Sleep Health - Q1 2020

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DR BIRGIT HÖGL, MD, WORLD SLEEP SOCIETY Tips to follow to help make sure you get a good night’s sleep » p2

K ATH HOPE, HOPE2SLEEP Snoring would cause June to stop breathing 15-30 times an hour” » p4

MARK ROWLAND, MENTAL HEALTH FOUNDATION Sleep: one of the single most important things? » p6

Sleep Health

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A good night’s rest is essential to a healthy lifestyle - protecting you physically and mentally as well as boosting your quality of living Lisa Artis, The Sleep Council p6

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Why your health needs quality sleep It is estimated that one in three people have trouble sleeping. While lack of quality sleep is tied to many health ailments, it is important to remember that you can do a lot to help your sleep.

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irst, simply plan enough time for sleep – it must be a priority.

Next, look at the environment that you sleep in; making it dark enough and striving for warm hands and feet at the time of falling asleep can help.

A n o t h e r, o f t e n o ve r l o o ke d , environmental factor is sound and protecting yourself from it. Even low sounds, that may not fully wake you, can disturb the integrity of your sleep.

Why do we need healthy sleep?

It is important to understand that healthy sleep restores and energises you, leaving you feeling wide awake, energetic and lively all day long.

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Wit hout he a lt hy sle ep, you w i l l l i kely fac e c on se quenc e s such as day t ime sleepiness or fatigue, irritability, moodiness, a nd d i f f ic u lt y foc u si ng a nd concentrating.

Certain sleep disorders c a n i nd ic ate a r i sk of f ut u re neurodegenerative disease, and need to be diagnosed so you can begin any necessary treatment and/ or make appropriate changes to your lifestyle.

The s e a re t he re a s on s why we must care that certain sleep disorders are sometimes unnoticed or not taken seriously. High quality sleep and good sleep integ r it y reduces rates of diabetes, chronic illnesses and high blood pressure.

How can you achieve healthy sleep?

World Sleep Society has created a list of sleep hygiene habits for healthy sleep. When seeking an optimal night’s sleep, try to: • Establish regular sleep and wake times.

• Avoid excessive alcohol ingestion four hours before bedtime.

• Do not smoke.

• If you are sensitive to caffeine, avoid it six hours before bedtime.

• Avoid heavy, spicy, or sugary foods four hours before bedtime, but also avoid going to sleep hungry.

• Avoid light from smartphones

WRITTEN BY: DR BIRGIT HÖGL, MD President, World Sleep Society

Certain sleep disorders can indicate a risk of future neurodegenerative disease, and need to be diagnosed so you can begin any necessary treatment and/or make appropriate changes to your lifestyle and tablets near bedtime.

• Reserve the bedroom environment for sleep and sex only, avoiding work or study.

• If you do not fall asleep in 20 minutes, leave the bedroom and return to bed when you’re actually tired so your body will begin to associate the bedroom environment for sleep only.

• Exercise regularly, but not too close to bedtime.

• If you have trouble sleeping during the night, do not exceed 30 minutes of daytime sleep or napping.

If you are still unable to sleep well after following these suggestions, consider consulting a sleep specialist.

Read more at healthawareness.co.uk

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Common myths about sleep One in three people in the UK suffer from sleeplessness.1 How can this be improved?

A good start is to address common misunderstandings.

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good night’s sleep is about more than feeling fresh, it is the bedrock of wellness.

Good sleep is associated with better cardiac f unction 2 , blood sugar regulation3, lower obesity4 and it also contributes to good mental health.5 Healthy sleep can insulate us against all sorts of ailments. A study found that mortality rates from ischemic heart disease, cancer and stroke were lowest for individuals sleeping seven to eight hours a night.6 Men sleeping six hours or fewer had nearly double the death rate than those getting the right amount of sleep.6 Studies of men under 65 found those who had three to five hours’ sleep a night had a 55% greater risk of dying of prostate cancer than men who slept for seven hours a night.7 Myth: ‘Dreams are meaningless‘ It is generally agreed that dreaming is positive. The process helps to embed memories in the long term8 and, it is suggested, allows stressful experiences to be replayed, analysed and downgraded.8,9 If sleep is interrupted the memories remain associated with emotion.

