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15/Jan/2018

Melatonin, a naturally occurring amide, is a hormone synthesized by the pineal gland from the amino acid tryptophan. Melatonin regulates the dark-light clock in our brains that govern such things as the sleep-wake cycle, body temperature, and hormone production.

Melatonin levels increase from evening tonight and then decrease as the morning approaches. People with high levels of melatonin sleep longer and more soundly than those with low levels. The concentration of the hormone in our bodies varies with age – 6 year-olds have more than five times the concentration that 80-year-olds have, which is one reason young people have less trouble sleeping than older people.

Foods that offer high levels of tryptophan are the excellent choice for a late night snack, including walnuts, almonds, and dairy (warm milk).


18/Oct/2017

(This article/interview was published and conducted by Terry Gross)

The National Sleep Foundation recommends an average of eight hours of sleep per night for adults, but sleep scientist Matthew Walker says that too many people are falling short of the mark.
“Human beings are the only species that deliberately deprive themselves of sleep for no apparent gain,” Walker says. “Many people walk through their lives in an underslept state, not realizing it.”

Walker is the director of the Center for Human Sleep Science at the University of California, Berkeley. He points out that lack of sleep — defined as six hours or fewer — can have serious consequences. Sleep deficiency is associated with problems in concentration, memory and the immune system, and may even shorten lifespan.

“Every disease that is killing us in developed nations has causal and significant links to a lack of sleep,” he says. “So that classic maxim that you may [have] heard that you can sleep when you’re dead, it’s actually mortally unwise advice from a very serious standpoint.”

Walker discusses the importance of sleep — and offers strategies for getting the recommended eight hours — in his new book, Why We Sleep.

Interview Highlights

On what you should do if you can’t sleep

You should not actually stay in bed for very long awake, because your brain is this remarkably associative device and it quickly learns that the bed is about being awake. So you should go to another room — a room that’s dim. Just read a book — no screens, no phones — and only when you’re a sleepy return to the bed. And that way your brain relearns the association with your bedroom being about sleep rather than wakefulness.

Another thing that people can do if you don’t want to get up and go to a different room is actually trying meditating. … Being quite a stoic, hard-nosed scientist, I actually didn’t really believe the data [about meditation as a sleep aid], even though the data is very strong. And I started doing it myself, particularly when I was traveling by jet lag, and I found it to be very effective. …

It just quiets the mind and it dampens down what we call the “fight or flight” branch of the nervous system, which is one of the key features of insomnia. And that can really have some efficacious benefits too. So that’s another solution if people would choose not to go to a different room.

On whether you can make up for a sleep deficit by sleeping longer another day

You’re trying to sleep off a debt that you’ve lumbered your brain and body with during the week, and wouldn’t it be lovely if sleep worked like that? Sadly it doesn’t. Sleep is not like the bank, so you can’t accumulate a debt and then try and pay it off at a later point in time. And the reason is this: We know that if I were to deprive you of sleep for an entire night — take away eight hours — and then in the subsequent night I give you all of the sleep that you want, however much you wish to consume, you never get back all that you lost. You will sleep longer, but you will never achieve that full eight-hour repayment, as it were. So the brain has no capacity to get back that lost sleep that you’ve been lumbering it with during the week in terms of a debt.

On letting teenagers sleep on weekends

Parents will often pull the covers off their teenager [on] weekends and say, “It’s daylight out! It’s noon! You’re wasting the day!” And that’s wrong for two reasons. … It’s not their fault; it’s their biology that wants them to be asleep at that time. But it’s more than that because it also turns out that they are trying to sleep off a debt that we have actually saddled them with by way of this incessant model of early school start times. We have to abandon that attitude and we also have to change the educational practice as well.

On how the quantity and quality of sleep decreases with age

The amount of sleep — the total amount of sleep that you get — starts to decrease the older that we get. I think one of the myths out there is that we simply need less sleep as we age, and that’s not true, in fact. We need just as much sleep in our 60s, 70s [and] 80s, as we do when we’re in our 40s. It’s simply that the brain is not capable of generating that sleep, which it still needs, and the body still needs. So, the total amount of sleep actually decreases.

