An Ergonomic Bed

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/

Start School Later meets with the Dept. of Health

Tomorrow, July 18, the leaders of the national Start School Later initiative will be meeting with directors at the Substance Abuse and Mental Health Services Administration of the Department of Health. There is a connection between early school start times and depression and suicidal thoughts that needs to be addressed.

The full press release is below, and I’ll post the update from the meeting in the next few days. If you’d like to weigh in with your support of later school start times you can sign the petition at http://www.startschoollater.net
RELEASE: July 16, 2012: GRASSROOTS GROUP ASKS FEDERAL AGENCY TO ADDRESS LINK BETWEEN EARLY HIGH SCHOOL START TIMES, MENTAL HEALTH, AND TEEN SUICIDES:

Contact: Heather Macintosh, 410-279-4569 heathermac@verizon.net
Dr. Terra Ziporyn Snider, Co-Director, 410-262-6616

Start School Later, a national coalition advocating for sane, humane high school start times, is meeting with Dr. Anne Mathews-Younes, Director of the Division of Prevention, Traumatic Stress and Special Programs, and Dr. Richard McKeon, Director of the Suicide Prevention Resource Center, at the Substance Abuse and Mental Health Services Administration (SAMHSA), an agency of the US Dept of Health and Human Services (HHS), Wednesday, July 18, in Rockville, MD.

Compelling scientific research shows that adolescents’ sleep needs are being dangerously compromised by the extremely early school schedules of many US high schools. Waking at 5:30 to catch a bus and begin school in the 7 o’clock hour is incompatible with adolescent sleep needs and causing teens to miss out on the crucial sleep they need for physical and mental health and development and optimum academic achievement. Sleep deprivation is strongly linked to anxiety, depression, and suicidal ideation, among other health effects.

SAMHSA is an agency of the U.S. Department of Health and Human Services (HHS), which, in turn, is increasingly recognizing the importance sleep plays in the health and wellness of young people.

“We’re looking forward to discussing ways federal agencies might be helpful in raising awareness and facilitating policies to ensure safe, healthy school hours for all children,” says Terra Ziporyn Snider, PhD, Start School Later’s Co-Director. “This has been impossible to achieve in many local school systems, where all too often politics and myth trump student health and well-being.”

Start School Later is an all-volunteer, national coalition working to ensure that all public schools can set hours compatible with health, safety, equity, and learning. Coalition members attending the SAMHSA meeting include Dr. Terra Ziporyn Snider and Kari Oakes, PA-C, both from Maryland, as well as Terry Cralle, RN, of Virginia, and Debbie Coleman, MBA, faculty member at the Miami University (Ohio).

“Sleep Deprived in Seattle” in Seattle magazine

It was a pleasure to talk with journalist Sheila Cain about my approach to treating sleep disorders. The article is now published in Seattle magazine’s Top Doc issue (July).

My favorite excerpt is: “My primary care doctor gave me a printout of things to try, then told me to go home and do them,” Crocker said. “With Dr. Darley, we worked on a very individualized plan that was specific to me.”

The thing I love most is the way in which each person’s sleepless story is unique, even if each one is coming in for what appears to be the same ‘insomnia’ complaint.  Taking the time in the first appointment to really understand how the sleep problem developed, how it impacts their quality of life, and the individual lifestyle makes all the difference in making an individual treatment plan that works.

Sometimes in an appointment a patient and I will have moments where we are communicating so clearly, heart to heart, and getting to the root of the sleeplessness. Those times I imagine if someone took a picture there’d be a big light bulb over both of us. Those break through moments make this work worth every effort.

You can read the full article here: http://www.seattlemag.com/article/sleep-deprived-seattle

Curing Insomnia is Like Climbing a Mountain

Being unable to sleep can be very distressing, especially when it’s an acute episode. One analogy that works when I think about treating insomnia is that Curing Insomnia is Like Climbing a Mountain.

Think about going for a hike up a mountain to the scenic view from the peak. You look at the paths that lead to the top, and choose the one that’s best for you. Your choice is based on where you came from, your preferences (a long gradual climb, or a short steep one), and your other abilities or conditions. Once you choose your path you stick with it, knowing that if you switch to another path, that horizontal movement is not getting you any closer to the goal.

It’s helpful to think of curing insomnia in a similar way, that you look at the treatment options available to you, and choose the one that’s the best fit. Once you’ve selected the treatment you want, stick with it long enough for it to be effective. Sometimes when people are in an acute episode of insomnia it is tempting to try different treatments, each for a short time. What’s more effective is to give a reasonable trial of a treatment approach (several weeks or a month at least), before switching paths. Knowing that insomnia is cured one night at a time, bit by bit, just like climbing a mountain can help keep you calm and focused on the end goal.

Here’s to the view from the top, and the peaceful sleep at the end of the path!

I’m Dizzy with Sleep Debt

So although I’m a sleep expert, unfortunately that doesn’t make me immune to the havoc that life events can wreak on sleep health. My usual healthy 8.3 hour average sleep which leaves me energetic and sharp all day has plummeted to a mere 6.5 hours over the last week. I’m not alarmed, as identifiable events are interfering with my sleep, and I know that once those settle down my sleep will easily bounce back. Today I’m feeling the effects of acute sleep deprivation, a perfect chance for a blog post.

During acute sleep deprivation, people can feel a variety of somatic symptoms, like stomach or head aches. Others may feel dizzy or have difficulty concentrating. And of course there are performance decrements which we’ve discussed previously, and health problems too.

For me, today, the sleep loss is making me feel slightly dizzy, ravenously hungry for sugar (which is more difficult to resist than usual), my eyes feel irritated, and I’ve been making errors like hitting the wrong elevator button, and feel I need to work extra hard to pay attention while driving. My temperature control also seems to be off.

Now 6.5 hours of sleep nightly for 5 nights is not bad for many people. About 30% of American workers report getting less than 6 hours on work nights. What I wonder is whether people who are habitually sleep deprived get accustomed to the feelings of sleep debt, so that it becomes their normal? Granted I’m not a good person to say, both because I spend more time thinking about sleep than average, and because I’m usually well-rested, so can really notice the effects of sleep debt.

Today and the rest of the week I’ll keep my healthy sleep habits in place, and not worry about it, knowing my sleep will get back on track in a day or two. Until then, sugar anyone?

Does a Hot Bath Help Sleep?

Many people ask me “Does a warm bath help sleep, or is that just a myth?” The research shows . . .

Yes, it seems to help somewhat. Medical research has investigated the impact of both baths and foot baths on sleep. One study in older people with sleep disturbance found that a 40 minute footbath at 41C decreased wakefulness in the second nonREM sleep period. Women undergoing chemotherapy for cancer have also found increased sleep quality with a warm footbath. Another study done in elderly insomniacs found that a full-body bath (immersed to the mid-chest) for 30 minutes at 40-41C did increase deep sleep, and caused people to experience a good night sleep. .

How does a warm bath improve sleep? Human body temperature is not constant, but varies with a consistent circadian rhythm.  There is a slight dip in body temperature at approximately 1pm, and then a more significant drop in the evening hours.  We get that sleepy feeling as our body temperature drops. The bath effectively raises our body temperature, and the subsequent drop helps sleep. The bath should be about 60-90 minutes before bedtime.

Of all the means you can use to improve your sleep, this one seems one of the most simple, with the least possible negative side effects. This is a good therapy to try first before using other, more invasive medicine.

Tobacco Impacts Your Sleep

In past posts we’ve talked about the impact alcohol can have on sleep, which is widely known. Nicotine also has an impact, which seems less well known by the public.

Studies show that nicotine changes sleep, so that it takes longer to fall asleep initially, people sleep a lower percentage of the time in bed, and REM sleep and total sleep time is decreased. None of these are effects we want!

According to the Centers for Disease Control “In 2010, 43.5 million adults (19.3%) in the United States were current smokers—21.5% of men and 17.3% of women.” So that’s about 1 in 5 people who are exposing themselves to nicotine, and suffering the consequences on their sleep.

If you are someone who struggles with sleep, and smokes, it may be worth the effort to stop smoking in order to improve your sleep, and reap all the other health benefits too. Many state health departments have ‘Stop Smoking’ helplines, and your primary care physician can assist you.

Sleep Interruptions – Not so Trivial!

Many people talk to me about their difficulties sleeping, either difficulty falling asleep initially, or returning to sleep in the middle of the night, or in some cases waking up before they want to start the day.

One question that can be very helpful in this situation is “what woke you?” or “what prevented you from falling asleep?”  Surprisingly often, there is a clear environmental disturbance that is interrupting sleep.

Here are some of the external sleep interruptions I’ve heard of over the years:
- a snoring, or moving, bedpartner who may have a sleep disorder of their own
- bedpartner who gets into bed later, or who gets up earlier, thus waking up the person experiencing insomnia
- dog’s collar jingling
- cat asking for attention by scratching on the bedroom door
- outdoor lights that turn off and on with movement (hate those!)
- children in the bed, snuggled right up against the patient who then is uncomfortable
- an appliance or toy that beeps
- the cell phone, often a problem when it is used as an alarm clock
. . . and the list could easily go on.

When you are working to improve your sleep, you first want to eliminate as many of these interruptions as possible. I recently was working with a woman struggling to sleep well, waking 2-4 times each night. When asked “what wakes you in the night” she identified that sometimes her husband’s snoring woke her. We dialed down into that a little more, and she estimated that his loud snoring is responsible for half of her wakings, and realized looking back on it that when he’s away she does sleep better. Another person, a mother, said that she’s often squished between her children during sleep, and has no sleep problem if she has the bed to herself.

When you are working to improve your sleep, a helpful first step is to see if any external factor is interrupting or preventing you from sleep. Systematically resolve those interruptions, and then re-assess. You may find that those interruptions you were tolerating are not so trivial!

Sleepy Transportation Workers – Scary!

Last week was National Sleep Awareness Week, and the time each year that the annual Sleep in America Poll is unveiled. This year it is all about sleep health in the transportation industry. This data raises concerns about public safety, and the health of the transportation workers. Here’s what pilots, train operators, and professional drivers of all types reported about their sleep.

Sleepiness and Safety
When asked about sleepiness, 1 in 4 pilots and train operators said that sleepiness has impacted their job performance once a week. Even more concerning is the number of professionals who say that sleepiness caused safety issues: 20% of pilots, 18% of train operators, and 14% of truck drivers.

These safety issues persist during transportation employees personal time: 6% were in an auto accident due to sleepiness compared to 1% of those who work in other industries.

The Sleep Schedule
Almost half of transportation workers are dis-satisfied with their sleep. Many say their work schedule does not allow enough time for sleep (44% train operators, 37% pilots). This compares to 27% of non-transportation workers.

Transportation professionals tend to work longer shifts, with less time off between shifts. They also tend to have longer commute times, and irregular shiftwork type schedules.

Adequate Sleep for Transportation Professionals
It’s been a pleasure in my office to help transportation professionals get healthy, natural sleep. This is primarily about strategically using our body’s sleep systems to promote alertness during work hours and sleep during sleep times.

First, create a window of time for sleep that can be as consistent as possible. Also put into place a routine of meal times, exercise, activity – all those things that signal time to the body. Second, reduce the commute as much as possible. Third, use precisely timed melatonin and light therapy to promote sleep at sleep times and increase alertness during the work day. This is a very individualized approach which takes into account the irregular work schedule, commute time, sleep environment, and lifestyle.

Summary

“The margin of error in these professions is extremely small. Transportation professionals need to manage sleep to perform at their best,” said David Cloud, leader of the National Sleep Foundation.  His comment really sums this up, that sleep health is so important for transportation professionals and the safety of the public they serve.

 You can read the report here: http://www.sleepfoundation.org//article/press-release/sleepy-pilots-train-operators-and-drivers

Cautions About Sleep Medications

In my office, people who are taking many sleep medications for long-term use often come in looking for alternatives. In naturopathic practice there is a place for medications in the ‘Therapeutic Order.’ In naturopathic medicine the ‘least force’ treatment is used which will be effective. For instance, behavioral medicine will be used for insomnia first. Of course, behavioral strategies may not work for each person, so then herbal or nutrient therapy may be used next, and then pharmaceuticals.

Recently a person came in who had been using a combination of four sleep medications over the last 10 years. He had been alternating the medications on his own schedule as they became ineffective, and to avoid the need to increase dosage. Here was his regimen:
Alprazolam (Xanax) at 4am at his early am wakening to get another 3 hours of sleep. Alprazolam is a benzodiazepine hypnotic. Side effects include an increase in depression. When stopping the medication rebound insomnia can occur. Most of the hypnotics should not be taken with alcohol.
Zolpidem (Ambien) or Eszopiclone (Lunesta) Both are non-benzodiazepine hypnotics. Ambien is long-lasting, and people should be sure to have a full 7-8 hours in bed after taking it. Lunesta is one of the few medications approved for use on long-term basis.
Clonazepam (Klonopin) which is a long-acting benzodiazepine.
Even with these medications he was having interrupted sleep and found his sleep to be unrestful.

Our approach was to first use behavioral strategies to make his sleep robust and restful. Once he was sleeping well, we designed a schedule in collaboration with his PCP to taper down off the medications slowly. In this way we were able to avoid rebound insomnia and other withdrawal symptoms.

So, if you are struggling with insomnia, use the ‘least force’ treatment strategy that will solve your sleep problem. If you are recommended a sleep prescription, find out how long that medication can be safely used, any drug interactions to be aware of, and the typical withdrawal symptoms.