Patients with post-traumatic stress disorder experience high levels of the hormone noradrenaline, which blocks the ability to dream typically.

As a result, the emotion associated with a memory remains vivid, long after the event.8,9

A good night’s sleep is more than merely about feeling fresh. It is the bedrock of wellness.

Myth: ‘Late risers are lazy’ Night owls are a real phenomenon, suggests science. They struggle to fall asleep early at night, even if they take all reasonable precautions.

They also dislike waking early, complaining of drowsiness if forced to attend early-morning meetings.10 There appears to be a strong genetic component to sleep types.

Our knowledge of night owls has recently been enriched by data from the genetic testing service 23andMe and t he U K Bioban k, wh ich researches the genes of people in the UK.10 Using genome-wide data from nearly 700,000 participants, a study found hundreds of genes associated w it h chronot y pe - t he t y pe of sleeper you are.10 The question is whether schools should adapt to the needs of their teenage students, who seem to become night owls. A University of Wash i ng ton ex per i ment on students moved the start time of t he school day from 7. 50am to 8.45am. Sleep times rose by 34 minutes. The study also cited

improved grades, and a reduction in lateness and absences.11 Myth: ‘All sleep aids are the same’ The range of treatments can be confusing for consumers to cope with. Consumers may fear a sleep aid will lead to addiction or have side effects. Each category of sleep a id is d ifferent a nd shou ld be considered independently.12 Long-term insomnia patients m ay b e p r e s c r i b e d a s t r o n g sedative. But the treatment for acute insomnia, typically lasting bet ween one to four weeks, is u s u a l l y a n o ve r- t h e - c o u n t e r t reat ment w it h fewer ser iou s side effects and a lower risk of developing dependency.12 Myth: ‘Catching up on sleep makes up for sleep lost’ In the chaos of modern living, it’s normal for bedtimes to be irregulated. Often, we say we’ll catch up on sleep later or at the weekend.

However, sleep loss cannot simply be replaced later without a cost.13,14

A recent study took two groups of people and limited their sleep to just five hours a night. One group was allowed to catch up on sleep at the weekend, the other group remained sleep restricted. Both groups snacked more, gained weight and showed signs of deteriorating metabolic health. The catch-up sleep failed to compensate adequately.13,14 The lesson is clear. To guarantee the best health in body and mind, a good sleep routine should be established and maintained.

All links last accessed on June 26, 2019

Essential information Nytol Herbal Simply Sleep One-A-Night tablets contain Valerian root extract. A traditional herbal medicinal product for use in the temporary relief of sleep disturbances exclusively based upon long-standing use as a traditional remedy.

Always read the leaflet.

Nytol One-A-Night Tablets contain diphenhydramine. An aid to the relief of temporary sleep disturbance. Always read the leaflet.

For more information please visit

References: 1. https://www.nhs.uk/live-well/sleep-and-tiredness/why-lackof-sleep-is-bad-for-your-health/ 2. https://www.sciencedaily.com/releases/2016/12/161202100943.htm 3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3869143/ 4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3632337/ 5. https://www.thelancet.com/journals/lanpsy/article/ PIIS2215-0366(17)30328-0/fulltext 6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2845795 7. https://www.aacr.org/Newsroom/Pages/News-Release-Detail.aspx?ItemID=1035 8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3768102/; 9. Walker, M. Why we sleep. Great Britain: Penguin Books; 2018 https://www.freud.org.uk/learn/discover-psychoanalysis/ the-interpretation-of-dreams/ 10. https://www.nature.com/articles/s41467-018-08259-7 11. https://www.npr.org/sections/healthshots/2018/12/12/676118782/sleepless-no-more-in-seattle-later-school-start-time-pays-off-for-teens 12. Ali F., Defeating Sleep Deprivation, February 2019; OTC Medicines Casebook – Insomnia; Independent Community Pharmacist: page 32 13. https://www.cell.com/current-biology/pdfExtended/S09609822(19)30098-3 14. https://www.bbc.co.uk/news/health-47400879

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June now helps to raise awareness of sleep apnoea with Hope2Sleep charity.

