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!

Start School Later – Contact your Senators!

Thanks to Terra Snider, Kari Oakes, and Mary King for delivering the Start School Later petition to our Washington State Senators Murry and Cantwell in person on Weds, April 18. This team is committing many hours to speak with congress people from around the country on this important issue. Now is the time for each of us to reach out and voice our support of this initiative with our state congress people. Please do so today!

Senator Patty Murray
448 Russell Senate Office Building
Washington, DC 20510
Phone: 202-224-2621
Fax: 202-224-0238
Toll Free: 866-481-9186
Email: Web Form: http://www.murray.senate.gov/email/index.cfm

Senator Maria Cantwell
311 Hart Senate Office Building
Washington, DC 20510
Phone: 202-224-3441
Fax: 202-228-514
Toll Free: 888-648-7328
Email: HTTP://Cantwell.senate.gov

For those of you reading this in other states, you can learn more about this initiative at http://www.startschoollater.net. There is a tool to find the congress people for your zip code here: http://independenceave.org/. Please contact them now, as the Start School Later team is systematically contacting all the Congress and House of Representatives. Together we can make this important improvement for thousands of teens!

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

Start School Later goes to Washington DC

Over the last week the efforts for the national Start School Later initiative have been intense. This week, March 7th, this petition will be presented to Congress. You can see the press release copied below.

SUPPORT BY SIGNING PETITION NOW at http://signon.org/sign/promote-legislation-to.fb1?source=s.fb&r_by=1521139

400 more signatures are needed as of this moment. I support this initiative in part because many of my adult insomnia patients say that their sleep problems began as a teen, and I’d like to prevent that in the next generation. Thank you, Catherine

Grassroots Petition to Start School Later Goes to Washington for Sleep Week
FOR IMMEDIATE RELEASE
March 1, 2012

CONTACTS
Annapolis, MD- Terra Ziporyn Snider, Ph.D., StartSchoolLater1@gmail.com 410-975-9759
Seattle, WA- Catherine Darley, ND, drdarley@naturalsleepmedicine.net, 206-293-2899

Annapolis, MD. To honor National Sleep Awareness Week, a grassroots coalition of parents, teachers, and health professionals will begin delivering a petition advocating a minimum school start time of 8 a.m. to Congress and White House officials on Wednesday, March 7, 2012. The petition, garnering national attention, has signatures from all 50 states and Washington, DC and has fueled activity in local communities from Short Hills, NJ to Woodinville, WA.
“Most U.S. high schools today start in the 7 a.m. hour, a practice that began several decades ago primarily to save money on bus runs,” explains Terra Ziporyn Snider, Ph.D., a medical writer and the petition creator from Maryland who is also the mother of three. After more than a decade of work advocating for later start times in her local school system, Snider recounts, “Although evidence is crystal clear that starting later is best for health and learning, political obstacles and myths have made change virtually impossible in most districts.”
The petition effort has galvanized a national coalition of health professionals, sleep researchers, educators, parents, and other concerned citizens called Start School Later. The coalition has representation from 16 states and includes an advisory board comprised of notable sleep researchers, adolescent health care providers, and education leaders.
Voluminous research indicates that later school start time can lead to:
• Reduced sleep deprivation, depression, mood swings, and suicidal ideation
• Decreased stimulant abuse, weight gain, and diabetes risk
• Reduced early morning traffic accidents and drowsy driving by new teen drivers
• Improved safety by eliminating waiting or walking in dark, low visibility settings
• Reduced risky after-school behaviors in unsupervised adolescents
• Reduced truancy and absenteeism, and improve school performance
• Improved lifetime earnings potential, according to a recent study published by the Brookings Institute
Locally, in Washington state about 375people have signed this national petition.
###
Signature totals and comments from Start School Later’s campaign: http://signon.org/sign/promote-legislation-to.fb1?source=s.fb&r_by=1521139

For more information on Start School Later: http://www.startschoollater.net/
Start School Later is a coalition of health professionals, sleep scientists, educators, parents, students, and other concerned citizens dedicated to increasing public awareness about the relationship between sleep and school hours and to ensuring school start times compatible with health, safety, education, and equity.

