On a ketogenic diet, your entire body switches its fuel supply to run mostly on fat, burning fat 24-7. When insulin levels become very low, fat burning can increase dramatically. It becomes easier to access your fat stores to burn them off. This is great if you’re trying to lose weight, but there are also other less obvious benefits, such as less hunger and a steady supply of energy. This may help keep you alert and focused.

We are brazilian, living in Brazil. My daughter, Isabel, 21y. o., born in 1996, has syndrome of deficiency of Glut1. She was diagnosed around her first year of life. At that time her baby bottle, her begining diet meal, was 50ml water plus 50ml oil plus vitamin. Since then, which means, for 20 years, she is under this diet. For almost 18 years under 4:1 proportion. At this right moment 3:1. The only problem she had since started the diet were kidney stones in 2002. Nothing else. Grateful to the diet she doesn’t take any kind of medicine to avoid seizures. Her health is perfect, no colesterol at all. We are at your will for any issues related to her health.


Aside from carb flu, be warned that staying in long-term, continuous ketosis may have drawbacks that may actually undermine your health and longevity. To stay on the safe side, I recommend undergoing a cyclic ketogenic diet. The "metabolic magic" that ketosis brings to the mitochondria actually occurs during the refeeding phase, not during the starvation phase.

In a way, moderate-intensity physical activity is that "magic pill" a lot of people are looking for, because the health benefits go beyond keeping your waistline trim: Not only can it reduce your risk of cancer, stroke, diabetes and heart attacks, but studies have shown that physical activity can significantly improve the moods of patients with major depressive disorders.
Laser-assisted liposuction. This involves a small incision and the insertion of a laser fiber probe that produces a burst of energy to liquefy the fat before it is removed. (Two of the brand names you may have heard about are SmartLipo and CoolLipo.) Proponents say that laser liposuction is the latest and greatest and may also tighten skin. But detractors say it adds nothing to the results of liposuction except for expense.
Want to lose that belly fat fast? In your dreams! Seriously, though: a good night’s sleep is one of the best ways to get rid of that extra fat around your waist for good. Among the 60,000 women participating in the Nurses’ Health Study, those who snoozed for fewer than five hours a night were at the greatest risk of becoming obese and gaining 30 or more pounds over the course of the 16-year study period when compared to those who slept for seven or more hours.
Hi Barb, That can definitely be it. Losing when you are close to goal can be more difficult. It could also be that your body’s healthy weight is a little higher than what you’d like – which doesn’t mean you can’t lose, but makes it more difficult. If just eating Keto foods isn’t working, double check the macros for your weight and see if the amount you’re eating needs to be adjusted. You’ll find more help and support in our support group here.
Fairly recently, the diet was introduced as a weight-loss diet by an Italian professor of surgery, Dr. Gianfranco Cappello of Sapienza University in Rome. In his 2012 study, about 19,000 dieters received a high-fat liquid diet via a feeding tube inserted down the nose. The study showed an average weight loss of more than 20 pounds in participants, most of whom kept it off for at least a year. The researchers reported a few minor side effects, like fatigue.
Hi Maya. I LOVE your site!! Interesting, informative with fab recipes and ideas. Hubby and I have just started eating low carb and I have to say, we are not finding it too difficult and I already feel sooo much better!! I find the hardest part is choosing low carb veg, I feel as if we are not eating enough. Any suggestions on how to get more veggies into our diet?
The body doesn't react to all fats in the same way. Research correlates high intake of saturated fat (the kind in meat and dairy) to increased visceral fat, says Patton. On the other hand, monounsaturated fats (the kind in olive oil and avocados) and specific types of polyunsaturated fats (mainly omega-3s, found in walnuts, sunflower seeds, and fatty fish like salmon) have anti-inflammatory effects in the body, and if eaten in proper portions may do your body good. But Patton warns that eating too much fat of any kind increases your calorie intake and could lead to weight gain, so enjoy healthy fats in moderation. 
Three awesome essential oils for weight loss are grapefruit, cinnamon and ginger. Grapefruit essential oil actually works with your body in activating enzymes that help your body break down brown body fat. Cinnamon oil has been shown time and time again to help regulate blood glucose levels and something in your body called GTF, glucose tolerance factor. For that reason, cinnamon oil is also fantastic for anybody with diabetes. (19, 20)
Lean protein like fish is a great way to fight fat and boost your metabolism. But the farmed salmon you get at the local market might not be the best bet for your belly. The cold-water fish has a well-deserved reputation for packing plenty of heart-healthy omega 3 fatty acids—1,253 mg of the good stuff, and just 114 mg of inflammatory, belly-busting omega 6s. But the farmed variety—and 90 percent of what we eat today is farmed—has a very different story to tell. It packs a whopping 1,900 mg of unhealthy omega-6s.
You’ll find lean, satiating protein in every single bite you take on Zero Belly Diet. The muscle-building macronutrient is fundamental to the plan, and eggs happen to be one of the easiest and most versatile delivery systems in the universe. Not only that, they’re also the number-one dietary source of a nutrient called choline. Choline, which is found also in lean meats, seafood and collard greens, attacks the gene mechanism that triggers your body to store fat around your liver. One Zero Belly Diet recipe—a breakfast hash with sweet potatoes and fresh farm eggs—became test panelist Morgan Minor’s go-to breakfast, and after just 3 weeks on the program, the female firefighter lost 11 pounds and 4 inches from her waist! The more eggs you eat, the less egg-shaped you get.

