History of Sleep – The Beginning

In the age of information, it can be difficult to find a comprehensive article about almost anything. Not many people are able to find the time to read about topics that interest and effect them, so the demand for easily digestable material is high.  Recently, an article appeared in the New Yorker by a person clearly interested in the history and study of sleep, Jerome Groopman.

His article discusses many fascinating aspects of sleep, ranging from the medical industry’s lack of knowledge about sleep to what happens to a person when they do sleep.  The theme of his article is much like what we’ve discussed on our blog – the necessity of sleep, and how it’s lack can be a severe detriment to a person’s daily life. At PDSM, we wanted to take a further look at the items discussed in Mr. Groopman’s article.  Gleaning information from his article and other sources, we were inspired to create this series in hopes of offering a more comprehensive look at sleep in general, and the things that can happen because – and in spite – of it.

 

“No one has been able to declare with certainty why all life forms need sleep”

-Meir Kryger

 

Though we now know that sleep is a very necessary part of a healthy lifestyle, it’s not always been a focus in the medical world.  Mr. Groopman states “in medical school, the subject [of sleep] had been covered in only the most cursory way.” In addition to the fact that sleep specialtiy is a relative newcomer to the medical world, there is also the shift work typical of medical residents.  It makes sense that new doctors have to work long hours to get used to the pressures of being a full-time doctor. However, it is also a scary idea – being the patient of a doctor that’s been awake for 24+ hours. Although it is well known that lack of sleep causes us to be ineffective, there is some interestingly contradicting cultural and historical information to discuss regarding what exactly may be considered proper sleep.

 

In the coming months, we will take you on the informative adventure.  We will learn more from Dr. Kryger, Mr. Benjamin Reiss and Mr. A.Roger Ekirch – three gentlemen that have quite a lot to say about sleep. We will discuss what we know, what we don’t know, theories surrounding what we don’t know, how our understanding has changed through the years, and what the future may hold.  

 

“Even God needed a seventh day to rest from all that he created.”

-Jerome Groopman

Signs of Worse News to Come?

Because sleep is connected to almost every facet of the medical industry and our lives, we here at Pittsburgh Dental Sleep Medicine try to stay in the loop with trending health topics. Almost every other month, something new is published about how smartphones are changing our lives in many ways, and sleep is not excluded from this discussion.

Sleep Texting

“…people had been performing semi-purposeful behaviours in their sleep for years, so it was no surprise when they started text” Sleep Services Australia medical director Linda Schachter

 

People sometimes do strange things in their sleep – it’s not a new thing.  Since smartphones have become a ubiquitous part of most people’s lives, it shouldn’t be a surprise that sleep texting has become a more prevalent part of daily life.  

 

Of course, sleep texting is not ideal.  As dangerous as the famed and funny “drunk text” can be, so can sleep texting.  Maybe it can get you into trouble with a boss, a lover, or a family member. A particular instance brought to light by Sleep Foundation’s deputy chair, Dr. Hillman, was that of on-call medical professionals answering their phones while still half asleep, and giving instructions without fully waking up.  

This state of constant-connectedness is showing ways that it’s changing our patterns, and thus our culture.  

“….sleep texting [was] a type of parasomnia which presented as people doing automatic-type behavior while asleep.”

 

Smartphone Addiction

“Along with a growing concern that young people, in particular, may be spending too much time staring into their phones instead of interacting with others, come questions as to the immediate effects on the brain and the possible long-term consequences of such habits.”Sleep Review Magazine

 

The studies discussed in this article have illuminated researchers regarding how smartphone addiction is changing brain chemistry in young people.  A professor of neuroradiology at Korea University found a correlation between smartphone addicted teenagers and higher scores in depression, anxiety, insomnia severity, and impulsivity.  

The specifics of the study are less important as touching on what this could mean for all of us.  It is suggested that more research be done to find out more about smartphone addiction and how it effects brain chemistry. PDSM has already posted many articles about links between depression, anxiety and sleep.  It is understood that sleep has a lot to do with a person’s mental health, and can also be disruptive to a person’s sleep.

This interconnectedness forces a realization that our phones may not be as high a priority as we make them.  If it’s a choice between health and happiness versus our phones, hopefully most people would choose health and happiness.  Of course we don’t know what will be determined in the future, but there is enough evidence suggested presently to recommend a large dose of caution when it comes to a phone’s role in a person’s daily life. If you keep your phone out of your bedroom while you sleep, it will not effect your circadian rhythym, nor will you have the opportunity to manage sleep phone calls or texts.

Wearable Technology as A Health Solution?

“Roughly 24% of men and 9% of women have sleep-disordered breathing, and 80% of people with diagnosable sleep apnea don’t realize they have it.” – Brandon Ballinger, co-founder at Cardiogram

Last year, Pittsburgh Dental Sleep Medicine took a closer look at the role sleep trackers play in a good night’s sleep. Though there has been some controversy of how sleep trackers can affect an individual’s sleep, there have been new advances in that arena. Since the individual purchase of wearable technology has been mainly geared towards sport and recreation, healthcare has not been a key focus of wearable technology – until now.

“Consumers rely on [fitness trackers] and the ecosystem of associated apps to meet fitness goals.  And yet, these devices often fall short of identifying actionable health insights, such as risk factors for diabetes and heart disease..”

Peter Daisyme

Converging recreation and health, some investors have found a new niche for fitness and sleep trackers. Brandon Ballinger dares to ask“What if we could transform wearables people already own – Apple Watches, Android Wears, Garmins and Fitbits – into inexpensive, everyday screening tools using artificial intelligence?” His article mentions hypertension and sleep apnea as two conditions most suited to be diagnosed with wearable technology and the assistance of his app.  He mentions that the rate of detection can be staggeringly accurate via consumer wearables and the DeepHeart app.

While Cardiogram promotes the DeepHeart app that they’ve developed to work with existing wearables, many technology companies are gearing their next generation devices to be more health-conscious.  Jawbone is focusing on interpreting the heart rate metrics gleaned from the device’s daily use; iBeat has a device that links it’s wearer to an emergency response center via a help button; Diabetes Sentry “tracks a patient’s skin temperature and perspiration levels to detect signs of a drop in blood glucose levels.”  

Perhaps the most exciting of all – for sleep apnea sufferers – is the Go2Sleep ring.  

“Go2Sleep monitors wearers’ heart rate, blood oxygen saturation levels, perfusion index (your pulse strength), and the amount that you’re tossing and turning during your sleep in order to provide you with a sleep report.”Lulu Chang

While it is appealing (and cost-effective) for an individual to use the fitness tracker that they already have to detect life-threatening health issues, it is also exciting to keep an eye on the new devices that are on the horizon of this new industry.  Morphing a recreational consumer item into a potentially life-saving device is very exciting indeed.

So what is the role that wearable technology plays on a good night of sleep?  It still remains to be seen, and we are looking forward to learning more as the developments come.

When Sleep Apnea Turns Deadly

If you have come to see us at Pittsburgh Dental Sleep Medicine, chances are good that you understand and recognize the severity of sleep apnea.  Unfortunately, the dangers of sleep apnea have a history of going undetected in many professions – most notably, in the mass transit industry. Recent train crashes have called to light some glaring inconsistencies in the regulations for mass transit.

According to an article from Sleep Review, a couple of recent railway accidents were possibly caused by “undiagnosed severe obstructive sleep apnea.”  The two accidents combined injured just under 250 people.  A closer look at these incidents reveals that undiagnosed sleep apnea seems to be a concern in transit workers. Additionally, the National Transportation Safety Board (NTSB) drew focus to the safety issues at these terminals. While an automatic-stop option seems a good idea in case of emergency, the article suggests there are “no mechanisms installed in the United States that will automatically stop a train at the end of the track if the engineer is incapacitated, inattentive, or disengaged.”

The lack of safety regulation is alarming.  A quick Google search of “subway safety regulations” brings up an article from the Baltimore Sun discussing the deteriorated safety standards of the Baltimore Metro rail system – for more than a year prior to shutdown.  While these system safety concerns are disheartening, perhaps a more serious point of contention is the operator of these mass transit vehicles.

