WHAT'S HAPPENING: SLEEP AND THE 4 Ms: Mind, Mental Health, Mood, and Memory

Check out this latest curation of news stories appearing since July 15 which focus on Sleep and the 4 Ms: Mind, Mental Health, Mood, and Memory. Topics discussed in this latest curation include:

• Poor decision making, judgment, and vigilance as they relate to sleep deprivation
• Sleep deprivation and politics
• PTSD and sleep disorders
• Nightmares in people with other sleep disorders
• How childhood or long-past trauma can continue to impact sleep
• The link between TBI and poor sleep
• Bipolar disorders and circadian rhythms
• Cancer, poor sleep, and mood disorders
• Sleep's impact on the mental health of children, adolescents, and seniors
• How to sleep when the sky is falling
• Seasonal affective disorder... in the summer?
• Using sleep apps to help conquer depression and anxiety
• The research gap between sleep and emotions
• Sleep's impact on memory formation in the mentally ill
• Memory consolidation during sleep
• Using electronic nerve stimulation during sleep to assist in memory

[Go there now!]

IN CASE YOU MISSED IT: Some of our best posts on sleep and its link to mental and emotional wellness

SleepyHeadCENTRAL has already posted a lot of good information showing connections between sleep health and depression, anxiety, PTSD and other struggles with emotional or mental well being.

INSOMNIA

• Are Insomnia and Winter Depression linked?
• Insomnia: Why is it linked to depression?
• The problem with insomnia forums
• Sleep Disorders 101 || What is Insomnia?

PTSD

• Ken Scholes on Sleeping and PTSD
• Safe sleeping with PTSD
• The very real fear factor of PTSD-troubled sleep following heart attacks

THERAPIES FOR ANXIETY AND DEPRESSION

• How meditation can help
• Mother's Little Helper: Things You Should Know
• Sleep hygiene tips to help Junior overcome fear of the dark

SleepyHeadCENTRAL encourages you to see the connections during Mental Health Awareness Week, Oct 4-10

Some sleep disorders have nothing to do with mental health issues. And some mental health issues have little in common with sleep disorders. But there are plenty of reasons why people with sleep problems should be wary of the potential for succumbing to mental illness like depression or anxiety, and for those with either problem to be especially mindful of their sleep habits, as one can argue that the intersectionality between the two is not only common but based in scientific fact.

SleepyHeadCENTRAL strongly support Mental Health Awareness Week, observed October 4 through 10. Please read the following links curated below to improve your understanding of how sleep health and mental health are inextricably linked. More information about the week's sponsor, the National Alliance on Mental Illness, can be found here.

BUSTLE || 11 things people with anxiety want you to understand
"Be gentle with us if you see that we're tired and cranky, because we probably didn't sleep at all last night."

DAILY MAIL|| Lack of sleep drove me to the brink of madness... and it could happen to you too
"Four years on she wonders how many sleep-starved mothers are dismissed as post-natally depressed and prescribed anti-depressants when what they really need is eight hours’ sleep."

DAILY TIMES || 5 deadly things happen if you don’t get enough sleep
"Insomniacs are also twice as likely to develop depression, and preliminary research suggests that treating sleep problems may successfully treat depressive symptoms."

THE EXAMINER || SAD to say it is that time again
"An individual with this type of depression can experience a wide range of symptoms including increased moodiness, decreased energy, disturbed sleep, changes in appetite, increased anxiety, irritability and/or lack of motivation."

HARVARD BUSINESS ONLINE || Sleep Deficit: The Performance Killer
"In reality, the research suggests that even small amounts of sleep deprivation take a significant toll on our health, our mood, our cognitive capacity and our productivity."

HARVARD BUSINESS ONLINE || Sleep is More Important than Food
"In reality, the research suggests that even small amounts of sleep deprivation take a significant toll on our health, our mood, our cognitive capacity and our productivity."

HUFFINGTON POST HEALTHY LIVING || Is Sleep Deprivation Making You Suicidal?
"'[By being sleep deprived, you're] setting up the same situation as people with clinical depression,' explains Dr. Oexman, who oversees the Sleep to Live Institute's research studies, particularly the studies on the impact of the sleep environment on quality of sleep."

IOL || Children who have trouble sleeping are more likely to develop mental health problems, researchers warned recently
"They said disturbed sleep patterns could be a warning sign of future problems including anxiety, depression and schizophrenia, and disorders such as autism."

JOURNAL OF CLINICAL SLEEP MEDICINE || Depressive Symptoms before and after Treatment of Obstructive Sleep Apnea in Men and Women [abstract]
"Depressive symptoms are extremely common in people who have obstructive sleep apnea, and these symptoms improve significantly when sleep apnea is treated with continuous positive airway pressure therapy, a new study shows."

JOURNAL OF EMERGENCY MEDICAL SERVICES || Survey Reveals Alarming Rates of EMS Provider Stress and Thoughts of Suicide
"Sleep deprivation, feeling underappreciated, poor nutrition and exercise are just a few of many issues that may contribute to poor mental health in this field."

MEDICAL DAILY || Sleep Deprivation Messes With The Brain's Emotional Response, Makes Everything Seem Important
"Lack of sleep throws the brain regions associated with emotion off balance, finds a new study."

MEDLINE PLUS || Sleep Apnea May Raise Risk of Depression: Study suggests popular apnea treatment could help ease symptoms of mood disorder
"The findings highlight the potential for sleep apnea, a notoriously underdiagnosed condition, to be misdiagnosed as depression," he added."

NATIONAL SLEEP FOUNDATION || The Complex Relationship Between Sleep, Depression & Anxiety
"...[A]ltered sleep patterns are a hallmark of many mental health issues."

NIH || Sleep disturbances and suicide risk: A review of the literature [pdf]
"As a warning sign, disturbances in sleep may thus be especially useful to research and may serve as an important clinical target for future suicide intervention efforts."

