In the fast-paced, first-world professional world, the employee who’s most on the ball, responding to emails past midnight and in the office before nine, is glorified. It has almost become a boast to say that you’ve been too busy to sleep. We all know someone who mentions his or her lack of sleep with pride. Along with ‘sleep is for the weak’, there persists a stubborn yet baseless business culture that adheres to the futility of sleep.
The phenomenon of encouraging insufficient sleep is strange, given how much attention corporations pay towards other areas of employee health, safety and conduct. Somehow we’re stuck on the notion that time spent on task equates to efficiency of task. Regrettably, this is not just a misguided blunder, but a costly one too.
A net annual capital loss of SGD18 million, a result of collective declined productivity rate, is found in companies where employees don’t get enough sleep. These employees are not just less productive, they are also less creative, less motivated and prone to making unethical decisions. On a managerial level, this makes them less charismatic and more abusive. On a national scale, inadequate sleep robs countries of more than two percent of their GDP—roughly the entire cost of its military and almost as much as its investment in education. Just let that sink in.
Sure, there exists a sleep elite, a group that is adept at getting six hours of sleep with minimal impairment. Members of this group carry a sub-variant of the BHLHE41 or Dec2 gene that allows them to sleep no longer than this duration even in the absence of alarms. Don’t be deluded into thinking you could be one of them because this anomaly is so rare that you stand a higher chance of being struck by lightning. Expressed as a percentage of the population, the rounded whole number would be zero.
So for the rest of us mortals, here are three things that could help improve sleep quality.
You probably know Melatonin as a hormone responsible for your dozing off, but sleep is not a block of time when you are knocked unconscious. Human beings, and all living things, live in constant oscillation. You have a circadian rhythm, an internal clock which coordinates according to external social and environmental factors (running at 24 hours and 11 minutes, according to an extensive cave adventure by the godfather of modern sleep medicine, Nathaniel Kleitman, and his science buddy Bruce Richardson). You are simultaneously on another beat working at 90-minute cycles. The ultradian rhythm is what maintains the equilibrium of rest and fatigue.
Besides melatonin, "quick fixes" like a nightcap may shorten the amount of time taken to fall asleep, but its presence in the bloodstream can disrupt the second half of the sleep cycle and the important information consolidation process that takes place during REM sleep. Meaning you get sleep, but not deep, restorative sleep. Alcohol also impairs breathing in sleep, affecting the brain’s breathing centre by masking the effect of low oxygen levels in the bloodstream, which leads to sleep apnoea. So while sleep is one way of energy renewal, the other essential things we do while awake also play a big role in the quality of our sleep. Nutrition, hydration, movement, relationships. Melatonin and the likes are merely the signal to sleep and not what effectualises it.
The thing about chronic (yes, chronic) sleep deficiency over years, or simply months, is that deteriorated alertness, energy and general capacity become the norm to the individual. Even while reading this, you might feel perfectly all right. But what if we told you that based on epidemiological studies of average sleep time, you are living in a sublime compromise in your mental and physical states? If you were to compare it to alcohol, which we all know can severely impede our mind, being awake for 17 hours (usually between 7am and midnight), makes your cognitive impairment no different from one who is legally drunk.
This was proven by the School of Psychology, University of New South Wales, which took two groups of healthy adults, intoxicated the first bunch to the legal driving limit, and kept the other bunch awake. The results of the concentration test by the latter were equivalent or worse. And if you think you can take the weekend to pay off your sleep debt, dream on. Assuming you sleep much less than eight hours a day, Stanford University Sleep Research Center shows even after three nights of ‘recovery’ sleep, your performance will not return to the original baseline of those who sleep the regular eight.
Not the sleeplessness, the positive wind-down rituals. You know them, the ones prescribed by Doctor Google. No heavy meals hours prior, switching off your phone, breathing exercises, etc. Setting an alarm to sleep is a good one. You have one to wake, so why not? It’s all about discipline. Even if they don’t show immediate results, practice them for at least 21 days (the average span for an action to become a habit).