As a community, we are coming to understand the significance of sleep in an individual’s lifestyle. More sleep research is bringing unknown circumstances to light – such as a person’s inability to recognize symptoms of sleep deprivation in his or herself.  This research must be taken into consideration when safety regulations are discussed and reviewed. Sleepapnea.org estimates “22 million Americans suffer from sleep apnea, with 80 percent of the cases of moderate and severe obstructive sleep apnea undiagnosed.”  

What this evidence suggests is that an individual cannot be the only determining factor regarding his or her capabilities – especially if hundreds of citizens rely on him or her for their daily commute.This is a perfect example of what government regulation should be all about.  When the greater good must trump an individual’s shortsightedness, we must be able to trust in our government and safety systems.

If you or someone you know struggles with any sleep issues, please have a sleep study done.  If your sleep habits concern you, please schedule an appointment.  Pittsburgh Dental Sleep Medicine can help to bring some closure to an issue that doesn’t have to be dangerous, if monitored and treated properly.

Sleep and Diet – The Information We Ignore

 

The American culture is fast-paced, and lack of sleep can be brushed off as a humorous rite of passage into adulthood.  New parenthood and work weeks of 50-80 hours are two examples of common ways our society justifies lack of sleep. As sufferers of sleep apnea know, the importance of sleep is often minimized even though it affects many aspects of an individuals well being.  When dealing with matters of weight loss, it is easy to overlook something as seemingly insignificant as sleep.  This article will pull together some old and new research that suggests that it’s all interrelated.

 

Sugar and Sleep

A recent article on news-medical.net suggest some interesting points regarding lack of sleep and its impact on an individual’s sugar cravings.  Dr. Ananya Mandal summarizes the findings of a study done with a sample group of under 50 healthy adults. Split into two groups, each one was given separate tasks. The first group was not to do anything differently than usual.  The second group was told to get an additional hour and a half of sleep a night.  They were also given directives regarding caffeine and food intake and a relaxation routine prior to bed time.  

Unsurprisingly, the second group got more sleep and were also found to have reduced their sugar intake the following day.  

She also confirmed with another sleep professional that “only raising total bed time duration by an hour or so was necessary to making better and healthier food choices….it has already been studied previously that poor sleep meant poor diets.”  

This one small study led to further investigation regarding sleep and its correlation to diet. Our findings went from a micro to a macro level quickly.

 

Looking at Our Health as a Whole

Sleep is a common answer to most of our health-related questions.  We all know that rest is a key factor for curing common malaise.  Why is it then so hard for us to consider that more rest may help us with other health-related concerns?  Looking at weight-gain in a similar fashion (as our body’s way of indicating that we are doing something wrong – like a cold), it stands to reason that more rest can play a significant role.

An interesting article from the National Sleep Foundation offers several examples of studies that bring relevancy to this discussion.  The article mentions that “an estimated 18 million Americans have sleep apnea” – which is something Dr. Rogers has studied in great detail.  Unfortunately, obesity can be a commonality with sleep apnea sufferers.  Since sleep apnea often leads to lack of sleep, these individuals are less likely to diet and exercise.  Further, even with proper diet and exercise, lack of sleep can still be a weight-loss inhibitor.  The study referenced showed a tie between minimal sleep levels and hormone characteristics of diabetics.  

If an individual has issues with accomplishing weight loss even with proper diet and exercise, it’s recommended to evaluate the time of day exercise takes place.  Exercise is recommended between morning and late afternoons, and no later than 3 hours prior to bedtime.  The interesting reason for limiting later workouts is that the body needs a cool down before bed.

One final piece to ponder – “people who don’t get enough sleep are more likely to have bigger appetites due to the fact that their leptin levels (leptin is an appetite regulating hormone) fall, promoting appetite increase.”  Additionally, “the psychological manifestations of fatigue, sleep and hunger are similar.”  The answer seems easy – sleep more to eat less.

Although sleep is crucial, exactly how and why may not be known.  But a good night’s rest is something we all need for our overall health.  If you or someone you know struggles with sleep deprivation or weight troubles, suggest a sleep study.  If you or someone you know struggles with sleep apnea, suggest that they come see us at Pittsburgh Dental Sleep Medicine.  We are here to help them!

