The Insomnia Blog - Sleep Doctor Michael Breus, PhD

Why Do We Sleep?

It’s a simple question that you’d think would have a simple answer. We know that sleep has restorative effects on our bodies down to the cellular level, but how it all works from a biological perspective has been somewhat of a mystery.

Now we’ve got more details to help tell the story of just what exactly goes on. New research suggests that during the initial stages of sleep, energy levels increase dramatically in brain regions that are active when we’re awake. The scientists behind this latest study believe that this surge of cellular energy may replenish the brain’s processes that we need to function normally during the day.

“Energy,” by the way, refers to ATP (adenosine triphosphate), which is our body’s chief energy molecule. It’s also the same energy currency in other animals like rats, which were used in the study. The researchers found the following:

•  ATP levels increased in four key brain regions that are normally active during wakefulness, when the rats were in non-REM sleep.
• During this time, however, an overall decrease in brain activity occurred.
• When the animals were awake, ATP levels remained steady.
• When the rats were gently nudged to stay awake three or six hours past their normal sleep times, there was no increase in ATP levels.

What does all this mean?  

The authors concluded that sleep is necessary for this ATP energy surge, as keeping the rats awake (depriving them of sleep to mimic a sleep deprived human) prevented the surge. The energy increase may power restorative processes absent during wakefulness, because brain cells consume large amounts of energy just to perform daily waking functions.

Indeed, there’s a lot to do when we’re awake. In addition to all the tasks we complete consciously, think about all the things we do practically subconsciously like breathing, think about things we do almost on autopilot: surfing the net, walking the dog, sometimes even driving a familiar route.  All this activity requires—you got it— the ATP energy that appears to be produced by a good night’s sleep. And a good night’s sleep is exactly what the doctor ordered to prepare us for the rigors of our day. No sleep, no energy expended in the brain to help us recover from the day and, in essence, recharge our minds for the next adventures of the next day.

It’s also worth noting that the precise mechanics of the brain also remain a mystery to some degree. There’s no doubt that the brain requires a lot of energy to function as the body’s master of ceremonies. We already know that sleep loss can actually result in brain loss. In fact, the obligations of the brain may be the only reason we need sleep: because without a brain the body isn’t worth much. And it certainly can’t do much.

In addition to food, water, and oxygen, the brain clearly needs sleep. If only sleep-deprivation were as compelling of a sensation as feeling famished or thirsty. We always seem to be able to put off sleep. But eating or drinking, well…

Sweet Dreams,

 

Michael J. Breus, PhD

The Sleep Doctor™

www.thesleepdoctor.com

Rock Yourself to Sleep

Any new parent who has tried to get an infant to sleep knows about the secret spell of a swing. There’s something magical about the rocking motion that a swing or even human arms can provide to put a baby to sleep. It also explains why a ride in the car or a train can be equally as tranquilizing.

So why couldn’t the same or a similar technique help an adult insomniac?

There is a technology that has been developed that may do just that.

The device is designed to simulate the gentle, soporific swaying sensation that seems to be the key factor in lulling babies (and adults) to sleep. And this can be achieved without the need for an actual bedroom swing to accommodate an adult (or asking your partner to do something impossible!).

It’s about the size of an MP3 player and is connected to the mastoid bone behind the ear using a sensor cable, which sends electric pulses into the vestibular system. This stimulates the balance centers in our middle ear to create a gentle swaying or rocking sensation. If it sounds too good to be true, or if you’re already feeling sick at the thought of being artificially rocked to sleep as if lying on a sailboat, listen up.

The device was researched and developed in Australia by Philips Home Healthcare Solutions, and according to tests performed in sleep labs throughout Sydney and Melbourne, it was found to decrease 67 percent of severe to moderate insomniacs down to a level of no clinical significance.

That’s huge. That means the cure for some insomniacs may be just a drug-free device away rather than another pill or strong-willed attempt at bedtime meditation.

Though I’m not quite sure there’s any substitute for a piece of technology that, at the touch of a button, can make you feel like you’re being rocked to sleep like a baby, there are other low-tech ways to “rock” yourself to sleep. Try these three techniques instead:

•  A warm bath before bedtime.
• Listening to relaxing music with a good pair of headphones on after getting into bed.
• Keeping your bedroom cool, quiet, and low-lit. 

These strategies won’t necessarily make you feel like you’re swaying, but you can add some visualization to conjure that rocking, swaying sensation.  With your music playing, close your eyes and just imagine safely floating on a raft or inner tube while drifting in the ocean. It’s actually not too difficult to visualize.  And it might just take the “difficulty” out of falling asleep.

Sweet Dreams,

Michael J. Breus, PhD

The Sleep Doctor™

www.thesleepdoctor.com

Jet Through Jet Lag

Jetting off for vacation sometime before summer ends? The anticipation of taking a time-out and getting away from the rigors of daily life can be exhilarating…until you get to your destination feeling tired, tense, and touchy thanks to jet lag.

Crossing multiple time zones can play funny games with your circadian rhythm. If you are traveling from New York at 8 a.m. to California and it’s a five-hour flight that crosses three time zones, that means you land at 10 a.m. L.A. time. But it’s really 1 p.m. your time back in New York and starting an afternoon romp through Disneyland with the kids works out great. Consider the reverse, however: Say you leave L.A. at 5:30 a.m. to get to New York for a 1 p.m. meeting in downtown Manhattan (without the kids). If getting up that early is not normal for you, you would do well to take a nap on the flight so you’re refreshed by the time you land in New York. Or leave later in the morning from L.A. and schedule the meeting for the following day so you have time to adjust.

Adjustment. That’s the key word when it comes to jet lag, and for good reason. When your internal clock doesn’t match the external clock, it can be—and feel—like World War III in your body. The problems that arise with jet lag are a clear example of how external influences can disrupt our internal body clock.

I’ve written about biological clocks before. It’s a fascinating area of research that has so many applications to everyday life. Consider how much your internal clock determines the quality of your life. And if you don’t know what I mean by that, then here’s a quick summary. All of the following relate to your internal clock:

• Your sleep/wake cycles.
• How refreshed you feel in the morning.
• How easy it is for you to fall asleep at night.
• Whether you can recover quickly from jet lag.
• The fate of a shift worker who has to be productive at odd hours.
• Whether you’re a lark or an owl.
• Your mood and energy level.
• The strength of your immune system.
• Your ability to ward off diseases, including cancer and Alzheimer’s.

It may seem hard to believe that your body’s clock can influence diseases like cancer, but it’s true. Think of your clock as your body’s central pacemaker—a means by which the body can remain balanced and, in medical speak, in a state of homeostasis. An entire network of molecular clocks found in the different organs coordinate the body’s various physiological processes ranging from the heart beat, temperature, sleep requirement and hormone balance to behavior. All of these clocks are controlled by the master pacemaker of the hypothalamic suprachiasmatic nuclei (SCN), which synchronizes all of the body’s “peripheral” clocks with the outside world. At the molecular level, all of the clocks are based on a handful of "clock" genes and proteins that regulate each other interactively and thus generate a molecular time signal in the form of a circadian rhythm, term that originates from the Latin for approximately (circa) and day (dies).

Research continues to emerge helping us understand our clock—or even clocks. Just last month, researchers at the Max Planck Institute for Biophysical Chemistry published a study in the Journal of Clinical Investigation demonstrating (at least for mice, which in turn often reflect humans), that the clocks associated with individual organs in the body adapt to the new time at different speeds. So while you feel out of whack once you reach a new time zone, it’s pretty much because your body’s physiological processes are no longer coordinated. And the adrenal gland plays a key role in this process. When the researchers switched off the adrenal clock or manipulated the synthesis of the hormone corticosterone by the adrenal gland, the rodents adapted more quickly to the altered circadian rhythm. These insights could pave the way for a new approach to the hormonal treatment of the effects of jet lag and shift work.

These findings surprised even the scientists. It marks the first time that anyone has systematically studied how individual “clock” genes and the internal clocks of the different organs synchronize with the new external time in the case of jet lag.

So what can you do to prevent the jet lag from making your trip a drag? How about setting your body clock to a new time zone before the journey? By using light therapy or an alarm clock that simulates dawn and dusk with techniques to induce sleep, you can reset your circadian body clock before a journey, thus preventing jet lag from the very start. If you are planning a trip across more than two time zones and want to get accustomed to your destination’s time zone quickly, this might be an approach to take.

 Let’s say you have an important business trip for which you have to fly east. Before flying, you’d go to bed and wake up earlier each day while using a light box in the morning and winding down earlier in the evening. If you’re traveling west, you would expose yourself to bright light later in the day, go to bed later and wake up a little later in the morning.

