Adolescent Sleep Needs and Later School Start Times

“Adolescents today face a widespread chronic health problem: sleep deprivation.  Although society often views sleep as a luxury that ambitious or active people cannot afford, research shows that getting enough sleep is a biological necessity, as important to good health as eating well or exercising.”National Sleep Foundation

Why Is This Important?

“Getting a little extra sleep in the morning can be vital for teens”
Horacia de la Iglesia

Sleep deprivation is a detriment to all age groups, however adolescents seem to need as much sleep as children do – 8.5 to 9.25 hours a night (National Sleep Foundation).  

Once children begin their transition to adolescence, their sleep patterns tend to change and their alertness becomes greater longer into the evening.  This may have something to do with their melatonin secretion, which has been shown to happen later at night than it did when they were younger. Since the beginning of the melatonin secretion happens later into the night, it also stops later in the morning – “which makes it harder the wake up early.

Mary A Carskadon pioneered this adolescent sleep research, and also found that “the circadian timing system can be reset if light exposure is carefully controlled.”  (National Sleep Foundation)
In 2014, the American Academy of Pediatrics issued a policy statement” denoting the benefits of moving school start times to 8:30 – and only 17% of public middle and high schools have followed suit. (NPR)

Later School Start Time Findings

Latest research suggests that school districts in Seattle that have delayed start times for high school have telling evidence of improved school engagement.  The experiment was conducted in two schools – Franklin and Roosevelt High Schools. The students’ sleep habits were studied before and after the school start time change, and there was an average of 34 additional minutes of sleep that the students were able to get after the change.

The study also found an improvement in grades and a reduction in tardiness and absences.”

The study also found that the later start times did not delay the adolescents’ bed time.  The researchers say they are not certain that the additional sleep increased academic performance, but that the classroom engagement was significantly higher.  

A doctor from the American Academy of Pediatrics – Dr. Cora Collette Breuner – was not involved, but she did react enthusiastically to the news of the study.  She also mentioned that this study was a progressive step toward finding a way to level the playing field between higher- and lower-income districts.(NPR)

Whether or not we listen, sleep continues to be a priority for individuals and adolescents are no exception.  In fact, they need the help of adults to help enforce the necessary changes for their benefit. Further research on these studies can be found in the embedded links, and more information can be found in our blog posts relating to the negative effects of sleep deprivation.

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.

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!

 

The Sleep Apnea / Cardiovascular Connection

Sleep apnea is extremely common in patients with cardiovascular disease. It is well known that when sleep apnea is left untreated, medical comorbidities are likely including; cardiovascular complications such as hypertension, heart attack, stroke, A-Fib, and endothelial dysfunction. Understanding the relationship between these two serious maladies and how to impact the ongoing negative cycle by treating OSA can help your patients improve their cardiovascular health.

 

Blood Pressure During Sleep

Sleep should be a time when the body regenerates, and recovers from the stress of waking hours. In normal sleep and breathing, blood pressure and heart rate remain below waking levels on average. For individuals without sleep apnea, sleep and normal breathing has a relaxing effect on the cardiovascular system. However for sleep apnea sufferers, disrupted breathing has a negative effect on the cardiovascular system that may result in an increase in blood pressure, cardiac dysrhythmias, endothelial dysfunction and more. The mechanisms triggered by sleep-disordered breathing can carry over into waking hours.

 

Sleep Apnea and Hypertension

Intermittent desaturations at night are associated with release of stress hormones (catecholamines) that cause vasoconstriction and elevated blood pressure. Studies have shown that this elevation in catecholamine then persists during the daytime resulting in systemic hypertension.

Patients with sleep apnea are also at risk for cardiac rhythm disturbances especially ventricular arrhythmias and atrial fibrillation as well as myocardial ischemia.
Untreated Sleep Apnea can lead to hypertension, cardiac Arrhythmias, Stroke, Myocardial ischemiaIt is estimated that 80% of Americans with sleep apnea are undiagnosed. Sleep apnea affects more than 20 million unaware Americans. This is why we urge health care practitioners such as yourself to keep sleep health at the forefront during patient interaction. Treating sleep apnea in individuals who also have cardiovascular issues has been proven to improve co-morbidities like hypertension and arrhythmia.

 

Start with Sleep Health

When assessing your patients, it is useful to inquire about quality of sleep, presence of snoring, observed apneas, awakening from sleep gasping and daytime hypersomnolence.  Urge your patients to get a sleep test when appropriate, and begin managing sleep apnea if indicated.

Please use our website as a resource, both for yourself, and for your patients. We have many blog articles to help understand sleep apnea, treatment options, the effects of sleep deprivation, sleep study information, and more. Our goal is to help your patients get treated if they suffer from sleep apnea, and improve their quality of life starting with improving sleep health.

This blog was co-written by Dr. Rogers, DMD, DABDSM, and Dr. Bijwadia, MD.

Disrupted Sleep Linked to Alzheimer’s Disease

Researchers recently reported at the Alzheimer’s Association International Conference that none other than disrupted sleep may be a cause of Alzheimer’s. According to researchers from the University of California, Berkeley, disrupted sleep aids in the creation of beta-amyloid, which starts a process that ends in neurodegenerative disorders.

How it works:

Beta-amyloid are the main component of Amyloids. Amyloids are protein aggregates developing from improperly folded proteins. This leads to amyloidosis, which we believe leads to neurodegenerative disorders including ALS, Parkinson’s, Alzheimer’s, and Huntington’s disease.

Plan to Treat

There is currently no cure for the neurodegenerative diseases listed above. But with this new research, we can take precautions and decrease our likeness of getting these ill-fated and incurable diseases. Get better sleep now. Get better quality sleep.  Plan for your future and the future of your loved ones and get the best chance at a long, healthy life. Get a sleep test and find out your sleep patterns.

Sleep Apnea

According to Dr. Kristine Yaffe of the University of California, San Francisco,

‘Sleep apnea — brief interruptions of breathing that repeatedly awaken people without them realizing — caused a nearly two-fold increase in the risk [of being more likely to develop mild cognitive impairment and early memory problems that sometimes lead to Alzheimer’s].” She recommended that people at risk of Alzheimer’s be screened for sleep disorders, especially apnea, which has effective treatment.

 Are you at risk for Alzheimer’s disease? Take a look at the risk factors listed below. If you have one or more of these risks, then you should get asleep test and do what you can to prevent the disease.

  • Advanced Age
  • Family History
  • Genetics
  • Latino and African American Dissent
  • History of unhealthy living

Take a closer look at these risk factors on the Alzheimer’s Association website.

Alzheimer’s Association

After reviewing three different and extensive scientific studies on disrupted sleep and Alzheimer’s disease, The Fisher Center for Alzheimer’s Research Foundation found this: “…Poor sleep, as well as sleep apnea, is a common problem in the elderly. Just because you don’t sleep well doesn’t mean you will get Alzheimer’s disease. A sound night’s sleep, though, may be a critical component of a healthy lifestyle – and might even help to keep Alzheimer’s at bay.”

Sleep Deprivation

A close look at the effects of deprived sleep on memory and learning.

Sleep Deprived

What happens when you are deprived of sleep? Whether you’re keeping yourself awake because of work or travel, or you are not getting proper sleep due to sleep disorders such as insomnia or sleep apnea, let’s take a look at why we need sleep, and what happens when we are sleep deprived.

Dr. Alan Pack, a Biologist at the University of Pennsylvania looks at sleep deprivation at the cellular level. Through his studies, he has developed a theory; Sleep deprived organisms do not ‘get proteins properly folded’ in certain cells. He has found this theory congruent in organisms such as mice, rats, and fruit flies. Unfolded proteins can form clumps inside cells, which Dr. Pack believes relates to that tiredness you feel when you are sleep deprived.folding proteins

The deepest stage of sleep, or non-rapid eye movement sleep, is also called slow wave sleep because of the synchronized slow waves that can be seen through EEG activity. A series of coordinated events happen to neurons during this time. “The first section of the wave signifies a down state, which is an inhibition period in which the neurons in the neocortex are silent. This is the period when the neocortical neurons are able to rest. The second section of the wave signifies an up state, which is an excitation period in which the neurons fire briefly at a high rate.” Neil Carson cited these scientific findings in his book, ‘Physiology of Behavior’. During these slow oscillations, the synoptic connections get progressively weaker, softening all of your connection and memories from the day. Which in turn, softens the background noise and makes more important memories and connections stand out. Sleep works in a way that ‘cleans the brain’, and in doing so, allows us to remember what we consider important, while ‘cleaning out’ the things that we consider less important.

Memory and making connections are only a few of the vital processes that sleep capacitates. Sleep is vital to life and there is good reason for it. Stay tuned to the Pittsburgh Dental Sleep Medicine Blog as we delve into the various essential processes sleep grants to the mind and body.

