Better Sleep Better Health

Getting adolescents to get the sleep they need can be a hard task to accomplish. Today’s world is filled with distractions that keep kids and teenagers awake. But a new study released in the latest issue of the journal SLEEP suggests that parents that take the hard line when it comes to bedtimes are truly helping their children’s futures.

The study looked at 385 children from different schools in South Australia. Researchers found that 17.5% of the those studied reported a parent-set bedtime. That group demonstrated earlier bedtimes, more sleep, and improved daytime functioning compared to their peers without parent enforced bedtimes. This is significant because especially in children sufficient sleep time is essential for cognitive and physical development. Lack of sleep has been linked to lower school test scores, depression, increased traffic accidents, and childhood obesity.

Teens may not like it when their parents make them go to bed, but in the long run the benefits of sufficient sleep may far outweigh the costs of struggling over bedtimes.

As the summer months approach and thoughts drift to vacation plans around the country and abroad, many people who have been treated for Obstructive Sleep Apnea with continuous positive airway pressure, or CPAP, may wonder how to maintain a healthy night’s sleep away from home.

Traveling by airline with a CPAP

Since 9/11 many restrictions have been put in place to increase security on airlines. One inconvenient measure has been the reduction of the number of bags allowed as carry-ons. This is one instance where having a CPAP machine and knowing your rights can come in very handy. The FAA classifies CPAP as a medically necessary device. This means that passengers are allowed to bring the machine and its bag on board as an extra carry-on. Savvy travelers can will find that CPAP bags, when well packed, can provide much needed valuable real estate in these times of $50 checked luggage. TSA handlers are generally well versed with CPAPs but may ask you to remove the machine from it’s bag for additionally screening, including swabbing for explosive residue, at the security checkpoints. If you happen to encounter an overzealous TSA agent that tries to make you check your CPAP, present them with this document issued by the Department of Transportation stating the machine is to be allowed through. An official note from your doctor showing medical necessity doesn’t hurt either, especially in foreign lands.

International Travel

Most currently produced PAP machines from major manufacturers utilize international power supplies. This means they can automatically adjust for different voltages, such as 240, without the need for special equipment. This eliminates the danger of burning out a PAP while on vacation. However, travelers will still have to bring plug adapters along to fit into different sized wall outlets. And it is prudent to look up contact information for your CPAP manufacturer in the destination country. If something goes wrong with your machine, having a certified repair center nearby can mean the difference between a memorable vacation and a ruined trip.

Camping with CPAP

Many people think that having a CPAP will stop them enjoying outdoor trips such as camping , hunting, and hiking. But newer CPAP machines are very portable and easy to use without a constant power source. There are now reliable battery powered CPAP units that can be recharged on the road via car adapters. Depending on the pressure level used, these units can provide overnight power for several nights before needing a recharge. Don’t want to spring for another machine? No worries, universal battery packs are also available for most major CPAP machine models on the market. These batteries are small, long lasting, and utilize the latest in battery advances. And most major companies, such as Resmed and Respironics offer car cigarette lighter adapters which make RV or car camping with CPAP easy.

For more information about traveling with CPAP, contact a qualified DME provider like the ones at Oregon Sleep Associates.

Recently two stories of overly tired air traffic controllers have made headlines. First, an air traffic controller inadvertently dozed off at Ronald Reagan Washington National Airport, leaving two cargo planes to land themselves. Then reports came out detailing a Nashville controller purposely sleeping during a busy shift. These incidents are frightening considering the important responsibilities these individuals are given every day.

One would expect sweeping changes to the follow such revelations about air traffic security, yet as an open letter from the chairman of the National Sleep Foundation to the FAA shows, the changes needed are not happening:

“Americans are justifiably concerned by the recent spate of incidents involving air traffic controllers who fell asleep on duty.  But now that the FAA/DoT has outlined the steps it intends to take to address this problem – minor tweaking of the controllers’ work/rest schedules combined with a threat of stricter disciplinary action against offending controllers in the future – the public’s response ought to escalate from concern to alarm.

