Sleep Disorders

Caffeine vs Napping

2009-06-26T12:58:00.001-04:00

If a 20-minute nap, a cup of joe, and more shuteye at night were in a cage match, who would win for reducing that classic afternoon "dip"? The answer is: (in order of effectiveness)

Nap,
Caffeine,
Then more nighttime sleep.

A new study just released proves the power of a nap over a jolt of caffeine and even more sleep at night. It's actually the first such study to look at all three methods for combating the afternoon lull that's commonly experienced – and which is a very normal physiological response to the body cycling through its natural rhythms during the day.

Just because you feel sleepy at some point in the afternoon doesn't actually mean you're sleep deprived. About eight hours after you wake up, the body's temperature dips a little, triggering that oh-so-annoying drowsiness after lunch and smack dab in the middle of your attempts to focus and get more done in the late afternoon.

Why am I not surprised the nap wins out? For many reasons:

Naps refresh you at a cellular level that – sorry, Mr. Joe and Soda – caffeine just can't do.
It's easier to over-sleep than you think. Biologically, the body doesn't necessarily need that extra sleep if you force yourself to sleep more at night. And getting sufficient sleep doesn't mean your body won't go through the dip regardless; it's a natural, physiological phenomenon tied more to your circadian rhythm than to your previous night's sleep and potential sleep debt.
Caffeine can wear off (especially if you're so used to it) whereas the benefits of a nap may charge your battery for a longer period of time. No one gets a "high tolerance" to napping.

I've long been an advocate for napping. The best kind? A 20-minute snooze within a 30 minute time period (10 extra minutes to get comfortable and into sleep mode). Or try the Nap-a-latte™, which is the dynamic duo.

But here's a big caveat: most people would probably choose caffeine over a nap, and ditch the nap entirely. Downing caffeine can be easier, quicker, and socially more acceptable in many ways. Finding a place to nap in the middle of the workday can be a challenge. And studies have also shown that when deciding between a nap and an "attractive wakeful activity," they choose the activity.

Let's face it, coffeehouses have multiple buzzes going on. People. Internet. Connectivity. Social interaction. Exchanges of ideas. And tasty treats beyond the joes and javas. Naps tend to be solitary and, dare I say, not as sexy.

But for what it's worth, hail to the nap.

Sweet Dreams,

Michael J. Breus, PhD, FAASM
The Sleep Doctor™

This article on sleep is also available at Dr. Breus's official blog, The Insomnia Blog.

Mattress Money Stasher Throws Out a Million!

2009-06-23T17:19:00.003-04:00

The story reads like something out of a sitcom or a joke that doesn't have a punchline. Woman stashes life savings to the tune of $1 million in her mattress. Woman throws out the mattress by mistake. After a day goes by, she remembers her major gaffe and frantically searches for her fortune in three different landfills. Finds nothing. One of the managers at a rubbish site suggests a homeless person picked up the mattress and probably has no idea he could give up the park bench and check into the Ritz.

Some of you may have heard of this crazy, true story last week in the news. To my knowledge, the Israeli woman is still fishing for her hidden treasure. (And no one really knows how she amassed such an amount, but she did say she had "traumatic experiences with banks" in the past, which might explain her homemade bank account.)

She may be the first person to stockpile a million bucks in a mattress and manage to mistakenly throw it away, but she won't be the first – or last – person to resort to this old-fashioned way of saving and storing money.

Especially in times like these, as people lose their faith in traditional banks, I bet more and more people are using their mattresses... and home safe boxes, cellars, closets, secret spots, etc. to keep a healthy sum of money should something go terribly wrong with the banking system (despite the government-backed FDIC guarantee up to $250,000 per person.)

And then there is this idea: how about a mattress wallet? You heard that right. A real mattress can be hard to carry around, let alone save in a house fire in the middle of the night with your dollars and cents. I don't think your homeowners insurance company will appreciate you claiming a lot of funds deposited into your now fried mattress. So what about a wallet-sized device that offers these "shrewd features":

Holds four traditional-sized credit cards.
Holds dollars, euros, yens, pounds, and I.O.U.s
Made from high-quality stitching and authentic mattress material (yes, it even looks like a mini-mattress!)
Doubles as a generous napping aid (up to 5mm of comfortable padding on each side).
Folds down to just about the same size as a traditional wallet.
And best of all, it's endorsed by Washington Mutual's CFO (ahem, one of the banks seized by the government and sold off to Chase).

Don't believe me? Then check it out yourself and have a good laugh. You might be able to rest more comfortably on your mattress if you don't have stacks of bills beneath you.

Sweet Dreams,
Michael J. Breus, PhD, FAASM
The Sleep Doctor

This article on sleep is also available at Dr. Breus's official blog, The Insomnia Blog.

Sleep on the Government's Agenda

2009-06-22T08:00:00.000-04:00

Has someone been falling asleep in Congress?

I was delighted to hear that Florida Congressman Gus Bilirakis has just introduced a sleep apnea awareness resolution to the House of Representatives. The goal is to raise public awareness of this serious condition and encourage all Americans to educate themselves – and others – about the consequences and potential treatments of sleep apnea. Perfect timing given the fact the President is about to focus on health care.

I've been talking about obstructive sleep apnea (OSA) for years trying to raise awareness and help people successfully treat it. Some basic facts about OSA:

OSA afflicts more than 12 million Americans.
OSA is characterized by repeated stops and starts of breathing during sleep when throat muscles relax and block the airway.
Snoring is often a sign of OSA.
When left untreated OSA can trigger a variety of health problems, from cardiovascular challenges to mood and memory problems.

Don't have OSA? Don't think it affects you? Well, consider the fact that people with OSA experience fragmented sleep, which makes for chronic daytime drowsiness. So imagine all those drowsy drivers sharing the same roads as you. Think about all the long-term health care costs that can be saved by treating OSA patients successfully.

Currently, the CPAP machine is the gold standard for treating OSA. But there's also an association between OSA and weight, as studies have shown that OSA decreases with more physical activity and less weight – a message that the health care industry would do well to support.

Kudos to Congress for not falling asleep at the wheel, so to speak, on this issue. I just wonder, though, how many of our Congressional leaders suffer from OSA? Those long sessions probably can be tiring and tedious, certainly not the place were you want to be caught nodding off. And luckily, this is one issue immune to the politics of partisanship. All of us can benefit, from the floors of Congress to the streets of America.

Sweet Dreams,
Michael J. Breus, PhD, FAASM
The Sleep Doctor

This article on sleep is also available at Dr. Breus's official blog, The Insomnia Blog.

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The Sounds and Sleeplessness in the ICU (Part II)

2009-06-18T09:25:00.001-04:00

Earlier this week I covered a new study that points to the disturbing effects (literally) of noise pollution in intensive care units. The second half of the article discussed several methods to reduce noise and their effectiveness.

Some of the methods examined in the study to reduce such noise included the following:

Earplugs/earmuffs on patients (self-explanatory)

Behavioral modifications: Enforcing stricter rules among hospital staff so they are more aware of how much noise they are making. This is the "Tone it down!" strategy, which entails establishing set quiet times during which the ambient light is lowered, alarms are cut down in intensity, and phones, televisions, and radios are turned off.

Sound masking: The use of white noise machines to neutralize certain noises.

Acoustic absorption:The use of certain materials like foam to dampen noise levels.

Not surprisingly, all four strategies to lower the noise proved effective. But surprisingly, sound masking beat out the sound-absorbing treatment. That's good news for people who want to take a study like this and apply it to their bedroom setting at home. Far from an ICU, yes, but the two places share much in common.

It helps to think of your own bedroom as sanctuary for recovery much like an ICU. Applying these techniques at home can be equally as effective, if not more so since you're not simultaneously battling serious health challenges (hopefully!). While I don't expect you to install sound absorbers in your walls, the top three ideas are quite practical:

Earplugs: these are inexpensive and available at most drug stores. I like the foam ones that expand in your ear canal.

Behavioral modifications: evict the gadgets and machines from you room; if a television is a must, set boundaries so you're not letting it encroach on your bedtime turf. Have a "lights-off" time set (and don't fall asleep with the TV still on! – there are TV timers on most TVs today.)

Sound masking: white noise machines can be incredibly powerful in axing out any background noise. Many clock-radios have built-in white noise makers, or you can try an oscillating fan. Some find the rhythmic beat of a fan to be very calming and "white-noise"-like.

