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!

Are You Sleep Deprived?

Is it possible to be sleep deprived and not realize it? Could there be potential misdiagnoses for some patients?  Compiled here are some symptoms and warning signs of sleep deprivation.  PDSM also recommends a closer look at your sleeping patterns and possibly a sleep study, if any of these symptoms or signs cause concern.

Sleep Deprivation: Effects

“A review of 16 studies found that sleeping for less than 6 to 8 hours a night increases the risk of early death by about 12 percent” (Ann Pietrangelo & Stephanie Watson, Healthline).

Most people understand that sleep is an important tool for an individuals’ recovery each night, and for the development of those growing into adulthood.  In a Healthline article, Ann Pietrangelo and Stephanie Watson discuss the effects of sleep deprivation; obvious effects are that of excessive sleepiness, yawning, irritability and daytime fatigue.  However, not having the proper rest can also effect other areas of a person’s health in a less than overt way.  For example, long-term sleep deprivation also increases your risk for chronic illnesses like diabetes and heart disease.  Sleep is closely related to hormone levels and production, such as cortisol, leptin, ghrelin, insulin and testosterone.  Chronic sleep deprivation can also create chaos within a person’s central nervous system, respiratory system, immune system, and cardiovascular system.

This information reinforces the need for a good night’s rest; but is it possible that a person may be sleep deprived without knowing it?  Following are some warning signs that could be caused from sleep deprivation and perhaps misdiagnosed as a symptom of something else.

Sleep Deprivation: Signs

An article on the NDTV Food site discusses several signs to look for with regards to sleep deprivation.  Perhaps the most unexpected signs of sleep deprivation are perpetual hunger and weight gain.  These two signs refer to the hormones – leptin, ghrelin and insulin.  When an individual’s leptin and ghrelin levels are out of balance, the perpetual hunger occurs, which is then accompanied by weight gain.  “Sleep deprivation also prompts your body to release higher levels of insulin after you eat.  Insulin controls your blood sugar level.  Higher insulin levels promote fat storage and increase your risk for type 2 diabetes” (Healthline).

Do you have high stress levels?  Do you sleep poorly because of your high stress, or do you have high stress because of poor sleep?  In this chicken-or-the-egg scenario, it’s important to pay close attention to sleep.  Levels of the hormone cortisol are effected by lack of sleep, which is directly related to stress.

While it may seem that daytime sleepiness and lethargy are self-explanatory and easy-to-spot warning signs, it can mean something as simple as an individual being chronically low on energy.  This symptom is particularly of interest if the person also meets their daily nutritional needs.

Something else that is usually attributed to daily nutritional needs is the effects of alcohol.  It should be no surprise that lack of sleep can also determine how your happy hour is going to hit you.  “Sleep deprivation is known to magnify the effects of alcohol on your body” (NDTV Food, 2017).

A lowered immunity and skin breakouts are two additional physiological signs of sleep deprivation.  This simply means that a body tends to get sick more frequently when it’s sleep deprived.  Also, night time is when collagen is produced.

Lastly – and certainly not least – are the signs of the mind.  Inabilities to make quick decisions, forgetfulness, and extreme emotions are all warning signs of sleep deprivation.  The brain uses the time during sleep to consolidate memory, so when it’s lacking, so is your ability to remember.  Anxiety, and vacillating between extreme highs and extreme lows in mood are both significant indicators of sleep deprivation (NDTV Food).  Additionally, microsleep is mentioned as a possible symptom of sleep deprivation.  Microsleep occurs when a person “fall[s] asleep for a few seconds or minutes without realizing it” (Healthline).

Some of these signs are indicators of other medical issues, and perhaps some patients are misdiagnosed because of these indicators.  If any of these signs strike a chord, a sleep study is recommended to find out if sleep deprivation is an issue.  These signs can also simply suggest a closer look at an individual’s sleeping patterns.