 

Information Linking Sleep Deprivation with ADHD

A recent Today article suggests new evidence linking lack of sleep and attention deficit/hyperactivity disorder (ADHD).  There seems to be an issue with the biological clock of ADHD sufferers, and they generally do not get enough sleep.  It all has to do with melatonin and dopamine – crucial chemicals to our body’s natural functions.  

The study – led by Dr. Sandra Kooji from VU Medical Center in Amsterdam – provides evidence that suggests a closer look at melatonin – a necessary hormone in our bodies “that sparks our urge to sleep.” Research found that melatonin levels in people with ADHD are significantly different than those without ADHD.  People have a general circadian rhythym that encourages sleep when it’s dark, and wake when it’s light. When a person starts to feel sleepy, it’s because the melatonin levels in their body have increased.  

A later rise of melatonin levels in the evening were the indicating patterns in people with ADHD.  Because of this later release of melatonin, people with ADHD fall asleep later and generally get less sleep.  According to Dr. Kooji, lack of sleep in ADHD patients can then also lead to increased symptoms.    

The author of the Today article, Linda Carroll, goes on to note that “non-drug treatments – like light therapy, for example – might at least mitigate symptoms.” While it’s not suggested as a replacement for drugs, she does describe light therapy as a potential assistant to regulating the biological clock.

She goes on to describe the benefits of a regulated biological clock for other mental health conditions, such as bipolar disorder. This aligns with some other topics discussed on the PDSM blog, such as the importance of considering blue light and its effects on a person’s circadian rhythym.

Perhaps the most important part of Ms. Carroll’s article is the evidence that suggests that when we sleep is almost as important as the amount of hours. So, increasing the amount of hours slept may not be as crucial as the regulation of a body’s circadian rhythym.

 

Some suggestions for those trying to regulate their biological clock are very general recommendations for anyone looking to get a better night’s sleep – with or without ADHD.  Minimizing light near bedtime, getting exercise in the morning, eating less at dinner time, and ridding the bedroom of electronics are all suggestions for getting good sleep.  If these tips can help a person sleep better, maybe it can also help minimize some of the ADHD symptoms as well.

As always, if none of the tips we mention are helping, schedule a sleep study.  Pittsburgh Dental Sleep Medicine is here to help you sleep well!

   

Squabbles at Home? Are Your Sleep Patterns Making You Fight?

A recent article in Sleep Review Magazine suggests some interesting correlations among partners’ sleep patterns and their abilities for conflict resolution.  The article cites researchers involved with a study at the Ohio University Institute for Behavioral Medicine Research.  The main topic of this discussion was stress-related inflammation, which “is associated with higher risk of cardiovascular disease, diabetes, arthritis, and other diseases.”  These finding are not that surprising, and a regular topic in the sleep world.  Because of the fairly common knowledge of how sleep can change a person’s physiological well-being, the researchers wanted to take things a step further.  They wanted to find out the effects of partners’ sleep patterns on their mates.

They invited 43 couples in for two visits.  Both times, blood samples were taken and the previous two nights’ sleep amount was recorded per partner.  By inciting a known source of contention amongst the couple, the researchers recorded their conflict resolution throughout the process.  They concluded the visit by taking blood samples for a second time.  

A researcher on the study, Dr. Stephanie Wilson, stated “We found that people who slept less in the past few nights didn’t wake up with higher inflammation, but they had a greater inflammatory response to the conflict.  So that tells us less sleep increased vulnerability to a stressor.”  In other words, someone that has had less sleep is more prone to react poorly to a conflict.

“If both partners got less than 7 hours of sleep the previous two nights, the couple was more likely to argue or become hostile.  For every hour of sleep lost, the researchers noted that levels of two known inflammatory markers rose 6%.” Another interesting note – the inflammatory response almost doubled when the couples employed unhealthy discussion tactics.  

With findings such as these, it is concerning to also hear from Dr. Wilson that “About half of our study couples had slept less than the recommended 7 hours in recent nights.”  

