The Insomnia Blog - Sleep Doctor Michael Breus, PhD

ADHD or sleep disorder: are we getting it wrong?

Millions of children and adults struggle with symptoms of Attention Deficit Hyperactivity Disorder (A.D.H.D.), a condition marked by problems with concentration, impulse control, organization, and memory. It can be a frustrating and difficult condition, stigmatizing and often isolating for those who suffer from it.  

But what if some of those who’ve been diagnosed with A.D.H.D. are, in fact, suffering from another disorder altogether—a sleep disorder? That’s the provocative and important question posed in this commentary by a practicing psychiatrist with extensive experience treating patients with A.D.H.D.  Dr. Vatsal Thakkar, who is also a clinical assistant professor of psychiatry at NYU Langone Medical Center, makes a powerful argument for the need to consider sleep problems as a possible cause when evaluating patients for A.D.H.D.  

As Dr. Thakkar points out, many of the symptoms of A.D.H.D. are very often similar to symptoms of insufficient and disordered sleep, for both children and adults. In children, the symptoms of A.D.H.D. and sleep deprivation can be indistinguishable. A diagnosis of A.D.H.D. in children frequently comes about after a child exhibits some or all of behavioral symptoms such as these:

Lack of focus: difficulty paying attention, problems listening, forgetfulness, disorganization

Agitated, excitable, impulsive behavior: excessive talking, inability to sit still, difficulty playing quietly, tendency to interrupt, difficulty sharing or waiting for one’s turn

These behaviors associated with A.D.H.D. interfere with a child’s social and intellectual development, causing problems with relationships with peers and adults, at school and at home. But what if A.D.H.D. isn’t always the underlying cause of these symptoms? Signs of poor quality and insufficient sleep in children can look remarkably like symptoms of A.D.H.D., as a number of recent studies show. There’s particularly strong evidence that children with sleep-disordered breathing exhibit many of the same symptoms—and suffer many of the same behavioral problems—as children who’ve been diagnosed with A.D.H.D.  

Sleep-disordered breathing in children has been an area of growing interest among sleep scientists—with good reason. I’ve written about the dangers of sleep-disordered breathing in children, which is linked to a range of developmental and behavioral problems—problems that often mirror those associated with A.D.H.D:  

• This study found that children with obstructive sleep apnea had higher rates of behavioral problems including difficulty paying attention, hyperactivity, communication problems, and aggressiveness. These children were also more likely to have learning difficulties and low academic performance than those without sleep-disordered breathing.  

• This large-scale study of more than 11,000 children found that those with sleep-disordered breathing were significantly more likely to show signs of hyperactivity, trouble interacting with peers, and conduct issues including aggressiveness and inability to follow rules. The study examined the effects of sleep-disordered breathing on children as young as 6 months. Researchers found that very young children who experienced some form of sleep-disordered breathing were, by the age of 7, 40-100% more likely to have behavioral problems similar to those used to diagnose A.D.H.D.  

Many adults being treated for A.D.H.D. have symptoms that are difficult to distinguish from the effects of poor quality and insufficient sleep. Difficulty concentrating, trouble completing tasks, problems with organization, and memory lapses are all common struggles for adults who’ve received an A.D.H.D. diagnosis. These are also some of the most common problems for adults with sleep problems. I’ve written about the challenges that lack of sleep and disrupted sleep pose to cognitive function in adults, including problems with memory, learning and focus.  

Given the similarities of symptoms between A.D.H.D. and poor sleep in children and adults, it’s not hard to see how misdiagnosis is possible, even likely. That risk increases when we consider the lack of regular screening that exists for sleep problems. We’ve made great scientific strides in our understanding of sleep in recent years. But we still struggle with a lack of attention paid to sleep problems by both physicians and patients. For both children and adults, sleep problems continue to be significantly under-diagnosed. This study of members of the American Academy of Pediatrics evaluated sleep-screening practices among pediatricians. Researchers found that fewer than 1 in 5 pediatricians surveyed had received any training in sleep disorders, and fewer than 1 in 6 felt confident about their ability to offer guidance to parents about children’s sleep. The study also revealed serious knowledge gaps among pediatricians about sleep, with most unable to answer correctly questions about sleep disorders in children.  

The news isn’t any better for adults. An analysis of data from the 2005-2006 National Health and Nutrition Examination Survey found that sleep disorders such as insomnia and sleep apnea remain drastically under-diagnosed. What’s more, though nearly all of the more than 2,000 adults surveyed reported at least one complaint about their sleep, fewer than 1 in 4 of them had talked with physicians about their sleep problems.  

More rigorous and effective screening for sleep problems starts with better training for physicians and medical professionals who must make diagnoses every day. As patients and as parents, we also need to be attentive to symptoms of poor sleep in ourselves and in our children. And we need to take these concerns—however mild they may appear—to our physicians. 

Another thing we can do? Protect our sleep, and our children’s sleep, by setting sleep-friendly limits against the nonstop, perpetually wired, always “on” culture we live in today. As Dr. Thakkar points out, the escalation of A.D.H.D. cases in the 1990s and 2000s coincided with the rise of the digital age, and the widespread use of personal technology that now pervades our daily lives. These devices—our laptops and tablets and cell phones—that enable so much convenience and connection, also threaten the quality and quantity of sleep. The nighttime exposure to light they emit interferes with the body’s release of melatonin, disrupting sleep cycles and diminishing time spent in the deepest, most restorative phases of sleep.  More than ever before in history, we must work to create the darkness that is so essential to sleep. Keeping our bedrooms, and our children’s bedrooms, gadget-free sanctuaries for sleep is one important way to guard against chronic sleep deprivation.  

