Get Some ZZZZ's -Living with Obstructive Sleep Apnea

Sleep Apnea can strike anyone

noreply@blogger.com (Lori Kay) — Sun, 17 Jan 2010 00:13:00 +0000

There has been information out that links sleep apnea to the death of Reggie White back in 2006. Think of that! He was a tough, in-shape guy! Kind of interesting to read more.... Sleep apnea factor in Reggie White's death

Preparing for a Sleep Study

noreply@blogger.com (Lori Kay) — Sat, 16 Jan 2010 23:45:00 +0000

I did my sleep study at Winmar Sleep Center. www.winmarsleep.com Their website has a good sleep questionaire that I did when I was first suspecting that I had sleep apnea. I scored horribly and knew it was time to get some help!! I was very nervous for my sleep study. For as tired and exhausted as I felt, I only slept about 2 hours! It was however, enough time for them to get good readings on me. I did have to go back for a second night to be fitted with a mask and the air pressure adjusted to my needs. The technician assured me that it was not unusall to have this happen since you are trying to sleep in an unusal place with wires stuck all over you!! You are also videoed to they can monitor your sleep positions, how many times you change position and also to monitor leg activity in-case restless leg syndrome may be an issue. After your sleep study, it if is discovered you are having apneic episodes, you doctor may choose to do prescribe several options: -CPAP (continous positive airway pressue) -Education on good sleep hygiene -Have you try to alter your sleep positions -Loose weight -Fix nasal congestion, possibly with surgery if needed -Encourage you to find daytime stimulation and not take naps to get on a good nighttime sleep cycle If your docotor prescribes a CPAP for you, you will take time with the sleep study staff to have a mask that is fitted to your physical needs. MANY INSURANCES ARE NOW RECOGNIZING THE IMPORTANCE OF GOOD SLEEP AND ARE COVERING COSTS OF SLEEP STUDIES AND CPAP MACHINES, PRIOR AUTHORIZATION IS OFTEN NEEDED AND USUALLY GRANTED!

Sleep Cycles

noreply@blogger.com (Lori Kay) — Sat, 20 Jun 2009 17:54:00 +0000

I have found that learning about the different cycles of sleep it has helped me to understand my symptoms of sleep apnea and to identify when I have or have not been having a good nights sleep. Unfortunately, I believe, that while a CPAP is essential to maintaining your health if you have OSA, it is like so many other conditions that you might have to take medications for - you feel better, but it is not a cure, just management of the disease. There are 5 stages if sleep: Stage 1 is about 5-10% of our sleep time and Stage 2 is about 30-50% of our sleep time. These are the lighter stages of sleep. Stage 3 into 4 is what is considered our deep sleep. it accounts for 20-40% of our sleep time. It is also called our slow wave sleep. There is no rapid eye movement, our heart rate, breathing and blood pressure all decrease. Many experts feel this is the time our body takes to restore itself physically. The last and final stage of sleep is REM sleep or Rapid Eye Movement sleep. It accounts for 20-25% of our sleep time. During this time our brain activity is very intense. Dreams are experienced in REM sleep. Experts are not sure why our brain activity is so intense, but it may the way our body restores our mind or psyche - it's like cleaning out all the bad garbage we don't need. I think of some of the dreams I have had where I finally got to be friends with someone who I had wronged or say goodbye to someone who is no longer living.... I DO believe dreams help us stay sane! The odd thing about REM is even though our brain is intensely active, our bodies are paralyzed. If you have ever been suddenly awakeed from this sleep cycle from a loud sound, like a police siren, you may have noticed that your body feels like a dead weight! You have been like paralyzed and it is hard to get your body to respond quickly to the whatever it was that awakened you! 1 sleep cycles of all 5 stages takes about 90 minutes. So there are about 4-6 cycles per night. As it gets towards morning, we have longer periods of REM than when we first laid down to sleep at night. You also come out of REM quicker as the am hours approach. Since dreaming takes place in REM and REM is longer towards morning, you will sometimes remember your dreams you had right before waking for the day!

