Healthier Sleep Magazine | Special Edition | Travel by World Sleep Society

healthiersleepmag.com Special Travel Issue In Collaboration with Langham Hospitality Group

Jet Lag

and How It Affects Sleep

Sleeping Pills

and Travel

Mindfulness

Can Improve Your Sleep

Healthier Sleep Magazine A publication of World Sleep Society Your Trusted Source for Improving Sleep Publisher World Sleep Society Editor Lindsay Jesteadt, PhD jesteadt@worldsleepsociety.org Sales Manager healthiersleep@worldsleepsociety.org Designer Brook Lanz Copy Editors Stephanie Fee Jennifer Haugen Koski Contributing Writers Aaron Bromberg Deepak Chopra MaryAnn DePietro, CRT Lindsay Jesteadt, PhD Wendi Kitsteiner Clete A. Kushida, MD, PhD, FAASM Jason Ong, PhD Jessica Thomas, MPH World Sleep Society Staff 2 | Special Travel Issue

ABOUT For advertising or editorial contact information, email healthiersleep@worldsleepsociety.org or visit healthiersleepmag.com for current rates. Healthier Sleep is published up to six times per year by World Sleep Society, 3270 19th Street NW, Suite 109, Rochester, MN 55901 and distributed to sleep medicine and research professionals as well as the public. No part of this publication may be reprinted or reproduced without written permission. Healthier Sleep does not necessarily endorse the claims or content of advertising or editorial materials. All advertisements and editorial material included represents the opinions of the respective authors. World Sleep Society/Healthier Sleep Magazine does not provide or offer medical advice. All content within the magazine, such as text, graphics, information obtained from sleep experts, and other material, is for informational purposes only. The content is not intended to be a substitute for medical diagnosis, advice or treatment. Relying on information provided by World Sleep Society and/or any of its employees, experts within the material, or other writers is solely at your own risk.

CONTENTS

Special Travel Issue

|4| Jet Lag and How It Affects Sleep

|8| Mindfulness Can Improve Your Sleep

| 12 | Sleeping Pills and Travel

Alcohol and Sleep

Ways To Stay Positive With Sleep Issues

Medication and Air Travel

Healthy Habits For Healthy Sleep

Sleep and Meditation

Melatonin

10 Ways To Improve Your Child's Sleep

The Future of Sleep - StimScience

Special Travel Issue In Collaboration with Langham Hospitality Group 3 | healthiersleepmag.com

Jet Lag and How It Affects Sleep Everyone’s body has an internal clock that regulates your sleep-wake cycles. This is referred to as your circadian rhythm (patterns your body follows based on a 24hour day). Unfortunately, when you travel over multiple time zones, your internal clock does not adjust as your cell phone or watch would to the new time. This can lead to a temporary sleep issue called jet lag, where your body is not in sync with the daytime-nighttime schedule of the destination. In fact, the more time zones you quickly crossed in your travels, the more likely you are to experience jet lag. This is especially true when traveling from west to east.

The longer you stay in your new destination, the better your body will adjust to this change. It just takes time.

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SYMPTOMS OF JET LAG

You may experience one or more symptoms of jet lag: ○ Headaches ○ Disturbed Sleep/Wake Cycles ○ Daytime Sleepiness ○ Stomach Problems (gastrointestinal) ○ Difficulty Concentrating ○ Lack of Energy ○ Reduced Alertness ○ Moodiness and Irritability ○ Decreased Work Performance (mental/physical) ○ Feeling Unwell

HOW TO REDUCE THE SYMPTOMS OF JET LAG

Luckily, there are some things you can do to help prevent or reduce jet lag.

1. BEFORE YOU TRAVEL, GRADUALLY ADJUST YOUR SLEEP ROUTINE. By changing

your regular sleep pattern a few days before your departure, it will help your internal clock to adjust to the destination time zone a bit easier. Depending on the direction you will travel, you can start going to bed an hour or two earlier (if traveling East) or an hour or two later (if traveling West) a week before your departure.

5. SEEK OUT SUNLIGHT UPON ARRIVAL. If you

arrive at your destination during the daytime, it is important that you seek out sunlight. Daylight is one of the most powerful tools for regulating your sleepwake cycle, as it influences the regulation of melatonin.

6. EAT HEALTHY. Try to avoid deep-fried, large, or rich/heavy meals. Try to eat healthy for the first few days as you are combatting jet lag.

7. STAY ON YOUR NEW SCHEDULE. Try to time your meals and your sleep schedule with local meal and sleep times. If you arrive at your destination during the day and feel like you need to sleep, only take a 20-minute nap and then try to stay awake until nighttime at your destination. 8. STAY ACTIVE. When you arrive at your destination, stay active. Exercise in the early morning or late afternoon will refresh you and help rest your internal clock. Avoid exercising too close to bedtime.

9. AVOID COFFEE AND ALCOHOL BEFORE BED. Consuming coffee and/or alcohol near bedtime will disrupt your system even more.

10. KEEP CALM. Stress can make the effects of jet lag even worse.

2. GET REST BEFORE YOUR TRIP. If you are

already sleep-deprived, then you will likely experience a worsening of jet-lag symptoms.

3.SLEEP ON THE PLANE IF IT IS NIGHTTIME AT YOUR DESTINATION. Using earplugs,

headphones, and eye masks can all help block out the noise and light. If it is daytime where you are going, try and resist the urge to sleep on the plane.

4. STAY HYDRATED. Dehydration can make jet-

lag symptoms worse. It is important to drink plenty of water before, during, and after your flight. You should also avoid alcohol and caffeine-heavy beverages. This will help to counteract the dehydrating effects of the dry cabin air when flying. 5 | healthiersleepmag.com

Alcohol and Sleep By Jessica Thomas, MPH

Many people struggle with not only falling asleep at night but also staying asleep all night. Typically, this restlessness is blamed on work and home stress. It could also result from too much screen time that can leave your nerves frazzled and anxiety heightened. However, one factor behind sleeplessness that is often overlooked is alcohol consumption too close to bedtime.

