Life with Q

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Insomnia can be a relentless, vicious cycle.  A bad night can turn into a day of coping strategies that in turn lead to more insomnia.  Add some worry and ruminations and you have a recipe for disaster.

Some people with chronic insomnia have a sleeping pill routine that has developed over time:  This pill for winding down, that pill for when a couple of hours go by without falling asleep, and maybe another for a middle of night awakening.  In my clinical work educating insomnia patients, the concern and attention over their sleeping medication routine seems to perpetuate their insomnia.  The concern and attention become problems in and of themselves.

Bluntly put, it’s really no way to live.  Sleep is meant to be a time for restoration, both physically and mentally.  Our heart is not designed to be in “wake mode” continuously – it needs to rest.  We need enough deep sleep for adequate growth hormone to be put into our bodies.  And we need REM sleep for mental restoration, clear thinking, and memory consolidation.

Enter the SleepQ sleep training app.  Packed with design features to help you take control of your insomnia, SleepQ is ready for a training session in the late afternoon or early evening after you experience one of those bad nights (when your sleepiness level is high).  As I’ve said in previous posts, sleep training is like exercise – it’s conditioning, done to perform (sleep) better with more confidence.  It is not a pill or gimmick that claims to put you to sleep.  Think of it as jogging shoes for your sleeping brain.

Life with SleepQ will indeed be a time of confidence, in your sleep, in your relationships, in your talents, and in your aspirations!  Back to the exercise analogy:  How do you feel when those clothes in the back of your closet start to actually fit?  Or when simple acts like getting up out of a chair become easier?  Confident.  Now imagine your life more rested, free of worry about sleep, and with less dependence on sleeping medication.

Learn to fall asleep…right on Q!

Til Morning,

Michael

Is Q for U? (re-post)

We are getting close to launch time for our SleepQ Kickstarter campaign, and things are hopping around here at MicroSleep!  I thought it would be helpful to repost some information to help identify who might benefit most from sleep training with SleepQ:

A 2005 survey found that about 15% of adults have chronic insomnia. This is the on-going type, unrelenting, where sleeping pills don’t work (or are not wanted) and phrases like, “My insomnia seems to have a life of its own” and “I’ve tried everything” are commonly heard. What may have started with a temporary erratic sleeping schedule caused by one of life’s twists or turns has become a big problem. Confidence in sleep has plummeted. Sleep is less predictable. The time window for falling asleep becomes very short: “I fall asleep on the couch watching TV, then later race to fall asleep in bed because if I miss my window I’m up all night.”

As a relatively active person, the concept of sleep training made a lot of sense to me. Most insomniacs I educate clinically do not want to be told for the millionth time that caffeine and alcohol are bad for your sleep. Or that they need to exercise more (“I’m too tired all the time for that!”), or sleeping-in is bad (“I have to get SOME sleep sometime!”). SleepQ is a way to take control of on-going sleeping trouble in a very direct, tangible way. Following along with the successful research protocol from 2007 and 2012, the first step is to get sleepy. In the research, this was done by asking the subjects to get no more than 5 hours the night before training. With SleepQ, you can just wait until you have a rough night (probably not a long wait for some of you!). Then, choose a couple hours before bed, ideally late afternoon or early evening when natural sleepiness is high.  Each trial will give you the opportunity to allow yourself a chance to fall asleep, briefly, and then get feedback as to whether or not you fell asleep. This feedback, over successive sleep trials, is how you gain confidence in your sleep. We are even designing the SleepQ app to 1) automatically adjust the training intensity with each sleep trial, and 2) display and share summary results about how well you performed during training!

SleepQ is for you. Simple, effective, non-drug, affordable, research-based.

So, are you one of the 15% of adults I described?

Watch for the launch of the SleepQ app in early 2014!!

Til Morning,

Michael

Talk to the Toe!

Zits Cartoon for Sep/15/2013

With a quick look at the calendar, I imagine this is a sensitive topic for many of you with teenagers.  Traditional school schedules seem to be a square peg to the round hole of teen sleep patterns.  Teens need more sleep than adults, perhaps 2-3 more hours per night more.  Teens typically go to bed late.  Sometimes very late.  And school often starts around 8am.  Teenagers may be just getting into their most consolidated REM sleep around that time, and research studies have shown that depriving a person of REM sleep leads to problems with learning and memory among other things.

Some argue that teens simply use computers, cell phones and TV too much at night.  In fact, most of these illuminated screens contain high levels of light in the blue spectrum, and this wavelength seems to most affect our sleep/wake rhythm.  Blue light tends to suppress the natural production of the hormone melatonin, an important chemical regulator of sleep.  Simply put, light keeps us awake at night.  A century or more ago, with the U.S. still a primarily agriculture-based country, those teens may have had more physical labor in their typical day (e.g., farming chores).  They had more time outside in natural light, and probably had more darkness at night.  The electric light bulb was invented in the late 1800’s, but in 1920 barely 1/3 of all homes were wired for electricity, and cell phones, computers, and big-screen TV’s were still decades away.  So is light the only factor keeping teens awake late?  And if not, should school start later?

Today’s typical teens are pressed with time demands of school sports/clubs, homework, socializing, part time employment, etc., and there are only so many hours in the day.  Additionally, many studies show that sleep patterns change when kids become teens.  From puberty to adulthood, the human brain naturally is less awake during the day than it is in the evening, often not shutting down until very late at night.  Electronic screens would seem to be fuel to the fire, adding more alertness to an already active late-night brain.  For parents fighting this biology, the biggest battles are in the morning.

There is little argument from parents or sleep scientists that teenagers need more sleep and a later wake time.  But our modern American society is built around an 8-5 model.  Over the years, various efforts have been made to push back school start times, and the momentum seems to be growing more quickly now.  Approximately half the states in the country have adopted later start times, and the reports are mostly positive.  For those high school districts that have implemented a later start time, absenteeism has declined, grades have improved and falling asleep in class less common.  But most efforts to delay start times have failed over the years, primarily due to pushback from community members who fear that a shift to later school hours will be prohibitively expensive and/or disrupt after school sports and other extracurricular schedules, student jobs, daycare arrangement, teacher training, or time for homework.  Also, at least one published study on later class schedules for college students showed increased binge drinking and lower GPA’s.

So while society continues the discussion, what are you, the parents, doing at home to try to fit the square peg into the round hole?

Til Morning,

Michael

Spanning the Globe for Sleep

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In previous posts, I have described different strategies for overcoming insomnia and about SleepQ, our research-based sleep training app we are developing to help people rapidly regain confidence in their sleep and to help people lessen their dependence on sleeping pills.  Today I thought I’d share some findings from a recent international sleep poll that shed light on the scope of the sleep disorders epidemic and a summary of some sleep habits in the six countries surveyed:  United States, Canada, Mexico, the United Kingdom, Germany and Japan). While some some of the items surveyed seem to me a bit frivolous (e.g., what scent helps you get to sleep?), there are some interesting and insightful findings.  As you will discover, sleep disorders are a big problem not just in America (well-documented in the annual NSF Sleep In America poll), but world-wide.

Although sleep is recognized as one of the three pillars of health (along with nutrition and exercise), with the exception of Japan less than half of the adults in the countries surveyed indicated they slept well most nights.  Adults in the US and Japan reported sleeping about a half hour less than the other countries.  Which country reports needing the most sleep to feel refreshed?  Mexico, at a little over eight hours.  One in ten of UK respondents reported they never sleep well on work nights.  About a third of US, UK and German adults reported rarely or never sleeping through the night in the last two weeks.  Country with the most trouble falling asleep?  The UK.  But Canadians were most likely to think about work stress while falling asleep.

Americans were the most likely group to wake on time in the morning.  Adults in Mexico were more likely to report waking refreshed most mornings.  About one in ten adults in Japan and Mexico reported sleeping with no pillow.  Germans were much more likely to report sleeping better when they aired out their bedroom, which most Germans surveyed reported doing each day.  Japan was the most likely to use a computer or tablet before bed and the least likely to meditate or pray before bed.  Japan adults also were least likely to report significant negative effects of a poor night of sleep.  Biggest nappers?  The US and the UK.

Surveys and polls are often only semi-scientific, but they are interesting.  And this poll is no exception.  And if you are an American reading this blog post, you are evidence of this final poll result:  Americans were the group most frequently searching for sleep-related information online.  Glad you found SleeponQ.com!

Til Morning,

Michael

 

Enough is, Well, Enough!

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“How much sleep do I need?”  It’s one of those popular questions I am often asked.  And at the risk of frustrating the asker, my answer is, “Whatever you need to feel rested during the day.”  Could it really be that simple?

