An amazing thing has happened to me recently. About a month ago I started noticing that I was getting dizzy and lightheaded when standing up suddenly from gardening or stooping over. A quick check of my blood pressure showed it was running about 105/70, so I quit my 12.5 mg of Atenolol. So far the BP is hanging in there at 112-118/80-85 range without medicine.

Now, I have been taking BP medicine for over 14 years. Hypertension runs strongly in my family. When we went to New Zealand 3 years ago, I lost about 10 kg and started walking more, and was able to cut down from my then 50 mg dose to 25 mg. I lost more weight in early 2006 and cut down from 25 mg to 12.5 mg daily. But my weight has now been stable for the last year, I am exercising and eating about the same.

The only explanation I can come up with is that I am sleeping better. I now get at least 8 hours of uninterrupted sleep every single night, usually getting up only one time to the toilet. I did a PubMed search yesterday, which confirms that this may have a significant effect. Last year a huge study on health and nutrition showed that short sleep is associated with hypertension. There have also been Japanese studies of shift workers showing more severity and faster progression of hypertension.

Usually we doctors think of lifestyle changes as weight loss and low salt diet and exercise, and neglect to talk to our patients about adequate sleep. But I am more convinced than ever that our 24/7 world, epitomized by 24 hour Wal-Mart in the U.S. is really bad for cardiovascular health. For me especially, the many phone calls and night calls I have been doing the last almost 30 years of medicine have not been healthy. I am convinced there are also a lot of not-so-obviously-obese people out there who also have sleep apnea and terrible sleep hygiene causing high blood pressure and vascular disease.

And this does not even take into account the other good effects of adequate sleep, which for me include better energy, more upbeat mood and an easier time "living in the moment". So when considering recent events like flying cows and bogged aircraft wheels, I don't feel especially stressed.

One social difference between the U.S. and both New Zealand and Australia are the limited shopping hours. Most everything here closes at 5PM daily, except the groceries which might stay open until 7 pm. This leads to busy noon hour shopping, but most people do not work late shifts or night hours, except for "emergency personnel" and hospital staff.

Certainly this gives me great pause when considering returning to a busy call schedule when we come back to the U.S. It should make all of us think twice about the work schedules of key people in our society: not just doctors and nurses, but aircraft and auto mechanics, police and fire personnel, and even factory workers and the poor guys behind the counter at 7/11 at 1 AM. We all may pay a terrible price for being "24/7".