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ALCOHOL CAN GIVE YOUR BODY MIXED SIGNALS Alcohol can send mixed signals to your body that may confuse you due to its powerful effects on the central nervous system. For instance, one moment, you might feel incredibly sleepy, and then the next moment, you’ll feel wide awake. The sleepiness comes from alcohol being a depressant, and depressants make us feel tired. However, just because your body is telling you that you’re tired doesn’t mean that you’re going to get a good night’s sleep. In fact, even if you have an alcoholic drink and find yourself falling asleep relatively quickly, it’s likely that your slumber won’t last long. After a while, its sedative effect will wear off and cause you to wake up multiple times throughout the night. This is known as sleep fragmentation, which happens when you wake up multiple times during the night, often for only a minute or two each time. Even though these interruptions are short, they can leave you feeling tired, groggy, and irritable the next day. ALCOHOL DISRUPTS YOUR BODY’S SLEEP PATTERNS If you decide to take a drink before bed, it may throw off your sleep cycle, and here’s how. Typically, we go through 4 sleep stages at night, with the beginning stages being light sleep.

When you have alcohol in your system, it causes you to remain in the lighter stages of sleep and not reach deep sleep. This is because you need deep sleep to repair the body and rid the waste from the brain. In addition, as the alcohol works its way out of your body, the depressant characteristics wear off. Once this happens, you are more likely to wake up, often several times. This disrupts your important slow-wave sleep and can leave you feeling exhausted. Simply put, alcohol disrupts a person’s sleep architecture. THESE ARE NOT THE ONLY POTENTIAL SLEEP PROBLEMS Although fragmented sleep may be the most commonly known sleep challenge associated with alcohol consumption before bed, it is not the only possible problem. YOU MAY EXPERIENCE INTENSE DREAMS, SLEEPWALKING, AND MORE Another relatively common problem is that alcohol use before bed can lead to very intense and vivid dreams. Sometimes these dreams go beyond the vivid and can become terrifying nightmares that disrupt your sleep even more. In addition, some people also report that they experience a tendency to sleepwalk with alcohol in their bloodstream.

If you’re already battling with sleep apnea, which is when your breathing stops and starts while you slumber, going to sleep buzzed or drunk can be especially dangerous. The alcohol may relax your upper airway, and a relaxed airway is more likely to collapse, which is definitely something you don’t want to experience while sleeping. ALCOHOL AND SLEEP: AN UNHEALTHY MIX So, what does this mean for you? It means that alcohol is not a cureall for people who have insomnia or a host of other sleep disorders. A glass of wine may help you drift off at the beginning of the night; however, it will likely leave you feeling more tired the next day. In fact, it could make your sleeping problems even worse. Therefore, if you have trouble falling asleep at night, it’s better to speak with a sleep specialist than use alcohol. *Citations available on healthiersleepmag.com

................................................................ Jessica Thomas is a public health professional, health & wellness writer, and entrepreneur. She enjoys learning about and educating others on healthy living and observing how technology is changing the healthcare space.

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OPINION

Mindfulness Can Improve Your Sleep, But Not How You Think It Will By Jason Ong, PhD

indfulness is bringing your full attention and awareness to the present moment…then just watching each moment unfold without trying to control it. REGULAR MINDFULNESS BENEFITS Mindfulness is usually practiced during meditations. These may be a quiet meditation such as breathing meditations, a movement meditation such as yoga or walking meditation, or an informal meditation such as eating mindfully. One of the biggest misconceptions is that mindfulness is another relaxation strategy in which people are able to “meditate themselves to sleep.” That is NOT the intention of mindfulness practices. Instead, these practices can help promote sleep health by developing a greater awareness of sleepiness and regulating cognitive arousals such as negative or racing thoughts. Ideally, formal mindfulness meditation practices are done during the daytime—not when you get in bed. In this way, regular mindfulness meditation can help improve the regulation of sleep by cultivating a greater awareness of when the mind and body are ready for sleep and when it might be more helpful to stay out of bed and 8 | Special Travel Issue

do a soothing activity until your mind and body are ready. The purpose of mindfulness is just to do the practice and see how each moment unfolds. It is not to use it for any particular purpose— whether it be for sleep, mental health or anything else. PROGRAMS AVAILABLE There are many mindfulness programs that are taught in-person or online. The most popular program is mindfulness-based stress reduction (MBSR), which typically involves an 8-week class where participants are asked to practice the mindfulness meditations at home. In our lab, we have developed a version of this program tailored to people with insomnia called MBTI (mindfulness-based therapy for insomnia). There are other online programs and apps, such as Headspace or Calm, which are also good ways to become acquainted with mindfulness principles and meditations. These programs do a nice job of making mindfulness more “digestible” by leading participants through shorter 10-minute meditations. Most people who ask me about this topic think I will tell them how to relax themselves to sleep using meditations. Even those

who take mindfulness classes often comment that MBTI isn’t quite what they signed up for, and some do drop out. I would like people to understand that practicing mindfulness involves a commitment and takes time and patience. It is not intended to be a quick solution or something you use to make yourself feel better. This is quite contrary to how most of us in Western societies are trained, but this is exactly why it is so powerful. Mindfulness gets us back to the essence of how we are as human beings without being clouded by the constant need to achieve, strive and multitask. ................................................................ Jason Ong, PhD is the Behavioral Sleep Medicine Director at Nox Health, as well as an Adjunct Associate Professor at the Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine. Dr. Ong has been working in the field of sleep medicine & research for 17 years.

WAYS TO STAY POSITIVE WITH CHRONIC SLEEP ISSUES

Engage in activities & practices that boost your mood. Studies have linked a positive outlook with better sleep.

MIND

BODY

SPIRIT

• Practice gratitude. By being

• Engage in light exercise. By

• Relax. Consider a bubble bath,

• Try mindfulness or meditation.

