Sleep Hygiene September || Take 2 Tips: Exercise now to sleep better later.

JUN 7 || LONG-TERM LIVING
Study: Exercise improves sleep and daytime awareness
“As people age, the body’s natural sleep/wake cycles (circadian rhythms) can get out of kilter. But the more a person exercises, the better the body can maintain its own internal clock, according to a study published in The Journals of Gerontology A."

AUG 4 || SOUND SLEEP HEALTH
How to exercise your way to sleep apnea relief
"A 2014 meta-analysis published in Lung revealed 'a statistically significant effect of exercise in reducing the severity of sleep apnea in patients with OSA with minimal changes in body weight.' "

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SLEEP HYGIENE TIP OF THE WEEK: Exercise during the light of day

So you've begun your weight loss plans in earnest!

But sometimes the time you'd like to commit toward daily exercise gets filled up with work or family obligations.

The next thing you know, it's dark out. And then it's dinner time, and then suddenly you just have one hour before you normally go to bed.

So you go to the gym or the home-based treadmill or hit the sidewalks in the dark with a bicycle flasher fixed to your back and a headlamp so you can rack up some mileage walking or running.

You come back, take a hot shower (it was cold outside!) and then try to go to sleep.

And try. And try. And you just can't.

That's because you just got your daily workout in at bedtime. Moderate exercise right before bed does a few things that make it harder for you to fall asleep.

• It raises your core temperature. Your body starts to cool off for the evening as the sun goes down in preparation for sleep. It's part of your body's overall circadian rhythms to do so. Exercising raises your body's temperature; right before bedtime, it takes that much longer for it to fall back to sleep-inducing levels. 
• Add in that hot shower and you're in for a double whammy. While a warm shower is quite conducive to preparing the body for sleep, hot showers also raise the core body temperature, with disastrous results at bedtime. 
• Your body kicks out major stress hormones (adrenaline, cortisol, norepinephrine) after a period of moderate exercise. These hormones encourage wakefulness, increase your pulse and breathing rates, speed up metabolism and arouse the liver and muscles to manage the changes in insulin and glucose that exercise brings. You may feel spent after a good workout, but your body is still in recovery mode and will take some time (half an hour or more) to process that additional burst of energy caused by your late-night jog or spin. 
• Exercising at unexpected times can disrupt the circadian system, confusing it into thinking it should prepare to stay awake longer.

What should you do if you run out of time during the day but still need to get in some form of exercise? 

Try a mild form of yoga (but avoid so-called "hot" yoga). Yoga stretches the limbs, promotes healthy breathing and relaxes the body. It encourages strength-building without raising the heart and respiratory rates to levels that trigger a stress response. It's also a great way to calm the mind before bed. 

Practice yoga in a cool room with dim lights, if at all possible, and avoid treating yoga like an aerobic form of exercise (which it's not meant to be, anyway). Yoga is meant to undo the damage of bodily stress caused by poor posture, too much sitting or strain from heavy exercise or other physical activity. Treat it as the unwinding practice it is meant to be and leave the major physical activity for the daytime.

Reset your workout regimen for the early morning instead. Brisk exercise in the morning, ideally while outside as the sun is rising, is probably the best way to not only get in your daily workout, but to also reset your circadian rhythms, especially during the winter. The combination of exercise and exposure to light, especially sunlight, will help you achieve healthy sleep onset at bedtime after a long, energized day. 

JUST BREATHE: What happens if I don't want or like PAP therapy? You have options

It's no secret that some people don't like PAP therapy (nor is it a secret that some people swear by it). Therapies that require the use of devices can be challenging for some people and even with their best efforts, they may not  be able to use them effectively.

Below is a list of options for those who have tried and failed at PAP therapy for whatever reason. It is not the purpose of this website to favor one therapy or another, or to compare and contrast, but rather to illustrate the variety of options that patients with sleep-disordered breathing may have.As always, your diagnoses and treatments are best discussed with your sleep physician, as this website cannot diagnose your problem or prescribe or advise as to which options are best for you. Whether you qualify for any of these treatments is going to be a decision you make with your physician. 

• Oral devices. Read here for a more detailed discussion about sleep dentistry and how it might help you. 
• Expiratory positive airway pressure. This is a kind of nostril patch device that works by blowing against the patches during exhale, which may improve the "patency" or rigidity of the upper airway tissue and provide, for some, a kind of "tracheal traction" to create greater ease in inhalation. 
• Oral pressure therapy. This works by using a small oral suction tube to draw the soft palate forward, which may stabilize the tongue and keep it from blocking the airway during sleep.
• Pillar procedure. This is a minimally invasive surgical procedure in which tiny implants are inserted into the soft palate. Their presence may reduce tissue vibration which can lead to snoring, sleep apnea and upper airway resistance syndrome. 
• Somnoplasty. This is a minimally invasive surgical procedure using radio frequency (RF) energy to sculpt upper airway tissue under local anesthesia; this may effectively open the airway.
• Upper airway neurostimulation. The Inspire is a small device implanted into the chest to deliver to deliver carefully timed mild stimulation to the airway during sleep. This controlled neurostimulation may achieve "patency" or firmness of the tissues in order to prevent their collapse. 
• Uvulopalatopharyngoplasty (UPPP). This surgical procedure removes excess tissue in the throat, soft palate, uvula, tongue, tonsils, and/or parts of the pharynx to create more space in the upper airway; this may prevent collapse airway collapse during sleep.
• Adenoidectomy. Removal of the adenoids (tonsils) make help make space in an otherwise crowded airway.
• Numerous other surgeries used to correct obstructive sleep apnea have been outlined clearly at this page hosted by the American Sleep Apnea Association.

Certain lifestyle changes or habits may not "cure" your sleep apnea, but they can certainly give you some relief. These include: 

• Positional therapy. Read here for a more detailed discussion about how just changing your sleep position can help those who snore or have mild apnea.
• Weight loss. Losing a few pounds, even just ten, can help shrink fat cells. Smaller fat cells retain less water and place less pressure on the tissues of the upper airway during sleep. This may reduce, if not completely eliminate, obstructive breathing patterns. Remember, even if you don't have noticeable fat pads in your neck, you may carry extra water weight in your feet during the day; when you lie down, the fluid recirculates and plumps up fat throughout the body, including in the neck area. 
• Gastric bypass or other surgical weight loss procedures. For those who are morbidly obese, these options may also help prevent obstructions secondarily, but these patients may need to have a sleep study prior to surgery to identify any preexisting sleep apnea so that the pre-surgical team can prepare proper anesthesia and respiratory therapies prior to the operation. 
• Smoking cessation. Smoking (of tobacco or any other substance) may inflame the upper airway and, in the case of tobacco, create a "rebound effect" in the upper away during the night because of short-term nicotine withdrawal. Smoking may also lead to Chronic Obstructive Pulmonary Disease, a chronic and irreversible respiratory disorder which can severely impact one's ability to breathe, especially at night while asleep.
• Daily aerobic exercise. Daily aerobic exercise may help to improve the tone of the tissues in the upper airway and may lead to weight loss and the shrinkage of fat cells which are partly to blame for obstructions of breathing at night.
• Change pillows or reduce the number of pillows used. If your pillow seems to be pushing your chin forward, it may be contributing to the mechanical obstruction of the airway. Find a pillow that allows your head to lie flat while still supporting your neck. Also, propping one's head up with multiple pillows may do the same thing. If you struggle to sleep with your head flat, it could be that you have a severe obstructive respiratory condition, and you should discuss this with your physician. 
• Play the didgeridoo. Seriously. There's some evidence that playing some form of wind instrument may help improve airway tone and build a skill called "circular breathing" which allows for better gas exchange. 

For more information about alternative therapies for sleep apnea which don't involve using PAP, click here. 

In Case You Missed It: January's most popular posts at SHC

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

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

Posts

• Alternatives: Using sound as a bedtime sendoff
• Definitions: What is normal sleep?
• Alternatives || Sleep Hygiene Tip of the Week: How meditation can help
• ALTERNATIVES || Dr. Scott Theirl suggests biomarker testing before you take an Ambien
• Alternatives || Sleep better when you have the flu with these tips
• Sleep Hygiene Tip of the Week || ALTERNATIVES: Aromatherapy
• ABCs of Sleep---C is for CPAP
• Alternatives || Sleep Hygiene Tip of the Week: Move, to rest

Pages

• SLEEPYHEAD CENTRAL || Sleep Disorders
• SLEEPYHEAD CENTRAL || Why Sleep Matters

Alternatives || Sleep Hygiene Tip of the Week: Move, to rest

Image courtesy Etandel.

From the National Sleep Foundation comes this gem:

"People sleep significantly better and feel more alert during the day if they get at least 150 minutes of exercise a week, a new study concludes."

What kind of improvement are they boasting? A 65 percent increase in sleep quality. That's no small thing, given how tired Americans are.

That boils down to 20-25 minutes a day of your favorite exercise, the equivalent of a brisk indoor or outdoor walk daily, or 3 days at the gym or pool or elsewhere for 50 minutes. And it doesn't haven't to include exercise in the formal sense, it could be some heavy lifting out in the yard, or your lunchtime walkabout during the week, or a dip in the pool with your kids on the weekend, or a challenging yoga class, or a night at the community center playing volleyball.

The idea is pretty simple: cardiovascular activity sharpens one's focus, improves daytime productivity and eliminates daytime sleepiness as well as leads to easier sleep onset at night and more restful sleep overall.

Perhaps the best way to look at it is this statement from the NSF: "“Increasingly, the scientific evidence is encouraging as regular physical activity may serve as a non-pharmaceutical alternative to improve sleep.”

If you could replace your sleeping pills with a brisk daily walk to prevent insomnia, wouldn't you?

Some tips for making exercise work for your sleep habits:

1. Reconsider exercise right before bedtime. Exercise releases hormones such as adrenaline (epinephrine) and cortisol, which will lead to extended wakefulness following the workout. Try to put three hours between the end of your workout and bedtime, if you are able.

