The Insomnia Blog by Sleep Doctor Michael Breus, Ph.D.

Tips for Sleepless Mariah Carey

I’m not usually the sort to wade through celebrity gossip pages, but this one came across my desk because it is, well, directly related to my area of expertise… and I am compelled to reach out and offer some advice.

Word travels fast: no sooner did Mariah Carey Twitter about her sleep problems did her issues show up on various websites. Here’s what she apparently wrote on her Twitter page:

"I just finished working out. Whooo! Quite naturally, 'its 5am and I still can't sleep' Who's up? Nick is too cute when he's sleep! I wish he didn't have to work tomorrow so he could help me sleep all day and I could sing all nite [sic]!"

How many red flags can you find in that tweet? Did she work out just before 5 AM and is only now trying to go to bed while the rest of the world (and the sun, let’s not forget) is about to get up? And does she normally live like a vampire—going to bed in the morning and getting up in the evening to sing all night long?

Melatonin: Miracle or Mistake?

In this day and age, when sleep rhythms can go haywire at the drop of bad news, questions about sleep aids are a hot topic. They are no longer confined to those who are presumed to have oddball sleep cycles, such as jet setters and shift workers.

I get a lot of questions about melatonin in particular, since many supplement companies and health food stores will tout that melatonin is a “natural” sleeping aid. Given the availability of this supplement today, you’d presume it’s safe and effective. But is it really?

What’s better, taking a melatonin supplement to help you go to sleep on a crazed Monday night or going for a “PM” version of a pain reliever? Melatonin is a hormone your body produces to help it regulate your sleep-wake cycles, but taking additional melatonin in the form of a supplement isn’t as good of an idea as you might think.

• And it’s not a regulated drug under the FDA.
• No other hormone is available in the United States without a prescription.
• In Europe, melatonin is only available by prescription.

So here’s the 101 on how natural melatonin—the kind produced by your body—works. When the sun sets and darkness sweeps over, a pea-sized structure located deep between the hemispheres of your brain called the pineal gland begins to secrete this hormone—preparing you for bed.

As melatonin levels in the blood rise, you begin to feel less alert and sleep becomes more inviting. Melatonin levels stay elevated for about 12 hours, falling back to low daytime levels by about 9 a.m. Daytime levels of melatonin are barely detectable.

The precise mechanism of melatonin secretion is not well-known. We do know, however, that melatonin isn’t just about sleep-wake cycles. It’s been shown to:

• Help regulate the female reproductive cycle and may also control the onset of puberty.
• Children who take melatonin can suffer a delay in sexual development. (So never ever give a child a melatonin supplement.)
• Studies have pointed to melatonin’s role in regulating blood flow, specifically in constricting coronary arteries.
• It’s been suggested that it can increase depression in people prone to the illness.

A hormone with all of these possible effects—even though it’s “natural”—isn’t something you should be taking without the specific recommendation of your doctor.

Most commercial products are offered at dosages that cause melatonin levels in the blood to rise to much higher levels than are naturally produced in the body. So taking a typical dose (1 to 3 mg) may elevate your blood melatonin levels to 1 to 20 times its normal state. If you take it at the wrong time of day, you may reset your biological clock in an undesirable direction.

How much to take, when to take it, and melatonin’s effectiveness, if any, for particular sleep disorders is only beginning to be understood. Remember Melatonin is a sleep regulator not a sleep inducer, so it really should not be used as a sleep pill. In the future, we may find several useful applications of melatonin.

You’re better off regulating your own sleep-wake cycles in a genuinely natural way by:

• exposing yourself to light during the day (preferably sunlight),
• engaging in physical activity regularly,
• practicing good sleep hygiene.

Remember: Your body will reset its own internal clock with the proper exposure to light at the right time. (And you shouldn’t need a PM formula, either, unless you truly do need an occasional fix for quelling muscle aches or other pains that can prevent you from going to sleep easily. Just don’t make this a habit every night.)

Bottom line: better sleep hygiene, better time going to sleep. And better moods the next day. Melatonin, on its own, is not a sleeping pill.

Sweet Dreams,

Michael J. Breus, PhD, FAASM
The Sleep Doctor

Click here to see Dr. Breus's list of recommended sleep products. Click here to order Beauty Sleep on Amazon or Kindle.

More Boost to Immunity

Cold and flu season is upon us, and the news last week which showed the impact of sleep on immunity was downright fascinating.

Pop quiz: does it matter whether you get an infection during the night versus during the day?

It appears so. Stanford researchers showed just how much stronger our immune system is at night by infecting flies with two strains of bacteria—but some of those flies were infected during the day. Those that got sick during the night were more likely to survive than those getting sick during the day.

Okay, so we’re not fruit flies. But researchers routinely use flies to help make observations and conclusions that can be related to humans. I have no doubt that if we were to test this theory on humans, we’d find similar results. It’s long been known that quality sleep boosts immunity (ahem, I wrote about this in my last post). I love another study emerging to confirm this fact. When most of our bodily functions are at rest, our immune systems can amplify.

What Sleep Clock Are You On? Ask Your Skin Cells.

Now, this is fascinating stuff. Researchers just learned that you can look at your skin cell genes to determine whether you are a lark (who likes to get up early), or an owl (who likes to stay up late). A team of German scientists just presented a new study showing that people’s preferences for rising early or late are encoded in their genes, including those found in skin cells.

Other factors also play a role in influencing the time that you like to get up in the morning, but this new finding help us understand the fascinating realm of circadian “clocks” as we continue to explore how the human body deals with the shifts in patterns of activity that are needed to cope with the 24-hour cycle of day and night. Let me explain.

Does Your Job Cause Cancer?