To raise the possibility that some cases of A.D.H.D. in children and adults may actually be un-diagnosed sleep disorders does not call into question the seriousness of A.D.H.D., the difficulties it poses, and the importance of effective treatment for this very real disorder. Additional research is critical to determine whether, and how often, sleep disorders are being misdiagnosed as A.D.H.D. The goal is to make the right diagnosis—whether A.D.H.D. or sleep problems—and pursue the most effective treatment. All patients, whatever their condition, deserve no less.  Pursuing the question of a link between disrupted sleep and symptoms of A.D.H.D. is a matter of public health, one that deserves prompt and sustained attention.

 

Sweet Dreams,

 

Michael J. Breus, PhD 

The Sleep Doctor™ 

www.thesleepdoctor.com

The Sleep Doctor’s Diet Plan:  Lose Weight Through Better Sleep

Everything you do, you do better with a good night’s sleep™ 

twitter: @thesleepdoctor 

Facebook: www.facebook.com/thesleepdoctor

Have you considered a ‘sleep divorce’?

I read this news story with great interest, as it covers a topic I get asked about a lot:  whether it’s a good idea for couples to sleep apart to improve their individual sleep.  

This is an issue that seems to come up with increasing frequency, as more couples appear to be sleeping in separate bedrooms. It’s estimated that 25% of couples in the U.S. are sleeping apart. This is a number that has been on the rise in recent years. What’s more, the residential construction industry in recent years has reported a substantial uptick in requests for 2 separate master bedrooms in new homes.  

What’s behind the drive to sleep separately? There are a number of reasons that couples find themselves considering separate bedrooms. Here are some of the most common:  

Different schedules: Early birds and night owls can disrupt each other’s sleep at either or both ends of the night, and grow to feel incompatible as sleep partners

Disrupted sleep: People who experience symptoms of disrupted sleep, such as snoring, or tossing and turning from insomnia, can keep their partners from sleeping well

Poor sleep equipment and sleep environment: A too-small mattress can make couples’ sleep challenging. A room that’s too bright, or too warm, can be disruptive to sleep.

Divergent sleep habits: One person likes to watch TV late into the night, or surf the web from bed. Partners can disturb each other with their non-sleep bedroom habits.

Conflicts over co-sleeping: Parents who don’t sleep well with children in bed, or who disagree about whether or not to co-sleep, can find themselves seeking separate sleeping spaces.  

With sleep disorders like insomnia and obstructive sleep apnea all-too-common and on the rise, it is understandable how couples might opt for separate bedrooms. There is no question that it is critically important for both partners to achieve restful and sufficient sleep on a regular basis. Disrupted sleep can increase risk for a range of serious illnesses, including cardiovascular problems, obesity, and diabetes. Poor sleep also can have negative effects on relationships. This recent study suggests that lack of sleep may diminish the positive feelings we have for our partners. Researchers found people with lower quality sleep demonstrated lower levels of gratitude, and were more likely to have feelings of selfishness, than those who slept well. People who slept poorly showed less of a sense of appreciation for their partners. What’s more, poor sleep on the part of one person in the relationship had a negative effect on feelings of appreciation and gratitude for both partners.  

So, sleep is important for individual health, and also for the health of relationships.  

But is sleeping apart really the best remedy for couples whose sleep needs improvement? I’m not convinced it is. For some couples, sleeping apart may indeed be the right choice. But couples who want to sleep together can and should consider addressing their sleep issues from within their shared bedroom before making the jump to separate sleeping quarters.  

Often, discussions of the merits and pitfalls of bed sharing will separate the issue of individual sleep quality from the psychological and emotional desire to sleep with a partner. For couples who sleep together, this time can be one of deep closeness and intimacy, sexual and emotional. The intimacy established by sleeping together is for many a cherished and valuable aspect of being a couple. The challenge is to create and maintain strong, healthy, and compatible sleep habits for a shared sleeping space.  

Here are some questions to consider before you set up separate bedrooms: 

Have you addressed any sleep issues with your doctor? Anyone who experiences symptoms of disrupted or poor sleep should consult their physician. Undiagnosed, disordered sleep can wreak havoc with an individual’s rest and a couple’s sleep. But effective treatments are available. And evidence suggests that people being treated for sleep disorders can benefit from having a partner continue to sleep with them. This study found that sleep apnea patients using CPAP therapy were 60% more likely to stay with their treatment plan if their partners remained in bed with them.  

Is your bedroom sufficiently sleep friendly? Several factors in your bedroom can enhance—or hinder—couples’ sleep. Having the right sleep equipment is critical, starting with a good mattress. Squeezing two adults onto a traditional full or queen-size bed will not give most couples enough room to sleep comfortably. Invest in a mattress that is large enough for both partners to claim their own space—and still meet up in the middle. Memory-foam mattresses can lessen the impact of a partner’s nighttime movements. Does one of you like a firm bed and the other prefers a softer one? Mattresses can be customized so each side has the right level of cushioning for both partners.  

Creating a comfortable bedroom environment is also important. Darkness, a moderate room temperature, and cleanliness all can affect sleep quality. Clean sheets and a dark and quiet bedroom can make a big difference to couples sleeping together well.  

Can you marry your sleep habits? Maybe you’re an early riser, and your partner likes to stay up into the wee hours. You like to read late into the night, and your spouse prefers lights out at 10 o’clock. Rather than simply trying to tolerate your differences—or moving to the spare bedroom—can you find middle ground? This kind of compromise can actually help improve everyone’s sleep habits, by moderating extreme tendencies and removing extraneous activity from the bedroom. If you get up much earlier than your partner, agree that you’ll take care of your morning routine—getting dressed, making a first check of email—outside the bedroom. If you’re in the habit of reading as the clock rounds midnight, consider opening your book earlier in the evening so you can move up your bedtime.  

