Great post— as always— I became a lymphedema “ expert”— at one point, so easy because so few medical professionals know about the lymphatic system. It’s so important and has been so ignored. Thanks!
Ah! As did a close relative after radiation for tonsil cancer. Was not told of the likely aftereffects. With a PT and further researches has found exercise/massage program to use on the mornings when that's a problem. Good wishes on your lymphedema situation.
Thankfully my lymphedema is well controlled but it was so upsetting to be treated incorrectly and given bad advice. I’m a family physician but worked for a radiation oncology practice for a while and trained as a lymphedema therapist. Head and neck lymphedema is so common and challenging to treat.
Medicare coverage for lymphedema garments finally became federal law recently!
Hi Jan and thanks for sharing this - we have a lymphedema program nearby which is really small and not known by many patients and providers. My patients who go there are really pleased that someone finally "gets it" and has comprehensive knowledge and practical advice about this situation. I'm sure your first hand experience and expertise is a huge asset for people, and good to know that Medicare covers garments for this. The default mode for so many medical supplies has become Amazon.
I know—Without a CMS code, coverage was spotty and you need to wear the correct garment, not an ACE wrap! The DME suppliers are currently overwhelmed in a good way.
My patients needed help to order online and I had to figure out who is in network and available and good. Very frustrating.
I’d helped to create an evidence based website, that’s currently dormant, and my PT lymphedema therapy instructor wasn’t too pleased when I corrected her— but my classmates told me they appreciated it.
Thanks Cheryl! I could have saved everyone some time by just showing the cheetahs and writing, sleep like this if you can, and if you can't, just keep sleeping however works best for you! But I'm glad you read anyway ;)
The novel mechanism of glymphatic clearance and head position was something I stumbled upon while searching a random question that popped into my own head... so much out there compelling us to sleep more, better, but head position was something I specifically searched for and of course there is so much to know. At least the basics are reinforced by this paradigm.
I can only go to sleep when in on my side at night whereas I can easily nap during the day on my back.
I’m glad the side position facilitates the Glymphatic cleansing of my brain, something I learned about while listening to Matthew Walker, who has a theory of dreams that makes no sense.
Now, can someone tell me why I have recurrent dreams in which my iPhone doesn’t work. When I experience this now in dreams I recognize that I’m dreaming.
Wow that meta awareness during the iPhone dream is impressive! I had something like that a while back, and it really exposes a schism in what we consider consciousness. Agree with you about the nap versus nighttime sleep position. If I take a nap lying down in the afternoon it is fretful and non restorative, but ok if sitting up. I’m sure there is something to that!
The meta awareness as you call it , is a new development for me. I frequently find myself unable to find important things, like my shoes or my car or my way out of a building in dreams. When the iPhone fails me I recognize this is a clue that I'm probably dreaming and I do things to wake myself up to get out of the anxiety-provoking situation. Next time, I'm hoping my dreaming self will stay in the dream and do some investigation.
Well, it's probably a great sign that you are dreaming and hitting REM cycles with a rested brain that can manipulate scenarios? I think I'm generally sleep deprived and sleep efficiency keeps me in fewer REM cycles by necessity! (hopefully stage 3/4 sleep?) Or else I've wrecked my brain but I don't know how to check the boxes of life any other way :) 6-7 hrs and scraping by
Wow, I’ve been fascinated by sleep my entire life and this is the first I’ve heard of our glymphatic system. We spend a third of our lives sleeping and we still don’t truly understand it. (Cats spend *half* their lives sleeping. Is that why they’re so much smarter than we are?) Thanks, Ryan, for giving me a wonderful new place to explore.
“Sleep that knits up the ravell’d sleave of care, the death of each day’s life, sore labour’s bath …” Hey, it’s the washing machine of the brain! Shakespeare was onto something there.
So true! I was actually looking for that quote because one of the articles I linked to mentioned Shakespeare but I couldn’t summon it. It definitely wasn’t this one:
“To die, to sleep – to sleep, perchance to dream – ay, there's the rub, for in this sleep of death what dreams may come…”
So thank you for dropping this correct one in there. And I had not heard of the glymphatic system either quite frankly until I went down this rabbit hole. Off to bed, good night!
I saw that, so fun when you hit a wave of trending-ness. Glad other people find this interesting. The poll I put in there had over 2k replies, much more than the NAOC one, and about 88% of responders reported they prefer side sleeping… so I’m going to add that to this post now 😉
Fascinating, multidisciplinary, highly specialized yet broadly primary care relevant stuff. Thanks. The washing machine is pretty wild, and I’m constantly amazed by the worlds within us. The tides if you will.
The tides indeed! Thanks Grant, and though the finer details of the glymphatic system are really mind boggling and technical, zooming out to find actionable, human level hacks from it is more in my lane 😊
Great post— as always— I became a lymphedema “ expert”— at one point, so easy because so few medical professionals know about the lymphatic system. It’s so important and has been so ignored. Thanks!
