The Insomnia Blog - Sleep Doctor Michael Breus, PhD

Are You a Ticking Time Bomb?

If someone said to you that your lifetime risk of a heart attack is close to 100 percent, you’d probably want to do everything you can to either prevent that fate or delay it by as long as possible. Right?

Heart attacks continue to be the number one killer of Americans; 1.5 million heart attacks occur in the United States each year with 500,000 deaths. Costs related to heart attack exceed 60 billion dollars per year.

Most of us are aware of the ways in which we can help keep our hearts healthy:

• Eating a sensible, balanced diet high in healthy fats and low in saturated fat.
• Keeping our cholesterol and blood pressure under control.
• Maintaining a regular exercise routine that gets our heart pumping faster.
• Managing stress.

But what about sleep? How does that factor in?

Turns out that sleep factors in big time: a new study shows that poor sleep may worsen heart health by increasing inflammation. Chronic inflammation has gained a lot of attention in recent years due to the associations found between this bodily process and an array of illnesses and disease. While inflammation is a normal physiological process and part of our immune system, when it runs amok it can wreak havoc on our cells and tissues. Which explains why inflammation can play a major role in heart health, as it can lead to restricted blood flow and increase the risk of heart attack and stroke.

This recent study found that regular bouts of insomnia and poor sleep quality may increase inflammation throughout the body, which may be further aggravated by high cholesterol, resulting in heart complications. The specifics:

• After surveying 525 participants on their sleep habits, researchers from Emory University measured their levels of certain inflammatory hormones, including the famous C-reactive protein that’s used as a biomarker for inflammation.
• They found that individuals who regularly got the least sleep were significantly more likely to have high levels of the hormones and consequently, inflammation.
• In fact, adults who slept for six or fewer hours had higher levels of all three inflammatory markers that the researchers measured.
• The researchers at Emory also noticed that men and women with poor sleep quality had higher blood pressures.

Something else that the researchers discovered to their surprise:  men—not women—who experienced poor sleep quality had less flexible arteries. This condition also contributes to hypertension and puts more stress on the heart.

The reason for this could be due to certain hormones or other variables going on in women that help explain the discrepancy. This doesn’t mean women can get away with poor sleep. It just means we need to study the gender differences when it comes to health and their separate risk profiles.

Fibrinogen, one of the other markers observed in this study, forms a fibrous mesh that slows the blood flow, thus increasing blood pressure and potentially causing hypertension. This fibrous mesh quickens the time it takes for your blood to clot, which can cause a stroke or heart attack. 

So it goes without saying that we all need to keep sleep on our list of priorities for keeping our hearts healthy and strong.

Bottom line: Rest up to keep your heart up and running. You may feel like a ticking time bomb as you juggle too many To Dos and run around like mad addressing your commitments and obligations. But that ticking time bomb can be real if you’re simultaneously throwing sleep out the window. Add more minutes to your life just by adding more quality sleep minutes to your time in bed. 

It really could be as easy as that.

Sweet Dreams,

 

Michael J. Breus, PhD

The Sleep Doctor™

www.thesleepdoctor.com

The Heart of the Sleep Matter

I know I’m not the first to tell you about the benefits of exercise. I also know I’m not the first to tell you that exercise can do a body good from both an emotional and physical standpoint.

But I might be the first to tell you that exercise, and specifically the aerobic kind that gets your heart rate up for an extended period of time, can improve your sleep. If you’re in insomniac, listen up: a new study from Northwestern Medicine that will be published in the journal Sleep Medicine soon showed serious promise to the dramatic effects of exercise on people diagnosed with insomnia. 

Millions of Americans suffer from symptoms of chronic insomnia, including difficulty falling sleep and/or staying asleep, and impaired daytime functioning. Insomnia also tends to strike more severely during middle age in and older adults. Women have the highest prevalence of insomnia. Many of these people resort to perscription drugs and sleep aids to help achieve a better night’s sleep. But drugs are not always a solution over the long term, and there’s no substitute for exercise, which has benefits that go far beyond restful sleep.

The highlights from the study:

• Twenty-three sedentary adults, primarily women, 55 and older with insomnia were grouped into two: one that would commence an exercise program and another that would engage in less physically demanding activities. Both groups received education about good sleep hygiene, which includes sleeping in a cool, dark and quiet room, going to bed the same time every night, and not staying in bed too long if you can't fall asleep.
• The aerobic physical activity group exercised for two 20-minute sessions four times per week, or one 30-to-40-minute session four times per week, both for a total of 16 weeks. Participants worked at 75 percent of their maximum heart rate on at least two activities including walking or using a stationary bicycle or treadmill.
• Participants in the non-physical activity group participated in recreational or educational activities, such as a cooking class or a museum lecture, which met for about 45 minutes three to five times per week for 16 weeks.