June was living with undiagnosed sleep apnoea until she spoke to her GP June Rymer, a retired NHS employee, is one of the patients Hope2Sleep supports. It took a weekend away for June to discover she was suffering from sleep apnoea.

WRITTEN BY: KATH HOPE Founder & CEO, Hope2Sleep Charity

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noring would cause June to stop breathing 15-30 times an hour, but it took depression to set in until she finally took action…

June was sharing a room with her cousin and daughter who, as well as struggling to sleep through the noise of June’s snoring, were shocked to notice that, in between snores – she stopped breathing.

June’s husband had mentioned this previously but, not realising the seriousness of untreated sleep apnoea, she ignored the warnings. It was only when her life took a downward spiral and depression set in that she knew a GP appointment was necessary.

Thanks to June’s GP, she was diagnosed and treated for sleep apnoea Fortunately for June, her GP spotted the symptoms of sleep apnoea and, before prescribing anti-depressants, referred her to the sleep and respiratory clinic at her local hospital for a home-sleep study. June was shocked to receive a diagnosis of moderate sleep apnoea (moderate means the person stops breathing 15-30 times per hour), and she certainly wasn’t looking forward to sleeping with a CPAP (continuous positive airway pressure) machine and mask, which is the gold-standard treatment for obstructive sleep apnoea.

To June’s relief, her depression began to lift After just a few nights of using the CPAP machine, June’s mood began to lift and her other symptoms of untreated sleep apnoea disappeared – snoring, morning headaches and the sleep disturbances caused by sweating, nightmares and occasional choking.

“Even the recurrent throat infections I’d previously suffered from stopped,” says June, “I started to get back my love for life – the lack of energy that I presumed was just a part of ageing actually returned.”

Untreated sleep apnoea is linked to heart attacks and strokes As a result of her life-changing diagnosis, June now regularly volunteers at Hope2Sleep’s support and awareness events, where we provide free advice and a sense of community. June believes that good support is vital for anyone who must sleep every night with a mask.

June would now never consider sleeping without her CPAP therapy, and risk all those old symptoms coming back. She hopes that, by reading her story, anyone who snores – or has been told that they stop breathing during sleep – won’t ignore the signs like she did. This is especially important as June now knows that untreated sleep apnoea can increase the risk of heart attacks, strokes as well as many other medical conditions.

Read more at https://www.hope2sleep.co.uk/sleep-apnoea-information.html

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The importance of dentistry in management of sleep apnoea WRITTEN BY: DR ADITI DESAI President British Society of Dental Sleep Medicine

One billion people are thought to suffer with sleep apnoea, yet many do not know they have it. Dentists could play an important role in the prevention, screening and treatment of sleep apnoea.

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here are thought to be over a billion people worldwide who suffer with obstructive sleep apnoea (OSA). A large percentage of these are either not aware of, or not diagnosed with, a sleep related breathing disorder (SRBD).

Dentists can be crucial in identifying patients at risk of sleep apnoea Dentistry’s role in the management of SRBD, of which snoring, daytime tiredness and obstructive sleep apnoea (OSA) are the most common, is an important one.

Patients visit their dentist and hygienist more regularly than their primary care doctor, which places them in an important position to screen, assess and identify those at risk of this debilitating disease.

Although formal diagnosis of this disease can only be carried out by a physician, once diagnosis is confirmed, dentists are best qualified to provide oral appliance therapy to treat these patients.

