Get Enough Sleep: Your Life Depends on It!

We can all remember our parents telling us how important it is to sleep.  Most of us can vividly remember the cry of a cranky toddler who has not had his or her nap and lets the world know it. Unfortunately, as adults we manifest the effects of not having enough sleep a lot more dangerously then the crying toddler.  As adults not getting enough sleep means having an increased risk of heart attack and stroke.

Many obstacles get in the way of us having healthy sleep.  To name a few: we have deadlines that need to be met, work longer hours, have “insomnia ,” travel for a living and are constantly in different time zones, and/or we have a disorder like Obstructive Sleep Apnea.  Whatever the reason, the problem of sleep deprivation must be corrected.  This is exactly what sleep physicians do—they get people sleeping.

Recently the American Academy of Sleep Medicine and The Centers for Disease Control and Prevention (which help support the development of the current guidelines) have recommended that adults get at least seven hours of sleep each night. Getting only six or less has been associated with a decrease in performance, increased risk of heart attack, stroke, diabetes, and obesity.

Although there are many causes of not getting enough sleep, today we will focus on the epidemic of undiagnosed sleep apnea which accounts for anywhere 75% – 85% of cases.

What is Sleep Apnea and how many people does it effect?

Estimates suggest that sleep apnea affects more than 18 million people in the United States. Sleep apnea is when breathing partially or completely stops during sleep. The most common type of sleep apnea, Obstructive Sleep Apnea, is caused by blocked airways in the throat. A person with sleep apnea will awaken, partially or fully, when the brain doesn’t get enough oxygen. In most cases, the person is not even aware of.  People with sleep apnea may be known as loud snorers and often the bed partners are the ones who bring them in to see a doctor. People with sleep apnea may have excessive daytime sleepiness, fatigue, insomnia, depression, or secondary hypertension.

What are the risk factors for Sleep Apnea?

  • Increased BMI>25.Around half the people with obstructive sleep apnea are overweight. Fat deposits around the upper airway can obstruct breathing.
  • Narrowed airway.You may have naturally narrow airways, or your tonsils or adenoids may be enlarged, which can block the airway.
  • High blood pressure.
  • Chronic nasal congestion.
  • People who smoke are more likely to have Obstructive Sleep Apnea.
  • A family history of sleep apnea.If you have family members with Obstructive Sleep Apnea, you may be at increased risk.
  • Recent research has found an association between asthma and the risk of Obstructive Sleep Apnea.

In addition, patients who have Atrial fibrillation (also called AFib) should be screened for sleep apnea. There are many risk factors for developing AFib. These include being age 60 years of age or older, having high blood pressure, diabetes, or existing heart disease. Another risk factor that is little known and not completely understood is sleep apnea.

 How is sleep apnea diagnosed?

Sleep apnea is diagnosed by an overnight sleep test. The study measures the number of times that a person either stops breathing during sleep or breathing becomes very shallow. It also measures the level of oxygen in the blood and monitors the brain and heart rhythm during sleep.

What are treatment options for sleep apnea?

The major treatment options are as follows:

  1. Lifestyle changes such as losing weight
  2. CPAP or BIPAP therapy
  3. Dental devices for sleep apnea
  4. Nasal dilators
  5. Surgical options of which there are many. Our patients have had a lot of success with the new Inspire therapy.

Dr. Thakkar is the founder and the medical director of Golden Gate Sleep Centers. She completed her Internal Medicine training at UCSF, Fresno, then a Sleep Medicine Fellowship at UC, Davis. She then served our Veterans at the VA in Sacramento / Mather. She remains part of the UC Davis volunteer Faculty in Sleep Medicine and has served as Medical Director of private practice Sleep Labs. Visit her website at or call (925) 820- 4472.


Aging & Osteoporosis

The risk of bone fractures from even small types of trauma increases dramatically as we age. A major contributing factor is osteoporosis or thinning of the bones. The most common bones that are broken are the hip and spine. Unfortunately, older adults’ overall health tends to decline exponentially when they suffer from one of these fractures. An increased risk of death within the next two years is associated with these fractures in the geriatric population, defined as age over 65 with serious health issues.

Fractures can occur if the bone density or strength is less than normal and then subjected to trauma, such as a slip and fall injury. If bone density is severely compromised, fractures can occur with little to no excessive force. In extreme cases, a hard sneeze can cause a fracture.

Bone density is evaluated using a low level x-ray test called a DeXA scan. With this test, a normal score is T -1.0 to 1.0. Osteopenia (lower than normal bone strength) occurs at a T score between -2.5 and -1.0, and osteoporosis (extremely low bone strength) is a T score of -2.5 or lower. The lower the T score, the higher the risk of bone fracture. Postmenopausal women, Asians and Caucasians have an increased risk of osteoporosis. Overall, one in four people, age 80 and older, has osteoporosis.