 If you don’t have the time or inclination to get a light box, then consider direct sunlight as the next-best alternative. Light boxes, while producing artificial light that mimics the sun’s intensity, don’t emit ultraviolet radiation. They are designed to produce those perfect wavelengths of light (peaking in the optimal “blue” wavelength range, or 460 nanometers) and the light gets directed angularly at your eyes for the greatest effect.

If you can shift your body clock naturally prior to departing this can be a particularly useful technique if your trip doesn’t allow for much time to adjust before kicking into high gear and demanding your top performance.

Try and switch over to your new time zone right away by going to bed and getting up at the same time you would normally, but on this new time zone. So if you usually go to bed at 10 p.m. in L.A., do the same the first night you land in New York even though your body might think it’s only 7 p.m. Then, the next morning try and go for a walk outside, exposing yourself to light and movement that can help re-set your internal clock.

And take my Traveler’s Survivor Kit with you:

• Ear plugs
• Eye mask
• Favorite soothing music and head phones or a device like an iPod
• C-shaped pillow that fits around your neck

These strategies can also be used for shift workers. But that’s another story for another day.

Bon Voyage and Sweet Dreams,

Michael J. Breus, PhD

The Sleep Doctor™

www.thesleepdoctor.com

 

Dreams, Nightmares, Stress and Sleep

Most of us have experienced them: weird, vivid dreams that leave us thinking about them the next day. But “weird” can mean several things in this regard. It can imply dreams that call up people from the past, the dead, or even those of a sexual nature. Strange dreams can also entail those that wake us up in a state of high anxiety and stress.  You know the kind: you’ve shown up for a big test that you didn’t study for, or an event in your real life goes horribly wrong in your dream life.

The stressful dreams usually follow a similar pattern.  And they are commonly experienced, ranging from those that have you losing your teeth to being chased or to coming close to dying.

An article in an online British paper recently reported on a Chinese study done on the effects bad dreams can have on us. No, it’s not just about the disrupting, sweaty sleep they can cause. Bad dreams can actually have far more health consequences than you might imagine. Problems like:

• Insomnia
• Fatigue
• Headaches
• Depression
• Anxiety

In fact, mental health problems, such as depression, were five times more common in people who had regular nightmares. And about one in 20 people suffer from frequent or chronic nightmares—defined as at least once a week. Technically, nightmares are defined as frightening dreams that awaken you from rapid eye movement or REM sleep, a time when there are high levels of brain activity.

Interestingly, the study also showed that women were more susceptible to these dreams than men. Other findings of note:

• Those in the “neurotic category” were more likely to have scary dreams.
• There is evidence of a genetic susceptibility to nightmares.
• Frequency was also linked to income and unemployment. Those reporting the lowest incomes were 2.3 times more likely to have three or more nightmares a week compared to the more affluent.
• Higher levels of stress associated with lower incomes and social status may predispose some people to nightmares.
• The risk of having a psychiatric disorder was 5.7 times greater for those with frequent nightmares compared with those without.

So what were the top nightmares in the study?

• Falling (39.5%)
• Being chased (25.7%)
• Being paralyzed (25.3%)
• Being late for an event (24.0%)
• Close person disappears/ dies (20.9%)
• Horror films (18.9%)
• Unable to complete a task (17.3%)

Which ones have you had?

If you’re the type who does experience frequent nightmares, don’t fret that you’re doomed to have a psychiatric disorder or on the road to depression. That’s not the point. The best solution to preventing bad dreams begins with better managing stress in your life. After all, living a low-stress life has enormous health benefits that will automatically reduce your risk for the very same conditions that nightmares seem to trigger, such as insomnia, depression, and anxiety.

You probably can’t prevent every bad dream from creeping into your bedroom at night, but look at it another way: perhaps the bad dreams allow you to work through some of your emotional issues that are better left in the bedroom than in your real, waking life.

Something to think, perchance to dream, about.

Sweet Non-scary Dreams,

Michael J. Breus, PhD
The Sleep Doctor™
www.thesleepdoctor.com

Are You Afraid of Sleeping?

Nightmares are a research and clinical area that has always fascinated me. While I have experienced nightmares myself, they have been quite rare in my life. However both a recent article and patient has piqued my curiosity. Nightmares can be defined as a frightening dream that will awaken an individual from REM sleep. Most people, when asked, will recall the content of the dream, in some cases even days after it occurred. If you ask people, almost everyone can recall having had a nightmare, but there are some unfortunate souls who have them with great regularity.