Sleeping on the Left Side

There are many articles that discuss the benefits and hindrances of different sleep positions. talks about sleeping on your back as the best position for the most restful sleep, while your stomach is the worst.  Sleeping on your side is considered the second best sleep position, and only 15% of adults sleep that way.  However, that number does not include those that choose to sleep in a fetal position – which is the most popular sleep position choice (by a landslide) at 41%.  These facts are interesting, but could the health benefits be even more specific?

One Side or the Other

A recent article references the Ayurveda school of medicine, and the benefits of sleeping on the left side as being particularly advantageous.  While the article recommends a loose fetal position on the left side for pregnant women, Ayurveda suggests that these benefits have a deeper meaning for more individuals than just pregnant women.  This all stems from the idea that our left and right sides act differently – almost independently of one another.  When considering our body composition from outward appearances, it may seem ludicrous.  Outwardly, we appear fairly symmetrical.  However, when one considers the internal composition of a human body, it can make more sense.

For instance, one proposed benefit of sleeping on the left side is that it improves digestion.  “Since our stomach and pancreas are located on the left side, sleeping on the same side enables them to hang naturally and function better.”  This position also allows the food to continue on its entire path undisturbed, from the stomach to the colon.  It is suggested that this can also reduce heartburn and indigestion.  Similarly, sleeping on the left side can be good for heart health, for the same reasons as stated above.  Since the heart is on the left side of the body, sleeping on the same side suggests that it may give the heart a break during sleep.

As the article also suggests, sleeping on the left side in the fetal position is especially beneficial for pregnant women.  It “improves circulation in your body and in the fetus, and it prevents your uterus from pressing against your liver…”  Another recommendation is to keep a pillow between the legs, to reduce strain on the hips.

Perhaps the most important benefit of sleeping on the left side is that it can help to prevent snoring.  “It keeps your tongue and throat in a neutral position and thus keeps your airways clear for you to be able to breathe properly.”  While this is a compelling reason to try sleep on one side or the other, there is not much evidence as to how the left side would be better than the right to assist with snoring.

Ayurvedic medicine is defined by WebMD as “one of the world’s oldest holistic (“whole-body”) healing systems. It was developed more than 3,000 years ago in India.  It’s based on the belief that health and wellness depend on a delicate balance between the mind, body and spirit.  Its main goal is to promote good health, not fight disease.  But treatments may be geared toward specific health problems.”

Sleep Trackers and Their Role in A Good Night’s Sleep

The Journal of Clinical Sleep Medicine has brought to light a new potential problem with regards to technology; sleep tracking with our wearable technology.  According to a recent article, “an estimated 15% of adults own a wearable fitness/sleep-tracking device, such as Fitbit or Apple Watch, and that another 50% might consider buying one.”  Though most wearable technology is marketed as fitness and movement tracking devices, the sleep tracking functionality is a selling point that has a fast-growing popularity.  So much so, the data collection has been found to cause a sort of anxiety for some users.

One patient mentioned in the article had purchased and used his sleep tracking device in hopes of encouraging better sleeping habits.  He had been having some issues with getting a good night’s sleep, and started using his tracker to fulfill his nightly goal “to achieve at least 8 hours of sleep every night.”  The suggestion is that, although the goal is noble, the sleep tracker can contribute to “a self-induced level of increasing anxiety” that the pressure of this goal can create.

While medical professionals commend users for the desire for better sleep, there is hesitation in placing too much reliance on these wearable pieces of technology.  Dr. Kelly Glazer Baron is one of the report authors, and her claim is that these trackers “don’t do a good job of estimating sleep accurately.”  In other words, these trackers are good for creating and maintaining awareness, but individuals should not live and die by the data.

Dr. Baron goes on to discuss further that this fixation on data – called “pursuing the ‘quantified self’” – can extend past simply sleep, and can cause stress.  In fact, terms such as “orthosomnia” and “orthorexia” have been coined to describe patients that are shown to have “unhealthy preoccupations” with sleep and food, respectively.  Because people are striving for their idea of proper living based on their tracked data, this causes some concern since the data has often been shown to be inaccurate.  One patient even questioned the accuracy of her sleep study in a lab due to her Fitbit showing opposing data.  Further inaccuracies include a lack in ability to “differentiate between light and deep sleep” and “reading in bed” versus sleeping.