PSYCH CENTRAL || Depression-Mortality Link in Heart Failure
"We know that depression is common in heart failure and affects 20 to 40 percent of patients. Depression is often related to loss of motivation, loss of interest in everyday activities, lower quality of life, loss of confidence, sleep disturbances, and change in appetite with corresponding weight change. This could explain the association we found between depression and mortality."--Professor John Cleland of Imperial College London, UK

RAW STORY || Here are 8 ways you don't realize stress is ruining your health
"As we get older, sleeping patterns often change and we may experience a decrease in the amount of deep sleep we get. ...This in turn leads to sleep deprivation, shown to cause memory lapses and lack of emotional control, leading to a further cycle of stress and sleep deprivation."

SCIENCE DAILY || Losing hope of a good night's sleep is risk factor for suicide
"'It turns out insomnia can lead to a very specific type of hopelessness and hopelessness by itself is a powerful predictor of suicide. ...It's fascinating because what it tells you is we have discovered a new predictor for suicidal thinking.'"-- Dr. W. Vaughn McCall, Chair of the Medical College of Georgia Department of Psychiatry and Health Behavior at Georgia Regents University

SCIENTIFIC AMERICAN || Can a Lack of Sleep Cause Psychiatric Disorders?Study shows that sleep deprivation leads to a rewiring of the brain's emotional circuitry
"Study shows that sleep deprivation leads to a rewiring of the brain's emotional circuitry."

VAN WINKLE'S || The Disturbing Relationship Between Sleep, Depression and Suicide
"At least 3/4 of clinically depressed people struggle with sleep, and insomnia is a well-proven risk factor for suicide."

WASHINGTON POST || Schools and parents need to help kids sleep more, says the CDC. Here’s how.
"Research shows that most teens get seven hours or less of shuteye a night, leaving them chronically sleep-deprived. And too little sleep leads to serious health risks, including depression, stress, obesity and car crashes induced by drowsiness."

WEBMD || Sleep and Depression
"If you've been diagnosed with clinical depression, you may be having trouble getting to sleep or staying asleep. There's a reason for that. There is a definite link between lack of sleep and depression. In fact, one of the common signs of depression is insomnia or an inability to fall and stay asleep."

Today's #Sleeptember FACT --- Teens sleep (or don't sleep) like that for a reason

By now you've probably heard that late bedtime and sleep-in periods for teenagers are part of the normal final development of their brain.

This delayed sleep phase in adolescents is usually just that--a phase--though adults may never "grow out of it" and end up being night owls. This can be a good or bad thing depending upon the goals of a person with late-night "eveningness," but that is the subject of another piece.

#SLEEPTEMBER

Teenagers are experiencing delayed sleep phase for a variety of reasons but what we all need to remember is that they still very much need their sleep, but aren't getting it. National Sleep Foundation Sleep in America polls annually bear out the truth: our teens are sleep deprived, due to burdensome schedules filled with homework, activities, sports and jobs.

On top of that, they are consuming large quantities of caffeine to medicate away their daytime sleepiness, getting into more automobile accidents than ever before, and suffering sleep-related health issues like anxiety, attention deficit, depression, even obesity, as a result.

To learn more about American teen sleep habits, check out the 2006 Sleep in America poll teen results here.

Today's #Sleeptember FACT --- New parents and sleep deprivation

It's not as if our friends and family don't warn us about all the sleepless nights we'll be getting in the coming months following the birth of junior, but usually that is a wink-wink-nudge-nudge kind of insider's joke shared among the experienced.

Certainly it is reasonable to expect to be sleep deprived as you adjust to starting a family (or adding to your family).

But it's not reasonable to live with chronic sleep deprivation, to accept that you may never sleep well again, or to literally endanger yourself and/or your children--even perfect strangers--with the side effects of sleep deprivation, which are serious and have major consequences, like drowsy driving, poor job performance, and even behavioral disorders which could actually put your children at risk for abuse or neglect.

#SLEEPTEMBER

Even in the long-term, trying to shoulder your way through life sleep-deprived not only doesn't make for healthy living, but it is a negative behavior that you could be handing off to your own children by default example. Sleep deprivation can also lead to disastrous marital consequences if left untreated, as well as long-term medical consequences. You want to see your grandchildren born, right?

It is not a badge of courage, competency or superhuman excellence to go through life sleep deprived, especially if you are a parent. If you suffer from a hefty sleep debt, please consult your healthcare provider about ways to get your sleep schedule back on track. Sleep is the critical THIRD pillar of help, equal to healthy diet and regular exercise. It is not optional. Not even for new parents. 

Want to learn more? The Science of Mom blog covers "Sleep Deprivation: The Dark Side of Parenting" quite comprehensively.

ABCs of SLEEP || F is for Fragmentation

Fragmentation is what occurs during sleep when you struggle to maintain one long stretch of uninterrupted sleep. Instead, you awaken frequently, and can't get good blocks of deep sleep, as a result. It is a marker of sleep-maintenance insomnia, the kind of insomnia in which you have no trouble falling asleep, but you arouse easily and often and, therefore, cannot maintain sleep.

What makes fragmentation particularly difficult is that if you have multiple periods of awakening, you become conscious that you aren't sleeping, but that you should be sleeping. Rumination and hypervigilance about sleep loss tend to perpetuate anxiety, which then only adds to your inability to fall asleep again. If you have ever watched the clock all night long, after falling asleep easily but waking up frequently after you've fallen asleep, then you are experiencing fragmented sleep.

The worry that comes with not getting good sleep isn't without good reason. Fragmented sleep can be a nighttime devil for many.

When your sleep is fragmented, you are less likely to cycle through the slow-wave sleep that helps your body heal and you are more likely to wake up unrefreshed in the morning (because you've been awake, on and off, all night).

Sleep fragmentation also threatens certain brain processing functions like memory consolidation and can even interfere with the brains ability to keep consciousness and memory separate.

As we age, our sleep is more likely to fragment, though it's not well understood as to why. It could be a normal byproduct of aging or the result of medication use or the presence of other illnesses.

People with depression and anxiety, who also have fragmented sleep, may see their mental illness worsen. Also, people with Parkinson's Disease, dementia and other neurological troubles may report broken sleep patterns as a symptom of their condition.

Other sleep disorders, like narcolepsy, periodic leg movement disorder, restless legs, UARS and sleep apnea, may also lead to sleep fragmentation.

Treating sleep fragmentation requires identifying its root cause first and treating it. Easier said than done...  If there are no physical or mental illnesses or medications that could explain the sleep fragmentation, then doctors have little else to go on except for the presence of sleep-maintenance insomnia. Patients with this sleep disorder may benefit greatly from cognitive behavior therapy.

Sleep Health Related Awareness Events in June

Mens Health Month puts out the call that men need to address their medical issues, including those that cause problems with sleep health, such as smoking and drinking, overeating, and medical conditions such as Obstructive Sleep Apnea (OSA), which leads to heart disease, stroke, depression, hypertension, and diabetes if not treated; and REM Behavior Disorder (RBD), which is a potentially dangerous parasomnia which also be an early warning sign of Parkinson's Disease.

Great Outdoors Month celebrates America's natural spaces in a way that can be very good for sleep health. Human circadian rhythms are set by the seasons and the cycles of day and night, and our ability to function requires adequate exposure to natural sunlight during the day, followed by quality darkness at night as we sleep. If your sleep patterns are out of whack, one of the most pleasant ways to help reset them is to go camping for a couple of nights.

PTSD Awareness Month helps bring awareness to those who have suffered from trauma during childhood, in violent situations like car accidents or crimes, or while serving in military or service roles where traumatic events have occurred. Learn how PTSD can seriously disrupt sleep health here.

Migraine and Headache Awareness Month strives to help people understand how migraines and other forms of chronic headache can be potentially disabling. Research shows that migraines may be caused by sleep problems or sleep medications, and those who suffer from sleep-breathing disorders often encounter daily headaches upon awakening every morning. Sleep deprivation and insomnia are also conditions which lead to chronic and often debilitating headaches.

WOMEN & SLEEP: Hormones, how could you?

When it comes to sleep problems, women get the added bonus of hormone-related issues which can disrupt nighttime sleep. Even healthy women with no other health conditions and no measurable sleep disorders can still struggle to get good sleep, thanks to visits with their monthly "friend." It can start as early as puberty and the start of menses (called menarche); can continue through young adulthood, pregnancy, and middle-age; and finally, it can lead right into the shifts we know as menopause. Any hormone therapies used at any time during the lifespan can also contribute to some sleep issues as well.

What is happening with female hormones that mess with the sleep process?

Let's review a typical menstrual cycle first.

Generally speaking, the menstrual cycle describes the full range of hormonal shifts generated by the body over a typical four-week period (of course, this varies widely from one individual to the next, but for our purposes, we're calling the cycle a 28-day one).

Menstruation involves several key organs: the ovaries, the uterus and endometrium, the vagina and the cervix.

The ovaries house a female's eggs; she is born with all of these, but they are not mature and will not be released until puberty, after new hormones flood the bloodstream and prompt their maturity. They are then distributed monthly over the reproductive lifespan of the female for the purpose of reproduction.

The uterus is the womb, the large organ meant to house and grow a fetus from a fertilized egg or embryo to a full-grown baby. Its lining is known as the endometrium.

The vagina is the passageway that connects the interior of the women's reproductive system to the body's exterior.

The cervix is the opening between the vagina and the uterus; think of it as a gatekeeper that opens more easily during the most fertile time, but is less accessible during the infertile stages of one's menstrual cycle.

Let's talk about hormones now.

The ovaries also release varying amounts of two key hormones to help regulate this process: estrogen and progesterone. Their levels in the bloodstream influence the quality of the lining of the uterus as well as the quality of the cervix. Both organs are extremely sensitive to this changing chemistry. These two hormones work in synch to prepare all the female reproductive organs for the potential implantation of a fertilized egg. When no eggs are fertilized, the lining of the uterus sheds via the blood and other fluids and tissues that have collected there over the cycle (this is what we think of as our "period,") and then a new cycle begins.

Estrogen is responsible for helping the body to develop all the accessory organs of the reproductive system (the uterus, the breasts, pubic hair, fatty deposits along the hips and breasts) as well as encourage the widening of the pelvis in preparation of a potential pregnancy. Estrogen also plays a role in metabolism. But you can think of estrogen as the harbinger of puberty.

Progesterone is the key hormone for the growth of the embryo, so it plays a much larger role during pregnancy than at other times, by inhibiting contractions in the uterus during pregnancy and helping the breasts to develop milk. However, progesterone during pregnancy is no longer produced by the ovaries, but by the placenta, the sac inside which the embryo grows.

Two other critical hormones include follicle stimulating hormone (FSH) and luteinizing hormone (LH); the roles these hormones play are described below.

Though women think of their "time of the month" as just being a few days, the actual menstrual cycle is not just a one-week process.

The first five days of the cycle are called the menstrual phase. This is the actual "period" part of menstruation, where blood and cells are sloughed away from the lining of the uterus and voided through the vagina as "flow." There is a major drop in progesterone at this time due to the absence of an implanted embryo. This is a time of infertility with no ovarian activity.

From days 6 through 14, the proliferative phase, estrogen production amps up, stimulating the process of relining the uterus. This is the fertility period, in which eggs in the ovary are developed and released for potential fertilization (usually around day 14). Another hormone is responsible for this process: follicle-stimulating hormone (FSH). It helps to mature eggs in the ovary. Because of FSH, there is more mucus in the cervix, which will also dilate somewhat and soften to receive released eggs for potential fertilization and implantation.

The secretory phase, from days 15 through 28, leads to higher production of progesterone by a separate organ within the ovary (the corpus luteum), prompted by the estrogen-primed status of the uterus. Luteinizing hormone (LH) helps aid in the actual release of the mature egg. Progesterone is the hormone that helps to nourish the organs of both mother and baby in the event an embryo (fertilized egg) has been implanted in the lining of the uterus.