• Practice good sleep hygiene.

thankful for what you have, you pay less attention to what you do not have.

Research has linked spending time "doing nothing" with better health of the body and mind as well as healthier sleep.

• Calm negativity. Practice

being more aware of negative thoughts. Purposely try to change your thinking patterns by replacing negative thoughts such as, “I will never fall asleep” with positive thoughts such as, “I choose healthy sleep."

choosing yoga, an outdoor walk or other light exercise, you are working toward better sleep. Understand that light, bedding, noises, and shared spaces all contribute to a good night’s sleep. Put a plan in place to get the best rest possible.

• Listen to your body.

Instead of living by the clock, try a few nights of going to bed when sleepy. Perhaps you are not listening to your natural circadian rhythm.

warm tea, quiet room or other way to relax after a stressful day. Give yourself time to unwind before getting into bed.

• Lessen worries. By writing in a

journal, praying or keeping a list of things to do the next day, there will be less for you to worry about at night.

• Choose sleep. Make a promise to yourself to put sleep at the top of your priority list. Then keep that promise.

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Medication and Air Travel By MaryAnn DePietro, CRT

f you take any type of medication, it is important to understand how traveling may affect your medication schedule and the effects of the drugs. It is also helpful to take steps to ensure you stay on track the best you can. Travel across 6 or more time zones will almost certainly disrupt the exact timing of medications and alter the internal biological time of exposure, but the body is resilient enough in most instances to adapt. HOW AIR TRAVEL MAY AFFECT YOUR MEDICATION SCHEDULE According to Dr. Robert Thomas, air travel can impact medical conditions and medication schedules. “Three things usually happen when you travel. You lose sleep, develop a circadian mismatch, and your meals are often different,” said Dr. Thomas. These factors can all affect a medical condition you have. For example, blood sugar may fluctuate during travel if you change the time you eat or what you eat. Your body may also experience stress when 10 | Special Travel Issue

traveling and taking a flight. Changing time zones can alter your circadian rhythm and even leave you sleep-deprived. Keep in mind, it is not necessarily the length of the flight that makes the biggest impact. It is the change in time zones that may play a more significant role in sleep disruption or how the body handles medications. (There can be important differences in effect based on when in body clock time a drug is taken). SPECIFIC TYPES OF MEDICATIONS AND AIR TRAVEL Traveling may cause disruption to your medication use. So, before you go, it is best to talk to your healthcare provider and find out what is acceptable and what you should avoid. Usually, taking a medication an hour or two early or late is not a problem. Different types of medications may require a few considerations when traveling by air. Consider the following suggestions on the next page.

CONTROLLED DRUGS These include opioids for pain, sedatives (including sleeping aids), stimulants (including those used for attention deficit disorder) and some special medications used for sleep disorders like Xyrem, Xywav, Wakix, as examples. Have clear documentation of use, ideally a letter from the prescribing physician, if traveling outside the USA. Some of these drugs are considered illegal or nearillegal to carry in several countries.

are long acting and are taken once a day, so a few hours' delay is not going to have a large impact.

IMMUNE SYSTEM MEDICATIONS Drugs like steroids need precision dosing. There are several new medications that impact immune system function, where individual doses cannot be missed. Speak to the prescribing specialist before major travel.

Non-insulin diabetes medications are usually taken once a day and thus there is some flexibility of a few hours' variability in time.

CANCER DRUGS These days, having a cancer is not a contraindication by itself to travel. Patients with cancer want to have as normal a life as possible, but they may also be on complex oral or selfadministered medications. Consulting with the cancer specialist is strongly recommended prior to travel. Many cancer drugs have limited availability outside the USA.

○ Pack medication in carry-on bags instead of checked luggage. The American Lung Association recommends packing all inhalers in your carryon bags. But that tip also goes for other types of medications. You do not want to go without medications if your luggage is delayed.

RESPIRATORY MEDICATIONS Respiratory medications include long-acting medications and fast-acting bronchodilators. Try to stick to the same interval between doses of your long-acting respiratory medications. Carry your rescue inhaler with you in your carry-on bag. PAIN MEDICATION Sleep loss, which may occur with travel, can make it more difficult to deal with chronic pain. Also, sitting for extended periods on an airplane can become uncomfortable and also make pain worse. Talk with your doctor about adjustments in dosing before your trip. Do not try to skip these medications abruptly for a long flight. BLOOD PRESSURE Sleep loss and stress to your circadian rhythm and eating different foods can affect your blood pressure. Certain blood pressure medications (diuretics) may also lead to increased trips to the bathroom. Most current blood pressure medications

INSULIN Your meals and sleep may become disrupted during your flight. How much you eat may affect how much insulin you take. Talk to your physician and check your blood sugar level inflight as needed. It’s safer to be slightly above ideal than below. Hypoglycemia at 30,000 feet is not a good thing!

GENERAL TIPS When traveling, there are some general tips to keep in mind:

○ Be aware of restrictions. There are rules for taking liquids on board, but liquid medications are handled differently. According to the Transportation Security Administration, you can carry liquid medication onboard that is larger than 3.4 ounces. But just let the TSA officer know when you start the screening. ○ Set an alarm if needed. To keep your intervals the same between doses, set an alarm on your phone so you remember when to take your meds. ○ Have enough medication just in case your travel plans change. It is better to have a little extra medication with you so you do not have to search for a place to refill prescriptions.

....................................................................................... MaryAnn DePietro, CRT is a medical writer and licensed respiratory therapist with over a decade of clinical experience, MaryAnn DePietro has been published in magazines, newspapers and on health websites. She earned degrees in both respiratory therapy and rehabilitation. As a therapist, she has worked with hundreds of patients with medical conditions, such as sleep apnea, and other sleep disorders. 11 | healthiersleepmag.com

Sleeping Pills and Travel By MaryAnn DePietro, CRT

Whether you love to travel or have to hit the road for work, traveling can interfere with getting quality sleep. Traveling may have an adverse effect on your sleep for a few different reasons, including the following: CHANGE IN CIRCADIAN RHYTHM Our circadian rhythm is the body’s natural sleep/ wake pattern or cycle. That cycle depends on brain chemicals, such as melatonin, which in part is affected by light (suppression). Changing time zones can disrupt your natural internal clock. CHANGE IN ENVIRONMENT Changing your sleep environment can make it harder to fall asleep and move into a deep sleep. A “first-night effect”, which can last more than one night, occurs when you sleep in a new environment, such as when traveling. One interesting study found that one hemisphere of the brain may not sleep as deeply under stressful conditions, which results in worse sleep. CHANGE IN BEHAVIOR When you travel, you may change certain things, such as how much you eat, drink alcohol, exercise, and the time you go to bed. Changing various lifestyle factors may also affect how well you sleep.

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TYPES OF SLEEP AIDS WHEN TRAVELING To improve sleep either while traveling or at your destination, you may turn to sleep aids. Options in sleep aids include:

TIPS FOR SLEEPING PILLS WHILE TRAVELING For people that may take sleeping pills when traveling, there are several factors to consider, such as the following:

○ Melatonin: This is a naturally

○ Don’t take the medication until

occurring hormone that may help you fall asleep. It is also available as a supplement. Using more than 3-5 mg is best avoided. ○ Over-the-counter sleep aids: Over-the-counter sleep aids often contain antihistamines such as diphenhydramine. This class of drugs can act for long periods, cause memory and driving impairment, and should be avoided by the elderly. ○ Prescription sleep medications:

Different prescription sleep medication is available to treat insomnia, including zolpidem.

They do help reduce jet lag by allowing sleep against the circadian system’s preference, but a careful discussion with your doctor is necessary for safe use. Prescription sleep medications have various side effects, and some may have a risk of dependency, though the latter is unlikely with use for a few nights of vacation. If you are a regular user of prescription sedatives, discuss the trip with your doctor before you travel.

you have boarded. You do not want to take any type of sleep aid until you have boarded the plane. You don’t want to feel groggy while sitting in the airport.

○ Only take the prescribed dose.

Never increase the dose you take without talking with your healthcare provider.

○ Give the medication a test run

at home. Before taking new sleep medication, it is best to try it at home first. Trying it at home first allows you to see how your body reacts before taking it while at 20,000 feet. ○ Skip the alcohol. If you are

used to having an inflight cocktail, it is best to skip it. Alcohol and sleep medication are not a good mix. ○ Consider reserving prescription

sleep medications for overnight flights. Prescription sleep medication may have a stronger effect than melatonin or an over-the-counter drug. If your flight is short, you might feel groggy when you arrive. Reserve the medication for flights crossing multiple time zones or red-eye flights. Avoid for a flight shorter than the duration of action of the drug.

GENERAL TIPS FOR IMPROVED SLEEP WHILE TRAVELING Sleeping pills are not the only way to deal with sleep issues. Whether you are traveling by plane, car, or train, there are several things you can do to improve the quality of sleep, such as the following: ○ Sit by the window while you

travel by plane. A window seat gives you control over the shade and how much light comes in. If it is darker, it may help you sleep.

○ Pack sleep accessories.

Bringing earplugs, an eye mask, and a blanket may help you catch a little sleep. ○ Get sunlight when you arrive.

If you are trying to adjust to a new time zone, try to get some sunlight as soon as you arrive to help your body shift its circadian rhythm.

○ Drink plenty of water.

Dehydration can add to fatigue. Be sure to drink plenty of water when you travel. If the trip is a quick one across many (say over 8 time zones), it may be better to forget about the circadian system as you cannot rapidly shift the clock across the large number of body rhythms that get disrupted. Do what one has to do, and use melatonin or a sedative to get 5-6 hours of sleep. Overthinking re-alignment is not useful.

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Healthy Habits For Healthy Sleep Healthy sleep is sleep which restores and energizes you so you feel wide awake, dynamic and energetic all day long, yet the majority of people are not achieving healthy sleep. By Clete A. Kushida, MD, PhD, FAASM

any people assume getting a good night’s sleep is judged by the hours spent asleep. In reality, there are three elements of quality sleep: duration (the length of sleep), continuity (sleeping without fragmentation), and depth (sleep deep enough to be restorative). Without healthy sleep, you’re often facing consequences such as daytime fatigue and sleepiness, irritability and moodiness, and difficulty focusing and concentrating resulting in poor memory. Longer term effects are being studied, but poor quality sleep or sleep deprivation has been associated with significant health problems, such as obesity, diabetes, weakened immune systems and even some cancers. So how can we sleep better? How can our sleep be improved?

MAINTAINING SLEEP DURATION First, assess the number of hours allotted for sleeping. Required sleep duration is different for each person. Current guidelines recommend at least seven hours of sleep for adults, though many will need 8-9 hours. Longer times are suggested for children and teenagers. Maintain a regular sleep schedule by going to bed and waking up at the same time throughout all days of the week. BETTERING SLEEP CONTINUITY Observing and researching sleep, we see individuals waking numerous times per night. For example, apnea is when breathing is suspended for a period of time. When sleep apnea occurs, a person is awakened and experiences sleep loss. In severe cases, a person is awakened hundreds of times during the night without obtaining quality sleep. Addressing the cause of poor sleep continuity should be a priority. Other ways to ensure sound sleep are by using comfortable bedding, a comfortable, cool sleep temperature setting and keeping the bedroom well ventilated. Blocking out distracting noises and eliminating as much light as possible will also help the body regulate for sleep. 14 | Special Travel Issue

IMPROVING SLEEP DEPTH Restorative sleep is really the goal. Sleep disorder sufferers sometimes report sufficient hours spent asleep, but if they are not reaching optimum REM sleep, they do not wake feeling refreshed. World Sleep Society has created a list of healthy habits for healthy sleep, including:

01 Establish regular sleep and wake times. 02 Avoid light from smartphones and tablets near bedtime. 03 Reserve the bed for sleep and sex only, avoiding work or study.

04 If you do not fall asleep in 20 minutes, leave the bedroom and return when tired.

05 Exercise regularly but not right before bed. 06 Do not exceed 30 minutes of daytime sleep or napping. 07 Avoid excessive alcohol ingestion four hours before bedtime and do not smoke.

08 Find a comfortable sleep temperature and keep the room well ventilated.

09 Avoid caffeine six hours before bedtime. 10 Choose a light healthy snack before bed that will not disrupt your sleep.

....................................................................................... Dr. Clete A. Kushida is a neurologist who specializes in the diagnosis and management of sleep related breathing disorders, sleep-related movement disorders, and parasomnias. He is a neurologist, a Professor in the Department of Psychiatry and Behavioral Sciences at Stanford; Associate Chair, Division Chief, and Medical Director of Stanford Sleep Medicine; and Director of the Stanford Center for Human Sleep Research.

Establish regular sleep and wake times.

Avoid light from smartphones and tablets near bedtime.

Reserve the bed for sleep and sex only, avoiding work or study.

If you do not fall asleep in 20 minutes, leave the bedroom and return when tired.

Exercise regularly, but not right before bed.

Do not exceed 30 minutes of daytime sleep or napping.

Avoid excessive alcohol ingestion four hours before bedtime and do not smoke.

Find a comfortable sleep temperature and keep the room well ventilated.

Avoid caffeine six hours before bedtime.

Choose a light healthy snack before bed that will not disrupt your sleep.

Created by World Sleep Society’s committee of internationallyrenowned experts in the field of sleep medicine and research.

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Sleep and Meditation Is This the Master Key? By Deepak Chopra, MD, FACP

leep might be one of those rare occasions when science needs to listen to poetry. In Macbeth, sleep is extolled because it “knits up the raveled sleeve of care,” perhaps the most famous Shakespeare comment on sleep. In modern language, he is saying something familiar to everyone, that a good night’s sleep helps to calm a troubled mind. But there’s another line in the same passage that is more significant for modern science, when sleep is called “the balm of hurt mind” and the “chief nourisher in life’s feast.” In other words, of all the factors that improve a person’s life, sleep comes first. Viewing the intricate biorhythms governed by sleep, medicine can confirm that sleep is the master biorhythm that resets the smaller ones. Since it can be asserted with a fair degree of certainty that individual cells have biorhythms measurable in thousandths of a second, evolution has provided an unimaginable gift by linking the smallest aspects of cellular processing to the larger schemes of hormones, immunity, digestion, neurotransmitters, and much more. In the ancient Indian tradition, the saying goes, “As is the great, so is the small.” This is quite fitting when it comes to sleep. Only in the past few decades has medical research validated the poet’s poetic praise of sleep. Now we know that the central nervous system is tied into the immune system and GI tract, forming a continuous feedback loop—or rather, many such interlocked loops— making it possible to say that every cell eavesdrops on the general wellness or illness of the body. This eavesdropping influences how each system listens and responds to every other system, which at first seems to add more confusion than clarity. Analyzing what is going on would be like monitoring every telephone call 16 | Special 2022 Travel Issue

in a city to judge public sentiment. The “sentiment” of the body, broadly speaking, isn’t about wellness or illness at any moment, or even in a given week, month, or year. But how far have we really come if all we wind up with is the need for good sleep every night? This advice has been drummed into public consciousness for decades without much effect. Modern societies are rife with insomnia, poor and irregular sleep, and catch-up sleep deferred until the weekend.

What we need, in my view, is better motivation, because the failure of modern people to give high priority—perhaps the highest priority—to good sleep comes down to noncompliance. Human nature has a perverse streak, and everyone knows what it means to not do what you know is good for you. Here the prospect of meditation enters the picture. Decades of research have underscored that yoga and many kinds of meditation improve sleep. Let’s accept that this basic finding is correct. There’s a deeper and

Decades of research have underscored that yoga and many kinds of meditation improve sleep. Let’s accept that this basic finding is correct.

more crucial point. Meditation works on the principle of mental homeostasis. Physical homeostasis is already well established; without a doubt the body returns to a state of dynamic balance as soon as stress is removed. The stress can be voluntary, like running a marathon, or involuntary, like getting stuck for two hours at the airport. Then there is the conundrum of traveling across many time zones, which creates dyssynchronous patterns of physical, mental, and sleeping imbalance Mental homeostasis is another matter as far as medical research goes, yet it is the foundation principle in Eastern wisdom traditions that the mind is essentially quiet, peaceful, self-organizing, and evolutionary. This is a startling claim if you believe that the mind is basically the same as brain activity. Brain activity is never quiet, peaceful, and evolutionary, although obviously it is self-organizing. The reason meditation improves sleep, once you accept the Eastern perspective, is that meditation allows a person to encounter the real mind as opposed to the storm of thoughts, feelings, and sensations that fill the mind.

The best case for mental homeostasis is the silent gap between thoughts. In this gap, awareness returns automatically to a reset point to clear the way for the next thought or sensation. If this reset didn’t occur, our minds would be a jumble of overlapping, confused impulses. As it happens, the reset point isn’t the same for each person. The silent gap brings each of us to the source of skill and knowledge we possess. A champion golfer relaxing before taking a swing does to a much deeper reset than a duffer relaxing before a swing. A surgeon poised to make the first incision is set to act from a quite different place than a home cook cutting up a chicken for dinner. In brief, I’ve described the two insights behind meditation, first, the mind can reset to a balanced state that is the equivalent of homeostasis, and second, meditation allows the set point to reach a deeper, more relaxed state of awareness. There is, of course, much more to say about meditation, since we haven’t even glanced at the claims that meditation leads to higher state of consciousness and exalted spiritual experiences. But we only need the two insights just mentioned to uncover the reason that sleep “knits up the raveled sleeve of care.” It does this by returning us to our deepest level of awareness, unhindered by incessant mental activity. In addition, meditation does essentially the same thing while allowing a person to remain awake. Longtime meditators can attest that a state of wakefulness can be attained in deep sleep. How is this possible? It is a natural result when the reset point is so deep while awake that it equals the reset point in sleep. Meditation continued on page 18 17 | healthiersleepmag.com

Meditation continued from page 17 One can venture that combining the benefits of good sleep and meditation is the passkey to long-term, perhaps lifelong, well-being. This is the first time in history that lifelong well-being has become a reasonable expectation. Obstacles like Alzheimer’s, type 2 diabetes, cancer, and coronary artery disease impede progress toward lifelong well-being, but these disorders also stand on the brink of potentially major breakthroughs. The deep rest of meditation is also a powerful antidote to ease the circadian misalignment that goes with long-haul travel. When experienced consistently, this re-setting of mental homeostasis through meditation alleviates the stress, insomnia and fatigue that often accompanies jet lag disorder. The last idea to consider is the first one I raised: motivation. At present the model for prevention is based on risk, and risk is psychologically linked to fear. If you have only anxious fear to motivate you, the likelihood of change is low, because fear is an extremely poor long-term motivator. But meditation brings the pleasurable experience of peace and quiet, and often

there is at least a glimpse of bliss. The motivation provided by pleasurable experience is excellent over the long term. Putting the picture together, the salient points are: ○ Sleep is the primary biorhythm in the body, affecting all other biorhythms down to the cellular level. ○ Good sleep deserves the highest priority among positive lifestyle choices. ○ Noncompliance is the major reason people don’t get good sleep every night. ○ Meditation resets “mental homeostasis.” This reset is aligned with physical homeostasis. This can be valuable in many circumstances, such as long-haul travel when there is mis-alignment between the physical and mental states of well-being. ○ Together, meditation and good sleep are the passkey to future well-being.

................................................................................................................................................... Deepak Chopra, MD, FACP, founder of The Chopra Foundation, a non-profit entity for research on wellbeing and humanitarianism, and Chopra Global, a modern-day health company at the intersection of science and spirituality, is a world-renowned pioneer in integrative medicine and personal transformation. Dr. Chopra is an Adjunct Professor of Urology at Mount Sinai, Professor of Internal Medicine at the University of Central Florida, Clinical Professor of Family Medicine and Public Health at the University of California, San Diego and serves as a senior scientist with Gallup Organization. He is the author of over 90 books translated into over forty-three languages, including numerous New York Times bestsellers. TIME magazine has described Dr. Chopra as “one of the top 100 heroes and icons of the century.”

CLEAR YOUR MIND FOR A BETTER NIGHT'S SLEEP Amit Anand, MD is a board-certified practitioner of pulmonary, critical care, and sleep medicine in the Department of Internal Medicine at Saint Elizabeth's Medical Center, Boston, MA.

Scan the code to listen to Dr. Anand lead a breathing meditation on ‘pranayama’, a practice in readiness for Sleep, with an emphasis on resonance and rhythm.

He is an Instructor in Primordial Sound Meditation (Chopra Center for Well Being) and a Yoga Alliance teacher of the Amrit Yoga Method. He is particularly interested in the Doctrine of “Pranayama” (Breath Extension and Control techniques as taught at the Kaivalya-Dham Institute of Yoga, Lonavala, India) given his background in pulmonary and sleep physiology.

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Melatonin

From hormone to over-the-counter supplement. By Wendi Kitsteiner

r. Lourdes DelRosso, MD is passionate about helping people find good rest. She has a particular interest in restless sleep and restless legs syndrome. Along with her work in sleep medicine, Dr. DelRosso has often been asked to discuss melatonin and its role in helping provide healthier sleep. According to Dr. DelRosso, melatonin is a natural component of our circadian regulation - circadian referring to our natural inner clock or cycle of sleep and wake. “Melatonin is a hormone produced in the pineal gland under conditions of darkness, such as in the evening,” Dr. DelRosso explains. “The production of melatonin is blocked by light exposure during daytime.” Dr. DelRosso explains that there are two main things that regulate our sleep circadian timing. “One is melatonin and one is light exposure,” she states. “When our circadian clock does not match our social sleep requirements such in situations of jet lag, we can use melatonin and light to adjust to the new time. Similarly, we sometimes have a ‘delayed sleep cycle’ and a low dose of melatonin can help regulate or set up the new time.” 20 | Special Travel Issue

There is sensible caution against using high doses of melatonin. What constitutes a high dose is debatable, but perhaps more than three milligrams per night. In a sleep clinic setting, patients may be treated with higher doses for specific sleep conditions, under medical supervision. Unfortunately, sometimes selfadministration doses exceed 20-30 milligrams. Melatonin has become a buzzword — especially for parents desperate to help their child find much-needed rest. But Dr. DelRosso cautions that there is a time and place for introducing this particular therapy into a child’s sleep regimen and to do so with help from your physician or pediatrician. “Our bodies naturally produce melatonin when it's dark,” she details. “The circadian rhythm is designed in a way that light signals our brain that it is daytime, and so melatonin is not produced. However, in the absence of light, our sleep clock (the suprachiasmatic nucleus) knows that it is time to sleep, and melatonin starts being produced.”

Before introducing melatonin, Dr. DelRosso suggests establishing a regular sleep schedule first: • Start dimming the lights one to two hours before bedtime. • Have a relaxed bedtime routine. • Keep the bedroom cool and dark. • Avoid caffeine for at least six hours before bedtime, remembering that chocolate and tea can also have caffeine. • Do not engage in vigorous activity close to bedtime. • Turn off all electronics and keep them out of the bedroom.

If, after establishing a solid routine, you or your child fail to find relief for sleep difficulties, a doctor should be consulted. There are several different sleep disorders that affect sleep and can mimic insomnia including restless legs syndrome, obstructive sleep apnea and behavioral insomnia in childhood. “It is very important to diagnose sleep disorders early to avoid consequences. Also, there may be other reasons affecting sleep including medical conditions, depression or anxiety, social issues or environmental problems,” she goes on to explain. “And the doctor can help identify and address these issues.” Dr. DelRosso says that the fact that melatonin is not regulated by the U.S. Food and Drug Administration and is simply sold over the counter as a “supplement” causes her great concern. She explains that this means the doses may vary or other substances may be used during preparation. “In fact, a research article on melatonin preparations published in the Journal of Clinical Sleep Medicine showed that the melatonin content in the products analyzed varied significantly from -83% to +478%! Other substances not reported to be in the preparation included serotonin, present in eight out of 30 preparations in this study.” Melatonin can be made from hormone secretions of animals or microorganisms, but more often are made with synthetic melatonin.

Currently, there is not much research in the field of melatonin. “We definitely need more research studying the long-term consequences of melatonin,” she says. Side effects, however, are not usually prevalent, with nightmares and headaches being the chief complaints that Dr. DelRosso has seen in her office. It is also unlikely you will become dependent on melatonin or have a diminished response after repeated use. Aging adults will naturally create less melatonin. Children can also use this supplement. Dr. DelRosso often recommends melatonin for short-term use in children. She specifically notes that children with autism spectrum disorder can benefit from melatonin. Dr. DelRosso states, “Recently published guidelines from the American Academy of Neurology recommend physicians offer melatonin if behavioral strategies are not helpful.” Other sleep disorders are also prevalent in children so it is very important to consult with your pediatrician or sleep physician before starting using melatonin. ............................................................................................ Lourdes DelRosso is a sleep physician at Seattle Children's Hospital and associate professor in the Department of Pediatrics at the University of Washington School of Medicine. Originally from Peru, she earned her medical degree at the University of Miami and then went on to complete a residency in family medicine at Kaiser Permanente/UC Irvine, a sleep medicine fellowship at Louisiana State University and a master's in medical education at the University of Pennsylvania.

............................................................................................ Wendi Kitsteiner is a former high school English and journalism teacher who has worked as a writer/editor for the RLS Foundation and as an editorial assistant for a cardiovascular researcher at Mayo Clinic. She is currently homeschooling her four children on a farm in East Tennessee. *Citations available on healthiersleepmag.com.

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10 Ways To Improve Your Child’s Sleep By World Sleep Society

leep. How can a parent help a child sleep better? First, by knowing that sleep is one of the most significant contributors to your child’s physical and mental health. Sleep is important. As parents, the primary point of action we can take is to set up good sleep practices, including providing an adequate opportunity for sleep as well as an environment conducive to good sleep quality and safety.

healthy sleep habits that help families across all cultures to support and encourage optimal sleep duration and timing are critical to achieving these goals.”

Liborio Parrino, MD, associate professor of neurology at Parma University, Italy, says, “Good sleep habits can create good sleep quality. And studies have shown quality of sleep is even more important that quantity of sleep. Sleep practices help children associate certain activities, such as a bedtime routine, and environments (like the child’s bedroom) with sleep.”

1. MAKE SURE YOUR CHILD GETS ENOUGH SLEEP BY SETTING AN AGE-APPROPRIATE BEDTIME AND WAKE TIME Pediatric sleep physicians and researchers suggest a bedtime that’s preferably before 9:00pm. To know the appropriate number of hours per age, refer to the Recommended Sleep Amounts table on the next page.

Judith Owens, MD, MPH, professor of neurology at Harvard Medical School and president of the International Pediatric Sleep Association (IPSA) adds, “The importance of sleep to children’s development, health and well-being cannot be underestimated, and

2. KEEP A CONSISTENT BEDTIME AND WAKE TIME ON WEEKDAYS AND WEEKENDS As grating as it can be when your little one wakes up bright and early on a Saturday, research suggests changing sleep and wake times on weekends can

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To aid parents and caregivers in this pursuit, World Sleep Society created ten tips for healthy sleep hygiene in children. Is your child practicing these good sleep habits?

interfere with natural circadian rhythms in both children and adults. Sticking with the same sleep and wake time every day of the week will improve sleep health. 3. ESTABLISH A CONSISTENT BEDTIME ROUTINE AND PROVIDE COMFORTABLE CLOTHES IN BED, INCLUDING STRONG ABSORBING DIAPERS FOR INFANTS Along with an established bedtime routine (think healthy snack, pajamas, stories in bed), it’s best to find a comfortable sleep temperature and make sure the child’s bedroom is well ventilated. Tip: Many thermostats can be set to automatically drop a few degrees at a scheduled time every night. 4. ENCOURAGE YOUR CHILD TO FALL ASLEEP INDEPENDENTLY As most parents of babies and toddlers can attest, this is easier said than done. But the more independently a child can fall asleep, the better (and earlier) sleep health will improve. 5. AVOID BRIGHT LIGHTS AT BEDTIME AND DURING THE NIGHT, AND INCREASE LIGHT EXPOSURE IN THE MORNING Blocking out distracting noises and eliminating as much light as possible will aid in falling asleep, but don’t forget the importance of light exposure in the morning. This keeps natural sleep/wake rhythms in sync. 6. KEEP ALL ELECTRONICS, INCLUDING TELEVISIONS, COMPUTERS, AND CELL PHONES OUT OF THE BEDROOM, AND LIMIT USE OF ELECTRONICS BEFORE BEDTIME Electronics in the bedroom distract from sleep. Experts agree that falling asleep in front of the television is on the “poor sleep health” list. Additionally, children could begin to associate the bedroom with stress. It’s best to avoid any electronics in the bedroom. 7. MAINTAIN A REGULAR DAILY SCHEDULE, INCLUDING CONSISTENT MEALTIMES Consistent daily schedules may be more difficult with fluctuating extracurricular activities, but research shows the more consistent daytime schedule, the less stress at bedtime, which can create better sleep. Monica Roosa Ordway, PhD, APRN, PPCNP-BC, an assistant

professor at Yale University, School of Nursing, studies stress and sleep in infants and toddlers. “More results are coming in and have not been published yet, but the preliminary data on associations between sleep and stress response are promising,” she states. 8. HAVE AN AGE-APPROPRIATE NAP SCHEDULE To reach the recommended number of hours of sleep by age (table below), fill in the remaining hours with naps during the day. The total number of hours of sleep at night and naps should reach the recommended amount. 9. ENSURE PLENTY OF EXERCISE AND TIME SPENT OUTDOORS DURING THE DAY For the best sleep, experts advise that everyone of every age exercise regularly. (Keep in mind that exercise right before bed may interfere with sleep.) Get those kids outdoors and active! It will help them sleep later. 10. ELIMINATE FOODS AND BEVERAGES CONTAINING CAFFEINE, INCLUDING MANY SODAS, COFFEE, AND TEA Sleep experts find the most promising sleep in children when caffeinated foods and beverages are eliminated completely. But if your child consumes caffeine, set a cut-off time when it’s “too late” for them to have it. In adults, World Sleep Society suggests avoiding caffeine six hours or more before bedtime.

RECOMMENDED SLEEP AMOUNTS Following the guidelines for better sleep in children can help prevent short sleep duration, fragmentation of sleep and sleep deprivation. Sleep deprivation has been linked to myriad health issues ranging from mental health disorders to cardiovascular disease.

AGE SLEEP NEED

○ 3-12 months ○ 1-3 years ○ 3-5 years ○ 6-12 years ○ 12-18 years

14 to 15 hours 12 to 14 hours 11 to 13 hours 10 to 11 hours 8.5 to 9.5 hours

Created By World Sleep Society 23 | healthiersleepmag.com

SLEEP TECHNOLOGY HIGHLIGHT

The Future of SleepStimScience By Aaron Bromberg

odern technology has already changed the way we sleep, and unfortunately most of these changes have been detrimental to our sleep health. International travel and early-morning / late-night conference calls confuse our body’s circadian clock. And phones and social media lead to increased nighttime blue-light exposure and “sleep procrastination”, reducing our time in bed. For these reasons and others, one in three adults struggles with insomnia, and more than half of us are dissatisfied with the quantity or quality of our sleep. Thankfully, sleep researchers and technology developers have started to recognize the opportunities for science and technology to help correct some of the sleep imbalances introduced by modern life. As the CEO of a Silicon Valley startup focused on sleep, I see a lot of the trends in the world of sleep technology in the very early stages. How will technology change the way that we sleep in the future? Here are a few predictions… Adaptive sleep environment. When most of us think about our sleep environment, we think about the softness of our pillow and mattress, or the thickness of our duvet. Smart home technology will allow us to control many more aspects of our sleep environments, including temperature, ambient lighting, and soundscape. You’ll be able to wake up to a simulated sunrise that can naturally keep your circadian rhythm in sync with your sleep schedule. Adaptive smart home technology can even help resolve the age-old conflict between partners with different sleeping temperatures - your bed can have a warm side and a cool side!

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Sleep tracking. People use all sorts of devices to track their sleep at home, from mobile apps to smartwatches to pressure-sensitive pads built into their mattresses. Today, there’s a big gap in accuracy between these consumer trackers and the advanced medical equipment used at professional sleep labs, but in the near future, at-home sleep trackers will be able to tell you - and with your permission your doctor - everything about your sleep that you could learn in a lab. These advanced sleep trackers will help you understand specific changes you can make to improve your sleep and will even serve as early warning systems for detecting diseases. Neuro-technology. Sleep is fundamentally a brain process, and one of the best ways to improve sleep is to directly stimulate the brain and nervous system to promote sleep. New wearables like Somnee™ do exactly that - they use the latest advances in non-invasive brain stimulation to improve sleep safely and effectively (see below). There are also neurotech approaches which stimulate the nervous system to treat sleep apnea or other health issues tied to poor sleep. As neuroscientists learn more about the brain’s behavior while sleeping, look for neuro-technology to become a core part of your sleep routine. To learn more visit stimscience.com ...................................................................... Aaron Bromberg is the Chief Executive Officer of StimScience. He has over fifteen years of experience launching and managing new consumer hardware and software products.

Introducing Somnee ™ The team of scientists and inventors at StimScience have created a new category of sleep aid. Somnee is an electronic headband that uses the latest advances in neuroscience to directly improve your sleep. Backed by science. Somnee is the only sleep aid to use personalized non-invasive brain stimulation to improve sleep quality. Its patented technology works by applying a gentle electrical stimulation at bedtime to mimic and enhance the brain’s natural sleep patterns. The science behind Somnee was developed by leading neuroscientists in a three-year sleep study with over 1,500 nights of data. On average, the system cuts the time it takes to fall asleep in half, and reduces the amount of overnight tossing and turning by more than a third. Designed for comfort. Somnee only needs to be worn for a 15 minute stim session at bedtime; after that, users can take it off and still benefit from a great night’s sleep. But for users that choose to sleep with it on, we designed it for all-night comfort. The electronics are entirely hidden behind layers of luxurious silk and comfortable cotton padding. Safe and effective. Improving sleep with Somnee is totally safe, doesn’t introduce the “next-day hangover” associated with sleeping pills, and takes just 15 minutes at bedtime. US based guests can learn more and pre-order at TrySomnee.com.

About StimScience

StimScience is a team of world-class neuroscientists and product developers, with a mission to help everybody to sleep better, using personalized neuroscience. The company is based in Berkeley, CA.

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