These last couple of months I shared several studies concerning heart failure in patients with fibromyalgia.  I also shared a recent blog post on the importance of having a sleep study done.  After further research, it seems that it is believed that 50% of fibromyalgia patients also suffer from Sleep APNEA.  So, you are already, I'm sure, making the connection that sleeping disorders can also attribute to high blood pressure, heart disease, and heart palpitations.  

It is inconclusive if the sleeping disorder causes the fibromyalgia, or if the fibromyalgia causes disruptions in the breathing canal due to relaxing the the nerves within the muscles too much so that it blocks the airway.

I have been a candidate to use a CPAC due to moderate Sleep APNEA.  If I can get used to using this machine is another blog all together.  But, I can tell you the newer machines are quiet, have comforting flexible tubing, and are completely automatic when aligning your breathing needs to computerized software that gradually increases your air pressure needs without any prompting.    They are, by far, the most up-to-date available and can meet the needs of the most sensitive individual.  Best of all, with most insurances they are free.  On top of all that, most supplies are free, too, and can be interchanged every three months to ensure cleanliness.  

That said, if you haven't spoken to your doctor about a sleep study yet, I leave you with the following article from Fibromyalgia Today:

​Researchers at Istituto Figlie di S. Camillo in Italy recently reported that fibromyalgia is common among patients with obstructive sleep apnea (OSA). The study was published in the European Journal of Internal Medicine and is entitled “Fibromyalgia is frequent in obstructive sleep apnea and responds to CPAP therapy”.

Fibromyalgia is a medical disorder characterized by a set of symptoms including widespread chronic musculoskeletal pain, incapacitating fatigue, stiffness and numbness in certain parts of the body, painful response to pressure, headaches, unrefreshing sleep (poor sleep quality), anxiety or depression and mood alterations. Fibromyalgia can affect people’s ability to conduct simple daily tasks, compromising their quality of life. It is estimated that 5 to 15 million Americans are affected by this disorder, especially women where a prevalence of 3.4% has been reported in comparison to 0.5% in men.

The poor sleep quality experienced by fibromyalgia patients has been suggested to be a key factor of disease pathogenesis. The prevalence of OSA (an obstruction of the upper airway characterized by repetitive episodes where the individual stops breathing during sleep) among fibromyalgia patients is not clear. In addition, data is also lacking on the impact of continuous positive airway pressure (CPAP) use, a device that helps individuals with OSA to breathe more easily during sleep.

Now researchers determined the incidence of fibromyalgia in OSA patients and the role played by CPAP as a therapeutic option. In total, 900 OSA patients were assessed in the study through a sleep test with a 25-channel portable polysomnography recording device, an Epworth sleepiness questionnaire, a full medical examination and a detailed analysis of their medical history.

Researchers reported that 15% of all OSA patients (135 individuals, mean age of 40 years) met the American College of Rheumatology (ARA 2010 version) criteria for a fibromyalgia diagnosis, and that of these, 74% were men (100 individuals). This is a curious fact as fibromyalgia is more common among women in the general population. All these patients were then submitted to a 6-min walking test, completed the SF-36 standard questionnaire (health survey form) and assessed in terms of symptoms severity scale and CPAP titration scores. Of these patients, 30 were excluded because they failed the scheduled follow-up, and five refused treatment. The remaining 100 patients were treated with CPAP, with follow-up visits at 3 and 6 months. As controls, 50 patients with fibromyalgia were treated with conventional therapy (tricyclics, serotonin reuptake inhibitors and gabapentanoids).

The team found that treatment with CPAP resulted in an overall superior improvement in the functional symptoms of the disease compared to conventional therapy. Patients under CPAP treatment had a significantly decrease in the apnea hypopnea index (AHI), an improved 6-min walking test result, and a reduction in symptoms severity scale.
​
The research team concluded that fibromyalgia is frequent among OSA patients, and propose CPAP treatment as an effective therapy for these patients.

Three friends on a wilderness excursion find a fortune stashed in the woods. Now they must outrun the white collar criminal who is hell bent on retrieving his money.

​When Abbie is diagnosed with cancer, she embarks on a humorous mission to find a new love for Sam, her fiancé and best friend since childhood.