A multi-disciplinary approach In 2 017, The A mer ican Denta l A s s o c i at ion adopte d a p ol ic y that states that dentists can and should play an essential role in the multidisciplinary management of patients with certain sleep related breathing disorders.

The underlying cause of SRBD is multifactorial, which is best treated through a multidisciplinary team approach with collaboration between the patient’s dentist and physician.

Most snorers and mild apnoeacs can be successfully treated with an oral appliance

Appropriately trained dentists are well placed with their education and hands-on experience that is necessary to provide such therapy, wh ich en ha nces t he pat ient ’s experience and treatment outcome.

It is the vast knowledge of the oral environment that further endorses the trained dentist’s role in delivering suitable appliance selection thus minimising complications.

In children, the dentist’s knowledge of anatomical deficiency, craniofacial growth and development or other risk factors should lead to medical referral or orthodontic intervention to treat and/or prevent SRBD. All patients should be entitled to treatment Surgical methods and positive airway pressure (PAP) devices are used by physicians. Combination treatment using PAP therapy with oral devices is recommended for those who are intolerant of PAP pressure but in whom oral appliance therapy alone may not be adequate to effect treatment success.

W h i l e c o n t i n u o u s p o s i t i ve

airway pressure (CPAP) remains ‘gold s t a nd a rd’ t re at ment for the moderate to severe OSA, the compliance rate is low.

As a result, the joint statement from the American Academy of Sleep Medicine and the American Academy of Dental Sleep Medicine in 2015, recommends that all patients are entitled to some treatment as opposed to none.

Patients need to be involved in their treatment decisions Most snorers and mild apnoeacs can be successfully treated with an oral appliance, and the noncompliant CPAP users should receive alternative treatment options of which a bespoke oral appliance is recommended.

It f ur t her recom mends t hat patients be part of the decisionm a k i n g pro c e s s a s to wh ic h treatment option is recommended versus which treatment option the patient is able to tolerate or is willing to accept.

Compliance rate of a bespoke Mandibular Advancement Device (MAD) is higher than CPAP, which makes the overall effectiveness of treatment benefit similar.

Bespoke Dental Devices m a nu f a c t u r e d w it h a b s o l u t e precision minimise the risk of compl ic at i ng side ef fe c t s a nd enhance the patient experience, which further improves compliance and treatment effectiveness.

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Sleep is the unsung hero of mental health

How to get a good night’s sleep

Many of us struggle to get a good night’s sleep regularly, which is having a knock-on effect on the way we feel emotionally and psychologically.

If there’s one thing you do this year, it should be making sure sleep is a priority. Good sleep habits will last a lifetime and it is one of the fundamental tools for maintaining good physical and mental health.

WRITTEN BY:

WRITTEN BY: MARK ROWLAND Chief Executive, Mental Health Foundation

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f you’ve ever gone without sleep or had too little sleep for a long period of time, then you will know what a big difference it can make to your life, including how you feel emotionally.

As the quality and quantity of our sleep has declined, millions of us are living with poorer levels of physical and mental health as a result.

Research links sleep with emotional wellbeing Research carried out by the Mental Health Foundation suggests that sleeping well is one of the single most important things people can do to look after their emotional wellbeing. How well we sleep can influence our mental health, and our mental health can influence how well we sleep.

There are lots of reasons why we don’t sleep well. We may have busy schedules, feel worried or anxious, care for young children or adults, look at our phones for too long, work shifts, or live in noisy neighbourhoods.

Perhaps you’ve tried to follow sleep hygiene advice, but it hasn’t worked.

Maybe you struggle with sleep and don’t know why.

It will take individual behavioural changes, but workplaces, education and healthcare policy all have a role to play in prioritising good sleep, and with it, mental health.