I see some of these patients in my practice, and it is often hard to know what can be done for them.  When is a nightmare just a really bad dream, and when does it cross the line into potentially something else? To try and answer one of these questions a recently published research study in the journal Sleep showed some very interesting results. In a community based population (not just college students, or a psychiatric population –where nightmares are prevalent) researchers at The Chinese University of Hong Kong observed:

• Once a week nightmares were found in 5% of the population
• Women were more likely than men to have nightmares
• In fact 71% of those with nightmares 3 times per week were females
• Those in a lower income bracket were the most likely to have nightmares
• 40-50% of those with some form of insomnia have nightmares

The finding that 5% of people have weekly nightmares was in line with previous studies. Why women have more nightmares than men may be due to the fact that women are better at recalling their dreams than men. Another theory posed by the researchers was that in their population women had a greater tendency for depression, anxiety and other forms of psychopathology. Most importantly those with insomnia appear to have a greater tendency to have nightmares but the next question would be which comes first? The insomnia or the nightmare? I have had several patients come to me with stories of both nightmares and insomnia. These patients will often present in clinic with:

• An inability to fall asleep
  • This can often be due to fear of having a nightmare.
• An inability to stay asleep
  • This can occur when they are woken up in the middle of the night, from a nightmare and do not want to go back to sleep for fear that the nightmare will continue.
• Restless Sleep
  • This is often the accumulation of both of the above situations.

So what are some of the current nightmare treatments available?
Unfortunately this topic is one that does not have a tremendous amount of research available but here is what we have seen:

• Medication: medication has been shown to be both a cause and a treatment of nightmares.

  • While in other cases certain anti-depressant medications (SSRI’s and tricyclics) can reduce the frequency of nightmares by reducing the amount of REM sleep you are getting.

• Talk Therapy: Work has been done where the person having the nightmare will wake up and write down everything that they can remember about the dream.

  1. In as much detail as they can, even with the potential horrible endings (people getting killed, or loved ones getting hurt, or persecuted).

  2. Next they collect these dreams over the course of a week or so and create a script as though it were a play or movie scene.

  3. Finally they CHANGE THE ENDING so that whatever is the horrible consequence is changed so that they become the hero of the dream!

  4. This new version of the dream is then read by the person several times right before they go to bed, to influence their dreaming.

So what can you do if you are having nightmares?

• First, realize that this may be more common than you think.  
• Next speak to your doctor about any medication you are taking and be sure to read the package inserts on any medication to see if vivid dreams or nightmares may be a side effect.
• Consider that a drug interaction (two medications together, or a glass of wine before taking a medication) could be causing the effect. Consider speaking to a psychiatrist or your general practitioner about a medication to help reduce nightmares by reducing your REM sleep
• Consider speaking to a therapist about how to begin the journaling process

Sweet Non-Scary Dreams,
Michael J. Breus, PhD
The Sleep Doctor™
www.thesleepdoctor.com

Lack of Sleep Can Trigger Migraine Proteins

Anyone who suffers from chronic headaches or worse, migraines, knows that lack of sleep can sometimes be the culprit. And anyone whose been victimized by a migraine also knows that losing sleep can be a trigger for these excruciating and often debilitating special types of headaches. I’ve talked about the connection between headaches and sleep—or lack thereof.

Now we have more evidence that shows the link between sleep deprivation and migraines in particular: pain researchers from Missouri State University report that rats deprived of REM sleep showed changes in the expression of key proteins that suppress and trigger chronic pain.

In other words, the quality of sleep was associated with whether or not the rats’ nervous system was aroused (hence leading to a headache) or shut down. At the center of this observation was the existence of specific proteins that orchestrate the nervous system’s arousal or suppression.

In the study, the researchers deprived one group of rats of REM sleep for three consecutive nights while allowing another group to sleep normally.

They found that the sleep deprivation caused increased expression of proteins p38 and PKA, which help regulate sensory response in facial nerves thought to play a key role in migraines, known as the trigeminal nerves.

Lack of REM sleep also triggered increased expression of the P2X3 protein, which is linked to the initiation of chronic pain.

About 12 percent of the population, or 36 million Americans, suffer from migraine headaches. Migraines still elude scientists; sleep disruption is one of the most important migraine triggers, yet very little is known about the molecular pathways that link sleep to headache pain.

So for now the best we can do is try to control them through medications when they strike and to take preventive measures that target potential triggers. People who suffer from routine migraines typically have powerful drugs on hand to aid in enduring a migraine when they occur, but often preventing the throbbing pain from even starting is the best medicine. It can become a catch-22 once the migraine takes hold: it becomes hard to sleep due to the pain, which then fuels the cascade of events that keeps the migraine pulsing.

Making sure you get enough sleep if you’re prone to headaches or migraines won’t always stave off pain, though. What’s more important is keeping the same sleep schedule. Ever gotten a headache or migraine on a day you slept in? Well, yes: you can get too much sleep! If your body is used to rising at 6 am during the workweek and you suddenly switch to 9 am on the weekend, guess what: you’ve just given your nervous system a reason to summon pain. The body likes routines. And it especially likes consistent sleep routines.

What I love about studies like this is that they have longitudinal implications across other areas of medicine. If we can learn how to prevent and treat a migraine, we can probably learn a lot about pain in general. And if sleep is a key to that treatment and prevention, then getting restful sleep is once again proven to be as much a part of health as any other vital sign of life.


Sweet Dreams,

Michael J. Breus, PhD
The Sleep Doctor™
www.thesleepdoctor.com

Sleep at the Beach

The fourth of July, in our home, represents the holiday to show that summer is really here. While in Arizona it is usually pretty hot by July (about 110 degrees or so), we usually get out of town to beat the heat at the beach!

At the beach, not only do I tend to sleep even better than normal, many of the people I meet tend to tell me about how well they are sleeping here. Sitting in the cool breeze, listening to the ocean and watching my kids surf and build sand castles, I thought about why everyone seems to sleep better at the beach. Here are a few of my ideas:   

1. The environment. Remember you are on vacation. This in and of itself is a time for relaxation (hopefully).  A change of sleep environment (one which lacks the reminders of your daily stress) certainly helps set the tone for more relaxation and usually better sleep.

2. The schedule. Many of my patients tell me that they have a tendency to sleep in on vacation, thus catching up on their much needed rest and reducing their sleep deprivation.

3. The heat. Being out in the sun all day always makes people sleepy, why? Well it may be because of the slight raise in core body temperature. Remember a raise in body temp will cause a subsequent fall and that can be a signal to the brain to release Melatonin  (the key that starts the engine for sleep).

4. The sounds. Remember, ocean sounds are the only documented sounds that have been shown to help with sleep. Try sleeping with the window slightly open to hear the waves.

5. The activity. Most people at the beach take time to engage in physical activities. I was inspired to go for an early morning run, not to mention lugging all the beach paraphernalia, setting up the umbrella, swimming, tennis, you name it. There are so many to choose from, it is great to be able to exercise, which we know can help promote better sleep.

6. The weather. Not only may the heat help with sleep, but the barometric pressure could be helpful as well. While there is little data yet (one or two studies), my theory is that the change to sea level does in fact help the body with sleep onset and sleep continuity.

7. The light. Let’s face it, being out in the sun during the day is one of the best ways to re-set your internal biological clock, which helps regulate your sleep cycle. 

So there you have it, my 7 reasons for better sleep at the beach. Whatever the reason, my prescription is for anyone, if they can, get out to the beach and get some great sleep.

Sweet Dreams,

Michael J. Breus, PhD
The Sleep Doctor™
www.thesleepdoctor.com

Better Sleep for a Technicolor World

Red.

Orange.

Yellow.

Green.

Blue.

Purple.

Look around and pay attention to the color you see.  Is it bright and vivid?  Better or worse than yesterday? Now think about how well you slept last night.  Or the night before.  Could it be that your ability to see colors depends on a good night’s sleep?

The Sleep Doctor on Doctor Oz! July 5, 2010

I'm on the Dr. Oz Show again, Monday July 5, 2010 - we talk about insomnia and what you need to know.

Check here for your local time and station.

Relief for Cancer Patients with Insomnia

Battling cancer is a tough job. Not only does the disease take its toll on an ailing body, but modern treatments often include side-effects that can make healing all the more challenging. And insomnia is among those side effects.

I see many patients who’ve gone through cancer treatment only to be left with chronic insomnia. In fact, as many as one-third of all cancer patients develop sleep problems during treatment that then can persist for years afterward—even after the cancer has gone into remission. Sadly, the insomnia doesn’t go into remission too. Insomnia takes over these patients’ lives for many reasons, including stress caused by their illness and changes to regular sleep patterns caused by their treatments.

But there’s hope. A new study is underway in a research program based in Alberta, Canada to help such patients gain the control they so desire of their sleep life. It’s called I-CAN Sleep (short for Individuals with Insomnia and CANcer), and it’s the first Canadian study to assess sleep-improving techniques specifically intended for cancer patients and survivors.