Perhaps the most crucial part of the study was mentioned by Dr. Janice Kiecolt-Glaser, who stated “Part of the issue in a marriage is that sleep patterns often track together.” Anyone that has shared a bed with another person can relate to having a troubled sleeper next to them. If one person in the bed sleeps poorly, the risk is greater that both will sleep poorly.  

There was one hopeful area of the study, though; it was noted that there was a “protective effect” between a couple with a well-rested and sleep-deprived partner.  The partner with better rest employed better conflict resolution mechanisms to pull the other out of the disagreement.   

As it is continually shown, a good night’s rest is crucial to our physical and emotional well-being as people.  If tensions at home are high, try getting a better night’s sleep.  If you are having trouble sleeping, find out why by scheduling a sleep study.  Pittsburgh Dental Sleep Medicine can help you find some answers.

What Can You Do to Help Curb Work-Related Stress?

A new study recently published found quite a few health-related issues with people that work long hours. This study found a shocking rise in atrial fibrillation (AF) between employees that worked long hours versus those that had a better work-life balance.  However, a very interesting sidebar in the study mentioned the significant benefits of a good night’s rest on a person’s stress levels.

According to an article written by Dube, the study referenced – done by the University College London – found long hours to increase the risk of AF by 40%.  As if heart-related problems like AF are not scary enough, having AF increases the risk of stroke by three to five-fold.

Specifics of the Study

The study focused on almost 86,000 people from four countries.  These people were split into two catergories – regular work hours (35 to 40 hours per week) and higher than usual work hours (55 hours).  “None of the participants had AF before the study” Dube notes.  This study lasted for ten years, and tracked who ended up with AF.  Though the results are telling, the researchers only asked about number of hours worked at the beginning of the study – which means they were not aware of any changes in work schedules during that 10-year period.  There was also no research into job type/category that could have affected the outcomes.

 

 

“An average of 12.4 per 1,000 people had developed AF.  However, among the participants who worked 55 hours or more, that figure rose to 17.6 per 1,000 people.”

Though this particular study is interesting in relation to atrial fibrillation, there have been many other studies done showing the negative health outcomes of stress on a person.  Heart disease and stroke are significant concerns to have, however there is one simple consideration that can help.

Stress and Sleep

It should come as no surprise that sleep is a very easy and natural remedy to what ails a person.  Dube’s article references Michigan State University researchers that say “Stress at work can also impact sleep and prompt people to overeat and make unhealthy eating choices.”  Though stress can be a catalyst for poor sleep, it also demands a consistent solution for the effects of stress.  The more stressed a person is, the more they need sleep.  One of the authors of the Michigan State study said “another key finding shows how sleep helped people deal with their stressful eating at work.  When workers slept better the night before, they tended to eat better when they experienced stress the next day.”

Sleep can help a person make better eating decisions under stress, but it is also a crucial part of our daily process. Sleep is not something to overlook, or discuss proudly as something that is regularly missing in daily life.  If you are having trouble sleeping

Some Interesting New Sleep Information for Expecting Parents

The necessity of sleep is well known, however, two recent studies mentioned in Sleep Review: The Journal for Sleep Specialists show an interesting focus on parents and children.  By narrowing the study groups to these select groups, some very interesting correlations were found between depression, childhood obesity and lack of sleep.  Whether it is the first or fourth child, these studies are of interest to any expecting parents.

The first article of note is regarding sleep interventions and how it may assist in fighting childhood obesity.  The comparative study highlights the differences between families who received recommendation and coaching surrounding “food, activity and breastfeeding” and some families being given “an innovative sleep program.”  There was a group that also received assistance in both areas. The families who received the support around “food, activity and breastfeeding” did not show any effects of the assistance.  “However, children in families who received the sleep program were much less likely to be overweight.”  The professors go so far as to say “the beneficial effects of the Prevention of Obesity in Infancy sleep intervention on the children’s weight were intriguing and quite substantial.”  While it’s a known variable in adulthood obesity, it is of significant interest that sleep may play such a large part in a child’s early development and weight.