At the tail end of this phase, women who are not pregnant will experience cramping, bloating, mood swings and other premenstrual discomforts as the hormones respond by shifting to the infertility phase. The ovaries continue their careful chemistry balance and egg maturation, the lining of the uterus breaks down to be released in the flow described in the menstrual phase (above) and the cervix dries and firms up.

However, if there is an embryo, the progesterone levels continue to rise and the placenta takes over its production, allowing the ovaries to take a break during pregnancy.

This description of the menstrual cycle more or less describes what happens throughout a female's lifespan between the age of puberty onset and menopause, unless they are pregnant. During pregnancy, the major rise in progesterone during that period of time can lead to all kinds of side effects: See our introduction to sleep during pregnancy here for more details.

At menopause, estrogen levels drop as there are fewer eggs to mature and release until, eventually, your cycles stop entirely. These changes in hormone levels lead to erratic changes in flow, mood swings, hot flashes, night sweats, sleep disturbances and vaginal pain during intercourse. Perimenopause marks the period of this transition in hormones, whereas menopause marks the point in which 12 months have passed without a menstrual cycle, which confirms the egg supply is empty.

But how does any of this relate to sleep?????

Hormone levels have a tremendous impact on sleep. When women are younger, they experience fewer problems with hormone-related sleep disturbances, but as they age (or during pregnancy), their sleep can become more disturbed, lighter and less refreshing. Estrogen and progesterone both have a chemical influence on sleep and can be partly to blame for problems with daytime sleepiness and sleep disturbances when their levels are out of balance (usually during the premenstrual period, pregnancy, postpartum periods and perimenopause). Also, it's been shown that lower estrogen levels during menopause may lead to problems with increased upper airway resistance during sleep, snoring, and obstructive sleep apnea.

For those women, from menarche all the way to perimenopause, who are not pregnant, rapidly changing hormones on a monthly basis can still lead to pain, such as headache or cramping, that can disrupt sleep.

Pregnant women (see our 4-part series on Adventures in Sleep for the Pregnant Woman to learn more) can encounter a multitude of sleep problems that are related not only to the circumstances of pregnancy, but to raging hormones.

For women who are in perimenopause, side effects caused by changing hormone levels, like night sweats and mood swings, can also interrupt sleep. Dr. Sharon Wong of Adventist Medical Center in Portland quotes sleep studies that show that "women are more prone to having their sleep disturbed in the first half of the night by having a hot flash.” However, “[d]uring REM sleep, in the latter half of the night, women seemed to be more able to suppress their sleep disturbances.”

Fortunately, once menopause sets in, these side effects do subside.

What can a woman do about sleep problems that she suspects are related to hormonal changes? It's always a good idea to speak with your doctor first about your concerns. Sleep problems have multiple causes and root causes need to be ruled in or out. If your doctor determines your sleep issues are related to hormones, you will have to decide what therapy is right for you. There are drug therapies, herbal therapies, lifestyle changes and/or simply riding out the phase. Your therapy will reflect what is most important for you.

Ultimately, if hormones are messing with your sleep, one of the best things you can do for yourself is to practice excellent sleep hygiene and address any issues you may have with depression, mood swings or anxiety, which may be aggravating your sleep as well as the hormone shifts themselves.

Spectrum Health offers this informative Q&A Session with Dr. Diana Bitner, an OB-Gyn who has some good advice for dealing with sleep problems that could be the result of menstrual cycle issues.


Sources

Hertz G, Cataletto ME, Benbadis SR. "Sleep Dysfunction in Women." Medscape. (2013, May 14). Retrieved on May 22, 2015 from http://emedicine.medscape.com/article/1189087-overview

Marieb EN. (2012). Essentials of Human Anatomy and Physiology. San Francisco: Pearson Education.

Popovic RM, White DP. "Upper airway muscle activity in normal women: influence of hormonal status." Journal of  Applied Physiology. March 1998;84(3):1055-62

Ross, M.  "Women: Depressed, agitated, can't sleep? It could be hormones." Contra Costa Times. (2014, April 30). Retrieved on May 22, 2015 from http://www.mercurynews.com/bay-area-living/ci_25661843/women-depressed-agitated-cant-sleep-hormones

Shaw, G. "Women, Hormones and Sleep Problems." WebMD, nd. Retrieved on May 22, 2015 from http://www.webmd.com/sleep-disorders/features/women-hormones-sleep-problems

WOMEN & SLEEP: Adventures in Sleep for the Pregnant Woman, Postpartum Edition

See Also:
Adventures in Sleep
for the Pregnant Woman, Part One:
The First Trimester
---
Adventures in Sleep
for the Pregnant Woman, Part Two:
The Second Trimester
---
Adventures in Sleep
for the Pregnant Woman, Part Three:
The Third Trimester

So you think you can sleep now that junior is born?

Not likely. Three things can prevent a new mama from enjoying sound sleep for quite a few more months:

1. Nighttime Awakenings
2. Postpartum Discomfort
3. Postpartum Insomnia

Let's take a closer look.

Baby needs nursing at 2 am. Most new parents "get" that, on an intellectual level. However, on a deeper level, they may grossly underestimate just how much these nighttime feedings and snuggles will cut into their sleep time and how long this period of sleeplessness can last.

Newborn babies may take anywhere from three to nine months to settle into their sleep architecture. Most people aren't prepared to endure yet enough nine months of poor sleep after having just gone through nine months previously dealing with sleep problems.

Getting insufficient sleep does take its toll on new parents, both physically and emotionally. It's important to take this sleep deprivation seriously; while making lighthearted jokes about not getting enough sleep is common in our culture, the fact is that anyone with ongoing sleep deprivation is setting themselves up for all kinds of health and safety issues.