Myths or Excuses

noreply@blogger.com (Lori Kay) — Tue, 02 Jun 2009 11:35:00 +0000

We all have excuses for why we aren't sleeping well or getting enough sleep. Here are some common ones: *You need less sleep as you get older...Wrong!! You still need the same amount of daily sleep. We tend to have more nightly waking episodes as we enter our golden years, so we need to take naps during the day to get our needed amount of sleep. *Alcohol helps you sleep better...Wrong!! Alcohol actually keeps you from getting into a deep sleep. *Snoring is harmless...Wrong!! It may be an indication of an underlying problem of OSA *I can get by on 5-6 hours of sleep...Wrong!! You can for short term buy eventually you will start to aquire SLEEP DEBT and it will affect your daily performance at work or school. *I can learn to get by on less sleep...Wrong!! Same reason as above! *Falling asleep during the day is a sign of laziness...Wrong!! It is a sign of a physiological need for sleep. *Napping is a bad habit...Not Necessarily. Not if we are truly needing sleep and our naps do not interfere with our night time sleep routine. You can't sleep more than your body needs. If you continue to nap, it is because for some reason your body needed it. *How I sleep doesn't affect the rest of my health...Wrong!! Sleep is essential to healthy living as much as diet and exercise!

Gone too long.

noreply@blogger.com (Lori Kay) — Tue, 02 Jun 2009 11:13:00 +0000

It has been almost 6 months since I have posted here. It has been way to long. I started a new job - which was more overwhelming that I ever thought it would be and just when I was getting settled in, Fargo/Moorhead had the worst flooding event of our Red River than we have ever had before. It has taken the many of our friend and even the whole city a while to get back to normal. All I can say is that this is the first week where I feel like I am back to doing the regular things I did before the flood. I am excited to continue the blog. I have been on treatment now for a year for OSA and there are some things to talk about concerning on going treatment. Stay tuned!