Here’s one great way to simplify your bedroom habits: remove the electronics. Televisions, computers, and cell phones have no place in a restful bedroom. Both the light they emit and the stimulation they provide are disruptive for sleep. Bedrooms are for sleep and sex.  

Like so many aspects of a relationship, sleeping together well as a couple is a dynamic process. By paying attention to sleep problems and sleep hygiene, many couples may find they can work out their sleep differences, avoid the “sleep divorce,” and stay together in bed.

 

Sweet Dreams,

 

Michael J. Breus, PhD 

The Sleep Doctor™ 

www.thesleepdoctor.com

The Sleep Doctor’s Diet Plan:  Lose Weight Through Better Sleep

Everything you do, you do better with a good night’s sleep™ 

twitter: @thesleepdoctor 

Facebook: www.facebook.com/thesleepdoctor

Sleep – The key to a long term, loving relationship?

It is one of the most common struggles that couples face: over the life of a relationship, partners can lose a sense of appreciation for one another. Holding on to a sense of gratitude for each other is one of the hallmarks of couples who stay content in their relationships over the course of many years. On the other hand, loss of gratitude and appreciation between partners can jeopardize a relationship’s long-term success.  

A new study suggests that poor sleep may contribute to a lack of appreciation between romantic partners.  Researchers at the University of California, Berkeley conducted a multi-part study to examine how sleep may affect people’s feelings of gratitude, and the ability to value and appreciate romantic partners. The study was presented recently at the annual conference of the Society for Personality and Social Psychology. The study included more than 60 heterosexual couples between the ages 18-56. They participated in three separate exercises designed to measure how sleep affects individual levels of gratitude, and sense of appreciation between partners:

• After a night of sleep, people were asked to make a list of 5 things for which they were grateful. Those with poor sleep demonstrated less of a sense of appreciation than those with better sleep quality and sleep quantity.
• Participants were asked to keep a daily record for two weeks of both their sleep and their feelings of gratitude—and lack thereof. Researchers identified a decline in levels of gratitude that was associated with poor sleep. People were more likely to report feelings of selfishness after a night of sleeping poorly.
• The third section of the study looked specifically at how sleep affects the dynamic of gratitude and appreciation between couples. Their results showed that people tended to feel less appreciated by their partners if either they or their partner slept poorly. 

The last finding is particularly interesting. A lack of sleep by one person in the relationship resulted in greater likelihood of diminished feelings of appreciation by both partners. This suggests just how deeply sleep can influence the emotional dynamic of a relationship. 

Sleep can pose a number of challenges to relationships. Poor sleep can make for difficult sleeping conditions for couples. The tossing and turning of insomnia and the noisy, disrupted sleep of snoring and sleep apnea don’t just diminish the quality of sleep for the individuals with the disorder. They also rob partners of restful sleep. Night owls and larks who share a bed may also have difficulty marrying their sleep schedules. If you’re an early-to-bed, early-to-rise type, having a partner who likes to read or watch television late into the night can interfere with sleep.  

These may be among the reasons why an increasing number of couples are choosing to sleep in separate beds. Research shows as many as 25% of couples are sleeping separately, and this is a number that’s been rising for years. The separate-bed strategy may seem like an attractive option for couples struggling to sleep together well. But it’s important to consider what might be lost in this choice. I’m talking about the intimacy created by sharing a bed. And I’m not only talking about sexual intimacy, although that’s certainly a risk of sharing separate beds. (At the very least, couples are much less likely to have spontaneous sex if they’re not sleeping together.) I’m also talking about the sense of togetherness and emotional connection that comes from sleeping together. 

What’s more, sleeping together can actually reinforce good sleep habits. Partners who sleep together can be a positive influence when it comes to keeping reasonable bedtimes, and not falling asleep to the television. Studies have shown that sleep apnea patients who use CPAP therapy are 60% more likely to stick with the treatment if their partners continue to share a bed, rather than sleeping separately.  

This latest research makes sense given what we know about how sleep affects mood and outlook, as well as emotional and mental health. Poor quality sleep and insufficient sleep can negatively affect mood and judgment, making us cranky and less apt to greet the inevitable ups and downs of life with perspective and an even keel. Research shows that poor sleep increases the likelihood of depression and anxiety, conditions that themselves can interfere with sleep. So it’s not surprising that gratitude might diminish when we’re short on sleep, and that the people closest to us—our partners—might bear the brunt of this diminished sense of appreciation.  

I’d like to see more studies like this—both for the specific knowledge and insights they provide us about the functions of sleep, but also for the way they highlight the very central role that sleep plays in the
quality of our waking lives, and the lives of those we love.

 

Sweet Dreams,

 

Michael J. Breus, PhD 

The Sleep Doctor™ 

www.thesleepdoctor.com

The Sleep Doctor’s Diet Plan:  Lose Weight Through Better Sleep

Everything you do, you do better with a good night’s sleep™ 

twitter: @thesleepdoctor 

Facebook: www.facebook.com/thesleepdoctor

The sleep stories of 2012, Part I

We learned so much about sleep this year. 2012 was bursting with great sleep stories, which revealed the power of sleep to enhance our health and well being, and the dangers associated with sleep deprivation and disrupted sleep. Here are my picks for the sleep stories of 2012—along with suggestions for ways you can bring the benefits of the latest in sleep science to your everyday life.

 

January

Sleep suggestion: In times of emotional turmoil, turn to sleep 

Scientists found that sleep may take some of the sting out of emotionally difficult experiences. Researchers at University of California, Berkeley monitored the brain activity of people while they were looking at a series of emotionally charged images. Some of the participants slept after viewing the images, while others stayed awake. All were shown the images a second time. Those who slept experienced a significant decrease in the intensity of their reaction to seeing the images a second time, compared to those who did not. Getting enough sleep is important for mental health. This research showed that sleep might also help ease the emotional pain of particularly difficult emotional experiences.

