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Parenting, Sleep, Women's Health

What other cultures can teach us about managing postpartum sleep deprivation

What other cultures can teach us about managing postpartum sleep deprivation

New_mom_072114Prior to becoming a mom, I felt fully confident that caring for a newborn would be less demanding than, or at least equal to, the physically grueling trainings from my college soccer days or my sleepless year of graduate school. But I soon learned that both of these experiences paled in comparison to the exhaustion I encountered after the arrival of my 8-pound-plus bundle of joy. So I was interested to read a recent Huffington Post blog entry from the Stanford Center for Sleep Sciences and Medicine examining how mothers in other countries cope with postpartum sleep deprivation.

In the entry, Mara Cvejic, MD, a neurologist at the University of Florida and former sleep medicine fellow at Stanford, notes that although sleep deprivation can profoundly affect cognitive function and mood, the brain of a postpartum mom is actually growing. She writes:

… despite all the formidable evidence of sleep deprivation in the everyday person, the scientific evidence of what happens to the postpartum brain is positively astounding — it thrives. A study published by the National Institutes of Health in 2010 actually shows that a mother’s brain grows from just 2-4 weeks to 3-4 months post delivery without any significant learning activities. The gray matter of the parietal lobe, pre-frontal cortex, hypothalamus, substantia nigra, and amygdala all form new connections and enlarge to a small degree. The imaging study confirms what animal studies have shown in the past — that these brain regions responsible for complex emotional judgment and decision-making actually bulk up with use. Rationale to the study shows that mothers who have positive interactions with their offspring — soothing, nurturing, feeding, and caring for them — are performing a mental exercise of sorts. Their learned coping skills in the face of novel child-rearing actually muscularize their brain.

She goes on to outline how new moms from Bulgaria to Sweden, and everywhere in between, turn to “hammocks, spa treatments, hired help, warm foods, arctic cradles, and cardboard” to cope with a lack of sleep. Personally, I’m in favor of Americans adopting this Malaysian tradition:

Food and warmth are also a focus of the Malaysian confinement of pantang. Steeped in the belief that the women’s life force is her fertile womb, she undergoes a 44-day period of internment to focus on relaxation, hot stone massage, lulur (full body exfoliation), herbal baths, and hot compresses. Typically a bidan, what can only be described as a live-in midwife and nanny combined, is hired to attend on the new mother. This is sometimes a family member, such as her mother or mother-in-law.

Previously: The high price of interrupted sleep on your health, What are the consequences of sleep deprivation? and Study: Parents may not be as sleep-deprived as they think
Photo by sean dreilinger

Parenting, Public Health, Research, Sleep

The high price of interrupted sleep on your health

The high price of interrupted sleep on your health

dad_baby_nap_time

As the mother of a 10-month-old, I’m constantly answering the question: Is your son sleeping through the night? And, much to my dismay, I have to repeatedly answer, “No.” So I was interested, and considerably alarmed, to read about new findings showing that interrupted sleep could be as harmful to your physical health as a lack of sleep.

A Time article published today describes the study and the Tel Aviv University researchers’ results:

Students slept a full eight-hours one night followed by a night of interrupted sleep in which they received four phone calls directing them to complete a brief computer exercise before returning to bed. The morning after both nights, the volunteers completed tasks to measure their attention span and emotional state — results proved that just one night of interrupted sleep had negative effects on mood, attention span and cognitive ability.

[Lead researcher Avi Sadeh, PhD,] believes that several nights of fragmented sleep could have long-term negative consequences equivalent to missing out on slumber altogether. “We know that these effects accumulate and therefore the functional price new parents — who awaken three to ten times a night for months on end — pay for common infant sleep disturbance is enormous,” he said in a statement.

In addition to parents with young children, the findings are applicable to people in certain age groups that experience fragmented sleep, as well those with jobs where frequent night wakings are common.

Previously: Stanford expert: Students shouldn’t sacrifice sleep, What are the consequences of sleep deprivation? and Study: Parents may not be as sleep-deprived as they think
Photo by Christina Spicuzza

Aging, Neuroscience, Sleep, Videos

Examining how sleep quality and duration affect cognitive function as we age

Examining how sleep quality and duration affect cognitive function as we age

We all feel better, and can think more clearly, after a good night’s rest. But new research underscores the importance of sleep quality and duration during middle age to stave off cognitive decline.

The study (subscription required) examines data compiled as part of the long-term Study on global AGEing and adult health (SAGE), which is funded by a joint agreement of the National Institutes of Health and the World Health Organization. The project began in 2007 and involves more than 30,000 individuals aged 50 and older across China, Ghana, India, Mexico, the Russian Federation and South Africa.