Good Video to view on You Tube

noreply@blogger.com (Lori Kay) — Fri, 19 Dec 2008 06:50:00 +0000

Light's Out - Dying for a Good Night's Sleep

noreply@blogger.com (Lori Kay) — Thu, 18 Dec 2008 01:08:00 +0000

T.S Wiley and Bent Formby, PhD are the authors of "Light's Out-Dying for a Good's Night Sleep". Their view is that, as a nation, Americans are sick because we don't get enough sleep. I want to take this post to highlight some points from this book that I really think are great. It isn't talking about sleep apnea - just sleep, or our lack-there-of. The book's focus is that our lack of sleep, not lack of exercise and poor diet, is what leads to heart disease, diabetes, obesity and cancer. The book is rather technical and you almost get a sense the authors think there is a goverment conspiracy behind the push for increased carbohydate intake in our nation. However, if you take some of what is presented with a grain-of-salt, the book does talk about hormones that are regulated in sleep which affect our appetite. It was a light-bulb moment for me. It was an understanding of most of my life of trying to loose weight! So here I go! I will try to give you the hormone connection to sleep and sugar in a nutshell.... "Light's Out" starts out with trying to convey an understanding of where humans have come from...cavemen/nomads scrounging for food. We would have summer, where food is abundant and humans would store up fat for winter, and then there was winnter. Winter was a time of sleeping, eating what little variety of food could be stored or hunted, and making babies. As we have progressed, we have taken those long winter naps our bodies long for from caveman days, and made it perpetual summer with our bright flourecent lights that are on all winter long. Because we have light (and TV and computers and sports events, etc) we stay up too late at night and have shortened our night's sleep to way less than the 9.5 hours that would be optimal for humans. The main hormones the book talkes about are cortisol, serotonin, melatonin, prolactin, leptin and insulin and how they function in the sleep cycle. Melatonin and prolactin are produced during sleep and are very important antioxidants. When we don't get enough sleep, these two hormones aren't allowed to function how they are supposed to and we loose out on their faboulous antioxidant properties. The authors stongly feel this leads to the manifestation of many different diseases. It's a complicated cycle, let's start with serotonin. Serotonin is a hormone that is released in respose to cortisol. Cortisol is also a hormone. It is high when we have too many stressors in our life. It doesn't have to be bad stress either (divorce, death of a loved one, moving, empty nest) it can just be the busy stress of coming home from work, quick eating supper, going to the kids basketball game, coming home for a quick shower. When Cortisol is high, serotonin is high. When we sleep our serotonin gets converted to melotonin during the night. Melotonin is good - it helps us fall asleep and stay asleep. If we have too much stress and therefore too much serotonin and don't sleep long enough at night so all that serotonin can gets turned into melotonin then we have left-over serotonin in the morning. If this chronically takes place, it can lead to high serotonin levels and depression. It helps to keep serotonin low by getting enough sleep. Melotonin helps us fall alseep and stay asleep. This is important because when we sleep, and not until we fall into a good sleep, prolactin is produced. Prolactin is an important hormone because it controls our daytime appetite. It affects the hormone leptin which regulates our carbhydrate cravings. If we go to bed too late, we cannot get all our prolactin produced in a short night and we continue to produce prolactin into the morning. This excess prolactin will suppress the hormone leptin. If we low levels of leptin - we crave carbohydrates!!! Our bodies think we are under stress and that we need to take in energy for a "fight-or-flight" response. Hormone cycles are difficult to understand, but can you see the picture I am trying to convey? We continually shorten our nights. We have work deadlines, children's activites, shopping to do, housekeeping to do and all this leads to more stress and longer days. Longer days mean shorter nights! Less sleep, more stress->high cortisol->high serotonin->not enough time to process all our serotonin into the antioxidants we need in melotonin. Less sleep-> delays the processing of the prolactin we need from during our sleeping hours into the morning hours->suppressed leptin->carbohydrate cravings->high intake of carbohydrates->excess carbohydrates decrease the effectiveness of insulin causing us to store our excess carbohydrates as fat.->high insulin levels->stress on our body->high cortisol.... One big cycle with a good's night sleep right in the middle!!Whew!!! That is a lot of info! This book definitely goes to the extreme of trying to get their point across, but I want you to take this with you today: Sleep is a good thing. Sleep is a biological need. It helped me to read the technical cycles of hormones in this book. I have tried to be more conscious of my bed-time since I read this book. If I need to be up later, I try to keep the lights low and the tv off, or the sound low. I try to not be at the computer or watching tv right before I go to bed, so my mind has a chance to slow down some and prepare for sleep. I sure don't get in 9.5 hours a night, but I try to shoot for 8. I still feel like I am recovering from so many years of lack of sleep due to the sleep apnea that 8-9 hours of sleep is great for me. Maybe I will not need quite so much after I have repaid some of my sleep debt. I can say this for sure : When I have a short night sleep or several in a row - I do find that I am looking in the cupboard for snacks. If I had a really long, restful night's sleep I can adhere to a lower carb lifestyle easier. I recommend this book to read. Just remember to not take everything they say to heart - the authors do tend to be a bit extreme!

Fatique Severity Scale

noreply@blogger.com (Lori Kay) — Thu, 11 Dec 2008 22:02:00 +0000

Fatigue Severity Scale (FSS) Questionnaire During the past week, I have found that: Disagree <--------> Agree My motivation is lower when I am fatigued. 1 2 3 4 5 6 7 Exercise brings on my fatigue. 1 2 3 4 5 6 7 I am easily fatigued. 1 2 3 4 5 6 7 Fatigue interferes with my physical functioning. 1 2 3 4 5 6 7 Fatigue causes frequent problems for me. 1 2 3 4 5 6 7 My fatigue prevents sustained physical functioning. 1 2 3 4 5 6 7 Fatigue interferes with carrying out certain duties and responsibilities. 1 2 3 4 5 6 7 Fatigue is among my three most disabling symptoms. 1 2 3 4 5 6 7 Fatigue interferes with my work, family, or social life. 1 2 3 4 5 6 7 Total Score: _________ This is a small test you can take to help you determine if you need to speak with your doctor on your exccessive daytime fatigue. It is taken from Lauren B. Krupps. The rest of the test and interpretive guide can be found at this link: http://www.healthywomen.org/FatigueSeverityScale.pdf Another questionnaire you can complete to check your daytime sleepiness is the Epworth Sleepiness Scale found here: http://www.stanford.edu/~dement/key.html I got a kick out of doing both of these as I have been using CPAP therapy for over 6 months now - I still rate a 13 on the Epworth Sleepiness Scale!! I feel 100% better than I used to, but wow! sometimes I wonder if I will ever feel completely rested! I have been catching myself staying up later at night. I am feeling so much better that I don't feel the need to go to bed at 8:30pm every night, so I stay up later getting more things done cutting my night's sleep down to 7 hours or less each night. I feel best when I get about 8.5 hours each night. How much you need each night might be different from me. I need to be more aware of the "sleepy" clues that my body is giving me.