Time to Help Teens Sleep

Teen Sleep

Do you remember dragging yourself out of bed for high school, then struggling to stay awake during class?  You were not alone in this.  Physiologically, teens are set to go to sleep later, and get up later.  Unfortunately school start times require that students be alert and functioning before their bodies are awake.  The good news is that a national movement to start schools later is gathering momentum, and you can join in!

Teen Body Clocks

As part of puberty, the circadian rhythm or ‘body clock’ shifts later.  Research in the last couple years has shown that this shift to later hours happens early in puberty, before other changes may appear.  Decades ago it was thought teens’ late hours were because they enjoyed late-night socializing or sadly some teens were called ‘lazy’ because they slept late.  We now know these sleep hours are based on their physiology. 

This shift can contribute to teens being sleep deprived in that they aren’t able to go to sleep earlier in the night because they aren’t sleepy, but yet they have to get up at a time they are sleeping well to go to school.  Research shows 80% of high school students are significantly sleep deprived, that’s a higher percentage than adults!

Help your Teen get Adequate Sleep

First, figure out how much sleep your teenager needs each night. It might help to remember a vacation when s/he was sleeping on their own schedule and was rested & energetic during the day. Next, plan to get up at the latest time for school, and count backwards to determine the bedtime that allows enough sleep. If it is not possible to go to bed at that time during the week, allow extra time for sleep on weekends.

Sometimes teens aren’t able to fall asleep even when they are in bed at a reasonable time. This is because their body clock is shifted later. They may need medical help to shift their body clock earlier.

Help Change Teens Sleep Nationally

In the last several months an effort to Start School Later has grown. There is a national petition to legislate that schools not start before 8am. This will be presented to Congress during National Sleep Awareness Week, March 5-11. Please join this effort to improve the teen sleep and the entire teen experience by signing this today (it will take 2 minutes). My hope is that we can change generations of teen experience of highschool and that time of life.

Sign the petition today!http://signon.org/sign/promote-legislation-to.fb1?source=s.fb&r_by=1521139

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.

Mommy’s Sleep Holiday

Pretty regularly, women who are desperate for sleep come to me. These women say things like “I’m losing it,” “I’m going to go insane if I don’t get some sleep” or “I can’t take this anymore.”

Most of them are mothers whose sleep is being regularly disrupted by their children. You may think of mothers with infants or toddlers, but this isn’t always the case. Just last week it was a mom of 3 tweens who was being interrupted in the night, and felt completely frazzled because of it.

If this is describes you, or someone close to you – Take It Seriously! When people are so sleep deprived that they are “desperate for sleep” they need help, and soon. Professional sleep help may be needed, however, sometimes a few nights for a ‘Sleep Holiday’ can do wonders.

What do I mean by ‘Sleep Holiday?’ Arrange a few (2-3) nights when the mom can sleep completely uninterrupted. This can make a huge difference helping her feel more emotionally calm, rested, and better able to problem solve and stick to a plan to help her children sleep more independently. (Note – although it’s typically mothers who I see in this situation, it could easily be fathers, or anytone in the position of caregiving in the night).

For those 2-3 nights, arrange for the mother and children to sleep in different places – assign mom the guest room on another floor, better yet, have the children go to grandmas, or mom to go sleep at a hotel or a quiet friends house. The mother should go to bed at her earliest usual time, and sleep until she is done, without an alarm. Do all the things we’ve talked about to make the bedroom an ideal place to sleep, and turn off all phones and alarms.

For mothers who are breastfeeding, it may not be possible to have such long breaks from night-time caregiving, but is just as important. Figure out a strategy that will work for your family to get mom some long periods of uninterrupted sleep. Possibly mom can do the first feeding of the night, then dad can give a bottle later in the night. Even just using this strategy on weekends will result in a better rested mom.

Again, if you or your loved one is feeling ‘desperate for sleep’ take it seriously, and make a plan for them to have a ‘Sleep Holiday’ with less interruptions immediately, starting tonight.