There are ways that these trackers have benefited patients; the Sleep Review article references a sleep apnea patient that did get help with better sleep in part because of his sleep tracker.  Although these trackers can be one part of a patients’ answer, no electronic device is a substitute for the consultation of a medical professional.  For more about how our tech items can affect sleep, please see our blog post about blue light and electronics here.

Tonsillectomies and the Sleep Apnea Connection

The Mayo Clinic defines a tonsillectomy as “the surgical removal of the tonsils, two oval-shaped pads of tissue at the back of the throat – one tonsil on each side.”  Historically, this procedure was used as a tool in fighting chronic streptococcal infections.  Recent research is suggesting that the prevention of these infections “appear to go away” over time.  But more interestingly is that this procedure has been found to be beneficial to patients in other unexpected ways.

A recent Reuters article by Lisa Rappaport discusses the interesting transition of the tonsillectomy.  Still a widely common procedure, the latest research suggests that the infections the tonsillectomy was enacted to deter are sometimes only bringing short term relief.  The article mentions a Pediatrics study that claims “three years after tonsillectomies, children who had these procedures had roughly the same number of throat infections as kids who didn’t get their tonsils out.”  Ms. Rappaport goes on to intimate that the existing research failed to address the correlation between level of severity and level of benefit, which would surely effect the results of the study.

One of the authors of this most recent study – Dr. Sivakumar Chinnadurai – stated to Ms. Rappaport:

“The recognition of risks, and the knowledge that some patients’ infection rate improves over time has led to (strep) infection being a much less common indication for tonsillectomy than it was in the past.  While tonsillectomy remains one of the most common surgeries performed in the United States, the main indication for children has switched to obstructed breathing.”

It may not seem too surprising that inflamed, swollen tonsils may cause a child some difficulty breathing.  In a second study, researchers gathered data from almost a dozen previous studies that showed a clear correlation between tonsillectomy and sleep quality.  Ms. Rappaport states that “Compared to kids who didn’t get surgery, children who had tonsillectomies had greater improvements in sleep-related quality of life and in negative behaviors that are worsened by apnea…”

As with most newly found data within the medical community, these findings are not definite; they do, however, offer some hope for possible future prevention of Sleep Apnea.  As always, Pittsburgh Dental Sleep Medicine will stay aware and report on this and all other sleep related topics.

Melatonin: A Safe and Natural Sleep Aid?

Disruptive sleep can lead to some serious disruption in daily life, which is why most people that have troubled sleep are desperate to change that fact.  A rising trend in recent years has shown that people are becoming more aware of what substances they put into their bodies, which is commendable.  However, patients’ self-education and assumptions can prove to be more than slightly misguided when considered within the scope of certain medical research.  Prior to taking any over the counter supplements, it is recommended to talk to a physician.  Melatonin is a hormone that already exists in the human body, but this post intends to address some external factors that may not have been considered by the self-educating patient.

What is Melatonin?

Merriam-Webster defines melatonin as “a vertebrate hormone that is derived from serotonin, is secreted by the pineal gland especially in response to darkness, and has been linked to the regulation of circadian rhythms.”  It is important to note a few things, based on this definition.  Notice that the only reference to sleep is that it has been linked to the regulation of circadian rhythms.

It is also important to note that the substance referenced is a hormone; this is something that affects all aspects of a human body.  While the hormone is linked to sleep assistance, it is important to consider the effects of this supplement on an individual in its entirety.


The Science Behind It

In an article by Ginger Skinner published in Consumer Reports, she mentions that the American Academy of Sleep Medicine claims “there is not enough research to clearly demonstrate [it] work[s] – more is needed.”  She goes on to state that “melatonin and valerian…. sleep-inducing benefits of the products are minimal at best.”  While these studies suggest further research, Ms. Skinner still recommends this supplement as a temporary possible aid “for those with jet lag or those who do shift work.”

