing sleep, one must be paralyzed for several hours during the night. If there is no extended period of zero physical activity, one may sleep 20 hours and still feel tired in the daytime. Fitbit would quantify the periods of sleep paralysis.

It can also be used to track physical and sports activity levels during the daytime. Once cleaned, it may be used by several patients.

Is Ford Admitting Its Cars Put Drivers to Sleep?

Is this an admission of a product defect?

Here.

The Police and Sleep

Email sent to the Professional Standards Division of a Town Police Department

I would appreciate a brief meeting, mostly to listen to your side of the story, and to your concerns and objections to a change in Department policy on sleep. I do not want to be advocating any change with a naive and incomplete information about the situation.

If you wish, I can provide information about sleep for your review.

1) Famous disasters involving sleep, including the destruction of the space shuttle, the Challenger;

2) sleepy people are as impaired as legally intoxicated people on standardized tests of performance, such as on driving simulators (would you allow a visibly intoxicated officer to get into a department car or to answer a call?);

3) the department itself causes sleep problems by requiring night shift officers to testify in the daytime;

4) the department punishes sleepy officers, inducing a cover up of the problem rather than a solution to it;

5) it is unknown if sleep is a factor in adverse police incidents; for example, it is unknown if the officers were sleepy when they blasted a law abiding black immigrant, taking a wallet out of his pocket; and NYC had to pay $millions in compensation; but the incident was in the middle of the night.

I did receive a copy of your rule on fitness for duty. I lost my copy, and would appreciate another copy. As I recall, it requires that officers arrive fit for duty.

I would like to change to a more realistic, real world wording.

Officers may self report sleepiness, with impunity. If a supervisor discovers sleepiness, sanctions could take place. The officer should clock out, go to a car or elsewhere and try to go to sleep fully for a minimum of a half an hour. If refreshed, clock back in, return to work.

If duty requires that officers respond despite being sleepy, they may have a dose of prescribed Modafinil, 200 mg, a medication FDA approved for shift worker sleep disorder.

In future investigations by your division, you will include a question about the alertness of the officers at the time of the incident. You will then add up the fraction of incidents involving impairment from sleepiness.

I do not have an easy answer to thinness of coverage, and now we are having sleeping officers, out of circulation. That is why I would like to hear your side of the story.

On the 80 Working Hours a Week of Residents

Banned on left wing blog and propaganda outlet, KevinMD. A resident discussed limits of resident time. So here is a reply to this post.

http://www.kevinmd.com/blog/2016/04/how-duty-hour-restrictions-are-hurting-residency-training.html

The answer, as usual, is freedom and technology.

They say it takes 10,000 hours to become proficient at a skill. One may reach that time in 2.5 years or 5 years. If one's income as a surgeon is $400,000 a year, the difference is worth $million.

The best would be to allow a choice.

Being sleepy is as great an impairment as being drunk on the job.

Although I oppose regulation, I support a regulation making all employers provide places and times to take naps up to half an hour. The time should be returned to the employer by staying after others have gone home, or by coming in earlier.

I also support the provision of modafinil over the counter, so it may replace caffeine. It is 100 more effective at promoting productive wakefulness, and has 1/100 the side effect of caffeine. I intend to submit a Citizen Petition to the FDA to allow it over the counter.

I have filed a regulatory complaint because generic modafinil costs $30 a pill in the U.S., even though made by 4 companies. It costs 80 cents in India, and is over the counter. No doubt the pharmacy and the maker are still making a profit at that price.