The National Sleep Foundation points to the following as the risks one assumes by not getting enough sleep:

1. Increased risk of car accidents caused by impaired judgment or drowsy driving
2. Increase in body mass index — after the baby, an increased appetite can be due to the needs of nursing, which uses calories, but if you are continuing to eat more calories than you burn and feel hungry all the time despite adequate calories, this can be caused by hormonal imbalances due to sleep deprivation
3. Increased risk for cardiovascular problems and for developing diabetes
4. Increased risk for long-term depression, substance abuse and mood disorders
5. Cognitive declines and reduced ability to manage executive functions like decision-making
6. Higher risk for illness

Solutions? Obviously the answer is to get your sleep, but how to achieve this may be tricky, especially for single, working mother households. But napping whenever possible is always a good option (especially while baby is sleeping). Hiring someone like a doula to help with nighttime awakenings or to be there for you and baby in the afternoon while you nap can make all the difference. Your spouse, best friend, or relative can also be good for handling feedings and simple babysitting so you can get the rest you need.

If you are at work, ask for napping opportunities during the day while you get through this stage of your new family life.

Finally, while the baby monitor has become the ubiquitous tool for 21st century parents who wish to check in on their babies, it can also be a trouble-some sleep thief. A mother can hear a crying baby from far, far away; it's hard-wired in her brain to do so, and some recent scientific studies back this up. If you are nearing the stage when junior may be just crying for comfort but not for hunger, it may be time to turn off the monitor video and sound and just get some sleep, perhaps moving toward the "crying it out" stage that many pediatricians advocate for teaching infants self-soothing. 

Postpartum discomfort mirrors many of the same prenatal problems a mother encountered prior to labor and delivery. There's the insistence on continued reflux, nighttime leg cramps, hormone changes that sweep over you and leave you feeling nauseated, tenderness in the breasts or the pelvic region due to surgical procedures or natural tearing from delivery. You may be weaning yourself off painkillers after a major abdominal surgery, or you may be passing large blood clots because you are trying to do too much in the early weeks after childbirth.

Solutions? In a nutshell, take care of your aches and pains with the help of your physician, and practice good sleep hygiene. Treat yourself to warm baths, even warm milk at bedtime. Eat healthy foods, try to exercise at a level that is appropriate to your postnatal condition (mothers experiencing Cesarean births will have different requirements from those who delivered vaginally), practice relaxation techniques such as yogic breathing or listening to soft music. All efforts to achieve relaxation also tend to assuage aches and pains and give you a better sense of overall well-being. Keep in mind that the more sleep you get, the less you will be bothered by transitory or residual pain in the postnatal term. Pain perception increases when sleep is insufficient.

Postpartum Insomnia may occur along the spectrum of Postpartum Depression (PPD) or the so-called "baby blues." It's quite common to experience emotional shifts following childbirth. Hormone changes lead to mood swings, fatigue and problems sleeping at night. Insufficient sleep then leads to memory problems, brain "fog," emotional sensitivity, even the desire to stop being a new mother. Whether the insomnia following childbirth is caused by PPD, or whether the PPD is caused by insufficient sleep is less important: what's critical here is that it can be serious and needs treatment.

Solutions? Get support at home for tasks that can be handed off to others (like spouses, relatives, neighbors, friends, or for-hire doula services). Use that time to sleep and recharge yourself. Take a morning off; even a couple of hours to yourself can be immensely rejuvenating. If depressive symptoms continue, don't hesitate to seek help from your doctor. PPD is not a sign of weakness or something to be ashamed of; much of it is caused by unstable hormone peaks and valleys and can be addressed with therapy, medication, or a combination of both. Your baby needs you to be a whole mother, and that includes emotional stability in the definition of "whole."

Final thought:
Getting good sleep isn't a luxury for the few. It shouldn't be a checkmark on one's bucket list of things you'd like to encounter some day, but as an all-out priority in your life. Not sleeping compromises both the health of you and your child. It is worth doing everything in your power to ensure you relieve yourself of the problems that sleep deprivation can bring.

IN CASE YOU MISSED IT: Our most popular posts in April

As determined by Blogger, Twitter, StatCounter and Google Analytics:

THANK YOU FOR VISITING! TELL YOUR FRIENDS! --The Curator

Posts

• April 15 || JUST BREATHE: Upper airway resistance. It's a thing. And it matters
• April 8 || JUST BREATHE: What happens if I don't treat my sleep apnea?
• April 30 || JUST BREATHE: "Heard About Sleep?" APNEA... If not, listen in here
• April 10 || JUST BREATHE: How to find out if you have a sleep breathing disorder 
• April 23 || JUST BREATHE: Hope2Sleep's "Dangers of Untreated Sleep Apnoea" infographic
• April 23 || JUST BREATHE: Go to the dentist to fix your apnea?
• April 21 || JUST BREATHE: CPAP basics--how to get through the adjustment, how to improve long-term outcomes
• March 24 || INSOMNIA: Why is it linked to depression?
• April 20 || JUST BREATHE: Twelve of our best previous posts on sleep breathing disorders
• April 6 || Today is Drowsy Driving Awareness Day in California: How sleep apnea fits into this concern, and why we should ALL be observing this day
• April 30 || JUST BREATHE: What happens if I don't want or like PAP therapy? You have options
• April 29 || JUST BREATHE: No, there are no magic pills for sleep apnea, and some magic pills just make it worse
• November 29 2014 || SHED SOME LIGHT || Ask the Expert: Misconceptions about Circadian Rhythm Disorders

Pages

• WHY SLEEP MATTERS
• MEDIA
• SLEEP DISORDERS
  

WOMEN & SLEEP: 14 of our best previous posts relevant to women and sleep

SHC has been publishing some great content on the subject of women's sleep health going back as far as last June.

Please scroll through this custom archive of 14 previous posts to find links relative to sleep health which are of special interest to women.


June 6, 2014
INSOMNIA CENTRAL || Can Insomnia Lead to High Blood Pressure?

July 5, 2014
SLEEP DISORDERS 101 || What is jet lag disorder?

September 14, 2014
SLEEP Rx || Mother's Little Helper: Things you should know

October 18, 2014
CPAP Central || A Season for Masks: Smaller Might Be Better

October 29, 2014
MONSTERS OF SLEEP || Research shows that women have the scariest nightmares... Why?