This is true. But only for 40 percent of the population. In adults, our preference for sleeping and waking times are based on our chronotype, which is pretty much programmed into our DNA. Unfortunately for the 30 percent of ‘evening types’, common societal practice restricts them from performing to their potential (usually past work hours), and leave them prone to ill health as a result of a forced early waking time and an innate inability to sleep until far later.
The reason for this genetic inequality? In a time before warm, cosy homes came along, this variation would reduce the period of vulnerability in a community of species living together. So while everyone gets ideally eight hours of sleep, the collective group is only in danger for half that duration. If you believe you belong to a special nocturnal group... the remaining 30 percent are just chronotypes who function best between morning and evening.
While it is good practice to stick to a sleep schedule, don’t lie in bed awake if you simply can’t fall asleep. Don’t allow yourself to be susceptible to attentional bias. Instead, go do something relaxing. Read (but not on devices because you know, blue light). Drink some milk. Daydream even. Picture yourself doing what you enjoy. It’s crucial to avoid exposure to information about sleep to take your focus off trying to sleep and unnecessarily scaring yourself with symptoms you believe you have that you actually don’t.
It all started with my first visit to the Chinese physician because of a sport-related ankle injury years ago. After simple acupuncture and some gentle rotation, the swollen joint was wrapped in a thick slab of heady herbs that had been stewing during the session, and I was told to have it on for a night before being sent on my way. No, it was really a curiosity on the persistence of alternative therapies in an age of modern medicine and technology.
Of course, the ankle sprain and TCM visit did happen, and you might be wondering what happened to the swell in the end. Not to sound like a TV episode that exploits sequence jumps—but we’ll get to it.
There are, needless to say, plenty of alternative or complementary therapies out there, many of which are not recognised by medical studies. From hypnotherapy to reflexology, they can be divided into alternative medical systems, mind-body interventions, biologically based treatments, manipulative and body-based methods, and energy therapies.
As Western medicine is primarily founded on ancient Greek theories and practices, it is logical for its ‘unorthodox’ counterpart to outnumber. You have Ayurveda from the Indians, Reiki from the Japanese, and the list goes on.
We start with the least invasive but potentially the most expensive—gemstone therapy. Associated with chakras and auras, crystals invoke the most spiritual connotations—and eyebrow raises—from their origins to their purposes. More so when they are commonly used as birthstones in accordance to your star sign.
Historical uses of crystals point to divine communication in ceremonies, such as the 12 embedded on the high priest’s breastplate of the Hebrews representing the tribes of Israel, the ancient Egyptians’ Blood of Isis amulets placed on the mummies’ throats to ensure rebirth into the afterlife, and the Aztec’s obsidian sacrificial knife.
In modern times, the procedures for owning a crystal still carry a sense of ritual. You start by choosing a crystal, physically cleansing it and then purifying it off negative vibrations—methods include burying it in a container of sea salt, salted lukewarm water, moist sand or soil and even seawater as long as it is unpolluted (we don’t make the rules!) for a minimum of 24 hours. Otherwise, smudging, where you pass your crystal several times through incense smoke, or even the candle flame itself. Sunlight and moonlight, with the aid of mirrors, are also permitted.
Then comes bonding by familiarising with your crystal, engraving its appearance in your mind and—wait for it—charging it. Not with a type C cable but a meditative intent, you hold the crystal while thinking of the function it’s meant to serve and visualise imparting this energy into it with each exhalation and what you want to receive from it at each inhalation. These are then ‘vibrations’ stored in the crystal. In terms of healing, there are specific properties assigned to each gemstone.
Common ailments—though books are quick to assert that these should not be a replacement of qualified medical diagnosis and treatment—have a recommended pairing. Examples are amber for asthma, ruby for low blood pressure, emerald for constipation, malachite for rheumatism, and a personal favourite—amethyst for alcoholism. All have yet (and are difficult) to be corroborated by science, but we’ll discover it isn’t the only one.