A Marine sergeant returns home after completing her third tour in Afghanistan. Unable to sleep, wracked by paranoia and anxiety, she carries unseen wounds. It is only a matter of time before she can no longer bottle up her trauma, and a boisterous welcome home party provokes her into an explosive outburst. Her husband is at a loss, and the VA seems to be an impossible option. When she has nowhere to turn, she runs deep into the woods.

Angela develops a friendship with a mysterious woman named Katie and offers her a job as a live-in nanny. The natural bond soon turns into a dangerous obsession as Katie becomes overly attached to the family's young daughter. Enduring lies and manipulations, Angela and her husband realize that sweet Katie is actually trying to destroy their family from within.

Teens in a low-income neighbourhood are lured into working for a violent and dangerous drug dealer. When a new girl harbouring a dark secret arrives in town, their relationship jeopardises everything.

Cory Lambert is a wildlife officer who finds the body of an 18-year-old woman on an American Indian reservation in snowy Wyoming. When the autopsy reveals that she was raped, FBI agent Jane Banner arrives to investigate. Teaming up with Lambert as a guide, the duo soon find that their lives are in danger while trying to solve the mystery of the teen's death.

​When married couple Simon (Jason Bateman) and Robyn (Rebecca Hall) unexpectedly encounter Gordo (Joel Edgerton), an acquaintance from Simon's past, little do they know that their perfect lives will be thrown into a terrifying tailspin. At first, Simon doesn't recognize Gordo, but after a troubling series of uninvited encounters and mysterious gifts, a horrifying secret emerges. As Robyn learns what really happened between Simon and Gordo, she begins to question how well she knows her spouse.

An idea from a young, new co-worker (Anna Kendrick) would put an end to the constant travel of corporate downsizer Ryan Bingham (George Clooney), so he takes her on a tour to demonstrate the importance of face-to-face meetings with those they must fire. While mentoring his colleague, he arranges hookups with another frequent-flier (Vera Farmiga), and his developing feelings for the woman prompt him to see others in a new light.

Frank (Leonardo DiCaprio) and April Wheeler (Kate Winslet) always see themselves as far-removed from the conventionality of suburbia. Yet that is exactly what creeps up on them when they buy a house in Connecticut. He toils 10 hours a day in a job he hates, while she, as a 1950s homemaker, yearns for fulfillment and passion. Rebelling against the torpor of their lives, the couple plan an escape that may push them to their limits.

​Christopher McCandless (Emile Hirsch), son of wealthy parents (Marcia Gay Harden, William Hurt), graduates from Emory University as a top student and athlete. However, instead of embarking on a prestigious and profitable career, he chooses to give his savings to charity, rid himself of his possessions, and set out on a journey to the Alaskan wilderness.

On the day his latest deal collapses, fast-talking-salesman Sam (Chris Pine) receives the news that his father has died. Reluctantly, Sam returns home to settle the estate of his father. In the course of carrying out the man's last wishes, Sam is surprised to learn of the existence of a 30-year-old sister, named Frankie (Elizabeth Banks). As the sister and brother get to know each other, Sam must re-examine both his perceptions about his family and the life choices that he has made.

Set against the backdrop of the 17th-century Tulip Wars, a married noblewoman (Alicia Vikander) has an affair with an artist (Dane DeHaan) and switches identities with her maid to escape the wealthy merchant she married. She and her lover try to raise money together by investing what little they have in the high-stakes tulip market.

A dutiful wife and mother re-examines her veneration of her husband after she finds another woman's underwear in his laundry.

Denounced by his wife as a possible spy in 1939, Janusz (Jim Sturgess) finds himself in a remote Siberian labor camp. Faced with brutal conditions inside and out, Janusz is determined to escape. A blizzard provides him with the perfect opportunity, and he and a small group of fellow prisoners make a break for it. Escape, however, is the easy part, for Janusz and his companions face a 4,000 mile trek on foot through the frozen Himalayas before they can truly be free.

​Legendary gunslinger "Wild Bill" Hickok looks to leave the past behind him by settling in the small town of Abilene, Kan., and becoming the marshal. His unparalleled skills are soon put to the test when he finds himself in a showdown with a gang of outlaws and the powerful saloon owner who put a bounty on his head.