However, if a person does find sleep assistance in these products, there are still risks to consider.  A 2015 Consumer Reports survey states “about 20 percent of melatonin users… reported next-day grogginess.”  In addition to side effects, it is also important to consider that supplements “are not closely regulated by the Food and Drug Administration.”  This means that there can be issues with consistency of the product, and also the possibility of harmful substances included in the pills.  Ms. Skinner refers to an analysis in 2013 in which valerian root studies showed lead contamination.

Ms. Skinner suggests to look for the “USP Verified” mark.  This is a certification from the U.S. Pharmacopeial Convention which confirms some safety standards (consistency of active ingredients and a clearance in relation to harmful substances).  She also recommends taking melatonin in small dosages for the first time.

Along with Ms. Skinner’s advice, we here at Pittsburgh Dental Sleep Medicine also recommend that you always consult with a physician prior to taking any sleep aids.

Circadian Rhythms, Blue Light and Your Sleep

In the last 20 years, mobile device usage has increased dramatically.  Phones, computers, and tablets/iPads are now all commonplace home items in the US.  While most of us have grown accustomed to the presence of these devices, it is important to be aware of what the increasing ubiquity of our electronic mobile devices could be doing to us as individuals.

In a recent article from New Atlas, Michael Franco asks some questions of Dr. Lakshmy Ayyar regarding these devices, and what it could be doing to our sleep.



Circadian Rhythms and Blue Light

According to, a circadian rhythm is defined as “A daily rhythmic activity cycle, based on 24-hour intervals, that is exhibited by many organisms.”  Dr. Ayyar stresses how critical it is to maintain a good cycle for sleep and other organ health; our bodies rely on external stimuli for this cycle to stay regulated.

Knowing this, it is necessary to note the top two most important external stimuli – daylight and darkness.  Per Dr. Ayyar,

“It is primarily light of a blue wavelength (blue light) that stimulates sensors in the eye to send signals to the brain’s internal clock.  Blue wavelengths are essential and beneficial during daylight hours as it helps us to stay alert and is known to boost performance and attention.”

She goes on to note that this blue light, while acceptable and even sometimes beneficial during daylight hours, can really confuse our circadian rhythm at night and in the evening.  Particularly LED lights, which have “peak emission in the blue light range (400-490 nm) … This essentially ‘tricks’ our brain into thinking it is daytime.” This exposure can also limit the production of melatonin, a hormone that is also critical to the success of an individual’s maintenance of his or her circadian rhythm.


What Can Help?

Most sleep specialists and medical professionals/outlets recommend removing exposure to blue light between one to two hours before bedtime.  If an individual has a regular bedtime schedule, maintaining this recommendation should be fairly easy.  Some people may have trouble maintaining such a schedule; in the instance of late-night deadlines and other necessary occurrences of blue light exposure, there are certain things that can be done to help limit the effects of this possibly harmful exposure.

Per Dr. Ayyar, “Studies have shown that amber colored glasses increase production of melatonin and can lead to improvement in sleep.”

In addition to amber colored glasses, there are filter applications and screen protectors that can be used and/or installed onto mobile devices that help to reduce blue light emitted.  Dr. Ayyar recommends the app Twilight for Android devices, “Night Shift Mode” on iOS devices, and “screen protector[s] such as Ocushield.”  While these are all important and helpful tips, perhaps the best suggestion of Dr. Ayyar’s is this – “It is also important to expose yourself to natural sunlight during the day as this will help to entrain the natural circadian rhythm.”

For more on the related topic of electronics and how they can affect sleep, please see the Pittsburgh Dental Sleep Medicine blog post regarding devices in children’s bedrooms.

New Study: Electronic Devices in Children’s Bedrooms


The use of mobile technology has changed the average American’s lifestyle considerably; we have the ability to answer most questions with just a few clicks of our touchscreen devices.  This convenience has become commonplace for most adults.  It has also become a fairly standard practice for children.  A study done by the National Sleep Foundation finds that well over half of children in the U.S. have some type of electronic mobile device in his or her bedrooms.  We use these devices for any number of reasons, varying from the alarm functionality to entertainment.

