Archive for the ‘sleep’ category

Light Impacts Sleep

November 7, 2014

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

April 8, 2014

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.

Sleep Impacts Cancer

February 6, 2014

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.

An Ergonomic Bed

October 30, 2012

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

July 17, 2012

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

July 14, 2012

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

June 20, 2012

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!


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