I am still loving the new transition into Paleo.  I am still losing weight, but it has slowed down a bit after returning to work.  It seems I'm a bit more hungrier now and working through that transition.  I can say though that the nutrient dense food is much healthier on my side.  I have more energy and my overall health is still improving.  I don't feel so "congested" any longer.  And, I'm not just talking about my nose.  I felt congested all over my body last year and things were not improving.  I was swelling and bloating, and it seemed my sinus were always stopped up or crusted. 

Since I started work, I found i was having difficulty sleeping again.  So I've added 1/2 cup oat granola to my bedroom routine and that has seemed to help.  I know that is a no-no on the Paleo list, but we have to survive.  And sleep is a natural survival method.   I know at one point over the summer, I ousted that for a month and slept amazingly fine.  So, it may take some time for my body to adjust.  I've also kept calcium in the form of kefier and certain cheeses that don't bother me.  I feel any tweaks we make to any diet is OK with our community as long as we see improvement. It takes our bodies longer to become comfortable for new routines.  Right now, I'm taking things slow.  And as long as weight loss continues and mental clarity increases I'm all on board.  

I'd like to share an article with you for all those who are trying this new method of eating.  It relates to common pitfalls you may experience, too.  It's from Be Well:

​When adopting a paleo diet, patients can begin to see and feel positive results within weeks, often including increased energy, weight loss, and improved digestion. While following this grain-free, Paleo diet, the body can normalize hunger hormones, repair the gut and begin to shed extra weight, however there are a few common setbacks that can cause people to fall off track.  Here are 5 common “Paleo Pitfalls”, and how you can avoid them…

1. “CARB FLU”
“Carbohydrate flu” is a term that is commonly used to describe feelings of body aches, upset stomach, low energy and headaches that are felt during the early stages of adopting a paleo diet. These symptoms are most often attributed to a greatly lower carbohydrate intake than the body is used to. These symptoms are most common if transitioning from a Standard American Diet, high in refined and processed foods, to a whole food based Paleo diet. It is possible to transition to a Paleo diet and maintain a healthy carbohydrate intake with fruits and vegetables such as sweet potatoes, winter squashes and other root vegetables to avoid these symptoms. If you are trying to initiate ketosis or focusing on a very low carbohydrate state for weight loss and fat burning, the symptoms may be inevitable in the early stages. Although uncomfortable, these symptoms typically resolve within a week or two as the body adapts to the lower carbohydrate state.

2. CONSTIPATION
Constipation is a top complaint of people who adopt a paleo diet.  The initial increase in protein on the paleo diet can cause a loss of water and electrolytes which contributes to constipation.  Maintaining adequate water intake each day can help combat this problem.  Another helpful key is to make sure you are seasoning your food using unrefined salt, such as Himalayan sea salt.  Salt intake is greatly reduced when you stop eating refined foods so adding a pinch of salt to your meal can help restore the balance that is often offset by the paleo diet. If you are having a particularly difficult time, the Ayurvedic supplement triphala can help get things moving. (I found this lasted only a few weeks)

3. SKIMPING ON FAT
If transitioning from a standard American diet where fat, particularly saturated fat, has been demonized, it can be shocking to start consuming fats regularly.  People who transition to paleo but keep a “low fat” mentality are missing out on the health and weight-loss benefits that good quality fats provide. Incorporating healthy fats like grass-fed butter, olive oil, coconut oil and avocado will help you feel full and satiated at meals, preventing cravings between meals.  Saturated fat is also necessary for healthy hormone production and brain health.

4. EATING TOO MANY NUTS
Nuts and nut butters are an easy on-the-go food when eating a paleo diet, making them easy to overdo. However, over-consuming nuts commonly causes stomach upset and bloating.  While they are a handy snack in a pinch and are a great addition to smoothies, nuts are high in phytates (phytic acid), which binds to minerals passing through the GI tract and prevents those minerals from being properly absorbed. Additionally, because nuts are higher in Omega-6 fatty acids (which tend to be pro-inflammatory) compared to Omega-3 fatty acids (which help reduce inflammation in the body), overindulging on them can actually create unwanted inflammation.  Ideally, keep your nut and nut butter consumption to one to two servings per day.