 

February 

Sleep suggestion: Stay at a healthy weight (a BMI below 25), and guard against diabetes, by getting enough sleep 

Research in recent years has established strong links between sleep and Type 2 diabetes. Studies have shown that sleep deprivation increases risk of developing diabetes. In 2012, scientists found a genetic connection between the sleep-hormone melatonin and diabetes risk. Researchers in this study identified a series of mutations to a gene involved in melatonin regulation that are associated with significantly elevated risk for diabetes. These mutations are rare, but identifying them could help improve diagnosis and treatment for high-risk diabetes patients. With this study, we continue to learn more about the role of melatonin, and the body’s circadian rhythms, in the onset of diabetes and other diseases. Sleep is a powerful tool for weight management, and an important part of any prevention strategy for Type 2 diabetes.  

 

March 

Sleep suggestion: Don’t ignore your child’s snoring or other signs of sleep-disordered breathing 

Children who experience sleep-disordered breathing are more likely to develop behavioral and emotional problems, according to this study. Researchers analyzed data on more than 11,000 children, using information from parent questionnaires. They found evidence of a relationship between sleep-disordered breathing and behavioral and emotional issues in children as young as 1 year. Hyperactivity, anxiety, depression, aggressiveness, and problems socializing with peers were all found more often among children with sleep-disordered breathing. Sleep-disordered breathing is actually a cluster of conditions that disrupt airflow during sleep. Snoring and mouth breathing are common signals of sleep-disordered breathing in children. If your child’s sleep appears disrupted—even mildly so—by breathing difficulties, talk with your pediatrician.   

 

April 

Sleep suggestion: Create—and maintain—a sleep-friendly bedroom 

In April we discussed the results of the National Sleep Foundation’s “bedroom poll”, which sought a comprehensive look at how Americans use, feel about, and care for their bedrooms—and of course how bedroom conditions affect sleep. The results showed that a majority of Americans feel pretty good about their bedrooms—but fewer than half said they slept well on most nights. Most people reported sleeping better when they slept on clean sheets and made their beds on most days.

The basics of good sleep hygiene include a clean bedroom, good-quality sleep equipment (mattress, pillows) and a room that’s cool and dark. The ability to make the bedroom dark at night is critical—this means shades or blinds for the windows, it also means no TV or tablet screens lighting up the room after bedtime. Put some time into making, and keeping, your bedroom comfortable and sleep friendly, and you’ll be rewarded with better and more restful sleep.

 

May 

Sleep suggestion: Curb your consumption of energy drinks 

Research increasingly shows that energy drinks may be harmful to health and to sleep. Studies such as this one found these caffeine-packed, high-sugar beverages raise blood pressure, heart rate, and are linked to anxiety and insomnia. Most of these drinks are classified and marketed as dietary supplements, which means they’re only minimally regulated by the Food and Drug Administration. Don’t let the colorful, kid-friendly packaging of these drinks fool you—some energy drinks have as much as 360mg of caffeine in a single serving. That’s 2-3 times as much caffeine as an 8-ounce cup of coffee.

It’s important to be careful about over-consumption, if you choose to consume these drinks at all, or let your kids drink them. If you need a caffeine boost, a regular cup of coffee will do the trick. Just make sure not to consume caffeine of any type after 2 p.m., so as not to interfere with your sleep at bedtime.  

 

June 

Sleep suggestion: Make sleep—and sleep disorders—an ongoing part of your conversation with your doctor.  

A pair of studies presented this year linked obstructive sleep apnea to an increased risk of cancer and cancer death. Sleep apnea is also associated with a number of other serious health complications, including heart disease, stroke and diabetes. These two studies are the first to establish a link between sleep apnea and cancer risk in humans. (Previous research has found this link in animals.) It’s important to note that neither of these studies established sleep apnea as a cause of either developing cancer or dying from cancer. What researchers in both studies found was a link between the presence of obstructive sleep apnea—and its severity—and the risk of developing from and dying from cancer. There will be a lot more research that explores the relationship between sleep apnea and cancer risk. For all the health risks associated with sleep apnea, it’s critically important that you talk to your doctor about your sleep, and any sleep difficulties you may have.

 

So much to talk about, and we’re only halfway through the year! Check back for the second installment of the sleep stories of 2012.

 

Sweet Dreams,

Michael J. Breus, PhD 

The Sleep Doctor™ 

www.thesleepdoctor.com

The Sleep Doctor’s Diet Plan:  Lose Weight Through Better Sleep

Everything you do, you do better with a good night’s sleep™ 

twitter: @thesleepdoctor 

Facebook: www.facebook.com/thesleepdoctor

How sleep friendly is your bedroom?

There’s no room in our homes that we spend more time in than the bedroom. You can say I’m biased, but I think it’s the most important room in the house. The National Sleep Foundation has just released the results of its first-ever “Bedroom Poll,” which is full of information about how aspects of our bedrooms affect sleep life. The survey covered many aspects of bedroom life, from how much and how well we’re sleeping, to romance and intimacy, to how often we change our sheets. The survey found Americans feeling pretty good about their bedrooms—a majority said they prefer their own bedrooms to a nice hotel. As much as we may appreciate our bedrooms as a retreat and a haven, the poll shows we’re still not actually get enough sleep there.