Getting Help for Your Poor Sleep

noreply@blogger.com (Lori Kay) — Wed, 03 Dec 2008 14:42:00 +0000

In order for you to determine is a sleep disorder is cause for concern, you must see your doctor! Your doctor will ask sleep questions and may have you keep a sleep log. You may be asked to log your feelings, fatigue, sleepiness, snoring or if you notice you stop breathing (or your partner notices).There are over 80 distinct sleep disorders! That's why visiting with your doctor and perhaps doing a sleep study is necessary to determine if your poor sleep is due to Obstructive Sleep Apnea (OSA). Sleep apnea is the most common sleep disorder with 25% of men and 10% women having it to some degree. Occasional apnea is normal in mature adults. It becomes a health concern when it is repetitive. Sleep apnea can occur in normal weight adults and even children!! OSA -is characterized by repetitive episode of complete (apnea) or partial (hypoapnea) upper airway obstruction during sleep. A few signs are snoring, gasping for breath during sleep, and excess daytime sleepiness. You may wake up often during the night due to snoring, acid reflux, leg/arm jerking, or the need to go to the bathroom. In the morning you may experience dry mouth and headache. ( I suffered terribly from dry mouth and headache. Every single day I woke up with a pounding headache....this doesn't make for a very cheerful morning at the breakfast table!) Above information compiled from "Getting a Good Night's Sleep - A Cleavland Clinic Guide" by Dr. Nancy Foldvary-Schafe, DO

Do you have a Sleep Disorder?

noreply@blogger.com (Lori Kay) — Tue, 02 Dec 2008 03:21:00 +0000

This blog will only get into the specifics of obstructive sleep apnea. However, you may not be searching for information precisely for OBS, but you may be looking for some answers on why you feel so terrible and are always tired. Again, some signs of sleep deprivation maybe: Impaired or shortened memory, loss of temper, irritable, dozing while driving or in a meeting, hitting the snooze repeatedly, lack of energy. Here are some questions to ask yourself or visit about with your doctor:

Are you often sleepy during the day
Do you snore or have interrupted breathing
Do you kick or thrash about in your sleep
Do you have trouble falling asleep or staying asleep
Is there a family history of sleep disorders
Do you have an unusual sensation in your legs that keeps you from falling asleep
Do you sleepwalk, sleep-eat, act out your dreams (that may harm yourself or others)
Do you keep irregular or inconsistent sleep times
Is your bedroom environment noisy, bright or uncomfortable
Have you felt any of these for more than 3 months

Your "SLEEP" activity is just as critical as your daytime activity. The quality of the time you spend going through the various sleep cycles at night is just as important to your health as eating wisely and making sure you get adequate exercise. Sleep loss, due to any of several sleep disorders, can lead to increased risk for diabetes, high blood pressure, weight gain and effects on you mental health as well.

Work on your Sleep Hygene - Here are a few simple suggestions to help you facilitate a better nights sleep before you have the chance to visit with your doctor.

Avoid caffine late in the day - better yet, no caffine after 4pm
Moderate your alcohol intake, especally in the evening. Alcohol disrupts the normal sleep cycles
Create an inviting environment for sleep - block out all light, shut of radio/tv, have room at comfortable temperature
Go to bed at the same time every night - the earlier the better! Shoot for 8-9 hours of sleep per night!
Use your bed only for sleep and sex. Do not read or watch TV before bed or at anytime during the day.
Keep a consistent waking time. Shoot for 8-9 hours of sleep before waking needs to occur.
Keep as closely too the same bedtime and waking hours on the weekends as needed for weekdays. Don't stay up too late just because it is Friday night!