Mental Health Awareness Week The Mental Health Foundation is going to focus on sleep during this year’s Mental Health Awareness Week from 18-24 May. The week will provide information and advice, while campaigning for the changes that can help to improve wellbeing and recovery.

And this includes sleep. With poor sleep, we may be just about surviving but not really thriving. The reality is that, most of us are not sleeping well because of circumstances that are beyond our control.

During Mental Health Awareness Week we will release new research into the factors that connect sleep and our mental health, and ask different age groups about their attitudes to sleep and how much they get.

The Mental Health Foundation wants to start a national conversation about how we can all sleep better, and uncover the hidden mental health costs of the poor sleep that affects so many of us. We want to investigate the changes we must make as individuals, communities and as a society, to all get the rest we need!

Read more at healthawareness.co.uk

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LISA ARTIS Head, The Sleep Council

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e all sleep, but many of us don’t do it ver y well. A good night’s rest is essential to a healthy lifestyle - protecting you physically and mentally as well as boosting your quality of living.

While there is no magic number for how many hours’ sleep you need, the consensus is most of us need around seven to eight hours. Being properly rested means you’re clear-headed, more focused and more patient.

It’s not uncommon to have one or two poor nights of sleep a month, but if you feel your sleep is starting to suffer and could be improved or optimised further, then it’s important to look at your sleep hygiene, which may be able to solve the problem.

What is sleep hygiene?

For starters, it isn’t about brushing your teeth or having a wash before bed! Sleep hygiene is a variety of different healthy lifestyle habits and behavioural approaches that play an important role in how alert we are in the day and how well we sleep at night.

E ve r yone c a n b e ne f it f rom practising good sleep hygiene to help create ideal conditions for healthy, restorative sleep. Sleep hygiene education is often used alongside other strategies, such as medication or cognitive behaviour therapy, to treat insomnia.

Key steps to maintaining good sleep hygiene Regularly assess your sleep quality, as even small changes can have a huge

impact. Completing a sleep diary for two weeks is ideal to see what you are doing, eating, etc on the days when you do and don’t sleep well.

From that you can start to identify what sleep hygiene principles to put into place. For example, if you can see that on a day you didn’t sleep well you drank eight cups of coffee then maybe it’s time to limit the caffeine intake!

content can be stimulating and keep us alert at the wrong time of the day.

Routines that are associated with sleep signal the brain that it’s time to wind down. Find alternative ways of relaxing like warm baths with calming scents, quiet, soothing music, reading, gentle stretching and yoga.

It’s also important to establish a

Regularly assess your sleep quality, as even small changes can have a huge impact To ensure you experience good sleep it’s essential to follow good lifestyle habits and to eliminate the factors that are causing you disturbed sleep. For example, make sure that your bedroom is the right environment (cool, dark and quiet), that your bed is comfortable, limit daytime naps, exercise to promote quality sleep and avoid foods, drinks and stimulants that can hinder sleep.

A daily dose of natural light (even on cloudy days) also helps reset our internal body clock; it helps us get over feeling groggy when we have just woken up and makes us more alert. Get out into the natural light as soon as you can after waking up, and preferably around the same time every day.

Avoid screen time at least an hour before bed – not only does it keep us awake longer as the blue light suppresses the production of the sleep hormone, melatonin, but the

regular sleep pattern – i.e. going to bed and waking up at roughly the same time. Your bodies and minds will feel much better for it.

The health benefits Getting quality sleep is important for your physical and mental health.

It improves mood, concentration, decision-making, alertness and memory.

It helps lower your risk of health conditions such as diabetes, strokes and heart disease. It strengthens your immune systems and can help maintain a healthy weight.

Sleep makes you look better, feel better, behave better, perform better and think better!

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Why mindfulness is the way to better sleep health Lack of sleep is the number one trigger of stress for the majority of Brits – but mindfulness and meditation has been linked to improving the quality of sleep.