Listen to the ‘Sleep Deprivation’ RadioLab below, and learn more about Dr. Packs’ theory and how it relates to the sleep deprived, as well as how sleep relates to our learning process.

Learn tips for getting better sleep by reading our ‘How to Get Better Quality Sleep‘ blog post, where you can find out how much sleep you should be getting for your age, the importance of maintaining a sleep schedule, how to make a sleep space, and more.

Cardiovascular Disease and Obstructive Sleep Apnea (OSA)

Risk Factors from Sleep ApneaSleep related breathing disorders such as obstructive sleep apnea (OSA) are very common disorders found in patients suffering from cardiovascular disease. OSA occurs within a large segment of patients with cardiovascular disorders such as coronary artery disease, stroke, and atrial fibrillation. It is important for those who suffer from cardiovascular disease to be treated for sleep apnea if they suffer from it because sleep apnea may contribute to how heart disease progresses. Research concerning the link between heart disease and OSA is difficult due to other conditions that often coincide in patients with sleep apnea and cardiovascular disease such as obesity, diabetes, and metabolic syndrome.

A person suffering from cardiovascular disease are 2 to 3 times more likely to have sleep apnea, according to the Sleep Apnea and Cardiovascular Disease Study conducted by The American Heart Association and the American College of Cardiology Foundation. The study gathers that patients suffering from heart disease should be especially concerned about the presence of sleep apnea when they also have any of the following symptoms:

  • Apneas
  • Disruptive Snoring
  • Obesity
  • Waking HypersomnolenceUntreated Sleep Apnea Affects

Sleep apnea can increases blood pressure to levels as high as 240/130 mm Hg. Apneas can increases sympathetic activity to peripheral blood vessels -which can cause vasoconstriction –which in turn causes a reduction in blood flow. Patients with OSA have faster heart rates during the day, which suggests an increase in cardiac sympathetic drive. All of the above repercussions of sleep apnea are detrimental in general, but to a patient with cardiovascular disease or someone prone to heart disease, it can prove fatal.

By treating sleep apnea, the measures of high blood pressure and heart failure improve greatly. Treating OSA lessens the work your body has maintain vital systems, such as giving your brain the oxygen it needs to survive. That is why treating sleep apnea decreases the complications of cardiovascular diseases.

If you know someone who is prone to heart disease, or currently a patient of heart disease or high blood pressure, share this article with them. Because sleep apnea is a treatable disorder, and treating it can significantly improve their condition and overall health. Learn more about sleep apnea on the Pittsburgh Dental Sleep Medicine page: ‘What is Sleep Apnea‘.

Dental Sleep Medicine: A Less Invasive Treatment for Depression?

Sleep Apnea and Depression

If you know someone suffering from Depression, you may recommend that they take a sleep study to learn about the quality of their sleep. Treatment of a sleep disorder could very well be the answer to treat their clinical depression.

Clinical depression is disorder that often coexists with obstructive sleep apnea (OSA). So, why does depression accompany OSA? And does one cause the other? This subject is highly controversial. So lets look at the different possible connections of the two disorders:

Depression frequently causes sleep disruption and weight increase which in turn, can cause or increase the severity of sleep apnea. Conversely, OSA could cause depression by disrupting sleep and consequently causing changes in thinking, as denying the brain of oxygen can create changes in cognition. So if depression is an effect of OSA, then treating OSA might improve depressive symptoms.

A recent systematic review conducted by researchers of University of Calgary, Canada shows notable results on the “Effect of Treatment of Obstructive Sleep Apnea on Depressive Symptoms: Systematic Review and Meta-Analysis.” The study analyzes data from 22 randomized controlled trials that linked OSA treatment with CPAP and oral devices to a decrease in depressive symptoms. Read the full research article.

The study showed that in 19 of 22 trials that examined CPAP or oral appliance therapy on patients with OSA and depressive symptoms, the therapy significantly improved depressive symptoms. Unlike past studies on the connection of depression and OSA, the results from this study are large enough to be clinically relevant. However, this study does not compare the efficacy of CPAP or oral appliances to that of antidepressant medication. However, the importance of the study is what is suggests; that treatment of OSA can be a less invasive treatment for clinical depression.

If you or someone you know suffers from clinical depression or sleep apnea, get a sleep test and get treated. You could treat two disorders  while you sleep with an oral appliance.

Tired Depressed Sleep Apnea Annoyed