January 5, 2015
Sleep Hygiene Tip of the Week || Foods that can help you sleep better

January 12, 2015
ALTERNATIVES || Aromatherapy

January 26, 2015
ALTERNATIVES || How meditation can help

February 17, 2015
ALTERNATIVES || Valerian, aka "Nature's Valium" -- safe to use, effective? You be the judge

February 25, 2015
ALTERNATIVES || The calming powers of magnesium

February 28, 2015
ALTERNATIVES || Guest Post: Using yoga to achieve relaxation, sleep and stress management [David Schaar]

March 16, 2015
INSOMNIA || Drugs and Sleep: If you have been taking Ambien (zolpidem) long-term (since before 2013), please read this

March 24, 2015
INSOMNIA || Why is it linked to depression?

April 15, 2015
JUST BREATHE || Upper airway resistance. It's a thing. And it matters.

JUST BREATHE: What happens if I don't treat my sleep apnea?

This is a common question asked by patients in the sleep lab who learn they have been diagnosed with obstructive sleep apnea (OSA).

They discover that they must commit to lifestyle changes and therapies in order to overcome their disorder. This is not easy news to take in a world where we expect to fix everything with a pill or a shot. 

It may seem that wearing a therapeutic PAP mask or oral device to bed at night, or opting for an invasive surgical procedure, or embarking upon a major weight loss kick or a challenging new exercise regimen are extreme solutions for a problem they don't think of as dangerous. These patients may even equate sleep apnea with snoring. 

Snoring is annoying, sure, embarrassing, but could it really be that bad? 

Snoring, itself, may or may not be all that bad. But obstructive sleep apnea, which may also (and usually does) include snoring, is not merely a bad case of snoring. It is a dangerous condition that, left untreated, will lead to a lifetime of health woes and a shorter life span.

When you lie down to sleep, your upper airway requires enough space for your body to inhale and exhale air. This air, introduced as oxygen (O2) molecules into the lungs through the tiny air sacs called the alveoli, brings much needed oxygenation to your red blood cells. These little rafts whisk oxygen molecules away to every nook and cranny in the body in order to help maintain important chemical balances, heal wounds, nourish tissues and cleanse your body at the cellular level. You need every last one of those O2 molecules for the body to work in tip-top shape. 

If you go without adequate oxygen during the day, you simply take a breath and balance is restored. However, at night, while sleeping, your body is essentially working in autopilot. If your upper airway collapses while you sleep, it blocks that important inhalation (or exhalation) of air, and your blood cells cannot do their job. You really can't expect to stay healthy if, night after night, you are not getting adequate oxygen to your bloodstream. Eventually, the body will begin to break down, fail to heal, and fall into disease or dysfunction.

When you have sleep apnea, systemic inflammatory responses take place throughout the body (pain, swelling) and several body systems suffer the impact of the loss in blood oxygenation caused by this simple mechanical failure of the upper airway to allow air into the lungs while you sleep. 

This is what COULD happen if you don't treat your sleep apnea. 

The cardiovascular system: When your blood loses oxygen repeatedly over the course of the night, this creates oxidative stress on the heart and leads to sustained elevations in blood pressure (hypertension). Heart attacks, atrial fibrillation, other heart arrhythmias, congestive heart failure, atherosclerosis ("hardening of the arteries") and chronic vascular disease are all potential hazards of leaving OSA untreated. Stroke is also one of the greatest potential risks that a person with sleep apnea faces if they ignore this condition.

The endocrine system: When it comes to metabolism, obstructive sleep apnea can lead to many different problems. Obesity is perhaps the most notable health condition linked to OSA, but many don't realize that Type 2 diabetes mellitus has a confirmed relationship to untreated sleep apnea. When the blood's oxygen levels dip dangerously below normal, this creates a sympathetic response in the body that leads to the maintenance of higher-than-usual levels of adrenaline in the blood over several hours every night. This shift in blood chemistry leads to problems with insulin sensitivity and/or resistance and with glucose tolerance. Polycystic ovary disease is related to the higher insulin resistance that occurs in women who have untreated OSA. Middle-aged adults with this sleep breathing disorder also risk developing acromegaly, a condition in which too many growth hormones are released into the bloodstream, leading to excessive growth in the soft tissues in the upper airway. Chronic edema (swelling) can also occur as a result of chemical imbalances in the body, which then can serve to further perpetuate the mechanical disruptions caused by sleep apnea, as the body's fluids are redistributed across the body while supine, leading to additional swelling in the soft tissues of the upper airway which cause its mechanical collapse. Finally, hypothyroidism has also been linked to obstructive sleep apnea.

The brain: The repeated drops in blood oxygen saturation overnight have been shown to cause damage to the mammillary bodies in the brain, which leads to the same short-term memory loss and daytime confusion that plagues chronic alcoholics and those suffering from Alzheimers. It can also lead to significant reduction to both the brain's white and gray matter, resulting in measurable impairments in cognition, mood and alertness. Emotional imbalances are also a side effect of obstructive sleep apnea: irritability, secondary depression and the worsening of preexisting mood disorders can result.

The respiratory system: Smokers, you are probably not breathing well even while you sleep if you have apnea; chronic obstructive pulmonary disease (COPD) is positively linked to untreated OSA. So is pulmonary hypertension. OSA has also been shown to be an independent risk factor for worsening preexisting asthma.

The reproductive system: Women with untreated sleep apnea have been shown to suffer from impaired ovarian function; men with untreated sleep apnea may suffer from "low T," or reductions in testosterone, as well as low sperm counts.

The urinary system: For some, the failure to treat OSA may increase the frequency of overnight urination, not necessarily due to overactive bladder but to the stress response that corresponds with the frequent awakenings caused by apneic episodes. Many people who wake up feeling the need to use the bathroom may not actually have full bladders, but their body chemistry has been forced into a wakefulness that signals for the body to void the bladder. Sleep apnea also occurs at a significantly higher rate in people with chronic kidney disease (between 50 to 90 percent). 