Ask your doctor for a sleep quiz. Here is the quiz I did from the center where I had my sleep study: http://www.winmarsleep.com/

What is Sleep?

noreply@blogger.com (Lori Kay) — Tue, 25 Nov 2008 16:15:00 +0000

I love the quote by Robert MacNish, "Sleep is the intermediate state between wakefulness and death; wakefulness being regarded as the active state of all the animal and intellectual functions and death as that of their total suspension." The reason I love this quote is because Mr. MacNish was quoted saying it in 1834 ! The need for sleep isn't something we are needing to learn to deal with in the 21st Century, the need to refresh, re-energize and renew has been something that man has speculated and researched for a very long time! Here is what we do know about sleep: 1) Sleep needs are a basic human need and is influenced by our genetics. Some people can live well on 7-8 hours of sleep, others need 9-10 hours. So if you are someone who needs a good 9-10 hours a night (like myself) please do not feel like you are lazy!! It is a biological need for your body! Studies have also proven that continually getting 6 or less hours of sleep per night is not enough for any person to continue to be healthy and function at full capacity. 2) We cannot learn to sleep less. Our body needs sleep and if we try to survive on less, we will have problems: high blood pressure, insulin intolerance, fatigue, reduced performance at work, reduced immune system, etc. 3) Sleep is not a waste of time. It is simply a biological need like eating and reproduction. 4) Sleepiness is not a character flaw, it is a sign of sleep deprivation. It often can be due to a sleep disorder like sleep apnea. Of course, not all of us who are sleepy have sleep apnea, but think about how driven we have all become! We sacrifice evening downtime to work longer and harder to get ahead rather than do things to unwind. We stay on our computers until late, watch TV late, go to kids activities until late in the evening, etc. Did you know it can take hours for your mind to unwind at night after a long hard days work? Give yourself and your kids time every evening to SLOW DOWN. Our brains need this time to slow down so it can prepare for a restful nights sleep. Instead of keeping the TV on or working on the computer until right before bed, try lowering the lights and reading a chapter in a book. Other good suggestions are turning the lights down and listening to some soft music while you visit with your spouse or children, you can even take this time to do some gentle stretching exercises. Find something that lowers the lights and just lets your mind go free! It will be a great lead in to a restful night of sleep!!

Above information compiled from "Getting a Good Night's Sleep - A Cleavland Clinic Guide" by Dr. Nancy Foldvary-Schafe, DO

Signs and Symptoms of Sleep Apnea

noreply@blogger.com (Lori Kay) — Fri, 21 Nov 2008 04:24:00 +0000

sudden awakening after apneic episode
feel like gasping or choking in sleep
daytime sleepiness
sudden daytime sleep "attacks" (ie -fall asleep at the wheel or in meeting)
overnight sleep was unrefreshing
fatigue
night sweats
dry mouth, sore throat in morning
morning headaches
forgetfulness
irritability
impotence, loss of sex drive
large neck; greater than 17 inch circumference
history of snoring (often loud "fog-horn" type sound)
high BMI (obese, excess weight)
hypertension
airway structural blockage (ie - nasal obstruction, enlarged tonsils)

SNORE - SILENCE - GASP

noreply@blogger.com (Lori Kay) — Fri, 21 Nov 2008 04:12:00 +0000

People who have sleep apnea are often terribly loud snorers, but not all! And not all snorers have sleep apnea! There are some structural physical features that have been associated with snoring and/or sleep apnea: small jaw, large tongue, overbite, enlarged tonsils, excess tissue blocking airway When we sleep, muscles in the throat relax and collapse, this blocks our airway. A partial collapse of the airway causes snoring, a complete collapse causes apnea. This is what ends up happening all night long for most sufferes of sleep apnea: You fall asleep-> there may be loud, disruptive snoring->all breathing and snoring stops->heart rate slows-> body becomes alarmed and says "HEY! WAKE UP!"->you wake up->catch your breath(gasp)->go back to sleep/snoring (information compiled from author Dr. Nancy Foldvary-Schafe, DO)

Sleep isn't a luxury...It is a necessity!!

noreply@blogger.com (Lori Kay) — Wed, 19 Nov 2008 16:03:00 +0000

I am going to spend the next several posts relaying highlights from the book: "Getting a Good's Night Sleep-A Cleavland Clinic Guide" by Nancy Foldvary-Schafe, OD I found very good information in this book covering many sleep disorders. I will highlight aspects of this book regarding the importance of sleep and then more specifically sleep apnea. I am not going to bother putting quotations marks to site Dr. Foldvary-Schafe because everything in this post is from her book put into my own words. As Americans we all need to learn that we are poor sleepers and that continually loosing sleep is a heath risk. Sleep restores nutrients, replenishes the spirit and refreshes the mind. As Americans we have adopted certain views at too much sleep.