Ah! As did a close relative after radiation for tonsil cancer. Was not told of the likely aftereffects. With a PT and further researches has found exercise/massage program to use on the mornings when that's a problem. Good wishes on your lymphedema situation.
Thankfully my lymphedema is well controlled but it was so upsetting to be treated incorrectly and given bad advice. I’m a family physician but worked for a radiation oncology practice for a while and trained as a lymphedema therapist. Head and neck lymphedema is so common and challenging to treat.
Medicare coverage for lymphedema garments finally became federal law recently!
Hi Jan and thanks for sharing this - we have a lymphedema program nearby which is really small and not known by many patients and providers. My patients who go there are really pleased that someone finally "gets it" and has comprehensive knowledge and practical advice about this situation. I'm sure your first hand experience and expertise is a huge asset for people, and good to know that Medicare covers garments for this. The default mode for so many medical supplies has become Amazon.
I know—Without a CMS code, coverage was spotty and you need to wear the correct garment, not an ACE wrap! The DME suppliers are currently overwhelmed in a good way.
My patients needed help to order online and I had to figure out who is in network and available and good. Very frustrating.
I’d helped to create an evidence based website, that’s currently dormant, and my PT lymphedema therapy instructor wasn’t too pleased when I corrected her— but my classmates told me they appreciated it.
[your posts are] perpetually grounded, stimulating, practical, fun. thx!
PS: Love the cheetah pic :)
Thanks Cheryl! I could have saved everyone some time by just showing the cheetahs and writing, sleep like this if you can, and if you can't, just keep sleeping however works best for you! But I'm glad you read anyway ;)
Thanks for a thoughtful look at sleep. Seems we do not put enough emphasis on sleep.
The novel mechanism of glymphatic clearance and head position was something I stumbled upon while searching a random question that popped into my own head... so much out there compelling us to sleep more, better, but head position was something I specifically searched for and of course there is so much to know. At least the basics are reinforced by this paradigm.
Lovely post! and fascinating.
I can only go to sleep when in on my side at night whereas I can easily nap during the day on my back.
I’m glad the side position facilitates the Glymphatic cleansing of my brain, something I learned about while listening to Matthew Walker, who has a theory of dreams that makes no sense.
Now, can someone tell me why I have recurrent dreams in which my iPhone doesn’t work. When I experience this now in dreams I recognize that I’m dreaming.
Wow that meta awareness during the iPhone dream is impressive! I had something like that a while back, and it really exposes a schism in what we consider consciousness. Agree with you about the nap versus nighttime sleep position. If I take a nap lying down in the afternoon it is fretful and non restorative, but ok if sitting up. I’m sure there is something to that!
The meta awareness as you call it , is a new development for me. I frequently find myself unable to find important things, like my shoes or my car or my way out of a building in dreams. When the iPhone fails me I recognize this is a clue that I'm probably dreaming and I do things to wake myself up to get out of the anxiety-provoking situation. Next time, I'm hoping my dreaming self will stay in the dream and do some investigation.
Well, it's probably a great sign that you are dreaming and hitting REM cycles with a rested brain that can manipulate scenarios? I think I'm generally sleep deprived and sleep efficiency keeps me in fewer REM cycles by necessity! (hopefully stage 3/4 sleep?) Or else I've wrecked my brain but I don't know how to check the boxes of life any other way :) 6-7 hrs and scraping by
Wow, I’ve been fascinated by sleep my entire life and this is the first I’ve heard of our glymphatic system. We spend a third of our lives sleeping and we still don’t truly understand it. (Cats spend *half* their lives sleeping. Is that why they’re so much smarter than we are?) Thanks, Ryan, for giving me a wonderful new place to explore.
“Sleep that knits up the ravell’d sleave of care, the death of each day’s life, sore labour’s bath …” Hey, it’s the washing machine of the brain! Shakespeare was onto something there.
So true! I was actually looking for that quote because one of the articles I linked to mentioned Shakespeare but I couldn’t summon it. It definitely wasn’t this one:
“To die, to sleep – to sleep, perchance to dream – ay, there's the rub, for in this sleep of death what dreams may come…”
So thank you for dropping this correct one in there. And I had not heard of the glymphatic system either quite frankly until I went down this rabbit hole. Off to bed, good night!
Ryan, you’re now #1 under “Trending Stories” on dailykos.
I saw that, so fun when you hit a wave of trending-ness. Glad other people find this interesting. The poll I put in there had over 2k replies, much more than the NAOC one, and about 88% of responders reported they prefer side sleeping… so I’m going to add that to this post now 😉
Fascinating, multidisciplinary, highly specialized yet broadly primary care relevant stuff. Thanks. The washing machine is pretty wild, and I’m constantly amazed by the worlds within us. The tides if you will.
The tides indeed! Thanks Grant, and though the finer details of the glymphatic system are really mind boggling and technical, zooming out to find actionable, human level hacks from it is more in my lane 😊
I love these well researched and practical posts you have! I should start claiming CME for reading your articles! Hope you have a great weekend!
You too! Well, for family medicine in the US at least, you can claim like 20 hours for independent study ;)
Have a great weekend, too!