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Scripps Clinic neurology chief doubles as sleep disorders specialist

By Kathy Day

Most people find they are either too sleepy or can’t sleep.

That’s the starting point when J. Steven Poceta, M.D., begins trying to diagnose a person’s problems in his special field of interest — sleep disorders.

J. Steven Poceta, M.D. (Photo: Rob McKenzie)
J. Steven Poceta, M.D. (Photo: Rob McKenzie)
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The head of the Division of Neurology at Scripps Clinic and a consultant in sleep disorders, the local resident has been on the La Jolla clinic’s staff since 1988.

“Sleep [is] very important for a sense of well being and quality of life,” he said in an interview in his office overlooking the Pacific and the Torrey Pines Golf Course. On the walls are photos of Vancouver, British Columbia — a favorite getaway — and of his wife, Lori, and their two children. Surrounding his desk are journals and patient files.

A tall, slender man, he shifts around a bit in the new chair he’s trying out to help with a sore back. A bit formal at first, he relaxes as the interview goes on — adopting a friendly manner certain to go over well with patients.

He disdains a few overused words, says he doesn’t have “a passion” but a “special interest” in sleep disorders, especially those with both neurological and sleep-related aspects such as restless leg syndrome, sleep-related headaches and circadian rhythm. He also sees patients with sleep apnea, insomnia, excessive daytime sleepiness and sleep-walking.

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Circadian rhythm disorders — such as jet lag or being an extreme night owl — are the least understood, he said. “I see teenagers not doing well in school because they can’t get up and can’t get to bed at a decent hour.”

It’s about whether you are a morning or a night person — which can be evaluated on a 19-question scale, he said.

“It’s fairly highly treatable,” he added as he turned on a super intense light box that patients can use to “fool the body” into better sleep patterns.

While the scientific side is the basis for diagnoses and treatments, it is the quality and safety issues such as optimizing job performance and staying awake while driving that motivate him. He primarily lets others study long-term consequences such as potential risk factors related to sleep disorders and stroke or cancer.

Even so, he has published more than 40 works, including a sleep disorders book. His most recent study, published in the Journal of Clinical Sleep Medicine, looks at a small group of patients as well as defendants being prosecuted for “sleep driving” who had taken Ambien.

Poceta, who received his bachelor’s degree from the University of Michigan — a half-hour drive from his Detroit home — and his M.D. from the University of Pennsylvania School of Medicine, calls himself a lucky man.

Lucky, he said, that he did well in high school and was able to go to college; lucky that he got a work-study job in a high-level research lab on campus that enabled him to skip most of the pre-med requirements, and lucky that school was easy for him and that the times were easier than they are for his college-age children. And, later he adds, lucky that his extended family has never faced a major tragedy.

Choosing his specialty was not one of those “eureka” moments.

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“You spend a lot of time in medicine and almost everything is interesting — the eye is interesting, how the kidney works,” he said. Instead, he based his choice more on the personalities of the doctors in the various fields than on the field itself.

Neurologists are generally considered the “brainy, nerdy type,” he added, “but I’m not like that.” He just liked the neurologists he met and felt it was a good fit for him.

He was among those on the leading edge of treating sleep disorders, which is atypical for a neurologist. Most sleep specialists are pulmonologists, he said.

In 1981-82, he sought out one of the only sleep centers in the country at Stanford and learned about the specialty, which he described as “multidisciplinary and offbeat. It straddles what’s normal and what’s abnormal.”

“As corny as is sounds, I really like being a doctor … People thank me every day, and even if I didn’t solve their problem they know I’m trying to help.”

While many physicians are keen on research, Poceta finds more satisfaction in clinical work — although his role as head of the Division of Neurology is cutting a bit into his time with patients these days.

Being head of a department with 14 practitioners and the paper work, administrative and financial responsibilities that go with that, and his involvement with the sleep lab keep him on the job 10 to 12 hours a day. He’s also “a little involved with politics” through the San Diego County Medical Society and is closely watching the healthcare reform debate.

Acknowledging that many people are “so stressed” about the day-to-day elements of medicine and the obligations that hospital organizations have to meet, he talked a bit about the history of medicine in the U.S.

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“I went to the first medical school in the country and used to look at the old pictures of surgeons … Medicine has been around for a very long time,” he said.

It has survived the Great Depression, World War II, not having health insurance, Medicare, he added. “In the long term there are going to be doctors and there are going to be patients … It keeps me from sweating the details.”

Poceta’s own personal daily challenge is balancing work and life.

“I’m not a workaholic — I work hard — and I enjoy my evenings and weekends,” he said, noting his day usually begins about 5 a.m. and he tries to get home before sunset.

When he gets there, he and Lori retire to their garden, where they grow a lot of their own food, and relax with a cocktail.

The couple also enjoys cooking — right now they’re working on Indian recipes from a Vancouver restaurant’s cookbook.

Then he “turns off” until about 2 a.m. before he starts thinking again. To help, he often meditates.

“I’m interested in the body clock and observe mine,” he said.

When he’s off the clock, so to speak, he and Lori like to travel, particularly to Vancouver, where they have an apartment. These days, they are studying Turkish as they prepare for a visit to Istanbul.

Trouble sleeping?

Dr. Poceta suggests:

• Keep a regular morning wake up time.

• As soon as you wake up, get some light. It kick-starts your body clock.

• Complete the course at

www.cbtforinsomnia.com

Quick Facts

Name:

J. Steven Poceta, M.D.

Distinction:

Head of the Division of Neurology; secretary, San Diego County Medical Society; publication in Journal of Clinical Sleep Medicine: “Zolpidem Ingestion, Automatisms, and Sleep Driving: A Clinical and Legal Case Series.”

Family:

Wife Lori is a nurse practitioner in the Scripps Clinic weight loss program; daughter Joanna, 22, is a philosophy major at Brown University; son Daniel, 19, is a cello performance major at the University of Michigan.

Interests:

Gardening, learning Turkish

Recently read:

“Down and Out in Paris and London,” written by George Orwell in 1933, and “A House for Mr. Biswas” V.S. Naipaul, 1961.

Favorite films:

“From Russia with Love,” primarily shot in Istanbul, where he’ll be going soon.

Favorite getaway:

Vancouver, B.C.

Philosophy and family motto:

Try your best and have fun.


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