My hope is that hospitals heed the lessons from studies like this one, and learn how to minimize unnecessary noise to maximize the very purpose those facilities serve – to spur the healing process and foster recuperation. Which is exactly what your bedroom is supposed to do. The ICU is a special place. And so is your bedroom.

Sweet Dreams,
Michael J. Breus, PhD, FAASM
The Sleep Doctor

This article on sleep is also available at Dr. Breus's official blog, The Insomnia Blog.

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The Sounds and Sleeplessness in the ICU (Part I)

2009-06-16T09:24:00.001-04:00

Noise. Whether it's the blare of traffic and the hustling sounds of a city, or just your neighbor's barking dog and lawn mower cutting into your Sunday snooze, noise pollution is something we all have to deal with to some degree. But what about indoor disturbances--in a hospital when you're lying in the Intensive Care Unit?

I know, it's not something we think about much, which is partly why there hasn't been extensive investigations into this arena. But a fresh study out of the U.K. sheds some fascinating light on this subject.

As we all can attest from experience, noises can disturb sleep and make for rude awakenings when your body is trying to cycle through its motions to refresh and rejuvenate itself. But for people under compromised health conditions and enduring recoveries in ICUs, noises and their resulting sleep interruptions can be especially problematic. And most aren't in a position to complain or tell people in the room to tone it down.

Most case studies show that the noise levels in hospitals are much higher than established guidelines, and the very nature of ICUs in particular make for off-the-charts excessive noise levels. How does this all affect a sleeping patient? Significantly. Here are just a few consequences highlighted by the recent study:

Deeper delirium: – the state of mind typical of those suffering through a trauma or fever and who experience restlessness, illusions, and incoherent thoughts and speech. No doubt any drugs a patient will be on can make this state worse, but so can poor sleep brought on by something as simple as too much ambient noise. Delirium not only increases a person's length of stay in a hospital, but also the severity of their condition.

Irregular circadian rhythms: ICU patients don't usually keep their normal sleep-wake patterns. Their physical condition can have them sleeping on and off during the day and night. Add to that intermittent loud noise and you've got a recipe for more erratic sleep patterns.

Post-traumatic stress disorder: Not all patients experience post-traumatic stress disorder after a stay in the ICU, but for those who don't get the sleep they need to recover quickly and stave off episodes of delusional memories, the risk for post-traumatic stress disorder rises considerably.

Lowered immune function: Just two days of sleep deprivation has been shown to impair the immune system. So imagine what this means for patients in need of their immune system the most at times like these.

Cardiovascular and respiratory effects: Studies have shown how noises can lower the function of these critical systems, causing a speed-up of the heart and negatively dampening respiratory performance.

Being in the ICU is hard enough to endure. Throw in sleeplessness caused by noise pollution and just about everything worsens. Sleep is essential in the recovery from illness or injury. Of all the places that should shelter sleep, the ICU has to be close to the top of the list.

So what can we do about all this? I'll get to that in my next post, when I cover the study's examination of noise-reduction techniques in Part II. Do they work? And can you try them in your home?

Sweet Dreams,
Michael J. Breus, PhD, FAASM
The Sleep Doctor

This article on sleep is also available at Dr. Breus's official blog, The Insomnia Blog.

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Do You Recognize Me?

2009-06-04T14:26:00.011-04:00

The Power of Sleep in Identifying a Face

We've all experienced it. You see a face and think, "Where do I now that person from? He looks so familiar!" Sometimes, a few more minutes of pondering or resorting to some awkward inquiry can result in an answer. Other times, you're not so lucky and you never figure it out. Can your sleep be at all related to this scenario?

A new study just released suggests that yes, our ability to remember faces is linked to how long we are awake.

Specifically, when you are awake for lengthy periods of time - 12 hours or more - your capacity to retain the new information of a fresh face is impaired. The study didn't find that sleep helps long-term consolidation of that memory, but I would venture to guess that future studies may confirm that sleep indeed helps us keep our new found friends and neighbors at our mental fingertips. It's well-documented that sleep has a profound role in helping us to:

remember things

learn new information

process data efficiently

consolidate memories (In fact, it's believed that dreams may play a special role in that consolidation, though we don't know exactly how that all works yet.)

I love a good study, and this one is especially unique because it examines an aspect of life so central to human behavior: being able to recognize others. This skill has been the basis for human interactions for millennia, key to not just social interactions but also survival. (Remembering where you put your keys or what time you're supposed to pick up the kids may also be on your survival radar, but those circumstances call for another study. And I bet sleep also would be a factor.)

So the next time you can't conjure a name quickly to match that oh-if-I-can-just-put-my-finger-on-it face, you may want to look no further than your last sleeping session. How long ago was it?

Keep that memory sharp. Keep up the good nights.

Sweet Dreams,

Michael J. Breus, PhD, FAASM
The Sleep Doctor

This article on sleep and memory, and other sleep articles, is also available at Dr. Breus's official blog, The Insomnia Blog.

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Fido or Tabby Got Your Sleep?

2009-06-03T07:44:00.003-04:00

If you're still scratching your head wondering why you're not feeling as refreshed as you should in the morning, you may have overlooked a little furry sleep thief: your pet.

I get asked about pets in the bedroom pretty frequently, and it can be a hard to hear that pets in the bedroom can be problematic for sleep. Pets are like family members, and we don't like to exclude them from snuggling with us when they show so much affection and beg to be with us at night. But they can be a major cause of poor and disrupted sleep.

Studies have demonstrated that a reasonable percentage of pet owners who allow their pets in bed have sleep problems. And if you think a cat is harmless, then look no further than a home video of what goes on in night when you think your furry friend acts like a stuffed animal. If only...

For starters, cats are nocturnal by nature. They typically won't snooze with you for 7 or 8 hours straight. They may look harmless when you’re about to drift off, but a cat usually will get up, move around, play, and try to rouse you.

Dogs aren't quite so nocturnal, but because of their size, every time they move or begin to scratch and groom themselves they can wake the soundest sleeper. They can also snore as badly as a human -- ever listen to an Old English Bulldog?

How about a cat or dog bed? If you've already introduced your pet to your own bed, then it's going to be pretty hard to get it to use its own special bed--no matter what the person at the pet store said or how fancy, fluffy, and "pet-friendly" the bed is. Fido and Tabby may turn their noses up at that and be in your bed faster than you can snap your fingers. To this end, let me offer some tips:

Everyone has a different tolerance level for pets in the bedroom, so both bed partners must agree on who gets to sleep where. If pets don't disturb anyone's sleep, then there's usually no harm.

Understand that once you allow pets to share your bed, it becomes difficult to curb or stop the habit. To stop the habit, you'll have to endure some heart-wrenching complaints from Fido or Fluffy until they learn that your bedroom is off limits.

Make sure that your intimacy needs do not suffer from sharing your bed with pets. Remember the bed is for both sleep and sex; do not trade one for the other.

Have your allergies checked. Over time it's quite easy to develop allergies to pets and not realize it. If you wake with a stuffy nose every day, it could be time to find Fido or Fluffy its own space.

Review the habits of your beloved pet to make sure they're compatible with yours: a snoring bulldog can be a bigger problem than you might think.

The good news is pets can't hold grudges the way humans can. So even though you may have to practice some tough love for a while, you won't risk losing your best friend.

Sweet Dreams,

Michael J. Breus, PhD, FAASM
The Sleep Doctor

This article about sleep is also available at Dr. Breus's official blog, The Insomnia Blog.

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Trouble Keeping Up with Your CPAP?

2009-06-01T15:45:00.001-04:00

It's widely known in sleep medicine circles that the most common - and helpful - treatment we have these days for patients with Obstructive Sleep Apnea (OSA) is the CPAP machine, short for Continuous Positive Airway Pressure. If you've been diagnosed with OSA, then you know exactly what I mean.

The problem with CPAP therapy is that not a lot of people are good about using it on a routine basis. Or, like trying to start a ambitious exercise program, they are compliant at the start and then slowly drop off. Within a few months, they are rarely found using their CPAP. And sleeping poorly as a result.

But there's hope: new research that just surfaced and was presented last week at a conference in San Diego has revealed that when patients are prescribed just a two-week course of a certain sleep aid (the one marketed as Lunesta), they are more apt to be using their CPAP in six months.