Diet, exercise and lifestyle changes can prevent or slow down the development of osteoporosis. Calcium and vitamin D are essential vitamins and minerals for bone formation. Diets that include green leafy vegetables, fish, soy, dairy, and fortified orange juice and rice are high in Calcium. Vitamin D can be found in fish, milk, egg yolks, fortified orange juice and rice. Avoidance of tobacco and excess alcohol also reduces the chances of bone thinning. Exercise, especially weight bearing, increases bone strength and density. Also, the more bone density a person has in their younger years carries through to their older years and decreases the risk of osteoporosis.

Vertebral fractures are especially painful and if left untreated can lead to chronic pain and deformity which can affect other body functions. When the back bone is fractured, even the simplest movements cause extreme pain. This is because the edges of the fracture are moving with each breath and change in position. Some people find that the only comfortable position is lying in bed, motionless. This, of course, is not healthy and leads to more problems such as pneumonia, deconditioning and weakness, and blood clots, to name a few.

A fracture of the spine can take six months to a year to heal naturally. For over 20 years, a non-invasive procedure called a Percutaneous Balloon Kyphoplasty, or PBK, has been available that can immediately fix the fracture and alleviate pain. It involves injecting cement into the fracture line through a small needle. Once the cement is injected, it immediately becomes hard and forms an “inner cast” for the spine. The cement cast also prevents the bone from collapsing. If the vertebra collapses, it causes a humpback type of deformity of the spine that can make it hard for people to stand up straight or take a deep breath. After having the PBK procedure, most patients are back to their previous activities of daily living within two to four weeks, with minimal to no pain.

Once you’ve had one vertebral fracture, your risk of having another one is five times greater, regardless of the treatment. This is why it is extremely important to start a plan that includes safe weight bearing exercise, balance and core strength re-education and bone hardening medications to lower your risk of repeat fractures.

Visit my website at for more information on the PBK procedure and osteoporosis treatment options.

Bike vs Car

I’ve seen it time and time again—a group of cyclists blow right through a red light or stop sign at a busy intersection. On more than one occasion, awestruck by what I was seeing, I’ve felt a sense of responsibility as the self-designated “bike police” to rescue these cyclists from themselves. I’ve pedaled feverishly to catch them screaming at the top of my voice, “What in the ‘heck’ were you thinking? Don’t you know it’s riders like you that give us all a bad name!” Only to be scorned for my efforts as if I’d lost my mind.

Some might say, rarely, if ever, “I hold my mud,” but, on this occasion, rather than pursuing further, I was so dumfounded that I simply turned around and pedaled home thinking, “If they want to die, it’s on them. Idiots.” I found out a few days later, one of them was hit by a car later in their ride.

Unfortunately, this scenario is all too common. Spend any time biking on the road in the Bay Area, and chances are you’ll see or experience a dangerous scenario of bike vs car. It both frustrates me and makes me sad because in the end, someone pays the price. It’s dangerous for the cyclists and the motorist. Whether cyclists are aware of it or not, the fact is that many Bay Area motorists are fed up with cycle traffic on the road. Frankly, given scenarios like the one above, who can blame them? Unsafe and inexperienced riders are all too common making things even worse. The same goes for motorists. We are a highly congested area; lots of people equals lots of traffic and lots of bikes.

The number of serious injuries and fatalities in car vs bike “accidents” has escalated dramatically over the past five years. Especially in the Bay Area. We live in an amazing place. We have beautiful terrain that allows us to ride up hillsides, mountain sides, around lakes, and every kind of scenery and topography you can imagine. Avid cyclists and triathletes view many parts of the Bay Area as “hallowed ground” for training—Mt. Diablo, Mt. Tamalpais, Three Bears, Redwood, Skyline, Grizzly Peak, Mines Road, just to name a few. All these locations are fed through a few main thoroughfares which are riddled with gobs of cyclists on any given weekend morning regardless of weather, time of year, etc.  Just drive your car down Danville Blvd on a Saturday morning in the summer and you will see hundreds of cyclists. Riders riding solo, couples on townies, pelotons of riders out for a group ride, and everything in between.

The bottom line is that no matter how experienced a rider is, they will lose the fight against a motorist in a car. Period. Common sense tells us that a 2000 lb piece of metal going 35 plus MPH on four wheels has a distinct advantage over a two wheeled bicycle weighing 15-22lbs with a rider wearing spandex (basically underwear) and a Styrofoam helmet. Yet, some neglect this principle.

Do cyclists have the right to ride on the road shared by cars? YES! The law even says so. After all, we even have our own lanes to use—some recently made safer by highlighted green paint and signage for which the cyclist community has fought hard for years. However, that doesn’t change the fact that we will still lose a confrontation with a car, regardless of who’s at fault. 

At the end of the day, it is up to us as cyclists and motorists to be safe, look out for ourselves, and look out for each other. After all, who wants to die because they lost a fight with a car in a fit of self-righteousness? Ride safely, drive safely.

Take This Warning Seriously

Let’s take a look at many diseases that are really symptoms and are truly warnings to us to correct our habits.

Arthritis: Proven by Colon Dong, over 50 years ago, to be treatable with diet.

Colitis and/or Chrones: Many causes, but commonly bad diet, food sensitivities, and change in intestinal bacteria.

Acne: Many times caused by dairy products.

Depression and Anxiety: Poor sleep, bad diet, untreated stress.