Another article of note states a headline – “How to Stay Sane When Your Child Can’t Sleep.” The study focused on parents that were lacking clinical depression at the outset.  There was scoring at the beginning, “and at 6 weeks and 24 weeks after the intervention.” Worries about managing a child’s sleep were a prevalent risk factor in higher levels of depression.  The study notes that it was true for mothers and fathers – the more he or she worried about their child’s sleep, the more likely they were to be depressed.

Again, it is of no surprise that there is a link between lack of sleep and depression; but this study highlights that anxiety and concern (in which the variables of parental fatigue and poor sleep are claiming to have been factored out) can also play a huge part of the depression.

Both studies maintain a firm stance in the benefits of sleep interventions.  By meeting with, coaching and promoting better sleeping habits, a parent’s concern with his or her child’s and his or her own well-being can be significantly reduced.  Could it be as simple as getting a better night’s sleep?

Anxiety Disorder and Sleep: What’s the Connection?

While it may come as no surprise that anxiety disorder and sleep are linked, there is an interesting cycle between the two. According to a Bustle article by JR Thorpe,  “anxiety and sleep can enter into a self-maintaining negative cycle.” There are additional sleep recommendations for anxiety disorder sufferers that will be analyzed here, while also addressing some indicators of how anxiety and sleep disorders may manifest in daily life.

 

Sleep and Anxiety in Daily Life

The Anxiety and Depression Association of America has an article about sleep disorders, and in response to the question “Anxiety Disorder or Sleep Disorder: Which Comes First?” their answer was “Either one. Anxiety causes sleeping problems, and new research suggests sleep deprivation can cause an anxiety disorder.”  This can have a lasting effect, as well; the cycle of high anxiety and poor sleep can help each to get worse with time.

An individual lacking in sleep can be more prone to overreacting to minor stressors (treating them as if they were major).  An example is that of an insomniac in panic mode – “catastrophizing” their lack of sleep as having potentially near-fatal effects.  A person lacking sleep can also read faces incorrectly, or “read faces as hostile rather than friendly.”  While it seems somewhat alarming to acknowledge the intensity of the connection between the two, it is relieving to see that treating insomnia can have a direct effect on minimizing the effects of anxiety disorders.  In addition to the regular sleep tips offered for those having issues sleeping, some additional considerations are outlined below for anxiety sufferers.

 

Suggestions for Anxiety Disorder Sufferers

The Anxiety and Depression Association of America recommends some generic ideas to help with anxiety.  They include common tips for any individual struggling to sleep, along with some additional ideas such as:

  • prioritize your daily to-do list
  • play soft and calming music
  • direct stress and anxiety elsewhere
  • talk to someone about daily troubles

 

Thorpe’s suggestions are slightly different, and potentially more helpful.  The first suggestion is more of a warning. Though the benefits of marijuana have been touted recently, using it as a sleep aid is apparently off the mark.  Although marijuana has a reputation for calming effects, it’s been shown that “heavy marijuana smokers showed more sleep disturbance and a greater degree of insomnia.”  Thorpe’s article references a Boston University study.

Another suggestion of Thorpe’s is aromatherapy. The two scents mentioned were lavender and gardenia.  Lavender was studied in intensive care units, while gardenia was studied in Germany and found to have two compounds that interact with GABA – a neurotransmitter that is crucial in the sleep process.

The final two suggestions are actions that an individual can take.  Clock-watching is a habit that individuals struggle with when trying to sleep, and it is something that increases panic although the individual needs calming.  The suggestion Thorpe mentions is to remove clocks from the room, or turn them around to face the wall.

Finally, there is an app to help with anxiety disorder management. Self-help for Anxiety Management (SAM) app is “a step-by-step activity guide to things like meditation and sorting out anxious thinking ruts, but it also provides a lot of information about what anxiety disorders are actually about.” Of course, use with the mindfulness of other sleep tips; limit its use until an hour before bed to avoid possible disruption of circadian rhythm.

Anxiety and sleep disorders do go hand in hand, but this information provides the hope that treatment of one should also help with the other.  If sleep disorders persists, please come and see us at Pittsburgh Dental Sleep Medicine.  We are here to help you find answers!