Among the key findings is that middle-aged or older people who get six to nine hours of sleep a night think better than those sleeping fewer or more hours, and that excessive sleep is equally damaging as too little sleep. In the above video, researchers discuss how despite cultural, environmental and economical differences, study results showed strong patterns relating to gender, sleep quality and cognitive function.

Via PsychCentral
Previously: What are the consequences of sleep deprivation? and Experts discuss possible link between sleep disorder and dementia

Health and Fitness, Obesity, Sleep

Why your sleeping habits may be preventing you from sticking to a fitness routine

Why your sleeping habits may be preventing you from sticking to a fitness routine

sleep_06.03.14New research suggests that a later bedtime is associated with a person spending more time sitting during the day and being less motivated to exercise.

The study involved a group of more than a hundred healthy adults with a self-reported sleep duration of at least six and a half hours. Researchers measured sleep variables over the course of a week using wrist actigraphy along with sleep diaries. Participants completed questionnaires about their physical activity and attitudes toward exercise. According to an American Academy of Sleep Medicine release, study results showed:

…that later sleep times were associated with more self-reported minutes sitting, and sleep timing remained a significant predictor of sedentary minutes after controlling for age and sleep duration. However, people who characterized themselves as night owls reported more sitting time and more perceived barriers to exercise, including not having enough time for exercise and being unable to stick to an exercise schedule regardless of what time they actually went to bed or woke up.

“We found that even among healthy, active individuals, sleep timing and circadian preference are related to activity patterns and attitudes toward physical activity,” said principal investigator Kelly Glazer Baron, PhD, associate professor of neurology and director of the Behavioral Sleep Medicine Program at the Feinberg School of Medicine at Northwestern University in Chicago, Illinois. “Waking up late and being an evening person were related to more time spent sitting, particularly on weekends and with difficulty making time to exercise.”

In their conclusion, researchers suggested that sleep habits – particularly those of adults who are less active – be taken into consideration as part of exercise recommendations and interventions.

Previously: Expert argues that for athletes, “sleep could mean the difference between winning and losing”, Ask Stanford Med: Cheri Mah responds to questions on sleep and athletic performance, A slam dunk for sleep: Study shows benefits of slumber on athletic performance and Want to be like Mike? Take a nap on game day
Photo by Becky Wetherington

Pediatrics, Sleep

How sleep benefits those with a rare neurological disease

How sleep benefits those with a rare neurological disease

In the latest Huffington Post blog entry from the Stanford Center for Sleep Sciences and Medicine, a pediatric neurologist highlights a rare neurological disease that’s characterized by an improvement of symptoms after sleep. Mara Cvejic, MD, shares the dramatic story of a young patient, writing:

As a sleep physician today, Jane’s face still haunts me — but in a good way. The miracles of sleep are too numerous for the scope of this article, but there is plenty of undisputed evidence to show that healthy sleep improves our mood, our heart, our ability to eat healthy, to exercise, and perform at our best during the day at work or school. It is even linked to lower cancer rates. But can it take away what appears to be Parkinson’s disease and make a little girl walk? Oddly, that answer is yes. Jane had Segawa’s disease.

Read on for the full story.

Previously: Stanford center launches Huffington Post blog on the “very mysterious process” of sleep

In the News, Research, Sleep

Sleep: More important than ever?

Sleep: More important than ever?

A headline today caught my eye: “It’s Time to Pay Attention to Sleep, the New Health Frontier.” (Since installing a sleep-tracking app on my phone, I’ve been playing with different bed times, forms of exercise and other factors to measure their effects on sleep time and quality.) Anyway, the piece, on Time.com, explains why sleep’s importance to health is more serious than many of us really acknowledge. And it offers this bit of historical perspective on why now is the time to pay attention:

According to a 2013 Gallup survey, 40% of Americans get less than the recommended seven to eight hours a night. While the typical person still logs about 6.8 hours of sleep per night, that’s a drop from the 7.9 Americans were getting in the 1940s.

Previously: Exploring the benefit of sleep appsSleep on it: The quest for rest in the modern hospital, Mobile devices at bedtime? Sleep experts weigh in and Stanford doc talks sleep (and fish) in new podcast

Aging, Genetics, Neuroscience, Research, Sleep, Stanford News

Restless legs syndrome, most common in old age, appears to be programmed in the womb

Restless legs syndrome, most common in old age, appears to be programmed in the womb

Restless legsWhile the sleep disorder called “restless legs syndrome” is more typical of older than younger people, it looks as though it’s programmed in the womb. And a group led by Stanford neurologist Juliane Winkelmann, MD, has pinpointed for the first time the anatomical region in the brain where the programming takes place.