The results: The people in the exercise group fared far better than the non-exercise group when it came to their sleep. Exercise not only improved their sleep quality—elevating them from being a “poor sleeper” to a “good sleeper” but they also reported feeling better. Their moods improved, and had more vitality and less daytime sleepiness.

I’ve long been an advocate for getting plenty of physical activity into your life to promote restful sleep. This study may have been among the first to examine the benefits of maintaining an aerobic regimen among insomniac women, but it certainly wasn’t the first to discover the profound role exercise has on supporting high-quality sleep.

Not everyone experiences the same sleep benefits to exercise, but people who suffer from insomnia aren’t usually the athletes and highly active individuals. (The only instance I’ve seen is where athletes over-train and for some reason have a hard time turning their mind off at night, or they are so used to exercising that on their “off days” their body craves that exercise to help with sleep.) To the contrary, most people who complain of sleep problems lead sedentary lives and don’t practice a regular exercise routine.

Aerobic exercise has shown to aid in sleep primarily by doing two things: 1) helping you fall asleep quicker; and 2) plunging you into deep (or delta) sleep for a longer period of time, which is where you need to be to feel refreshed and restored the next day. Other studies on people who participate in aerobic activities show that they have a tendency to secrete more growth hormone at night, which aids in repairing and rejuvenating the body.  And let’s not forget the stress component to exercise: getting active tends to help us lower our stress levels, which allows up to calm down enough to welcome sleep!

One of the current reasoning behind exercise’s effects on sleep centers of the brain is the thermogenic hypothesis, which states that exercise promotes sleep by heating the body or brain. When you work out (it has to be an aerobic workout for at least 20 to 30 minutes), your body’s core temperature rises a couple of degrees (about 2 ⁰F) and stays that way for about 4 to 5 hours. When it cools back down, your core temperature will decrease to a point lower than had you not worked out at all. And it’s this drop in body temperature that is theorized to promote falling asleep and gaining the deep, sound sleep your body needs.

Exercise your body to rest your body. It’s as simple as that

 

Sweet Dreams,

Michael J. Breus, PhD

The Sleep Doctor™

www.thesleepdoctor.com

Do Football Players Have a Higher Risk for Sleep-Disorders?

I’m still trying to get over the fact we’re into football season already. Monday night has millions of people glued to televisions for their pro games. This past week a news brief reported on Minnesota Vikings player Percy Harvin, who lost consciousness and had to leave practice in an ambulance on August 19^th. It was a scary incident that led to, of all things, a sleep test.

Harvin is a long-time sufferer of migraines, and at first he thought his collapse on the field was solely related to another headache. But it turns out that his problem is much simpler than that: an overnight sleep test determined that Harvin has sleep apnea. Eight times during the sleep test he stopped breathing for up to ten seconds at a time.  The doctors suspect Harvin wasn’t getting enough oxygen while sleeping, which clearly affected his performance during the day.

The reason I call Harvin’s problem “simple” is because migraines can be very challenging to prevent and treat. They are still quite a mystery. But sleep apnea has a clear solution that works on many people. The CPAP device helps regulate a person’s breathing while sleeping, and no sooner did Harvin start using one than his sleep was transformed. And so was his track record with migraines: he no longer needs medication for them. I guess a good night’s sleep is enough to keep his migraines in check.

Harvin’s recent experience brings to light a lot of similar health concerns for football players:

• The nature of the sport raises their risk for physical injury, head trauma, and fractures.
• Defensive players are encouraged to keep a certain amount of weight on, so they tend to be “overweight” according to standard body-mass-index charts, and live with a heighted risk for heart disease, diabetes and stroke, etc.
• Having a sleep disorder exacerbates these risks.

But here’s something interesting: a new study shoots down prior studies that have suggested that the prevalence of sleep disordered breathing (SDB) among NFL players is disproportionately high. According to this latest study, which examined a total of 137 active veteran players from 6 NFL teams, SDB wasn’t nearly as pervasive among players as you’d imagine. It was “modest,” predominately “mild” and any SDB documented did not account for excess cardiovascular risk factors.

I admit, I was scratching my head at this one. I would have guessed that the scientists confirmed the obvious—that football players are more likely to have sleep disordered breathing, which in turn increases their risk for cardiovascular problems. What really surprised me was reading that linemen and non-linemen were no different in their prevalence or severity of SDB!

If there’s one takeaway to highlight here it’s the fact sleep can be the ticket to a reduced risk for headaches and migraines.  There’s plenty of research to back this up. And you don’t have to be a professional football player to appreciate that!

Sweet Dreams,

Michael J. Breus, PhD

The Sleep Doctor™

www.thesleepdoctor.com

 

 

Tai Chi, Fibromyalgia and Sleep

Every wonder what those people are doing in the park on Saturday mornings?  Or on the beach early in the morning? They are all standing in lines and seem to be moving very slowly, with purpose, with their arms or legs in very specific positions, in what looks like a beautifully orchestrated dance. They are actually setting themselves up for a good night sleep! In an article in the New York Times, a research group out of Tufts University has published a study in the New England Journal of Medicine, showing the effectiveness of Tai Chi on Fibromyalgia (and sleep).

A clinical trial at Tufts Medical Center discovered that after 12 weeks of Tai Chi (60 minute sessions, twice per week), patients (66 subjects) with the chronic pain syndrome known as Fibromyalgia performed significantly better on measurements of pain, fatigue, depression and sleep. Subjects were then tested again at 24 weeks to see if the findings persisted, which they did. The study design was excellent, and the journal that published the study is of particular significance. Historically it has been very difficult to define Fibromyalgia, since there are no blood tests or biopsies that can be done for diagnosis. To have one of the most respected medical journals accept an article about this topic helps validate its existence. In the sleep research world we have seen some possible markers of Fibromyalgia.

When looking at sleep studies of those suffering from Fibromylagia, 40%  show a very unique brainwave called alpha-delta sleep. While this brainwave can be seen in other populations, it is interesting because it often reflects how the Fibromyalgia person reports their sleep, which is typically un-refreshing. Delta or deep sleep, includes stages 3 and 4 sleep where we see a large number of delta brain waves. This is the most physically restorative sleep, where the body re-energizes. Alpha waves are the brainwaves produced when someone is awake lying with their eyes closed. So alpha-delta sleep is your deepest sleep, but with an awake pattern thrown in, so your deep sleep does not feel so deep anymore. And maybe your physical restoration does not occur as well, causing the fatigue and pain feels often seen in Fibromyalgia patients.

Currently there are no medications to help us address alpha-delta sleep in Fibromyalgia patients, but there are some encouraging studies with the Narcolepsy medicine Xyrem.  Currently the FDA does not approve the use of Xyrem for use outside of the treatment of Narcolepsy.

In my clinical experience, many patients with Fibromyalgia have an underlying sleep disorder, and if we treat that disorder (apnea, narcolepsy, etc.), often the Fibromyalgia gets better.

With this new research in mind, there may now be more evidence of this amazing alternative therapy with the beautiful rhythm of Tai Chi to help those in need.

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

Get Moving, Get Sleeping

I love hearing news that confirms lessons I’ve already given in my presentations, conversations with patients, and published works. Just this past week, another study came out that points to the value exercise has in upping the quality of sleep.

I’m not the first person to tell you that exercise is good for you. But if there’s one magic bullet for enhancing the quality of your life—from increasing your overall health to fighting the onset of age-related disease and elevating your mood and sense of well-being—it’s exercise. And it can also have a positive impact on your sleep.

When you think about it, most people who complain of sleep problems lead sedentary lives and don’t practice a regular exercise routine. Aerobic exercise has shown to aid in sleep primarily by doing two things:

Sleep Secrets from the Olympians

The Beijing Olympics are off to a fiery start. High expectations abound, the least of which is the monster one placed on China to clear the air. At that level of competition, everything has to be absolutely perfect—you can’t get sick or injured, and you definitely can’t be tired. So you know there’s no late-night partying going on before an event. These athletes may be superhuman, but even the elite set limits.

Most Olympians endure years of training, keeping up with the top information about how to nourish and care for their precious bodies that are charged to win. Sure, they have access to the best of the best. The best trainers, equipment, coaches, physical therapists, nutritionists, and sports psychologists.  Even the much-adored Dara Torres who, at 41, is being watched like a hawk to see if she can take home a medal in swimming, admits that she drops $100 grand a year on hiring these bests (this includes a stretching coach and a masseuse; where’s mine?).

Clearly, these Olympians probably know a thing or two about being in tip-top shape. Everything about them is elite. And I bet secrets to diet and exercise aren’t their only concerns. They know how to recover, rest, and listen to their bodies when it cries for a time-out. They understand the value of sleep for repairing worn tissues, restoring their muscles for the next workout, and re-charging their brains to think clearly, calculatingly.

For many of these elites, life is simply about training, eating, and sleeping. That’s it. And when the training gets tough, they cycle through several workout-eat-sleep periods throughout the day. Sleep, in fact, even when it arrives in pulses of naps, is a training tool on par with any other asset they need to win. 

In September’s issue of Runner's World, the magazine highlights some of these “secrets,” and a few guilty pleasures the athletes keep. Of course, since the magazine is geared for running enthusiasts, the marathoners and “athletic” athletes (“athletics” is traditional Olympic speak for track-and-field) get the spotlight. Some fun tidbits: