SLEEP HYGIENE TIP OF THE WEEK: Clean your bedroom!

This isn't just advice for those messy teenagers with wet towels on their bedroom floors, unmade beds, collections of soiled dishes, and mounds of dirty laundry in direct contact with the space where they sleep.

Even though recent studies suggest that teenagers may have problems with sleep thanks to the smells coming from their bedrooms, the problem of messy, unkempt sleep spaces is not limited only to people in their age bracket.

How we keep our bedrooms has a direct impact on the quality of sleep we can expect at night. The three main areas of concern for any bedroom center on comfort, clutter, and sanitation.


Comfort

Comfort matters. If we are uncomfortable, we can't relax, and if we can't relax, sleep will be hard to come by. Don't shortchange yourself basic comfort at the end of the day. It's not really optional, much in the same way sleep is not optional.

• Have you ever noticed... an unmade bed is not comfortable to climb into at the end of a very long day. A made bed is inviting, smooth, and enveloping. Show yourself five minutes of self-love in the morning by making your bed. You will thank yourself after a long, hard day.
  
• Flat pillows that are no longer "plumpable" need to be replaced, not only because they are no longer comfortable, but because they can contribute to neck and shoulder pain and problems with breathing. They can also harbor microorganisms if they are not cleaned properly. You can simplify this by bagging your pillows with washable liners before placing them into cases.
  
• Mattresses that are lumpy, caving in at the center, missing their bounce, damaged by fluids, or which have springs poking through the surface need to be replaced. Most mattresses last about 10 years. Again, this is not only a comfort measure (which still counts as good sleep hygiene) but also critical to avoiding back and hip problems. Pain is the enemy of sleep; don't let your bed be the reason you can't sleep!
  
• Room temperature is much more critical to good sleep hygiene than you might think. A cooler room not only means it will be less stuffy, but it means your body will be better prepared for sleep. The body's thermostat makes important changes during the sleeping period that are a reflection of the circadian system. Too warm a room can mean your core body temperature is not cool enough to allow for quality sleep. Lower your thermostat and add more blankets in layers that you can adjust throughout the night if you find it hard to sleep in a cool room.

Clutter


There's plenty of discussion these days about how to keep up with clutter, how to deep clean personal spaces, and why decluttering is good for your overall mental health. This definitely relates to the bedroom as much as to the more active living spaces in your home.

• If you take work with you to bed, the chances are high you have a nearby mess of pens, papers, folders, electronics, notepads, or paperwork that is cluttering the space. This clutter can not only get in the way of sleeping (literally), but it's also an unpleasant reminder of work "still to do." It's quiet presence alone can fuel racing thoughts at bedtime and prevent sleep onset. Also, waking up to reminders of unfinished work is not exactly a good way to rise and shine. Best practice: Don't take your work to bed with you.
  
• General clutter has been shown to negatively alter important cognitive functions and mood (as well as serve as a dust magnet!—See Sanitation below). Is this how you want to wake up in the morning? How you want to go to bed at night? Think about it. Television's popular home improvement shows frequently describe how the bedroom should be a "sanctuary," and they are right on. Your bedroom should be a welcoming space, not one that you dread going to or waking up in.
  
• Do you use your bedroom as a storage space to make other rooms in your home more accessible? You might want to rethink this habit, not only for the purposes of "preserving your sanctuary," but because a bedroom's main purpose is for sleep and intimate time with your partner. The clear delineation between your sleeping space and your living space is not accidental; living space is for living, sleeping space is for sleeping. When these two purposes collide, anxiety enters the picture and messes with both the sleep and wake portions of your daily life.

Sanitation

This is the most obvious reason to keep your bedroom clean, but it bears repeating. We all get busy and don't always make housekeeping the priority. Here are some reminders why getting out the vacuum and the window cleaner are not only investments in your home, but also in your health.

• If you don't vacuum or dust regularly, all those particulates in the carpets, the bedding, the air, and collecting along the woodwork can worsen air quality and lead to congestion, allergies, and all the other upper respiratory problems we normally attribute to air pollution. Make sure any air intakes or filters are regularly cleaned (or filters changed) to improve air quality.
  
• The same goes for clean sheets and pillowcases: your body sheds skin cells and bodily fluids at night even if you don't notice them. These can create an environment for bacteria as well as leave odors and contribute to allergies. Anyway, clean linens smell great and feel great!
  
• Dirty laundry smells just as bad in an adult's bedroom as it does in a teen's room. The term "nose-blind" seems appropriate to use here (see also "Why can't you smell your own home?"). It describes our inability to note the odors in our own personal living spaces even as strangers entering the house may notice them right away. This isn't a missive on aromatherapeutics, however. Spraying a fragrance does not fix the underlying problem. Odors you don't notice in your own sleeping space still introduce bacteria in the airspace and become part of "room air," which you breathe all night long.
  
• Recycled air in a bedroom, even when the laundry isn't allowed to pile up, becomes less "aerobic" when the windows are sealed shut all the time. Anaerobic means that the amount of oxygen available to you as "room air" is not adequate for good health in the long term: it contains less oxygen, which your bloodstream requires for sustaining the body's myriad functions. "Room air" is measured normally as 21 percent of any space's atmosphere (that is to say, 21 percent of the atmosphere you breathe is composed of oxygen). The less aerobic the air in your bedroom means your body, over time, will need to compensate in other ways—such as by altering the respiratory rate—so that you can maintain a healthy oxygen balance in your bloodstream. (Read this interesting discussion of what happens to a human locked in an airtight room for some ideas about why.) But the solution is pretty simple: Most homes are meant to "gas off" to help achieve a healthy, balanced atmosphere; briefly opening the windows, even in winter for just a few minutes, can make all the difference.

• Check your windows for mold patches and any mildew formed around the frames or inside the mesh screens. These can enter your airspace and lead to disease. Wipe windows, frames, and screens regularly—frequently if you have windows that leak air or water. Moisture and/or oxygen in a warm space can provide the breeding ground for microorganisms, which can detract from your bedroom's air quality. 

SLEEP HYGIENE TIP OF THE WEEK: Using CPAP with a head cold

When the cold and flu season hits, the inconvenience of dealing with viral symptoms can be magnified if you're also using a PAP device (CPAP, BiPAP, APAP). Some people think it is better not to use your PAP therapy at this time, but the truth is, you still need it, even if you experience more discomfort while asleep. Your body will get through a respiratory illness more quickly if you continue your therapy because it will have more sleep (even if it doesn't consciously feel like it).

Here are some tips to stay the course through those nights when sore throats, runny noses, congested sinuses and coughs crop up this winter.

1. Adjust your sleeping position. A runny nose or congestion can make breathing very comfortable while you sleep. Try sleeping on your side, which will use gravity to drain your sinuses (one side at a time). If you have a reclining chair, that might also be helpful for the same reason. You don't want phlegm collecting in the back of your throat, which will just worsen matters. Avoid sleeping on your back or completely flat; even elevating the head of your bed by 3 inches can make a big difference.
   
2. Make sure you use your humidifier. The warm moist air will really help your passages remain pliable and comfortable through the course of a virus.
   
   If you don't know how to use your humidifier, ask the CPAP specialist who initially set you up with your current machine. Some people normally don't use the humidifier, but may turn it on just for head colds or allergies.
   
   If you have an older machine, it may not have a humidifier, or if it has a humidifier, it may not have a heated setting. If you get a lot of respiratory illnesses during the winter, you should ask your doctor about updating your machine to one with a heated humidifier.
   
3. Try using nasal sprays. These can be a quick, easy and affordable solution. Look for sprays which are designed for decongestion. Even a simple saline nasal spray (or gel) can help relieve stuffiness. If you have allergies, opt for a spray with an antihistamine in it, if you don't already have one.
   
   Avoid any over-the-counter spray which causes sedation; this can worsen your apnea. Unsure which spray is best for you? Ask your pharmacist.
   
4. Similarly, consider menthol. Menthol can help to clear blocked nasal passages pretty swiftly.
   
   You won't want to suck on menthol drops while trying to sleep, as that is an obvious choking hazard, but you could have a drop right before bed to help open up your airways.
   
   Also, 15 minutes before bed, try rubbing a little menthol ointment on your chest and let the vapors rise and help decongest your airways before applying your mask.
   
   Sometimes the challenge is just getting to sleep; once asleep, the humidity from PAP therapy can often take over and keep everything clear.
   
   Please do not add menthol products to your PAP humidity reservoir without first checking with your mask and PAP machine user's manuals to ensure you can safely do so; if so, they will also advise on which kinds of menthol products and how much to use.
   
5. Try cleansing your sinuses with a neti pot. These are little bulb- or teapot-shaped vessels that help you to flush your nasal passages out. They can be found in most drugstores and are often an effective pre-sleep solution for anyone with a problem with congestion.
   
