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How Often Should a Baby Feed at Night?

May 27th, 2015 Raquel Rothe

By: Brandon Peters, MD (Sleep Expert)

If you have a young baby, you might wonder: When can my sleep get back to normal?! As part of this, you may want to learn how often your baby should be feeding at night. Learn about weaning in the first 6 months of life, how you can minimize awakenings to eat in the night, and at what age those feedings should go away entirely.

First, each baby is different. Don’t try to force something to happen that may not be right for your child.

  • If more than 8 ounces of fluid are consumed overnight, it may be necessary to redistribute this intake to the daytime. This should occur gradually.

Another way to assess whether the feedings are needed is to pay attention to the number of diaper changes that occur. Most babies who are older than 3 months do not need to be changed at night. If the diapers are frequently soaked at night, this can be a sign of excessive fluid intake. A well-hydrated baby will urinate the extra fluid. Older children with bedwetting may experience this due to other reasons.

It is possible to gradually reduce the frequency and volume of feedings at night. Your child will learn to consume the needed fluid during the daytime and sleep soundly through the night. Adults don’t typically drink or eat during the night. Similarly, most babies beyond the age of 3 months shouldn’t either.

If you are concerned about your child’s need for feedings at night, or if you have difficulty weaning these nighttime feedings, speak with your pediatrician to obtain further guidance.

Source:

Ferber, R. “Solve Your Child’s Sleep Problems.” Simon & Schuster, The Fireside Edition, 2006.

It’s time to get healthy sleep for your entire body

April 29th, 2015 Raquel Rothe

April 9, 2014

Your doctor could soon be prescribing crucial shuteye as treatment for everything from obesity to ADHD to mental health as experts say carving out time for sleep is just as important as diet and exercise

After being diagnosed with brain and lung cancer in 2011, Lynn Mitchell, 68, was averaging about an hour of solid sleep a night. Stressed about her treatments, she was paying for it in hours of lost sleep.

The brain cancer was already affecting her mobility—Mitchell was often dizzy and would lose her balance—but the lack of sleep was exacerbating things. Even walking became increasingly difficult. Exhausted in the mornings, she was practically incoherent. When her doctors recommend she see a sleep therapist, Mitchell was relieved at how benign it sounded in comparison to the chemotherapy she had undergone and the gene therapy trial she was undergoing, which had side effects like nausea and fatigue.

For about nine weeks, Mitchell worked with the sleep therapist to adjust her sleep habits. She got under the covers only when she was extremely tired. She quit watching TV in bed. She stopped drinking caffeinated coffee in the evening. She also learned breathing exercises to relax and help her drift off. It was all quite simple and common sense, and, most importantly, noninvasive and didn’t require popping any pills.

“It’s common knowledge that sleep is needed for day to day function,” says Dr. David Rapoport, director of the Sleep Medicine Program at NYU School of Medicine. “What isn’t common knowledge is that it really matters—it’s not just cosmetic.” Rapoport has long seen people seek sleep therapy because they’re chronically tired or suffering from insomnia, but an increasing number of patients are being referred to his center for common diseases, disorders, and mental health.

Researchers have known for some time that sleep is critical for weight maintenance and hormone balance. And too little sleep is linked to everything from diabetes to heart disease to depression. Recently, the research on sleep has been overwhelming, with mounting evidence that it plays a role in nearly every aspect of health. Beyond chronic illnesses, a child’s behavioral problems at school could be rooted in mild sleep apnea. And studies have shown children with ADHD are more likely to get insufficient sleep. A recent study published in the journal SLEEP found a link between older men with poor sleep quality and cognitive decline. Another study out this week shows sleep is essential in early childhood for development, learning, and the formation and retention of memories. Dr. Allan Rechtschaffen, a pioneer of sleep research at the University of Chicago, once said, “If sleep does not serve an absolutely vital function, then it is the biggest mistake the evolutionary process ever made.”

But to many of us, sleep is easily sacrificed, especially since lack of it isn’t seen as life threatening. Over time, sleep deprivation can have serious consequences, but we mostly sacrifice a night of sleep here and there, and always say that we’ll “catch up.” Luckily, it is possible to make up for sleep debt (though it can take a very long time), but most Americans are still chronically sleep deprived.

While diet and exercise have been a part of public health messaging for decades, doctors and health advocates are now beginning to argue that getting quality sleep may be just as important for overall health. “Sleep is probably easier to change than diet or exercise,” says Dr. Michael Grandner, a sleep researcher at the University of Pennsylvania. “It may also give you more of an immediate reward if it helps you get through your day.” Sleep experts claim that it is one of the top three, and sometimes the most, important lifestyle adjustments one can make, in addition to diet and exercise. And while there’s more evidence linking diet and exercise as influential health factors, sleep is probably more important in terms of brain and hormonal function, Grandner says. “Among a small group of [sleep researchers], it’s always been said that [eating, exercise, and sleep] are the three pillars of health,” says Dr. Rapoport.

In our increasingly professional and digital lives, where there are now more things than ever competing for the hours in our day, carving out time for sleep is not only increasingly difficult, but also more necessary. Using technology before bed stimulates us and interferes with our sleep, yet 95% of Americans use some type of electronics like a computer, TV, or cell phone at least a few nights a week within the hour before we go to bed, according to a 2011 National Sleep Foundation survey. “Many doctors, lawyers, and executives stay up late and get up early and burn the candle at both ends,” says Dr. Richard Lang, chair of Preventative Medicine at the Cleveland Clinic. “Making sure they pay attention to sleep in the same way they pay attention to diet and exercise is crucial.”