Restless legs syndrome, or RLS, is just what it sounds like: a pattern of unpleasant sensations in the legs and the urge to move them. It has been described as a feeling similar to the urge to yawn, except that it’s situated in the legs or arms instead of the upper torso and head.

Estimates vary, but something on the order of one in ten Americans has RLS. Women are twice as likely as men, and older people more likely than young people, to have it. This urge to move around comes in the evening or nighttime, and can be relieved only by – wait for it – moving around. Needless to say, that can cause sleep disturbances. In addition, RLS can lead to depression, anxiety and increased cardiovascular risk.

Very little is known about what actually causes RLS, although it’s known to be highly heritable. Although a number of gene variants (tiny glitches in a person’s DNA sequence) associated with the condition have been discovered, each by itself appears to contribute only a smidgeon of the overall effect, and nobody knows how.

Winkelmann has been exploring the genetic underpinnings of RLS at length and in depth. In a just-published paper in Genome Research, she and her colleagues have shown that one gene variant in particular depresses the expression of a protein involved in organ development and maintenance. The DNA abnormality Winkelmann’s team zeroed in on occurs not on the gene’s coding sequence – the part of the gene that contains the recipe for the protein for which the gene is a blueprint – but rather on a regulatory sequence: a part of the gene that regulates how much of that protein (in this case, the one involved in organ development and maintenance) gets made, and when.

The kicker (pardon my pun) is that the regulatory sequence in question seems to be active only during early brain development and only in a portion of brain that is destined to become the basal ganglia, a brain region well known to be involved in movement.

“Minor alterations in the developing forebrain during early embryonic development are probably leading to a predisposition in the [basal ganglion],” Winkelmann says. “Later in life, during aging, and together with environmental factors, these may lead to the manifestation of the disease.”

(Wondering if you’ve got RLS? Check this out.)

Previously: National poll reveals sleep disorders, use of sleeping aids among ethnic groups, Caucasian women most likely to have restless leg syndrome
Photo by Maxwell Hamilton

In the News, Sleep, Technology

Exploring the benefit of sleep apps

Exploring the benefit of sleep apps

man sleeping in bedCan sleep-related apps be of benefit to the bleary-eyed masses? That’s the question explored today by the New York Times’ Molly Young, who sought the advice of one of our sleep experts for her story:

Browse the iTunes store or Google Play and you’ll find them by the dozen: offerings with names like SleepBot and eSleep, represented by icons of placid sheep or glowing moons. The offerings fall into two basic categories. One tracks sleep patterns through the smartphone’s accelerometer (the doodad that recognizes when your phone is upside-down), giving users a blueprint of their time in bed. The second promises to lull users to sleep with music, hypnosis or guided meditation.

If you’re the data-driven type, a sleep-tracking app surely appeals. By placing the phone next to you in bed and tapping a button, you record your movements and a sleep chart is created. But according to Dr. Clete Kushida, the medical director of the Stanford Sleep Medicine Center, these apps are hardly precise.

“Without EEG — brain wave activity — it’s very hard to tell different stages of sleep apart,” Dr. Kushida said. “People can stay still and the device will think the person’s asleep.” Still, “the advantage of these devices is that they can help individuals become more aware of a potential sleep problem,” Dr. Kushida said.

Previously: Why physicians should consider patients’ privacy before recommending health, fitness apps, A look at the “Wild West” of medical apps, Designing the next generation of sleep devices, Exploring the effect of sleep loss on health, Turning to an app to help your health and Stanford sleep expert offers evaluation of science behind one sleep device
Photo by dearoot

In the News, Parenting, Pediatrics, Sleep

Study: Baby sound machines may be too loud for little ears

Study: Baby sound machines may be too loud for little ears

DSC_0293Sound machines that help babies sleep more soundly are a staple on many new parents’  baby registries (I had a little sheep that mimicked the sounds of rainfall and ocean waves). Well, as you may have read about elsewhere today, a new study published in the journal Pediatrics finds those soothing sounds may actually do more harm than good. Researchers from the Hospital for Sick Children in Toronto have found that infant sleep machines can reach sound levels that are hazardous to infant hearing and development. Writer Michelle Healy outlines their findings in an article in USA Today:

When set to their maximum volume:

– All 14 sleep machines [studied] exceeded 50 decibels at 30 cm and 100 cm, the current recommended noise limit for infants in hospital nurseries.