6. Switch to a different style mask. There are many patients who have more than one mask. They use their nasal or pillow mask for normal use but switch to a full-face mask if they find they are breathing through the mouth, as full-face masks cover both mouth and nose and allow for oral breathing. Pillow masks are sometimes difficult to wear if the nose it sore and swollen; a nasal mask might be a good alternative if you aren't mouth breathing. However, having a head cold leads to mouth breathing even in those who don't normally do so; it might be worth it to look into having a spare full-face mask on hand for this reason.
   
7. If you use CPAP, consider APAP. This is a more expensive solution but if you suffer from seasonal allergies or viruses on a regular basis, the "smart technology" in an AutoPAP (or APAP) might help you breathe better when congestion is a regular problem. The APAP delivery system senses your need for more or less pressure and automatically adjusts, unlike the CPAP which, as its names suggests, only delivers one continuous pressure. Discuss this option with your physician; you will need a prescription in order to acquire one of these.

Here's what a simple neti pot looks like; there are also
more extravagant ones, but a simple over-the-counter
product can be just as effective.

Finally, keep everything clean! You should be vigilant about cleaning your PAP tubing and mask anyway, but if not, NOW is the time to change that bad habit to make it a regular part of your daily routine. Learn some basics here.
Keeping your tubing, masks and accessories clean and sterile is necessary to prevent the growth of bacteria inside your equipment, which can actually make you even sicker (or cause illness when you aren't sick).

Follow manufacturer's instructions for cleaning your PAP-related items or, if you know you are just not going to follow through on a daily regimen, look into one of the new PAP cleaning kits now available which sanitize all of your items with the push of a button.

Today's #Sleeptember FACT --- Snoring as a result of allergies

#SLEEPTEMBER

If you've been sneezing a lot lately and you're certain you don't have a head cold, you probably have allergies or sensitivities to particulate matter in the air. Pollens and grasses are problematic all the way to the end of the fall, but people who live in areas where wildfires are a problem will also suffer from rhinitis caused by the added smog caused by them.

At SHC we often talk about snoring in the context of obstructive sleep apnea (OSA) or upper airway resistance syndrome (UARS), but allergies can also commonly lead to snoring. After all, the mucous membranes are swollen or inflamed as they do their work battling histamine responses and filtering external pollutants and allergens. When you have a swollen upper airway, and your nasal passages are congested, you naturally have an increased chance of snoring while you sleep.

"20 Minute Fix for Nasal Allergies."
Turbinate coblation procedure on video (snip).

Aside from treating the allergies so that you don't have strong reactions to particulates that lead to airway restrictions, you can also treat  chronic snoring related to allergies by a procedure known as turbinate coblation. This outpatient treatment shrinks the swollen turbinate tissues within the nasal passages to achieve better air circulation in the upper airway, which can lead to fewer problems with snoring. Patients receive the procedure and then immediately return to a normal day of work or family; there is no downtime associated with turbinate coblation.

See the video about how this procedure is performed here. 

Note: the procedure, which lasts between 10 and 20 minutes and can be done during one's lunch hour, can cost up to $1500 and may or may not be covered by insurance. However, patients who've received this treatment say it does work immediately and the results are positive and noticeable.

If you are interested in learning more about turbinate coblation, please consult your general practitioner to determine if you are a good candidate for this procedure.

SLEEP STUFF: Anti-snoring nasal products

For some people, the worst thing about their sleeping life truly is their snoring. It's loud enough to keep their sleeping partner awake, and it leads to discomfort in the nasal tissues and airway, dry mouth and sore throat. 

For those who snore but do not have sleep apnea*, the options for treatment are a bit different. It may be that they have other issues causing their airway resistance, such as a deviated septum, chronic allergies, narrow passageways or other physiological problems, such as overlarge tonsils or swollen turbinates.

Many of these people qualify for surgical approaches to repair their physiological challenges, but these can be expensive procedures, difficult for adults to recover from and may still not completely eradicate the problem.

Treatment of allergies is generally limited to nasal steroid sprays and medications, yet chronic post-nasal drip associated with allergies--even when treated--can still contribute to snoring.

There are small companies out there manufacturing various kinds of mechanical devices which promise to help physically open up the nasal passages via the nostrils in order to facilitate better breathing.

Some users swear by these products, while others try them and find no relief. Fortunately, most of them are inexpensive and promise to be a one-time purchase, so if they do work, the promise of a simple inexpensive solution delivers.