To some, sleep has become a powerful antidote to mental health. Arianna Huffington, president and editor-in-chief of the Huffington Post Media Group, advocates that sleep is the secret to success, happiness, and peak performance. After passing out a few years ago from exhaustion and cracking a cheekbone against her desk, Huffington has become something of a sleep evangelist. In a 2010 TEDWomen conference, Huffington said, “The way to a more productive, more inspired, more joyful life is getting enough sleep.” Research linking high-quality sleep with better mental health is growing; a 2013 study found that treating depressed patients for insomnia can double their likelihood of overcoming the disorder.

While 70% of physicians agree that inadequate sleep is a major health problem, only 43% counsel their patients on the benefits of adequate sleep. But there’s growing pressure on primary care physicians to address, and even prescribe, sleep during routine check-ups. In a recent study published in the journal The Lancet Diabetes & Endocrinology, the researchers concluded that health professionals should prescribe sleep to prevent and treat metabolic disorders like obesity and diabetes. And overlooking sleep as a major health issue can also have deadly consequences. It was recently reported that the operator of the Metro-North train that derailed in New York last year, killing four people and injuring more than 70, had an undiagnosed case of sleep apnea.

Sleep therapies can range from simply learning new lifestyle behaviors to promote sleep, to figuring out how to position oneself in bed. More drastic measures involve surgery to open up an airway passage for people suffering from disorders like sleep apnea. Sleeping pills can be prescribed too, to get much needed rest, but sleep therapists tend to favor other approaches because of possible dependencies developing.

A large part of reaping the benefits of sleep is knowing when you’re not getting the right amount. According to a 2013 Gallup survey, 40% of Americans get less than the recommended seven to eight hours a night. While the typical person still logs about 6.8 hours of sleep per night, that’s a drop from the 7.9 Americans were getting in the 1940s.

When it comes to adequate sleep, it’s much more personalized than previously thought. Some people feel great on five hours of rest, while others need ten. The best way to determine if you’re getting the right amount, doctors say, is to find out how many hours of sleep you need to be able to wake up without an alarm and feel rested, refreshed, and energetic throughout the day.

Since reforming her sleep habits, Mitchell has been clocking up to seven hours of shuteye a night for the past two months. “I’m alert in the morning, my balance is better, and I feel peppier,” says Mitchell. Getting enough sleep has helped her better deal with her cancers, and its symptoms. The best news is that she recently found out that her brain tumor is shrinking, and there are fewer cancerous spots on her lungs.

Tom Brady Explains Why He Goes To Sleep At 8:30

November 13th, 2014 Raquel Rothe

Sleep and performance go hand in hand!

  • NOV. 10, 2014, 10:51 AM
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tom brady patriotsJeff Zelevansky/Getty Images

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At age 37, Tom Brady is still one of the best quarterbacks in the NFL.

For years, many have been anticipating his inevitable decline. Twice in the past four years the Patriots have drafted quarterbacks in preparation for the post-Brady era.

But every time he starts to look his age, he manages to put together a string of strong performances in which he looks like the Brady of old.

On Monday, Brady did an interview with WEEI radio in Boston, and he talked about how he stays youthful.

One of his strategies: getting plenty of sleep.

In a recent column, ESPN’s Bill Simmons said that Patriots wide receiver Julian Edelman told him Brady goes to sleep at 8:30 each night.

WEEI asked Brady about the 8:30 p.m. bedtime. He said he went to sleep so early because football was the only thing he loved to do, and all his decisions were designed to keep him playing at an age when most players retire.

“Strength training and conditioning and how I really treat my body is important to me, because there’s really nothing else that I enjoy like playing football,” he said. “I want to do it as long as I can.”

Here’s his entire answer when asked about his sleep habits (full audio here):

I do go to bed very early because I’m up very early. I think that the decisions that I make always center around performance enhancement, if that makes sense. So whether that’s what I eat or what decisions I make or whether I drink or don’t drink, it’s always football-centric. I want to be the best I can be every day. I want to be the best I can be every week. I want to be the best I can be for my teammates. I love the game and I want to do it for a long time. But I also know that if I want to do it for a long time, I have to do things differently than the way guys have always done it.

I have to take a different approach. Strength training and conditioning and how I really treat my body is important to me, because there’s really nothing else that I enjoy like playing football. I want to do it as long as I can.

Later in the conversation, Brady talked about how different his lifestyle was from his early days in the NFL. He said he was “fast and loose” when he was 25 but would not change a thing:

The 25-year-old Tom Brady had a great time. I probably wouldn’t change much from those days … I was kind of fast and loose back then … I wouldn’t change anything when I was 25.

I tell [young players], I say, ‘You guys live it up, enjoy it. Because there’s going to be a time when you don’t have that opportunity again.’ You try to make good decisions and your mistakes you don’t want to be permanent. But when you’re in your youth, you should have fun and do those things that young guys do.

Brady has three years left on an extension that he signed in 2013. The $26 million in base salary for those three years becomes guaranteed if he’s still on the team for the last game of this season — which is a certainty at this point. If he plays out his contract, he’ll still be quarterbacking the Patriots at age 40.

Read more: http://www.businessinsider.com/tom-brady-sleep-2014-11#ixzz3Ixv4iJhb

College and Sleep Should Be Two Peas in a Pod

September 3rd, 2014 Raquel Rothe

Our new college bedding study highlights problems with the pillows and mattress pads that college students take to school with them.  But, gross fungi aside, it also brings up a very important point — a good night’s sleep increases a student’s chance of success in college exponentially.

Multiple studies have been done on the subject.  One, covered here at SleepBetter.org, looked at 60 college-age subjects.  The participants were split into two equal groups.  In the morning, the first group learned a batch of 30 fake words.  They then returned later in the evening to take a test on how well they learned the words. Meanwhile, the second group studied the same phony words at nighttime. This group did not complete their vocabulary test until the following morning after a full night’s sleep.

Once the tests were scored, researchers found that the subjects who slept after learning the new words performed much better than those who were awake throughout the day.

By entering a deep sleep, your brain is better able to establish connections between new facts and previous knowledge.  Since learning new things and applying connections is what college is all about, it only stands to reason that sleep and attending college should go together like two peas in a pod.

Here are some recommendations from an article we published last year called Five Tips to Help College Students Sleep Better:

  • Make sure they have a proper pillow.  Check out that pillow your student is taking to school.  Has it been around since they were in kindergarten?  If so, replace it.  Not only could it be filled with fungi, an outdated, out-of-shape pillow can also make it hard to get comfortable at night.
  • Add a mattress pad. Dormitory beds are notoriously uncomfortable, but adding a good mattress pad can make them tolerable.
  • Earplugs may not be a bad idea.  It’s no secret that dorms are noisy.
  • Talk about what a bed is used for.  This will sound strange, but using a bed for a desk, a TV chair, and even a video game lounge can lead to not getting to sleep when it’s bedtime.
  • Suggest a good sleep routine.  Going to bed and getting up at the same time every night is the best way to go.  Knowing that’s unrealistic, however, perhaps suggest they try to go to sleep at around the same time Sunday through Thursday.  Recognizing that Friday and Saturday night probably won’t mean lights out at 10pm, suggest trying to get to bed no later than a couple of hours after their weekday bedtime.

After reading about our college bedding story, are you freaked out about what’s inside your pillow?  Be sure to check out our article on how to clean your pillow!

http://sleepbetter.org/college-and-sleep-should-be-two-peas-in-a-pod/

In Elderly, Less Sleep Linked to Aging Brain

July 11th, 2014 Raquel Rothe

Researchers at Duke-NUS Graduate Medical School Singapore have found evidence that the less older adults sleep, the faster their brains age. These findings, relevant in the context of Singapore’s rapidly aging society, pave the way for future work on sleep loss and its contribution to cognitive decline, including dementia.

Past research has examined the impact of sleep duration on cognitive functions in older adults. Though faster brain ventricle enlargement is a marker for cognitive decline and the development of neurodegenerative diseases such as Alzheimer’s, the effects of sleep on this marker have never been measured.

The Duke-NUS study examined the data of 66 older Chinese adults, from the Singapore-Longitudinal Aging Brain Study. Participants underwent structural MRI brain scans measuring brain volume and neuropsychological assessments testing cognitive function every 2 years. Additionally, their sleep duration was recorded through a questionnaire. Those who slept fewer hours showed evidence of faster ventricle enlargement and decline in cognitive performance.

“Our findings relate short sleep to a marker of brain aging,” says Dr June Lo, lead author and a Duke-NUS Research Fellow, in a release. “Work done elsewhere suggests that seven hours a day for adults seems to be the sweet spot for optimal performance on computer based cognitive tests. In coming years we hope to determine what’s good for cardio-metabolic and long term brain health too,” adds Professor Michael Chee, senior author and Director of the Centre for Cognitive Neuroscience at Duke-NUS.

The study was published in the journal SLEEP

- See more at: http://www.sleepreviewmag.com/2014/07/old-less-sleep-aging-brain/?utm_source=newsletter&utm_medium=email&utm_term=SR+Sleep+Report+7%2F09&spMailingID=8979349&spUserID=MjQxMTIxNTA4MjUS1&spJobID=340679522&spReportId=MzQwNjc5NTIyS0#sthash.DcXOgPRa.dpuf

REM Sleep Disturbance May Signal Future Parkinson’s or Dementia

July 2nd, 2014 Raquel Rothe

REM behavior disorder could be a sign of impending neurodegenerative disease, including Parkinson’s and dementia, according to new research at the Society of Nuclear Medicine and Molecular Imaging’s 2014 Annual Meeting.

Researchers are not sure why spontaneous and unexplained disturbance in REM sleep should lead to a neurodegenerative disease like Parkinson’s, but new longitudinal imaging data show a clear correlation between idiopathic REM behavior disorder and dysfunction of the dopamine transporter system involved in a wide range of vital brain functions, including memory and motor control. Dysfunction associated with dopamine in the brain marks the first hints of Parkinson’s disease.

In order to gauge the relationship between the REM sleep disorder and neurodegeneration, scientists performed molecular neuroimaging using a technique called single photon emission computed tomography (SPECT), which allows clinicians to evaluate bodily functions instead of focusing on structure, the forte of conventional radiology.

“Our SPECT study showed a trend toward decreased dopamine transporter density in the brain and Parkinsonism in the follow-up data of patients with REM sleep disorder who had no previous evidence of neurodegenerative disease,” said Hongyoon Choi, MD, a researcher at Seoul National University Bundang Hospital, Sungnam, Korea. “To our knowledge, a study looking at a long-term link between the two has never been conducted before.”

A total of 21 consecutive patients with no known Parkinsonism or cognitive decline were enrolled in the long-term study between 2004 and 2006 and were followed after about 8 years. A baseline SPECT scan of dopamine transporter function was performed with the radiopharmaceutical I-123 FP-CIT as an imaging agent. A follow-up scan was performed to assess progression of neurodegenerative disease. Results showed that after follow-up, patients’ SPECT scans revealed substantial decreases in radiotracer binding to the dopamine transport system in the nigrostriatal regions of the brain. A lack of tracer binding in these regions of the brain is closely linked to neuronal degeneration and the development of dementia and movement disorders.

A total of 10 patients out of the original 21 patients with disturbed REM sleep were found to have decreased striatal tracer binding at the beginning of the study. Of these, seven had developed neurodegenerative disease by follow-up some years later, including four patients who developed Parkinson’s disease and two patients who developed dementia with Lewy bodies, a neurodegenerative disease identified by the build-up of proteins, called Lewy bodies, in brain regions associated with memory muscle control.

- See more at: http://www.rtmagazine.com/2014/06/rem-sleep-disturbance-future-parkinsons-dementia/#sthash.PQJm2EyR.dpuf

10 Unconventional (But Great) Sleeping Tips You’ve Probably Never Heard

January 10th, 2014 Raquel Rothe

By: Lifehack

Increasingly, science is showing that sleep is a basic building block for sustaining life and that sleep, like digestion, respiration and meaningful relationships, is one of the most important processes for the human body. During sleep the body heals, grows, and replenishes itself so that people can thrive with abundant, vibrant lives.

When we are children, sleep comes very naturally. The body demands it and it occurs. Children can sleep in almost any circumstance—driving in a car, with a TV on in the next room, with the dog barking. Children, teens and even young adults fall easily into sleep providing their circadian rhythm has not been disrupted. Unfortunately for adults, sleep is too often an elusive state that escapes us, causing a myriad of problems with health, happiness and productivity.

Sleep issues can arise for many different reasons, and for different reasons at different times in one’s life. Physical or emotional stress, changes in schedules and routines, dietary changes and disruptions to our natural circadian rhythm are the most common reasons that sleep problems arise. Unfortunately, when sleep problems do develop, they can become the norm rather than the exception for many people, and reversing these patterns takes some time and effort.

Next time you’re struggling with sleep, experiment with any of the following 10 unconventional but great sleeping tips to determine what will work best for you:

1. Strategize Your Day Plan

Plan your day as closely as you can so that you follow the same pattern and routine each day. Although this may sound boring, as it lacks spontaneity, when it comes to improving your sleep, your body thrives on daily rhythms and schedules. Wake up and go to sleep at the same time and try to have your meals at the same time as well. This will allow your body, hormones and other brain chemicals to function optimally, and this will allow your body to produce the hormones needed to fall and stay asleep.

2. Move Your Body Daily

Exercise has numerous benefits, and research finds new benefits every day. Regular exercise improves heart health and blood pressure, builds bone and muscle, helps combat stress and muscle tension, improves mood, and improves sleep. Exercise helps you sleep sounder and longer and feel more awake during the day.

When engaging in physical activity, it’s important that you choose activities that resonate with you and bring you happiness while participating. If you love dancing, try a Zumba class, if you like being outside, try running, cycling or skating. An additional benefit to exercising outside is exposure to sunshine. Twenty minutes per day of sunshine helps produce vitamin D, an important vitamin to your overall health and hormonal system. Also consider the time of day you are engaging in physical activity. Earlier in the day is better when it comes to sleep. Exercise excites the body and creates new energy, when you do this too close to bed time it could interfere with sleep.

3. Sleep Naked

The body naturally cools down as it produces melatonin and prepares the body for rest. Among other things, this process requires the body temperature to drop. When you sleep with heavy pajamas and blankets, the body has a difficult time lowering your temperature and this will wake you up. Try sleeping naked in good quality, comfortable sheets, and keep the temperature down in your bedroom.

4. Understand You Have a Circadian Rhythm

The body’s system and functions are based on rhythms. Humans have a circadian rhythm and a circannual rhythm. These rhythms control many things. The circadian rhythm—our daily time clock—is particularly important when it comes to sleep. Hormones provide signals to the body all day and all night long that control sleep and eating patterns. For this rhythm to function optimally, there are environmental components we can control to support this important process. When your sleep is compromised by work or stress, for example, you will lose this rhythm and re-establishing it can be difficult.

5. Turn Off Your Screens

Your circadian rhythm is strongly signaled by light. The bright light of the morning produces certain hormones and signals and the darkness of the evening and night produce others. The access to 24-hour lighting has largely influenced our exposure to light and therefore our daily rhythms. The one key thing you can do is limit your exposure to light in the evening, particularly the light emitted by TVs and computers. The light produced by these devices significantly interferes with the production of melatonin, the sleep hormone produced in the pituitary gland that signals sleep to the body. It’s crucial that the amount of light the body is exposed to decreases slowly over the course of the evening. Ideally, you would turn off all screens one to two hours before you’d like to sleep.

6. Do Something Relaxing

Avoid activity that is too stimulating in the evening. The brain is wired to respond to your physical and emotional needs at any time of day. When you engage in stimulating activity such as a dramatic TV program, a heated discussion with a family member, or work-related emailing, your brain’s awareness is heightened and bringing yourself down from that will take time. Avoid that by winding down. Have a cut-off time, perhaps one to two hours before bed, in which you will not engage in anything too stimulating. Make this a daily practice and tell the people you live with that it’s a goal you have. Try something relaxing like reading a book, meditation or gentle stretching.

7. Have Sex

After a day of work, commuting and children, the last thing many people want to consider is sex. But there are many health benefits to having sex, including better sleep. Weekday sex can be a simple quickie if time and energy are concerns, and that too will provide benefit. You’ll fall asleep faster after orgasm and there’s good reason for that. The hormone prolactin is released after orgasm. Prolactin is responsible for feelings of relaxation and sleepiness. As well, following orgasm, the body produces oxytocin, the feel-good hormone that reduces stress and helps us bond with others, so the benefit extends to your relationship and your overall health.

8. Watch Your Food Intake

The body is sensitive to all of the things you do to it, expect of it and feel throughout the day. Food digestion is a key function of the body that influences many things, including sleep. Keep your consumption of caffeinated beverages, including coffee, to a minimum and consume them before 3 p.m. if possible. Caffeine is very stimulating and interferes with the hormones required to relax the body and produce sleep.

Also, consider the type of food you’re eating. Having simple carbs in the evening has a relaxing effect on many people and helps with relaxation and sleep. Keep in mind how close you’re eating to bedtime. Ideally, you should stop eating three hours before bed. Digestion requires a lot of energy and time. If the body is busy digesting your last meal, you will have problems falling and staying asleep. Give your body the break it needs during the night to heal and repair you by allowing it to be free of the job of digesting food.

9. Drink Calming Tea After A Warm Bath

Magnesium is a mineral responsible for many functions in the body. One of its most important functions is calming muscles. By adding magnesium to a warm bath with some essential oil, you will be able to relax and drift into a deep sleep. Having a cup of herbal tea in the evening is calming and when done regularly (like turning off screens, taking a bath or reading a book), functions as an important signal to the brain and body that time for rest is near, allowing the required systems to begin their work. Chamomile tea has long been thought to be a helpful sleep aid. There are many companies producing blends that help relax the body and aid with sleep.

10. Keep Your Room Dark

Even the smallest amount of light hitting the eyelid (some research says the size of a pinhole will do it) can interfere with the production of melatonin, which would result in poor quality sleep or lack of sleep. Keeping your room both dark and cool have been shown to be imperative in regulating sleep. Invest in blackout curtains to ensure that your room is dark all night. Turn off and block the light from all electronic appliances, such as clock radios and cell phones. Better yet, remove them from your bedroom if possible. If blocking out the light is problematic, purchase a soft eye-mask that you can wear comfortably throughout the night.

Sleep apnea may hold hidden dangers for women

November 5th, 2013 Raquel Rothe

A new study on sleep apnea reveals there could be some hidden dangers – particularly for women who have the condition – where breathing is interrupted during sleep. Women with sleep apnea may appear healthy, but they have subtle symptoms so their sleep problem is often misdiagnosed.

Now, new research, led by the University of California Los Angeles (UCLA) School of Nursing, shows that the body’s autonomic responses, which normally control blood pressure, heart rate, sweating and other basic functions, are not as strong in people with obstructive sleep apnea, and even less so in women.

Obstructive sleep apnea is a serious condition that happens when the person is asleep, sometimes hundreds of times a night. When it occurs, blood oxygen drops and eventually damages many cells of the body.

There are over 20 million adult Americans living with the condition, note the researchers, who explain that it is linked with several serious health problems and also early death.

Women are much less likely to be diagnosed with obstructive sleep apnea than men.

Lead researcher Dr. Paul Macey says:

“We now know that sleep apnea is a precursor to bigger health issues. And for women in particular, the results could be deadly.”

Early detection and intervention needed

Dr. Macey and his colleagues describe their work in a recent online issue of PLOS ONE.

For their study, the team recruited 94 adult men and women, comprising 37 newly diagnosed, untreated obstructive sleep (OSA) patients and 57 healthy volunteers to act as controls.

The three groups had their heart rates measured as they went through three different physical challenges:

  • The Valsalva maneuver – where they had to breathe out hard while keeping the mouth closed
  • A hand-grip challenge – where they had to just squeeze hard with one hand
  • A cold pressor challenge – where the right foot is inserted into near-freezing water for a minute.

The team notes the main results:

“Heart rate responses showed lower amplitude, delayed onset and slower rate changes in OSA patients over healthy controls, and impairments may be more pronounced in females.”

Dr. Macey adds:

“This may mean that women are more likely to develop symptoms of heart disease, as well as other consequences of poor adaptation to daily physical tasks. Early detection and treatment may be needed to protect against damage to the brain and other organs.”

The team now intends to investigate if the usual treatments for OSA, such as continuous positive airway pressure (CPAP), help to improve the autonomic responses.

CPAP is where a machine helps the OSA patient breathe more easily while asleep.

Funds from the National Institutes of Health and the National Institute of Nursing Research helped finance the study.

In another study published recently, researchers from Brigham and Women’s Hospital in Boston, MA, found that sleep apnea is linked to early sign of heart failure.

Written by Catharine Paddock PhD

Circadian Rhythms in Modern Life

October 10th, 2013 Raquel Rothe
Circadian-RhythmThis paper discusses the Western human circadian rhythm and its relation to health.

1. The circadian rhythm of a modern man

“In 1910, the average American slept nine hours a night, disturbed only by the occasional Model T backfiring. We now average 7.5 and declining.” – Robert Sapolsky (Why Zebras Don’t Get Ulcers)

The typical Western person’s circadian rhythm differs in at least three main ways of which the human species has adapted to in its history

First of all, the amount of light during night time. Before artificial lighting popularized, people spent the night in almost complete darkness . Today, most families live in almost constant light even if it is pitch black outside.

Second, the amount of light during the day is now lower than it has ever been in human history . The reason is that we do not spend much time outdoors. We spend the days indoors, where the amount of light can be over a hundred times less than the amount of light outside.

“Bright light can help shift even the most extreme body clocks,” says Professor Roenneberg. “But the amount of light in most offices is laughable. You would be lucky to get 400 lux [a unit of measurement of the intensity of light] at a bright vertical office window during the day, whereas outside on a cloudy day in summer you would experience more like 10,000 lux. If it’s a blue sky, you could get as much as 150,000 lux.” (Independent: Could you be suffering from ‘social jet lag’?)

The third current problem is sleep duration, which has been decreasing in recent decades.

In a study on connections between sleep and obesity published this year, it was found that in the 1960’s people slept about 8-9 hours a night. By 1995, the amount had shrunk to seven hours. In 2005, a third of the population slept for about six hours a night. Actigraphic and polysomnographic studies show that middle-aged people only get six hours of sleep on average. (Reiter et al. 2011)

Now we are going to speculate the effect of these on health by studying some research material on the subject.

2. The circadian rhythms’ connection with health – shift work and clinical sleep studies

People doing shift work is an interesting group when reflecting on the circadian rhythms’ effects on health. These people must for follow a very unnatural sleep rhythm because of their profession. Epidemiologic data shows that certain health problems are much more common among shift workers than in the average population.

  • Obesity – In a Swedish study 27485 people answered a survey and according to the results, shift work correlates to a 40% higher risk for obesity (BMI over 30) after adjusting for age and socioeconomic factors. (Karlsson et al. 2001)
  • Breast cancer – In Denmark the risk of breast cancer in nurses is 80% higher in those working day and night shifts. The longer the shift work had lasted, the larger the risk was. Those who had been working in shifts for over two years, the risk was 160% higher (after adjusting the results) than in those only working during the day. (Hansen&Stevens 2011)
  • Cortisol and obesity – In the Netherlands a small study (122 persons) showed, that in people doing shift work the amount of cortisol in a hair sample was larger (47 .32 vs 29.72 pg/mg). In young people doing shift work the BMI of these people was clearly higher compared to day workers (27.2 vs 23.7). (Manenschijn et al. 2011)

“If light were a drug, the government would not approve it,” says Professor Charles Czeisler of the Harvard Medical School. And Professor George Brainard of Thomas Jefferson University in Philadelphia, adds: “Humans evolved on a planet without electric light over thousands and thousands of generations. The body is designed to be alert and awake during daytime hours and to sleep at night. Now we have a 24-7 society that isn’t in harmony with our biological design.”

“In the new study, scientists grafted human breast cancer tumours on to rats and infused them with blood taken from women during the day, in the early hours of the morning, and after being exposed to light at night. The blood taken in darkness slowed the growth of the cancers by 80 per cent, but the blood taken after exposure to light accelerated it.” (Independent: Avoid breast cancer. Sleep in the dark…)

If even a few years of shift work can clearly be seen as an elevated risk for breast cancer, could a lifetime of sleep deprivation or other light related problems that affect most people have an effect on the risk of chronic disease? I would say it’s possible.

Some experimental studies have been done, in which for example the test subjects duration of sleep has been reduced.

  • In a study conducted by the University of Chicago, eleven young men were sleep deprived (four hours of sleep per night) for six days. This caused the test subjects’ cortisol levels to rise and sugar tolerance to temporarily decline. (Spiegel et al. 1999)
  • The same university published a cross over study, in which 10 overweight people were calorie deprived for two different time periods. During the one period they were allowed to sleep for 8.5 hours and in the other only 5.5 hours. The actual amounts of sleep were 7h 25 min and 5h 14 min. In both groups the subjects weights declined 3 kilograms, but in the sleep deprived group 80% of this weight was muscle. Without sleep deprivation 52% of the dropped weight was muscle and the rest fat. (Nedeltcheva et al. 2010Whole Health Source – The Big Sleep)
  • In an American study conducted in 2009, ten test subjects followed a 28 hour day instead of the normal, 24 hour day. Half way in the study the test subjects spending night time as day time, the test subjects leptin levels were about 20% lower during the day than before the test but during sleep the difference was smaller. Also the insulin levels were on average 22% higher and after breakfast (2h) the blood sugar rose 32% higher than normally. (Scheer et al. 2009)

3. The environmental light and melatonin secretion

Next we’ll dive into the world of melatonin, but first the basics.

The ambient light contributes significantly to the body’s circadian rhythm. In particular, blue light (460-490nm) inhibits the pineal gland from secreting melatonin. Melatonin is often called the dark hormone, because it is secreted at night.

Only blue light affects the secretion of melatonin, so if a person is wearing blue blocker sunglasses, melatonin secretion will not be affected. Of course, removing the short wavelengths (blue light) from lamps will have the same effect. (Sasseville et al. 2006Kayumov et al. 2007Chellappa et al. 2011).

Even normal lighting before going to sleep can decrease melatonin secretion which can have effects on health. The melatonin blocking effects of blue light can be significant especially in winter time, when the small amount of daytime exposure to light can cause the body to react more significantly to bright artificial light used in the evening. (Gooley et al. 2011Higuchi et al. 2007Park&Tokura 1999).

Only blue wavelengths of light have effect on melatonin secretion, but for example cortisol levels can rise from other wavelengths as well. (Figueiro&Rea 2010Leproult et al. 2001).

Below are empirical studies in which the amount or type of light has been altered and the results have been documented:

  • In Ohio the effect of blue blocker glasses and their effect on a person’s quality of sleep and mood was studied. Orange colored blue blocking glasses improved quality of sleep, but grey control glasses didn’t. (Burkhart&Phelps 2009)
  • Blue blocker lenses seem to be very effective for insomnia in ADHD subjects. The average PSQI score fell from 11.15 to 4.54, dropping below the cut-off score of 5 for clinical insomnia“. (Fargason et al. 2013)
  • Doctor James Phelps described a small experiment in his article, in which persons (n=21) suffering from bipolar disorder and sleep complications were given blue blocker glasses for evening usage. Nine test subjects felt their condition improve “very much” while eight people didn’t notice any effect. Also a few felt smaller improvement and also a few were somewhat bothered because of falling asleep too early. (Phelps 2008 ; see also Seth Roberts’ blog post Bipolar Disorder: Good Results with Blue-Blocker Glasses).
  • In New York State a study was conducted in which school children wore blue blocker glasses (with orange lenses) during the day for one school week. This caused their melatonin secretion at evening to begin a half an hour later than normally. (Figueiro&Rea 2010)
  • Bright light treatment seems to be beneficial in the treatment of specific mood disorders, including depression and seasonal affective disorder (Golden et al. 2005Lieverse et al. 2011).

I believe that the effect seen in the bright light study mentioned before could be replicated and possibly surpassed with ordinary daylight. Expensive bright lights shine light at 10 000 lux at the best, but outside the amount of light can be ten times larger. Daylight might also have other benefits like vitamin D production caused by UV-radiation, the temporary lowering of blood pressure caused by nitric oxide metabolism, plus the stress-relieving effects of red and near-infrared light. The problem of course is, that in the winter time natural light isn’t available in large amounts in all parts of the world. (Holick et al. 2007Opländer et al. 2009Feelisch et al. 2010Barrett&Gonzalez-Lima 2013).
Melatonin can also be used as medication and in clinical trials it has been portrayed as quite a useful drug:

  • In one study, melatonin had quite a good effect on irritable bowel syndrome. (Lu et al. 2005)
  • Melatonin supplements might be beneficial to patients suffering from CFS and/or fibromyalgia. The benefits are possibly caused at least in part, by the improvement of subjects’ quality of sleep. Those who used melatonin showed significant improvement in sleep / sleep parameters. (Hussain et al. 2011van Heukelom et al. 2006)
  • According to a recent meta-analysis of melatonin, a slightly higher dose (20mg) seems to be have quite a large effect on conventional cancer treatments. It decreases the mortality rate and reduces treatment side effects significantly. (Wang et al. 2012, see also Mills et al. 2005)

Even though light is very important influence to human / animal circadian rhythm, apparently among light, food, other people and physical activity also have a notable effect. I’m not yet particularly familiar with that data, so it will not be discussed in this essay.

4. Tips for improving sleep and health
Get some light after waking up and during the day

The effect of light on the circadian rhythm seems to be the largest immediately after waking up, so walking outside for ten minutes after waking up can be beneficial.

If you want an adequate amount of blue light during the winter, there are roughly two types of light therapy lamps. Large ones and small ones. The larger lamps have a large lux amount (they are brighter), and the smaller ones compensate with the light spectrum and by a smaller distance between the user and lamp. The lights of small lamps are slightly bluer to compensate for the smaller intensity of light. (Meesters et al. 2011)

I have noticed that if I don’t get enough light during the first 1-2 hours after waking, I’ll stay more or less sleepy for the rest of the day.

Sufficient blue light during the day might be important for alertness, mood and sleep. (Viola et al. 2008)

circadian1

A light box (left), blue blocker sunglasses (right).

Avoid unnecessary light during the late evening

Turning lamps off and dimming your computer’s display are some of the simplest non-pharmaceutical ways to increase melatonin levels at night. And to make it easier to fall asleep.

If I get a too much light into my eyes at bedtime, I will suddenly become very alert and that means that I need to wait another 1-2 hours until I’ll be able to fall asleep. When I was in high school, this was a significant problem for me. I had to wake up at 7am on almost every morning, yet I usually couldn’t fall asleep before midnight. The late evening, the time when I should have been already sleeping, was the most productive time of the day, because of the strong alerting effect of light at night.

F.lux is a popular computer program that changes the displays color to orangish automatically in the evening. Personally I prefer to use Gamma Panel (gapa.exe), a program that allows you to remove blue light completely from your computer screen.

The blue blocker sunglasses are another alternative. If you want to block out blue light, you can buy some nice lenses from ebay (use keyword “aviator blue blocker”) and wear them in the evenings.

Also red light bulbs (LED) can be used can be used as night reading lamps.

Poor curtains can leave the room too bright during the night or early morning. A sleep mask is an easy and cheap way to correct this problem.

redden computer screen

In the evening, I usually use Gamma Panel software to redden my computer screen. This makes falling asleep much easier.

Nutrition and sleep

A combination of melatonin, magnesium and zinc has been shown to have great results in sleep quality studies. (Rondanelli et al. 2011)

In a few studies, glycine has been shown to improve quality of sleep. The primary source of glycine is collagen protein or gelatin. This means that head cheese and bone broth are a good source of glycine and can improve quality of sleep. I occasionally make jelly out of gelatin and concentrated juice. (Yamadera et al. 2007Inagawa et al. 2006)

I personally agree with the basics of Matt’s “Eat for Heat” ideology. If I have trouble falling asleep, I try to eat some extra starch and fat calories (e.g. rye/wheat bread with butter and cheese) and avoid too large amounts of fluid.
Other ideas

Seth Roberts, a Professor of Psychology, has written a lot about his various experiments, some of which are related to circadian rhythm. (Roberts 2004Seth’s blogPerfect Health Diet – Seth Roberts and Circadian Therapy)

Here’s a list of things that, according to Roberts’ experiments, could benefit those having problems related to their diurnal rhythm.

  • Intake of vitamin D3 might affect one’s circadian rhythm if the doses are high enough. Because of this, Roberts has recommended taking 4000IU (100µg) of vitamin D shortly after waking up. (1,2,3,4,5,6,7,8,9,10,11,12,13,14,15)
  • Standing so much that your legs become fatigued might be useful. Roberts noticed consistently high quality of sleep when he stood at least 9 hours during a day. He also noticed that this time can be dramatically reduced by standing on one leg. (1 (p.13-15) ja2)
  • Morning Faces Therapy: According to Roberts, if one sees faces after waking up, he/she will be more sleepy and unmotivated in the evening, but more alert and motivated in the next morning. (1 ja 2 (p. 5-13)

A mirror, to see my own face during my piano improvisations. (Seth Roberts' faces therapy)

A mirror, to see my own face during my piano improvisations. (Seth Roberts’ faces therapy)

Acknowledgements

Thanks to Laura Mikkonen for doing most of the translating work.

The Perfect Nap: Sleeping Is a Mix of Art and Science

September 21st, 2013 Raquel Rothe

There’s an art to napping.

Studies have found different benefits—and detriments—to a nap’s timing, duration and even effect on different people, depending on one’s age and possibly genetics.

“Naps are actually more complicated than we realize,” said David Dinges, a sleep scientist at the University of Pennsylvania’s Perelman School of Medicine. “You have to be deliberative about when you’re going to nap, how long you’re going to nap and if you’re trying to use the nap relative to work or what you have coming up.”

For a quick boost of alertness, experts say a 10-to-20-minute power nap is adequate.

A snooze on the couch on a Sunday afternoon may seem like the perfect way for a responsible adult to unplug. But at a time when roughly one-third of people report not getting enough sleep, more naps, albeit short ones, might make for a more functional workforce, researchers say.

How Long to Nap

Sleep experts break sleep down into several stages, which the brain cycles through roughly every 90 to 120 minutes. These stages are broadly characterized into non-rapid eye movement (NREM) sleep and rapid eye movement (REM) sleep. NREM is further broken down into stage one and two, which are considered light and intermediate sleep, followed by slow-wave sleep. Awakening from slow-wave sleep, the deepest kind, results in what doctors call sleep inertia or sleep drunkenness: that groggy feeling that can take awhile to shake off. Finally, there’s REM sleep, often associated with dreaming.

Sara Mednick, an assistant psychology professor at the University of California, Riverside, said the most useful nap depends on what the napper needs.

For a quick boost of alertness, experts say a 10-to-20-minute power nap is adequate for getting back to work in a pinch.

For cognitive memory processing, however, a 60-minute nap may do more good, Dr. Mednick said. Including slow-wave sleep helps with remembering facts, places and faces. The downside: some grogginess upon waking.

Finally, the 90-minute nap will likely involve a full cycle of sleep, which aids creativity and emotional and procedural memory, such as learning how to ride a bike. Waking up after REM sleep usually means a minimal amount of sleep inertia, Dr. Mednick said.

Experts say the ideal time to nap is generally between the hours of 1 p.m. and 4 p.m. Napping later in the day could interfere with nighttime sleep.

The body’s circadian rhythms help people to expect to be awake in the morning and early in the night. “So if you take naps when your brain doesn’t expect to be sleeping, you feel kind of thrown off,” contributing to the sleep inertia effect, said Rafael Pelayo, a clinical professor at Stanford University School of Medicine’s Sleep Medicine Center.

A telltale sign of being very sleep-deprived, he said, is dreaming during a short nap. “Definitely in a 20-minute nap you should not be dreaming,” he said.

Ilene Rosen, an associate professor of clinical medicine at Penn’s Perelman School of Medicine, said the ideal duration of a nap is still being debated, but generally speaking the “10-to-20-minute nap is really the optimal time in terms of bang for your buck.”

Leon Lack, a psychology professor at Flinders University in Australia, found in a 2006 study in the journal Sleep that among shorter breaks, 10-minute naps packed the most punch.

The study compared naps ranging from 30 seconds to 30 minutes, testing 24 participants at each of several intervals. After each nap the individuals were tested on a variety of mental-processing tasks. The sharpness of the 10-minute nappers became apparent “right away,” Dr. Lack said, and remained apparent for about two to 2 1/2 hours.

Those who took 20- and 30-minute naps tended to feel groggy immediately after the nap for up to about 30 minutes. From there, they showed mental sharpness similar to what researchers saw from the 10-minute nappers, with that sharpness lasting a bit longer.

Jonathan Brandl is a Newton, Mass.-based consultant who works from home. Up at 5 a.m. to hit the gym, he finds himself fading around 2 p.m. His solution is a fast snooze in a comfy chair in his den. His trick for waking up: He holds a pen or pencil in his hand, which usually falls about 10 to 15 minutes into his nap, waking him up.

“After the nap, I feel totally refreshed and then power through the rest of the day,” the 56-year-old Mr. Brandl said.

Though napping at work often remains taboo, experts say growing scientific evidence of its benefits has led select workplaces to accept it.

Christopher Lindholst, chief executive and co-founder of New York-based MetroNaps, has installed specially designed sleeping pods for Google, Huffington Post, an Iowa construction company and the Arizona Diamondbacks baseball team. The chairs retail for $8,995 to $12,985.

The 60-minute nap may not be kosher in most workplaces, but it also has its pluses.

In a 2012 study in the journal Neurobiology of Learning and Memory, researchers split 36 college-aged students into three groups. Each group learned a memory task, pairing words on a screen with a sound. Afterward, one group had 60 minutes to nap, another 10 minutes. The final group didn’t sleep.

Upon retesting, the napping groups fared better, as expected, said Sara Alger, lead author of the study and a postdoctoral research associate at the University of Notre Dame.

More interesting, she noted, was that on further testing, including a week later, the 60-minute group performed far better than the 10-minute group, which now performed as poorly as the non-napping group. The researchers concluded that slow-wave sleep—only experienced by the 60-minute nappers—is necessary for memory consolidation.

Researchers continue to explore why some individuals don’t seem to benefit from naps. Dr. Mednick said ongoing studies are looking at potential genetic differences between habitual and nonhabitual nappers.

Kimberly Cote, a professor of psychology and neuroscience at Brock University in St. Catharines, Ontario, said individuals who don’t normally nap tend to slip into the deep stages of sleep more quickly than those who do. Studies have found through monitoring brain waves that regular nappers are good at maintaining a light sleep when they nap and show better performance improvements than their non-napping counterparts.

“We’re not sure what those individual differences are,” she said, “if that’s something that they’ve learned to do over time or if there’s something biologically different that allows them to nap like that.”

Another trick to waking up perky after a short nap is to drink a cup of coffee before sleeping. Caffeine won’t hurt such a short break and should lessen the effect of sleep inertia.

Dr. Dinges recommends sleeping partially upright to make it easier to wake up. Studies, he said, have found that not lying totally flat results in avoiding falling into a deeper sleep.

“A lot of people say, ‘I only need four hours of sleep a night.’ There’s a few of them around but not very many,” he said.

Write to Sumathi Reddy at sumathi.reddy@wsj.com

A version of this article appeared September 3, 2013, on page D1 in the U.S. edition of The Wall Street Journal, with the headline: A Field Guide to the Perfect Nap.