Studies have shown that the average adult needs about 8 hours, but some need a little more or a little less.  A small number of us need a lot more or a lot less.  Some people with sleep apnea or restless legs report that the amount of sleep they get has little or no bearing on their daytime alertness.  And sleep does not have to occur all at night, especially when we are relatively young or old.  A fairly short, early/mid afternoon nap each day has been employed by various cultures in warm environments for eons as part of their 24-hour sleep accumulation.

Some insomniacs feels VERY strongly that they need at least 8 hours when in fact they have never really paid attention to how a little less makes them feel during the day.  Some might only need 7-7.5 hours, but the anxiety generated by the thought of not getting at least 8 hours creates a vicious cycle of insomnia.  Good sleepers have developed a good sense of how much they need, what alters this need (e.g., activity level or food intake), and how not to lose confidence in being able to get enough sleep the night after a short night of sleep.  This confidence can be difficult to obtain for many people, leading many to the chronic use of sleeping pills or alcohol.  SleepQ is being designed to address this lack of confidence in sleep.

Sleep should be easy, efficient, and, well, enough!  How much sleep is enough for you?  And just as importantly, does a short night of sleep make you anxious or eager for bedtime the following night?

Til Morning,

Michael

Slippery Slopes

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Because I am in the field of sleep disorders, I am often asked by a friend or a patient whether a certain activity is bad for their sleep.  Lists of sleep tips abound and most people know the common ones about avoiding caffeine, alcohol, and smoking.  Some people further understand that watching TV late into the night or sleeping-in on weekends should be avoided.  And a few are well versed in such pitfalls as going to bed earlier to make up for lost sleep, staying in bed fraught with worry if alert at night, or jumping on the stationary bike to wear themselves out if they can’t get to sleep.

When presented with such questions, I always end my answer with, “… if you are having trouble sleeping”.  The reason is that good sleepers are confident in their sleep, and they understand how to keep their sleep on track if they indulge themselves a bit from time to time.  For example, watching TV late into the night is not a good idea for someone with insomnia because it emits light and sound, and because it can engage the mind and keep a person up much later than intended.  However a good sleeper, as I like to say, can do whatever they want.  Late TV for a night?  Usually fine.  Extra slice of key lime pie before bed?  Why not.  Sleep-in a while after a late night?  Sure!

But here is where caution should be applied:  Sleep can go from good to bad in a fairly insidious manner.  The extra time lounging in bed can start an association of the bed with alertness (see my recent blog post on drooling).  Working on the computer later into the night can affect (suppress) our melatonin levels, leading to more difficulty falling and staying sleep.  The leisurely afternoon nap can start to affect our nighttime sleep if too long or late in the day.  These activities can begin to sap our daytime energy level as sleep starts to deteriorate at night.

Think of it like eating and weight gain.  You may be doing fine, but then you find that those jeans are getting just a little snug.  It’s usually not a surprise once you stop and think about it.  The burger joint you started to frequent, the extra computer work you have been doing (causing you to sit more), the forgotten gym membership, or my personal vice: the leftovers on the kids’ plates.  Studies have even shown that when people don’t sleep enough they eat higher calorie food during the day without realizing it.

So yes, if you sleep great, enjoy!  But beware of some slippery slopes with sleep:

  • The morning coffee that becomes an additional afternoon cup to ward off fatigue
  • The occasional short weekend nap after some good exercise that gradually turns into a big afternoon siesta when adequate sleep has not been attained during the week
  • The couple of drinks with dinner that slowly turn into a nightcap, especially when getting to sleep becomes more difficult
  • The normally short awakening at night that morphs into the extended event of a racing mind, a bowl of ice cream and a check of email

I would never encourage any of my friends or patients to remove all the fun out of life to get some better sleep, but rather encourage them to find a balance that works.  Balance that can be challenging on a slippery slope!

How do you keep from slipping?

 

Til Morning,

Michael

Drooling Over a Great Night’s Sleep!

From this title, it may sound like I am announcing a new recently discovered sleep disorder!  Even though many rare and somewhat esoteric sleep disorders have been found, I don’t believe “Sleep Drooling Syndrome” has yet been described.  Instead, I would like to describe one of the most common disorders of sleep, Conditioned Insomnia, in the context of a historical reference to drooling.

As the name implies, Conditioned Insomnia (CI) is something which develops over time.  CI is insomnia which is in a sense “learned”.  When getting to sleep or back to sleep becomes increasingly difficult due to any number of reasons (stress, worry, pain, irregular work schedule, medications, etc.), CI is developing.

This type of conditioning is called “classical” conditioning, first described about a century ago by a Russian physiologist named Ivan Pavlov (1849-1936).  Dr. Pavlov was studying digestion and used dogs as subjects.  Periodically, as the story goes, he would enter the lab, present the dogs with meat powder, and the dogs would of course salivate (drool).  At some point, he noted that the dogs began to drool as soon as he entered the room, or as history has noted, when a bell on the lab door rang as he entered.  The dogs became conditioned to drool, that is, they “learned” to drool for a psychological reason, not a physiological reason.  In the same manner, a person with CI becomes conditioned to become alert in the evening or around bedtime for no physiological reason.

Drool

CI can often be uncovered with a few simple questions: “Do you become more alert at bedtime?” and “Do you tend to sleep better away from home?”.  Answering “Yes” to one or both of these questions, combined with the complaint of frequent difficulty getting to sleep or back to sleep, confirms the presence of CI.  CI is not an all-or-none condition.  It is a gradual continuum, the extreme being downright dread of the bed or bedtime.  Coping behaviors often develop as CI progresses:  using TV for distraction at night, alcohol or sleeping pills before bed, or the oh so fun act of racing from the couch to bed so as not to miss the brief window of time in which sleep must occur or it’s “no sleep tonight!”.  The run-on sentence is meant to give you a glimpse of the anxiety at bedtime that accompanies CI.

So, what can a classically-conditioned insomniac do?  The answer is fairly simple, but effort is required.  CI must be “un-learned”.  This is done by the simple strategy of never being or staying in bed when alert.  Even if someone with CI is falling asleep on the couch, gets the elbow from their spouse that it’s time for bed, and then proceeds to race into bed only to miss their sleep window, the best thing to do is to calmly leave the bed.  Then what?  In a previous blog post I suggested doing anything low tech, low light, and low noise.  Best to start with some reading.  For how long?  Until sleepy again.  Not bored, tired or exhausted, but sleepy, such as when you start dropping your book.

Over time, this strategy has been shown to really help, but it does take will-power.  Not many people are usually there at 3am to encourage you to leave your warm cozy bed on a cold winter’s night when you become alert.  Perhaps the best strategy is prevention: have a bit of low-tech wind-down time each evening without TV or computer screens in front of you.  Adopt a calm, relaxed demeanor.  Feel confident about sleep.  And if you feel like sleep is difficult on a particular night, shrug, foot on the floor, do something quiet in another room until sleepiness returns.

Good sleepers know that an occasional rough night happens, but that sleep will be easier the next night.  But if you struggle with persistent CI, and your doctor has indicated that nothing medically or psychologically is causing it, consider trying the SleepQ app, coming in spring 2014!  A little late afternoon sleep training with SleepQ may be just the ticket to get your sleep back on track quickly!

Til Morning,

Michael

Sleep Strategies Friday: Morning and Napping

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Morning

Sleeping in – one of life’s sweetest pleasures! If you’re a good sleeper, sleep the morning away!  But if you struggle with your sleep at night, a very consistent “start your day” time, regardless of how well you slept that night, can really help.  Starting your day at a regular time gives your brain a sort of circadian “anchor”, a way to establish an end to sleep and a start of wake time.  It can take some effort setting that alarm for the same time each day and ignoring the snooze button, but you can do it!  Yawn, stretch, feet on the floor, and go get some light for a little while.  Good morning!

 

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Napping

I know what you’re thinking…napping is probably bad.  Actually, napping is not always a bad thing.  In fact, a short, early afternoon nap can be quite restorative, allowing us to make it through the afternoon and evening.  Otis prefers to power nap in the back yard on nice days (I think he’s on the chaise more than I am).  On the other hand, long and late naps sometimes leave us feeling a little groggy afterwards, and they can make getting to sleep that night more difficult.  But if you can fall asleep every afternoon, it is very important to examine why.  A plethora of things can increase daytime sleepiness: medical disorders, medications, sleep disorders, not enough sleep, heavy foods, alcohol, increased physical exertion, depression, a common cold…heck, even plain boredom!  Check with your doctor to see if a short, early siesta is good for you or if you might have a sleep disorder (e.g., sleep apnea) at night that is causing the daytime sleepiness.

How is your morning routine?  Up and at ‘em at the same time, or just up whenever?  And how about naps?  Do they seem to affect your nighttime sleep?

 

Til Morning,

Michael

Sleep Strategies Thursday: Awake and Time

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Awake

You wake up in the middle of the night and can’t get back to sleep.  Fun.  Ok, let’s think this one through.  Falling asleep is a passive act.  Our natural sleepiness cannot be forced.  So why try? Try to be indifferent about being awake.  Shrug, get out of bed, keep the lights dim, and go do something quiet somewhere else, like in your living room.  Keep things low tech, low light and low noise.   No TV, no computer, no cell phone, no back-lit reader.

 

So what might you do?  Consider something enjoyable.  Reading (paper book, not an electronic reader) is great, but you don’t have to read the dictionary or War and Peace. Novels are good because they tell a story and are organized into chapters.  If low vision is an issue, how about an audio book? Maybe some quiet music.  I hear knitting is enjoyable.  Hungry?  Have a light snack.  Don’t reorganize your garage or bake a bunch of cookies in your brightly lit kitchen, or start preparing next year’s taxes.  What about those old photos you’ve been meaning to organize, that silly dice game that’s kind of fun, or that numbers game that’s so popular, what’s it called? Lastly, you might consider just going outside in the dark for a few minutes.  The darkness and cool air can help to settle you down.

 

Keep away from your bed until strong natural sleepiness has returned.  If it doesn’t, don’t panic.  Find out in tomorrow’s post what to do (and not do).

 

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Time

You’ll love this one.  What’s the first thing people do when they wake up in the middle of the night?  About 99.9% of people with insomnia check the time.  Guess what?  Clever scientists determined that people sleep better and are a lot less anxious about their sleep with no clock available.  Why?  It turns out that simply knowing the time at night makes us worry about not sleeping.  It also makes us do math to figure out how long we’ve been awake and how long until morning.  Wasn’t 10th grade algebra bad enough?  Besides, what does it matter that it’s 3am WHEN it’s 3am?  Got somewhere to go?  Didn’t think so.  Don’t check the time at night. And if you don’t know what to do with your clock, Otis can come chew it up for you 🙂

Have trouble getting back to sleep?  Do you leave the bed or stay and try to tough if out? What if you didn’t know what time you wake at night?

 

Til Morning,

 

Michael

Sleep Strategies Wednesday: Light and the Bedroom

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Light

House lights, TV, computers, cell phones… Wonder why nobody seemed to complain about insomnia before Edison invented the light bulb in the late 1800s?  Wonder why, when scientists had people live in a cave for a while (ahh, the 60s…), they fell asleep about every 24-25 hours?  It’s the Circadian Rhythm (“circa” = about, “dian”=day).  Our Circadian Rhythm makes us more alert in the morning and more sleepy in the evening, regardless of how much or how little sleep we obtained the night before.  Artificial light levels in the evening affect our Circadian Rhythm, mainly by delaying the time when we feel sleepy at night.  Conversely, bright light in the morning shuts down melatonin production and gets us in wake mode.

So what might you do?  If you have trouble getting to sleep, start by getting some light each morning soon after you get up – turn on some house lights, linger for a couple minutes getting the paper in the morning, check your flowers, smile at your sleepy neighbors outside, etc.  Try sitting by a south or east-facing window while you have breakfast for more natural light.  Then at the end of the day, start dimming those room lights early if possible.  And for Pete’s sake, kill the TV and other electronic screens well before bedtime!  Lots of studies have shown that they emit high levels of light in the blue spectrum, and blue light seems to affect our Circadian Rhythm more than other types of light.

 

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Bedroom

Quiet, dark, cool and comfortable is the goal.  Noises can wake us up (obviously), especially erratic noises.  Simple ear plugs or the constant low-pitch hum of a small room fan can be easy solutions to the things that go bump in the night.  Light in the bedroom?  Light can affect us even with our eyes closed, especially as we age and our skin (eyelids) become thinner.  Consider darker window shades or an eye mask.  Too hot?  Take a cool shower and consider splurging for the AC at night.  Too cold?  Try warmer blankets and wearing socks.  Hate your mattress?  Spend an afternoon sleeping around town at the mattress stores to find a good one.  Trust me, they’ll let you nap as long as you want!  Cats wandering around your room at night?  Think laundry room. Dogs seem to be less nocturnal, and Otis hangs out with us just fine.

Make your “bed” room your “sleep” room!

I’d love to hear about your light strategies!  And what efforts have you made to turn your bedroom into your sleep room?

Til Morning,

Michael