Remember the days when smoking wasn’t linked to cancer? At first, it was un-thought (and unheard) of, then it was invariably presumed, then it was proved. Well, get this: graveyard shift work is now considered a “probable” carcinogen. And the proof is already mounting.

This month, the World Health Organization's cancer division will classify shift work as a probable carcinogen—just like anabolic steroids, ultraviolet radiation, and diesel engine exhaust. (Following suit, the American Cancer Society said it would most likely add shift work to its list of “known and probable carcinogens” as well.)

Scary? It think so. In a fast-paced world that demands shift work in numerous industries, millions—billions perhaps—could be affected globally. About 20 percent of the working population in developed countries work night shifts.

You’ve Gained an Hour Since Last Week: How Are You Feeling?

How many of us woke up Monday morning this week an hour earlier than the actual time because our bodies were still on Daylight Savings Time? Millions, probably.

And how many of us rejoiced when we realized we had another hour to sleep because we needed it? Millions more, probably.

As it turns out, we’re not good at adjusting to the time change naturally. Daylight savings time, which affects a quarter of the world’s population and entails a one-hour time change twice a year, reflects a change in social clocks—not biological ones. New studies are showing that we don’t actually adjust to these changes in time so easily—especially the “spring-forward” one.

What If Your Kid’s First Bell Rang Close to Lunchtime?

If I could go back in time and be a high school student again (let me re-phrase that: if I had to go back and do it all over again), I’d like to attend one of the schools in Toronto where kids can start classes as late as 11:30 a.m.

Finally, we are seeing changes happen in school systems to support students’ natural rhythms that prefer later nights and even later mornings. It hasn’t happened yet, but I read an article online reporting that next year one high school in this Canadian city will be chosen for allowing its students to sleep in—big time. In the United States, school districts in 19 states have implemented later start times, but I don’t think any push it out to as late as 11:30! For adults, that sounds like lunchtime.

Ask the Sleep Doctor: Is it Safe to Re-Calibrate My Body Clock for the Short-Term? (For Example, to Prepare for an All-Nighter Study Session)

Here's an interesting question from a resourceful student/athlete:

Q:

Dear  Dr. Breus,

I had a quick question that I was hoping I could get your advice on! :)

I'm a 20 year old male.  It's Wednesday now, and next Saturday night I will be attending the final session of a fitness and self protection course I signed up to at college. According to friends of mine who had done the course before, the final session is akin to basic training for army recruits. Apparently from Saturday night to Sunday lunch time they don't let you sleep, but make you run a marathon, do thousands of push-ups, sit-ups and other draining tasks.

What I was thinking of doing was perhaps changing my sleeping pattern so my body will effectively not be missing out on sleep. Let's say I stayed up tomorrow night (Thursday night), slept all of Friday, stayed up all Friday night, and slept all Saturday - come Saturday night my body will expect to be awake and it won't be as grueling – right? Would this be effective? Is this enough time for my body to adjust or would I just be making things worse?

Any help would be greatly appreciated!

Thanks a lot!

Brett

A:

This is actually not a bad idea. I would say it is worth trying but I would avoid driving anywhere when you are doing this experiment as your reflexes will be slower than normal.

Sleep Article Roundup, 4/2/07

On the sleep-friendly foods front:

Newsweek continues its Up Close and Edible series by shining a light on peanut butter. It turns out that peanut butter can lower triglycerides and help reduce the risk of heart disease.   Peanut butter, like sleep, can also help with waistline management. Says Newsweek:

Penn State researchers found that peanut eaters had lower body mass indexes (BMIs), compared to non-peanut eaters. The higher your BMI (25 and lower is considered optimal), the greater your risk of obesity-related problems like heart disease or diabetes.

But don't fall prey to eating too much of a good thing. Peanut butter is high in calories. A single serving, or two tablespoons of low-fat or regular peanut butter, has about 190 calories. "The point is not to go through the whole jar in one sitting," says Dr. Penny Kris-Etherton, distinguished professor of nutrition at Penn State. She recommends peanut butter as a snack alternative or as a meal, such as a PB&J on whole-wheat bread. Good news for those of us who like our foods comfortable and sticky.

This is also good news for people searching for an ideal pre-bedtime snack: peanut butter and jelly on whole wheat is a high-glycemic snack that may help one fall asleep faster.

Regarding women and sleep:

Over at the Chicago Tribune, Julie's Health Club shares tips for overcoming insomnia. (She likes Yoga Nidra.)

Sleep and Insomnia Articles Roundup

Here's a quick roundup of interesting sleep articles I've gathered:

Daylight Savings and Seasonal Affective Disorder - Sleep Review Magazine synopsizes an L.A. Times Article (viewable only upon registration) about how the change in Daylight Savings timing has affected some people with SAD.  Apparently the delay in sunrise can trigger depression in people who suffer from SAD. Light therapy devices that help manage circadian rhythms seem to help.

70% of Doctors Have Sleep Disorders according to this article posted in PanAsianBiz.  Apparently the problem is particularly severe in China.

Insomnia May Be Cheaper to Treat Than to Ignore according to this article by The National Academies. Says the article:

Untreated insomnia creates a “significant economic burden” through missed work and medical expenditures, according to a new study in the medical journal Sleep. Roughly 10 percent of the U.S. population is estimated to suffer from chronic insomnia.

The study concluded that insomnia costs employers roughly 4.4 days of wages per untreated individual over a period of six months, and this is just from the direct costs. The study did not look at the added impact of indirect costs such as accident rates or lost productivity. However, even taking only the direct costs into account, it appears that it would be cost-effective for businesses to motivate their employees to seek treatment early.

In addition, patients who were eventually diagnosed with insomnia tallied significantly higher medical expenses than people without insomnia, which also supports the argument for early formal treatment, to avoid unnecessary medical expenditures.