Listed below are four products out on the market that have been created to assist those people with sleep breathing problems that are not related to apnea or upper airway resistance that can be linked to a clinically identified respiratory system condition.

NASAL DILATORS
These products use plastic or medical grade stainless steel with silicone to physically widen, or dilate, the nostrils in order to increase airflow while sleeping. The applications vary, but all of them require inserting a portion of the dilator into the nostrils. The user adjusts the device following instructions provided by the manufacturer to achieve a widening of the nasal passages. Some of these devices are meant to be cleaned and reused repeatedly, while others are disposable and recommended for up to three uses in a row before disposing. These products are generally marketed toward people who struggle with nasal congestion, allergies, deviated septum or sinusitis, all of which can interfere with breathing during sleep. Price ranges are all across the map; cheaper dilators tend to be all-plastic and disposable, while more expensive ones that incorporate stainless steel wire run closer to $30. Some brands available include Airmax, Brez, ClipAir, Nozovent, Respitec, Rhyno and SleepRight. FDA approval depends upon the product.

NOSE CONES
These are a different variety of device which are shaped exactly as they sound, like tiny conical shaped cage-like inserts for the nostrils. They also purport to prevent nasal collapse while sleeping and can be found in both disposable and reusable options. Some brands available include Max-Air, SinusCones and Snorepin. FDA approval depends upon the product.

NASAL STRIPS
You're probably most familiar with these products, BreatheRight being the most popular brand. These external nasal passage wideners are applied across the bridge of the nose, and usually incorporate tension from the adhesive with or without a wire insert to stretch open the upper passage of the nose. They come in a wide variety of options, including some with fragrances, color choices, variations in strength and special adhesive for sensitive skin.

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*The only way to know whether a snoring condition is related to sleep apnea is to undergo a sleep evaluation from a sleep health professional. Not all snorers have sleep apnea and not all people with sleep apnea snore. SHC encourages its readers to seek the advice of a medical professional and resist the urge to diagnose themselves. 

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A friendly reminder that links to websites offering products does not imply endorsement by SleepyHeadCENTRAL.com.

SleepyHeadCENTRAL strongly encourages people with ongoing sleep health problems to approach a medical professional to determine appropriate differential diagnoses and treatment. This post, like all other posts on SHC, is not intended to substitute for medical advice.  

Health Awareness Campaigns for May

May is...

National Mental Health Month - Because sleep and mental health go hand in hand

National Asthma and Allergy Awareness Month - It's hard to sleep if you can't breathe

American Stroke Month  - Untreated sleep apnea can lead to this

Older Americans Month  - Our sleep needs change as we age

May 3-9: Children's Mental Health Awareness Week
Bad sleep habits start at a young age; so do sleep-related mental health problems

May 10-16: National Womens Health Week  - Women need more sleep than men

Just Breathe || Sleep Breathing Disorder basics

The most obvious form of sleep breathing dysfunction comes by way of the snore. Yep, the humble, often annoying, snore. Just about everybody snores at some time or another, but often it's an ongoing problem...not only for the bed partner of the snoring sleeper, but for the snorer, too. Not getting adequate oxygen over several hours at night is simply not conducive to good overall health and can actually lead to health problems if poor breathing at night is not identified and treated.

Sleep breathing disorders move well beyond the range of snores and other noises one might make or hear at night, and include a wide range of conditions--some common, some not--all of which are critical to treat. These include many kinds of health problems related to getting enough oxygen while asleep, such as:

• Obstructive Sleep Apnea || OSA (a mechanical disorder of the upper airway)
  
• Central Sleep Apnea || CSA (various problems with brain function related to sleep drive and maintenance)
  
• Upper Airway Resistance Syndrome || UARS (due to issues like crowded airways, allergies, deviated septum, swollen turbinates, etc.)
  
• Hypoventilation problems related to existing respiratory issues such as chronic obstructive pulmonary disease [COPD], asthma, pneumothorax, or hypoventilation caused by high altitude, etc)
  
• Neuromuscular disorders, which can impact the body's ability to breathe properly (scoliosis, or myasthenia gravis)

If you notice a loved one struggling to get adequate sleep at night, don't ignore it. Talk to them about your concerns. Encourage them to speak to a physician. Most sleep breathing disorders are treatable, and once treated, those who've suffered stand to feel much better and maybe even improve key health measures, like blood pressure, by doing so.