The prevalence of metabolic syndrome increases with age, with about 40% of people older than 60 years meeting the criteria. [26] However, metabolic syndrome can no longer be considered a disease of only adult populations. Alarmingly, metabolic syndrome and diabetes mellitus are increasingly prevalent in the pediatric population, again in parallel with a rise in obesity. [50]

Get enough calcium. Adults typically need around 1,000 milligrams of calcium every day to help maintain muscle and nerve function, and it's necessary for healthy bones and teeth.[21] But calcium may also help prevent the body from storing visceral fat in the abdomen. Though studies have not shown a drastic change in weight due to increased calcium intake, researchers suggest that it may have a small effect in some people. Calcium requires vitamin D to be absorbed into the body; therefore, be sure to get enough vitamin D as well.[22] Sources of calcium include:[23]
Metabolic syndrome (MetS) is the commonly observed clustering of obesity, hypertension, dyslipidemia, and insulin resistance. The components of MetS occur together more often than expected by chance and display significant heritability. Investigations into monogenic diseases that model features of the common MetS have uncovered responsible genes. Genome-wide association studies (GWAS) of the components of the MetS have been enormously successful. Meta-analysis of public GWAS data and risk-score analysis are revealing the role of common single-nucleotide polymorphism genotypes in MetS pathophysiology. A pleotropic polygenic architecture underlies MetS, making it a fascinating complex trait. Research will continue to uncover how metabolic pathways interact to form the MetS and its subsequent risk for atherosclerosis and diabetes.

Even small changes to your diet can make a difference when you're trying to lose weight, so don't feel like you have to follow a strict regimen or cut out entire food groups. If you like to bake, try low-calorie substitutions in your recipes. Cooking at home more often can help you lose weight, especially if you look for ways to reduce fat and calories in your meals. As you make changes like these, you may even find that you enjoy healthy eating.
Let me explain what I mean by insulin resistance. A healthy digestive system breaks down food into glucose. Next, insulin, a hormone made by the pancreas, helps the glucose enter your cells to be used as fuel. However, if you experience insulin resistance, your cells won’t respond in a typical fashion to insulin, and hence, the glucose cannot enter your cells as easily. This phenomenon results in increased glucose levels in your bloodstream despite your body’s efforts to manage the glucose by producing more and more insulin.
Arteries (are-te-rease): The blood vessels that carry oxygen-rich blood away from your heart for delivery to every part of your body. Arteries look like thin tubes or hoses. The walls are made of a tough outer layer, a middle layer of muscle and a smooth inner wall that helps blood flow easily. The muscle layer expands and contracts to help blood move.
• Your body is still growing — In one study, epileptic children experienced a reduction in symptoms and improved cognitive performance when a ketogenic diet was introduced.49 However, this may have a negative effect on the growth of their bodies in the long run, according to a study published in the journal Developmental Medicine & Child Neurology.50
Tumescent liposuction (fluid injection) is the most common type of liposuction. It involves injecting a large amount of medicated solution into the areas before the fat is removed. Sometimes, the solution may be up to three times the amount of fat to be removed). The fluid is a mixture of local anesthetic (lidocaine), a drug that contracts the blood vessels (epinephrine), and an intravenous (IV) salt solution. Lidocaine helps numb the area during and after surgery. It may be the only anesthesia needed for the procedure. Epinephrine in the solution helps reduce loss of blood, bruising, and swelling. The IV solution helps remove the fat more easily. It is suctioned out along with the fat. This type of liposuction generally takes longer than other types.