INTERVIEW WITH:

DR MEGAN JONES BELL Chief Science Officer, Headspace

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n these information-heav y, technology-driven days, many of us live at a frantic pace. We’re always rushing somewhere, our phones are always on, and our brains are always overloaded. “ We’re i nu nd ate d w it h information,” agrees Dr Megan Jones Bell, Chief Science Officer at Headspace, a global leader in mindfulness through its app and online content offerings. “Not only that, but a lot of the content we’re consuming is worrisome, particularly if we’re reading the news headlines.”

In bed at night, we might start thinking about the problems we’ve encountered during the day, or the problems we might encounter in the future. No wonder many of us have trouble sleeping.

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The problem is, the more pressure we put on ourselves to fall sleep, the more frustratingly awake we feel.

“Just because you’d like it to be time to sleep, doesn’t mean that your brain is going to slow down and let you sleep,” says Dr Jones Bell. “That’s where mindfulness can help. Mindfulness is the ability to be present in the moment and to be free from distraction with an open mind and a kind heart. It’s to have compassion for yourself and for the world around you. It can help reduce stress, job-related burnout, depression and anxiety, as well as improve your focus.”

Daytime meditation for better focus and improved sleep One way to achieve mindfulness is through meditation, something that Dr Jones Bell has experienced personally. “Meditation has helped me in my day-to-day, moment-tomoment life for at least a decade,” she says. “When I meditate and apply mindfulness to my life, I’m more patient with my husband, I’m more present for my son, I listen more effectively to my co-workers, I’m more compassionate to strangers. I’m happier with myself and I feel calmer and more focused.”

To sleep better at night, Dr Jones Bell advises meditating during the day, ideally first thing in the morning. “If you’re feeling a bit foggy

Mindfulness is the ability to be present in the moment and to be free from distraction with an open mind and a kind heart when you wake up, meditation can help you set an intention for your day and be your best self in your interactions with others.”

You’ll also improve your sleep if you use mindfulness activities to reduce daytime ‘hyperarousal’ — overloaded feelings of stress or anxiety. “We have to give our brains the chance to recover and take a break,” notes Dr Jones Bell. “That could be with a mindful walk, a guided meditation, or even just making a cup of tea and being really focused on the smell of the tea. Essentially, you can be present in anything you do, which can help buffer the effects of chronic stress that many people experience.”

Living in the present gives you a feeling of control One of the most important things we can do to improve sleep quality is to wake up at the same time every day.

“Having a consistent sleep/wake time is much more important than

having a consistent bedtime,” says Jones Bell, who also advocates a wind down ritual before bed, such as reading a book or listening to some music.

“Plus, improve your sleep hygiene by ensuring you’re in a darkened room that’s the right temperature.” Even so, she points out that researchers found that a group of people aged 55 and older with significant sleep disturbances benefitted more from mindfulness awareness practice (M AP) than improved sleep hygiene practices.

Technology can impact our sleep hygiene, especially via the blue light of a phone screen when staring directly into the phone. However, tech can also be a force for good. Sleep by Headspace offers sleepcasts, sleep music, wind downs, soundscapes, and guided exercises to help with waking up in the night and easing the mind into a truly restful night’s sleep.

“Technology is neutral,” notes Dr Jones Bell. “It’s how we engage with it and control it that affects us.”

Control is key to mindfulness, too.

“Mindfulness is beneficial because it puts you in the driving seat,” says Dr Jones Bell. “Living in the present gives you more control over how you spend your time and where to focus your thoughts. And that’s extremely empowering.”

More info Headspace’s sleepcasts and sleep music have been specially tailored and developed to create the ideal conditions for a healthy, restful sleep at night. The app also recently launched new daily Wake Up content, designed to help members start their day on a mindful note by prompting users to take healthier actions throughout the day, focusing on five key elements of living a mindful life: meditation, sleeping, moving, eating and playing. Active Headspace members average over 1.25 million minutes of sleep content every night over the past two years.

Find out more at: www.headspace.com

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