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September 12, 2020

Dear Clinic Members,

Today’s newsletter focuses on two things that profoundly affect overall health: air quality and good quality sleep.

First, the wildfire smoke that is turning our skies yellow is very concerning, particularly since the pandemic has created new ways of doing business and personal routines that rely on spending time in the fresh air. We encourage everyone to check the resources at the bottom of this letter to guide your actions. Advice from the State Department of Health right now includes:

Stay indoors when it’s smoky and keep indoor air clean. Improve filtration of indoor air in your home and consider creating a clean air room where you spend most of your time. Making your own box fan filter can be a less expensive option to filter air and improve indoor air quality in a single room.

It’s important to know that cloth masks will not adequately filter the particles and gases in the air right now; N95 masks, if fitted and worn properly, can reduce your exposure to wildfire smoke, but the supply of these masks remains limited. If you happen to have a professional type of respirator (N100 or P100 rated) that uses filtration canisters, this would offer fairly good protection from the unhealthy air if you do need to spend time outside.

While these are steps for everyone to take during this weekend, we also want to send the message that this air quality situation will almost certainly happen again. When it gets this bad in the future, vulnerable patients (like those with heart disease or lung disease, or who have had a stroke) should consider a standing plan as to how they might remove themselves to somewhere with cleaner air.

The second thing we want to discuss is sleep quality. Anxiety, financial stressors, social isolation, and changes to our usual daily routines have resulted in a lot of sleepless nights for many of us. Experts agree that getting consistent, high-quality sleep improves virtually all aspects of health, which is why it is worthy of our attention during the coronavirus pandemic.

The National Sleep Foundation points out some reasons why sleep is especially important right now:

Sleep increases the effectiveness of your immune system. If you are exposed to the coronavirus, you have a better chance of fighting it off if you are well-rested.

Studies have found that lack of sleep can decrease the effectiveness of vaccines–this is especially important as we approach flu season.

Sleep heightens overall brain function and especially helps executive function. In a situation where we are constantly adapting to new routines and many of us are trying to learn and work from home, good sleep will help us be sharp and productive decision-makers.

Sleep enhances mood. This fact is particularly important for adolescents experiencing anxiety and depression; sleep deprivation is correlated with suicidal ideation and family members should do what they can to encourage adequate sleep for adolescents.

Here are some tips for a better night’s sleep from sleep scientist Matthew Walker:

Regularity. Going to bed at the same time and waking up at the same time will anchor your sleep’s quality and quantity.

Coolness. Try to keep your room cool. (65 degrees is ideal.) If you don’t have air-conditioning and your room is too warm, you can make use of things like fans or ice packs or coolish (not cold!) showers to help lower your core body temperature.

Darkness. We need darkness in the evening before we go to sleep, especially in the last hour before bedtime. During the night, you might use an eye mask and blackout shades.

Get up if you can’t fall asleep (or back asleep) after 25 minutes. Do something boring, and then go back to bed when you’re sleepy.

Try to stay away from caffeine in the afternoon and evening and monitor your alcohol intake.

Have a wind-down routine. It takes time for your brain to gradually descend into the firm bedrock of good sleep — it’s not merely a matter of turning off the light switch when bedtime arrives.

All of the above is general guidance; patients who are concerned about a sleep disorder should reach out to the clinic.

Our current thoughts about the coronavirus pandemic include a sense of encouragement as we see the decreasing numbers of new cases in Kitsap County and in Washington State. At the same time, we feel compelled to point out again that continued vigilance in adhering to social distancing guidelines is paramount. To let down our guard is to invite resurgence of viral spread, as happened over the summer. Research published in the last week shows that the survey subjects who had been infected with Covid19 were twice as likely to have eaten in a restaurant or spent time in a bar during the two weeks prior to diagnosis — which reinforces the importance of these social distancing guidelines.

Testing capacity has been improving, and turnaround time for test results is much better than it was in early July. Please call if you develop symptoms of infection or have had known contact with a positive case.

Although we continue to operate on reduced hours, Dr. Crandell remains available when the clinic is not open. Please call the office for urgent matters, and choose the option to ring through directly to Dr. Crandell. For items that are not so urgent, you can use the Elation Passport messaging portal to reach us.

Supplies of flu shots have been tight, and we are currently waiting on our next shipment of high-dose vaccine (for folks over age 65). We expect it to arrive at the beginning of October and we will continue reaching out to schedule patients for their shots as our supply dictates. If you received your flu shot at a pharmacy or other location outside of Member Plus Family Health, please drop us a line to let us know.

We feel grateful for the patience and understanding that our clinic members have continued to extend to us during these trying months, and we remain committed to your health and well-being.

Warm regards,

Dr. Crandell and staff

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Resources for monitoring air quality:

This Washington Department of Ecology website can be checked for the latest information on current air quality:

https://enviwa.ecology.wa.gov/home/map

https://enviwa.ecology.wa.gov/home/text/421

This explanation of what the levels of air quality mean in practical terms is important information to know:

https://enviwa.ecology.wa.gov/Documents/1802024.pdf

The State Department of Health contributes to this website:

https://wasmoke.blogspot.com/2020/09/wildfire-smoke-covid-19-bad-combination.html

Resources for sleep quality and importance:

Matthew Walker’s short TED talk:

This is a conversational and informative article on sleep scientist Matthew Walker’s tips for getting good sleep:

https://www.ft.com/content/e6ccdcac-133d-11e9-a581-4ff78404524e

https://www.mayoclinic.org/diseases-conditions/insomnia/expert-answers/lack-of-sleep/faq-20057757

https://www.ucsf.edu/news/2012/08/12458/sleep-affects-potency-vaccines

https://www.ucsfhealth.org/education/tips-for-a-better-nights-sleep