If you have been diagnosed with sleep apnea, please take your doctor's orders seriously and seek out treatment. There are numerous treatments available; if you fail at one, try another. Your body will thank you later, and so will your loved ones, and you will feel better and live longer.

SOURCES

American Academy of Sleep Medicine || Brain damage caused by severe sleep apnea is reversible
Endocrine Society || Endocrine Aspects of Obstructive Sleep Apnea
Health.com || Sleep Apnea May Damage Brain Cells Associated With Memory 
Healthday || Sleep Apnea Linked to Kidney Disease Progression in Diabetics
Huffington Post & The Stanford Center for Sleep Sciences and Medicine || What Untreated Sleep Apnea Means for your Blood Pressure 
Journal of Clinical Sleep Medicine || Obstructive Sleep Apnea and Asthma: What are the links?
Lung || Chronic lung disease in the sleep apnea syndrome
Mayo Clinic || Sleep apnea complications
Renal Support Network || Sleep Apnea and Kidney Disease
SCOPE/Stanford Medicine || Sleep apnea linked with male infertility
SLEEP || Obstructive Sleep Apnea Syndrome is Associated with Overactive Bladder and Urgency Incontinence in Men
Sleep Better, Live Better Blog || How Does Sleep Apnea impact the brain?

INSOMNIA || Why is it linked to depression?

Image courtesy TMS NeuroHealth Centers

This could be a chicken/egg question, truly... which came first, insomnia or depression?

One can definitely lead to the other. Let's think about this for minute.

Depression can be its own illness, categorized in severity based on a wide range of physical and emotional symptoms and linked to physical illness, hormonal imbalance, stress and aging. When people experience the psychic symptoms of depression (feeling emotionally drained, agitated, anxious, worried, or suicidal, for instance), it makes sense that it could become either difficult for them to sleep or difficult for them to get out of bed feeling rested.

When it comes to insomnia, not being able to sleep due to physiological triggers (other underlying sleep disorders, transient illness, chronic illness, pain, stress, hormonal imbalance, aging) can lead to disorders of mood, thanks to shifting brain and body chemistry and processes that come from not getting adequate sleep. Sleep helps your body to heal itself at the cellular level as well as maintain the proper body and brain chemistry necessary for normal, balanced function. It makes sense that, lacking sleep, a person is more likely to become ill, either physically or mentally, or even suffer from both.

According to a study published in SLEEP in 2005, people with insomnia are 10 times more likely to develop depression than those who sleep well. This is a serious problem, as insomnia is the most common sleep disorder in the United States. Problems with insomnia range from having trouble falling asleep, staying asleep, fragmented sleep and day-after fatigue or excessive daytime sleepiness.

Major depressive disorder, according to the National Institute on Mental Health, is no small problem, either. As one of the most common mental health disorders in the United States, nearly 7 percent of our entire population suffers from it.

It seems there are endless ways in which insomnia and depression can pair up. Drug addiction or withdrawal, for instance, or even the side effects of some maintenance drugs people must take for chronic illness. Major life stressors, such as divorce or the death of a child or a lost job, will cause one or the other--or both--if not addressed. Poor diet or lack of exercise may lead to insomnia or depression. Another common and very specific relationship between sleep and mood--Seasonal Affective Disorder--has also been researched at length (see what SHC published on this topic in 2014).

Treatments for insomnia often mirror treatments for depression, which may simplify the process for many. They usually involve either a pharmacological therapy, cognitive behavioral therapy, or ideally, a combination of both. A medical doctor will review history, symptoms and ask for a thorough physical exam to help establish any biological causes for either sleep insufficiency or depression, to help determine a therapeutic course that serves to treat both.

The main takeaway is this: never think that ongoing symptoms of either insomnia or depression are best ignored. The presence of ongoing bouts with either--and especially both at once--is a major cause for concern and should not be overlooked.

Can you relate to this discussion?
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There is no badge of courage attached to going without sleep; the longer you go without it, the worse your brain and body will suffer. The human body can go for up to 11 days without sleep, and then it will die. Sleep is not optional.

Likewise, there is no shame in admitting to feelings of despair or chronic low mood; in fact, these could by symptoms of a physical condition you could easily treat. Often, the challenges of our lives also require outside help; even the strongest individuals will struggle to power through dark times.

If you are struggling with either condition, you are best advised to seek help regarding either via the healthcare professional you are most comfortable approaching, whether it's your primary care physician, a behavioral therapist you are already seeing, a naturopath, or a specialist who oversees any other chronic health conditions you might have.

(And please avoid going to online forums or private groups as these communities; even when they strive to provide support, they can often be the source of some of the worst, most dangerous misinformation out there. Members and moderators of these groups are generally not medical professionals.)

Ultimately, hope lies in the reality that both insomnia and depression, together and separately, are eminently treatable.

INSOMNIA: Twenty of our best previous posts on the topic

SHC has been publishing some great content on the subject of insomnia going back as far as last June. Please scroll down to this custom archive of 20 previous posts to find links related to insomnia of special interest to you and your loved ones.


June 6, 2014
INSOMNIA CENTRAL|| Can Insomnia Lead to High Blood Pressure?

July 11, 2014
INSOMNIA CENTRAL || Is There a Connection Between Insomnia and Suicide?

July 14, 2014
SLEEP HYGIENE TIP OF THE WEEK || Forget About Those Nightcaps

July 21, 2014
SLEEP HYGIENE TIP OF THE WEEK || What Alarm Clock?

July 28, 2014
SLEEP HYGIENE TIP OF THE WEEK || Step Away From the [Blue Spectrum] Light

Aug 11, 2014
SLEEP HYGIENE TIP OF THE WEEK || Stay Cool

Aug 18, 2014
SLEEP HYGIENE TIP OF THE WEEK || Just Say No to Phones in Beds

Aug 19, 2014
AASM NEWS HEADLINES || FDA approves new sleeping pill Belsomra (suvorexant) for insomnia

Aug 25, 2014
SLEEP HYGIENE TIP OF THE WEEK || Think carefully before napping

Aug 30, 2014
NEW TECHNOLOGIES || Blue light blocking shields for electronics

Sept 1, 2014
SLEEP HYGIENE TIP OF THE WEEK || Capture your worries first

Sept 14, 2014
SLEEP Rx || Mother's Little Helper: Things You Should Know

Sept 17, 2014
INSOMNIA CENTRAL || Do you have Insomnia...or do you have Sleep Apnea?