Obesity: Poor sleep, candida dominance in the intestine, poor diet, poor lifestyle.

All of the above can be covered up with drugs to ignore the WARNING.

Much of Western medicine is a result of junk science, teaching doctors to treat symptoms, not patients. It appears that the current medical establishment has a goal of forcing drugs on us to feed the monstrous cash cow. I was just informed that some medical insurance companies will not pay physical therapists for the use of microcurrent therapy or white laser to treat pain. Why should a treatment option without side effects be replaced by drugs with sometimes horrible side effects? 

That is the reason that I wrote my last book, WHY? The Question that Could Save Your Life. To have the best chance for a wonderful, healthy and productive life, you must take a strongly proactive part in your healthcare. We don’t have to experience the morbidity associated with aging. Before I woke up to this subject about ten years ago, I was, like many others, having the usual stays in the hospital and going under the knife for very preventable diseases.  That is all in the past now and I am experiencing the best health of my life.

At AODTC, my holistic TMJ and sleep apnea practice, we take time on our initial exam to learn as much about the many factors contributing to the patient’s vitality as possible.  I have taken the time to study physiology at Cal, acupuncture at UCLA, endocrinology (hormones) at the American Academy of Anti-Aging Medicine and many more. One example of how my patients benefit is in the case of migraines. My acupuncture training has helped me to find other potential reasons for the migraine symptoms rather than simply labeling it a migraine. I have had patients who were suffering for years, using prescriptions drugs with side effects for headaches, finally able to be free from this horrible pain, without medication! 

When your body is crying out for help with warning symptoms, don’t let anyone say to it, “take this pill and stop crying”.  You find out why it is crying and take away the cause. It could save your life. Alternative medicine, which includes ancient medicine, concentrates on the total body and mind. It is the future of healthcare.

If you are suffering from TMJ symptoms, headaches, popping in your jaw, or sleep apnea, we can help. Visit for more information, call 925-837-8048.


Healing Shoulder/Rotator Cuff Injuries

The Rotator Cuff muscles (four muscles in total) are the primary support structures for the shoulder. Therefore, even minor dysfunction associated with these muscles can create pain and decreased performance of everyday tasks.  A Rotator Cuff injury can be caused by many everyday activities. These activities include traumatic events (e.g. fall on an outstretched arm, “yanking” of the arm), repetitive motion (e.g. throwing a ball, carrying children) and chronic improper posture (e.g. operating a computer, driving).

There are three major types of Rotator Cuff injuries that we treat successfully:

  1. Rotator Cuff Muscle Tears: This is a partial tear of one or more of the four Rotator Cuff muscles. Rotator Cuff muscle tears are often accompanied by deep achy pain in the shoulder and arm weakness.
  2. Tendonitis: Tendons are at the ends of each muscle and attach the muscles to the bones they move. When there is inflammation of these tendons it is called Tendonitis. The symptoms of Rotator Cuff Tendonitis are often trigger point pain over the tendon accompanied by deep, achy pain in the shoulder and arm weakness.
  3. Rotator Cuff Impingement Syndrome: Chronic injury of the Rotator Cuff can lead to a “pinching” of the nerves passing through the shoulder. This is commonly referred to as a Shoulder Impingement or Rotator Cuff Impingement. Symptoms often include numbness, tingling or sharp, shooting pain into the arm or hand.


The most common forms of medical treatment for Rotator Cuff injuries are anti-inflammatory medications, cortisone injections and surgery.  Although meds and injections may reduce the severity of pain associated with rotator cuff dysfunction, they are not a long-term solution and may do more bodily harm than good in the long run. Surgery is a last resort and should only be used if there is irreparable damage to the shoulder that cannot be handled with proper rehabilitation.

First:  Heal the Damaged Tissue

Ending the pain caused by a Rotator Cuff injury requires stopping the cycle of inflammation that is creating the pain. Class IV laser therapy is an excellent method for this, because it is presently the only modality that can both reduce inflammation and heal tissue simultaneously.  During Laser Therapy, the infrared laser light interacts with tissues at the cellular level, increasing metabolic activity and improving the transport of nutrients across the cell membrane.  This creates an optimal healing environment that reduces inflammation, swelling, muscle spasms, stiffness and pain. As the injured area returns to normal, pain is relieved and function is restored.

Second: Correct the Shoulder and Postural Mechanics

Long-term pain relief of shoulder injuries involves rehabilitation of the shoulder, neck, and thoracic spine.  Shoulder rehabilitation is achieved by utilizing specific postural adjustments, exercises and specific posture stabilizing methods in order to re-establish proper motion and strength of the shoulder joint. Ongoing strengthening and stretching exercises are used to rehabilitate the musculature of the shoulder to ensure lasting results. 

If you suffer from chronic pain, it is worth your while to spend some time figuring out which of any number of factors are contributing to your pain — we will help you explore which combination of therapies will help you heal it. The good news is — you can do it without drugs, and you can get back to the activities you love!

Dr. Niele Maimone, DC is the owner and founder of Align Healing Center in Danville, CA. For more information or to set up a consult call 925.362.8283 or visit