Let’s take a look at some of the details. The survey, which included 1,500 adults ages 25-55, interviewed by telephone, gathered basic information about how well Americans think they are sleeping. Many people report sleeping well sometimes, but fewer than half say they sleep well most nights:

•  77% of respondents said they get a good night’s sleep on at least a few nights per week
• 42% said they experience a good night’s sleep every night or almost every night
• 13% reported rarely or never getting a good night of sleep

Overall, people report sleeping more on weekends than during the week. The average nightly sleep for weeknights was 6 hours and 30 minutes, at the low end of the recommended 6-8 hours per night. The weekend average rose to 7 hours and 12 minutes. Those with the strongest sleep habits--people who reported sleeping well every night or almost every night—also reported sleeping more on both weeknights and weekends, averaging almost 1 hour of additional sleep, compared to the rest of respondents.

How much sleep do we think we need to function at our best? The survey found:

The average amount of sleep respondents think they need per night was 7 hours and 25 minutes.

•  37% said they needed at least 8 hours per night to function at their best during the day
• 13%
       said they needed less than 6 hours per night to function at their peak

 I’m suspicious of this last figure: there are super sleepers out there, but they are rare. The rest of us need somewhere in the range of 6-8 hours of sleep per night to feel good during the day.

We may not be sleeping enough, but Americans are pretty upbeat about their bedrooms. Not surprisingly, most people reported that a clean, fresh bedroom environment made them feel better about hitting the sheets:

•  78% reported feeling more excited about going to bed when they have clean sheets
• 71% reported sleeping better on clean sheets
• 29% reported going to bed earlier when they have clean sheets on the bed
• 88% said they make their bed at least a few days a week
• 71% reported making their bed every day or almost every day

These responses echo something I’ve said for a long time: a clean bedroom and a welcoming bed (which includes not just clean sheets, but also well-made mattress and pillows) can have a significant effect on how we approach our nightly sleep, and how well we sleep once we’re in bed. It’s worth noting that the people in the survey who reported making their bed every day or almost every day were more likely to also say they slept well every night or almost every night.

When asked to rate the environmental factors in the bedroom that contributed to a good night’s sleep, a majority of respondents rated a clean bedroom as important—but it wasn’t the number one factor. According to the poll, a cool temperature was most often cited as the most important factor in creating a sleep friendly bedroom environment, followed by:

• Fresh, allergen free air
• A dark room
• A quiet room
• A clean bedroom

This list looked a little different when it came to creating a romance-friendly environment. When asked to name the most important factors for romance in the bedroom, respondents chose:

• A comfortable mattress
• Comfortable sheets and bedding
• A clean room
• A cool temperature in the bedroom
• Comfortable pillows
• A quiet environment

The results of this survey confirm what I and other sleep experts have been saying for years: the condition of your bedroom really matters, for the quality of your sleep as well as your intimate life and your health.  Here are my tips for keeping your bedroom in good shape—or shaping it up, if it’s been neglected:

•  Invest in your sleep equipment. A good mattress and quality pillows are important investments in your sleep and health. Replace your pillows every year, and invest in a new mattress at least every 7 years—or whenever your body tells you it’s time.

•  Go cool and dark. Your bedroom climate is important. Most of us sleep better in a cool room. And we all benefit from darkness for sleep. Try an electronic curfew about an hour before bed. Disengage from email, phone, and texting. -there’s plenty of research that shows how disruptive these devices are for sleep. Better yet, keep them out of the bedroom altogether. If you fall asleep to the TV, use your TV timer so it turns off after you have fallen asleep.

•  Fresh sheets are an easy indulgence. Keep fresh sheets on your bed, wash them often, and invest in an extra set so you can change them frequently. As this survey indicates, fresh sheets are a big draw—they can entice you to bed earlier and help you sleep better once you’re there.

• Pamper. Give yourself a sleep vacation at home! Those sleep-spa getaways are increasingly popular, but you don’t have to leave home to reap the benefits of some sleep-focused down time. Unplug from your regular responsibilities—and your PDA. Sign up for a yoga class or a local spa visit. Follow up these relaxing activities with an afternoon nap and a quiet evening before bed. And think about adding some of these “indulgences” into your regular routine!

Sweet Dreams,

Michael J. Breus,PhD 

The Sleep Doctor™ 

www.thesleepdoctor.com

The Sleep Doctor’s Diet Plan:  Lose Weight
Through Better Sleep

Everything you
do, you do better with a good night’s sleep™ 

twitter: @thesleepdoctor 

Facebook: www.facebook.com/thesleepdoctor

Sleepless in the City

Real Age has just published its ranking of the best and worst cities for sleep in the U.S., part of its 2012 Oldest and Youngest Cities report. There’s good news for residents of cities like Charlotte, NC, Philadelphia, and Austin Texas—you are among the urban dwellers getting the most consistently good sleep. Now, let’s take a closer look at that “worst” list. These are the top 10 worst cities for sleep, according to Real Age:

1. Louisville, KY
2. Memphis, TN
3. Knoxville, TN
4. New Orleans, LA
5. Jacksonville, FL
6. Las Vegas, NV
7. Tampa-St. Petersburg, FL
8. Portland, OR
9. Los Angeles, CA
10. Providence, RI

It’s pretty clear why Real Age would create a list like this: sleep is a fundamental aspect of long-term health and wellness. Their age-determining algorithm calculates that getting the recommended 7-8 hours of sleep per night can make your “real age” as much as 1.5 years younger than your actual age.

How did they determine the worst cities for sleep? The cities that made the worst list were the ones where people reported the most change in the amount of sleep they got on a nightly basis, a change of more than 2 hours in either direction, compared to the first time they took the Real Age test. Most people who took the test reported being short on sleep. But people who sleep too much are also
at risk for health problems: in Real Age terms, too much sleep can age you as much or more than too little sleep.

Interestingly, the Real Age worst cities list shares many of the same entries with another recent ranking of cities struggling with sleep. Bert Sperling recently released his own list of the most sleepless cities. Sperling, who researches quality of life issues in cities and towns, used a different methodology to compile his list, one that considered life circumstances such as employment and marital status, and daily commute time. Still, the two lists share several of the same apparently sleepless cities, including Louisville, New Orleans, Las Vegas, and Tampa-St. Petersburg.

Back to the Real Age rankings, this ranking was looking at the DIRECT effects on change in the amount of nightly sleep (not looking at other factors which may affect sleep).

What are some possible causes of such a substantial change—more than 2 hours, up or down—in the amount of sleep one gets per night?

 People who are sleeping too much are often dealing with one or more of the following issues:

• Depression. Depression is linked to both sleep deprivation and to excess sleep. Lethargy, feelings of being overwhelmed, and fatigue are all hallmarks of depression and can they themselves lead to too much sleep.

•  Illness. Excess sleep can be both symptom of and a risk factor for an underlying illness.

•  Unemployment. In today’s difficult economy, many people are facing unemployment
       and under-employment. Being without a job can cause depression, stress and
       anxiety, which can wreak havoc with sleep. Losing a job also often means
       losing the schedule that goes with employment, and that loss of routine
       can lead to irregular bedtimes and wake times, and too much sleep.

• Loss of a loved one. Difficult losses—whether by death,
       divorce or separation—take a deep toll, both physically and emotionally.
       These events can cause immediate and significant problems for sleep,
       including an increase in sleep to unhealthful levels.

 At the other end of the spectrum, what are the most common circumstances that lead to a
change toward too little sleep?

•  A new baby. Bringing home an infant is a wonderful event—and notoriously challenging
       for the sleep habits of parents.

• Stress. This might be the most common cause for a decrease in sleep. Whether chronic or acute, stress is disruptive for sleep and bad for your health. Remember, too, that stress is not only caused by negative circumstances and events. Exciting, positive changes—think weddings, job promotions, and moving house—can still be stress-inducing.

• Exercise. There’s plenty of evidence that exercise enhances sleep. But exercise too close to bedtime can interfere with your nightly rest. I’m NOT suggesting you give it up! Rather, move your exercise too early in the day. Morning is an ideal time for exercise, when it will help strengthen your circadian rhythms and help you sleep better at night.

 Whether you’re living in a Los Angeles high rise or a townhouse in New Orleans’ French Quarter—or anywhere that you’re struggling to get the right amount of sleep—here are some simple steps you can take to help improve your nightly sleep: 

1.  Calculate your bedtime: Determine the time you need to be out of bed. Now work backward 7.5
        hours. That’s your ideal bedtime. Set an alarm to remind you to go to
        bed—just make sure to reset it for your wake up time.
2. Nap during the day: Midday are rejuvenating for mind and body. Creating time for a short nap during the day—20 minutes is ideal—is not laziness, its smart sleep strategy! Just be sure not to
        nap too late in the afternoon. Napping after 3:30 p.m. could interfere with your overnight sleep.
3. To help stave off daytime drowsiness, try my Nap-a-Latte™ technique: quickly drink a small cup of cool-drip coffee, and then take a 25-minute nap. The Nap-a-Latte™ reduces your drowsiness and the caffeine will wake you up, but taken no later than early afternoon will not keep you awake at night.
4. Reduce your caffeine: Limited use of caffeine is okay, but too much caffeine can interfere with falling asleep even several hours after it’s consumed. If you’re short on sleep, keep your caffeine intake to a minimum, and don’t consume caffeinated beverages after 2 p.m.

So we now can use this “RealAge” information to change our sleep and change our lives!

Sweet Dreams,

Michael J. Breus, PhD 

The Sleep Doctor™ 

www.thesleepdoctor.com

The Sleep Doctor’s Diet
Plan:  Lose Weight Through Better Sleep

Everything you do, you do better with a good night’s sleep™ 

twitter: @thesleepdoctor 

Facebook: www.facebook.com/thesleepdoctor

 

 

Spring Forward – Are you Ready?

I write regularly about the state of sleep deprivation in today’s society. This sleep deprived situation isn’t going to be helped by the start of daylight savings time this Sunday, on March 11^th.  The time change in the spring is always more difficult than in the fall since we spring forward and end up losing an hour of our day—and since that time change officially happens at 2 AM on Sunday morning, the hour we lose is an hour of sleep. 

I know there can be great benefits to changing the clocks – we will gain an extra hour of sunlight in many cases, there are studies that have shown energy savings in the clock change.  But I hate sacrificing an extra of much needed shut-eye when we are already a society that is chronically sleep deprived!

So who do I predict will have the most difficulty with the time change? People who like to stay up late, and those in the southeast part of the United States.  Sound like a strange prediction? Well here are my reasons….

In a recent study in The Journal of Clinical Sleep Medicine we learned that sleep problems and fatigue seem to vary by STATE! I find this data fascinating.

The 10 states that currently have the most sleep disturbance in descending order include:

• West Virginia
• Oklahoma
• Alabama
• Arkansas
• Mississippi
• Louisiana
• Missouri
• Utah
• Nevada
• Michigan

When reviewing the study I noted that they controlled for things like age, sex, education, ethno racial group, income, employment, general health, healthcare access and depression, to try  and explain why these states seem to suffer so much. Whether you live in one of these states or not, anyone losing an hour will feel the effects of it, especially if you are already sleep deprived (and you know who you are).

But the good news does not stop there.

Did you know that night owls are more affected by the time change than early birds?

In a study from 2008 that I was reading on www.sleepeducation.com it turns out that night owls, during the time change, have significantly more restless sleep. Do you know if you are a night owl or a morning lark? This chart can help you decide:

Ask yourself the following questions:

	Early Bird	Night Owl
I feel Alert	In the early morning	Late in the evening
I feel the sleepiest	In the early evening	Past midnight
I enjoy waking up	At 6am or earlier	At 8 am or later
I have the most energy	A few hours after waking	A few hours before bed

So if you are a night owl from West Virginia, what can you do before disaster strikes and you only become more sleep deprived?

