Light Impacts Sleep

Posted November 7, 2014 by Dr. Catherine Darley
Categories: body clock, circadian rhythm, Light therapy, optimal sleep, sleep

Tags: , , ,

Now that the nights are longer, it’s time to think about the impact light has on our sleep. And oh, does it have impact! This last month it’s been a pleasure to read two books on light, and human’s historical experience of night – The End of Night by Paul Bogard, and At Day’s Close Night in Times Past by A. Roger Ekirch. Let’s dive into some of the details, and then how you can design light exposure to help your sleep.

The negative effect of light at night
Roger Ekirch talks about the human experience of night over the centuries. Streets until the 1600s had only the light spilling from homes to light them. To be out at night was dangerous, and many towns would close their doors at night and enforce a curfew. For safety, fires and candles would be put out before bed. Their use would be conserved to save money, so some poor people would go to bed soon after dark.

Compare that history to the “sky glow” that many of us are now living in, where we can hardly see the stars at night. In The End of Night author Paul Bogard outlines what is lost when we no longer have dark nights. Not only is human physiology influenced, but migrations of birds and the life-cycle of trees is altered.

Melatonin is a hormone secreted by the pineal gland of the brain. Melatonin is nicknamed “the hormone of darkness,” and helps us feel sleepy at bedtime. Unfortunately melatonin is very sensitive to light, particularly blue light, which suppresses it’s release. And what are 90% of us exposed to during the evening? The blue light of electronics which suppresses melatonin!

The positive effect of light during the dayA recent study compared the sleep of office workers who get natural sunlight to those who work on the interior of the building and don’t. Those who got more light during the work day had better sleep quality, slept longer, and had more physical activity. They also reported a higher quality of life – something we’d all like!

Using light exposure to improve sleep
The basic principle is to get historical light levels during both day and night. In other words, bright full-spectrum light it the morning and during the day, then full darkness at night. How can you do that? Here are some ideas:
– in the morning get some bright outdoor light as soon as possible. Maybe go stand on the porch and look out while having your morning tea.
– continue to get bright light in bursts throughout the day
– in the evening, have lights low, and use the yellow-red spectrum if possible (rather than blue or full-spectrum lights). Avoid electronics for the hour before bed.
– if you are up in the middle of the night, again have low lighting. Particularly troublesome in many homes are the bright bathroom lights, instead put a small night-light in the bathroom to use if need be.
– watch out for your neighbors too by turning off outside lights that aren’t truly needed, and if you need outdoor lights, aim them downward so you are not committing ‘light trespass.’ (Interestingly, Bogard cites studies showing that increased lighting does not decrease crime, that criminals like to work in a well-lit area just like everyone else!)

Be purposeful about making all of these lifestyle changes at the same time. Then notice after a week or two how your sleep has changed!

The Problem with Alarm Clocks

Posted April 8, 2014 by Dr. Catherine Darley
Categories: bedroom, optimal sleep, sleep

Beep-Beep. Beep-Beep. Beep-BEEP. BEEP-BEEP. BEEEP-BEEEEP!

Using the alarm clock each morning to wake up is common for many Americans. It’s a practice that is hard on sleep, and a practice I’d like to do away with for everyone. Here’s some of the problems.

- If you are waking to the alarm, you haven’t gotten enough sleep. Most adults need a solid 8-9 hours of sleep nightly, and there are many negative consequences of being sleep deprived (see the video mentioned in the last post). Allowing yourself to wake on your own helps ensure that you are getting enough sleep.
– If you wake to the alarm, you may be woken out of deep sleep, or “slow-wave” sleep. This can leave you feeling groggy and take some time to “get with it” mentally.
– A feature many people use is the snooze button, giving themselves another 8-10 minutes of rest before the alarm goes off. Really it is disrupting your sleep for 10-20-30-40 minutes before you have to get up, making that sleep much less restorative.

So here’s my recommendations:
– If you’re waking to an alarm, move your bedtime earlier by 15 minutes every 4-5 days until you are waking up on your own at the time you need to. Alternatively, you can shift your committments later so that you can sleep later in the morning.
– Set the clock for the time you truly need to get out of bed. Then place it across the room so you have to be out of bed to turn it off. This will help you avoid the snooze button, and really get quality sleep until it’s time to get up.

Think about this for yourself, and for your kids too. If you are waking your children up for school they’re not getting enough sleep either.

Great video on Sleep Deprivation

Posted April 3, 2014 by Dr. Catherine Darley
Categories: Uncategorized

Over the years I’ve written a lot about sleep deprivation and it’s effects.  Primarily because Behaviorally Induced Insufficient Sleep ie, chronic partial sleep deprivation, is the most common sleep problem, affecting 47% of adults in America.

Right now I’m working with a group of shift workers to help them create a lifestyle that promotes healthy sleep on work nights and days off, and optimal alertness when awake.  People can be very motivated to work nights because of the increased pay, and often shorter work week because of longer, 12 hour shifts.  But trying to sleep during the day is hard, and often shift workers are sleep deprived.  To help them stay motivated to get enough sleep, I’ve been teaching them about the negative impact of sleep deprivation.  This excellent youtube video about “25 scary and surprising effects of sleep deprivation” by List25 tells it well.  Enjoy!

http://www.youtube.com/watch?v=pbJxLITdt_E

 

Reducing Night Nurse Fatigue

Posted March 30, 2014 by Dr. Catherine Darley
Categories: body clock, circadian rhythm, public safety, Seattle, shiftwork

Lately it’s been a pleasure to provide an intervention program for night-shift nurses to help them sleep well during the day, and thereby improve their alertness at night. For many nurses working nights a typical shift is 12 hours, often from 7pm to 7:30am. This requires them to function well during the hours that human beings are designed for sleep. Many of these employees like to sleep during the night on a similar schedule to their loved ones when not working, which keeps them in a perpetual state of circadian misalignment, making it even more difficult to function well at night.

In December 2011 the Joint Commission issued Sentinel Event Alert #48 on the effect of extended work hours and cumulative work hours on patient safety and nurse health. They summarize the extensive research on the performance effects of working at night. Some of the results of fatigue include:
– impaired information processing and judgement
– inability to focus attention
– reduced motivation
– loss of empathy
Fatigue among healthcare workers increases the risk of adverse events, decreases patient safety, and negatively impacts the health of the night shift workers.

The Commission report goes on to suggest steps organizations take to improve employee alertness and thereby improve patient safety. Fatigue management typically includes steps for both individual employees and the administration. Sleep training for employees so they can sleep well during the day, and entrain their circadian rhythm to the schedule, is one step. Another is fatigue reducing strategies such as precisely-timed caffeine and light to increase alertness on the job. Administrations can optimize their scheduling practices, and provide an alerting work environment. You can see the full Sentinel Event Report of the Joint Commission here: http://www.jointcommission.org/sea_issue_48/

Over the next 6 months I hope to continue this work for Seattle-area hospitals, and expand to help other public safety organizations that are providing 24/7 service, including the police and fire departments. Around the clock service is a must for public safety, and helping these night-shift staff to sleep well during the day, so they can be alert and healthy during the night is extremely rewarding!

Sleep Impacts Cancer

Posted February 6, 2014 by Dr. Catherine Darley
Categories: cancer, insomnia, sleep

We have become a 24-hour society where people can work, shop and exercise at all hours of the day or night. But just because we can, does that mean we should?

Humans evolved in a rhythmic world, with daily and seasonal variations in light, temperature, and food availability. In our modern world we can control all these environmental factors so they are the same throughout the year, but our body is still programmed for circadian variation. Cancer incidence increases when people live out of sync with natural rhythms, like those who do shift work.

Shift Workers at Increased Cancer Risk

Those people who work graveyard shift have an increased risk of breast cancer. This risk increases with the number of years graveyard shift has been done. Getting bright light at night suppresses our natural melatonin surge. Melatonin is a powerful anti-oxidant, protecting our cells from damage.

Shift workers also are at increased risk for:
•Hypertension
•Cardiovascular disease
•Duodenal ulcer
•Elevated stress hormones
•Menstrual irregularities

Cancer Causes Sleep Disruption

The sleep – cancer relationship goes both ways. For those people undergoing cancer treatment, sleep disruption can be a symptom. This can be a side-effect of chemotherapy, or of pain, or other factors.

The good news is that several studies have shown that sleep of cancer patients can be improved by doing Cognitive-Behavioral Therapy for Insomnia. Specifically, after treatment, cancer patients ended up sleeping a higher percentage of the time they were in bed, had improved mood, and decreased fatigue. Another study additionally found that the people had fewer nights on medication, and that the improvements were maintained for 12 months afterwards.

Similarities between Childrens Sleep and Gambling?

Posted January 30, 2014 by Dr. Catherine Darley
Categories: behavioral treatment, Children's sleep, fall asleep

Okay, you may think this is a stretch.  What similarities could there possibly be between children’s sleep and gambling?  Well, let’s talk about it.

Remember from a psychology class the idea of “intermittent reinforcement?”  This is when a behavior is only sometimes rewarded.  Researchers found that in animals, if a behavior was only rewarded about 50% of the time, that behavior would persist longer than if the action always gave a reward.  The same is thought to be true in human beings. 

We see this in gambling, because the gambling behavior is only rewarded by winning on an occasional basis, people will continue gambling for long durations in the hope of getting the reward.

Let’s relate this to helping your young child learn to fall asleep on their own.  After the bedtime routine you say “Goodnight” to your child, leave the room and close the door.  However, your child prefers to fall asleep with you there, so gets up and comes out to get you.  You return to the bedroom with your child, tuck them in, say “Goodnight” leave the room and close the door.  And the cycle repeats, with your child coming to get you, and both of you returning to the bedroom. 

As the night wears on, you are becoming tired, and think “well, if I just lay down with my child until he is asleep, I’ll finally be able to get some rest myself.”  If you sometimes stay with the child until he is asleep, and not other times, you’ve just given intermittent reinforcement, which will keep the child’s behaviour of seeking you out at bedtime to persist.

So for parents, first decide what the ideal scenario and expectations are for your child.  Then, be consistent so there is no “intermittent reinforcement” of the bedtime behaviors you don’t want.   Writing down the plan so that both parents are in agreement, and so you can remember and stay motivated when you are tired can make all the difference.

An Ergonomic Bed

Posted October 30, 2012 by Dr. Catherine Darley
Categories: bedroom, sleep, sleep deprivation

Tags: , , , , ,

Regularly there are new sleep products on the market. Just last week I saw one that really impressed me, so much so that I’d like to share. Rest assured, I have no affiliation with this company, financial or otherwise.

It is a new bed which was designed ergonomically so the body can be in a neutral side-lying position during sleep. There is a cut-away so that the lower arm is supported underneath the body, while the head and shoulders are supported above. In this position the spine is not twisted, as it commonly is when side-lying. The support system allows the shoulders to be in a neutral position also, instead of rolled inwards as commonly happens.

The mattress is wedge-shaped so that the head is elevated. There’s been some work showing that when the body is supine, edema can re-distribute and cause narrowing of the airway. That airway narrowing increases the risk of apnea.

The bed is made of foam, and when I first heard that my alarm bells went off. However, I’ve learned that they only use pure foam that has not been treated with the harmful chemicals found in some foam. There were no fumes evident in the store, either when first walking in or after spending time looking at the bed.

So many people have pain conditions which interrupt their sleep, and the improvements to their sleep are limited until the pain can be eliminated. This bed gives me hope for some of those pain patients

In the next weeks someone will be trying it out for me, and I post an update here after the test. If you’d like more information, you can find it on the inventors’ site http://www.squiresleep.com/


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