5. MISSING OUT ON PREBIOTICS
Legumes are credited for giving the gut plenty of soluble prebiotic fiber which is the fiber that serves as the food source for healthy bacteria in the gut.  When you remove legumes from the diet, making a conscious effort to increase soluble fiber with prebiotic vegetables is a must to keep your gut microbiome in top shape. Making sure to include foods like onion, garlic, leafy greens such as dandelion and chicory, leeks, asparagus, radish and cruciferous veggies like broccoli and cauliflower can help serve your gut bacteria and promote a healthy microbiome.

The use of oral fluoroquinolones (FQs) poses the same level of fibromyalgia risk as other antibiotics such as amoxicillin and azithromycin, a study suggests.

The study, “Oral Fluoroquinolones and Risk of Fibromyalgia,” was published in the British Journal of Clinical Pharmacology.

Oral FQs, which are the most prescribed antibiotic, received a black box warning in 2016 from the U.S. Food and Drug Administration. The warning was based on severe side effects reported after the use of FQs that resembled fibromyalgia — widespread amplified pain in the muscles and joints. But the prevalence of this risk has not been quantified in detail.

Of significance, respiratory infections, for which FQs might be prescribed, may also lead to fibromyalgia, which could confuse the association between fibromyalgia and FQs.

In this study, researchers in Canada aimed to correlate the use of FQs to cases of fibromyalgia that were part of health claims filed between 2006 and 2016.

Using a large health claims database in the U.S., PharMetrics Plus, the team identified cases reported as fibromyalgia by a rheumatologist. All FQ prescriptions were identified, and only those individuals whose FQ prescription preceded their fibromyalgia diagnosis entry by three months to a year were included. Patients who were prescribed amoxicillin and azithromycin were also included.

Amoxicillin and azithromycin, which are chemically different from FQs, served as a control for any effects seen because of a bacterial or viral infection mimicking fibromyalgia.

The team identified 5,148 such cases and included 51,480 cases without a fibromyalgia diagnosis as controls. Of the 5,148 fibromyalgia cases with past FQ, amoxicillin, or azithromycin use, 87% were women.

Of these three antibiotics, the researchers found that the chances of a fibromyalgia diagnosis being associated with FQs was 1.63 times higher, amoxicillin 1.64 times higher, and azithromycin 1.68 times higher than in the control group. No significant difference was noted between the three antibiotic groups.

These results indicate that the risk of fibromyalgia with FQs is similar to that of amoxicillin and azithromycin, according to the authors.
​
“Despite the case reports of fibromyalgia and FQ use in both the literature and various drug regulatory agencies, risk seems to be similar with amoxicillin and azithromycin,” they wrote. “Risk might therefore be due to possible infection that triggered fibromyalgia symptoms.” - Shared from Fibromyalgia News Today

I live with Multiple Chemical Sensitivities (MCS) and severe food sensitivities.  This diagnose came shortly after my initial diagnosis of Fibromyalgia.  This is one pain in the butt to say the least.  Most of the sensitivities center around food and chemicals.  All of a sudden most foods became unpalatable.  I found myself living on a diet of meat, beans, and certain veggies for a long period of time.   Furthermore, I was unable to handle most chemicals touching my skin.

​Multiple chemical sensitivity can include a wide range of symptoms, which some people link to their environment. It's also known as “environmental illness,” "sick building syndrome,” or “MCS.” Your doctor may call it “idiopathic environmental intolerance.”

The symptoms people report are wide-ranging. They include headache, fatigue, dizziness, nausea, congestion, itching, sneezing, sore throat, chest pain, changes in heart rhythm, breathing problems, muscle pain or stiffness, skin rash, diarrhea, bloating, gas, confusion, trouble concentrating, memory problems, and mood changes.

Possible triggers that set off people's symptoms vary a lot, too. They include tobacco smoke, auto exhaust, perfume, insecticide, new carpet, chlorine, and such. 

The American Medical Association doesn’t consider multiple chemical sensitivity to be an illness. Nor do they consider food sensitivities a real illness either, but it can wreck havoc on your daily life.  

One issue with having this illness is that you can't go out to eat and enjoy a normal dinner like most people.  You never know you will be affected by what you ingest.  You could be sitting there eating a meal with family and friends, and then wham! All of sudden you are overcome with dizziness, shortness in breath, and a huge amount of disorientation until your body redirects.  That could last a minimum of 20 minutes or days.  

Now I have my menu choices in my head for EACH restaurant BEFORE I sit down to avoid such catastrophes.

But I think the worst of it is the hair salon.  I used to LOVE getting pampered while getting my hair done.  It is a small kuddo in life that most woman appreciate.  You spend your days taking care of others, and then all of a sudden, every six weeks or so, you get someone to take care of you.  

If you are over 40 it is often a necessity if you work.  Being 50 with tons of gray hanging about is not appealing to some individuals like myself.  I pride myself on keeping a few years off by indulging in such a luxury.  

But shortly after being diagnosed, I got my usual highlights.  I get the foil packets and then a bit of low lights to cover the gray around my scalp.  This has NEVER been an issue previously. All of a sudden ten minutes into the procedure, I feel a tingling in my scalp and my heart begins to race.  Within minutes my heart is knocking so rapidly it feels as if it is rattling my chest.  I can see and feel its vibrations as I run to my hairdresser shouting, "I got to get this out! Something is not right!"

Visibly shaken, she says we can just try the "foils" solo next time.  "Great," i think.  "One more thing this illness has taken from me."  

I know what you're thinking, "My goodness!  Live with the gray!"

But when fibromyalgia has taken so much out of your life already, there are just times you say, "Screw it.  I gotta live some how."  But, then again, i also noted if it happened again severely I would HAVE to STOP.

Since then the reactions are less, more mild.  Sometimes they don't happen at all.  But, you can imagine, sitting in that chair doesn't have that warm fuzzy feeling anymore, it is a necessity (to me, of course). It is one thing I draw the line at for myself.

I had thought it was gone all this year.  Then recently on my birthday, trying to get myself dolled up for a dinner, I experienced it again.  Not as severe, but a bit of tingle, and then a pulse rise.  I grabbed my hair tech and she washed it immediately.  Symptoms disappeared shortly afterwards, but I was left with two days of chest tightness, spine swelling, and pain.  I should state for all you pre-med Google searchers, it was not the chest pain of the heart but of the rib cage.

To people who do not experience fibromyalgia, this may seem obscure.  But, when you suffer from this debilitating disease, there are just some things you are robbed of that send you over the edge.  Get you thinking and get you a bit disgruntled.  I felt the need to share today.  It ruined my birthday weekend a bit.

What is the one thing fibromyalgia has taken from you that drives you nuts?  

​Sometimes, Robb likes to remind me that I can come off as, well… not the most warm and nurturing person in the world. I admit that my passion (and sensitivity) can sometimes come off as unsympathetic, but it’s only because I actually really give a shit about things. Maybe being a nutritionist was the wrong career choice for me. I love helping people, but can get frustrated when I hear excuses for why they “can’t” follow my advice. I REALLY care about how people treat themselves, and it’s super hard for me to see them sabotage themselves. I sometimes feel like people are paying me to give them a life preserver and instead they’re choosing to swim in the opposite direction, towards the sharks.

Last week, I was working with a young woman and her husband who are trying to lose weight and start a family. They eat out a lot and often make poor choices regarding food. As I was trying to illustrate how important it is to cook food from scratch instead of getting takeout, I got some push back. She told me she doesn’t have the time to cook. I asked her how she spends her weekends, and it was pretty typical of your average millennial. She totally had the time, but it was her priorities that were out of whack. I see this a lot. I also hear that it can cost too much to eat real food. Even though many of you have probably heard all of this before, I figured this warranted just a small and gentle reminder that yes, in fact, you probably do have the time and the money to eat well.

What are your priorities?

This is a very basic question but something that really requires some hard thinking if you’re using excuses to shortcut your health. I get that some people are just struggling to make it day to day, and in the basic hierarchy of needs, long-term health can sometimes take a backseat.

Let’s look at Maslow’s hierarchy of needs:

Nope, a strong Wifi connection is not at the bottom. I’m sort of joking. But not really. I think a lot of people have their needs and wants way mixed up. If you’ve got a safe place to sleep and clean water (which, I acknowledge, some people legitimately do not have), then food is one of the next items on the hierarchy. How you choose to fuel yourself is often an afterthought. But if you consider that the only thing we actually “have” is time here on earth, you can make a choice to help yourself feel great while you’re here, or you can feel like crap. Some things are of course out of our control, but good food should be placed BEFORE you upgrade to the iPhone 7, next monthly subscription of clothing you don’t need, or whatever it is you do to keep up with the Joneses. The time spent in the kitchen is much more important than spending time watching reality TV or on social media. Time and money spent on clean food is an investment in the quality of life you’ll have while you’re walking the planet.

I know it can seem like life is hard, and things are expensive, but actually, we’ve got it pretty good. The Western Hemisphere is currently war-free. Let’s look at all of the other things that are going our way…

1. Look at how many people didn’t have electricity until 1950

2. Today, hardly anyone only has a landline

​3. You’re much less likely to die from a violent crime

4. More people have high school diplomas than ever before

5. Look at how cheap it is to fly

​Now let’s look specifically at how we’re spending our food dollars and using our time that could be spent in the kitchen…

6. As a %, less of our disposable income is spent on food

7. We’re spending more money going out to eat, and less at the grocery store – and when we go out to eat, people generally do not choose “clean food”

8. Look at what we’re buying when we are at the grocery store – in the 20 year span, spending on processed foods & sweets has doubled.

9. Check out how we’re spending our leisure time – nearly three hours a day on TV!

10. And, how much time are you spending on social media?

Finally, if you compare many processed foods to nutrient dense foods, you’ll see that the healthier foods are actually cheaper. For example:

The average price of a snickers bar (2015) in the US is $1.24 for a standard bar. That’s $0.66 per ounce.  I don’t see my clients complaining about the price of candy. ​

​Now, let’s take something that people do complain about to me: grass fed beef. Consumer Reports purchased 300 packages of ground beef in 103 stores in 26 cities across the United States in 2015. They paid an average of $4.95 per pound for conventional beef (which, I would argue is better than a snickers bar) and an average $7.83 per pound for grass-fed organic beef. That’s $0.39 and $0.49 per ounce, respectively. So, even grass-fed organic beef is $0.17 cheaper by weight than a snickers bar.

​And we’re not even including the fact that beef is so much more nutritious than candy bars. It’s full of bioavailable iron and other vitamins and minerals. Contrary to many reports, beef does not take a billion gallons of water to produce a pound of meat, and pasture-based herbivores can help sequester carbon. Processed food takes incredible amounts of resources to make compared to an animal raised in a natural way. In fact, I bet that if someone were to compare a life-cycle analysis of what it takes to produce a snickers bar (so, all the inputs required from the fossil fuels, crops, water, electricity, etc.) and compared it to what it takes to produce the same weight in grass-fed beef, the beef would win hands down.

 If you can afford a smart phone, a wifi connection, a winter vacation, or a snickers bar, then you can afford healthy food. If you generally spend your leisure time in a similar way to most Americans, then I challenge you to spend less on food “away from home,” more on the raw ingredients. A little more time in the kitchen is an investment in yourself.  - Diana Rodger ND

​Our prehistoric ancestors survived and flourished on high-protein diets filled with fresh meats, fruits, and vegetables. While you no longer have to hunt down a saber-toothed tiger for supper, following the Paleolithic diet can transform your body and help prevent obesity, diabetes, and cancer. You'll learn to prepare 150 nutritious recipes, including:

• Bacon and Vegetable Omelet
• Chicken with Sauteed Tomatoes and Pine Nuts
• Thai Coconut Scallops
• Roasted Pork Tenderloin
• Nutty Chocolate Trail Mix
• Mango Creamsicle Sorbet

​Daniel is an idealistic and dedicated priest who loves his work more than anything else, until a chance meeting with a woman at confession stirs up emotions that make him question his true calling.

​Financial strain, an unplanned pregnancy and an abusive ex threaten the stability of a poor couple's (Naomi Watts, Matt Dillon) relationship.

​A fast-talking lawyer transforms his body and takes a vow of silence, which is not to be broken until he learns who killed his wife and daughter and has his revenge.

​On the outskirts of a mountain town grappling with a series of abductions and murders, Paul, a reclusive writer, struggles to start what he hopes will be a career-saving screenplay. After a tense encounter with a drifter named Jack, Paul offers Jack a place to stay. Soon, the edgy, demanding Jack muscles his way into Paul's work. As a storm cuts off power to the isolated cabin, the two men begin a jagged game that will bring at least one tale to an end.

​A fisherman has an affair with a fashion writer, who later has his child. When she turns up dead, he becomes the prime suspect.

​When veteran hit man Jimmy Bobo (Sylvester Stallone) and his partner, Louis (Jon Seda), kill a corrupt ex-cop, Louis in turn loses his life to an ex-mercenary named Keegan (Jason Momoa). Detective Taylor Kwon (Sung Kang) senses a connection between the two killings and seeks out Bobo, who subsequently saves Kwon from an assassination attempt. The pair join forces against a common enemy: a ruthless real-estate developer named Robert Nkomo Morel (Adewale Akinnuoye-Agbaje)

​As two couples dine at an upscale restaurant, their polite discourse disguises the fact that they are struggling with weighty family issues.

​As the only legitimate heir of England's King William, teenage Victoria (Emily Blunt) gets caught up in the political machinations of her own family. Victoria's mother (Miranda Richardson) wants her to sign a regency order, while her Belgian uncle schemes to arrange a marriage between the future monarch and Prince Albert (Rupert Friend), the man who will become the love of her life.

​A marketing executive (Lacey Chabert) gets in touch with her spiritual side, while trying to find Mr. Right.

​Kate Mercer and her husband are excitedly planning a party to celebrate their 45th wedding anniversary. However, one week before the celebration, a letter arrives for her husband. The body of his first love has been discovered, frozen in the icy glaciers of the Swiss Alps. As the party nears, there might not be a marriage left to celebrate.

My cardiologist also ordered a sleep study test due to the recent heart complications.  As I took my referral home, a thought plagued my mind.  Why had my neurologist never ordered this test?  

When I was first diagnosed with fibromyalgia, I spent many a night up.  Each time I'd try to fall asleep, electrical charges pulsed my body continuously.  This situation never died down completely.  I just notice it happens less frequently.  

​Obstructive sleep apnea (OSA) affects more than 18 million Americans. Left untreated, sleep apnea can have serious and life-shortening consequences: high blood pressure, heart disease, stroke, automobile accidents caused by falling asleep at the wheel, diabetes or depression. An in-home or in-center sleep study can diagnose OSA and many other sleep disorders.

It could be one of these risk factors:

• You’ve complained of excessive daytime sleepiness
• Your neck circumference is over 17″ (for men) or 15″ (for women)
• You’ve complained of waking up with morning headaches, dry mouth or a sore throat
• Your bed partner has observed that you gasp for air in the night
• You wake up frequently in the night to urinate
• Your body mass index (BMI) is over 30

​
In preparation for your in-lab sleep study, it's important to know some of the key differences between the different types of sleep studies offered at sleep clinics.
​

1. Polysomnogram (PSG). A polysomnogram is an overnight sleep study that records brain activity, eye movements, heart rate, blood pressure, oxygen levels, body movement, and more. Polysomnograms are used to help diagnose some of the following:
   • Sleep related breathing disorders such as obstructive sleep apnea (OSA).
   • Sleep related seizure disorders.
   • Sleep related movement disorders such as periodic limb movement disorder (PLMD).
   • Sleep related disorders caused by excessive daytime sleepiness (EDS).
2. Multiple Sleep Latency Test (MSLT). A MSLT is a sleep study that is performed during the day to measure how sleepy you get or to discern whether breathing treatments for your disorder are working properly. MSLT's generally follow a Polysomnogram and record whether you fall asleep during the test, and if so, which stages of sleep you enter. In an MSLT you are generally given five 20-minute nap opportunities spaced 2 hours apart while a sleep technician monitors your brain activity and eye movements. An MSLT is often used to test for narcolepsy.
3. Maintenance of Wakefulness Test (MWT). A MWT is a daytime sleep study that measures how alert you are during the day and your ability to stay awake. They are usually performed after a PSG and can help determine if your sleepiness is a safety concern. Results of an MWT can be critical if a person's job involves public transportation. Often, employers will require an employee to have an MWT if they have a history of excessive daytime sleepiness or other related sleep disorders.

How To Prepare for Your Sleep Study

Most sleep clinics want you to go about your nightly routine so as to get the best results. If you over-prepare or do things differently leading up to your sleep study, the results may not be as accurate as they would if you kept to your normal routine. It sounds crazy, but a sleep tech wants to see you at your worst, so that they can recommend a treatment that is the best. However there are some things you will want to do in preparation for your test:

• Arrive shortly before your usual bedtime, approximately between 8 p.m. to 9 p.m. for an overnight study.
• Make sure you have already had dinner and are ready for bed.
• Bring your medications.
• Bring comfortable clothes that you normally sleep in.
• Bring your morning bathroom supplies.

What Happens During an Overnight Sleep Study?

When you arrive for your sleep study, you will be met by a registered polysomnographic technologist (RPSGT) who will be administering your sleep study. They will generally go over your paperwork, have you fill out any necessary forms, and review with you what the sleep study will entail. After collecting your health history as well as some vitals like your blood pressure, the tech will apply monitors to measure activity in your body as you sleep. This will normally include:

• Wires with small cup electrodes attached to your scalp with a conductive paste to measure brain activity. This lets the tech know if you are sleeping, and what stage of sleep you are in.
• Wire electrodes are taped to your face near the eyes and chin to show muscle activity. These electrodes are used to measure eye movements, which also give clues to sleep stages, as well as chin movements which can observe possible nocturnal teeth grinding as well as other sleep disorders related to muscle activity.
• 2 elastic belts around your chest and stomach to measure breathing effort.
• A nasal cannula (clear plastic tubing) and small heat monitor to measure all breathing activity.
• A wire electrode on each leg to measure body movement/muscle activity.
• A monitor taped to your finger to detect oxygen levels during the study.
• 2-3 lead EKG monitors to show heart rate and rhythm.
• A small  mic applied to your throat to detect snoring.

Once you have been hooked up to the various machines, the RSPGT will begin monitoring the data from another room. They will communicate with you via an intercom system and run through a series of tests to calibrate the equipment. When the calibrations are finalized you are encouraged to sleep.

Getting to Sleep during an In-lab Sleep Study

Being able to sleep comfortably outside of one's own bed while hooked up to a myriad of wires may seem an impossible feat. But it's really not. Rarely does a sleep study fail because the patient was unable to sleep. Even if you think that you didn't get any sleep during your overnight sleep study, you may be surprised to find that you slept much more than you realized. And even if you really didn't get a whole lot of sleep during your study, chances are you slept enough to obtain an adequate amount of data.

​What Happens After A Sleep Study?

In the morning, around 6-7 a.m., the sleep technician will wake you, remove your monitors, have you fill out some more paperwork and allow you to go home or to work. Most sleep clinics have facilities available for showering and getting ready in the morning so that you don't have to run home first to prepare for your day.

The RSPGT will not be able to share your results with you. Instead, the information is sent to your doctor or a sleep specialist for evaluation. Your doctor or sleep specialist will review the results of your sleep test as well as your medical history and sleep history to make a diagnosis.

Results from the sleep study often take a week to 10 days to get reviewed and finalized before you will be contacted with the results. At this point, if a sleep disorder was detected in the study, your doctor or sleep specialist will go over possible treatments for your condition.

​When Gerry (Gerard Butler), the husband of Holly Kennedy (Hilary Swank), dies from an illness, she loses the love of her life. Knowing how hard Holly will take his death, Gerry plans ahead. Beginning on her 30th birthday, she receives the first in a series of letters written by him, designed to ease her grief and encourage her to move forward to a new life.