Some 21 years ago, the Traditional Chinese Medicine Practitioners Act was passed in Parliament. By the fifth year, all acupuncturists, physicians and dispensers were registered with the TCM Practitioners Board. So what entitles this 2,000 year old discipline the recognition while others remain in the lurch, especially when it has yet to be fully verified?
“Strictly speaking, there is no alternative medicine. There is only scientifically proven, evidence-based medicine supported by solid data,” Dr NK Ho writes for Singapore Medical Journal in an article titled "Understanding Traditional Chinese Medicine —a doctor’s viewpoint". “Many people still consider traditional medicine as unproven medicine for which scientific evidence is lacking.”
Let’s just trace back to what these Chinese healing techniques entail. Most famously acupuncture and tui na but not exclusive of herbal remedies, dietary therapy, breathing exercises, cupping and moxibustion, all essentially means restoring qi that flows through meridians in the body. One is unwell when his internal qi falls out of balance.
Many translators ascribe qi as the energies that exist in all things in universe. Ruling philosophy combines Buddhism, Confucianism and Taoism, encompassing the harmony of man with the heavens. The principles of yin (negative) and yang (positive) governed theories on bodily functions such as cold and heat, xu (deficiency) and shi (excess). Illness was a result of imbalance. Obviously, these concepts aren’t exactly explainable by modern medical theory. However, the originating Greek principles weren’t entirely different.
Hippocrates believed the balance of passions was key to good health. Likewise, the four humours—blood, phlegm and yellow and black biles—had to be modulated, resulting in infamous practices such as bloodletting. People who prefer Chinese remedies often believe that they have fewer side effects, though most TCM practices have not been validated by randomised controlled trials. Acupuncture seems the most promising of the lot because it has proven lineage between somato-visceral regulation and corresponding brain function. There is functional MRI evidence that suggests a relation to induced analgesia with the release of opioids like endorphins.
Or is it all a big sham? The big question and possibly what got you started on this article. In 2009, Daniel C Cherkin, PhD, carried out a sizeable randomised trial comparing acupuncture, simulated acupuncture and usual care for chronic low back pain. The 638 patients all had pain for at least three months and were divided into four batches.
One was given seven weeks of standardised acupuncture treatment with a fixed number of needles assigned to eight designated points and strictly kept on for the same duration. The second group received individualised treatment where professional physicians had the freedom to prescribe any number of needles and points, while the third involved non-acupuncture points poked at with toothpicks encased in skinny plastic tubes.
As all were completely new to acupuncture and blindfolded for the treatment, most participants could not discern which group they were in. The final control batch received no acupuncture and continued with regular medication and physical therapy as other batches were also allowed to as well.
The results are nothing short of intriguing. Comparing the three types of acupuncture, none was more effective than the others in reducing disability and discomfort. Yet, compared to 39 percent of the control group having no acupuncture, approximately 60 percent of those who had received acupuncture, were ‘toothpicked’ or otherwise claimed improvement after two months. This does not ignore the minority who would have improved due to fluctuations in symptoms or response bias.
Even the Hawthorne effect where subjects of an experiment modify their behaviour in lieu of undergoing observation—in this case a clinical trial inspiring them to take better care of themselves. Still, 21 percent is no insignificant number, and conclusions share similarity with studies from German researchers around the same time.
“Medicine is not only a science; it is also an art.
—Paracelsus
It does not consist of compounding pills and plasters;
it deals with the very processes of life, which must be
understood before they may be guided.”
“A great many of us can block our pain and relieve other symptoms without ever realising it,” reporter Melanie Warner writes in her book, The Science of Alternative Medicine and the Surprising Power of Belief. She cites studies for modern surgery like vertebroplasty for spinal fractures and arthroscopy for osteoarthritic conditions. Heck, even percutaneous coronary intervention for chest pain—you know, where a tiny balloon and stent are inserted into obstructed arteries—is no more effective than having a surgeon give a placebo incision.