We also know that the continuity of sleep also starts to fall apart. Sleep becomes much more fragmented. There are many more awakenings throughout the night — pain, bathroom trips, etc. But we also know that it’s not the quantity of sleep that changes with aging, it’s also the quality of sleep.

It seems to be particularly the deepest stage of sleep — something that we call non-rapid-eye-movement sleep, or non-REM sleep, the very deepest stages of non-REM sleep — those are selectively eroded by the aging process. By the time you’re in your 50s, you’ve perhaps lost almost 40 to 50 percent of that deep sleep you were having, for example, when you were a teenager. By age 70, you may have lost almost 90 percent of that deep sleep.

On using sleeping pills, like Ambien, to sleep

Unfortunately, the current set or classes of sleeping pills that we have do not produce naturalistic sleep. So they are all a broad set of chemicals that we call the sedative-hypnotics, and sedation has not slept, it’s very different. It doesn’t give you the restorative natural benefits of sleep. … If you look at the electrical signature of sleep that you have when you’re taking those medications, it’s not the same as a normal night of sleep.

On how caffeine affects sleep

First, and most obvious for some people, is that it stops you falling asleep. Some people, however, say, “I can have a cup of coffee after dinner and I fall asleep just fine, so I’m not one of those people that is sensitive to caffeine.” And that’s quite dangerous because we also know that even if you can fall asleep, the depth of the sleep that you have when caffeine is swilling around within the brain is not going to be as deep anymore.

So people may wake up the next morning, they’ll feel unrefreshed. They’ll start to reach for the coffeepot earlier. They’ll drink more caffeine, never having realized that it was the cup of coffee last night that has left you feeling underslept because they didn’t wake up during the night, they didn’t have problems falling asleep, but caffeine can still have that deleterious impact.

On alcohol’s effect on sleep

Alcohol … is a sedative drug, and what you’re doing there is simply knocking yourself out. You are removing consciousness quickly from the brain by way of having alcohol, but you’re not putting yourself into naturalistic sleep. The other issue is that alcohol will fragment your sleep — it will litter it and punctuate it with many more awakenings throughout the night, so short … that you tend not to remember them. So, once again, you’re not quite aware of how bad your sleep was when you had alcohol in the system. The final aspect of alcohol is that it is very good at blocking your REM sleep, or your dream sleep, which is critical for aspects of mental health within the brain and emotional restitution too. So alcohol [is a] very misunderstood drug when it comes to sleep — not helpful.


16/Sep/2015

One of the most difficult things to deal with when trying to obtain a good nights sleep is nasal congestion. Moreover, if you are a CPAP user, congestion can create a world of troubles. There are many nasal decongestant products on the market, some stimulate you when your trying to relax, others, like nasal sprays, can lead to horrible rebound congestion. I have always been a fan of natural medicines and would prefer a natural remedy, rather than ingesting a synthetically created product, even if our FDA says its safe (because they have never been wrong before…). The only issues with natural products are they sometimes take a little longer than I would like to work.

I recently was introduced to a product called Respigard, created by Natures Nurse, using red mangroves. These mangroves have survived some harsh living environments and have developed some neat characteristics. A study conducting with Dr. Carroll (Largest Asthma Institute in the US) in Atlanta found that 79% of his participants had most or all of their cold symptoms (including congestion) cleared up within 24-48 hours. That’s as fast, if not faster, than most cold medicines. Nevertheless, I carried a bit of skepticism.

I acquired a bottle of Respigard and was pleasantly surprised and amazed that it actually works. I suffer from horrible congestion, and as a CPAP user, have always had to breathe through my mouth. With CPAP therapy, this causes a lot of dryness, which leads to discomfort and eventually, deep-rooted dislike for my CPAP therapy. However, since I have been taking this product, it has helped me enormously. I currently give it to my daughter, whose 3, for all those pre-school bugs she likes to bring home. And by the way,….it actually tastes good.

So consider this an endorsement and I intend on sharing this information with all our patients who have to use CPAP or who suffer from congestion. If you would like more information about this product, visit www.naturesnurse.com. I will currently work to see if we can distribute and you will be able to purchase from this website.


15/Aug/2015

What is periodic limb movement disorder (PLMD)?

Periodic limb movement disorder (PLMD) is a condition that was formerly called sleep myoclonus or nocturnal myoclonus. It is described as repetitive limb movements that occur during sleep and cause sleep disruption. The limb movements usually involve the lower extremities, consisting of an extension of the big toe and flexion of the ankle, the knee, and the hip. In some patients, the limb movements can occur in the upper extremities as well.

The limb movements occur most frequently in light non-REM sleep. The repetitive movements are separated by fairly regular intervals of 5 to 90 seconds. There can be significant night-to-night variability to the frequency of limb movements.

What causes PLMD?
The exact cause of PLMD is unknown. However, several medications are known to make PLMD worse. These medications include some antidepressants, antihistamines, and some antipsychotics.

Many individuals have periodic limb movements in sleep (PLMS). This is observed in about 80 percent of patients with restless legs syndrome (RLS). PLMS can occur in over 30 percent of people aged 65 and older and can be asymptomatic. PLMS are very common in patients with narcolepsy and REM behavior disorder and may be seen in patients with obstructive sleep apnea and during PAP therapy initiation…

True PLMD — the diagnosis of which requires periodic limb movements in sleep that disrupt sleep and are not accounted for by another primary sleep disorder including RLS — is uncommon.

What are some of the symptoms of PLMD?
Most patients are actually not aware of the involuntary limb movements. The limb jerks are more often reported by bed partners. Patients experience frequent awakenings from sleep, non-restorative sleep, daytime fatigue, and/or daytime sleepiness.

How do I know if I have PLMD?
The diagnosis is based on the clinical history as well as an overnight polysomnogram (PSG). This is a test that records sleep and the bioelectrical signals coming from the body during sleep. A thorough neurological examination should be performed. Respiratory monitoring during the PSG allows one to rule out the presence of sleep-disordered breathing as a cause for the disrupted sleep and excessive muscle activity. Occasionally, additional sleep laboratory testing is useful. Blood work may be ordered to check on iron, folic acid, vitamin B12, thyroid function, and magnesium levels.

Who gets PLMD?
PLMD has been less extensively studied than RLS. The exact prevalence is unknown. It can occur at any age; however, the prevalence does increase with increasing age. Unlike RLS, PLMD does not appear to be related to gender.

As with RLS, some medical conditions are associated with PLMD. These include uremia, diabetes, iron deficiency, OSA, and spinal cord injury.

How is PLMD treated?
First, certain products and medications should be avoided. Caffeine often intensifies PLMD symptoms. Caffeine-containing products such as chocolate, coffee, tea, and soft drinks should be avoided. Also, many antidepressants can cause a worsening of PLMD in many patients and should be reviewed, discussed and replaced by your doctor.

Generally, there are several classes of drugs that are used to treat PLMD. These include dopamine agonist, anticonvulsant medications, benzodiazepines, and narcotics. Current treatment recommendations consider the dopamine agonist as the first line of defense. Medical treatment of PLMD often significantly reduces or eliminates the symptoms of these disorders. There is no cure for PLMD and medical treatment must be continued to provide relief.

  • References
    American Sleep Association. Periodic Leg Movements During Sleep: PLMS/PLMD. www.sleepassociation.org. Accessed 11/13/2012.
  • National Heart Lung and Blood Institute. National Center on Sleep Disorders Research. Section 5: Sleep Disorders: Restless Legs Syndrome/Periodic Limb Movement Disorder. www.nhlbi.nih.gov. Accessed 11/13/2012.
  • Clark CP, Moore PJ, Gillin JC. Chapter 27. Sleep Disorders. In: Ebert MH, Loosen PT, Nurcombe B, Leckman JF, eds. CURRENT Diagnosis & Treatment: Psychiatry. 2nd ed. New York: McGraw-Hill; 2008. www.accessmedicine.com. Accessed 11/13/2012.

30/Jul/2015

Athletes and Apnea: Finding the Common Link

By Gina Roberts-Grey

Obstructive sleep apnea affects as many as 22 million American men, women, and kids, according to the American Sleep Apnea Association. And while certain risk factors such as smoking or having a family history of the disorder can increase the odds, a 2003 study published in The New England Journal of Medicine links being an athlete with sleep apnea.

According to the study, pro football players in the United States are five times more likely to develop sleep apnea than their non-athletic counterparts. Those at the highest risk were linebackers and defensive players charged with stopping quarterbacks and rushers alike—34 percent of these athletes experience sleep apnea, the study noted.

Not only can sleep apnea—which can leave sufferers feeling fatigued or sleep-deprived—impact sleeping quality, the study noted it also can wreak havoc on the gridiron. Players with sleep apnea had the lower reaction time of as much as 11 percent, according to the study.

A separate study conducted at the Douai Memorial Hospital in Tokyo, says many Sumo wrestlers also suffer from sleep apnea.

So what’s the link between sleep apnea and typically healthy athletes?

Athletes may be in peak physical condition, but having a “thick” neck—something that comes with excessive weightlifting as well as carrying the extra pounds needed to push people around the football field—is one of the risk factors for sleep apnea, according to the National Heart, Lung, and Blood Institute. That’s because the National Institutes of Health says all the extra tissue (muscle or fat) on the neck can thicken the wall of the windpipe, making it harder for the airway to stay open when the body is relaxed.

Like football players, wrestlers and other muscular athletes who carry extra weight are at risk for health concerns related to sleep apnea, including high blood pressure, stroke and other life-threatening issues.

Many athletes are affected—Upon his retirement from the NBA, basketball great Shaquille O’Neal announced via a YouTube video that he had been diagnosed with sleep apnea.

Death can be a consequence–Sleep apnea was listed as a contributing cause of the 2004 death of Reggie White, a former NFL defensive end. His widow has since founded the Reggie White Sleep Disorders Foundation to educate the public about sleep apnea and other sleep disorders.

A sleep expert can diagnose and develop a plan to treat obstructive sleep apnea, increasing the odds an affected athlete can get a good night’s sleep and stay healthy off the field.


24/Jul/2015

Healthy Sleep Tips

Healthy sleep habits can make a big difference in your quality of life. Having healthy sleep habits is often referred to as having good “sleep hygiene.”

Try to keep the following sleep practices on a consistent basis:

  1. Stick to a sleep schedule of the same bedtime and wake up time, even on the weekends. This helps to regulate your body’s clock and could help you fall asleep and stay asleep for the night.
  2. Practice a relaxing bedtime ritual. A relaxing, routine activity right before bedtime conducted away from bright lights helps separate your sleep time from activities that can cause excitement, stress or anxiety which can make it more difficult to fall asleep, get sound and deep sleep or remain asleep.
  3. If you have trouble sleeping, avoid naps, especially in the afternoon. Power napping may help you get through the day, but if you find that you can’t fall asleep at bedtime, eliminating even short catnaps may help.
  4. Exercise daily. Vigorous exercise is best, but even light exercise is better than no activity. Exercise at any time of day, but not at the expense of your sleep.
  5. Evaluate your room. Design your sleep environment to establish the conditions you need for sleep. Your bedroom should be cool – between 60 and 67 degrees. Your bedroom should also be free from any noise that can disturb your sleep. Finally, your bedroom should be free from any light. Check your room for noises or other distractions. This includes a bed partner’s sleep disruptions such as snoring. Consider using blackout curtains, eye shades, ear plugs, “white noise” machines, humidifiers, fans and other devices.
  6. Sleep on a comfortable mattress and pillows. Make sure your mattress is comfortable and supportive. The one you have been using for years may have exceeded its life expectancy – about 9 or 10 years for most good quality mattresses. Have comfortable pillows and make the room attractive and inviting for sleep but also free of allergens that might affect you and objects that might cause you to slip or fall if you have to get up during the night.
  7. Use bright light to help manage your circadian rhythms. Avoid bright light in the evening and expose yourself to sunlight in the morning. This will keep your circadian rhythms in check.
  8. Avoid alcohol, cigarettes, and heavy meals in the evening. Alcohol, cigarettes and caffeine can disrupt sleep. Eating big or spicy meals can cause discomfort from indigestion that can make it hard to sleep. If you can, avoid eating large meals for two to three hours before bedtime. Try a light snack 45 minutes before bed if you’re still hungry.
  9. Wind down. Your body needs time to shift into sleep mode, so spend the last hour before bed doing a calming activity such as reading. For some people, using an electronic device such as a laptop can make it hard to fall asleep, because the particular type of light emanating from the screens of these devices is activating to the brain. If you have trouble sleeping, avoid electronics before bed or in the middle of the night.
  10. If you can’t sleep, go into another room and do something relaxing until you feel tired. It is best to take work materials, computers and televisions out of the sleeping environment. Use your bed only for sleep and sex to strengthen the association between bed and sleep. If you associate a particular activity or item with anxiety about sleeping, omit it from your bedtime routine.

23/Jul/2015

Healthy Sleep Tips

Healthy sleep habits can make a big difference in your quality of life. Having healthy sleep habits is often referred to as having good “sleep hygiene.”

Try to keep the following sleep practices on a consistent basis:

  1. Stick to a sleep schedule of the same bedtime and wake up time, even on the weekends. This helps to regulate your body’s clock and could help you fall asleep and stay asleep for the night.
  2. Practice a relaxing bedtime ritual. A relaxing, routine activity right before bedtime conducted away from bright lights helps separate your sleep time from activities that can cause excitement, stress or anxiety which can make it more difficult to fall asleep, get sound and deep sleep or remain asleep.
  3. If you have trouble sleeping, avoid naps, especially in the afternoon. Power napping may help you get through the day, but if you find that you can’t fall asleep at bedtime, eliminating even short catnaps may help.
  4. Exercise daily. Vigorous exercise is best, but even light exercise is better than no activity. Exercise at any time of day, but not at the expense of your sleep.
  5. Evaluate your room. Design your sleep environment to establish the conditions you need for sleep. Your bedroom should be cool – between 60 and 67 degrees. Your bedroom should also be free from any noise that can disturb your sleep. Finally, your bedroom should be free from any light. Check your room for noises or other distractions. This includes a bed partner’s sleep disruptions such as snoring. Consider using blackout curtains, eye shades, ear plugs, “white noise” machines, humidifiers, fans and other devices.
  6. Sleep on a comfortable mattress and pillows. Make sure your mattress is comfortable and supportive. The one you have been using for years may have exceeded its life expectancy – about 9 or 10 years for most good quality mattresses. Have comfortable pillows and make the room attractive and inviting for sleep but also free of allergens that might affect you and objects that might cause you to slip or fall if you have to get up during the night.
  7. Use bright light to help manage your circadian rhythms. Avoid bright light in the evening and expose yourself to sunlight in the morning. This will keep your circadian rhythms in check.
  8. Avoid alcohol, cigarettes, and heavy meals in the evening. Alcohol, cigarettes, and caffeine can disrupt sleep. Eating big or spicy meals can cause discomfort from indigestion that can make it hard to sleep. If you can, avoid eating large meals for two to three hours before bedtime. Try a light snack 45 minutes before bed if you’re still hungry.
  9. Wind down. Your body needs time to shift into sleep mode, so spend the last hour before bed doing a calming activity such as reading. For some people, using an electronic device such as a laptop can make it hard to fall asleep, because the particular type of light emanating from the screens of these devices is activating to the brain. If you have trouble sleeping, avoid electronics before bed or in the middle of the night.
  10. If you can’t sleep, go into another room and do something relaxing until you feel tired. It is best to take work materials, computers and televisions out of the sleeping environment. Use your bed only for sleep and sex to strengthen the association between bed and sleep. If you associate a particular activity or item with anxiety about sleeping, omit it from your bedtime routine.

If you’re still having trouble sleeping, don’t hesitate to speak with your doctor or to find a sleep professional. You may also benefit from recording your sleep in a Sleep Diary to help you better evaluate common patterns or issues you may see with your sleep or sleeping habits.


Copyright by Florida Sleep Solutions 2018. All rights reserved.

Jacksonville: (904) 683-0687