Oct 13, 2014
MONSTERS OF SLEEP || When naps set you up for a visit with the Insomnia Vampire

Oct 29, 2014
MONSTERS OF SLEEP || Insomnia? Find your vampire friends online

Nov 4, 2014
SHED SOME LIGHT || Are insomnia and winter depression linked?

Dec 10, 2014
VISIONS OF SUGARPLUMS || Why insomnia and sleep deprivation cause cravings

Jan 26, 2015
SLEEP HYGIENE TIP OF THE WEEK || How Meditation Can Help

Feb 17, 2015
ALTERNATIVES || Valerian, aka "Nature's Valium" -- safe to use, effective? You be the judge

Feb 19, 2015
ALTERNATIVES || Guest Post: Acupuncture can relieve insomnia and, possibly, more [Dr. Dave Shirazi]

Alternatives: What about Melatonin, anyway? America's favorite OTC sleep remedy may work... or not...

Melatonin, as a natural supplement for reclaiming sleep, has never been more popular. It is perhaps the leading "alternative" sleep aid out there. Not only is it cheap and easy to source, but there are thousands of evangelists for this exogenous form of a hormone we naturally produce on our own.

Does it work?

Some basics about melatonin, first.

• Natural (endogenous) melatonin is derived from the neurotransmitter, serotonin, in a chemical process which takes place only during the night. Endogenous melatonin is naturally low during the day and high during the evening as it is inhibited by exposure to light due to the ultrasensitivity of the pineal gland to circadian and seasonal rhythms and cues, the strongest of which is light.
  
• Melatonin is key to modulating the circadian clock in the brain because it signals day-night information to a specific pacemaker in the brain called the suprachiasmatic nucleus. However, secretion of endogenous melatonin is also easily altered by environmental factors like exposure to bright light during the evening or the introduction of a late meal or heavy exercise at bedtime. Other circadian rhythms in other parts of the body can be influenced by disruptions in endogenous melatonin secretion as well, including the digestive system, the systems which regulate core body temperature, even blood pressure and reproductive cycles.
  
• Endogenous melatonin also acts as a vasodilator in the skin, increasing blood flow which results in heat loss and lowered body temperature. These physiological processes, in turn, support the sleeping process.
  
• Interestingly, endogenous melatonin is not essential for circadian rhythms; the removal of the pineal gland shows very little impact on these rhythms in humans.
  
• Abnormalities in endogenous melatonin secretion are most commonly associated with the following three psychiatric disorders: Seasonal Affective Disorder (SAD) with winter depression, major depressive disorder, and premenstrual disorder (PMDD). These disorders, in turn, can have a major impact on sleep function, potentially leading to hypersomnia and overeating.
  
• While we secrete our own melatonin in the pineal gland, there is also a manmade form of melatonin (exogenous) which you can also take in pill form. It is rapidly absorbed (within 30 minutes) and has a 40-60 minute half life (meaning it is metabolized and eliminated within this amount of time).
  
• We can purchase exogenous melatonin as an over-the-counter drug because the FDA classifies it as a food supplement and does not require rigorous data supporting its safety, composition or effectiveness.
  
• The exogenous (manmade) form of melatonin is used in two ways: to potentially help shift circadian sleep phases into a more normal pattern, and to serve as a sleep inducer or maintenance drug. Its effect on the suprachriasmatic nucleus is directly related to the amount of endogenous melatonin already being supplied by the pineal gland: those with shortages in endogenous melatonin will feel stronger effects if they take exogenous melatonin. 

• Studies show varying rates of therapeutic success in using exogenous melatonin. The risks of using exogenous melatonin are still unknown; no public health risks have emerged anecdotally. The most common potential side effect is headache. It is considered nonaddicting.
  
• Researchers still cannot agree on an optimal dosage of exogenous melatonin for most people as they have yet to discover a consistent dose-response relationship in studies (the lowest amount which can be shown to be effective).
  
• The effectiveness of exogenous melatonin depends upon the time of day it is administered, though researchers have yet to define an accurate window of time for taking it; the range is as broad as 30 minutes to 3 hours. It has been noted that if people take exogenous melatonin during the day, it may result in impaired function while driving a car, operating machinery or during job performance.
  
• The reason why research is so inconclusive about exogenous melatonin usage resides in the fact that while many studies have been conducted, the variables (dosage, type of subject tested, timing of dosage) vary wildly and cannot be cross compared. 

So, does it work? You be the judge. Here are some articles to consider before jumping on the melatonin bandwagon.

Cleveland Clinic || Melatonin Supplement Review

Mayo Clinic/Dr. Brent Bauer || Is melatonin a helpful sleep aid — and what should I know about melatonin side effects?

Wise Geek || What Are the Pros and Cons of a Melatonin Sleep Aid?

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Resources consulted

"Biochemical Pharmacology of Sleep." Chokroverty, S. From Sleep Disorders Medicine; Butterworth Heinemann, 1999.

"Circadian Rhythm Sleep Disorders." Berry, RB. From Fundamentals of Sleep Medicine; Elsevier, 2012.

"Clinical Pharmacology of Other Drugs Used as Hypnotics." Buysse, DJ. From Principles and Practices of Sleep Medicine, eds. Kryger, Roth and Dement; Elsevier: 2011.

"Melatonin and the Regulation of Sleep and Circadian Rhythms." Guardiola-Lemaitre, B and Quera-Salva, MA. From Principles and Practices of Sleep Medicine, eds. Kryger, Roth and Dement; Elsevier: 2011.

"Pharmacologic Treatments: Other Medications." Krystal, AD. From Principles and Practices of Sleep Medicine, eds. Kryger, Roth and Dement; Elsevier: 2011.



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.