Healthier Sleep Magazine

healthiersleepmag.com Special Autumn 2020 Issue

Healthy Habits for Healthy Sleep 5 Untruths We Believe About Sleep The Sleep Secret Experts Prioritize

Healthier Sleep A publication of World Sleep Society Your Trusted Source for Improving Sleep Publisher World Sleep Society Special Issue Reviewers Lourdes DelRosso, MD Melissa C. Lipford, MD Robert J. Thomas, MD Rochelle Zak, MD Editor Gina Dewink dewink@worldsleepsociety.org Sales Manager healthiersleep@worldsleepsociety.org Designers Eileen Madsen Brook Lanz

ABOUT

For advertising or editorial contact information, email healthiersleep@worldsleepsociety.org or visit healthiersleepmag.com for current rates.

Healthier Sleep is published 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 throughout the United States. No part of this publication may be reprinted or reproduced without written permission.

Healthier Sleep magazine 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.

Copy Editor Wendi Kitsteiner Contributing Writers Antonio Culebras, MD Gina Dewink Clete A. Kushida, MD, PhD, FAASM Liborio Parrino, PhD

Š2020 World Sleep Society.

All rights reserved.

Printed in the U.S.A.

CONTENTS

Special Autumn 2020 Issue 2

About Healthier Sleep Magazine

6

2021-2022 Editorial Calendar

7

10 Ways to Improve Your Child’s Sleep

9

World Sleep Society Programs

10 The Chronic Inability to Sleep

Healthy Habits for Healthy Sleep | 4

11 The Snooze Button 15 Sleep & Self-Worth 19 Road to Better Sleep 20 Sleep Apnea & Stroke 22 The Consequences of Poor Sleep 23 Let’s Talk about Sleep 27 Advertising Rates

5 Untruths We Believe About Sleep | 13

IN EVERY ISSUE The BuZZZ about Sleep

Right Now in Sleep Science

PAGE 12

PAGE 14

Bedtime Reads

Ask the Sleep Doc

PAGE 22

PAGE 25

Sleep Divorce

The Sleep Secret Experts Prioritize | 16

The Sleep Revolution: Transforming Your Life, One Night at a Time

Poor sleep and blood pressure

Questions answered by sleep professionals

3 | healthiersleepmag.com

Dr. Clete Kushida mentoring Wenjing (Athena) Wang, MD during her year in the International Sleep Research Training Program (ISRTP).

Healthy Habits for Healthy Sleep

By Clete A. Kushida, MD, PhD, FAASM

H

ealthy sleep is sleep which restores and energizes you so you feel wide awake, dynamic and energetic all day long, yet 1 in 3 Americans is not achieving healthy sleep.

Many 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

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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.

IMPROVING SLEEP CONTINUITY Observing and researching sleep, we see individuals waking numerous times per night. For example, apnea is when breathing stops for a period of time. When sleep apnea occurs, a person is awakened and experiences sleep

Healthy Habits continued from page 4 loss. In severe cases, a patent 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.

ENHANCING 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.

Better sleep is possible by creating healthy sleep habits. If you are still unable to achieve good sleep after following these suggestions, consider visiting a sleep specialist. Healthy sleep is an achievable dream.

World Sleep Society has created a list of healthy habits for healthy sleep

• Establish regular sleep and

wake times.

• Avoid light from smartphones and

tablets near bedtime.

• Reserve the bedroom environment

for sleep and sex only, avoiding work or study.

• Do not smoke.

• Avoid caffeine six hours before bedtime.

• Avoid heavy, spicy, or sugary foods four

hours before bedtime.

• A light healthy snack before bed

is acceptable.

• If you do not fall asleep in 20 minutes,

leave the bedroom and return to bed when tired so your body will begin to associate the bedroom environment with sleep only.

• Exercise regularly.

• Do not exceed 30 minutes of daytime

sleep or napping.

• Avoid excessive alcohol ingestion

four hours before bedtime.

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2021-2022 EDITORIAL CALENDAR JANUARY/FEBRUARY 2021

MARCH/APRIL 2021

HEALTHY SLEEP

SLEEP DISORDERS

Ads Due: 10/26/20

Ads Due: 12/23/20

Ads Due: 2/25/21

SLEEP APNEA

• • • • •

Sleep apnea Snoring Stress Telehealth Myofunctional therapy

• World Sleep Day: Nutrition, exercise & sleep • Autism & sleep Shift work • REM Sleep Behavior Disorder • Aging & sleep

JULY/AUGUST 2021

INSOMNIA

Ads Due: 4/28/21

• Insomnia • Pediatric sleep disorders • Chronic lack of sleep/effects of sleep deprivation • Anxiety • Insomnia & mental health

JANUARY/FEBRUARY 2022

SNORING & OSA

• Night Terrors • Circadian Rhythm Sleep Disorders • Sleepwalking • Nightmare disorder • Sleep Related Hypoventilation/Hypoxemia

SEPTEMBER/OCTOBER 2021

NOVEMBER/DECEMBER 2021

Ads Due: 6/30/21

Ads Due: 8/26/21

HYPERSOMNIA & NARCOLEPSY

• • • • •

MAY/JUNE 2021

Narcolepsy Hypersomnia Parasomnias Depression Non 24 Sleep Wake Disorder

RLS

• Restless Legs Syndrome • Periodic limb movement disorder • Alzheimer’s disease • Parkinson’s disease • Sleep & sports performance & injury

IN EVERY ISSUE

Ads Due: 10/25/21

• • • • •

Sleep Breathing Disorder Bruxism or teeth grinding Sleep & Memory CPAP Sleep & women (pregnancy to menopause)

ABOUT HEALTHIER SLEEP MAGAZINE Healthier Sleep is published six times per year by World Sleep Society.

World Sleep Society is a membership organization for professionals working in the field of sleep medicine and research with a mission to advance sleep health worldwide. Welcome to Healthier Sleep.

CONTACT US For more information, visit healthiersleepmag.com.

For a custom quote, contact healthiersleep@worldsleepsociety.org.

S

10 Ways to Improve Your Child’s Sleep

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.

being cannot be underestimated, and 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 cause 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 ageappropriate bedtime and waketime.

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 included 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-

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?

2. Keep a consistent bedtime and waketime 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 interfere with natural

circadian rhythms in both children and adults. Sticking with the same sleep and waketime 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) his/her sleep health will improve.

10 Ways continued on page 8 7 | healthiersleepmag.com

10 Ways continued from page 8 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. during the day. The total number of hours of nightElectronics in the bedroom distract from sleep. Exsleep and nap-sleep should reach the recommended perts agree, falling asleep in front of the television is amount. on the “poor sleep health” list. Additionally, children (and adults) could begin to 9. Ensure plenty of exercise associate the bedroom with and time spent outdoors Following the guidelines for stress. It’s best to avoid any during the day. better sleep in children can help electronics in the bedroom.

For the best sleep, experts prevent short sleep duration, fragmenadvise that everyone of every tation of sleep and sleep deprivation.

7. Maintain a regular daily age exercise regularly. (Keep in Sleep deprivation has been linked to schedule, including consismind that exercise right before myriad health issues ranging from mental tent mealtimes. bed may interfere with sleep.) health disorders to cardiovascular disease.

Consistent daily schedules Get those kids outdoors and may be more difficult with active! It will help them sleep fluctuating extra-curricular aclater.

TABLE OF RECOMMENDED SLEEP AMOUNTS tivities, but research shows the CREATED BY WORLD SLEEP SOCIETY more consistent daytime, the 10. Eliminate foods and less stress at bedtime, resulting beverages containing AGE SLEEP NEED in better sleep. Monica Roosa caffeine, including many 3-12 months 14 to 15 hours Ordway, PhD, APRN, PPCsodas, coffee, and tea.

1-3 years 12 to 14 hours NP-BC, an Assistant ProfesSleep experts find the most 3-5 years

11 to 13 hours sor at Yale University, School promising sleep in children 6-12 years 10 to 11 hours of Nursing studies stress and when caffeinated foods and 12-18 years 8.5 to 9.5 hours sleep in infants and toddlers. beverages are eliminated “More results are coming in completely. But if your child and have not been published consumes caffeine, set a cutyet, but the preliminary data off time when it’s “too late” on associations between sleep for them to have it. In adults, and stress response are promWorld Sleep Society suggests ising,” she states. avoiding caffeine six hours or more before bedtime.

8. Have an age-appropriate nap schedule.

To reach the recommended number of hours of sleep by age (table included), fill in the remaining hours with naps 8 | healthiersleepmag.com

MISSION

The fundamental mission of the World Sleep Society is to advance sleep health worldwide. World Sleep Society will fulfill this mission by promoting and encouraging education, research and patient care throughout the World, particularly in those parts of the world where the practice of sleep medicine is less developed.

World Sleep Society will act as a bridge between different sleep societies and cultures, supporting and encouraging worldwide exchange of clinical information and scientific studies related to sleep medicine. World Sleep Society will seek to encourage development and exchange of information for world-wide and regional standards of practice for sleep medicine.

GOAL & PURPOSE

The goal and purpose of World Sleep Society is to advance knowledge about sleep, circadian rhythms, sleep health, and sleep disorders worldwide, especially in those parts of the world where this knowledge has not advanced sufficiently.

World Sleep Society will promote world-wide sleep health by advancing public education, supporting public policies related to sleep health, and supporting sleep research. World Sleep Society currently represents individual members, societies, and organizes the World Sleep Congress every other year.

OPERATING PROGRAMS

World Sleep Society developed the following programs that consist of promoting sleep education, awareness, and member services and include World Sleep Congress and World Sleep Day.

WSS

International Sleep Disorder Specialist

THE BEST OF SLEEP MEDICINE & RESEARCH COMING TO ITALY

EXAMINATION PROVIDING SLEEP MEDICINE COMPETANCE

ANNUAL AWARENESS EVENT WITH CALL TO ACTION

MENTORING & TRAINING SLEEP RESEARCH LEADERS

ASSOCIATE SOCIETY MEMBERS

The fundamental mission of World Sleep Society (WSS) is to advance sleep health worldwide. In an effort to increase global awareness of sleep issues, WSS has formed a relationship with the following national sleep societies or regional federations.

FOUNDING MEMBERS

MEMBERS SINCE 2018

• • • • •

• Georgian Sleep Research and Sleep Medicine Society • International Pediatric Sleep Association • Indian Association of Surgeons for Sleep Apnoea • Austrian Sleep Research Association • Brazilian Sleep Society • European Academy of Dental Sleep Medicine • Hong Kong Society of Sleep Medicine

Asian Sleep Research Society Australasian Sleep Association Canadian Sleep Society European Sleep Research Society Federation of Latin American Sleep Societies • Sleep Research Society MEMBERS SINCE 2015 • Taiwan Society of Sleep Medicine • Czech Sleep Research and Sleep Medicine Society • German Sleep Society • Russian Society of Somnologists • Serbian Sleep Society • Turkish Sleep Medicine Society • British Sleep Society • French Society for Sleep Research and Sleep Medicine • Finnish Sleep Research Society MEMBERS SINCE 2016 • Israel Sleep Society • Peruvian Association of Sleep Medicine • Romanian Association for Pediatric Sleep Disorders • Sleep and Wakefulness Medicine Moroccan Federation • Bulgarian Association of Obstructive Sleep Apnea & Snoring • Indian Society for Sleep Research MEMBERS SINCE 2017

ENDORSED SOCIETY

INTERNATIONAL SLEEP

MEETINGS PROMOTING SLEEP MEDICINE & RESEARCH WORLDWIDE

GUIDELINES ONLINE LIBRARY OF EDUCATIONAL CONTENT

CONNECT WITH US

RECOMMENDATIONS FOR DIAGNOSIS & TREATMENT

THE OFFICIAL JOURNAL OF WORLD SLEEP SOCIETY Official journal of World Sleep Society & International Pediatric Sleep Association

• Asian Society of Sleep Medicine • Japanese Society of Sleep Research • South East Asian Academy of Sleep Medicine • Australia and New Zealand Sleep Science Association • Integrated Sleep Medicine Society Japan • International Restless Legs Syndrome Study Group

MEMBERS SINCE 2019 • • • • • •

ASEAN Sleep Federation European Restless Legs Syndrome Minnesota Sleep Society American Academy of Sleep Medicine Chinese Sleep Research Society CMDASM -Chinese Medical Doctor Association sleep medicine Specialized Committee • Canadian Sleep and Circadian Network MEMBERS SINCE 2020 • Portuguese Sleep Association • Indian Sleep Disorders Association • Italian Association of Sleep Medicine