1. Go to bed 20 minutes earlier Wednesday and Thursday; then another 20 minutes earlier Friday and Saturday. This will help your body adjust to the difference easier.
2. When you wake up Sunday morning, immediately change the time on your bedroom clock.  Help your brain visualize the time change.
3. Eat lunch and dinner 30-60 minutes earlier for 3 days before the time change to get your other daily routines in sync for the new time change.

1. Beginning a few days before the time change, stop drinking caffeine at 1:00 in the afternoon to help with the earlier bedtime.
2. Avoid alcohol during the weekend of the time change (this one can be tough).
3. Keep up your exercise during the week for better sleep quality and maybe throw in an extra work out this weekend.
4. Make sure you get sunlight in the morning the day of the time change to help reset your body clock.

And if possible, my #1 recommendation for this Monday, March 12, 2012:

Ask your boss if you can either work from home the morning after the time change, March 12, 2012, or come in late.

The roads will be filled with sleep deprived people running late for work or school!

Be aware of your bedtime routine as the clock springs forward—otherwise you might fall back asleep at the wrong time.

Sweet Dreams,

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

The Sleep Doctor’s Diet Plan:  Lose Weight Through Better Sleep

Everything you do, you do better with a good night’s sleep™ 
twitter: @thesleepdoctor 
Facebook: www.facebook.com/thesleepdoctor

 

 

Aging, eyes and our circadian clock: what’s the connection?

It’s not every day that a news story about circadian rhythms shoots to the top of the “most read” list in a major newspaper. But that’s exactly what happened with this story about how the aging of our eyes may affect our circadian clocks and in turn, our overall health. This New York Times piece outlines research that is working to connect the aging of the eye with disruption to the functioning of the body’s circadian clocks, and the development of many of the chronic and serious health conditions that are associated with age.

Circadian rhythms—our own internal biological “clock”—govern our sleep-wake cycle and several other daily rhythms of the body. It’s a complicated and finely tuned system of hormonal and bio-chemical reactions that helps us live in rhythm with the 24-hour day, waking in the morning and remaining alert throughout the daylight hours, then sleeping and rejuvenating at night. A key component of our circadian system is the timed release of the “sleep hormone” melatonin. When our circadian clocks are functioning properly, melatonin levels rise during the nighttime hours, promoting sleep. Melatonin levels are suppressed during daytime hours, as other hormones such as cortisol rise, helping to provide the alertness and energy we need to navigate our waking day.

Our bodies’ circadian clocks, and the rise and fall of melatonin, are driven by exposure to light. And our eyes play a critical role in capturing that light and transmitting information to the part of the brain that governs our circadian clocks.

Scientists in recent years have discovered a group of cells in the retina of the eye that are triggered by light to communicate with the area of the brain that controls the circadian clock. Researchers have determined that these light-sensitive retinal cells communicate directly with the brain’s suprachiasmatic nucleus. This small cell cluster, located in the hypothalamus, is responsible for controlling the body’s circadian rhythms.

Our circadian clocks are incredibly precise, and can be very sensitive to disruption:

Exposure to light at night. This happens most often these days through our ever-present electronic devices, which seem to be everywhere, including the bedroom. Falling asleep with the television on, leaving a cell phone, laptop or tablet on your bedside table—the light emitted from these devices can throw your circadian rhythms out of whack and disrupt your sleep.

Age. Evidence has shown that the body’s circadian clock functions less effectively as we age.

Shift work. People who work nights, or an irregular combination of day and night shifts, are frequently living at odds with their biological clocks. Firefighters, police, medical professionals, pilots and other shift workers—as well as people who travel frequently across time zones—suffer sleeplessness and other health problems as a result of disruptions to their circadian clocks.

Here’s where the aging of the eye comes into play. As our eyes age, they become less effective at absorbing light. Pupils become narrower. The lens of the eye takes on a yellow cast. Overall, our eyes become less adept at absorbing light—particularly blue light, the part of the light spectrum that has an especially powerful effect on the retinal cells that work with the brain to control circadian rhythm. This study showed how dramatically blue-light absorption decreases with age:

•  The eyes of a 10 year old have 10 times the ability to absorb blue light as the eyes of a 95 year old
• By age 45, a person’s eyes are able to absorb only 50% of the blue light needed to keep circadian rhythms functioning properly

Research into the effects of blue light exposure on the body’s circadian rhythms reveals the negative consequences of the decrease in blue-light absorption that comes with age:

•  In this study, women were exposed to blue light for a continuous 30-minute period. The younger women in the study responded to the blue light exposure with a drop in melatonin levels. Older women, exposed to the same amount of blue light, did not experience a suppression of melatonin levels.
• This research revealed that older men were significantly less affected by exposure to blue light than younger men, when researchers measured for alertness and mood. Younger men experienced a boost in alertness and mood after exposure to blue light that older men simply did not experience.

What does all this fascinating science mean in practical terms? Exposure to light, especially sunlight, matters. And it matters increasingly as we age. As our ability to use light effectively decreases, we need to increase the amount of our exposure in order to help strengthen and boost our circadian rhythms. Keeping our eyes healthy and promptly treating eye problems such as cataracts is critical. The health of our eyes, it seems, may have a profound effect on the quality of our sleep and our overall health.