“Just thinking you’ve gotten your shoulder or knee fixed is as good for pain relief and mobility as actually having the procedure done.” Warner also tries simulations with neuroscientist Luana Colloca and discovers that despite being aware of placebos, she is still susceptible to it. This aligns with the recent studies of patients who were given vials clearly marked ‘placebo’ while knowing its effects, and having a notable fraction of them still achieving meaningful relief. Some even wanted to continue their dosage after the conducted studies were over.
Ah, the healing wafts of aromatherapy and all the smells of zen. Not to be the constant harbinger of bad news, but as Dr Tieraona Low Dog says, “when looked at in totality, the evidence is weak for beneficial effects with inhalation”. Studies have been done to determine if different scents can carry differing effects on our moods. One compared lavender and lemon and while the latter was purported to be positive for those under stress, neither altered stress indicators, pain control or biochemical markers of immune system changes. Pretty disappointing, we know.
So though there currently isn’t any rigorous research backing lavender scent as a cure for insomnia, essential oils aren’t entirely useless. Many exhibit antiseptic or antioxidising capabilities when applied, some assisting with cellular regeneration. The word antiseptic is self-explanatory; ‘anti’ meaning against and ‘septic’ from sepsis, a potentially fatal severe body response to bacterial infection that causes tissue damage. Thus, what we can say is, the best way to use an essential oil is probably still to smear it on than breathe it in.
Much as we slammed dear Hippocrates earlier, his diagnosis on exercise, rest and good diet on health still stands. In other words, there’s no cheating your way out of this. If there’s any consolation, there prevails one healing method to tap into.
“Herbs are rich in nutrients, and they contain a higher ratio of phytochemicals, which is why their taste and smell are so intense,” registered dietitian Gabby Luo explains. “A moderate consumption of herbs is recommended daily, and the most effective way is by using herbs as conditioning agents to replace salt and sauce.”
A resident nutritionist at Sangha Retreat in Suzhou, Luo goes on to advocate mindful eating, where the practice is not centred on appreciating your food while eating it, but being aware of your body’s need for the right foods and nutrients. The wellness retreat, known for individually curated programmes and facilities designed for a holistic healing, adopts a fused approach.
The East-meets-West approach of observing an individual’s ailments to find the root cause through TCM tenets, then using Western science to quantify nutritional value, including food acidity, to subscribe a recommended diet and ideal meal plan has proven to work effectively together. Especially for chronic health issues, she says.
A diet that is low in palmitic acids (found mostly in saturated, fat-rich foods) and high in oleic acids (abundant in olive oil and tree nuts) is anti-inflammatory and can enhance the sensitivity of the body’s insulin response. Dark-coloured foods are normally high in antioxidants, which help us battle reactive oxygen species (the agent that causes inflammation).
“One of the most common misconceptions is that only ‘superfoods’ are good for anti-inflammation. However, food diversity is of the utmost importance. As all the natural foods contain some certain anti-inflammatory substances, and they interact with each other in the body,” says Luo. “You should always choose multi-coloured fresh vegetables, nuts with skins and coloured whole grains. To create a high-quality and diverse diet that suits your appetite is always a good idea.”
Inflammation is not altogether detrimental. One of the body’s natural defences against illness and injury, though what is more often discussed is how a high sugar and fructose diet triggers major inflammation and precipitates disease. Like how Type 2 diabetes is closely related to obesity, cardiovascular disease, renal diseases and other metabolic syndromes. It is the most-studied chronic disease that can be prevented or even reversed by a lifestyle change. Anti-inflammatory diets are key and more effective than any other medical prevention.
“An effective way to decrease the inflammatory effects of your diet is to use an oil high in oleic acid to cook with, and to consume a predominantly plant-based diet. It is important to include a wide variety of non-starchy fruit and vegetables to balance your nutrient intake, the benefits of which are more explicit when they are eaten as opposed to drunk,” Luo concludes.