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Long-term compliance is low and can be a big issue with a ketogenic diet, but this is the case with any lifestyle change.  Even though the ketogenic diet is significantly superior in the induction of weight loss in otherwise healthy patients with obesity and the induced weight loss is rapid, intense, and sustained until at least 2 year, the understanding of the clinical impacts, safety, tolerability, efficacy, duration of treatment, and prognosis after discontinuation of the diet is challenging and requires further studies to understand the disease-specific mechanisms.
Certain studies suggest that keto diets may “starve” cancer cells. A highly processed, pro-inflammatory, low-nutrient foods can feed cancer cells causing them to proliferate. What’s the connection between high-sugar consumption and cancer? The regular cells found in our bodies are able to use fat for energy, but it’s believed that cancer cells cannot metabolically shift to use fat rather than glucose. (11)
Arteries (are-te-rease): The blood vessels that carry oxygen-rich blood away from your heart for delivery to every part of your body. Arteries look like thin tubes or hoses. The walls are made of a tough outer layer, a middle layer of muscle and a smooth inner wall that helps blood flow easily. The muscle layer expands and contracts to help blood move.
Studies have shown that post-natal and post-menopausal women have seen significant reductions in visceral fat stores when adding yoga to their workout and health regimens. Yoga is a wonderful way to reduce stress and eliminate excess stress hormones from your body, namely cortisol. Dr. Janice Kiecolt-Glaser, an eminent psychologist from The Ohio State University, carried out a study in which she found yoga fastened an individual’s physiological recovery. Furthermore, it also stated that there’s a direct link between chronic stress, cortisol levels, and belly fat. Thus it is important to clear your mind, calm down, and keep that visceral fat at bay!
Clinical improvement was observed in Alzheimer’s patients fed a ketogenic diet, and this was marked by improved mitochondrial function. (15) In fact, a European Journal of Clinical Nutrition study pointed to emerging data that suggested the therapeutic use of ketogenic diets for multiple neurological disorders beyond epilepsy and Alzheimer’s, including headaches, neurotrauma, Parkinson’s disease, sleep disorders, brain cancer, autism and multiple sclerosis. (16)
Although you'll be cutting way back on carbohydrates and sugar, some fruits are still okay to eat on the keto diet (though you'll still want to be mindful about quantity in order to remain in ketosis). The fruits that make the cut contain far fewer carbs than their off-limits cousins such as apples, pears, bananas, pineapples, papayas, grapes, and fruit juices in general.
Cardiovascular Disorders Clinical Pharmacology Critical Care Medicine Dental Disorders Dermatologic Disorders Ear, Nose, and Throat Disorders Endocrine and Metabolic Disorders Eye Disorders Gastrointestinal Disorders Genitourinary Disorders Geriatrics Gynecology and Obstetrics Hematology and Oncology Hepatic and Biliary Disorders Immunology; Allergic Disorders Infectious Diseases Injuries; Poisoning Musculoskeletal and Connective Tissue Disorders Neurologic Disorders Nutritional Disorders Pediatrics Psychiatric Disorders Pulmonary Disorders Special Subjects
The concept of removing excess fat from localized body sites to achieve similar gains is credited to Charles Dujarrier, who in France,[2–4] attempted to remove subcutaneous fat using a uterine curette on calves and knees of a ballerina in 1921. An inadvertent injury of the femoral artery led to amputation of the dancer's leg. This unfortunate complication arrested further progress in this field and but it was a valiant attempt at the time.[5]
Many people struggle with weight loss issues. Losing belly fat in particular is about more than just aesthetics: visceral fat, the kind of fat that tends to settle around the midsection, can cause an increase in your body's production of stress hormones that can affect your body's insulin production. As a result, excess belly fat can lead to serious complications like type 2 diabetes and heart disease.[1] There is no way to target belly fat, but diet and exercise will eventually burn off belly fat. Knowing how to take the first step can help you feel better and get you on the road to a healthier, more active lifestyle.
First, I want to thank you for all of your dedication and work in providing this site. The difficulty of maintaining a healthy weight is a big problem for so many people. My personal question & issue in staying on Keto is my craving for fresh fruit. This a.m I had a large fresh peach along with my “Bullet Proof” coffee. Have I now sabotaged today’s Keto eating?

An increase in fat content can be either hypertrophic or hyperplastic. An increase in total fat cell numbers is hyperplastic obesity. It predominates as body fat levels exceed 40% and is more resistant to dieting and exercise regimens. In those cases where the actual number of fat cells remains stable, the cells increase or decrease in their volume with weight gain or loss.[13]
When Johns Hopkins researchers compared the effects on the heart of losing weight through a low-carbohydrate diet versus a low-fat diet for six months—each containing the same amount of calories—those on a low-carb diet lost an average of 10 pounds more than those on a low-fat diet—28.9 pounds versus 18.7 pounds. An extra benefit of the low-carb diet is that it produced a higher quality of weight loss, Stewart says. With weight loss, fat is reduced, but there is also often a loss of lean tissue (muscle), which is not desirable. On both diets, there was a loss of about 2 to 3 pounds of good lean tissue along with the fat, which means that the fat loss percentage was much higher on the low-carb diet.
The most common and relatively minor short-term side effects of ketogenic diet include a collection of symptoms like nausea, vomiting, headache, fatigue, dizziness, insomnia, difficulty in exercise tolerance, and constipation, sometimes referred to as keto flu. These symptoms resolve in a few days to few weeks. Ensuring adequate fluid and electrolyte intake can help counter some of these symptoms. Long-term adverse effects include hepatic steatosis, hypoproteinemia, kidney stones, and vitamin and mineral deficiencies.
The end result of the “ketone diet” is staying fueled off of circulating high ketones (which are also sometimes called ketone bodies) — which is what’s responsible for altering your metabolism in a way that some people like to say turns you into a “fat-burning machine.” Both in terms of how it feels physically and mentally, along with the impact it has on the body, being in ketosis is very different than a “glycolytic state,” where blood glucose (sugar) serves as the body’s energy source.
Hi Cyn, The numbers are general guidelines but will vary depending on many factors, such as activity level, insulin resistance, weight and more. There is no single magic number, just conventional recommendations that are a good starting point. I will have a macro calculator coming soon that will help determine what is best for each person, but even then it’s an approximation. The only way to know for sure is to test. If keto is your goal, it’s usually best to start lower and then see if you can stay in ketosis when increasing.
After deciding to have a tummy tuck, Lynn thought it best to have body contouring done at the same time. She chose this option to both minimize downtime from having two separate procedures, and to ensure that, once her stomach had been improved and was more taught, that her thighs matched. She talked with her doctor about making her look as natural as possible. 
Russel Wilder first used the ketogenic diet to treat epilepsy in 1921. He also coined the term "ketogenic diet." For almost a decade, the ketogenic diet enjoyed a place in the medical world as a therapeutic diet for pediatric epilepsy and was widely used until its popularity ceased with the introduction of antiepileptic agents. The resurgence of the ketogenic diet as a rapid weight loss formula is a relatively new concept the has shown to be quite effective, at least in the short run.

Non-cosmetic applications of liposuction were pioneered or developed by surgeons of other specialties. Liposuction could be used to remove lipomas, angiolipomas, and improve hyperhidrosis. Liposuction techniques can assist in hematoma evacuation. Klein[22] demonstrated liposuction techniques for breast reduction [Figure 4]. Field[23] pioneered liposuction to facilitate flap movement in cutaneous reconstruction, gynaecomastia, [Figure 5] and benign symmetrical lipomatosis (Madelung's disease), and Dercum's disease.
Liposuction is a body sculpting procedure that uses a cannula, a thin tube with a vacuum, to break up and suction fat from specific areas of your body. Liposuction is a safe and time-tested procedure that Dr. Ayoub recommends for patients who want to reduce fat from problem areas that just won’t go away no matter how much they diet or exercise. Because the treatment targets specific areas of your body, incisions are small (2-4 millimeters), and patients in Omaha see immediate results that continuously improve during recovery.*
Carbohydrate facts: Simple = bad, complex = good? Carbohydrates provide energy for the body, but the health benefits they offer depend on the type of carbs we consume. Complex carbs, found in brown rice, for example, contain more nutrients than simple carbs, such as white rice. Refined carbs, such as sugary drinks, are best avoided, as their nutritional value is low. Read now
The metabolic syndrome is the name of a cluster of risk factors that, when they appear together, dramatically raise your risk of heart disease, heart failure, stroke and diabetes, as well as other non-cardiovascular conditions. Like smoking, it’s one of the strongest predictors of heart disease. “Nearly one in three Americans have metabolic syndrome. Many people don’t recognize that they have the condition and underestimate the risks it presents,” says Chiadi E. Ndumele, M.D., M.H.S. , cardiologist at the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease. “Understanding that you have metabolic syndrome in the first place can help motivate you to make the needed changes.” 

Interest in body sculpting and cosmetic surgery is at an all-time high. One of the most common questions that patients have when coming in for a liposuction consult is “Is liposuction safe?” Everyone has seen the news stories highlighting bad outcomes, but how often does that really happen? The truth is that complications from liposuction are very rare.  This blog discusses the most common and the most serious risks of liposuction and what you can do to minimize your liposuction risks.
In some ways, it’s similar to the Atkins diet, which similarly boosts the body’s fat-burning abilities through eating only low-carb foods, along with getting rid of foods high in carbs and sugar. Removing glucose from carbohydrate foods will cause the body to burn fat for energy instead. The major differences between the classic keto and the Atkins diet is the former emphasizes healthier keto fats, less overall protein and no processed meat (such as bacon) while having more research to back up its efficacy.
Regular follow-ups with the dietitian, and medical team, will monitor your or your child’s growth (height and weight, if applicable), health, their epilepsy, and if there is a need for any change to their anti-epileptic drugs (AEDs), such as changing to sugar-free versions. If the diet is followed carefully, individuals do not put on weight, or lose weight inappropriately.

Also frequently seen with metabolic syndrome are tendencies for excessive blood clotting and inflammation. While obvious symptoms may be absent, these features are a warning of an increased likelihood of clogged arteries, heart disease, stroke, diabetes, kidney disease, and even premature death. If left untreated, complications from diseases associated with untreated metabolic syndrome can develop in as few as 15 years. Those who have metabolic syndrome and also smoke tend to have an even poorer prognosis.
Pre-tunnelling (Mladick)[25] increases instrument control as, without suction, it creates desired superficial as well as deep planes of fat removal. It prevents an inadvertent removal in the sub-dermal fat layer that can result in contour irregularities. Similarly, cross tunnelling with at least two port sites at right angles are used to treat an area of adiposity. The use of multiple port sites provides for better contouring and feathering of edges.
The keto diet was originally designed not for weight loss, but for epilepsy. In the 1920s, doctors realized that keeping their patients on low-carb diets forced their bodies to use fat as the first-line source of fuel, instead of the usual glucose. When only fat is available for the body to burn, the body converts the fats into fatty acids, and then into compounds called ketones, which can be taken up and used to fuel the body's cells.
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Ultrasonic-assisted liposuction is not a substitute for a healthy diet and regular exercise. Most patients who are good candidates for traditional liposuction are also good candidates for Ultrasonic liposuction, although the result may not necessarily be better. Patients who require a large amount of fat removal may have a better results with ultrasonic liposuction because of the possible enhanced skin retraction.
When in the hospital, glucose levels are checked several times daily and the patient is monitored for signs of symptomatic ketosis (which can be treated with a small quantity of orange juice). Lack of energy and lethargy are common, but disappear within two weeks.[17] The parents attend classes over the first three full days, which cover nutrition, managing the diet, preparing meals, avoiding sugar, and handling illness.[19] The level of parental education and commitment required is higher than with medication.[44]
Regular follow-ups with the dietitian, and medical team, will monitor your or your child’s growth (height and weight, if applicable), health, their epilepsy, and if there is a need for any change to their anti-epileptic drugs (AEDs), such as changing to sugar-free versions. If the diet is followed carefully, individuals do not put on weight, or lose weight inappropriately.
I have pancreatitis, well controlled, which is the way I want to keep it. The biggest difficulty I have with keto is this: I eat a small portion of steel cut oats in the morning. When I don’t, within two days , I start having bleeding, dark in colour. My endrocrinolagest feels that I need the roughage in the steel cut oats to replete the bowel lining. I have great difficulty loosing weight, always have, even though I eat very clean, no junk food, never eat out, don’t like pop, don’t crave sugar, cook all food fresh. Any comment? Willing to try anything you can suggest.