It's my personality, I have never slept well and that's how I am
We need to be ambitious: we can sleep when we are dead
Sleep is regarded as optional
Coffee cures will give us the boost we need

In reality, lack of sleep may find us dozing at the wheel or during meetings at work. Our work performance can actually suffer because we are too tired during the day. The one that hurts the most...we are often too tired to do things with our family and children.

So if your morning goes like this: you feel the alarm goes off WAY to early, you hit snooze several time, you feel drowsy, you may be grumpy (even after several cups of coffee) then you are probably like 70 million other Americans who are sleep deprived. Not sleeping well effects our relationships, work, education, appetite and motivation. So we need to explore what sleep is, how come it can be poor sleep or not enough sleep, and specifically for us here - what sleep apnea is and how to live better with this condition.

Long path to discovery.

noreply@blogger.com (Lori Kay) — Tue, 18 Nov 2008 03:50:00 +0000

It was about two years ago when my husband (who is a night owl and often comes to bed an hour or two after I am well into slumber) noticed I would quit breathing while I was sleeping. He had long since complained about my horrible snoring that was much like a fog horn. He would climb into bed and become frightened - no not because of my hairy legs!!!! - but I would completely stop breathing! Many times he would shake me, "Lori, Lori...are you alright? Wake up!" A few times he thought I had quite breathing for good. Most of time, when he shook me, I would wake some, gasp for breath, roll over and go back to sleep. I had to go in for a regular check up and was suffering from fatigue, like normal, and again mentioned to my physician that I was so tired all the time. We briefly talked about sleep apnea, but I had a few other medical issues that seemed more immedicate and basically we both forgot I had mentioned it. ( I was dealing with a horrible case of hives that I suffered from for several months and nearly drove me crazy, plus my thyroid levels were way high again). Time went by - I went on a protein diet, lost weight, my snoring got somewhat better and I felt better. But just like all the other times, I gained all the weight back again. The snoring got bad enough again that it bothered my husband. One day he just asked me what was wrong with me because I snore and quit breathing and gasp for breath all night long! Wow - I didn't even really know it. About this same time we were under tremendous stress with our business. It was just like I was giving out. I hurt all over, slept all the time, couldn't think, couldn't focus and just felt awful. I was begining to think I had fiber myalgia, chronic fatigue syndrom or I feared it could even by something worse. I was working part time in our local university as a lab tech in the student health center. I was covering for my supervisors vacation and happened to be there on a Tuesday. I hardly ever worked on a Tuesday. Tuesday's are typically the day used for staff education and this Tuesday a rep from the local sleep clinic was coming in and providing lunch. I hardly ever stay in the building over my lunch hour so I could run home and let my dog out, but I thought - hey, a free lunch! So I went and had my life changed that very day. I believe it was God's intervention that had me work on this odd day just so I could hear this sleep clinic rep and get some help. Everything she talked about was me to a "T" and when I went back to the lab after lunch I called my doctor's office and made an appointment to talk with him about sleep apnea. We talked about symptoms and the interrupted breathing my husband had noticed and he got me into the sleep clinic right away.

My Journey to Feeling and Living Better

noreply@blogger.com (Lori Kay) — Sat, 08 Nov 2008 04:33:00 +0000

Pretty much all my life I have loved to sleep! I have never been one to stay up late -even in my wild and woolly college days. I function best in the morning after a shot of caffeine. Falling asleep on the couch watching evening TV was a frequent occurrence. I have many other symptoms and problems I will share on this blog. Not to complain, but in the hopes someone else will come across what I have written here and maybe won't have to struggle to find answers. About 6 months ago I finally went in for a sleep study and was diagnosed with severe sleep apnea. I was on the verge of a physical collapse after so many years of lacking sleep. I am a person who thirsts for explanations and knowledge -I want to learn as much as I can about sleep apnea. I am now on a quest to live my life as fully as possible (which starts with getting plenty of quality sleep.) I am finally starting to feel "rested" or "caught up" on sleep and it has been almost 6 months on my CPAP machine! I never knew I could feel this way! I still require 8-9 hours of sleep a night, but I am so much clearer headed in the morning and ambitious throughout the day than ever before in my life! I can finally see there are many issues I have to address before I can truly be healthy including; thyroid problems, depression, sexual hormone imbalance and excess body weight. Please walk this journey with me...together we can strive for a healthier tomorrow and living life to it fullest with our family and friends.