Sweet Dreams,

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

The Sleep Doctor’s Diet Plan:  Lose Weight Through Better Sleep

Everything you do, you do better with a good night’s sleep™ 
twitter: @thesleepdoctor 
Facebook: www.facebook.com/thesleepdoctor

 

 

 

 

 

Your Brain on Sleep

There’s still a great deal of information about the effects of sleep on the brain that we don’t yet understand, so any research that sheds light on this subject is exciting and potentially important. We know that sleep has restorative, cognitively-enhancing effects. We also know the absence of sleep can have detrimental effects on brain function. Recent studies in sleep-brain research have shown:

• A link between deep sleep and the formation of long-term memories. Researchers at Washington University School of Medicine were able to establish this direct link by manipulating a cluster of cells in the brains of fruit flies. After breeding the flies to sleep on demand, the researchers discovered that with sleep, fruit flies were able to convert new information into long-term memories. Without sleep, the fruit flies were only able to retain new information for a brief period, as short-term knowledge.
• Chronic insomnia may lead to damage in the brain. Another recent study in the sleep-brain connection revealed that chronic insomnia is associated with loss of grey-matter density in the human brain. Scientists in the Netherlands found a strong correlation between chronic insomnia and a decrease in grey matter in certain regions of the brain. Moreover, they discovered that the more severe the insomnia, the more significant the decrease in grey matter.

In this post, “Can Sleep Help Heal Painful Memories?”, I wrote about newly published research that showed REM sleep helps the brain to process emotional memories. In this study, people who slept after being exposed to emotionally charged images had a less intense reaction to seeing these images a second time, compared to people who saw the images twice without sleeping between viewings. Measuring brain activity using MRI, researchers observed a quieting of activity in the region of the brain that processes emotions, indicating that during REM sleep the brain is “soothing” itself of stress.

 This latest study may provide another important piece of the puzzle as we work to understand how sleep affects our brain chemistry and brain function. This is also one of those studies that answers a question only to raise many more. Does this insight into the role of sleep in processing emotions provide us a glimpse into why we dream? For people who have suffered severe emotional trauma, is the “re-living” of those experiences connected to their sleep, and to the repetitive nightmares that often accompany significant emotional distress?

 The implications of these most recent findings could be significant for people with a wide range of conditions. People with:

• psychiatric disorders
• who live and work under prolonged, chronic and intense stress
• who suffer from mood disorders, depression and anxiety
• post traumatic stress disorder

 All of these and others stand to benefit from a greater understanding of how sleep can help process emotions.

 Stress and emotional upheaval are part of everyone’s lives at some point, of course, so this news is relevant for every one of us. As science works toward greater knowledge of how sleep works within the brain, let’s take this moment to remember just how powerful—and helpful to your well being, emotionally and physically—a good night of sleep can be.

 Sweet Dreams,

 Michael J. Breus, PhD 
The Sleep Doctor™ 

www.thesleepdoctor.com

The Sleep Doctor’s Diet Plan:  Lose Weight Through Better Sleep

 Everything you do, you do better with a good night’s sleep™ 
twitter: @thesleepdoctor 
Facebook: www.facebook.com/thesleepdoctor

 

Can sleep help heal painful memories?

 Here’s some truly fascinating sleep news, the kind that shows just how deeply sleep can affect every facet of our lives. Scientists at the University of California, Berkeley examined the relationship between sleep abnormalities and the brain areas related to emotions. They discovered that REM sleep processes emotional experiences, so that these experiences feel less painful, difficult, and emotionally charged after sleep.

 Thirty-five adults participated in the study, all in good health. Researchers divided the participants into two groups. Both groups were shown the same series of 150 emotionally charged images, while researchers monitored brain activity with MRI. Each group was shown the entire series of images two times, with a 12-hour break between viewings. One group saw the images first in the morning, and again in the afternoon, and they stayed awake during the 12-hour interim period. The other group saw the images for the first time in the evening, followed by a full night of sleep, during which their brain activity was monitored by electroencephalogram. Upon awakening, the second group was shown the images a second time. Researchers found that exposure to REM sleep had a dramatic effect on people’s reaction to the images:

• People who slept between seeing the emotional images reported a decrease in the intensity of their emotional reaction the second time, compared to those who did not sleep
• Brain scans during sleep showed that during REM sleep the brain’s electrical activity slowed, essentially “soothing” the brain of stress.
• MRI showed a significant decrease in the region of the brain that processes emotions. This decrease corresponded with an increase in activity of the brain’s center for cognition, rational thought, and decision making.

 Based on these results, it’s as though REM sleep allows the brain to have some control of an emotional memory.

 This is a single study, and we need to see more research on this subject. But think for a moment about the implications of these results. Sleep problems and sleep disorders—from insomnia and sleep apnea to sleep deprivation and restless leg syndromes—can all increase risks for other health problems, from obesity to diabetes to heart disease. They also can affect mental health. One thing all sleep problems seem to have in common is in bringing about a feeling of being overwhelmed, or of having difficulty coping well with the demands of daily life. Anyone who has ever run short on sleep, or weathered a string of sleepless nights, will know what I’m talking about. Irritability, emotional fatigue, distractedness, short-temperedness—these feelings are common enough with disordered sleep as to be considered universal.

 What if this possible function of REM sleep—to manage and soothe emotional experiences from our waking lives—is at play here? Is the absence of REM sleep a factor in the emotional and mental toll that sleeplessness takes on us? A greater understanding of this possible connection could have a profound effect on how we view, and treat, sleep problems and the secondary effects of sleeplessness.

 So remember, as I always say, it is truly better to “Sleep on it” to feel better.

 Sweet Dreams,

 Michael J. Breus, PhD 

The Sleep Doctor™ 
www.thesleepdoctor.com

 The Sleep Doctor’s Diet Plan:  Lose Weight Through Better Sleep

Everything you do, you do better with a good night’s sleep™ 

twitter: @thesleepdoctor 
Facebook: www.facebook.com/thesleepdoctor