Lunesta is one of the more popular prescribed sleep aids, which can help you to fall asleep and stay asleep by enhancing the activity of a sleep-friendly chemical called gamma-aminobutyric acid (GABA). My guess and experience is that many of the sleep aids in this category would work as well.

So I ask you:

Do you have OSA?

Do you have a CPAP collecting dust in your closet or beside table?

Are you tired of being tired?

Have you ever heard about apnea and how it can affect your health and relationship?

If you answered yes (and I know there are a lot of you out there) then you may want to take up this conversation with your doctor. Using a sleep aid for a short period of time in conjunction with a CPAP appears to be able to help you set an important pattern in your nightly routine. You'll get used to using the CPAP, and feel the difference a good night's sleep brings.

I know, the CPAP isn't the sexiest of devices, especially for a bedroom. But it can transform an OSA-sufferer's sleep. OSA is associated with some pretty unwanted health consequences - from heart problems to mood and memory problems, and even weight issues. Yet there's no consequence to using a CPAP machine other than better sleep, better health...and a happier bed partner who doesn't have to listen to your episodic breathing (and probably snoring) all night.

It's time to put OSA to bed.

Sweet Dreams,

Michael J. Breus, PhD, FAASM
The Sleep Doctor

This article about Obstructive Sleep Apnea is also available at Dr. Breus's official blog, The Insomnia Blog.

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Not Fit to Fly

2009-05-20T10:24:00.001-04:00

Photo Credit: Josh Hallett

It's hard to legislate sleep. As an employer you can certainly set rules and guidelines, hoping your employees show up refreshed and ready to perform, but you can't really enforce or police it - even when lives depend on it.

Hearing about the fatigue factor involved in Continental's February plane crash on a cold, icy night near Buffalo, New York has been horrifying. According to the latest reports from the NTSB, the main cause of the crash is being blamed on the crew's lack of experience and lack of sleep (lack of proper conduct in the cockpit, too, which certainly stems from a lack of experience and sleep).

Have you ever wondered:

When you step on to a plane, how alert are your pilots?

Have they just gotten off a transcontinental flight and haven't slept in a day - or two?

Have they been working the graveyard shift and catching some Zs on a couch in the terminal before taking control of your plane?

Are they feeling fuzzy and spacey as they continue to fight a nagging cold bug (which really prefers them to be sleeping more)?

How much does sleep factor into performance...even when an emergency happens suddenly?

To quickly answer that last question, sleep plays a huge role in the ability to perform, even when it comes to basic skills we've done over and over again. And thinking about our pilots' alertness is probably not something that enters our minds as we're boarding planes and getting organized in our seats, but the thoughts are crossing millions of grounded minds this week as more news emerges about the fate of that February ride.

The history books are loaded with similar stories: the 1989 Exxon Valdez oil spill off Alaska, the Challenger space shuttle disaster, and the Chernobyl nuclear accident have all been attributed to human errors in which sleep-deprivation played a role.

The NRMA (National Roads and Motorists Association) estimates fatigue is involved in one in 6 fatal road accidents. In fact, 17 hours of sustained wakefulness leads to a decrease in performance equivalent to a blood alcohol-level of 0.05%. Too bad "sleepy driving" doesn't have the same buzz to it as "drunk driving."

Sorry, but sleep deprivation - regardless of your job - is not a badge of honor. Pilots aside, think of all the jobs that rely on alertness in critical, potentially life-threatening scenarios: ER doctors, surgeons, ground transportation drivers, air-traffic controllers, freight train engineers, etc. The sad part is the challenge of ensuring our pilots, drivers, controllers, and so forth are indeed fit to be at the helm. What can we do?

Have them keep journals of their sleep/wake cycles?

Invent a test they can take to measure their alertness prior to clocking in?

Enforce stricter guidelines for when, say, a pilot, can be in the cockpit after a certain stretch of wakefulness?

It's all a hotly contested debate. No one is perfect. But we demand perfection in certain situations when the lives of people are at stake. May this recent incident and ongoing investigation shed a brighter light on the importance of sleep hygiene and the value of ensuring our public servants get all the sleep they need.

Sweet Dreams,

Michael J. Breus, PhD, FAASM
The Sleep Doctor

This article on sleep is also available at Dr. Breus's official blog, The Insomnia Blog.

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Stormy Weather, Stormy Sleep

2009-05-13T08:00:00.001-04:00

Photo Credit: TysonA

Have you ever had trouble sleeping when a storm blows through? (No, I don't mean being awakened by the sound of thunder or the pelts of rain on your window.) If you suffer with obstructive sleep apnea, listen up: there's new evidence that the weather can worsen your sleep-disordered breathing. In other words, when the pressure drops, so does your ability to achieve smooth, restful breathing during the night.

Surprisingly, not much has been studied when it comes to connections between the weather and sleep. Lots of studies have been done to show the effects of high-altitude, which also worsens sleep apnea; but weather-related changes in atmospheric pressure and breathing during sleep has been a neglected area of study. Until now.

I've written a lot about obstructive sleep apnea (OSA), a common sleep disorder whereby one briefly stops breathing multiple times during the night when the muscles in the back of the throat fail to keep the airway open. This results in:

fragmented, poor sleep
low blood oxygen levels
an increased risk for myriad health problems, including hypertension, heart disease, mood and memory problems
the recommendation from your doctor to use a machine called a CPAP at night to keep your airway open for sound sleep

This new wrinkle in the mystery of sleep opens the door wide open for much more exploration. We have no idea how the atmospheric pressure could affect apnea. It's still a big question that researchers are now going to investigate. Weather has always carried with it an aura of mystique. People have blamed it on everything from bad moods to joint and muscle pain. I predict that some of those connections are very real.

Something to think about this week as we watch wicked weather pass through parts of the US.

And blame it on the rain.

Sweet Dreams,

Michael J. Breus, PhD, FAASM
The Sleep Doctor

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Short Sleeper: Are You Fooling Yourself?

2009-05-12T08:28:00.005-04:00

There are plenty of stories about famous short sleepers to go around. Among those who claim (or claimed, as some are no longer with us) that they do perfectly well on four hours of sleep are Jay Leno, Madonna, Michelangelo, Napoleon Bonaparte, Florence Nightingale, and Thomas Edison (whose invention - the light bulb - forever changed our sleep habits). Winston Churchill got by on six hours, and Leonardo DaVinci kept one of the most outrageously crazy sleep schedules, sleeping 15 minutes every four hours day and night.

If you're a short sleeper, which is technically defined as someone who gets fewer than 6 hours a night, are you living well off that brief sleep? Are you catching more Zs during the day in the form of a nap? (Which, by the way, is how some of the aforementioned geniuses got by. Churchill took a complete 1.5- to 2-hour nap in the afternoon-and he undressed and got into bed.)

Well, if you think you could use more sleep time, you're probably right. And science continues to reveal what sleep deprivation can do to us (other than make us tired and cranky). The National Sleep Foundation recently released an alert pointing to new evidence: people who average fewer than six hours a night could develop prediabetes. And you know what that leads to: full-fledged diabetes.

Granted, some people actually can do well with fewer than four hours of sleep, and those people are probably genetic anomalies - people programmed to avoid all the risks related to insufficient sleep. For them, four to six hours is sufficient.

But that, unfortunately, is not the case for the vast majority of the rest of us. Just as you don't hear about people who drink, smoke, and eat poorly living to the ripe old age of 100 very often, you don't hear about too many people who live like vampires and escape the ravages of that lifestyle. Those who claim they "get by" on little sleep are likely fooling themselves, but their bodies won't fool them.

So I ask you:

How many hours of sleep are you getting on a regular basis?

Do you feel refreshed when you wake up?

Do you reach for caffeine, an energy drink, or a sugary snack in the afternoon?

Are you having trouble losing weight or maintaining your ideal weight?

Have you been diagnosed as prediabetic or diabetic but haven't changed your sleep habits?

May those answers inspire a lunch pad for making change. I'll give you wiggle room if you're about to change the world with an incredible invention you've been working on like mad, or if you're ruling the world as a great leader. But if you are... then it's highly unlikely - I'll make that impossible - that you're reading this blog.

Got ya. Now go get some more sleep!

Sweet Dreams,

Michael J. Breus, PhD, FAASM
The Sleep Doctor

This sleep article is also available at Dr. Breus's official blog, The Insomnia Blog.

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Tips for Sleepless Mariah Carey

2009-05-01T05:00:00.003-04:00

I'm not usually the sort to wade through celebrity gossip pages, but this one came across my desk because it is, well, directly related to my area of expertise... and I am compelled to reach out and offer some advice.

Word travels fast: no sooner did Mariah Carey Twitter about her sleep problems did her issues show up on various websites. Here's what she apparently wrote on her Twitter page:

"I just finished working out. Whooo! Quite naturally, 'its 5am and I still can't sleep' Who's up? Nick is too cute when he's sleep! I wish he didn't have to work tomorrow so he could help me sleep all day and I could sing all nite [sic]!"

How many red flags can you find in that tweet? Did she work out just before 5 AM and is only now trying to go to bed while the rest of the world (and the sun, let's not forget) is about to get up? And does she normally live like a vampire - going to bed in the morning and getting up in the evening to sing all night long?

There's nothing "quite naturally" about any of that. Her body is rebelling, thrown totally off key (pun intended) by the crazy break in its natural rhythm that wants to sleep at night and sing during the day. I help lots of jet setters and shift workers who struggle with weird working hours and blocks of time when they do, in fact, live during the night and sleep during the day due to their job.

Being a rock star (or singing sensation or pop queen or however you categorize Ms. Mariah is your choice) has its downsides. The music industry has to be one of the worst fields to work in if you love your sleep. I honestly don't know how some musicians do it when they travel constantly across continents and time zones-going from one late-night show to the next. And I have no idea how someone living on such a schedule can find time to exercise. It's hard enough for the rest of us.

The three simple things Mariah should heed:

Exercise can be stimulating for some people, making it hard to fall asleep soon thereafter. She might want to try scheduling in her exercise earlier in the day (er, I mean night - maybe before her show?). Or exercise first thing after waking.

Jumping right into bed and expecting to fall asleep quickly is unrealistic. It can take time for the body to unwind and prepare for sleep. This is when having good sleep hygiene is key.

Consider re-calibrating the body clock for the short-term when there will be days when she expects her body to keep up with an unusual sleep-wake cycle

I wonder how her hubby fares once Mariah gets into bed. Does his sleep get disturbed? And when he rises, does it disturb Mariah? Ah, the joys of marriage. Hopefully they can sync up their schedules once in a while to enjoy one another.

Sweet Dreams,

Michael J. Breus, PhD, FAASM
The Sleep Doctor

This article on sleep is also available at Dr. Breus's official blog, The Insomnia Blog.

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Take a Caffeinated Shower

2009-04-28T18:24:00.001-04:00

Looking for an extra boost in the shower to wake you up? How about a caffeinated shower?

You read that right. I had to do a double-take myself when I read about this in an airplane magazine. It's called Shower Shock (aptly titled) and the product claims to contain approximately 12 servings (yes, that'd be 12 showers) per 4-ounce bar.

The hilarious part of the sales pitch: 200 milligrams of caffeine per serving, which is the equivalent of two mugs of coffee. According to the product label, caffeine can be absorbed through the skin and for maximum effect, "build up a good Shower Shock lather across your entire body before rinsing!"

Is this a joke? No, I don't think so, at $6.99 per bar. But how true is it? Can you really get a jolt from caffeinated soap?

Not so fast. We've watched caffeine turn up in all kinds of products lately, from water to lip balm, cosmetics and beauty products. I don't blame manufacturers for trying to sell caffeine in whatever they can put it in - after all, it's arguably the world's most popular drug. It will never go out of style. But don't be fooled by gimmicks like this. Some facts to consider:

The effectiveness of such products has not been proven, and they are likely to have little stimulatory effect on the central nervous system.

Caffeine is not readily absorbed through the skin and even if it could be, soap is probably not the best delivery device.

The soap itself is likely to keep much of the caffeine from coming in direct contact with the skin by holding the chemical in suspension.

The water and soap will dilute the caffeine, and generally soap is washed off the skin after less than a few minutes, or even seconds.

As a comparison, most drugs delivered through the skin (called "transdermal drug delivery") is done with substances with active doses under 1-2 milligrams. Far from the case here with caffeinated soap.

So are there any benefits to this soap?

Well I bet the peppermint oil in the soap will give you a nice little wake up call when it hits your nose and eyes. Perhaps the peppermint oil is adding to the placebo effect of the caffeine.

And let's not forget that caffeine is a strong antioxidant, so assuming you get some of that caffeine into the upper layers of your skin, it can help you ward off those free radicals that contribute to aging. A beauty bar, just as soap should be.

Not, I'm sorry to report, a substitute for your morning cup of Joe.

What will they think of next...

Oh, I guess they already have. How about a caffeine necklace (a necklace with a caffeine molecule pendant)? Or sunflower seeds imbued with the powers of caffeine, taurine, lysine, and ginseng (just like an energy drink)? And just how do they get those ingredients into the seeds? A topic for another day. Let me sleep on that.

Sweet Dreams,

Michael J. Breus, PhD, FAASM
The Sleep Doctor

This article on sleep is also available at Dr. Breus's official blog, The Insomnia Blog.

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Snoring: A Health Hazard or a Harmless Habit?

2009-04-27T07:00:00.004-04:00

When I tell people that snoring can be a sign of a serious health problem, they typically act surprised because snoring is so common. In other words, how can it be so serious if it's so universal?

Approximately 90 million American adults snore, and of those 37 million snore on a regular basis. It's a problem among all ages and both genders, but it seems to affect men more than women, and it can worsen with age.

Snoring is a turbulence problem. Air rushes down a tube that causes a vibration in the tissue, which causes a cadence and then a snore. This can cause frequent disruptions in a person's sleep (not to mention the other person trying to sleep in the same bed). Snorers generally don't wake up feeling as refreshed as they should.

So, what makes this so dangerous?

It can be a sign of obstructive sleep apnea (OSA), a common sleep disorder I've blogged about several times. People with OSA briefly stop breathing multiple times during the night when the muscles in the back of the throat fail to keep their airway open. This results in fragmented, poor sleep, as well as low blood oxygen levels. OSA has been associated with an increased risk for myriad health problems, including hypertension, heart disease, mood and memory problems.

Not everyone who snores has OSA, but the link between the two is well documented, and research showing the strong association between snoring and cardiovascular problems continues to come out. The good news is treating OSA is pretty simple these days thanks to the Continuous Positive Airway Pressure machine, or CPAP.

This nifty device, which forces the airway to stay open so breathing is possible, is the best we have right now for treating sleep apnea. Sleep becomes much more restful and solid; it also shuts up the snoring that frequently accompanies that apnea. People who sleep with a snorer often rejoice, as data shows that sleeping with a snorer can steal about 1 hour of sleep. CPAP has others ways of saving lives; check out my previous post here.

Is there a way to nix the OSA and the snoring altogether? Yes, but the cure isn't necessarily the easiest to achieve. Of all the risk factors for OSA, weight and physical activity factor heavily in that risk. People who have thick necks are more likely to experience OSA due to the extra fat they have at the back of their throats, which can be an underlying cause to the blocked airway. Studies also have shown that OSA wanes among people who begin exercise programs, regardless of weight loss. Losing weight and boosting exercise both require lifestyle shifts that aren't always easy. The benefits are huge, though, and extend beyond the issue of OSA and snoring. Many people do not know it, but being sleep deprived, like having undiagnosed apnea, can prevent you from losing weight; it's a vicious cycle, as described in my previous blog post on weight loss and sleep loss.

The bottom line is clear: preventing OSA is largely about maintaining a healthier, more active lifestyle. If you do suffer from OSA, treating it with a CPAP will help support sound sleep, which can then foster a healthier, more efficient body. And a more efficient body will shed those extra pounds more easily, as well as energize you in ways you never thought possible before.

I've always said that the bedroom should be saved for sleep and sex only. The time has come to put snoring in its place. It's not a harmless habit. It's a health hazard, and a wake up call to action.

Sweet Dreams,

Michael J. Breus, PhD, FAASM
The Sleep Doctor

This sleep article is also available on Dr. Breus's official blog, The Insomnia Blog.

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Secrets of Sound Sleepers

2009-04-23T13:31:00.008-04:00

Just because I'm a sleep doc doesn't mean I only encounter insomniacs and narcoleptics. Much to the contrary, I meet sound sleepers all the time and love engaging them in conversation. Have they always been good sleepers? What's their "secret"?

Well, sorry, but there isn't just one secret. But a pattern emerges when you begin to collect such words of wisdom:

I set clear boundaries, like never working past 7 pm and I don't bring work to bed with me.
I read to my kids and it helps me wind down.
I don't have a television or computer in my room.
I drink a warm cup of tea about an hour before bedtime.
I practice some deep breathing once I tuck myself in.
I have the coziest bed in the world!
I don't see midnight anymore. I'm pretty good about bedtimes.
I avoid coffee in the afternoons and switch to tea if I need a boost.
If we eat late, I make my husband do the dishes and clean the kitchen so I can relax.
Sex. We do it just before bed and I drift off quite easily.
As long as I exercise, I sleep great.

And my personal favorites:

I love sleep! I don't fear it like some people. It's my micro-vacation every day.
What do you mean? I work so hard all day long that there's nothing left in me BUT sleep by the time I crawl into bed!

Do you see the pattern?

They all practice good sleep hygiene (maybe not the person in the last comment, thought there's something to be said for physically tiring yourself out during the day and having no problem transitioning at bedtime).

Every one of these secrets is based on preparing for bed throughout the day, and having a positive mindset toward sleep. The person with the coziest bed probably invested in a great mattress and doesn't take her bedroom's setting for granted.

Okay, so you want just one thing to do differently this week and see if it has an impact on your sleep?

How about this: Avoid the Internet within 30 minutes of bedtime.

It should come as no surprise that staring at a computer screen and enthusiastically typing or surfing not only can steal precious time you should be banking in deep sleep, but the actual light emanating from the screen can also disrupt your body's ability to prepare for sleep and literally wind down.

Your taxes should already be done. Finito. So you don't need to be scrambling for last-minute tips. Quit hopping online just to check one more thing, news brief, e-mail, or blog (ahem, okay, except maybe this one).

See how many of the above statements you can make in the coming weeks. It's more about choosing restful sleep than expecting it.

Got some secrets of your own? Send them to me.

Sweet Dreams,

Michael J. Breus, PhD, FAASM
The Sleep Doctor

This article of sleep tips is also available at Dr. Breus's official blog, The Insomnia Blog.

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Melatonin: Miracle or Mistake?

2009-04-20T22:00:00.000-04:00

In this day and age, when sleep rhythms can go haywire at the drop of bad news, questions about sleep aids are a hot topic. They are no longer confined to those who are presumed to have oddball sleep cycles, such as jet setters and shift workers.

I get a lot of questions about melatonin in particular, since many supplement companies and health food stores will tout that melatonin is a "natural" sleeping aid. Given the availability of this supplement today, you'd presume it's safe and effective. But is it really?

What's better, taking a melatonin supplement to help you go to sleep on a crazed Monday night or going for a "PM" version of a pain reliever? Melatonin is a hormone your body produces to help it regulate your sleep-wake cycles, but taking additional melatonin in the form of a supplement isn't as good of an idea as you might think.

And it's not a regulated drug under the FDA.

No other hormone is available in the United States without a prescription.

In Europe, melatonin is only available by prescription.

So here's the 411 on how natural melatonin-the kind produced by your body-works. When the sun sets and darkness sweeps over, a pea-sized structure located deep between the hemispheres of your brain called the pineal gland begins to secrete this hormone-preparing you for bed.

As melatonin levels in the blood rise, you begin to feel less alert and sleep becomes more inviting. Melatonin levels stay elevated for about 12 hours, falling back to low daytime levels by about 9 a.m. Daytime levels of melatonin are barely detectable.

The precise mechanism of melatonin secretion is not well-known. We do know, however, that melatonin isn't just about sleep-wake cycles. It's been shown to:

Help regulate the female reproductive cycle and may also control the onset of puberty.

Children who take melatonin can suffer a delay in sexual development. (So never ever give a child a melatonin supplement.)

Studies have pointed to melatonin's role in regulating blood flow, specifically in constricting coronary arteries.

It's been suggested that it can increase depression in people prone to the illness.

A hormone with all of these possible effects - even though it's "natural" - isn't something you should be taking without the specific recommendation of your doctor.

Most commercial products are offered at dosages that cause melatonin levels in the blood to rise to much higher levels than are naturally produced in the body. So taking a typical dose (1 to 3 mg) may elevate your blood melatonin levels to 1 to 20 times its normal state. If you take it at the wrong time of day, you may reset your biological clock in an undesirable direction.

How much to take, when to take it, and melatonin's effectiveness, if any, for particular sleep disorders is only beginning to be understood. Remember melatonin is a sleep regulator not a sleep inducer, so it really should not be used as a sleeping pill. In the future, we may find several useful applications of melatonin.

You're better off regulating your own sleep-wake cycles in a genuinely natural way by:

exposing yourself to light during the day (preferably sunlight),

engaging in physical activity regularly,

practicing good sleep hygiene.

Remember: Your body will reset its own internal clock with the proper exposure to light at the right time. (And you shouldn't need a PM formula, either, unless you truly do need an occasional fix for quelling muscle aches or other pains that can prevent you from going to sleep easily. Just don't make this a habit every night.)

Bottom line: better sleep hygiene, better time going to sleep. And better moods the next day. Melatonin, on its own, is not a sleeping pill.

Sweet Dreams,

Michael J. Breus, PhD, FAASM
The Sleep Doctor

This sleep article is also available at Dr. Breus's official blog, The Insomnia Blog.

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Foods for Sweet Dreams

2009-04-14T14:04:00.002-04:00

Pop Quiz: Which is the better bedtime snack - an oatmeal raisin cookie with milk or another serving of the pasta with meat sauce you ate at dinner?

Answer: Go for the cookie and milk.

It's common knowledge that caffeine and alcohol can ruin a good night's sleep if consumed too close to bedtime. But what about foods? Which ones will keep you up and which ones will work in sync with your dreams of sleep?

Everything you put into your mouth within the hours of bedtime can have an impact, a fact I've talked about numerous times. Even water that you drink can disrupt your sleep, which is why I advocate avoiding all liquids within 90 minutes of bedtime (with the exception of herbal tea during your prep time to calm you down and get you ready for sleep). Ninety minutes is about how long it takes for your body to process liquids.

Dinner needs to incorporate some protein but be on the complex carbohydrate track. Studies have shown that meals high on the glycemic index are ideal since carbohydrate intake may help induce sleep. This is when the timing of the meal is most important. It's best to schedule your dinner about four hours prior to your self-prescribed bedtime.

Why? This gives you plenty of time to metabolize whatever you've eaten that day. Meals that are high in carbohydrates and low-to-medium in protein will help you relax in the evening and set you up for a good night's sleep. Here are some of my favorite sleep-friendly meals:

pasta with Parmesan cheese (you may want to avoid red, tomato-based sauces since the high acidity can increase the likelihood for reflux)

scrambled eggs and cheese

tofu stir-fry with brown rice

hummus with whole wheat pita bread (as a side to any lean protein dish)

seafood, pasta, and cottage cheese

meats and poultry with veggies (especially broccoli, spinach, and artichokes)

tuna salad sandwich

chili with beans, not spicy, and with a sweet potato

sesame seeds (rich in tryptophan - for regulating sleep) sprinkled on salad with tuna chunks, and whole wheat crackers

You may need to sneak in a snack closer to bedtime (about an hour prior), however, if you experience hunger pangs at night. That snack should be from the complex carbohydrate category, like a piece of whole grain toast with a thin spread of natural peanut butter or slice of cheese on top.

The best bedtime snack is one that has both complex carbohydrates and a little protein, plus some calcium. Calcium helps the brain use the tryptophan to manufacture melatonin. This explains why dairy products, which contain both tryptophan and calcium, are one of the top sleep-inducing foods. And by combining carbohydrate together with a small amount of protein, your brain produces serotonin, which is known as the "calming hormone."

The oatmeal raisin cookie and milk beats the pasta for this reason. The pasta can be too heavy and, if spicy or garlicky, can present further problems once you lie down and suddenly feel bloated and acid reflux coming on. Similarly, eating too much protein without accompanying carbohydrates may keep you awake, since protein-rich foods contain the amino acid tyrosine, which perks up the brain.

The trick to eating the ideal bedtime snack is to stick with foods that are high in carbohydrates and calcium, and medium-to-low in protein... BUT avoid heavy carbs that you're bound to overdo, like pastas and rices. Watch your portions before bedtime. Some examples:

small slice of apple pie and 1 scoop of ice cream (my favorite)

whole-grain cereal with skim milk (steer clear of the high-sugar cereals)

hazelnuts and tofu

oatmeal raisin cookie and a glass of milk

peanut butter sandwich, ground sesame seeds

fruit and sour cream or cottage cheese

whole grain toast topped with 1 small slice of low-fat cheese

whole wheat crackers topped with mild cheese

a banana with 1 teaspoon of peanut butter

Bedtime snacks should be consumed about an hour before your actual bedtime, and should be within 200 calories - not more. It takes about an hour for the tryptophan in the foods to reach your brain, so don't wait until right before you hop into bed to have your snack.

Warning: If you are lactose intolerant you should use lactose-free products.

Sweet Dreams,

Michael Breus, PhD
The Sleep Doctor

This sleep article is also available at Dr. Breus's official blog, The Insomnia Blog.

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Teens and Troubled Sleep

2009-04-08T08:00:00.006-04:00

Photo Credit: Chuck Patch

Any parent of a teenager knows that teens don't keep regular bedtime hours, and it can be a chore to rouse them out of bed in the morning. Why is this the case? Does a preteen need as much sleep as a 15-year-old? Or more? What are the rules of disengagement from the world when it comes to adolescents?

First, let's get one thing straight: Despite the fact sleep is required for life - regardless of age - it's seen as a luxury among many today because it competes with our highly plugged-in society. We live in a virtual world now that steals our attention 24/7. We can, if we choose, work and communicate in the middle of the night through texting, emailing, and blogging to the universe (and that includes kids old enough to engage in such activities). Just a few years ago that wasn't possible. It has changed most everything, including bedtimes.

Shifts in Rhythms, Changes in Bedtimes
What hasn't changed, however, is a human's need to sleep based on a circadian rhythm. Everyone's body clock or circadian "pacemaker" ticks at a different rate, but as you age your pacemaker will speed up or slow down, thus altering how your body responds to that 24-hour cycle. Teenagers typically don't go to bed much before 11 at night (no matter how much you try) due to their rhythm. From the age of about 15 to 25, that pacemaker slows down so a 17-year-old's body usually won't want to go to sleep early or get up early. Sometime during our late 20s the body clock speeds back up again so it matches the 24-hour day.

That said, it helps to realize that problems with sleep actually can start long before a kid turns 13. School-aged children - kids between 5 and 12 years - need 10 to 11 hours of sleep, which doesn't happen in many families. Trouble can set in as school gets more demanding, and life gets busier with sports and other extracurricular and social activities. Kids at this age also become more interested in the very things that steal sleep from adults, such as the television, cell phones, computers (including the Internet), and yes...caffeine products. For example, playing on the computer or watching TV close to bedtime has been associated with bedtime resistance, difficulty falling asleep, anxiety around sleep, and sleeping fewer hours.

What's more, poor sleep can lead to mood swings, behavioral problems like hyperactivity, and cognitive problems that affect their ability to learn in school. This can then continue into a kid's teenage years, when school gets even more demanding and social activities entice an adolescent to choose wakefulness over sleep.

Even though a teenager's biological sleep patterns shift toward later times for both sleeping and waking, they still need about 9 1/4 hours of sleep each night to function best (for some, 8 1/2 hours is sufficient), which doesn't typically jibe with the morning school bell. For this reason, most teens frequently don't get enough sleep and they can struggle with staying awake during classes.

Cutting into a teenager's sleep hygiene is the irregular sleep pattern they keep throughout the week. Very few teens maintain the same exact schedule seven days a week. They prefer to stay up late and sleep in late on the weekends, which can affect their biological clocks and hurt the quality of their sleep during the school week. Teens can also suffer from treatable sleep disorders, such as restless legs syndrome or sleep apnea.

Multiple sleep studies have been done in recent years to look at teen sleep, some of which have revealed surprising findings. A recent study, for example, indicates that the prevalence of insomnia among adolescents is high - and is associated with future physical and psychological problems. That's not something any parent wants to hear. Getting through adolescence is tough enough. What's more, most people don't realize (or appreciate) the fact that its pervasiveness is comparable to that of other major psychiatric disorders such as mood, anxiety, disruptive, and substance use disorders.

A study like this is a call to action. A teen's bout with insomnia may have more serious consequences in the long term as they continue to mature and grow. The brain, for example, does not finish its complete development until one's early to mid twenties. So if a person has insomnia for years through those critical phases of one's physical and psychological development, what does that mean for one's future health?

A lot.

Sleep and health go hand in hand at every age, from young to old. With so many opportunities to engage in wakefulness today, my hope is that people pay more serious attention to their sleep patterns if they don't feel their absolute best day in and day out. This goes for adults and parents of kids who clearly aren't functioning at their best. Bedtimes are important- and not just for kids. As parents, we need to set examples and be open with our kids about the value of sleep. To that end, here are a few pointers:

Make sufficient sleep a family priority. It's important for the health of all family members.

Help your adolescent child try to establish regular bedtime routines, creating a quiet and comfortable bedroom. Televisions and computers need to be out of the bedroom and caffeine should not be part of a child's diet. Help your kids prepare for bed by making sure they disengage from stimulating activities at least 30 minutes prior to bedtime. Reading, for example, is much more relaxing and sleep-inducing than emailing or talking on the cell phone.

Learn to recognize sleep problems. The most common sleep problems in children include difficulty falling asleep, nighttime awakenings, snoring, stalling and resisting going to bed, having trouble breathing, and loud or heavy breathing while sleeping. These sleep problems can be evident in daytime behavior such as being overtired, sleepy or cranky.

Talk to your child's doctor about sleep - even if your doctor doesn't breach the topic.

The better we help growing, maturing kids learn to balance their disengagement from the world and their wakeful engagements with the world, the better we can, in fact, help them participate in life to the fullest.

Good Night.

Sweet Dreams,

Michael Breus, PhD
The Sleep Doctor

Related Topics:

Why Little Kids Need Big Sleep

2009-04-06T06:00:00.001-04:00

Photo Credit: Gareth Saunders

If sleep weren't such a necessity during those tender years, then you wouldn't see babies snoozing most of the day, and you wouldn't have your toddler take afternoon naps so there's a semblance of sanity in the home. We all need sleep as much as we need water and food, but how much is enough? What's the difference between the needs of a baby and that of a toddler or nine-year-old? What are the rules of disengagement from the world when it comes to children under 10?

Shifts in Rhythms, Changes in Bedtimes
One of the most profound changes that occurs in a developing human is the shift in biological rhythms. Everyone's body clock or circadian "pacemaker" ticks at a different rate, but as you age your pacemaker will speed up or slow down, thus altering how your body responds to that 24-hour cycle. Babies don't get a rhythm going until about 6 months of age, at which point they establish a rhythm that matches closely with the 24-hour day. This is explains why newborns maintain irregular sleep schedules. But even once they establish a rhythm and have a regular sleep-wake cycle, sleep remains the dominant theme here as they develop and grow. Sleeping a total of 10.5 to 18 hours around the clock with periods of one to three hours of wakefulness, a newborn's cycle is primarily based on the need to be fed, changed, and nurtured. A lot is going on developmentally and at the cellular level, for which sleep is the ideal environment.

By six months of age, many infants don't need to be fed during the night; 70 to 80 percent will sleep through the night by nine months of age. Infants typically sleep 9 to 12 hours a night and take 30 minute to two-hour naps, one to four times daily. Naps become fewer as they reach their first birthday.

By the age of two, most children have spent more time asleep than awake. A child will spend about 40 percent of his or her childhood asleep. Why? Because it's critical for their development both mentally and physically.

Trouble Beings During Toddler and Preschool Years
Virtually everyone has witnessed the tantrums of toddlerhood. It is during this stage in life when trouble can set in to the achievement of high-quality sleep, which is why napping should be carefully planned so it doesn't occur too close to bedtime. In general, toddlers need about 12 to 14 hours of sleep in a 24-hour period. By the time they are 18 months old, toddlers nap only once a day for about one to three hours.

As many parents can attest, toddlers' rapidly growing sense of independence coupled with their expanding motor, cognitive, and social skills can make for difficult bedtimes. They may not want to go to bed when they are supposed to, and can also show signs of separation anxiety from mom and dad. Nightmares can also become a common experience, intruding on a toddler's sleep. It helps to remember that a child's imagination is also springing into action at this age, which can further complicate restful sleep. Toddlers who are unusually sleepy and cranky during the day may not be getting enough sleep.

Photo Credit: katrinket

Those between the ages of 3 and 5 typically sleep 11 to 13 hours nightly, and most don't nap after five years of age. As with toddlers, difficulty falling asleep and waking up during the night are common. With further development of their imagination, preschoolers commonly experience nightmares and a general fear of the night. Sleepwalking and sleep terrors peak during these years.

There's nothing more frustrating for a parent than a sleep-deprived child-at any age. Bedtimes are important, and not just for kids. As parents, we need to set examples and be open with our kids about the value of sleep. To that end, here are a few pointers:

Make sufficient sleep a family priority. It's important for the health of all family members.

As parents, you need to determine the amount of sleep each family member needs, especially if you have a household with mixed ages, and take steps to ensure individual needs are met.

Establish regular bedtime routines, creating a quiet and comfortable bedroom. Help your toddlers prepare for bed by making sure they disengage from stimulating activities at least 30 minutes prior to bedtime. Reading, for example, is much more relaxing and sleep-inducing than watching TV.

Learn to recognize sleep problems. The most common sleep problems in children include difficulty falling asleep, nighttime awakenings, snoring, stalling and resisting going to bed, having trouble breathing, and loud or heavy breathing while sleeping. These sleep problems can be evident in daytime behavior such as being overtired, sleepy or cranky.

Talk to your child's doctor about sleep - even if your doctor doesn't breach the topic.

Remember: little kids need big sleep. It's during these critical years that they are rapidly developing physically, socially, and psychologically. Sleep plays a huge role in this development and will continue to do so as they get older and learn new things. If they can enter their preteen and teenager years "well-rested," they will be all the more prepared and ready for whatever life brings. Which is sure to get more challenging.

Sweet Dreams,

Michael Breus, PhD
The Sleep Doctor

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Spring Sleep Makeover!

2009-04-05T13:04:00.011-04:00

In some parts of the country, winter is still holding down the fort. But for many of us, spring is really right around the corner and soon we'll be embracing the outdoors and welcoming warmer weather. Where I live in Arizona, it is time to break out the flip flops!

Now is also when we start to think about cleaning house literally and figuratively. Attempts to clean out the garage or closets are met with similar attempts to clean up our diets and get ready for shorts and bathing suit season.

I've blogged numerous times about the benefits of sleep on the body, particularly its ability to stay trim and shapely. Around this time of year, those New Year's Resolutions to get more exercise and eat higher quality foods are a thing of the past. Way past. So here's a suggestion:

Stop beating yourself up on what you've failed to accomplish thus far this year, and instead, just put sleep at the top of your priorities and watch what happens!

Sleep - not exercise or diet - is the stronger common denominator to feeling and looking better. Sleep is what will restore you from the inside out. It will boost your immune system, maintain your memory (so you can remember those commitments to getting into shape), and keep certain hormones in balance, including the ones that, when they run amok, will sabotage any efforts to lose weight because you won't be able to keep your hands out of the feedbag.

Imbalanced appetite hormones, for instance, can set the stage for gorging on high-calorie sweets and unhealthy carbs. Yet getting restful sleep can help optimize your body's hormonal system (not to mention prepare your body for burning up those calories throughout your day).

I'll admit, there are a lot of new wrinkles in this year's spring cleaning. The economy has most people on edge. I have no doubts that today's intense stress levels are adversely affecting the quality and quantity of our sleep. Not only do we take our worries to bed with us, fueling insomnia, but we also delay going to bed as we tool around the Internet late at night paying bills or seeking support through others on the Web.

So if you do one thing differently this month, hoping to arrive a little more refreshed and a little less stressed come May, try a sleep makeover:

Commit to relaxing for at least 30 minutes before bedtime. No internet, no bill paying, no stimulating activities. If worries begin to creep in, write them in a journal, include a To Do list if that helps, and be done with them for the night.

Go to bed and get up at the same time 7 days a week. Make sure to get the right amount of sleep. For most of us, that's 7 or 8 hours.

Watch what you eat and drink late in the day and into the evening. Too much caffeine and/or alcohol can disrupt sleep, and so can drinking water that will have you going to the bathroom in the middle of the night.

A little spring cleaning of our sleep hygiene will allow us all to spring forward...and achieve the kind of vibrant health we all dream about year round. For more tips and ideas, see my blog.

Sweet Dreams,

Michael Breus, PhD
The Sleep Doctor

This sleep article is also available at Dr. Breus's blog, The Insomnia Blog.

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What's in a Dream?

2009-03-16T15:04:00.005-04:00

Apparently, a lot. An intriguing article posted online summarizes studies exploring how much people value - and heed - their dreams. In short, most of us put a lot of significance on our dreams and believe they speak the truth to us.

What do you think? Ask yourself...

Let's say you're about to embark on a plane trip and the night before you take off, you have a vivid dream that has you in a terrible plane crash. You wake up the next morning to learn that security has been "heightened" at airports. Which bothers you more: the heightened terror alert or the dream (ahem, nightmare) of you crashing to earth from thousands of feet in the sky?

If you're like most people who answered a similar question, the dream bothered you mightily and now you don't want to walk onto that plane. The anxiety you feel is chiefly from the dream, as if it were a warning.

Dreams are indeed wondrous events (minus the occasional nightmare), and we don't have a full understanding of them yet. Most of us remember our dreams on a regular basis, especially during times of acute stress or psychological mayhem. There's been a surge in the study of dreams lately, fueled by an increased interest in understanding them as meaningful representations of our deepest concerns and emotions.

So when do dreams happen, and why do they seem to be tied to our feelings?

I get these questions a lot, and I start by explaining that the most memorable and emotionally powerful dreams happen during the REM (rapid-eye movement) phase of sleep, which is the stage of sleep when our brains are most similar to a wakeful state.

It is during REM that the hippocampus and amygdala, two organs in our heads responsible for memory and emotions respectively, and areas in the frontal and prefrontal lobes near the forehead responsible for attention and coordination, work together in dream production.

If, for example, you have a fear of flying and it's literally on your mind, you're more likely to produce an associated image of that fear, which then emerges during REM as those emotionally-charged areas of the brain become activated.

Exceptionally vivid and memorable dreams occur just before we wake up, but it's possible that we've been dreaming similar themes all night long during the four or five phases of REM that we go through. So even though we recall just what we dreamed about in the last cycle, it could be reflective of the night's cumulative dream content. Like a single television show with one theme interrupted by unrelated commercials, which are the other phases of sleep where we don't dream.

I've heard all kinds of stories from people who claim they work out their emotions in their sleep, or how they've come to rely on dreams as an important "survival strategy." Indeed, I think dreams do serve a role in our survival - otherwise, what would be the point?

This doesn't mean that I believe dreams are to help us avoid plane crashes or catastrophic events. But, I think there's something to be said for taking dreams seriously once in a while when they do touch us in a deeply mysterious way. They are, after all, part of what make us human.

What I'd like to know is whether other animals dream, too. Or is this just a human experience? Ever asked a rat or reptile what he dreamed about last night? Science has yet to find a way to capture the dreams of animals. Maybe that's best left to Mother Nature.

Same goes for future events, however good or bad.

Sweet Dreams,

Michael Breus, PhD
The Sleep Doctor

This article on sleep and dreaming is also available at Dr. Breus' official blog, The Insomnia Blog.

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Headaches and Insomnia Going Hand in Hand

2009-03-06T16:24:00.001-05:00

Headaches come with the territory these days. Any look at the news can give you one of the most common types around: the tension-type. But if you suffer from chronic tension headaches and resort to sleeping them off, you may want to listen up: a new study out of Rush University just emerged showing a behavioral link between these kinds of headaches and insomnia.

In other words, you could be worsening your headaches-and the quality of your sleep - by snoozing them off.

It's no surprise that one of the ways to treat a headache is to lie down and take a nap (assuming, of course, you have the luxury of napping in the middle of your day). But napping can also conflict with your nighttime sleep if it's not planned carefully. It also appears to incite a vicious cycle: 59 percent of those in the study with tension-type headaches complained of sleep problems as a trigger of those headaches.

It's the classic catch-22. Sleep to dull headache. Sleep to trigger headache.

Not fair? Well, there are some solutions to consider.

The first is treating the headache with other means, such as drugs like aspirin or ibuprofen. A little bit of caffeine can help, too (which can be found in headache meds like Excedrin). But the secret is to be mindful of your nighttime sleep schedule and avoid things that can disrupt your normal bedtime.

I've always advocated avoiding naps after 3:00 pm, and the same goes for caffeine, including those caffeine-rich headache medicines.

So what do you do if your head begins to pound in the late afternoon?

The late-day headache can be a monster. Sometimes they are simply the result of:

staring too long at the computer

losing all sense of good posture and straining your neck, upper back, and shoulders

forgetting to have a snack when your blood-sugar dives

not realizing you haven't had anything to drink in hours

letting the tensions of the day pile up in your head-literally.

For late-day headaches, why don't you try:

Take a 15 minute break from whatever you were doing. Go outside, breathe in some fresh air, and get your circulation going at a faster clip. You'd be amazed by what a little circulation can do.

Have a light snack and drink plenty of water.

Consider a brisk walk.

If you can work the headache out without resorting to pills, naps, or caffeine late in the day, you'll be able to sleep better at night and welcome a better-headache-free-day the next.

Nothing is more frustrating than a headache that won't go away... or chronic insomnia that has you perpetually on edge. The good news is acknowledging the link between the two can kill these two annoying beasts with one stone.

Sweet Dreams,

The Sleep Doctor
Michael Breus, PhD

This article by The Sleep Doctor is also available at Dr. Breus's official blog, The Insomnia Blog.

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Make Money in Your Sleep

2009-03-03T12:52:00.003-05:00

Now this is pretty funny. Depending on how you look at it.

Earlier this month Steve Martin appeared on David Letterman talking about his experience with a sleep aid (you can go here to view the actual clip). An avid online poker fan, Mr. Martin found himself playing late one night, going to sleep after taking a sleep aid, and then waking the next morning to find new winnings in his online poker account. He'd gone to bed with $500 in his account and discovered that the same account was worth $1,500 the next day.

He thought there had been a glitch in the system. He thought there had been a mistake. But no, there wasn't a glitch or a mistake. When Mr. Martin called to check with the people behind the online poker game, he was told that he'd in fact won that extra $1,000 while playing between 4 am and 5 am.

Needless to say, Mr. Martin had no recollection of getting up, getting online, and playing poker in the middle of his sleep. The experienced freaked him out enough that he stopped using the sleep aid.

Is this the norm?

Far from it. Sleep aids are some of the most widely prescribed medications in America, and it's rare to have such a bizarre reaction to these drugs. Reports have emerged about strange side-effects like sleepwalking, sleep talking, driving, eating, and performing tasks while supposedly in your sleep. But again, these side-effects are extremely rare.

It's not known whether Steve Martin's mid-sleep poker playing (and win) was related to his taking a sleep aid. But his experience marks the first time someone has come out and blamed a sleep aid on winning money from playing poker during sleep.

This gives new meaning to "making money in your sleep," doesn't it? Good thing he posted winnings that night. What if he'd gone online and unknowingly blown away thousands of dollars? He'd probably call his lawyer.

Sweet Dreams,

The Sleep Doctor
Michael J. Breus, PhD

This article by The Sleep Doctor is also available at Dr. Breus's official blog, The Insomnia Blog.

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Good News for Coffee Drinkers

2009-02-26T09:00:00.010-05:00

Photo Credit: Colin and Sarah

I frequently get asked if I think drinking coffee is like sleeping with the devil. People are surprised when I tell them no, and that coffee can be a healthy part of life - it doesn't have to mess with your sleep. There are a multitude of benefits that accompany coffee drinking, and now we have one more reason to add to the list: it can cut the risk of stroke in women.

The new study just published shows that four or more cups of coffee a day reduced the risk of stroke by 20 percent in women. (Sorry, but men were not analyzed; this study came from a 24-year examination of nurses with no history of stroke, heart disease, diabetes, or cancer, starting in 1980. My guess is they'd find similar results in men. The risk of stroke is higher in women, however.)

The best news came for those who don't smoke. Among those who either quit or never smoked at all, the risk was reduced by 43 percent. That's incredibly telling. Another blow to smoking. Another reason to kick that habit. But keep drinking your coffee.

So, how do you get your coffee fill without losing sleep over it? Four cups might seem like a lot, but not if you're drinking a regular brew. Some coffees contain more caffeine than others (a cup from Starbucks is like high-octane gas versus the regular stuff you make at home).

The secret is to avoid drinking coffee after 2 PM. It's a challenge if you're used to getting a pick-me-up when those late-afternoon slumps kick in. This is when switching to a less caffeinated beverage like green tea is ideal. Or sneak a 20-minute nap before 3 PM, then have a cup of tea. Just be sure to avoid all sources of caffeine after 3.

Interestingly, the benefits of drinking coffee seem to be limited to coffee. It's not the caffeine that's lowering the risk for stroke. There's something in the components of coffee itself.

That means don't start doubling up on your soda intake. No free passes on that, no matter how much you love a cold can of Coke or Pepsi. I know plenty of people who are addicted to soda and wonder why they don't sleep well at night when they drank it too close to bedtime. Caffeine and sugar make for a powerful "insomnia" punch. If you need the fizz, try sparkling water. You'll probably lose weight, too, as you gain better sleep and nix excess calories. A sure-fire way to reduce your risk for all sorts of health problems.

Sweet Dreams,

The Sleep Doctor
Michael J. Breus, PhD

This article on sleep is also available at Dr. Breus's official blog, The Insomnia Blog.

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Getting Paid to Sleep... in Public

2009-02-11T13:19:00.003-05:00

Now this is downright bizarre. Imagine being on display in a museum. Correction: Imagine getting paid to sleep for an exhibit...and be on display.

That's what the New Museum of Contemporary Art (hey, you knew it'd have to be contemporary) in Manhattan is offering. This past week the museum sought women ages 18 to 40 to participate in a new exhibit that would have them taking sleeping pills so they can be in bed between noon and 6 p.m. daily for the artist Chu Yun. (Yes, the sleeping pills are doctor-prescribed.)

I wouldn't bother trying to be one of these women at this point. I hear the museum has been inundated with volunteers. Talk about the perfect job for someone who recently got laid off or is so depressed about the state of affairs in the world that she only enjoys the blissfulness of sleep.

I'll admit, I'm not quite sure what the real meaning of seeing a woman sleeping soundly in real life is all about. The exhibit is called "The Generational: Younger Than Jesus" and will feature an installation by the artist, who "creates a human sculpture by inducing sleep."

What happens when these women move during sleep or worse, have weird dreams that have them talking or moaning in their sleep? Can they ruin the exhibit? According to the details I read, the title of the work changes according to the participant's name, from "This is Kate" to "This is Jenny", and so forth. This isn't a first for this exhibit; it was first seen at Frieze Art Fair in London, where the piece featured a different participant each day. Chu Yun's work has been exhibited throughout China and Europe.

I always wished I could camp out in a museum. I think all of us have dreams of sleeping in a forbidden place like that. Nap next to creations of great artists. But to be on display? I guess there's that other dream of pretending to be a mannequin in a store-front window display. But seriously. Sleep in front of the public like that?

Assuming you're truly sound asleep, you wouldn't be able to see what's going on, or hear what people are saying. And what if you start drooling...or an old flame shows up to see the exhibit... or a piece of your clothing comes loose (which brings up another question: what are these women wearing to bed?)

Okay, so that's being a little pessimistic. It's a fun bit of news this week, and it probably is a fascinating exhibit. Oh, and did I mention how much they pay? $10 an hour. That's more than what you get working a hard, laborious shift at a fast food joint.

Please, if any of you go see this exhibit, write to me and tell me what you think.

This article on sleep is also available at Dr. Breus' official blog, The Insomnia Blog.

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