Prevalent, Significant, Costly

The Chronic Inability to Sleep

I

nsomnia is a society—is quite profound.” sleep disorder we cannot Recent research puts the inafford to trivialdividual economic burden of ize. The National chronic insomnia at $5,000 Sleep Foundation per year, per patient, accordstates around 1 ing to Dr. Morin. “This may in 3 people has at sound like a large number,” least mild insomDr. Morin asserts, “Until you nia. World reCharles Morin, PhD realize only 10 percent of (Canada) nowned insomnia that number is related to the researcher, Charles individual’s cost of treating the Morin, PhD of Canada, puts the sleep disorder. The remaining 90 prevalence of chronic insomnia percent is indirect costs.” The redisorder in adults at around 10%. search sites indirect costs related to Considering the current global chronic insomnia as the frequency population, this means somewhere of being absent from work and dearound 2 billion people are living crease in productivity due to lower with some form of insomnia. “It energy and memory function. is a common assumption,” begins Dr. Morin, “that as we age, we THE INDIVIDUAL IMPACT have more sleep disturbances. And There is a familial aspect to chronic for the most part, that is true. But insomnia. If one or both parents insomnia and chronic insomnia are have insomnia, the children are most common in middle-aged paat a higher risk of developing the tients, with a slightly higher prevasleep disorder. But researchers are lence among women.” still looking at all of the variables.

Could watching parents struggle THE ECONOMIC BURDEN with the inability to sleep make it Dr. Morin is a professor of psya learned behavior? “What I like chology and researcher at Univerto offer,” Dr. Morin suggests, “is sité Laval in Quebec, Canada. With hope. If sleep difficulties are a dozens of journal publications and learned behavior, that means you awards behind him, currently, he is can unlearn them. And if you working to push insomnia into the know you are at a higher risk, then spotlight. “Too often, insomnia is when you face life stressors such seen as trivial,” Dr. Morin states. as a death or divorce, you can “But we are able to show that the hold out hope the issue is tempoimpact on individuals—as well as rary.” Though Dr. Morin has seen

10 | healthiersleepmag.com

stressors strike high-risk patients and take insomnia from temporary to chronic. “Clinicians are now aware of the connection between depression and sleep disturbances.

And where they were once told to treat the depression to relieve the insomnia, too often the sole treatment of depression did not stop the sleep disturbances. Today, we treat both health concerns, giving them equal significance.

Sleep disorders such as insomnia need to be viewed as the high-level health factor that it is.” Per World Sleep Society’s sleep talking points, chronic lack of sleep has not only been connected to an increased likelihood of mental disorders such as depression, anxiety and psychosis, but also a higher risk for heart disease, stroke and diabetes.

THE BEST TREATMENT OPTION For the billions of people living with insomnia, what is the most recommended line of treatment? A form of therapy known as CBT-I. Cognitive Behavior Therapy for Insomnia (CBT-I) has been listed as the first-line of insomnia treatment for those with moderate to chronic insomnia by some of the top experts in the world. The American College of Physicians® published insomnia treatment guidelines that note CBT-I as “a strong recommendation” with “moderate-quality evidence.”

Chronic from page 11 The European Sleep Research Society also has published guidelines on the positive outcomes of using CBT-I for the treatment of insomnia. So what is it, and why isn’t it a more well-known form of treatment?

“I fear patients hear cognitive behavior therapy and assume it is a lengthy psychoanalytical process that can take years to work through, but it is not,” says Dr. Morin.

“CBT-I is generally a 4-, 6- or 8-week process that puts the patient in the driver seat of the entire process. The healthcare professional is merely the coach encouraging the patient along the way. And when the program is followed, patients will likely see results because—as I want to reiterate—when dealing with a learned behavior, we can teach patients to unlearn it.”

The general idea of Cognitive Behavior Therapy for Insomnia is that personal feelings and attitudes affect everyday behavior. CBT-I teaches patients coping strategies and methods for dealing with life stressors.

Dr. Morin adds, “However, if the insomnia is not yet chronic, or is triggered by one of those life stressors I mentioned, then one option is prescription medication.

While medication should be seen as a temporary solution, I do want patients to be aware of all options, and know solutions are out there.”

TAKE ACTION World Sleep Society has found that most sleep disorders are preventable or treatable, yet less than one-third of sufferers seek professional help. For patients ready to be proactive about sleep health, the Society of Behavioral Sleep Medicine offers an online directory of providers who treat sleep disorders, including insomnia.

Patient Organization Highlight

The Snooze Button

T

he Snooze Button—That’s the name of the podcast, the working title of the book and various other projects connected to the book. The man behind the button is Neil Hedley. Hedley explains, “I’m the host, producer, webmaster, social media guy, chief shoe polisher.”

According to Hedley, The Snooze Button is his attempt to fix a lifelong battle with insomnia in such a way that it also offers help to others with sleep issues by “helping them avoid all the horrible information that’s being shoved out onto the internet.” Hedley accomplishes this by talking to sleep experts and neuroscientists from around the world. But it’s way more than that. Hedley clarifies, “We’re also talking to celebrities and high achievers who have sleep challenges baked in to their everyday experience. How do you fall asleep when you’re on a concert tour that has you and your toddler sleeping in a different hotel every night for seven months? How do you fall asleep on the International Space Station?

How do you fall asleep the night before “the big game” when you’re the starting quarterback tomorrow? When I get a sleep tip from those folks, I’ll try it out for two weeks myself, and share the actual data from my sleep tracker to determine which things worked and which things didn’t.”

The Snooze Button podcast series began with Hedley’s visit to a sleep lab in Toronto where he learned “just how little” he and his primary care doctor knew about one of the most basic yet critical processes of the human body.

So what does Hedley hope to gain from his podcast? A good night’s sleep. Or maybe several. Hedley states, “Sleep is at the heart of virtually everything our bodies do. There isn’t a single process in your body that can’t be improved by getting better sleep, but because sleep is something that eventually happens without much effort to everybody on the planet to one degree or another, we don’t pay it nearly enough attention.”

—thesnoozebutton.com

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The BuZZZ about Sleep The Latest Buzzword is Sleep Divorce When a couple stops sleeping in the same bed or bedroom in an effort to better sleep quality and quantity, such as when a member of the couple has a sleep disorder or works a night shift.

The term gained popularity in 2019 with a New York Times article, and again in 2020 when TV Host, Carson Daily, publicly spoke about his sleep divorce from his wife due to his sleep apnea.

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5 Untruths We Believe About Sleep The 94 classified sleep disorders are not always to blame

By Gina Dewink

I

n the world of medicine, Sleep Medicine is a relatively young subspecialty, but Preserving it’s evolving at a rapid pace. Sleep Medicine is a regular subspecialty of practice and research devoted to circadian understanding sleep and its rhythms has complicated importance in our overall health, as well been found to as treatments for the sleep lower the risk of disorders keeping you from a good night’s sleep. sleep disorders, The recent list of sleep disorders, the International Classification of Sleep Disorders (ICSD-2), cites 94 known sleep disorders.

But what if it’s not a sleep disorder keeping you awake? What if it’s just the misconceptions you believe about your sleep?

If you believe any of the untruths below, it may be time to rethink sleep.

mental health disorders and chronic health issues such as obesity and diabetes.

I NEED 8 HOURS OF SLEEP PER NIGHT. [UNTRUE] The truth is, even if you’re not getting that many hours (and studies show many of us are not), this is a myth disguised as a guideline. Sleep experts can only seem to agree that healthy sleep hours range from 6.68-10 hours of sleep per night, depending on the person.

Your optimal sleep duration requirement is largely

determined by heredity. And ‘Long Sleeper’ and ‘Short Sleeper’ are both listed as sleep disorders in the ICSD2, meaning you may need more or less than the standard eight.

I CAN TRAIN/TEACH MYSELF TO SLEEP LESS.

[UNTRUE]

Because our heredity plays such a large part in our sleep needs, we are unable to train ourselves to sleep less. Though you may test various lengths of sleep to find your optimal amount, you will not be able to convince your body that less is needed. Sleeping your optimal amount is only one-third of the “magic.” Dr. Clete Kushida, MD, PhD, FAASM explains, “A truly restorative sleep depends on duration as well as continuity and depth of sleep.” It’s a three-pronged approach to obtaining the perfect amount of sleep.

I CAN SLEEP ANY TIME, AS LONG AS I GET THE HOURS IN. [UNTRUE] Following your body’s circadian rhythms is important.

This means sleeping at your body’s optimal and natural time. Preserving regular circadian rhythms have been found to lower the risk of sleep disorders, mental health disorders and chronic health issues such as obesity and diabetes.

Professor Debra J. Skene of the University of Surrey, UK has over 25 years research experience studying human circadian rhythms in health and disease. Dr. Skene explains, “Synchronization between our body clocks and the external environment ensures optimal timing of events. If there is misalignment between the circadian timing and behavior, such as during night shift

Untruths continued on page 14 13 | healthiersleepmag.com

Untruths from page 13 work or following travel across time zones, then one is sleeping and eating at the wrong time of day. This has acute consequences (daytime sleepiness; reduced performance and increased risk of accidents) as well as long term consequences (increased risk of metabolic disorders, cancer).”

SLEEP IS A WASTE OF TIME. [UNTRUE]

SLEEP DISTURBANCES ARE HARMLESS. [UNTRUE]

Research shows again and again how sound sleep can improve memory, cognitive function, academic performance in children, sports performance, mental health and even beauty.

Untreated sleep disorders causing multiple wake-ups have been linked to several chronic diseases, mood disorders, anxiety and more. Poor sleep affects every aspect of life, including one’s vitality and general outlook. Symptoms of excessive daytime sleepiness predispose the growth of traffic accidents, traumatism in the workplace and the development of mental illness. In addition to the multitude of health risks that accompany sleep disturbances, a study by RAND found that lack of sleep is costing the U.S. economy $411 Billion dollars per year. The data can be found in droves, and it all explains why sleep disturbances have consequences many of us do not consider. Sleep disturbances should be placed at the same level as other health concerns.

In a culture that works 24/7, sleeping can seem like a low priority. But in reality, by sleeping your optimal amount, you will push yourself ahead by functioning your best.

But until we place sleep at the top of our priority list, it will always seem there just isn’t time for this routine activity. And that’s the hard truth about sleep.

Right Now in Sleep Science Poor sleep can raise blood pressure and alter gut microbiome. A recent scientific study suggests that staying awake all night can lead to high blood pressure, though it’s not yet clear what mechanisms underlie the development of this conditions. Researchers from the University of Illinois at Chicago (UIC) have identified a connection between disrupted sleep and elevated blood pressure, as well as changes in the gut microbiome.

Physiological Genomics, 2020, Vol. 52, No.7 doi.org/10.1152/physiolgenomics.00039.2020

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Sleep & Self-Worth The Unlikely Duo Affecting Your Life

By Gina Dewink

basic and a bit unremarkable, we now have a name for the magic weight loss solution we’ve been coveting!

And thy name is sleep.

There is value to treating sleep disturbances in treatment-resistant depression.6 Science and anecdotal evidence have long linked depression and trouble sleeping. But this new research is a bit like the chicken and the egg. Its findings suggest that instead of treating depression to stop the sleep disturbances, we should treat the sleep disturbance which in turn will improve the symptoms of depression! (Mind blown.)

I

t is not uncommon to read about connections between exercise or balanced diet with health and selfesteem. But researchers are urging we take a look at the third pillar of health: sleep. Recent studies show just how important sleep is when evaluating your own value, self-image and worth.

Not getting enough quality sleep negatively impacts your cognitive function, mood, reaction time, learning and memory tasks.1-3 Deep down inside, many of us value ourselves based on how others perceive us. But by depriving ourselves from the sleep we need, we are more likely to appear gruff and forgetful. By getting too few hours of quality sleep, we are setting ourselves up to forget that acquaintance’s name… again.

Individuals getting better quality sleep are perceived to appear more alert, more youthful, and more attractive (changes in facial surface volume and color were identified).4 Appearing more youthful and attractive? Yes, please.

Chalk up another self-worth point for sleeping. As it turns out, beauty sleep is real. (Science says so.)

Short sleep duration appears independently associated with weight gain, particularly in young age groups.5 Weight gain and physical appearance have always been tied to self-esteem and worth. Though the answer is

Sleep loss affects social abilities such as moral awareness, leadership ability and empathic accuracy.7 During the process of evaluating ourselves, these three are heavy hitters. Our moral compass, ability to lead and empathy for others can be viewed as signs of success. By striving for that quality sleep, we can better ourselves in the social situations that make up our lives.

Sleep is a basic human need—a crucial component of survival, much like breathing, eating a healthy diet or getting enough exercise. But it is not yet a mainstream topic until we make it one.

References 1. Dinges DF, Pack F, Williams K, et al. “Cumulative sleepiness, mood

disturbance, and psychomotor vigilance performance decrements

during a week of sleep restricted to 4-5 hours per night,” Sleep, 20

(1997): 267-77.

2. Carskadon MA, Dement WC. “Cumulative effects of sleep restriction

on daytime sleepiness.” Psychophysiolog y, 18 (1981): 107-13.

3. Van Dongen HP, Maislin G, Mullington JM, Dinges DF. “The

cumulative cost of additional wakefulness: Dose-response effects

on neurobehavioral functions and sleep physiology from chronic

sleep restriction and total sleep deprivation.” Sleep, 26 (2003): 117-26.

4. Chervin, RD, Ruzicka, D, Vahabzadeh, A, et al. Journal of Clinical Sleep Medicine, 9 (2013): 845-852.

5. Patel SR, Hu FB. “Short sleep duration and weight gain: a systematic review.” Obesity (Silver Spring), 16(3) (2008): 643−53.

6. Dr. YK Wing (U. Hong Kong, China) presented new data on the

“Added value of treating sleep disturbances in treatment-resistant depression.” World Sleep 2017.

7. Dr. Tina Sundelin (Sweden), “How sleep loss affects social

perception and social abilities, which includes recent experimetal

sudies determining how sleep deprivation affects self-reported

sociability, emotional expressiveness, moral awareness, leadership

ability, and empathic accuracy.” World Sleep 2017.

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The Sleep Secret Experts Prioritize

S

leep is one of the three pillars of good health, along with a balanced diet and regular exercise.

The world’s leading sleep experts have hectic daily agendas, often directing a sleep center or university department while also conducting and publishing research and managing personal/family life. In a time when business leaders are proudly proclaiming they only sleep a few hours per night, what are leading sleep experts doing? Are they only sleeping four hours a night to get ahead?

World Sleep Society interviewed five internationally-renowned sleep experts who all understand that success does not have to come at the price of sleep deprivation. The real secret? Making time in a busy life for adequate sleep.

Dr. Liborio Parrino (Italy) “Sleep is a non-negotiable condition that warrants wellness and prevents diseases,” states Liborio Parrino, MD, an Associate Professor of Neurology at Parma University, Italy. “Unfortunately, sleep is generally considered a time-wasting duty by many.”

Dr. Parrino began his sleep career by studying the recovery of sleep in comatose patients. Thirty-five years later, his current sleep research centers around the overlap between insomnia and sleep apnea syndrome.

Dr. Parrino is industrious and successful. But does he make time for sleep? “In accordance with the recommended indications, I try to respect the range of 7–8 hours of sleep per night,” he relays.

“No matter the content of my day, after 9:00pm, I start to slow down in order to welcome sleep in a relaxed and peaceful background.”

Dr. Parrino believes by making sleep a “trendy and attractive” activity, we can better our own health as well as the world’s. He explains, “When we sleep, we spend less on energy, water and food — And that’s in addition to improving our personal health. Once we all accept that, perhaps people will start rushing to their beds every night to enjoy the reinvigorating and rejuvenating properties of a good night’s sleep.”

16 | healthiersleepmag.com

Dr. Charles Samuels (Canada) Charles Samuels, MD, CCFP, DABSM is the Medical Director of the Centre for Sleep and Human Performance as well as a Clinical Assistant Professor at Cummings School of Medicine, University of Calgary. He also is the current President of the Canadian Sleep Society. “The general public needs to know that sleep is important, has a purpose and we should all make it a priority,” Dr. Samuels declares. “I aim for an 8-hour window at night, usually from 11:00pm to 7:00am,” he says of his sleeping habits. “If I have to get up early, napping is a key part of my strategy. If I get 6 hours of sleep, I nap during the day for 15–20 minutes.”

But Dr. Samuels wasn’t always able to balance his schedule around sleep. During prolonged work hours as a rural physician, sleep debt impacted his behavior with his young family, his performance as a physician and almost cost him his life. “Two incidents cemented why sleep should be priority number one in my health,” Dr. Samuels relays. “First, while on-call, I rolled my car in the middle of winter while driving to the emergency room from my house at midnight. I was clearly not fit to drive, and I was very lucky. Another more dramatic incident occurred one summer night driving

...And Why You Should Too home from the emergency department around 2:00am.

I drove by my house, continuing on a country road and ended up at the shore of a lake, having fallen asleep driving. I woke up scared to death. I had no idea where I was, and it took me an hour to find my house.”

After these incidences, Dr. Samuels began researching the science of sleep. He also learned how to organize his day and night around sleep. When following his routine, he has the energy to work, train and enjoy the weekends.

Dr. Maree Barnes (Australia) “On an individual level,” begins Dr. Maree Barnes of the Institute for Breathing and Sleep, Austin Hospital in Melbourne, “sleep is essential to good physical, emotional and psychological health. On a societal level, inadequate or poor sleep is a significant financial cost to our community.” Sleep disorders cost the Australian economy more than $5.1 billion each year in healthcare and indirect costs. Reduction in life quality caused by sleep disorders in Australia has a further cost equivalent of $31.4 billion per year.

“Personally,” Dr. Barnes explains, “I try to average 8

hours sleep each night. There are some nights when this is not possible, so I sleep in when I can. I don’t nap during the day. I make this possible in two ways,” she continued. “Firstly, by making sure I have at least 8 hours reserved every night, and secondly, by ensuring my bedtime behaviors promote good sleep.” Dr. Barnes creates the right sleep environment by making sure the bedroom is dark, quiet and comfortable, avoiding caffeine, alcohol or exercise for at least one hour prior to bed, and leaving electronics out of the bedroom.

“When I fell into the field of sleep medicine, I was at home with three children under the age of 5 and expecting a fourth. Training and research provided me with the interest and challenge I needed, as well as insight into the importance of prioritizing sleep in our family. We must all remember that without adequate sleep, we are at risk of accidents on the road, at work and in the home, as well as cardiovascular and metabolic illnesses.”

1. SLEEP MORE 2. SLEEP MORE 3. SLEEP MORE!!!

17 | healthiersleepmag.com

Sleep Secret from page 17

Dr. Clete A. Kushida (United States) When Clete A. Kushida, M.D., Ph.D. was a freshman in college at Stanford, he saw an advertisement in The Stanford Daily (a student newspaper) that said, “Are you interested in sleep?” It turned out to be a recruiting session for students interested in being research sleep technologists for academic credit. Dr. Kushida explains, “I ended up staying up during the night to monitor the polysomnograms of research participants whom had narcolepsy. This piqued my interest in sleep disorders and I subsequently enrolled in Dr. William Dement’s “Sleep and Dreams” undergraduate course.” Dr. Dement encouraged Dr. Kushida’s interest in the scientific study of sleep, leading Kushida to follow his footsteps at the University of Chicago for medical and graduate school to pursue further training in sleep medicine and research.

Currently, Dr. Kushida is researching treatment effectiveness for patients with obstructive sleep apnea, as well as new therapies for sleep apnea, restless legs syndrome, and narcolepsy. “I average 7 to 8 hours of sleep per night,” Dr. Kushida states. “I do this by consistently setting a standard sleep routine, and going to bed and waking up about the same time. Sleep is so important — not only for health, but also for maintaining optimal alertness in job performance, particularly in occupations where public safety is at risk,” he says.

18 | healthiersleepmag.com

Dr. Nesreen Elsayed Morsy (Egypt) “When I was starting a pulmonology career eleven years ago,” begins Dr. Nesreen Elsayed Morsy, the Deputy Chairman of the Board and Council Secretary of Mansoura University Sleep Center (MUSC) and Faculty of Medicine of Mansoura University in Egypt, “sleep medicine was a mysterious area to me. I was excited to explore it. Especially in Egypt, it was a new field in the medical practice.” Currently, Dr. Morsy is researching the relationship between obstructive sleep apnea and venous thromboembolic diseases (blood clots, veins and circulation). “Although daily I have a lot to do, I am eager to have 6 to 7 sleep hours for workdays, and increase it to 9 hours on weekends,” Dr. Morsy states. “I am careful to get enough continuous sleep in a suitable place.”

Dr. Morsy believes more individuals should be aware of how optimal sleep is important for the body’s health. “Our sleep period is a time of growth hormone release and body repair, essential for learning and memory,” she describes. “Sleep loss can impair immune response, increase hunger, elevate cardiovascular diseases mortality and impair neurocognitive performance. We must all place sleep at the highest of importance.”

The professionals highlighted in this article represent the many leaders belonging to World Sleep Society’s membership, committed to advancing sleep medicine and research worldwide.

World Sleep Society’s Road to Better Sleep 10. Reserve your bed for sleep and sex, avoiding its use for work or general recreation.

9. Block out all distracting noise and eliminate as much light as possible.

1. Establish a regular bedtime and waking time.

10 TIPS FOR BETTER SLEEP

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

6. Watch your workout routine.

7. Use comfortable, inviting bedding.

5. Change up your bedtime snack.

2. Allow yourself to take a nap if you’re tired.

3. Adjust to a healthier lifestyle regarding your substance use.

4. Create a caffeine cut-off time.

THE 3 ELEMENTS OF GOOD QUALITY SLEEP

Created by World Sleep Society’s committee of internationally-renowned experts in the field of Sleep Medicine and Research.

DEPTH

DURATION

CONTINUITY

DURATION

The length of sleep should be sufficient for the sleeper to be rested and alert the following day.

CONTINUITY

DEPTH

Sleep periods should be seamless without fragmentation.

Sleep should be deep enough to be restorative.

Created by World Sleep Society’s committee of internationallyrenowned experts in the field of Sleep Medicine and Research.

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Sleep Apnea & Stroke

The symbiotic relationship you need to know about

T

wenty years ago, you would be hard pressed to find data on sleep apnea’s connection to stroke. Even ten years ago it may have been difficult to find supporting data to clarify the association.

But today, we are fortunate enough to have dedicated researchers and sleep experts working to let everyone know—sleep apnea and stroke have a well-documented connection that should not be ignored.

Karl Doghramji, MD is the Medical Director of Jefferson Sleep Disorders Center in Philadelphia specializing in Sleep Disorders Medicine. “Several years ago, I began noticing a high prevalence of sleep apnea among incoming stroke patients,” Dr. Doghramji begins. “After searching out national data and examining sleep apnea rates in our own stroke patients, I became involved with the Sleep Stroke Study Group.”

This international group is a growing medical community comprised of sleep and stroke researchers Dr. Karl Doghramji from around the world. “From there, I focused on post-stroke outpatients,” Dr. Doghramji explains. “We wanted to know—could implementing treatment for sleep apnea in post-stroke patients prevent a future stroke?”

20 | healthiersleepmag.com

EXPLAINING THE CONNECTION A number of long-term studies spanning six or more years have concluded that leaving sleep apnea untreated in an individual who has had a stroke increases the risk of having a second stroke. Dr. Doghramji cites those living with untreated severe sleep apnea have a three-fold risk of a repeat stroke. “If the connections between sleep apnea and stroke do not seem apparent, it may help to think about it like this — sleep apnea promotes the right biological environment for a stroke; it is very ‘pro-stroke.’

Stroke is a thrombotic vascular build-up of plaque that forms in an artery supplying blood to your brain. Sleep apnea promotes that process by lowering blood oxygen

levels, increasing heart rhythm disturbances, increasing blood pressure…essentially, sleep apnea is the fire in the oven of stroke.”

UNDERSTANDING THE OPTIONS Treating sleep apnea, especially when severe, may lower the risk of stroke. But for patients who have already lived through a stroke episode, CPAP machines and other forms of treatment may not be well-tolerated. “Post-stroke patients often suffer with daytime sleepiness, weakened cognitive function and physical impairments that make using a CPAP difficult.

Currently, we are studying a different form of treatment, which may one day be applied to stroke patients.

Sleep Apnea from page 20 One such treatment is Upper Airway Stimulation Therapy. Jefferson has been a leader in understanding and implementing this form of sleep apnea treatment.” Much like a pacemaker, an Upper Airway Stimulation Therapy device is implanted into the patient’s chest area. The implant sends mild stimulation to airway muscles, keeping the airway open while the patient is asleep. The implant is turned on at night and off during the day via remote control. “This type of therapy is available commercially to the public,” Dr. Doghramji states.

“Studies are being conducted to follow the efficacy of this type of treatment, and so far, the findings have been positive.”

KNOWING THE RISKS For patients who are unsure if they are living with sleep apnea, Dr. Doghramji advises using the STOP-BANG questionnaire to determine next steps. The STOPBANG questionnaire is available online, and is an acronym for the

factors that put individuals at risk for sleep apnea. Snoring, feeling Tired during the day, Observable pauses in breathing and a history of high blood Pressure are what make up the STOP. BANG stands for BMI of higher than 35kg, Age over 50, Neck circumference of more than 16 inches and Gender of male.

and treating sleep apnea may lead to lower rates of hospitalization, lower mortality rate due to stroke, and a myriad of other potential benefits.”

To learn more about stroke and stroke risk, Dr. Doghramji suggests reviewing content of the American Stroke Association.

A score of 3 or greater helps healthcare professionals determine where patients are at a higher risk for OSA, and who would need a sleep study to confirm the diagnosis.

“Patients falling within the high sleep apnea risk categories should be taking steps for risk reduction, such as controlling blood pressure, losing weight, quitting tobacco use, etc.,” states Dr. Doghramji. “Because sleep apnea can create such a perfect environment for stroke to form, I always suggest at-risk patients begin with a sleep study for diagnostic assessment. Diagnosing

21 | healthiersleepmag.com

The Consequences of Poor Sleep

M

issing one night of sleep is a normal occurrence for individuals around the globe.

But what if you lack sleep on a regular basis? Or if you’re unable to obtain quality sleep due to a sleep disorder?

Then, the consequences may be more serious.

ally causes fatigue, poor concentration and reduced memory. Stretching one poor night into chronic sleep loss can Liborio Parrino, PhD lead to irritability, mood swings, and several mental disorders such as depression.

Sufficient sleep is one of the pillars of good health, along with regular exercise and a balanced diet. We charOutside physical health, poor attenacterize good quality sleep tion while driving increases as having sufficient durathe risk of motor vehicle tion, satisfactory depth, accidents. And on the job, seamless continuity and Recurring lack of sleep deprivation reduces well-balanced architecwork productivity. In the quality sleep can U.S., the economic cost of ture. Recurring lack of lead to quality sleep can lead insufficient sleep among the to long-term health long-term health working population is $411 risks such as hypertenbillion per year. risks such as sion, diabetes, heart hypertension, disease, stroke, cogniBecause sleep deprivation diabetes, heart tive alterations, and shortens telomere length in disease, stroke, possibly even cancer.

DNA which facilitates chaotic cellular growth, it can cognitive When children are alterations and even increase the risk of various deprived of sleep, they forms of cancer. gait disturbance. become irritable and hyperactive. Since the Clinical studies suggest that major episode of growth telomere shortening may be a hormone liberation occontributing factor for breast curs in association with deep sleep, cancer risk among female shift workers sleep deprivation can lead to stunted like nurses and flight attendants. growth. One study is searching for biomarkers in saliva and hair samples If your sleep is insufficient, impaired of toddlers who are not sleeping well, by a relevant sleep disorder or of poor meaning very soon researchers could quality, the risk to jeopardize healthy have biological aging is statistically high and menacing evidence that lack and we ask that you consult a medical of sleep harms professional about better sleep. developing minds and bodies.

In an adult, sleep deprivation looks Antonio Culebras, MD different. It usu22 | healthiersleepmag.com

Bedtime Reads

Looking to learn even more? Each issue, we highlight one book about sleep.

Check out this bestseller in sleep.

Arianna Huffington, of The Huffington Post and Thrive Global, is the author of The Sleep Revolution: Transforming Your Life, One Night at a Time.

“Arianna Huffington shows how our cultural dismissal of sleep as time wasted compromises our health and our decision-making and undermines our work lives, our personal lives— and even our sex lives in this New York Times bestseller.”

—ariannahuffington.com

Let’s Talk About Sleep

When international sleep experts collaborate, the public benefits

By Gina Dewink

P

op quiz, hotshot. If someone asked you to name the three pillars of health, could you? Sure, there’s healthy food (please stop talking about kale) and then there’s exercise (can I get a New Year’s resolution) and, you’ve probably surmised by the title of this article, the third is sleep. Sound sleep, to be exact.

FROM THE SLEEP EXPERT “There are close to 100 disorders of sleep, but most can be modified and are manageable with the help of sleep specialists,” explains Birgit Högl, MD of Austria.

“Most sleep disorders are preventable or treatable, yet less than 1/3 of sufferers seek professional help. Sleep problems constitute a global epidemic that threatens health and quality of life for up to 45% of the world’s population.”

WORLD SLEEP SOCIETY’S CONGRESS ON SLEEP MEDICINE When sleep experts come together from over 75 countries around the world, the public benefits in three main areas: statistics, sleep awareness and international collaborations that further our understanding of sleep and its functions.

STATISTICS Ready to worry about your quality of sleep? You probably should be. Recent studies (many completed by members of World Sleep Society and/or published in the scientific journal Sleep Medicine) show: • Individuals who get an entire night’s sleep without any interruptions experience lower rates of high blood pressure, diabetes, obesity and other chronic illnesses.

• Insomnia affects between 30–45% of the adult population.

• Primary insomnia (insomnia with no underlying condition) affects 25% of our elderly.

• Obstructive sleep apnea has an estimated a prevalence of 17% among men and 9% among women in the United States.

Dr. Högl is also the President of World Sleep Society.

It’s a prestigious organization devoted to networking and collaborating sleep specialists and researchers from around the world. (Meaning you must be established in the sleep health community to belong to the society.)

Let’s Talk About Sleep continued on page 24

BETTER SLEEP BETTER LIFE

BETTER PLANET 23 | healthiersleepmag.com

Let’s Talk About Sleep from page 23 AWARENESS Have you ever rolled your eyes at your coworker because they’re complaining (again) about their lack of sleep? Or perhaps you’re the one being negatively affected by lack of sleep? World Sleep Society has a request: “Be cognizant,” Dr. Liborio Parrino of the University of Parma in Italy states, “that most sleep problems can be managed by changing behaviors around sleep, medical therapy, or cognitive behavioral therapy. We hope patients suffering from sleep complaints, or who suffer from excessive daytime sleepiness, see a physician and, if needed, obtain a consultation in a sleep center.

Sleep problems are no less important than other health concerns.” Dr. Parrino has also been the Chair of the World Sleep Day® Committee for the past several years.

SAVE THE DATE

Dr. Parrino continues, “Join participants from around the world in a global call to action about the importance of sleep each March for World Sleep Day.”

Guatemala

Portugal

Created and hosted by World Sleep Society, World Sleep Day is an internationally-recognized awareness event bringing sleep health professionals and patients together for one important common cause: Sleep.

COLLABORATIONS Sleep is such a broad topic it can bring people together in amazing ways. During its biennial congress on sleep medicine, World Sleep Society gathers thousands of sleep professionals to hear scientific presentations led by hundreds of speakers from dozens of countries.

This offers a unique lens to compare research taking place in other countries. Through international collaborations, the understanding of sleep, sleep disorders and sleep medicine is increased worldwide.

With organizations spending time, resources and funding on the study of sleep, we are able to better understand its importance in our health, as well as discover other ways to help us get a great night’s sleep. And that point just may help you sleep at night.

India

Hungary

United Kingdom

World Sleep Day is an annual event, intended to be a celebration of sleep and a call to action on important issues related to sleep. Hosted by World Sleep Society, it is a data-driven opportunity for sleep experts to inform the public about the importance of sleep in all aspects of health.

Become one of the hundreds of delegates representing over 70 countries by visiting worldsleepsociety.org/WSD.

worldsleepday.org

24 | healthiersleepmag.com

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Ask the Sleep Doc

As answered by our Special Issue Reviewers

Lourdes DelRosso, MD

Q: How do I know if I’m getting enough sleep?

Dr. Thomas The average sleep requirement is about 7 hours, but shorter and especially longer is normal. The need to sleep in for more than 1-2 hours on an off day suggests inadequate sleep on other days, as does fatigue relieved by a nap.

Melissa C. Lipford, MD

Robert J. Thomas, MD

Dr. Zak Sleep needs vary from individual to individual. If you feel you are not able to function well during the day, particularly if you awaken feeling fairly refreshed, but get very sleepy later in the day, try experimenting with increasing time in bed and see if getting more sleep helps.

If you awaken unrefreshed and/or having difficulty functioning regardless of total sleep time, then seeing someone to address intrinsic sleep disorders would be important.

Dr. Lipford Most adults need between 7-9 hours of sleep nightly on a regular schedule to feel their best. If you follow this gen-

Rochelle Zak, MD

eral guideline and you feel rested in the morning and energized throughout the day, you can rest assured you are obtaining sufficient sleep.

Q: How long should it take me to fall asleep?

Dr. Zak Generally, 20-30 minutes is considered normal, but for some people, lying awake and resting for longer is not distressing and, thus, would not be considered pathologic.

Dr. DelRosso As a rule of thumb, less than 30 minutes is considered within the normal range.

However, this also depends on your “internal clock.” For example, if you are used to falling asleep by 11pm, you can expect to fall asleep within 30 minutes if going to bed at 10:30pm, but not necessarily at 9pm. It’s important your bedtime matches your natural circadian clock time.

Ask the Sleep Doc continued on page 26 25 | healthiersleepmag.com

Ask the Sleep Doc from page 25 Dr. Thomas Anything more than 30 minutes unless your own choice (e.g., watching a movie, reading something interesting) is probably undesirable. Common reasons include too much light in the 2-3 hours prior to bedtime, and cognitively engaging or activity with high emotion content just before bedtime. All of us have a certain degree of “sleep reactivity,” or how easily our sleep is disturbed by stress.

Q: How do I know if my insomnia is environmental or something I should see a doctor about?

Dr. Thomas Some “red flags” include insomnia not caused by an obvious trigger, persistence beyond 2-3 months, very unrefreshing sleep, bothersome daytime fatigue or daytime sleepiness, abrupt startled awakenings at night, daytime irritability which interferes with job/relationships or reduction in usual motivated behaviors and feeling depressed or anxious in the daytime.

Dr. DelRosso I would not call it insomnia until you have been evaluated by a sleep specialist. There are many contributors to difficulty falling asleep. Easy to target environmental causes include: noise, temperature, light and other disruptors at home (smaller children crying, bed partner moving or snoring, among others.)

Dr. Lipford Many of us experience temporary insomnia in the setting of stressful life events. Environmental factors can also trigger insomnia (like a noisy bedroom environment, or a partner/roommate who keeps different hours than you). If your symptoms persist, check in with your healthcare provider. They will review your medical and sleep history and may recommend additional tests.

Q: What are some ways to fall back to sleep if I awaken in the night?

Dr. Lipford One of the most frustrating aspects of insomnia is the harder you try to fall back asleep, the more your mind resists falling asleep. Trying relaxation methods (such as meditation, deep breathing or guided imagery) help calm the mind and allow drowsiness to build.

26 | healthiersleepmag.com

Dr. Thomas A common mistake is spending too much time in bed, in part “trying to catch up” for lost sleep. This extra time will reliably make it harder to fall asleep after a major awakening. Other disruptive things to do are eating, light exposure, physical activity or trying to “get some work done.” Sleep is also naturally NOT continuous, so be tolerant to some brief awakenings.

Long durations of wake (30-60 minutes) need to be addressed. If you routinely spend time in bed worrying, leave the bed until you feel sleepy and return when ready to sleep to break an association of being awake, rather than sleep, with the bed.

Dr. Zak The first thing to do is to try to be patient with yourself. A bad night’s sleep is not optimal, but is also not a disaster. Trying to put in perspective your need to return to sleep can help with relaxation and the ability to fall back asleep. Secondly, you will likely feel that your bladder is full, so do use the bathroom and when you return to your bed, begin your usual pre-sleep routine.

For some people, it can include slow deep breathing and muscle relaxation, for others it can be listening to relaxation apps or calming music.

Dr. DelRosso Do not turn the lights on or start checking electronics.

Get comfortable, be sure your environment is not too hot or too cold; be in a comfortable position. If you can’t sleep after 30 minutes, get up and read a book (if close to getting up time get up and start your day, avoid a nap the next day).

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