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Sleep Well

with Michael Breus, PhD, ABSM

This blog has now been retired. We appreciate all of the insights that Dr. Breus has provided to the WebMD community.


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Tuesday, March 18, 2014

Sleep Habits Run In the Family

By Michael Breus, PhD, ABSM

parent and child

The National Sleep Foundation has released its annual Sleep in America Poll. This year, the poll examines sleep in the modern American family. How well—or not—are parents and children sleeping today? What are the challenges facing families in their pursuit of high-quality, plentiful sleep? What are the strategies that parents are using to help their children sleep, and how well are those strategies working? These are some of the questions that this year’s sleep survey investigates. The answers paint a picture of American families needing more sleep than they are getting, and struggling to contend with challenges to sleep that are a product of technologically-driven and highly-scheduled lives.

The survey included 1,103 adults with at least one child between the ages 6-17 living in their households. Among respondents, 54% were mothers. The families surveyed varied in size: 40% of respondents had 2 children, 24% had 1 child, and another 24% had 3 children.  Eleven percent of respondents had 4 or more children in their households. Adults reported on their own sleep and answered sleep questions about their children.

The results indicate challenges to sleep within American families that are, in fact, distinctly modern. Despite a high level of awareness of the importance of sleep to health and well being, neither children nor their parents are getting enough high quality sleep. This appears to be in part because of a heavy rotation of evening activities and commitments for both adults and children. Technology has taken up residence in most bedrooms—parents’ and children’s—to the detriment of sleep for both. The survey also found that parents’ own behaviors about sleep, as well as their willingness to set rules for their children’s sleep, can have a significant effect on sleep within the family:

  • There is broad consensus among parents about the importance of sleep to their family’s mental and physical health. More than 90% of parents reported their belief that sleep is highly important to the health and well being of both adults and children in their family.
  • Despite this recognition about the importance of sleep, both children and their parents are struggling to get enough sleep, and to sleep well. Fewer than 45% of children between the ages 6-17 are sleeping 9 or more hours per night. Recommendations for sufficient sleep amounts for children vary by age, but at all stages of childhood and adolescence, children need at least 9 hours of sleep per night. Younger school-age children need in excess of 10-11 hours nightly.
  • As children age, their nightly sleep shortens, according to these results. Among 12-14 years olds, less than a third were reported to be sleeping 9 hours a night. Among older adolescents ages 15-17, a majority—56%–were reported to be sleeping no more than 7 hours nightly.
  • Researchers compared the amount of sleep to quality of sleep, and found that children who slept less also were more likely to experience lower quality sleep. Among children who slept fewer than 7 hours a night, more than a quarter—28%–were reported to have poor quality sleep.
  • Parents tended to rate their children’s sleep quality as significantly better than their own. Only 13% of adults reported their sleep as excellent, compared to 42% who rated their children’s sleep this highly.
  • When asked about the challenges they face in getting enough sleep for themselves and their children, parents cited busy schedules as the most common obstacle. Evening activities were the most frequently cited challenge, both for parents and for children. For children, homework was also often reported as a nightly obligation that delayed bedtime or otherwise made sleep more difficult.

A substantial majority of adults and children are sleeping in proximity to at least one or more electronic device, according to the survey results. Televisions, computers, tablets, smartphones, gaming and music devices are commonly found in children’s bedrooms as well as in their parents’:

  • 89% of adults and 75% of children have at least 1 electronic device in their bedrooms. Roughly half of children—51%–and 68% of adults have 2 or more electronic devices in their bedrooms.
  • Televisions are the most common electronic devices in both parents’ and children’s bedrooms. MP3 players, tablets and smartphones are also common in both.
  • The results also indicate that these devices are frequently left on during the night, rather than turned off before bedtime.

Electronic devices pose serious hazards to sleep when they take up residence in the bedroom. These devices emit light that disrupts sleep cycles and alters sleep-related hormone levels. The noise and stimulation that they provide is counterproductive to sleep, pushing back bedtimes and risking waking during the night when they are left on. It’s not surprising, then, that the survey found children with electronic devices in their bedrooms slept less and experienced lower quality sleep than those children without these gadgets in their bedrooms. Sleep quality suffered most dramatically when the devices were regularly left on during the night. And the more devices were present, the worse children slept.

Despite the sleep problems associated with electronics in the bedroom, many adults and children use these devices as a means to fall asleep, according to the survey. Sixty-six percent of adults reported a habit of relying on television or videos to help them fall asleep, and 37% used the internet. Parents reported that their children often used these same tactics to help them sleep: 47% of children were reported to watch television to fall asleep with some regularity, and 27% played games or used the internet to help bring about sleep.

One of the more striking details about how technology is intruding on sleep? The prevalence of texting and emailing after initially falling asleep, among both children and their parents. More than one quarter of adults—26%–either read or sent emails and text messages after first falling asleep for the night, as did 16% of children. More than half of the children who texted and emailed during the night had parents who did so as well.

This points out another important finding from the survey: the influence of parents’ sleep -and-technology-related habits on their children’s own sleep behaviors. The results indicate that children with electronic devices in their bedrooms are significantly more likely to have parents’ who also have these devices in their bedrooms. Children who let their devices run during the night are also more likely to have parents who do the same.

Ready for some good news about parental influence on kids’ sleep? Parents who establish sleep-related rules and enforce them consistently report their children sleep longer and better than children whose parents don’t apply regular rules to bedtime. These rules include consistent bedtimes, and also govern before-bed activities like watching television, using phones, playing video games, and drinking soda with caffeine. Children in households with sleep rules that are routinely enforced sleep an average of 1.1 additional hours per night.

There are a lot of moving pieces in this picture of the American family’s sleep life—busy schedules, crowded and active evening hours, constant temptation from technology. These threats to high-quality and plentiful sleep are not going away—in fact, they’re more likely to proliferate. It is our modern-day challenge to find ways to manage these ever-present demands with balance and moderation—and with an eye on protecting sleep.

Sweet Dreams,

Michael J. Breus, PhD

The Sleep Doctor™

Posted by: Michael Breus, PhD, ABSM at 12:36 pm

Tuesday, March 4, 2014

Is It Time to Start School Later?

By Michael Breus, PhD, ABSM

sleepy teen

Teenagers are notoriously difficult to rouse in the morning, as parents know well. Our teens’ struggle to “rise and shine” in the early morning hours isn’t really about adolescent obstinacy or laziness. Teens are biologically driven to these sleep-in, stay-up-late schedules—routines that can frustrate parents and make early school mornings challenging for everybody. What if the remedy lies not in attempting to change teens’ sleep routines, but in making adjustments to the requirements of their daily schedules?

New research indicates that even a small delay in school start times can have a significant effect on teenagers’ sleep, as well as on their waking mood and daytime habits. Researchers at the Bradley Hasbro Children’s Research Center in Rhode Island studied the impact of a 25-minute delay in school start time on adolescents’ sleep patterns, daytime sleepiness, and mood, as well as daytime habits including caffeine consumption. The study included 197 high-school students attending an independent boarding school. Researchers collected data about sleep habits during a winter term when school start time was delayed from 8 a.m. to 8:25 a.m. They found this modest adjustment to the beginning of the school day was associated with significant changes to sleep and waking mood:

  • Students’ overall sleep duration increased significantly when their school day began 25 minutes later. Total sleep time increased by an average of 29 minutes.
  • With the later start to the school day, the percentage of students sleeping 8 or more hours per night more than doubled, from 18% to 44%.
  • Younger students (grades 9 and 10), as well as students who were sleeping less at the study’s outset showed the greatest benefit from the 25-minute adjustment to school start time.
  • Students also experienced significant reduction in daytime sleepiness, as well as improvements to mood, during the later school-start period.
  • Caffeine use among students also reduced during this period.
  • Students’ daytime activities—time spent doing homework, and time engaged in extracurricular activities including sports—did not change with the alteration in the start to the school day.
  • When the students’ school start time returned to 8 a.m. after the end of the winter term study period, students lost the sleep gains they had achieved. Their sleep duration returned to levels that researchers observed at the study’s outset.

These results add compelling new information to the body of evidence that suggests students’ health and sleep would be well served by adjusting school schedules to be more aligned with adolescent sleep-wake cycles, and to better meet their sleep needs.

Teenagers are particularly vulnerable to insufficient sleep, for several reasons. Adolescents’ sleep requirements are greater than adults—teens need roughly 9-10 hours of nightly sleep, compared to a general recommendation of 7-8 hours for adults. Their busy schedules, with homework, sports and extracurricular activities, as well as time spent socializing make this 9-plus hour nightly sleep demand difficult to meet. Teens also experience biological changes that make them prone to sleep deficiencies, and can make an early start to the school day particularly challenging. During adolescence, sleep cycles undergo a shift toward a later phase, leaving teenagers biologically more inclined to stay up later in the evening and sleep later in the morning. Teens tend to experience reduced alertness during daytime hours, and heightened alertness in the evening. This adolescent circadian rhythm shift includes a delay in the release of the sleep hormone melatonin, which begins its rise later in the evening than for younger children or adults. The morning downturn in melatonin levels also happens later, contributing to teens’ difficulty in rising early. Adolescents are more prone to daytime tiredness and also to irregular sleep routines—sleeping less during the week and catching up with extended sleep on the weekends.

Studies show insufficient sleep is common among teenagers, and the impact of sleep loss is broad, affecting learning and academic performance, as well as mood and behavior. Short on sleep, high-school students are more likely to perform worse on tests, and receive lower grades. They are also more at risk for a range of unhealthy behaviors, including smoking and drinking, as well as physical violence. Teens with chronic sleep deprivation are also more prone to depression.

Other research has shown that changes to school schedules—even modest changes, like the current study—can have a dramatic effect on sleep, mood, and daytime functioning for teenagers:

  • Changing school start time from 8 a.m. to 8:30 a.m. resulted in a substantial rise in sleep time—an average of 45 minutes of additional sleep—among high school students in Rhode Island, according to research. The percentage of students sleeping fewer than 7 hours nightly decreased by 79.4%, while the percentage of students sleeping 8 or more hours nightly increased from 16.4% to 57.4%. Students experienced improvements to mood and motivation levels, and reductions in daytime sleepiness. Attendance improved, while visits to the school health center for complaints related to fatigue dropped.
  • Researchers studied the effects of rolling back start time to an earlier hour with a group of students through 9th and 10th grades. In the 9th grade, school started at 8:25 a.m. In the 10th grade, the school day began at 7:20 a.m. Researchers found that students went to bed at the same time even after the transition to the earlier start, and they slept less overall. In 10th grade, students also experienced significantly more daytime sleepiness.
  • Though adolescents’ sleep patterns and sleep needs are distinct from younger children, it’s not only teenagers who could benefit from a later start to the school day. Researchers in China spent 4 years studying primary school students’ sleep habits, and sleep’s relationship to academic performance. They found that well more than half of students—64.4%–experienced daytime sleepiness, and that this daytime fatigue was linked to lower academic performance, as well as to diminished attention span and reduced motivation for learning. Delaying the school day by as little as 30 minutes increased sleep duration and reduced daytime sleepiness significantly.

Its time to stop requiring adolescents to adhere to a schedule that contributes to widespread sleep deficiencies—a schedule that is at odds with students’ basic biological inclinations. Adjusting the start of the school day is complicated. Many parents and school officials will likely have their own schedules and routines affected by any changes. But even small delays in favor of students can have significant effects on the quantity and quality of their nightly rest, their physical and emotional health, and their performance at school during the day. With all that at stake, it’s worth giving these changes serious consideration.

Sweet Dreams,

Michael J. Breus, PhD

The Sleep Doctor™

Posted by: Michael Breus, PhD, ABSM at 1:46 pm

Tuesday, February 25, 2014

Bad Dreams or Nightmares?

By Michael Breus, PhD, ABSM

scared boy

Dreams are one of the most fascinating—and least understood—aspects of sleep. Though science has offered possibilities, we don’t yet understand the purpose of dreaming. Dreams can encompass a dramatic range of emotion, and subject matter. Some dreams seem plucked directly from our everyday lives. Most of us have had the experience of waking up shaking our heads at the odd and sometimes amusing circumstances that unfolded while dreaming. Dreams can contend with deep emotions, dealing with loss and reunion, anger, sorrow, and fear. Bad dreams and nightmares are among the most startling and emotionally potent of remembered dreams. Even a partially remembered disturbing dream can linger in our waking minds. But what do we know about this phenomenon of disturbed dreaming? And what’s the difference between a bad dream and a nightmare?

Much of the research into disturbed dreaming has focused on the neurological activity of these dreams, as a way to investigate the function and purpose of dreaming. Other research has focused on the connections between disturbed dreams and psychological conditions, such as post-traumatic stress disorder, and anxiety disorders. Less attention has been paid to the content of disturbed dreams, in particular the disturbing dreams that occur as a normal aspect of sleep life among a broad and varied population. We know that nightmares and bad dreams are common experiences—but we don’t know much about what these dreams contain.

What distinguishes a nightmare from a bad dream? One common theory is that nightmares are more emotionally disturbing and intense versions of bad dreams, a more severe form of the same essential phenomenon. One way nightmares are often distinguished from dreams is in whether the dream causes a person to wake—whether out of fear, or to put an end to the dream.

New research investigates the content of disturbed dreams, in an effort to gain a better understanding of what emotions, triggers, and themes propel these dreaming experiences, and also to help further illuminate potential distinctions between bad dreams and nightmares. Researchers at Quebec’s Université de Montréal recruited 572 volunteers, both men and women, to keep daily dream reports of all remembered dreams—good and bad—for anywhere from 2-5 consecutive weeks. The reports included details about dreams’ narratives, the emotions present and their level of intensity, as well as the presence of sleep terrors—brief, highly intense periods of fright during dreams, that are often accompanied by actual screaming or movement like sleepwalking. Researchers considered episodes of sleep terrors to be distinct from nightmares.

They collected nearly 10,000 dream reports on dreams of all types. From this collection, researchers identified 431 bad dreams and 253 nightmares, experienced by 331 participants, which met the criteria for evaluation. Researchers excluded dreams that were too vague to analyze, as well as dream experiences that seemed to be sleep terrors. They also excluded nightmares and bad dreams experienced by people who reported having only these 2 types of dreams. Researchers used the result of waking from the dream as the distinguishing characteristic between bad dreams and nightmares: nightmares resulted in awakenings, and bad dreams did not.

Researchers defined several themes for volunteers to use in identifying the content of their dreams. The themes covered common territory for disturbed dreams, including physical aggression, being chased, interpersonal conflicts, accidents, failures and helplessness, evil presences, disasters and calamities, apprehension, worry, and health concerns. Volunteers were allowed to identify both primary and secondary themes.

They also established emotional categories to further define dream content, including fear, anger, sadness, confusion, disgust, guilt, and frustration. Researchers used scales of both rationality and “everydayness” to evaluate levels of bizarreness in disturbed dreams.

Their results give insight into the complex emotional and thematic landscape of disturbing dreams, as well as new possibilities for delineation between bad dreams and nightmares:

  • Nightmares occurred more rarely than bad dreams, according to results. Of a total of 9,796 dreams collected, nightmares made up 2.9%, while bad dreams accounted for 10.8% of all dreams.
  • The most common themes in both bad dreams and nightmares were physical aggression, interpersonal conflicts and failure or helplessness. More than 80% of nightmares, and more than 70% of bad dreams contained one or more of these themes, compared to 38.2% of non-disturbing dreams.
  • Fear was the most common emotion reported in both nightmares and bad dreams. Among nightmares, 65.1% contained fear as the main emotion, as did 45.2% of bad dreams.
  • Fear was not only more common in nightmares, it also took a larger proportional share of emotional content in nightmares than in bad dreams.
  • Though fear was the most prevalent emotion, nearly half of all disturbing dreams had primary emotions other than fear.
  • Volunteers reported nightmares having significantly higher intensity than bad dreams.
  • Nightmares contained more aggression, more frequent experiences of failure, as well as more unfortunate and negative conclusions, than bad dreams. Nightmares were also more bizarre.
  • Physical aggression was 1.5 times more frequent in nightmares than in bad dreams. Evil presences and experiences of being chased were other commonly reported themes of nightmares.
  • Bad dreams overall contained a wider range of themes than nightmares. After physical aggression, interpersonal conflicts, and failure, bad dreams also included themes related to health concerns and apprehension and worry.
  • The thematic differences between nightmares and dreams suggested to researchers that nightmares are more likely to contain threats to basic physical security and survival, while bad dreams are more apt to grapple with a broader range of psychological anxieties.
  • Researchers found some interesting differences between men’s and women’s dreams. Both men and women dreamed about the same basic range of thematic and emotional content. But men’s nightmares were more heavily populated with themes of disaster and calamity, while women’s nightmares were more than twice as likely to contain interpersonal conflicts.

One particularly unexpected finding? Researchers compared the presence of negative events and outcomes in everyday dreams to disturbing dreams. They found nightmares and bad dreams contained more aggressions and misfortunes, and contained fewer positive, friendly aspects than everyday dreams. However, bad dreams and nightmares contained less failure than everyday dreams. This suggests, says researchers, that our disturbing dreams deal less often with issues of competence than more ordinary, less overtly upsetting everyday dreams.

Fascinating stuff, isn’t it? These results give further credence to the theory that nightmares are a rarer, stranger, and more intense form of bad dreams, but that both types of disturbed dreaming are versions of the same basic experience. It’s not clear what purpose these dreams serve, or what relationship the content of our disturbing dreams may have to issues and concerns in our waking lives. But these findings should make scientists—and the rest of us—eager to discover more about our dreaming lives.

Sweet Dreams,

Michael J. Breus, PhD

The Sleep Doctor™

Posted by: Michael Breus, PhD, ABSM at 2:57 pm

Tuesday, February 11, 2014

More Sleep for Kids Could Reduce Calories

By Michael Breus, PhD, ABSM

sleeping child

We all want our kids to learn healthy eating habits, to be active and to grow and live comfortably at a healthy weight. Yet for too many children, excess weight is a very real health concern. Too much junk food and too little physical activity are frequently-cited culprits in the problem. But what about sleep?

New research suggests that a moderate increase in sleep may prove effective in helping children eat less and lose weight. Researchers have found that extending sleep reduced calorie consumption, altered hormone levels associated with appetite, and contributed to weight loss. Their results suggest that ensuring children get plenty of sleep on a regular basis may offer significant help in maintaining healthy weight and avoiding obesity.

The study included 37 children ranging in age from 8-11. Among the group, 27% of the children were obese. The 3-week study began with all children adhering to their typical sleep schedule for 1 week. During the second week, the children were randomly divided into 2 groups. One group increased their sleep time, adding 1.5 hours to their nightly time in bed. The other group decreased their time in bed by the same amount. After a week, the groups switched sleep routines. Throughout the study period, researchers tracked children’s food intake, measured the levels of appetite-regulating hormones leptin and ghrelin, and also recorded weight. They found extending sleep was linked to lower calorie consumption, as well as hormonal changes and weight loss:

  • During a week of moderately increased sleep, children consumed an average of 134 fewer calories per day than children whose sleep was decreased
  • Morning levels of the appetite-regulating hormone leptin were lower in children during the period of extended sleep. Leptin plays an important role in regulating metabolism and energy expenditure, signaling to the body that it has enough energy to function, thereby reducing appetite. Abnormal and high levels of the hormone can lead to leptin resistance, and the body becomes less equipped to use the hormone effectively to regulate appetite and metabolism.
  • Children lost an average of 0.5 pounds during the week of increased sleep.

This study appears to be the first of its kind to investigate how adjusting sleep duration can affect calorie consumption in children. The results point to the strong influence sleep can have on eating behaviors, a connection we’ve seen established in a significant body of research involving adults. Studies have shown insufficient sleep linked to an increased intake of hundreds of additional calories per day. Lack of sleep has also been shown to influence the types of foods we crave, leading to changes in brain chemistry that make unhealthful foods more tempting.

This latest study adds to a growing body of research that has established sleep as a critical factor in helping children establish and maintain a healthy weight. The importance of sleep in weight control can be seen even in very young children. What’s more, childhood sleep habits appear to have an extended influence on appetite and weight as children age:

  • Studies have shown that sleep patterns during the first months of life can influence risk for obesity down the road. Researchers at Harvard University found that babies and toddlers who slept fewer than 12 hours nightly had twice the risk of being obese at age 3. (The rates of obesity were highest among children who slept fewer than 12 hours and watched 2 or more hours of television daily.)
  • Researchers in New Zealand conducted a study of the relationship between sleep and weight in children ages 3-7. They found that children who slept more at ages 3-5 had lower BMI at age 7 than children with shorter sleep routines during these younger years. The children who slept longer at ages 3-5 also weighed less than their shorter-sleeping counterparts, and were less likely to be overweight.
  • A German study of more than 6,000 children ages 5-6 found that the prevalence of obesity was lowest for those children who slept more than 11 hours on a nightly basis. A study in China returned similar results, with preschool-age children who slept 11 or more hours nightly exhibiting lower rates of obesity than children who slept fewer than 11 hours.
  • Sleeping fewer than 8 hours nightly has been associated with a decline in eating habits among teenagers. Scientists at Case Western Reserve University found that teenagers who slept fewer than 8 hours nightly during the school week consumed more calories on a daily basis than teens who slept at least 8 hours. The teenagers who slept fewer than 8 hours also received more of their daily calorie intake from fats, and more of their overall calories from snacks.

This latest study provides further evidence that sleep can strongly influence eating habits and risks for weight gain in children, and that sleep can be an important therapeutic tool in helping children lose weight and keep it off. Rates of obesity among children have risen sharply over the past several decades, as the number of children and adolescents considered obese has more than doubled and even tripled. Recent estimates indicate that these dramatically rising rates of obesity in children have leveled off, and in some cases begun to lower. Still, more than a third of children and adolescents are either overweight or obese, according to the Centers for Disease Control.

Obesity puts children at risk for many of the same health problems that adults face, including high blood pressure and cholesterol, increased risk of cardiovascular disease, as well as type 2 diabetes. Breathing problems, including obstructive sleep apnea, are also more likely among children who are obese. Weight problems that begin during childhood and adolescence often continue throughout adulthood: children who are obese are significantly more likely to be obese as adults, facing the range of serious health risks associated with excess weight.

To change these numbers, reduce these risks, and protect the long-term health of children, we must use all the tools in our arsenal to combat obesity in children and adolescents. Sleep is a powerful weapon in this fight.


Sweet Dreams,

Michael J. Breus, PhD

The Sleep Doctor™

Posted by: Michael Breus, PhD, ABSM at 4:26 pm

Tuesday, February 4, 2014

Understanding Narcolepsy

By Michael Breus, PhD, ABSM

man sleeping

We’re witnessing some significant breakthroughs in our understanding of the sleep disorder narcolepsy. Two new studies, conducted independently, provide strong evidence for what’s long been suspected: that narcolepsy is an autoimmune disorder, triggered by a mistaken response of the body’s defense system and strongly influenced by a particular variation of an immune-system gene.

Narcolepsy is a neurological disorder, stemming from the brain’s inability to regulate periods of sleep and wakefulness. Studies have indicated that narcolepsy’s neurological dysfunction likely stems from a lack of hypocretin, a protein that works as a neuropeptide in the brain to stimulate wakefulness, and helps to govern the sleep-wake cycle. But the cause of this deficiency in hypocretin, and of narcolepsy itself, has remained unknown.  Science has in recent years pointed to an immune system dysfunction as a trigger. And a growing body of research also has provided evidence of a strong genetic component to narcolepsy. The latest results into the origins of narcolepsy in the brain provide significant new information on both fronts. The findings of one study are compelling enough to essentially confirm narcolepsy as an autoimmune disorder. The other study pinpoints a specific, immune-related genetic variation as a near-certain prerequisite for the condition.

Researchers at Stanford University School of Medicine conducted a study of immune system T-cell activity in people with narcolepsy. Their subjects included volunteers who showed a genetic predisposition to the disease. Based on earlier research that established the role of hypocretin deficiency and gave strong indications of immune system dysfunction, they investigated the response of T-cells to hypocretin in patients with narcolepsy and in healthy control subjects.

Researchers made a number of important discoveries. They found that in their patients with narcolepsy, hypocretin-producing neurons stimulated a T-cell immune response that did not occur in patients without narcolepsy. Autoimmune disorders occur when the body’s immune system misinterprets the body’s own healthy tissue as something potentially harmful. The immune system then goes into attack mode, destroying the healthy cells as though they were a threat to the body’s system, such as a virus, bacteria, or a toxin. In this study, the immune systems of narcolepsy patients reacted to hypocretin-producing neurons as though they were a threat, rather than the producers of an essential neurotransmitter.

Researchers also discovered that a portion of the hypocretin protein bears a strong resemblance to the protein found in the H1N1 strain of influenza virus that was widespread in 2009, and was commonly known as “swine flu.” Vaccinations at the time of the 2009 H1N1 pandemic were later associated with a spike in cases of narcolepsy among populations that had been given the vaccine. The H1N1 vaccine was used widely in Europe during 2009-2010. It was never used in the United States, and has not been used anywhere since the 2009-2010 flu season. This connection between H1N1 virus and narcolepsy spurred the Stanford researchers to examine whether the immune systems of people with narcolepsy might attack and destroy the neurons that produce hypocretin, because of its similarity to the H1N1 virus. To test this thesis, researchers exposed T-cells from these patients to the H1N1 protein. They found that indeed, exposure to H1N1 caused a spike in T-cells targeting hypocretin-producing neurons. Researchers also found evidence that other similar viruses may also lead the immune system to attack the source of hypocretin in the body, in people who are genetically predisposed.

That genetic predisposition is the subject of the other recent study, conducted by scientists at the Center for Integrative Genomics at Switzerland’s University of Lausanne. Researchers there investigated the link between narcolepsy and a variation of a gene that is involved in immune system function. The genetic variant is located within the human leukocyte antigen (HLA) system. This system plays a pivotal role in the immune system’s ability to accurately distinguish friend from foe, targeting potentially dangerous antigens and leaving healthy, normal tissue alone. Their study included 1,261 patients with narcolepsy and a control group of 1,422 people without the disorder. Researchers used highly precise genotyping to identify each participant’s individual genetic variations. The HLA system includes several already known genetic variants. Researchers found that people with a particular HLA variant were 251 times as likely to have narcolepsy as people without this particular variation. Among the participants with narcolepsy, nearly 100% had this gene variation. They also discovered 4 other HLA gene variations that appeared to have a protective effect against narcolepsy. The gene variant that is so strongly associated with narcolepsy is not especially rare—the scientists estimate that approximately 20% of the population of Europe has the variation. It is important to emphasize that not everyone who posses this genetic variation will get narcolepsy. But because nearly everyone who develops narcolepsy appears to have this variant, this population is at higher risk. This information could be critical to identifying those at-risk individuals, and to reducing the chance of misdiagnosis.

While less common than many other sleep disorders, narcolepsy is less rare than most people believe it to be. The disorder is estimated by federal health officials to affect approximately 1 in 3,000 people in the United States. Its symptoms often begin in childhood or young adulthood, but also can occur in older adults. Because of its highly disruptive and difficult symptoms, narcolepsy is a disorder that can often be highly debilitating, affecting normal daily functioning and relationships. People who suffer from narcolepsy experience extreme daytime tiredness, along with episodes of uncontrollable urges to sleep that often result in sudden and jarring “sleep attacks.” Many people with narcolepsy experience a symptom known as cataplexy, a sudden onset of muscle weakness that makes it difficult or even impossible for people to move. Other symptoms of narcolepsy include extremely poor nighttime sleep with frequent awakenings, intense dreams and hallucinations, and episodes of paralysis right before falling asleep and just after waking.

Both of these studies offer compelling new information about the root causes and mechanisms of this very serious disorder. They also offer the promise of swifter and more accurate diagnoses, and of improvements to treatment. For people who suffer the often devastating effects of narcolepsy, those improvements can’t come quickly enough.

Sweet Dreams,

Michael J. Breus, PhD

The Sleep Doctor™

Posted by: Michael Breus, PhD, ABSM at 1:21 pm

Tuesday, January 28, 2014

Does Sleep Deprivation Raise Diabetes Risk?

By Michael Breus, PhD, ABSM


Poor sleep is strongly linked to increased risk for type 2 diabetes. The two problems—which have been referred to as twin epidemics—present serious public health risks in the United States and worldwide. Sleep problems are also linked to risk for obesity, a primary risk factor for diabetes, and to metabolic syndrome, a condition that often precedes diabetes.

Research has indicated that sleep deprivation disrupts glucose metabolism, the process by which the body regulates blood sugar and processes that sugar into energy. Disruptions to healthy glucose functioning include decreases to insulin sensitivity and glucose tolerance, both of which contribute to elevated, unhealthful levels of blood sugar that eventually can lead to diabetes.

We have a great deal of evidence that establishes this connection between sleep and diabetes. But we don’t yet understand well the mechanics behind this connection. A new study points to a possible pathway by which insufficient sleep influences the development of diabetes. Recent research has found that sleep deprivation in mice leads to altered cell function in the pancreas, an organ that plays an important role in regulating blood sugar. Endocrine cells in the pancreas produce hormones—including the hormone insulin—that help process and regulate glucose. What’s more, researchers found that age played a significant factor. They discovered older mice experienced more significantly the negative cellular effects of sleep deprivation compared to younger mice, whose systems were able to cope more effectively with the cellular stress that resulted from lack of sleep.

Researchers at the University of Pennsylvania’s Perelman School of Medicine examined the effects of sleep deprivation on cell function and cellular stress in mice. They focused attention on the cells within the pancreas, as well as looking at changes in glucose metabolism. The study also investigated age as a factor in the relationship between cell function and glucose metabolism. Researchers submitted two groups of mice—young and old—to periods of both acute and chronic sleep deprivation, and studied the response of cells in the pancreas, including the endocrine cells that are involved in regulating blood sugar. In particular, researchers were looking for changes in a process known as the unfolded protein response. This is a protective response of the body to cellular stress that helps maintain healthy cell function. Changes to the activity level of the unfolded protein response are more likely to occur with age, and are linked to a number of serious and chronic diseases related to aging, including Alzheimer’s Disease and Parkinson’s, as well as to type 2 diabetes.

Researchers found that after being deprived of sleep, both younger and older mice experienced both cellular stress and increases to blood glucose levels. Younger mice, however, demonstrated signs that their bodies were able to cope with these alterations more effectively than older mice:

  • After periods of sleep deprivation, the degree of cellular stress was significantly higher in older mice than in younger mice.
  • Older mice showed increased levels of a protein that is indicative of cell death after being deprived of sleep. The younger mice did not.
  • Sleep deprivation appeared to magnify the impairment of the body’s reaction to cell stress in older mice, weakening a protective response that is already challenged by age.
  • While all the mice experienced negative changes to glucose metabolism after sleep deprivation, the younger mice appeared to weather these changes better than older mice. The younger mice showed significantly better control of their blood glucose than older mice. After acute sleep deprivation, older mice became hyperglycemic and experienced changes to insulin levels.

These results suggest that sleep deprivation may result in alterations to cell function that disrupt normal glucose metabolism, raising the risk of diabetes. These results also strongly indicate that age may make us increasingly ill-prepared to cope with these challenges. Older bodies are less adept at protecting cells from dysfunction, and lack of sleep appears to diminish this ability even further. This latest research builds upon an earlier investigation that showed sleep deprivation diminished the effectiveness of the unfolded protein response—that protective response to cell stress—in older mice. With these latest results, we’re beginning to see how this consequence of insufficient sleep has an impact on specific functions within the body.

The relationship between sleep and diabetes is complicated and multi-faceted, and there are other pathways by which sleep problems increase risk for the disease, including the significant effects of poor sleep on weight. But this research may present a significant development in our understanding of at least one way that sleep deprivation can influence the development of diabetes, and how this risk becomes more serious we age. It is also a striking and important view inside how deeply sleep can impact our bodies, placing us under physiological stress in ways that are potentially damaging to our health—especially as we grow older.

Sweet Dreams,

Michael J. Breus, PhD

The Sleep Doctor™

Posted by: Michael Breus, PhD, ABSM at 3:09 pm

Tuesday, January 7, 2014

Does Circadian Timing Give West Coast Teams an Edge?

By Michael Breus, PhD, ABSM


Whether you’re a fierce competitor in your fantasy football league, or you’d just like to be on the winning end of the couch come game day, here’s a tip that could help you pick your team: when making your prediction, consider circadian timing.

This advice may seem far afield from rushing yards, completion percentages, power rankings, or any of the other typical criteria fans consider when assessing a team’s prospects on game day.  But you’d be surprised how relevant circadian timing—and sleep more broadly—can be to a team’s success. New research indicates that the timing of play in relation to players’ circadian rhythms is a factor in NFL team performance. Scientists at Harvard, Stanford, and the University of California San Diego analyzed 40 years of NFL games between East Coast and West Coast teams, and found that West Coast teams appear to have a distinct advantage over their East Coast competitors when competing in games that start after 8 p.m. Eastern Standard Time. Researchers identified 106 games between 1970 and 2011 that included East Coast-West Coast match ups where kickoff occurred after 8 p.m. EST. They used 293 games played by the same team match ups during daytime hours as a control group. In analyzing their data, researchers controlled for other factors that could influence the outcomes of games. In particular, they used the Las Vegas point spread to factor out other game-day influences, including team skill differences, home field advantage, and player injuries. After adjusting for the point spread, West Coast teams demonstrated a clear advantage in evening games against East Coast teams:

  • West Coast teams beat the point spread twice as often as East Coast teams in games played after 8 p.m. EST.
  • West Coast teams beat the point spread in 66% of the games, by an average of 5.26 points.
  • In contrast, there was no advantage for West Coast teams over East Coast teams in games played during eastern standard daytime hours.

This new study follows up on earlier research conducted by some of the same scientists. That study examined East Coast-West Coast NFL Monday Night Football match ups that started after 9 p.m., during the years 1970 to 1994. That analysis also found that West Coast teams significantly outperformed the point spread in evening games against East Coast teams. The advantage was significant enough to eliminate home field advantage for East Coast teams playing at night, in the researchers’ estimation. Studies of other professional league play have also returned similar findings. An analysis of circadian timing as a factor in Major League Baseball found that West Coast teams traveling east to play were more likely to prevail in games than East Coast teams traveling west.

So what’s at play in these results? How does circadian timing translate into such a clear performance advantage? The body’s circadian rhythms control a range of important physiological process, including sleep and activity levels, on a 24-hour cycle. All of us—professional athletes, weekend golfers, and couch surfers included—experience optimal and preferred times for rest and for different types of activity, based on our individual circadian clocks. When the timing of an activity is in line with circadian rhythms, our performance at that endeavor is likely to be closer to its best. (Mid-morning, for example, is a time that’s often associated with peak cognitive function, which is why you may often feel you hit a groove at work during these hours, before a commonly experienced mid-afternoon slump.) For professional and competitive athletes, this means that taking the field at the right time of day can give them an edge over players who are gearing up to perform at different, less conducive points in their circadian cycles.

Forget what the wall clock says—when it comes to the benefits of circadian timing to athletic performance, it’s the body clock that matters. West Coast teams playing during evening hours on the East Coast have an advantage of playing in their biological, circadian late afternoon—considered to be an ideal time for physical and athletic performance. Research indicates that several aspects of athletic performance peak during the late afternoon and early evening, when body temperature nears its highest daily levels. For athletes this time of day is when strength, speed, flexibility, and endurance are often at their overall best—and risk of is injury at its lowest.

Of course, circadian timing isn’t the only sleep-related factor that can contribute to—or undermine—success in sports. Athletes face any number of sleep challenges, including grueling practice and game schedules that don’t allow for sufficient rest, sleep and performance hazards associated with frequent travel and jet lag, and the sleep-disrupting anxiety of performing at an elite level. Research demonstrates that extending sleep times and allowing for the creation of healthy sleep routines for athletes enhances both their physical performance and their mental game, as well. And professional sports seem to be slowly waking up to the power of sleep to improve athlete performance, protect athletes’ health, and even to extend career duration.

While you may feel you don’t share much in common with a professional linebacker, when it comes to circadian timing we’re all influenced in similar ways, which means the success, ease, and pleasure of daily activities can often be affected by their alignment—or lack thereof—with circadian rhythms. I’d like to see greater attention paid not only to the importance of circadian timing in professional and elite sports, but more broadly to how we all can benefit from better aligning our lives, including our work and school schedules, with circadian timing in mind.

Sweet Dreams,

Michael J. Breus, PhD

The Sleep Doctor™

Posted by: Michael Breus, PhD, ABSM at 1:11 pm

Tuesday, December 31, 2013

Why You Shouldn’t Ignore Insomnia Symptoms

By Michael Breus, PhD, ABSM


With our busy lives, it can be tempting to shrug off—or ignore altogether—difficulties with sleep. Trouble falling asleep, difficulty staying asleep throughout the night, waking feeling tired and unrefreshed: these are commonly experienced disruptions to sleep for millions of adults. Too often, these sleep problems aren’t taken seriously, or are considered the less-than-ideal price to pay for living full and sometimes hectic lives.

Difficulty falling asleep, waking during the night, waking very early in the morning, and experiencing un-restorative sleep are all symptoms of insomnia, a serious sleep disorder. People may experience these symptoms all at once, or some of them and not others. They may experience them chronically or every so often. They are signs of disrupted, poor quality sleep and they should never be ignored.

New research indicates how high a price we may pay for overlooking signs of insomnia. Scientists at Massachusetts’ Brigham & Women’s Hospital have identified a link between insomnia symptoms and elevated risk of death. Their study, which included more than 23,000 men, found certain symptoms of insomnia associated with higher mortality risk from cardiovascular disease. The men were all participants in the Health Professionals’ Follow-Up Study, a long-term, ongoing research endeavor that investigates issues related to men’s health. In 2004, 23,447 men reported to researchers about their sleep and any insomnia symptoms. Researchers followed up with the men over a period of 6 years, during which time 2,025 of the men died. After adjusting for other mortality-influencing factors including age, lifestyle habits, and other health problems, researchers analyzed data on men’s mortality as related to the presence of the following insomnia symptoms:

  • Trouble falling asleep
  • Difficulty maintaining sleep
  • Waking in the early morning
  • Experiencing non-restorative sleep

They found that several symptoms of insomnia were associated with higher rates of cardiovascular death among the men. In particular:

  • Men who reported having difficulty falling asleep had a 55% increased risk of death from cardiovascular disease as compared to those men who did not experience this sleep difficulty.
  • Men who reported experiencing un-refreshing sleep most of the time were at 32% higher risk for cardiovascular death than men who did not report this symptom.

Poor sleep is well understood to have a serious, negative impact on heart health. Not sleeping well, or enough, raises the risks for a number of cardiovascular problems, including high blood pressure, heart attack, heart failure, and stroke. Protecting the quality of sleep as we age is a critical component of protecting long-term cardiovascular health.

This isn’t the first scientific evidence of a link between poor sleep and increased mortality risk. But the news is particularly worrisome because these symptoms are quite common, particularly as we age. Estimates suggest that 30% or more of American adults experience some insomnia symptoms at least periodically, and for 10-15%, insomnia is chronic. Insomnia grows increasingly common with age: more than half of adults over the age of 65 experience symptoms of insomnia. Women are at higher risk than men for insomnia, due in part to hormonal cycles during childbearing years and to the hormonal changes associated with menopause. This current study included only men, but other research has shown higher risks of mortality associated with poor sleep in both men and women:

  • In a number of studies that included both men and women, sleeping fewer than 6 hours and more than 8 hours per night has been associated with increased mortality risk.
  • Obstructive sleep apnea in men and in women is linked to significantly higher cardiovascular and overall mortality risks. Studies have shown that mortality risks from cardiovascular problems are 2 or more times greater for adults with obstructive sleep apnea. The more severe the obstructive sleep apnea, the greater the mortality risks.
  • Research has also linked use of sleeping pills to increased mortality risk. The link between higher rates of mortality and sleeping pill use exists even after factoring out other possible contributors to death risk, including health problems, age, and gender.

Ready for some good news? While sleep problems left untreated may shorten longevity, improving sleep can have powerful positive health benefits. A study conducted recently in the Netherlands found that a regular routine of 7-8 hours of sleep may have as significant an impact on risk for cardiovascular death as not smoking. Regular, sufficient amounts of high-quality sleep have also been linked to reduced risk for type 2 diabetes, largely because of the positive effect that sleep can have on improving insulin sensitivity.

If you have symptoms of insomnia, don’t ignore them. Share them with your doctor. Make an honest assessment of your sleep habits and make a commitment to taking simple steps to improve your sleep routine and your overall sleep hygiene. Taking steps to improve the quality and quantity of your sleep is one important way to protect your cardiovascular and overall health for the duration of your life. And sleeping well may actually help you extend that duration.

Sweet Dreams,

Michael J. Breus, PhD

The Sleep Doctor™

Posted by: Michael Breus, PhD, ABSM at 1:21 pm

Tuesday, December 24, 2013

How Caffeine Affects Sleep

By Michael Breus, PhD, ABSM


You hear it all the time, when it comes to sleep: Don’t drink caffeine too late in the day. It’s among the most common sleep tips—and it’s a good one. Caffeine, with its stimulant effects, is disruptive to good sleep. And these days, with the popularity of energy drinks and other caffeine-laden beverages and snacks, it’s not difficult to wind up consuming caffeine throughout the day, even if you’ve set your coffee cup aside. The negative health consequences of too much caffeine also extend beyond sleep problems. Research shows that caffeine may contribute to cardiovascular problems. A recent large-scale study also suggests that heavy caffeine consumption—more than 4 8-ounce cups of coffee per day on a daily basis—is linked to higher mortality rates in men and women.

But how late in the day is too late in the day to be consuming caffeine? Despite consensus about caffeine’s sleep-disrupting effects, recommendations about the timing of caffeine consumption—and when it’s best to stop for the day—can vary widely. Though an abundance of research has been conducted to establish caffeine’s negative effects on sleep, very little attention has been paid to the specific timing of caffeine consumption relative to bedtime.

A new study attempts to fill in some of these important specifics about the effects of late-afternoon and early-evening caffeine consumption on nightly sleep. Researchers at Michigan’s Henry Ford Hospital’s Sleep Disorders & Research Center and Wayne State College of Medicine analyzed the sleep-disruptive effects of caffeine consumption at different lengths of time before bedtime. They found that caffeine consumed even 6 hours before bedtime resulted in significantly diminished sleep quality and sleep quantity. This is believed to be the first study to investigate directly the effects of caffeine at specific times before nightly sleep.

The study included 12 adult men and women, all of whom were healthy and were normal sleepers who in their regular lives were moderate consumers of caffeine. During the study period volunteers kept up their normal sleep routines, which included bedtimes between 9 p.m. and 1 a.m. and wake times between 6 a.m. and 9 a.m. Participants’ total nightly sleep duration fell somewhere in the range of 6.5 to 9 hours per night, with no regular habit of napping during the day. Throughout the study researchers tracked sleep by having participants keep sleep diaries and by using at-home sleep monitors. Participants were given doses of caffeine in pill form as well as placebo pills, on a schedule that enabled researchers to measure the sleep-disruptive effects of caffeine taken at 3 different points: at bedtime, 3 hours before bedtime, and 6 hours before bed. They found significant disruptions to sleep as a result of caffeine taken at all three points:

  • Caffeine consumed 0, 3, and 6 hours before bedtime significantly reduced total sleep time. Even caffeine consumed 6 hours before bed reduced total nightly sleep amounts by more than 1 hour.
  • Caffeine consumed at all 3 points diminished sleep quality. Caffeine taken 3 and 6 hours before bedtime, as well as caffeine consumed at bedtime, significantly increased the amount of time spent awake during the night.
  • Disruptions to sleep as a result of caffeine were perceived by volunteers (as recorded in sleep diaries) for caffeine consumed at bedtime and 3 hours before bed, but were not reported for caffeine taken 6 hours before bed. However, sleep monitors measuring total sleep time, and sleep efficiency (time spent sleeping relative to total time spent in bed) showed that caffeine consumed 6 hours before bedtime had significant detrimental effects to both.

This last finding is especially important, because it suggests that people can’t—and shouldn’t—rely entirely on their own perceptions of how much or little caffeine affects their sleep, especially caffeine consumed in the afternoon. Even if you don’t feel that late-afternoon cup of coffee has a negative impact on your sleep, this study suggests that it is likely to be interfering nonetheless. This is one reason that I have long recommended a 2 p.m. cut off time for caffeine consumption.

Remember, limiting caffeine doesn’t mean removing it entirely from your daily routine. A moderate amount of caffeine, consumed at the right times, can be useful and even healthful, stimulating alertness and energy. These new findings provide us with some really important specifics about just how significantly late-in-the-day caffeine can undermine a good night’s sleep. Want to enjoy your coffee without wrecking your sleep? Follow these basic suggestions for consuming caffeine in a sleep-friendly way:

Stick to a 2 o’clock cut off. As this current study shows, late-afternoon caffeine can cause problems for your sleep, even if you aren’t aware of it. To avoid sleep disruption, restrict your caffeine consumption primarily to the morning hours. If you do have a midday cup of coffee, make sure to drink it before 2 p.m.

Taper caffeine as the day progresses. Start your day with your most highly caffeinated beverage and ease up on the caffeine as the morning goes on. First thing in the morning is likely when you’ll crave caffeine the most, and when it can do you the most good in terms of boosting energy and shaking off the effects of a night’s sleep. Switch over to tea or decaffeinated coffee as the morning continues, to keep overall daily caffeine amounts moderate and be comfortably caffeine-free by mid-afternoon.

Avoid jumbo drinks. These days, everything seems to be “super-sized”—and caffeinated drinks are no exception. From a 20-plus ounce latte or soda to a caffeine-packed energy drink, a lot of caffeine products deliver way more of the stimulant than is healthful. Stick to something much closer to the old-fashioned 8-ounce cup, and savor it.

Don’t ignore your sleep problems. Being tired makes us more likely to feel the need for caffeine, and that extra consumption can in turn make sleep problems worse. Avoid this sleep-disruptive cycle by making sleep a daily priority. Practice good sleep hygiene and talk to your doctor about how you are sleeping, particularly about any problems that arise.

Thanks to this new research, we now have an even better idea of just how—and for how long—caffeine can interfere with sleep. I hope this and future research in this area will lead to consistent recommendations about caffeine consumption and, most important, to better sleep.


Sweet Dreams,

Michael J. Breus, PhD

The Sleep Doctor™

Posted by: Michael Breus, PhD, ABSM at 3:02 pm

Tuesday, December 17, 2013

Melatonin May Aid Weight Loss

By Michael Breus, PhD, ABSM

woman looking in mirror

We’re now officially deep in the holiday season, that time of year when holiday parties, decadent treats, and frequent toastings of good cheer can make it easy to put on extra weight. Looking for some help to avoid the seasonal weight gain? In addition to the standard (and very good) advice—be selective with your indulgences, fill up on healthy foods before hitting the holiday buffet, drink water in abundance and everything else in moderation—I’d like to add another strategy to the list: get plenty of sleep.

Sleep remains an underrated tool in the weight-management arsenal. A regular routine of sufficient, high-quality sleep can make a real difference in the ability to maintain a healthy weight, and can help to reduce the risks of serious health problems including type 2 diabetes and other metabolic disorders. New research indicates that the sleep hormone melatonin may encourage weight loss, by increasing the presence of a particular kind of fat that actually helps burn energy. This may sound surprising, that the presence of fat in the body leads to weight-loss inducing fat burning. In recent years scientists have identified specific types of fat that burn energy rather than storing it, as regular fat cells do. One of these types of fat is a so-called “beige fat,” which is found near the collarbone and along the spine in adult humans. (Another recently identified fat in adults is “brown fat,” which also burns energy.) Stimulating the presence of energy-burning body fats has been identified as a prospective treatment for obesity, as well type 2 diabetes.

A team of researchers from Spain and Texas has found that melatonin increases the presence of beige fat in rats given a 6-week regimen of orally-delivered melatonin. Their experiment included both obese rats with type 2 diabetes and healthy-weight rats that were diabetes free. Half of the rats (both obese and normal weight) were given melatonin in their drinking water every day for 6 weeks, while the remaining rats were given no supplemental melatonin. At the end of the 6-week period, rats that received the oral melatonin displayed increased presence of beige fat—this included both obese and lean rats. Researchers found that the rats who received melatonin had increased their sensitivity to the thermogenic effects of both cold and exercise. Thermogenic processes in the body—including exertion through exercise and activity, generating heat in reaction to cold temperatures, digestion of food and sleeping —raise metabolic rate and cause the body to burn additional energy. According to these study results, melatonin may boost beige fat stores and trigger an increase in energy burn.

These latest findings build on earlier research that demonstrated that supplemental melatonin slowed weight gain, lowered blood pressure and improved glucose function in obese, type-2 diabetic rats. Other research also suggests melatonin may have a role to play in treating metabolic dysfunction and disease. Low melatonin levels have been linked to insulin resistance and associated with elevated risk for type 2 diabetes. Supplemental melatonin given to mice and other animals has been shown to improve insulin sensitivity, lower blood sugar and decrease blood pressure.

So, should you start taking melatonin supplements in order to help shed a few pounds? The answer is no—for a few reasons. While these results are promising and in line with earlier discoveries, we still don’t know enough yet about how melatonin functions in relation to fat production and metabolic function, and how supplemental melatonin might best be used safely and effectively as a weight-loss treatment, or a therapy for metabolic disease.  The body’s natural production and calibration of melatonin is complicated and incredibly precise. Melatonin supplements, even taken in recommended dosages, can elevate levels of the hormone to several times greater than normal. This can result in disruption to circadian rhythms and to a healthy sleep cycle—an outcome that isn’t good for overall health or for weight control.

The good news is there are ways to stimulate the body’s own natural production of melatonin without drugs or supplements. These strategies are also, not surprisingly, part of the foundation for a good night’s sleep:

Avoid nighttime exposure to light. Melatonin levels rise in the body after dark, and fall back during daylight hours. Artificial light in the evening hours can delay melatonin release and disrupt sleep-wake cycles. Keep electronics—including computers and television—out of the bedroom. Make sure your bedroom is dark and protected from outside lights. Give yourself an hour or so before bed away from brightly-lit digital screens, to allow your body to respond to the evening’s darkness.

Soak up light early in your day. Taking in light during the daylight hours—especially sunlight—can strengthen circadian rhythms and help to avoid melatonin deficiency. Take some time to walk outside in the morning, or make sure you’re working in proximity to a window in order to provide your body with some exposure to sunlight.

Exercise regularly. Physical activity is another way to strengthen healthy circadian function and improve sleep. It’s also a critical aspect of long-term weight control. Schedule your exercise no closer than 3 hours before bedtime, so that the exertion doesn’t interfere with sleep. If you can exercise outdoors in the daylight, even better.

There are also a number of foods that contain melatonin, which fit well into a healthy diet. Almonds and walnuts, sunflower seeds, tart cherries, tomatoes and fennel, as well as the spices cardamom and coriander are good sources of melatonin.

This latest discovery of the influence of melatonin on energy-burning fat may eventually develop into a new form of treatment for obesity and its related illnesses, which are epidemic in the United States and around the world. It’s critically important research. Equally important is understanding how we can stimulate our own bodies’ melatonin production, to protect health and improve sleep.


Sweet Dreams,

Michael J. Breus, PhD

The Sleep Doctor™


Posted by: Michael Breus, PhD, ABSM at 5:03 pm

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