– All but one machine exceeded that recommended noise limit even when placed across the room, 200 centimeters away.

–Three machines produced outputs greater than 85 decibels when placed 30 cm away. If played continuously, as recommended on several parenting websites, infants would be exposed to sound pressure levels that exceed the occupational noise limits for an 8-hour period endorsed by the National Institute for Occupational Safety and Health and the Canadian Centre for Occupational Health and Safety.

It’s important to note that the researchers only tested the maximum output levels produced by the sound machines, and not their direct effect on infants. But Nanci Yuan, MD, tells Healy that the study does raise some important concerns:

​Parents “can feel desperate and want to try anything” when a baby has difficulty sleeping, says Nanci Yuan, pulmonologist and sleep medicine specialist at Lucile Packard Children’s Hospital Stanford.

But this research highlights the potential for a previously “unknown harm that can occur,” Yuan says. “We’re getting more and more concerned about issues related to sound and noise and hearing-loss in children because it’s progressive.”

Photo by Margarita Gallardo

Sleep, SMS Unplugged

Sleep on it: The quest for rest in the modern hospital

Sleep on it: The quest for rest in the modern hospital

SMS (“Stanford Medical School”) Unplugged was recently launched as a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

hospital bed cornerI first saw it on the face of a resident at the end of a 24-hour shift. And then again on the weary visage of a nurse after a whirlwind shift in the emergency room. Soon it was written across my own brow: The expression that said, It’s time to take a break. But as I soon realized, it wasn’t just the students, doctors and nurses who were struggling to get enough rest.

“It’s impossible to get any sleep here,” remarked one patient whom we awoke on early morning rounds. “There’s just constant disruption. I don’t feel like I’m healing.”

“Is there anything we can offer him besides sleep medications?” I asked the supervising physician after we left the room.

“Everyone says they can’t sleep,” he replied. “Unfortunately it’s just part of being in the hospital.”

I often ask patients to suggest one thing we can improve in their medical care. An overwhelming majority of them comment on the lack of peace and quiet. Perhaps the most memorable example was an elderly gentleman hospitalized for tuberculosis. Even in an individual room with airtight separation from others (“respiratory isolation”), he couldn’t go more than a few minutes without being disrupted. Doctors and medical students started their morning rounds before sunrise, vital signs were measured every four hours (including at night), and nurses constantly came in and out with meals and medications. He lamented, “The only thing I want to do is sleep. But as soon as I do, someone else comes in.”

Hospitals didn’t always used to be hectic. In fact, restful environments were long thought to have healing properties. Early in the 19th century, the French physician Laennec noticed lower rates of tuberculosis in seaside communities away from the hustle and bustle of the city. Wanting to bring a piece of that environment to his urban-dwelling patients, he began putting ocean seaweed under the beds of Parisians. More recently in the 1940s, a popular treatment for tuberculosis and other serious illnesses was the ‘sanatorium.’ Patients enjoyed the fresh air of the countryside, where it was thought they could rest and give their bodies a chance to build protective ‘walls’ around the infected nodules in their lungs.

The advent of antibiotics around the time of World War II brought a rapid end to seaweed, sanatoriums and other similar remedies. Nowadays, it’s easy to look back and chuckle at the idea of trying to cure tuberculosis by lying in a bed on the seashore. But it’s also increasingly difficult to justify the (somewhat) controlled chaos of today’s hospitals – an environment that is at best claustrophobic and at worst dangerous. After all, the benefits of a good night’s sleep have been proven beyond the shadow of a doubt. And numerous studies show that many people live longer and healthier if sent home instead of staying in the hospital with the exact same disease. Granted, much of the benefit of going home lies in avoiding exposure to others with contagious infections. But after seeing innumerable patients exhausted from being poked and prodded around the clock, it’s hard to shake the thought that the hospital environment itself may be more pathologic than we once believed.

Many of our clinical mentors came to this realization long ago, and teach us on a daily basis how mindful doctors can buffer patients from the stresses of a bustling hospital. Of course, helping someone to rest comfortably is more easily said than done. But as students, we can at least identify role models who are the kind of physicians we want to be – physicians who notice when a patient is sleeping and decide, “I’ll come back later.” Or those who notice when someone is exhausted and ask, “What can we do to help?” And if we can help patients sleep a little better, maybe – just maybe – their doctors will too.

Mihir Gupta is a third-year medical student at Stanford. He grew up in Minnesota and attended Harvard College. Prior to writing for Scope, Mihir served as co-editor in chief of H&P, Stanford medical school’s student journal.

Photo by oddmenout

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