Besides ingestion, the physical application of herbs is an age-old concept. In war, the simple meadow herb yarrow was used to staunch haemorrhages and aid scar healing, earning its nickname Soldier’s Woundwort. While we don’t go picking among the grass for stinging nettle, disinfectants like garlic (used in World War II to prevent gangrene) remain unchanged in their antibacterial properties.
Which circles us back to the very start, as promised. My ankle did ‘miraculously’ reduce in swelling to its original state overnight. Whether that was the placebo effect of the needles, the efficacy of the herb patch or simply my body’s natural recovery, it’s hard to say for sure. However, it is now clearer to see that there are ‘alternative’ therapies that work, and why they do. Nonetheless, long-standing methods like TCM are not entirely placebo. Scientist Tu Youyou was awarded for her discovery of artemisinin as a cure for malaria in 2015.
Her team reviewed ancient medical texts before finally finding a reference to sweet wormwood, which treated malaria-like symptoms in China around 400 AD. The extract was developed into a class of drugs and a standard treatment for Plasmodium falciparum. Tu is the first mainland Chinese scientist to achieve a Nobel Prize in a scientific category without a doctorate, medical degree or training abroad.
Just as TCM proves viable in the research for new drugs, there’s also untapped potential in the human body to heal itself. Understanding how the mind holds the reigns. Alongside physical aids procured by science and cues unearthed by history, it’s truly in us to unlock the cure.
While your body, according to John Mayer, is like a wonderland, it is also a machine. And a machine of muscle, blood and skin requires the occasional tune-up. For example, it is advisable to rest after a strenuous physical activity. After a strenuous workout, microscopic tears will appear in your muscle tissues. Only rest allows the fibroblast cells to repair these tears, leading to stronger muscles.
And then there are the injuries that come with the exercise. Maybe you pulled a muscle or there’s stiffness in the joints. Sometimes you have to deal with the injuries that come with exercise. Well, different hurt requires specific cures, right? But Hydragun (the sports health brand that made... well, the Hydragun) created the Thermosleeve with different recovery modalities. You have a cold pack, a heat pack and a compression sleeve—or, as my mother would whole-heartedly favour as, a “three-for-one deal”.
Inflamed joints and muscle pain? Chuck the Thermosleeve in your freezer for an hour or two; the chill from the Thermosleeve retards blood flow to reduce swelling and inflammation, and reduces pain by slowing pain signals to the brain. Muscle stiffness or tightness? A quick 50 seconds of Thermosleeve in the microwave oven should do the trick; just wear it on your elbows, wrists, knees, calves and thighs.
Put the Thermosleeve over the affected area or wear it like a sleeve and the relief should set in in no time. I rolled my ankle around the time I wrote this and the cold was a balm. The swelling subsided and I was able to regain full use of my ankle in no time. After sneezing, a sharp pain shot out in my lower back (it was a really hard sneeze, mmmkay?). Only a warm Thermosleeve helped with the soothing (although for my sleeve, the heat tended to dissipate quite quickly).
The Thermosleeve compression sleeve retails for SGD69.
This was originally printed in the 2022 March issue of Esquire Singapore.
Why is there the phrase “knickers in a knot” but not “boxers in a bunch”? This April in Singapore, the hottest day of the year was recorded at 35.9°C. The worst to me? It was only April. Coupled with the average humidity level of 84 per cent, and sparingly light winds if Mother Nature had mercy, you wouldn’t be able to imagine what our crotches feel like most of the time.
One Tuesday a couple weeks back in May, after an early morning game of basketball with the boys, we sat by the sidelines. While beads of perspiration gathered up and trickled past furrowed brows, we broached the unlikely topic of underwear. Now, as straight men, our conversations are unintentionally skin deep: that “work is relentless”, that someone “tried this omakase place”, that something is “ridiculous in this bear economy...” That morning, though, we debated singularly on the relevance of underwear amid climate change and the perpetual Singaporean summer. Considerations around protection, support, a sense of security and propriety were pit against concerns such as comfort, ventilation, odour, and even confidence.
