ANNIVERSARY SPECIAL: SleepyHeadCENTRAL's top 25 most popular posts

As determined by Google Analytics, including posts timestamped between September 19, 2014 and September 19, 2015

1. APR 15. 2015 || JUST BREATHE: Upper airway resistance. It's a thing. And it matters.
   
2. NOV 29, 2014 || SHED SOME LIGHT: Misconceptions about Circadian Rhythm Disorders
   
3. NOV 21, 2014 || SHED SOME LIGHT: Terra Ziporyn Snider, PhD, on later school start times
   
4. JUN 12, 2015 || GUEST POST: Insights into the recent ASV device recall
   
5. FEB 13, 2015 || ALTERNATIVES: Therapies for Sleep Apnea that don't involve a mask
   
6. APR 30, 2015 || JUST BREATHE: "Heard About Sleep?" APNEA... If not, listen in here.
   
7. APR 30, 2015 || JUST BREATHE: What happens if I don't treat my sleep apnea?
   
8. NOV 7, 2014 || SHED SOME LIGHT: ...on circadian disorders
   
9. OCT 24, 2014 || MONSTERS OF SLEEP: Ken Scholes on sleeping and PTSD
   
10. NOV 17, 2014 || SLEEP HYGIENE TIP OF THE WEEK: Melatonin is tricky
    
11. NOV 11, 2014 || SHED SOME LIGHT: ...on non-24 disorder
    
12. OCT 18, 2014 || CPAP CENTRAL: A Season for Masks: Smaller Might Be Better
    
13. JAN 2, 2015 || DEFINITIONS: What is normal sleep?
    
14. NOV 4, 2014 || SHED SOME LIGHT: Are insomnia and winter depression linked?
    
15. MAR 24, 2015 || INSOMNIA: Why is it linked to depression?
    
16. JUL 24, 2015 || SLEEP STUFF: Smartphone apps for sleep
    
17. SEP 20, 2014 || GUEST POST:  Edward Grandi on Sleep Apnea: What is it and what can I do about it?
    
18. JAN 17, 2015 || ALTERNATIVES: Sleep better when you have the flu with these tips
    
19. DEC 18 , 2014 || VISIONS OF SUGARPLUMS: Alcohol is NOT the sweet dream fairy
    
20. FEB 17, 2015 || ALTERNATIVES: Valerian, aka "Nature's Valium" -- safe to use, effective? You be the judge
    
21. MAR 11, 2015 || INSOMNIA: On Sleep State Misperception, with Dr. Robert Rosenberg, DO
    
22. DEC 17 , 2014 || VISIONS OF SUGARPLUMS: Sleep Disorders 101: NS-RED and NES, Sleep Eating Disorders
    
23. FEB 17, 2015 || ALTERNATIVES: Aromatherapy
    
24. MAR 17, 2015 || INSOMNIA: The problem with insomnia forums
    
25. APR 23, 2015 || JUST BREATHE: Hope2Sleep's "Dangers of Untreated Sleep Apnoea" infographic 

GUEST POST: Thoughts on over-the-counter sleep aids, by Amy Korn-Reavis RRT, RST

Is there an Easy Answer to Insomnia?

by Amy Korn-Reavis RRT, RST

We are all looking for that easy solution to staring at the ceiling at night. A pill that will allow you to fall asleep as soon as your head hits the pillow. 

We have also heard about the issues with the prescription medications that are prescribed. Some physicians are refusing to prescribe sleep aids and some insurance companies are unwilling to pay for them. 

We then turn to over-the-counter medications to help us get to sleep.

The most common ones are ones that contain antihistamines. You know the ones that have 'sleep' or 'zzzz' or 'som' in their names. They use two very common antihistamines mixed with nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen to help reduce pain. They are used because drowsiness is a common side effect. 

The issues with these are multiple. You can build up a tolerance to the medication, and an increased dose will cause other health issues such as liver damage, increased sinus swelling, and sensitivity to the medications. 

Another issue is known as rebound. You take yourself off the medication and the insomnia you were worried about increases as soon as you stop taking the medication. 

If you are going to use any of these medications, please follow the directions. Be aware: you should never use these medications for more than 3 days consecutively; you most likely will experience rebound after you take it, then stop using it.

Melatonin is another popular over-the-counter sleep aid. It is a natural hormone that our brain makes when we are exposed to darkness. As we get older we produce less of this hormone. Does it work? That depends. It might help you, unless you are on a medication that blocks melatonin production, or if you do not turn out the lights before bedtime. If you are going to take it, you need to take it and then turn off the lights and go to sleep. It works best when you take it sublingually (under your tongue). You should also start with a low dose such as 1 mg; you should not go higher than 3 mg unless your physician prescribes it for you. There is not enough research on melatonin to show it is safe to use at higher doses.

Teas that help you sleep, such as chamomile tea, are thought to help you relax. The heat of the tea alone can be relaxing for some people. The chamomile herb itself is also believed to help; however, there is little research to support his.   

Supplements that help with sleep--such as L-theanine, CoQ10 or manganese--are thought to help people to relax and fall asleep. While this may be true for some people, it is not true for everyone. Usually it works if you happen to have a low level of the supplement in your system. If you are an average healthy person, then these supplements will not change your sleep onset.  

There is no such thing as an easy answer when it comes to sleep problems. The newest research has found that changes in behavior, with the help of a good counselor who specializes in sleep disorders, appears to be the best help for insomnia. 

We need to remember that achieving quality sleep depends upon relaxing, getting that exposure to quiet and darknes, and getting a little exercise in the morning, all things that will help you best achieve a good night sleep every night.  

________________________________

Amy Korn-Reavis is a registered repiratory therapist (RRT) and registered registered sleep technologist (RST) who has worked in the health field since 1986. She is also the coordinator of the Polysomnography program at Valencia College, where she helps to instruct the next generation of sleep technicians. She is also the founding president of the Florida Association of Sleep Technologists. She currently manages the sleep lab at Emery Medical Solutions in Orlando, Florida.

INSOMNIA: Guest Post on Sleep State Misperception, with Dr. Robert Rosenberg, DO

You Didn’t Sleep At All Last Night?
Actually, Maybe You Did: Insomnia, Reconsidered

by Dr. Robert Rosenberg, DO

"Alarm Clock." Public Domain Image.

Every year, I see many patients who tell me that they get only a few hours of sleep each night. In fact, I have had several swear they barely sleep at all. In most cases, they honestly believe this to be true. Interestingly, if we bring them into our sleep lab, many of these individuals will insist that they slept only a few hours when their electroencephalogram (EEG) indicates that they actually slept much longer.

This type of insomnia, called Paradoxical Insomnia, is also referred to as Sleep State Misperception. Previously it was considered a rare condition, present–or so we thought–in no more than five percent of insomnia sufferers. We now know this estimate to be incorrect. Furthermore, in several recent studies, the incidence is closer to 50% when defined as misperceiving-sleep-as-wake-time by at least one hour or more per night.

As a result, we are now coming to realize there are two basic types of insomniacs:

1) Those who sleep greater than six hours a night but perceive they sleep less;

2) Those who actually sleep fewer than six hours, but accurately estimate their sleep time.

Why is it important to differentiate between the two groups of insomniacs? Because those who actually sleep fewer than six hours a night are much more likely to develop hypertension, diabetes, and suffer earlier death than those who misperceive their sleep time. These findings are potentially revolutionary when it comes to our understanding of the diagnosis and treatment of insomnia. Consequently, we need objective data in order to differentiate these two types, since effective treatment approaches are different.

What I find fascinating is that those with the misperception of their sleep cycles are more likely to respond to CBT (Cognitive Behavioral Therapy), while those who actually sleep fewer than six hours–the short sleeper type–are more likely to require pharmacological therapies. Why? It appears that the short sleepers have an underlying level of physiological hyperarousal. They have elevated levels of stress hormones such as cortisol and adrenaline, while the misperception group seems to demonstrate more of a psychological basis for their insomnia.

Can you relate to this discussion?
Click to share your story!

The good news is that in sleep medicine we now have accurate tools for differentiating these two types. We have a device called an actigraph that is worn like a wristwatch on the subject’s arm. It correlates movement with wakefulness and its absence with sleep. Even more astonishing is a new form of technology called the Sleep Profiler. It records the subject’s brain waves during the night at home, accurately differentiating sleep from wake and also the distinctive stages of sleep. In fact, I have used this form of technology in my own practice with great success.

Due to our new understanding of insomnia and these technological advances, we can offer our patients evidenced-based therapies. As with many other things in medicine, we are learning that in the treatment of insomnia, one size does not fit all.

--This article originally appeared in Everyday Health, 2.18.2014

________________________________

Dr. Robert Rosenberg, DO

Dr. Robert Rosenberg sees patients at his private practices, the Sleep Disorders Centers of Prescott Valley and Flagstaff, and contributes a regular column, Sleep Answers, at EverydayHealth.com. His book, Sleep Soundly Every Night, Feel Fantastic Every Day, was published in June 2014; a copy of it will be selected as a prize in this month's SleepyHeadCENTRAL giveaway. Follow Dr. Rosenberg here:

Twitter: @AnswersForSleep
Facebook page: AnswersForSleep

SHED SOME LIGHT || Guest post: Terra Ziporyn Snider, PhD, on later school start times

The Start School Later Movement

by Terra Ziporyn Snider, PhD

When I moved to Maryland in 2000, plans were in the works to delay our county’s brutal 7:17 a.m. high school start time. Sleep research was already clear that these hours were unhealthy and counterproductive, and school leaders were leading the charge for change. With my oldest child in seventh grade and my baby in kindergarten. I assumed the problem would be solved by the time my kids were affected. Nearly 15 years later, my baby is in college, and nothing has changed.

Nothing has changed in most of the 15,000 or so school districts around the US either. Education Secretary Arne Duncan may have tweeted his view that later start times are a “common sense way to improve student achievement,” but fewer than 15 percent of US high schools start before 8:30 a.m., the minimum acceptable time for middle and high schools recommended by the American Academy of Pediatrics. Nearly 43 percent of high schools start before 8 a.m., and 10 percent before 7:30 a.m.

This inaction shocks sleep researchers and health professionals, as well as many parents who know the grim reality of trying to rouse sleep teenagers before sunrise. For decades, sleep scientists have been telling us why: at puberty, circadian rhythms shift later, not only in humans, but in other mammals as well. Typical sleep cycles begin around 11 p.m. for teenagers and continue through 8 a.m. This means that an early wake-up call (5 or 6 a.m. in many cases) not only allows a maximum of only six to seven hours of sleep, but it also requires students to wake in the middle of deep sleep. 

Since the average teenager needs 8.5-9.5 hours of sleep per night, it’s no wonder that nearly 70 percent of US high school students get under 8 hours – and 40 percent get six or fewer. In addition, they’re getting this insufficient sleep at the wrong time, sleeping in on weekends or napping after (or in) school, creating a situation that amounts to chronic jet lag or shift work.

This wasn't always the case. A hundred years ago, most schools (and places of business) started the day around 9 a.m. In the 1970s and 1980s, many schools shifted to earlier hours. Back then the importance of sleep and adolescent circadian shifts were little understood, and cost savings of running the fewest possible buses in multiple cycles was appealing. Even schools that didn't run buses often found it helpful to match hours to those of nearby schools. As a result, many students today are required to be in class much earlier than their parents and grandparents had been. 

These changes might have saved bus money, but they shifted costs to students and families. Sleep-deprived teens not only risk eating disorders and obesity, heart disease and diabetes, immune disorders, substance abuse, anxiety, depression, and suicide, but they put their safety and that of others at risk by walking to the bus or driving themselves to school on dark, deserted streets. Judgment, focus, and memory are impaired, and risks of tardiness, truancy, and dropping out increase, reducing chances of school success, particularly in disadvantaged children.

When public school times changed, the whole community's rhythms changed, too: Today, "after" school stretches out to four hours (and fills up with activities), leaving many kids unsupervised at the peak period for adolescent crime and risky behavior. Elementary schools often start as late as 9:15 or 9:30, forcing working parents to send young children to before-school care as well as after-care. Families whose children are in multiple school levels often have start and end times that span two hours in the morning and another two in the afternoon. 

Most people now perceive these adaptations as inevitable and normal. And this perception is the key to understanding why schools aren’t listening to sleep research. People who have adapted their lives to current school hours assume that they cannot adapt to changing them again. Fearing that new hours will disrupt commutes, daycare, teacher training, after-school activities, and so forth, they protest shifted schedules vehemently, sometimes to the point that superintendents have lost their jobs. It’s no wonder that school officials find ways to make later school start times sound as complicated and expensive as putting a man on Mars. 

“One of the hardest things you can ever do as a superintendent…is to begin to tinker with the bell schedule,” said Deb Delisle, Assistant Secretary of the US Department of Education. “People go absolutely bananas over that. You can change textbooks, you can change report cards, [but] as soon as you tinker with that bell schedule – whoa, too scary!”

The good news is that finding ways to run schools at safe, healthy hours is not rocket science. Schools have, and continue to, run at many different times around the world, and community life always adapts to them. We now have plenty of success stories providing data that put the many dire speculations blocking change to rest. 

Even the common sense speculation that later hours would just lead teens to stay up even later has 
been felled. In every study to date, students actually go to bed around the same time, and get significantly more sleep, when morning bell times are delayed.

The hundreds of examples of schools that have found ways to run schools at later, healthier hours by prioritizing sleep, health, and learning provide empirical evidence that the challenge to later start times isn’t daycare or jobs or sports or even the cost of running more buses. The real challenges are fear of change and failure of imagination.

Combating these challenges will take more than sporadic local advocacy efforts. It will also take more than sleep research, however compelling. Instead, it will take treating sleep and school hours as fundamental matters of public health rather than as negotiable school budget items.

Once we start viewing sleep and school hours as equivalent to other public health issues like child labor, smoking, and seatbelts, objections to later start times will melt away. Making that happen, however, will require health practitioners, sleep researchers, educators, policymakers, and advocates to join forces, with a common goal of consciousness-raising and collective action on local, state, and national levels.

 --------

Terra Ziporyn Snider, PhD, is the Executive Director of Start School Later, a nonprofit organization dedicated to increasing public awareness about the relationship between sleep and school hours and to ensuring school start times compatible with health, safety, education, and equity.

MONSTERS OF SLEEP: Christa Zielke on the challenges of living with narcolepsy

I've Never Fallen Asleep In My Soup

by Christa Zielke

I had always been tired. 

Now before you think, “Well everyone does! Ever hear of the 2pm slump?” 

I don’t mean that kind of tired. I mean the kind of tired where I would sit down on a bench outside of classes in college, ready to head into class on time, and I’d wake up an hour after class ended. The kind of tired that meant that I made a terrible passenger in a car – I’d always fall asleep ten minutes after the car started. The kind of tired that meant, no matter what time I’d go to bed, waking up was a painful experience – even with 8, 10, 12 hours of sleep. Sometimes, without an alarm, I’d sleep for 14 hours straight. My record was 16. Even once I was upright and in the shower, I’d fall asleep standing up. That kind of tired. 

I thought it was my sleep schedule, which I made as regular as possible. I thought it was my diet, so I cut processed sugars, red meats, starches, every culprit I could think of, out. I tried vitamin regimens. I exercised regularly (cycling, weightlifting, yoga, hockey, just to name a few). I was still tired. I always chalked it up to being someone who really, really needed a lot of sleep. And hated waking up.

Luckily, as I got older, I developed strategies to ensure that I could keep my job, keep morning appointments, and keep commitments to meet up with friends on a Saturday morning. It didn’t always work, but many times it helped. It involved multiple alarm clocks and a support system of trusted, close friends who would call me in the morning on days where I had a big morning meeting, checking in or taking turns calling at intervals to ensure that I was up and getting where I needed to be. Friends whom I’d made weekend morning plans with knew the passcode to my security system, and I would leave my door unlocked so they could come in and head to my bedroom in case I wasn’t awake. They’d help me up, walk me around sometimes. I had a boyfriend who would pull me out of bed each morning, lifting me up when needed to help me get up. I have some seriously understanding and kind friends, I know. 

By the time I was 29, other strange sleep issues arose. The first time I had a hypnogogic hallucination, I saw a man walking into the room. I was wide awake. I sat up, stared – the man was standing there, at the foot of the bed. I could see what he was wearing (white tank top, jeans) and the color of his hair (blonde, straggly). I did what anyone would do when they saw a stranger in their room – I screamed my head off and woke up my boyfriend, who of course screamed in response to my screaming. I thought he was screaming because he saw it too. But then, the figure just vaporized – disintegrated into nothing. I had no explanation. 

This continued off and on for years. I ran out of my room a few times a month, seeing something completely terrifying, thinking it was real. A burglar, a cat (I had no pets), spiders, rats, even remote control cars zooming around on the floor at one point. 

After a few years, I was quicker to realize that they were hallucinations, but they never stopped terrifying me. Once they vanished, or a few minutes after running out of the room, I’d figure out that they were not real. Eventually, this would turn into a 2-3 night a week thing. My love life became challenged… as in, “I’d love for you to spend the night, but…” 

Then, in my thirties, I started seeing a new doctor for unrelated issues. After missing every morning appointment with this doctor, he asked what had never seemed like an obvious question up until then:  “Why are you always having trouble waking up? You’re athletic, you eat healthy, you don’t drink alcohol, and you’re young. This doesn’t make sense. Maybe you have a sleep disorder.” 

I had never really considered this. But after his comment, I conceded that perhaps I was dealing with sleep apnea or some other common sleep ailment. So I agreed to go to a local sleep clinic and meet with a neurologist to discuss my symptoms.

When I talked to the neurologist about being tired so much, he immediately asked about hallucinations. 

“How’d you know?” I asked, and he just said, “I’m fairly certain you have narcolepsy.” 

I was blown away. “Not possible,” I said. The only thing I knew about narcolepsy was what I had seen in a movie in the 90’s where a character with the disorder was constantly collapsing and going into deep sleeps (I’d learn to really hate these representations of narcolepsy, as most people based their understanding of the disorder on these films).  

He laughed and said I should just do the two days of testing, including the MSLT (Multiple Sleep Latency test). These tests weren’t really that bad, although they glue about a million wires to your head, face and body. By the time I had shampooed all the weird glue out of my hair a few days later, the results were definitive. And so my treatment began. 

Being that there is no cure for narcolepsy, the best option is medication to reduce symptoms. The main drug that is prescribed is Xyrem – a terrible-tasting liquid that you mix with water and take twice nightly (I recommend adding a few drops of the new water-flavor enhancers). Xyrem is intended to help achieve the “deep sleep” that a narcoleptic cannot typically get on their own. 

The disorder itself is your brain’s inability to manage the sleep-wake cycle. Hence, you get very little “restorative” sleep when you go to bed at night, and you are prone to hallucinations either right before you sleep or right after you wake. 

Other related symptoms include sleep paralysis (the inability to move when you wake up), EDS (extreme daytime sleepiness – your body is trying desperately to “catch up”) and the co-diagnosis that many narcoleptics have, cataplexy (sudden loss of muscle tone in response to strong emotions). 

Xyrem helps with most of these for many narcoleptics, but not all. I’m one of the lucky ones, it works really well for me. During the daytime, I also take a mild dose of Ritalin (previously I took Nuvigil, but had difficulty with it) to keep me “awake” during the day. Granted, these medications don’t work well for everyone, and adjustments have to be made before you find the right levels/doses/combinations. But for me, this current medication combination has worked wonders. 

The difference has been amazing for me. People who work with me say I’m more awake, more cheerful, a “whole new person.” It wasn’t easy getting there, though. In the beginning, getting used to the medications, dealing with nausea (it went away eventually) and even getting used to being AWAKE – really, really awake (I often felt anxiety when I’d wake up so suddenly and fully) – was a huge adjustment. 

I’ve been fortunate to have great doctors who have helped me along the way. While my narcolepsy isn’t gone (I still fall asleep in cars, all the time), and the ongoing medication regimen is not always my favorite thing in the world, my life has improved greatly as a result of the treatment. I actually get up on my own, no alarm, at 6 or 7 a.m. most days (sometimes I take days off, just to take a break and “sleep in”, which also keeps the medication working well when I go back to it). 

Honestly, the most difficult thing has been dealing with others when they find out I have narcolepsy. Back to the “Hey, everyone gets tired!” comment. 

Yes, I’ve heard that one – a lot. Well-meaning friends have also asked me “Have you been tested for a thyroid thing? It might be that.” Or said, “I’ve never seen you fall asleep in our soup!! You can’t have narcolepsy!” 

While others want to share their thoughts on how I should use herbal remedies, teas, and other options (not that I’m opposed to alternative medicines), I’m fairly happy with the results I’m getting with my current medications. I know these people are just trying to relate to something that they don’t fully understand. That doesn’t make it any easier when I’m feeling like I have to defend my diagnosis or the means for treating it. 

As a result, I don’t really share my diagnosis with many people. But luckily, I have a few close friends and coworkers who are very understanding and supportive, and to this day will occasionally ask, “How’s the sleep thing going?” 

Much better, thanks. 

---

Christa Zielke resides in Cincinnati, Ohio. She was diagnosed with narcolepsy in 2012.