My Story

Journey Begins.

More has been learned about sleep over the past 10 years then the previous 10 centuries combined. However, most health professionals and education specialist do not have formal training in sleep. A person cannot be expected to know what they have not learned.

As a Sleep Medicine specialist, there are common issues that I see.

-One, I find that when a child has a certain sleep issue, usually multiple people in the family including parents have similar issues.

-Second, I find that there are several topics that as sleep science has evolved have become basic information in the field of sleep medicine. However frequently the individual has not been exposed to some of these concepts.

The purpose of this site is to help inform people about sleep health. My method is to take the information that has been presented in Sleep Medicine textbooks and journal articles, and to attempt to present them in a reader friendly manner. In addition, I use my personal experiences as well as some of my clinical Sleep Disorders experience to help drive some points.

Please note that this does not replace communication with your physician or other health care providers. What I encourage is you take the information learned and you present this to your physician to see what does apply to you.

My Journey.

I find how I got into sleep medicine to actually be an interesting story of discovered passion and life experience.

Early days.

My father, who is a general pediatrician, used to take me to work with him on his Sunday rounds.  I always saw how much he loved his work and I found that I had a passion for what he did as well.  I originally went into medical school to be a general pediatrician since I shared an interest in what my father did.  However, during medical school, I found it hard to give anticipatory guidance and parental advice when I had no kids of my own and no real experience in childcare.

Towards the beginning of my 4th year of medical school, I took my neurology elective.  This was a required course that I previously had not given thought to as a career.  The problem that I ran into is that I discovered I loved it.  Later, during the same rotation, I learned about pediatric neurology.  This seemed like the best of both worlds for me.  At that point I decided to pursue a career in pediatric neurology.  I followed by doing my pediatrics training at USF in Tampa FL and my child neurology fellowship at Vanderbilt University in Nashville TN.

Vanderbilt Medical Center

At Vanderbilt, The department of sleep medicine is through the department of Neurology. I remember my first sleep lecture, I found that I loved it. I was submersed in it. I found it to be interesting, and I also found that I had a talent for it. Another thing I frequently observed was that if I saw a kid for a sleep problem, frequently the parent had the same problems. Essentially, I was helping the family unit. The ability to work with adults and children, I found also satisfied an interest that I had in family and public health. During medical school and my residency, I additionally worked for my Master in Public Health, in Child and Maternal Health. Things seemed to be falling into place.

As I was learning about sleep in my first of three years at Vanderbilt, I was also struggling with insomnia. Essentially, I had psychophysiologic insomnia. — That is, I had problems sleeping because something was bothering me, But what was bothering me was that I was not sleeping. — Once I realized what my sleep problem was, Through behavioral therapy my nights with insomnia have been very rare.

In my second your at Vanderbilt, I took many electives in sleep medicine. Also, I made time in my schedule to attend every sleep lecture and journal club that the sleep medicine fellows had. Essentially, by the end of the year, I had all the same series of lectures and didactic sessions that the sleep medicine fellows had. Interesting, I was teaching the neurophysiology fellows how to read sleep studies as there ability to take sleep electives were limited.

While I was in my last year at Vanderbilt, a career changing series of events occurred. Multiple of the sleep medicine faculty had abruptly left, all for different reasons, mostly family reasons. The department found itself very back loaded in sleep studies. I took it upon myself for every single down time that I had to read sleep studies. If I was on inpatient service, and there were no patients, I would go read sleep studies. My radiology rotation was half a day at a time, the other half of the day I read sleep studies. On my EEG rotation, when I was done going through the studies, I would go read sleep studies. I helped with the back log, and the experience was great. I also took many Sleep CMEs, did independent readings, would take a sleep textbook from cover to cover. I essentially did a sleep medicine fellowship within my child neurology fellowship.

The student became a teacher, and then a parent, and then a patient.

Later, when I started practicing child neurology and sleep medicine, my son Manuel was born. That is when I learned about sleep deprivation. I thank my mother in law and my parents, who would come up about once a month and take our little man into there room so we could get a full night sleep. Later, I started to work with my son about concepts of sleep association and bed time routine. What I realized was very powerful: That is that the same principles and setting of limits and boundaries for sleep, were very helpful for daytime behavior management as well.

Two years later, I found myself with weight gain, snoring, my second child, and I was also studying for my sleep medicine boards. I realized that I was getting insufficient sleep quantity, but with the snoring I realized that I had sleep apnea, and cognitively I felt it. After evaluation, I was started on CPAP. Wow!!! I learned many things there. One, I felt amazingly better after having my sleep apnea treated. Incredible concentration difference. However, I also realized exactly how hard CPAP use can be. To this day, more frequently I awake and my CPAP mask is on the floor, I take it off my face almost nightly, without any knowledge or awareness that I have done this. Yet, I remained motivated to keep using it. However, at the same time with weight management and sinus control  my snoring improved. Finally in 2013 I started using Oral Mandibular Advancement Device and there is no more snoring thanks to collaborations with Dental Sleep Medicine.

Past meets present.

The reason why I find my sleep history interesting, is that during medical school I had only received two lectures in sleep medicine. One was an adult pulmonologist talking about CPAP. Another was a psychiatrist talking about narcolepsy. That is it! And general consensus among my med school colleagues is that both of these “sleep” lectures were above our heads. Now, during my pediatrics residency, I never even received one lecture in sleep medicine. So really, it wasn’t until my child neurology fellowship that I learned about sleep medicine. This is interesting, because the average physician that is practicing has about the same knowledge about sleep as a high school student.

Many Thanks!

My educational experience at Vanderbilt University was the keystone to my pursuit of sleep medicine. However, it is the personal and family experiences that make me a good sleep physician. Thank you to all at Vanderbilt

Thank you Ramon Cuevas, Beth Malow, and Kanika Bagai for allowing me to learn sleep under your wings. Thank you Eric Pina-Garza for showing me how to practice compassion more then medicine. Thank you Gerald Fenichel for passing the torch to generations of child neurologist, but more so for being a role model on how to be a gentleman. Thank you Randy Williamson, Trish Ritch, and John Flat for your friendship and support as we were training – I am proud to be associated with our class.

There are so many other faculty and colleagues that I have trained with both at Vanderbilt and USF that have made positive impact as well.

I have many people to thank who helped and mentored me along the way. I hope to make positive impact in other’s lives, as my friends have done for me.

And the most thanks to my wife. Thank you for all the love, support, and patience through the ongoing journey!