Juggler's Syndrome

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I saw a man not too long ago who could only get five or six hours of sleep. We ruled out the obvious causes for insomnia, including sleep apnea, restless leg syndrome, depression, excess caffeine, and chronic pain. He was a doctor who often found himself lying awake at night thinking about his responsibilities. Along with his sleep problem, he had begun having bouts of atrial fibrillation, a disorder marked by an irregular heartbeat. He had begun to feel very 'old.'

Endocrine tests revealed low thyroid activity as well as extremely low levels of testosterone and cortisol. Thanks to a look into his brain via MRI, we noted that his pituitary gland, a key regulator of the endocrine system, had shrunk as well.

The treatment was two-pronged: We put him on hormone replacements, and he retired. In his words, 'the stress was just too much.' Within six months he reported feeling well, his dentist noted that his gums were 'rejuvenated,' his sex life improved, and so did his heart irregularity. Even more interesting, he started getting the restorative, undisrupted sleep he badly needed.

What started his troubles? We had no definite answer. His sleep problems may have been caused by his endocrine disorder, but there was another possibility. It could be that his overloaded life led to chronic stress, and the resulting cascade of ill effects included a withered endocrine system. If I had to hedge my bets, I'd go with the latter explanation.

Chronic stress has been shown to weaken our immune system, strain the heart, damage memory cells in the brain, and cause the insulin resistance that leads to type 2 diabetes. It has been implicated in cancer, depression, and even rheumatoid arthritis.

The bottom line is that we need to take responsibility for slowing down. To a stressed-out patient (or friend) I'd say: Try to limit your commitments. Give yourself time to rest, to exercise, and to eat sensibly. Stop at one drink, limit the caffeine, and definitely don't smoke cigarettes. Here's one more: Control your impulse to multitask! In the effort to do too much, we actually accomplish less. Rediscover the pleasure and surprising efficiency of doing one thing at a time. Most of us harbor a nagging belief that a slower life is a luxury we can't afford. Our bodies tell us otherwise. Slowing down is essential to our health.

Dan Beskind, M.D., M.P.H. is medical director of Southwest Preventive Health, an integrative health center located in Tucson, Arizona (www.southwestpreventivehealth.com). He also lectures on preventive health and hosts a radio show on KNST in Tucson called An Ounce of Prevention.

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