Thankfully, there is realistic hope for naturally preventing metabolic disorders in the body. You can prevent or delay metabolic syndrome mainly with something that is very much in your control — lifestyle changes. A daily and long-term effort to maintain a healthy lifestyle is no doubt your surest and best bet to avoid metabolic syndrome and all the complications that can arise from this multidimensional health struggle! So keep the following in mind:
"Depending on your approach, [keto diets] can contribute to significant lean body mass loss along with fat loss," said Melinda Manore, a professor of nutrition at Oregon State University. (Typically, dieters want to shed only fat, not lean body mass, which includes muscle.) And as with other fad diets, people typically regain the weight once they go off the diet.
This procedure has become one of the most commonly performed cosmetic procedures. At Aesthetic Surgical Images, you can rest assured that our entire staff of caring professionals will treat you with personalized attention. In your initial consultation, one of our plastic surgeons will discuss your goals, address any concerns and even help you visualize realistic results using a state-of-the-art computer imaging system. Learn more about this procedure by reviewing our list of Frequently Asked Questions.
In a way, moderate-intensity physical activity is that "magic pill" a lot of people are looking for, because the health benefits go beyond keeping your waistline trim: Not only can it reduce your risk of cancer, stroke, diabetes and heart attacks, but studies have shown that physical activity can significantly improve the moods of patients with major depressive disorders.
Dr. Campos, it is so discouraging to see that you disparage the ketogenic diet based on your assumption that it is very heavy in poor quality processed meats. No diet that relies on processed foods can be viewed as “healthy”. Become better informed by getting up to speed with what Jeff Volek, RD, PhD, calls a “well-formulated ketogenic diet.” Also, learn more about the potential of the diet to slow cancer progression (my specialty). You owe it to your patients who are depending on you for advice. Present them with facts, not opinions.
The researchers explain that people who cook their own meals may simply have other good-for-you habits, like exercising more. However, they also concluded that home cooks ate more fruits and vegetables (along with a wider variety of foods), have healthier methods of prepping their food, and splurge less on foods high in calories and sugar. No clue where to start? Check out these 25 high-protein chicken recipes for weight loss.
Limits of lignocaine dosage have been explored since the development of this technique. Lillis[14] unofficially reported no complications with tumescent lignocaine dosages of greater than 70 mg/kg.[4] Ostad et al,[15] proposed the maximum tumescent safe lignocaine dosage to be 55 mg/kg of body weight. Maximum safe dose of tumescent lignocaine was a major bone of contention in academic discussions. The demonstration that the peak lignocaine concentration in the blood occurs at approximately 12 hours of initiating of the tumescent infiltration as against the 2 hours as was originally conceived was an unprecedented finding. A safe dosage for tumescent lignocaine was shown to be 35 mg/kg to 50 mg/kg by Kleinin.[16] The rate of infusion of the tumescent anaesthesia was shown to be independent of plasma lignocaine levels.
Wondering how many carb foods you can eat and still be “in ketosis”? The traditional ketogenic diet, created for those with epilepsy consisted of getting about 75 percent of calories from sources of fat (such as oils or fattier cuts of meat), 5 percent from carbohydrates and 20 percent from protein. For most people a less strict version (what I call a “modified keto diet”) can still help promote weight loss in a safe, and often very fast, way.
In the post operative period following abdominal liposuction, the patients are advised to avoid prolonged sitting for 3 to 4 weeks to prevent development of skin folds and creases. Pressure garments are to be religiously worn for 3 to 6 months. While, a regular finger tip pressure massage in the indurated areas is fine with small areas of induration, an ultrasound massage works well for lumpy areas and sites with persistent pain or edema.
The exact cause of metabolic syndrome is not known. Many features of the metabolic syndrome are associated with "insulin resistance." Insulin resistance means that the body does not use insulin efficiently to lower glucose and triglyceride levels. Insulin resistance is a combination of genetic and lifestyle factors. Lifestyle factors include diet, activity and perhaps interrupted sleep patterns (such as sleep apnea).
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