Why is this of importance?

An editorial piece written for the Journal of American Medical Association (JAMA) Pediatrics by Drs. Czeisler and Shanahan suggests that children (like adults) fall prey to the alluring appeal of near-constant streaming content, which can lead to a fear of missing out.  This information – coupled with the increased responsibility of school work and extracurricular activities during the school year – is showing some potentially alarming statistics in regards to the American child’s sleep patterns.

We here at PDSM have come to understand some of the important correlations between lack of sleep and several illnesses, including obesity, Type 2 diabetes risk, lack of ability to focus, poor mood, lowered immunity, anxiety and depression.  These studies suggest that the symptoms of poor sleep can be more than doubled with children.  One idea in the JAMA Pediatrics editorial piece suggests that sleep loss and attention-deficit/hyperactivity disorder have almost exact symptoms; which raises the concern of our children suffering unnecessarily.

Another publication in JAMA Pediatrics suggests a link to screen-based electronic devices as being a cause for lack of sleep in children between the ages of 6 and 19.  The main outcomes of the study included “inadequate sleep quantity, poor sleep quality, and excessive daytime sleepiness.” Perhaps the most interesting piece of evidence was shown in the data revealing that the devices did not even have to be in use to cause sleep disruptions in a majority of the children studied.

While there is still more research required to determine the effects of electronics in the bedroom on a person’s sleep habits, the latest children studies mentioned above suggest that parents should be more vigilant regarding the usage of mobile devices before and during bedtime.  Creating a family spot for mobile devices to charge overnight is one way to eliminate this potential threat.  Another idea is creating a phone-off time, about an hour before bed time.  This can help the child to calm down before bed time, which can assist in more restful sleep.

For further reading, check out our additional sleep tips at the PDSM blog.



Pittsburgh Sleep Apnea Dentist


Are You Looking For a Sleep Apnea Treatment?
If you’re located in or near the Pittsburgh area, you’re in luck! There just so happens to be an experienced and highly qualified team of sleep medicine dentists in four areas in and around the Pittsburgh region.

Pittsburgh Dental Sleep Medicine (PDSM) was created by Dr. Robert Rogers, a pioneer in dental sleep medicine. He was founding president of the Sleep Disorders Dental Society, which is now known as the American Academy of Dental Sleep Medicine (AADSM). The AADSM was the first ‘national professional society dedicated exclusively to the practice of dental sleep medicine.’ It now has over 3,000 members.

Dr. Rogers has been treating sleep apnea in the Tristate area for over 25 years. He started the Pittsburgh Dental Sleep Medicine Network and now treats sleep apnea out of the main office in Wexford, PA, while also traveling all over the United States giving lectures on sleep apnea and oral appliance therapy. Most recently, he patented a multi design appliance that is used at all PDSM locations. He works with 3 other dentists in the Pittsburgh area who he personally trained in the treatment of Obstructive Sleep Apnea: Dr. Michael Fazzini, DDS, DABDSM, FAGD, Dr. Christopher Mascio, DMD, and Dana Mascio, DMD.

The Pittsburgh Dental Sleep Medicine Network treats obstructive sleep apnea (OSA) with oral appliances. Oftentimes, oral appliance therapy is a treatment option for OSA sufferers who cannot tolerate cumbersome continuous positive airway pressure CPAP treatment. Oral appliances fit in the mouth like a sports mouth guard, and are custom made. They support the jaw and open the pharynx to keep the airway open during sleep. (Learn more about oral appliances here)


The Pittsburgh Dental Sleep Medicine Network has 4 locations in the Pittsburgh area including Wexford, Downtown Pittsburgh, Monroeville and Burgettstown. Make an appointment at any of our locations by calling 724-935-6670.

Learn more about oral appliance therapy at Pittsburgh Dental Sleep Medicine by reading the following articles: