Archive for the ‘body clock’ category

Reducing Night Nurse Fatigue

March 30, 2014

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!

Top 10 Online Influencers Helping America Sleep Better

January 27, 2012

It was a good morning to open my inbox and see that I’ve been named one of ‘The Top 10 Online Influencers Helping America Sleep Better’ by SharecareNow.  See their announcement here  http://www.sharecare.com/static/sharecare-now-shift-work-sleep-disorder

There are some great resources among this list for people wanting healthy sleep and it’s many benefits. Here’s a run-down of the Top 10, with the links to their sites. Enjoy!

Meet Us at the Bus Stop

January 24, 2012

So . . . how many of you are driving to work at 6:30ish? Ever see a kid suddenly caught in your headlights as they are waiting for the bus?

Over the last months the Start School Later movement has been gathering steam as almost 3,000 people across the nation have signed the petition, and the media has discussed the research showing that students do better when school starts later.

This week, on Thursday January 26th, the Meet us at the Bus Stop event is happening across the country to highlight how early children have to get up for school, so early that they are often waiting in the dark, on cold winter mornings, to catch the bus. Please join in by posting photos or video interviews of your children as they are waiting for the bus on Thursday morming. You can post them on Facebook at https://www.facebook.com/events/279393105455960/

See video from the previous Winter Solstice 2011 event at http://www.youtube.com/watch?v=rl0zvs43wjQ&feature=youtu.be

Sign the Start School Later petition at http://signon.org/sign/promote-legislation-to.fb1?source=s.fb&r_by=1521139

Better School Start Times

December 31, 2011

Over the last several months national efforts to start school later have been growing, and it’s about time! For over 2 decades it’s been well established by medical research that there is a shift of the internal body clock during puberty. This causes teens to become sleepy later than younger children, and wake up later. This is a physiologic change, and not simply a preference for later socializing or “laziness” in the morning as was sometimes described.

Terra Snider, PhD, has created a national petition calling for legislation to prevent high schools from starting before 8am. When students go to school at times when they are most alert their performance improves, including improved test scores, decreased absenteeism, and increased graduation rates.

This issue is very close to my heart, and of utmost importance. Right out of college, in the early 1990′s, I worked in the research lab of Dr. Mary Carskadon, the leading researcher on children’s sleep/alertness patterns. After a couple years my impression was that a lot was known about this among researchers, but wasn’t being used to make children’s lives better. So although I’m interested in research, I decided to become a physician and help people with sleep problems. Now in my private practice it is striking how many adults say their sleep problems started as teens. For this reason I love to help children with sleep problems in hopes of improving their sleep before they’ve had problems for 20+ years.

Please sign this important petition, then ask your circle of friends to sign it too. http://signon.org/sign/promote-legislation-to.fb1?source=s.fb&r_by=1521139.   As of this writing there are 1466 signators across the nation, and growing each day.

There is a wonderful website by Dennis Nolan, JD, summarizing the impact of school start time on student’s well-being at http://schoolstarttime.org/.

If you are inspired to lend your talents to improving student’s lives in this way please let me know, or contact organizers directly.

Timing Light Therapy and Melatonin Supplements

October 28, 2010

It’s been fun to talk with people suffering from Delayed Sleep Phase over the last couple days.  There’s been some questions about shifting sleep phase using light therapy and melatonin supplements.  The timing of these therapies depends on whether you want to delay sleep, ie. make it begin later, or advance sleep, making it occur earlier.  Once you know that, then you use the Phase Response Curve to see when to use these therapies.

A word of warning:  The correct timing is crucial, so it is best to work with a sleep professional if you want to shift your sleep phase.  If you use light or melatonin therapy at the wrong time you can cause problems by shifting your circadian rhythm the wrong direction.

Follow this link to the Phase Response Curve on Wikipedia: http://en.wikipedia.org/wiki/File:PRC-Light%2BMel.png

On the horizontal axis you see time, and the sleep period written in.  On the vertical axis you see hours of phase advance on the top, and hours of phase delay on the bottom.  Bright light is represented by dark purple, melatonin by green.  Note that the light curve goes both higher and lower than the melatonin, that is because a much larger phase shift can be achieved with light.

Let’s look at an example.  Say an adult is unable to sleep until 2am, but must get up for work at 7am.  Getting 5 hours of sleep each night is not enought for her.  She would like to sleep from 11pm to 7am, but is just not sleepy.  Using the Phase Response Curve, she begins using light therapy each morning when she gets up for the day.  She also takes some melatonin 6 hours before bed.   These combined therapies allow her to feel sleepy at 11pm, and fall to sleep easily.  Now she can get a full night’s sleep, and all the benefits of sufficient sleep.

Are you an Owl or Lark?

October 25, 2010

An ‘Owl’ is someone whose body clock is set to sleep later than average, and a ‘Lark’ is someone whose set to sleep earlier than average. It is your inherent melatonin rhythm and temperature rhythm that determine when you sleep.

Being an Owl or Lark can impact how well you do with different schedules. Generally speaking, Owls do better with later schedules and shift work like graveyard. Larks are the ones you’d want to open the shop in the morning. It’s important to know that alertness fluctuates over the 24 hours in almost the same curve as temperature. As your temperature drops you are less alert and more sleepy.   If you get into bed and try to sleep before your body is ready, you may experience this as insomnia.  About 10% of chronic insomniacs actually are Owls, and if they go to bed later have no problem sleeping.

To determine if you are an Owl or Lark you can do the Horne-Ostberg Morningness-Eveningness questionnaire, which was developed in 1976. You can find a modified version of it online at http://web.ukonline.co.uk/bjlogie/test.htm.

This information can help you develop a lifestyle that best suits your circadian rhythm.  If you are not able to shift the time of your commitments, a sleep specialist may be able to help shift your circadian rhythm.

Shiftwork and Your Health

December 9, 2009

High numbers of people in America do shiftwork – 20% of those who are employed. One definition of shiftwork is starting work after 6pm, and before 6am. “Swing shift” which often starts around 3-4pm is also included in some definitions of shiftwork. Whichever definition you use, it is clear that the health of people who do shiftwork suffers.

Shiftworkers experience symptoms such as stomach upset, moodiness, high blood pressure and elevated stress hormones. In the long term these employees also have higher rates of breast and colon cancer in women, and prostate cancer in men.   These problems are thought to be due to the fact that shiftworkers are awake and engaged during a time that our body clock and circadian rhythm are programmed to be asleep.

Although these symptoms and conditions are concerning, it’s clear that some industries must work around the clock. Especially industries such as public safety, healthcare, and transportation. Fortunately there are ways in which the negative effects of shiftwork can be minimized. Check back on Friday for info on how to lessen these effects.

At The Institute of Naturopathic Sleep Medicine, Dr. Darley provides care for people of all ages who have sleep problems. More at http://www.naturalsleepmedicine.net/

Melatonin, the Sleep Hormone

November 11, 2009

You have probably heard of melatonin, one of our bodies’ endogenous hormones. Today we’ll talk about natural melatonin cycles, how melatonin relates to health, and also how melatonin is taken as a supplement.

Your Natural Melatonin Cycle
Melatonin is a hormone produced by the pineal gland. It also acts as a neurotransmitter. In dim light conditions melatonin levels will start to rise about 2 hours before your habitual bedtime, and peak about 2 hours afterwards. This increase is partly responsible for tired feelings before bedtime. It will decline during the night and be at very low levels during the day. Melatonin is suppressed by bright light, such as sunshine.

People who are either “larks” or “owls,” have a melatonin rhythm that is different from the norm. This causes them either to get sleepy much earlier in the day – “larks”, or much later than usual – “owls.” An example is found during puberty in teenagers whose melatonin rhythm shifts later, causing their sleep and wake times to shift later.

Uses of Melatonin
Melatonin can be taken as a supplement to improve sleep. In the past, higher doses (5-10mg) were used like a pharmaceutical drug, and some people experienced a hang-over effect the next morning. Newer research has shown that much lower doses (.3-3mg), which are in line with the levels naturally found in the body, are just as effective.

- Precisely timed melatonin can be used to shift the habitual sleep time for those people who are “owls” or “larks.” Exposure to bright light can also be used to shift sleep times as it will suppress melatonin.
- Melatonin can be used by travelers to reduce jet-lag symptoms. It is especially effective when used in combination with a well-thought out sleep schedule, bright light exposure and limiting light with sunglasses.
- Melatonin can be a gentle aid in promoting sleep for those who have sleep onset insomnia. There are also time-released formulas for people who have difficulty staying asleep through the night.

You can always take advantage of your endogenous melatonin rhythm by going to bed at approximately the same time each night, and getting bright light exposure in the morning. This is one way to naturally keep your sleep healthy!


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