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Behavioral Science, Public Health, Sleep

Six simple ways to improve your sleep for the holidays

Six simple ways to improve your sleep for the holidays

IMG_5595The holiday season is usually one of the busiest – and often most stressful – times of the year. It’s also a season that often brings poor sleep. To improve your health and your mood, consider six simple ways that you can maintain healthy sleep during the hustle and bustle of the holidays and even discover the resolve to improve your sleep in 2015.

1. Go to bed when you’re sleepy.

It seems obvious, but it isn’t always easy to do: Sleep most easily comes when we are feeling sleepy. Insomnia, characterized by difficulty falling or staying asleep, can plague us throughout the year. With the added stress of the holidays, it can be even harder to fall asleep.

Many insomniacs will start to go to bed earlier, or stay in bed long after waking, to make up for lost sleep. This desperation often thins out sleep and makes it less refreshing. Imagine showing up for a holiday feast after having snacked all day. You wouldn’t have much of an appetite. If you spend too much time in bed, or take naps, you similarly will show up for the eight-hour feast of sleep without much interest.

Prolonged wakefulness helps to build our drive for sleep and staying up a little later until you feel sleepy can ease insomnia.Preserving 30 to 60 minutes to relax before bed can also aid this transition.

2. Ease yourself into a new time zone to prevent jet lag.

If you’re flying across the world, or even across the country, you may find that your sleep suffers. This is due to our body’s natural circadian rhythm, which regulates the timing or our desire for sleep. This rhythm is based in genetics, but it is strongly influenced by environmental cues, especially morning sunlight exposure.

If you suddenly change your experience of the timing of light and darkness by hopping on a jet plane, your body will have to play catch up. As a general rule: “West is best and east is a beast.” This points out that westward travel is more tolerated because it’s nearly always easier to stay up later than it is to wake up earlier.

Another rule of thumb is that it takes one day to adjust for each time zone changed. If you travel across three time zones, from San Francisco to New York City, it will take about three days to adjust to the new time zone. This adaptation can be expedited by adopting the new time zone’s bedtime and wake time before you depart. If you’re like most people, your best intentions might not lead to pre-trip changes.

Never fear: To catch up once you arrive, delay your bedtime until you are sleepy, fix your wake time with an alarm, and get 15 minutes of morning sunlight upon awakening.

3. Put an end to the snoring.

Whether you’re staying in grandma’s spare room or sharing a hotel suite, close quarters during the holidays may call attention to previously unnoted snoring and other sleep-disordered breathing like sleep apnea.

Remember that children should never chronically snore; if they do, they should be seen by a sleep specialist. Adults don’t have to snore either. Snoring is commonly caused by the vibration of the soft tissues of the throat. If the airway completely collapses in sleep, this is called sleep apnea. This may lead to fragmented sleep with nocturnal awakenings and daytime sleepiness. It is also commonly associated with teeth grinding and getting up to urinate at night.

When sleep apnea is moderate to severe, it may increase the risk of other health problems including hypertension, diabetes, heart attack, stroke, and dementia. It’s more than a nuisance, and if you or a loved one experience it, further evaluation and treatment is warranted.

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Research, Sleep

Holiday nightcap? Drinking before bed may be counterproductive

Holiday nightcap? Drinking before bed may be counterproductive

nightcap2

If you’ve ever taken a drink of alcohol before bed to help you fall asleep, you’re not alone – approximately 20 percent of Americans do so regularly. But new research from the University of Missouri shows that while a nightcap can make you sleepy in the short term, regular alcohol consumption before bed interferes with the body’s sleep regulator and can actually cause insomnia.

A study published last month in Alcohol helps us understand alcohol’s effects in a new way. It was previously thought that alcohol shifts the circadian rhythm, the body’s “internal clock,” resulting in simply being sleepy sooner; in fact, it disrupts the mechanism by which the brain “feels” tired. Alcohol increases the production of adenosine, a naturally occurring chemical that accumulates outside cells when you’ve been awake for a long time; it signals the need for sleep by blocking “wakefulness” receptors in the basal forebrain. Adenosine levels decrease during sleep, maintaining the brain’s sleep/wake homeostasis.

Alcohol-induced adenosine wears off too quickly, which makes for less restful sleep in the short term, and can compromise the brain’s ability to maintain homeostasis in the long term (i.e., insomnia).

I asked Stanford sleep expert Brandon Peters, MD, to weigh in and he told me:

I concur that alcohol should not be used as a sleep aid. Though alcohol may induce sleepiness, as it quickly wears off it fragments sleep, leading to awakenings. Alcohol also can relax the muscles of the upper airway and contribute to obstructive sleep apnea and snoring. It is recommended that alcohol not be consumed for the several hours preceding bedtime.

What to do instead? Peters suggests:

Rather than relying on an alcohol-containing nightcap, insomnia can be improved with changes as part of a structured cognitive-behavioral therapy for insomnia (CBTI) program. Sleeping pills are also not a preferred option; you don’t need medication to feel hungry, so why would you need medication to feel sleepy? Sleep is a natural process that can be enhanced with simple interventions. If difficulty falling or staying asleep persists beyond 3 months, assistance should be sought from a board-certified sleep specialist.

Photo by Stephen Janofsky

Fertility, Men's Health, Research, Sleep

Sleep apnea linked with male infertility

Sleep apnea linked with male infertility

14258396551_0d3b8edb81_zOver the past two decades, there have been a number of studies suggesting that men’s sperm counts have been steadily declining. Now research out of Spain and published in the journal Sleep suggests a connection between sleep apnea and decreased sperm production.

Michael Eisenberg, MD, a Stanford expert in male fertility, thinks the results are important but inconclusive. When reached for comment he told me:

My research focuses on the links between a man’s overall health and his reproductive health, so this study has a lot of connections. I think it shows another health factor that can impact fertility; we are seeing sleep apnea more and more commonly, and here’s something showing a link with decreased sperm production. A big drawback of the study is that before we can incorporate it in clinical practice the research needs to be replicated in humans.

The research, conducted collaboratively by research institutions in Spain, induced intermittent hypoxia (lack of oxygen) in male mice to mimic sleep apnea. These mice, along with a control group who had been experiencing normal oxygen levels, were mated, and researchers compared the numbers of pregnant females and fetuses, which were significantly lower for the hypoxic group.

Previously: Male infertility can be warning of hypertension, Stanford study finds, Poor semen quality linked to heightened mortality rate in men and Low sperm count can mean increased cancer risk
Photo by Kelsey

Neuroscience, Research, Sleep, Stanford News, Technology

Cheating jet lag: Stanford researchers develop method to treat sleep disturbances

Cheating jet lag: Stanford researchers develop method to treat sleep disturbances

jets landing in sunset - 560

Last month, I went to a conference back East. It was a short trip, four days, and I was jet lagged the whole time. I spent my mornings gulping down hot coffee to help shake off the sleepy haze; in the evenings, when I should have been making up the lost sleep, I was wired, tossing and turning in bed. I could have tried adjusting to East Coast time in the days before I left by getting to bed a few hours earlier and getting up around 4 AM, but that would have required a level of coordination and planning that I’m unlikely to muster in the days before an out-of-town trip.

So I was curious when I learned that a team of Stanford researchers, led by neurobiologist Jamie Zeitzer, PhD, were working on a technique that helps people shift their sleep cycles by flashing light briefly at their eyes while they sleep. They recently published their findings in the Journal of Biological Rhythms.

Beyond the obvious job of vision, our eyes and brain are constantly processing information about the light around us. Light affects our moods and the daily ebb and flow of our biological clocks. It influences when we are sleepiest and most alert. Our brains do a lot of this work behind the scenes and because it happens unconsciously, we are rarely aware of these circadian rhythms – unless something disturbs them, like flying across several time zones.

Zeitzer and his team recruited volunteers and had them get on a routine sleep-wake cycle, going to bed and waking up at the same time every day for about two weeks. The researchers then had the volunteers come sleep in the lab, where the experimental group was given a series brief flashes of light about two millisconds long – about as long as a camera flash – aimed at their eyes. A control group slept in complete darkness, and the volunteers didn’t know which group they were assigned to. The team then measured whether the subjects’ sleep cycle had been affected by measuring the amount of melatonin in their blood. The brain floods the body with melatonin a couple of hours before bedtime and continues releasing the hormone until about an hour after wake time.

The researchers found that the volunteers who got the light flashes were able to shift the sleep phase of their circadian systems. What was surprising was that the intervention did not noticeably disturb the subjects’ sleep. The volunteers in the experimental group didn’t report any less restful sleep than the controls. “This kind of treatment can help people adjust even before they leave for a trip,” says Zeitzer. “Leaving for Australia, the night before you leave, you can adjust a couple of hours. On the plane, you can adjust a couple more. By the time you arrive, you’re already half-way adjusted.”

Besides jet-lagged travelers, this technique could also help teenagers who have a hard time getting up at the right time (a clinical condition for many that goes beyond adolescent laziness) and shift workers. Current treatments for sleep disturbances include sitting in front of bright lights for sometimes hours at a time, which often means it’s only used in extreme cases.

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Health and Fitness, In the News, Research, Sleep, Stanford News

Superathletes sleep more, says Stanford researcher

Superathletes sleep more, says Stanford researcher

alarm-clock-146469_640Hit snooze again – it just might boost your performance, Stanford sleep expert Cheri Mah believed. Seems intuitive, yet research findings were needed.

Mah originally tapped Stanford’s men’s basketball team to test her theory. When the team went from an average of 6.5 to 8.5 hours of sleep a night, they hit 11 percent more free throws and sprinted more quickly. Her work grabbed headlines at the time, and now it’s featured in Mark McClusky’s  forthcoming book, Faster, Higher, Stronger: How Sports Science is Creating a New Generation of Superathletes — and What We Can Learn from Them.

The Atlantic excerpted a key section from the book today; here’s McClusky (who also edits Wired.com):

For us humans, sleep is completely crucial to proper functioning. As we’ve all experienced, we’re simply not as adept at anything in our lives if we don’t sleep well…

It seems like certain kinds of athletic tasks are more affected by sleep deprivation. Although one-off efforts and high-intensity exercise see an impact, sustained efforts and aerobic work seem to suffer an even larger setback. Gross motor skills are relatively unaffected, while athletes in events requiring fast reaction times have a particularly hard time when they get less sleep.

McClusky goes on to write that Mah’s research “strongly suggests that most athletes would perform much better with more sleep – if they could get it.” But it’s tricky for top athletes to get enough sleep. Fly across the country, or the world, and your sleep schedule is skewered. And West Coast teams have it particularly hard:

In 2013, the Seattle Mariners flew more than 52,000 miles while the Chicago White Sox, with their central location and nearby division rivals, only flew about 23,000… Bouncing around the country, leaving late, arriving early, having to play the next day—it’s no surprise that travel and the management of sleep is a huge problem for athletes.

Some athletes squeeze in an afternoon nap to boost their rest times, McClusky said. And that sounds like a mighty fine idea to me.

Previously: Ask Stanford Med: Cheri Mah responds to questions on sleep and athletic performance, Expert argues that for athletes, “sleep could mean the difference between winning and losing,” Why your sleeping habits may be preventing you from sticking to a fitness routine and A slam dunk for sleep: Study shows benefits of slumber on athletic performance
Image by OpenClips

Neuroscience, Research, Sleep

Memory of everyday events may be compromised by sleep apnea

Memory of everyday events may be compromised by sleep apnea

sleeping_11.3.14Previous imaging studies have shown that sleep apnea, which causes periods of disrupted breathing during the night, is associated with tissue loss in regions of the brain that process memory. Now new research published in the Journal of Neuroscience offers more evidence that the sleep disorder can cause difficulty in remembering where you left your keys and other daily events.

In a small study (subscription required), people with severe sleep apnea spent two separate nights at the NYU Sleep Disorders Center. At the lab, individuals were administered a baseline examination consisting of playing a video game requiring them to navigate three-dimensional spatial mazes. During one night of the experiment, participants’ use of their continuous positive airway pressure (CPAP) machine was reduced during REM sleep allowing sleep apnea to naturally occur. On the second night, they resumed normal use of the CPAP. Individuals played the video game before and after each sleep period.

As Medical News Today reports:

When sleep was aided by therapeutic CPAP all night, researchers observed a 30 percent overnight improvement in maze completion time from their baseline examinations. However, when REM sleep was disrupted by sleep apnea, there was not only no improvement from baseline testing, but, in fact, subjects took 4 percent longer to complete the maze tests.

Equally important, when sleep apnea occurred in REM sleep, subjects did not experience delayed reaction times on a separate test to measure attention, called a psychomotor vigilance test. [Lead researcher Andrew Varga, MD, PhD,] says that this suggests that sleepiness or lack of attention were not reasons for the decline in spatial memory, as indicated by the maze performance after experiencing sleep apnea in REM sleep.

Sleep apnea affects approximately 18 million adults in the United States. While the disorder is difficult to diagnose in children because of monitoring techniques, it’s estimated that a minimum of 2 to 3 percent of kids suffer from sleep apnea and some believe it could be as high as 10 to 20 percent, according to data from the National Sleep Foundation.

Previously: “Sleep drunkenness” more prevalent than previously thought, Study shows women with gestational diabetes at increased risk for obstructive sleep apnea, Why untreated sleep apnea may cause more harm to your health than feeling fatigued and How effective are surgical options for sleep apnea?
Photo by Jared Polin

Neuroscience, Research, Sleep, Videos

How sleep acts as a cleaning system for the brain

How sleep acts as a cleaning system for the brain

Here’s one more reason why getting a good night’s sleep is critical to your health. As neuroscientist Jeff Iliff, PhD, explains in this just released TEDMED video, the brain has a specialized waste-disposal system that’s only active when we’re slumbering. Watch the talk above to learn how this system clears the brain of toxic metabolic byproducts that could lead to Alzheimer’s disease and other neurological disorders.

Previously: Why sleeping in on the weekends may not be beneficial to your health, The high price of interrupted sleep on your health and Examining how sleep quality and duration affect cognitive function as we age

Research, Sleep, Stanford News

William Dement: Stanford Medicine's "Sandman"

William Dement: Stanford Medicine's "Sandman"

dement

Sixty years before he would be referred to as the “Father of Sleep Medicine,” William Dement, MD, PhD, got kicked out of a class for dozing off.  One of the world’s foremost sleep experts, Dement is profiled in the current issue of STANFORD magazine, with writer Nicholas Weiler describing how Dement blazed a trail for the field of sleep research and medicine.

From the piece:

When he arrived at Stanford, he set aside most of his research on dreams and shifted his focus to pathologies that affect sleep quality—and to the importance of optimal sleep in our daily lives. “It wasn’t until we realized there were sleep disorders,” he says, that people started paying attention to sleep research. In 1970, he founded the Stanford Sleep Disorders Clinic, a center dedicated to the diagnosis and treatment of these maladies. The clinic was soon inundated by patients complaining of extreme daytime sleepiness due not to narcolepsy or insomnia, but to a recently discovered disorder, sleep apnea, in which the patient’s airway would collapse during sleep, causing him to wake gasping for air hundreds of times each night.

Galvanized by the unexpected prevalence of undiagnosed sleep disorders, Dement spent the next decade working feverishly to raise the profile of sleep medicine as a clinical field. Before long, similar clinics were springing up all over the country, “and they were finding the same thing,” Dement says. Still, it wasn’t until 1993 that the first long-term epidemiological study found that 24 percent of men and 9 percent of women suffer from sleep apnea. Research at the Stanford Sleep Disorders Clinic and elsewhere has found strong correlations between sleep apnea and obesity, high blood pressure and heart disease, America’s leading cause of death.

Thanks to his work and the popular sleep class that he has taught since 1971 (more than 20,000 students have taken it!), Dement is well-respected and loved among his peers and students – something captured by this 2008 video.

Previously: Stanford docs discuss all things sleepCatching some Zzzs at the Stanford Sleep Medicine CenterThanks, Jerry: Honoring pioneering Stanford sleep research and Catching up on sleep science
Related: Stalking the netherworld of sleep and Dement keeps last class wide awake
Illustration, which originally appeared in STANFORD, by Gabriel Moreno

Parenting, Pediatrics, Sleep

With school bells ringing, parents should ensure their children are doing enough sleeping

With school bells ringing, parents should ensure their children are doing enough sleeping

With so many schools starting today – or having recently started – it’s a good time for a reminder of the importance of sleep among children. In a recent blog post and the video above, Seattle Mama Doc (a.k.a. Wendy Sue Swanson, MD), offers guidance on how much sleep a child needs and offers five ways that parents can support good sleep:

    • Keep to an 8pm bedtime for young children. Move bedtime back slowly (move it by 30 minutes every 3-5 days) to prime your child for success and avoid battles!
    • 10pm bedtime for children age 12 & up is age-appropriate. More info here.
    • Habits: No screens 1-2 hours prior to bed, no caffeine after school, no food right before bed.
    • Exercise or move 30-60 minutes a day to help kids sleep easier
    • No sleeping with cell phones (create a docking station in the kitchen)
    • Don’t use OTC medications (cough & cold, for example) to knock your kids out and get them to sleep. Using medications that have a side effect of drowsiness can cause sleepiness to extend into daytime which can negatively affect school and sports performance.

Previously: Study shows poor sleep habits as a teenager can “stack the deck against you for obesity later in life”Stanford expert: Students shouldn’t sacrifice sleep, TV in a child’s bedroom? “No way,” says expert and Districts pushing back bells for the sake of teens’ sleep

In the News, Public Health, Sleep

A window of time for better sleep

A window of time for better sleep

SleepThe only time I consider myself a “morning person” is when I have jet lag. But I’ve learned that if I’m in bed by 10:30 PM, I can be relatively cordial and not hit the snooze button the next morning.

Based on my own sleep patterns, it didn’t surprise me to read in a recent Time article that the time we go to bed affects the structure and quality of our sleep. As described in the piece, there’s a shift that occurs from non-REM, deep sleep, to the lighter dream-inspired REM sleep, and it happens during the night regardless of what time we go to bed. But going to bed late will deprive us of some of the deep non-REM sleep that replenishes the brain and body. Writer spoke with several sleep experts and reports:

When it comes to bedtime, [Matt Walker, PhD, head of the Sleep and Neuroimaging Lab at the University of California, Berkeley], says there’s a window of a several hours – roughly between 8 PM and 12 AM – during which your brain and body have the opportunity to get all the non-REM and REM shuteye they need to function optimally. And, believe it or not, your genetic makeup dictates whether you’re more comfortable going to bed earlier or later within that rough 8-to-midnight window, says Dr. Allison Siebern, associate director of the Insomnia & Behavioral Sleep Medicine Program at Stanford University.

“For people who are night owls, going to bed very early goes against their physiology,” Siebern explains. The same is true for “morning larks” who try to stay up late. For either type of person- as well as for the vast majority of sleepers who fall somewhere in between – the best bedtime is the hour of the evening when they feel most sleepy.

Siebern goes on to suggest trying out different bedtimes, plus making sure to wake up at roughly the same time every morning. These two factors can help maximize our natural sleep cycles and help prevent us from hitting the snooze button.

Jen Baxter is a freelance writer and photographer. After spending eight years working for Kaiser Permanente Health plan she took a self-imposed sabbatical to travel around South East Asia and become a blogger. She enjoys writing about nutrition, meditation, and mental health, and finding personal stories that inspire people to take responsibility for their own well-being. Her website and blog can be found at www.jenbaxter.com.

Previously: Stanford docs discuss all things sleep, “Sleep drunkenness” more prevalent than previously thought and Mindfulness training may ease depression and improve sleep for both caregivers and patients 
Photo By: FloodG

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