What felt like nine sweltering minutes went by before the group dispersed into the shower cubicles. Our crotches had been exactly like sweat-drenched, heat-radiating boxers in a bunch.
Though I am not overzealous about free balling, I contemplate it from time to time to cope with the dreaded double whammy of heat and humidity here. For some, freeballing in summer has the same energy as attending a fancy party with minimal make-up—it is about comfort, confidence and a touch of fabulous. Yet, for others like me, it may not be so much a flex as it is pragmatic. Combining the opinions of those around me and on Reddit, it seems reduced perspiration, a lower chance of bacteria growth and odour, and better ventilation are compelling reasons cited by men when asked why they might free ball.
Regardless of motivation, going commando in public, akin to rocking up bare-faced to a soirée, is a ballsy move. My advice as an aesthetics doctor is to invest in some self-care.
At the core of comfort and confidence is self-care. Thankfully, skincare and grooming have burst through the seams of the feminine realm, slowly seeping into the daily lives of men, queer or not. Those who are not yet on board may see skincare regimes as means to achieving the pretty Korean star look, but as a mostly reticent member of the male species myself, I implore even the quintessential macho guys to take skin and body care more seriously. In my field of work, treatments sought by male patients are very commonly for acne scarring, the regrettable result of sheer negligence that does not plague women as much.
Especially for severe acne scarring, treatments are typically customised, taking advantage of different cool equipment and technologies for optimal effect. Bear with me as I geek out: one of those that amaze me is Ultherapy, a non-invasive treatment that lifts, smoothens and tightens skin. Bypassing skin’s surface, Ultherapy is able to deliver the right amount of ultrasound energy at the right depths and temperature, in order to trigger a natural response under the skin, jumpstarting the regenerative process that produces fresh, new collagen. Ultherapy is commonly used to lift skin on the neck, chin and brow, and to reduce lines and wrinkles. With an appointment, patients are usually in and out the clinic in an hour tops; some even get it done over lunch break.
For the bolder (or more macho, if you please) among us, one of the injectables that stand out as an especially efficient treatment is Profhilo. It super-charges skin with a high concentration of the formidable hyaluronic acid (HA), stimulating the production of new collagen and elastin, both of which give skin great texture and brightness. Profhilo delivers deep hydration and treats skin laxity, helping to lift and tighten it too.
Coming out of my awe of potion-like chemicals and marvellous technology, I lament the predicament of men who suffer from pubescent acne and its emotional and mental implications. If only men felt empowered too, to begin caring for their skin from adolescence as women usually do. I mean, if we collectively have such poor facial and dermal hygiene, what could it be like where the sun doesn’t shine?
In my advocacy for self-care and living well, comfort down south is just as big a deal as the rest of the body. The ultimate nemesis of modern-day grooming needs no introduction: we have a troubling love-hate affair with hair—too much, too little, too patchy, too thick. Down south though, more want their lawns mown, be they flat or hilly terrains, to prevent ingrown hair and pimples that come with an inevitably sticky, itchy crotch in tropical weather.
IPL, short for intense pulsed light, is an effective way to get rid of hair permanently. It involves long-term treatment every four to six weeks, where high-energy light is used to permanently destroy hair and hair follicles where you don't want them. You'll have less scratching and pinching, just good ol’ hanging.
Where a partner is involved, smell must be the chef’s kiss. There is now a gamut of hygiene products dedicated to the cause. Check out a ball wash, rub or deodorant the next time you are in a drug store—they help to fight odour, leaving us fresh, clean, and hopefully, yummy. It would also be wise to invest in a set for when shorty gets low, low, low.
Next time the mercury level hits over 33°C and the potentially bashful idea of free balling comes to mind, don’t get your boxers in a bunch. Do what is necessary so you can shake, shake, shake it, bruh.