This is because the announced changes amount to tokenism – gestures more likely to assuage public anxiety than to meaningfully reduce fatigue in air traffic controllers.  For example, although it is true that extending the time off between shifts (from 8 to 9 hours) will probably result in more sleep (which is good) it will not result in adequate sleep (the amount of sleep necessary to sustain normal alertness during the night shift).  Prior research shows (and common sense dictates) that a significant portion of the 9 hour break will be devoted to commuting, eating, personal hygiene, socializing with family, etc.  If the FAA was truly serious about optimizing alertness in air traffic controllers, and if the policy makers based their decisions on scientific evidence, the time off between shifts would have been extended to at least 12 hours – and scheduled napping would now be encouraged during work shifts, rather than prohibited. Likewise, prior sleep research (and, again, common sense) suggest that the threat of more severe punishment will have no beneficial effect on alertness.  Those air traffic controllers who fell asleep did not do so because they were not properly motivated to maintain wakefulness.  They fell asleep because they had a significant, physiological need for sleep.  And they probably didn’t even realize they were falling asleep – sleep onset can be insidious. (Think about it. If sleep onset was not insidious, would anyone ever fall asleep while driving an automobile?)

Also, it should be pointed out that both the airline industry and the FAA have known about this problem for decades.  In 1981 the National Transportation Safety Board (NTSB) published a special investigative report on air traffic controller fatigue. However, the recommendations outlined in that report were essentially ignored – and classified as “Closed—Unacceptable Action” in 1989.  Since then, the NTSB (which is the congressionally-mandated special investigative body charged with determining causes of transportation accidents) has issued more than 80 new fatigue-related safety recommendations.  Care to guess how many of these recommendations have been implemented?

History is replete with accidents resulting in human death and injury caused by sleepy transportation workers, and the NTSB routinely cites air traffic controller fatigue in its findings. One tragic example is the August 2006 accident involving Comair flight 5191 in Lexington, Kentucky, in which the air traffic controller cleared the plane for take-off on the wrong runway, resulting in a crash that killed 49 people. Unfortunately, given the inadequate response to the recent incidents, we can expect more sleep and sleepiness-related errors and accidents involving air traffic controllers in the future.”

The hectic schedule of an NBA team can wreck havoc on players’ performance and well-being. Constant traveling leads to sleep deprivation which increases recovery time from injuries, lowers judgement and reaction times, and leads to losses on the court. One team has found a way to gain the edge over the competition with sleep medicine.

The Boston Celtics coaching staff realized the impact constant traveling and a lack of sleep were having on their players, so they enlisted the help of Harvard’s Sleep Medicine director, Dr. Charles Czeisler. Czeisler detailed the detrimental effects of sleep loss to Celtics coach Doc Rivers and they took action to ensure a rested team. Paul Flannery of Boston Magazine recounts the changes on his blog:

The Celtics soon eliminated morning practices and instituted the “2 a.m. rule,” which holds that if the players can’t get to their hotel rooms in the next city by that time, then they stay where they are for an extra night and get their eight hours. Sound rest is all the more important for a veteran team like the Celtics, who have struggled playing games on consecutive nights. “Trying to create a window of 8 to 10 hours of sleep — it’s almost impossible during an NBA season,” Rivers says. “The way we were doing it made it completely impossible.”

The lessons learned from the Celtics sleep hygiene practices can be applied to everyone’s daily life. Allowing oneself plenty of time for sleep and eliminating distractions such as TV and computers from the bedroom are good steps to maintaining a balanced sleep schedule.

As reported by the New York Post:

“Yankee captain Derek Jeter has a new clubhouse — a $15,500-a-month, two-bedroom, three-bath rental at Trump World Tower, reports The Post’s Jennifer Gould Keil. Yes, that’s the same building where Jeter already owns a $20 million apartment that is now on the market. We hear that a neighbor’s noisy construction was hampering the star shortstop’s crucial rest. So Jeter signed a lease for a 2,087-square-foot corner pad away from the racket to ensure some serious shut-eye during baseball season.”

As expensive as that sounds, Jeter is taking a proactive approach to protect his sleep, something that is all too often ignored by many people. Having a proper sleep environment is very important to getting a good night’s rest. Sleep specialists recommend that your sleep environment be dark, cool, and quiet. Remove televisions and computers from the bedroom and don’t let pets sleep in the room to limit sleep disruptions. For more tips on proper sleep hygiene visit Oregon Sleep Associates.

The National Sleep Foundation recently talked to comedian Mike Birbiglia, author of the book Sleepwalk With Me, about his experiences with REM Behavior Disorder, living with a sleep disorder, and taking part in Downy’s Clean Sheet Challenge.

One of the highlights of the interview comes when he talks about his experience jumping out a hotel room window as a result of his REM Behavior Disorder, a condition in which people physically act out their dreams:

SleepMatters®: “You are well-known for talking about your experience with a rare sleep disorder (RBD). (I will never forget your description of jumping out a hotel window in Walla-Walla, Washington.) Can you tell us a little about this? How are you doing now?”

Mike: “In my early twenties I was a young comic hustling to get any foothold in the business. I took every gig, every red-eye flight, and drove any distance to make my career work. In my apartment in Brooklyn I had experienced a series of frightening sleepwalking episodes, but I just didn’t think they were serious. I would stand on my bed and try to fight flying jackals, and I had fallen off the bookshelf in my living room, which in my dream was an Olympic podium. Still, I thought I was too busy to see a doctor.

On one trip to Washington state, I was performing at 5 colleges in 4 days. I was staying up late, obsessed with cable news coverage of the war, and eating pizza on my bed while on the Internet right before I went to sleep. That night I nearly died when I jumped through my hotel window in my sleep.

That’s when I saw a sleep specialist and was diagnosed with REM Behavior Disorder. For the most part, I have been able to control these episodes with medication and behavioral changes. I definitely have a lot more respect for the importance of proper sleep.”

Read the rest of the interview with Mike Birbiglia here.

The National Sleep Foundation conducts a nationwide poll each year to gauge Americans thoughts, attitudes, and habits concerning sleep. This year’s topic related to electronic connectivity and sleep. Here are some highlights from the NSF website:

Many Americans report dissatisfaction with their sleep during the week.
The poll found that 43% of Americans between the ages of 13 and 64 say they rarely or never get a good night’s sleep on weeknights.

Communications technology use before sleep is pervasive.
Americans report very active technology use in the hour before trying to sleep. Almost everyone surveyed, 95%, uses some type of electronics like a television, computer, video game or cell phone at least a few nights a week within the hour before bed.

Interestingly, cell phones were sometimes a sleep disturbance. About in one in ten (9%)of generation Z’ers (13-18 year olds) say that they are awakened after they go to bed every night or almost every night by a phone call, text message or email.

Baby boomers are less sleepy than generations Y and Z.
Roughly one in five of generation Z’ers (13-18 year olds) and generation Y’ers (19-29 year olds) rate as “sleepy” using a standard clinical assessment tool (included in the poll) compared to about one in ten generation X’ers (30-45 year olds) and baby boomers (46-64 year olds).

Coping with sleepiness through caffeine and naps.
Americans are coping with sleepiness by drinking caffeine and taking regular naps. The average person on a weekday drinks about three 12 ounce caffeinated beverages, with little difference between age groups.

Sleepiness also played a factor in safe driving practices. Half of generation Y’ers (50%) say they drove while drowsy at least once in the past month. More than a third of generation X’ers (40%) and approximately a third of generation Z’ers (30%) and baby boomers (28%) also say so.

Many people have trouble sleeping and search for a remedy on the shelves of their local grocery store. But even though they don’t require a prescription, over the counter medicines can carry some significant health risks.

Many over the counter sleep medications are one of two substances. The active ingredient in medications such as  Sominex, Nytol, and Tylenol PM is Diphenhydramine, an antihistamine with drowsy effects. This substance is more well know as the common allergy medication Benadryl. Diphenhydramine has several side effects including:

• Dry mouth
• Dizziness
• Prolonged drowsiness lasting into the next day
• Memory problems

The other most common OTC sleep medication is Doxylamine, found in Unisom and Nyquil. This medication can offer more sedation than many prescription hypnotics and is also an antihistamine.

These substances may help to ameliorate short term insomnia but should be treated with caution. Individuals who are pregnant or have health complications such as glaucoma, enlarge prostate, heart problems, or asthma should not use them. In addition, the effects of these drugs can depress respiratory effort and worsen the effects of sleep apnea, leading to more disrupted sleep. Also the “hangover effect” can be worse than many prescription sleep aids and can increase daytime fatigue. These medications should not be used nightly or to treat chronic Insomnia.

If you suffer from Insomnia, doctors recommend addressing the root source of the condition, not the symptoms. Many health issues can cause Insomnia and there are both pharmacological and natural ways of treating them. Contact a sleep center near you to get tested for an underlying sleep disorder and to treat your insomnia properly.

Obstructive Sleep Apnea is widely known as a danger because of its association with increased cardiovascular complications, stroke risk, diabetes, and other health problems. But not many people are aware that OSA can lead to problems with vision as well.

Obstructive Sleep Apnea is a condition in which a person’s airway collapses during sleep, leading to lowered blood oxygen levels and disruptions from sleep. Many complications can ensue from untreated sleep apnea. Several conditions which affect vision may be connected with the disease:

• Floppy Eyelid Syndrome occurs when a person’s eyelids become exerted, or turned inside out. The patient may awaken with their eyelids flipped inside out and can experience watering, stickiness, discomfort, blurred vision, downward pointing eyelashes, and eyelid droop or inversion. These events can lead to conjunctivitis and corneal injury. Most of the time this condition is benign, but it could indicate the presence of OSA.

• Glaucoma is a serious condition that can lead to blindness. It’s caused by damage to the optic nerve and is often associated with increased pressure in the fluid of the eye. OSA is associated with both primary open-angle Glaucoma and normal-tension Glaucoma. The constant variability of blood pressure and oxygen levels caused by OSA may contribute to this disease. In fact, one study found that 20% of patients with Glaucoma may have Obstructive Sleep Apnea.

• Nonarteritic Anterior Ischemic Optic Neuropathy (NAION) occurs when vision is suddenly and painlessly lost in one eye upon awakening. It has been associated with OSA and can cause irreversible vision loss.

• Papilledema is swelling of the optic nerve in both eyes. It typically occurs due to increased pressure within the skull and can lead to progressively worsening vision and, in some cases, blindness.

These and other conditions may be brought on by OSA. It is prudent for everyone to visit an eye doctor every 2 years and if any signs of these conditions arise, get screened for Obstructive Sleep Apnea by a sleep specialist.

The National Sleep Foundation recently conducted a bedroom poll to determine what environmental factors influence Americans sleep the most. The NSF Bedroom Poll looked at different areas such as temperature, romance, sleep habits, and bed condition and polled 1500 people from all walks of life to get the results.

Respondents were asked to rate the level of impact each factor has on their ability to get a good night’s sleep. Some of the more interesting results:

• Pillows and bedroom temperature were the two areas that have the most impact on sleep (70% and 69% impact respectively). Professionals recommend a cool environment as being the most conducive for sleep.

• Bedroom darkness and sheets were also considered important factors with 57% and 53% of participants rating them as being of high importance. These are common factors impacting good sleep hygiene, along with bedroom temperature.

• Snoring from a bed partner is a common reason for people to lose sleep with 41% of respondents saying it impacts their night. This shows that there are still millions of people being affected by untreated Obstructive Sleep Apnea and its most common symptom, snoring.

For more on good sleep hygiene visit the NSF or Oregon Sleep Associates.