2. That said, some people can exercise right before bed and not suffer from delayed sleep onset. In fact, this might be the only time some people CAN get their exercise. If you aren't sure how it will affect you, keep a sleep diary that captures how long it takes for you to fall asleep on nights when you've been visited with insomnia. You can also swap muscle-building exercises for high intensity aerobics activities in order to ease into sleep more smoothly.

3. Keep an exercise routine to help establish good sleep patterns overall. Your body likes regularity... in exercise, sleeping, eating... more regularity means less stress.

4. Exercise in the morning outside is the optimal opportunity to not only get your sleep-worthy exercise, but to also re-entrain your brain to daylight, thereby giving your circadian rhythms a boost.

5. Focus on your breathing as you exercise, and try to find a pattern you can stick with comfortably. The respiratory boost of mild exercise can be an excellent way to instill calm in the body afterward.

6. If you shower afterward, try not to use overly hot water if you are heading off to bed. Your body needs a cool down at bedtime if it is going to fall asleep. Keep your shower warm, then follow with a glass of cold water. Sleep in a cool room with layers of blankets you can adjust so as not to be overwarm.

SOURCES

• CNN: Can exercising at night hurt your sleep?
• Mental Health and Physical Activity: Association between objectively-measured physical activity and sleep, NHANES 2005–2006
• National Sleep Foundation: Study: Physical Activity Impacts Overall Quality of Sleep

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.  

Lifespan || Back to School: Have You Reset Your Kids' Bedtimes?

Kids are usually not ready to go back to school in the fall, and to confuse matters, they sleep following a summer schedule which generally puts them in bed later than is recommended for school-aged kids needing to get up early for school the next day. This can mean a tough transition from summer to school days for many families, with many elements to blame for this challenge.

Daylight hours are still long and late enough to make it hard for kids to go to bed at a normal time. The sky doesn't darken early enough in August, even in early September, and that means parents may have to double their efforts to get their kids to bed at a healthy time.

On top of that, many schools still have earlier start times than are recommended by most sleep health organizations. This is a particularly significant problem for teenagers as their sleep phases tend to delay at this time in their lives, as they are literally unable to fall asleep until later as a result of major developments in the brain combined with considerable changes in hormone levels. Many school districts have become aware of the need for teens to sleep in and start school later and have adjusted their start times so elementary aged children start off the day earlier (between 7 and 8 AM), allowing junior high and high schoolers the later (around 9 AM) slots. But there are still many school districts across the country which have not made these changes, perhaps at the peril of the kids in those communities. Some research shows that test scores for teens with early start times are considerably lower than those who get to sleep in, and other studies indicate that teens with early start times are also more likely to get into motor vehicle accidents as a result of sleep deprivation which may partly be blamed on this lack of allowance for sleep imposed on them by their school district.

Warmer temperatures in late summer and early fall can also make it harder to fall asleep, as the human body must be able to "cool off" at night in order to achieve sleep onset; warm days, especially in humid areas east and south, can interfere with sleep hygiene in this regard.

What can parents do?

• Know what your child's sleep needs are first, then factor in bedtime rituals, morning rituals and transportation to school, then subtract these from your child's school start time to find the right bedtime to which your child acclimates.
• Preschoolers (up to age 6) need 10 to 12 hours
• Pre-adolescent school-aged kids (ages 7-12) need 10 to 11 hours
• Teens (13 to 18) need 8 to 9 hours
  
  Picking a bedtime (example): If your child is 10 years old, and they need about half an hour to get to bed, half and hour to get ready in the morning and half an hour to get to school, and their school start time is 8am, then they need to start going to bed at about 830 at night. This allows them to get ready between 830 and 9pm, to sleep until 7am, then they can get ready from 7 to 730am and head off to school promptly to meet the 8am start time. 
• Gradually put your kids to bed earlier over the course of the late summer, if they are pre-adolescent. 
• In the case of older kids in late summer, ask them to try to be home earlier or go to bed earlier so they can adjust to the more structured sleep schedule they'll have to deal with in the fall. If you have teens in sports or other activities that meet before school, discuss with them the importance of getting enough sleep so they can better manage the demands these early schedules can place on their energy and alertness while in class.
• Go cold turkey: the night before school starts, put the kids to bed at the time you want them to go to bed. Prepare for them to be tired or unruly or otherwise less functioning for the first couple of days. Many school districts start in mid-week to prepare for this reality anyway.
• If you have to choose one time to be consistent about, make it the morning wake-up time. All human beings do better if they rise at exactly the same time every morning and allow the day's activities and their own natural circadian rhythms to determine their bedtimes later. 
• Don't give your teens too hard a time about the fact they can't get to sleep at an earlier time. This is something they physiologically have no say over and is, in fact, a normal part of their development.
• Institute "screen rules" at bedtime. Kids in 2014 are essentially "plugged in" through their phones, laptops, and video game consoles. The problems with screens are two-fold: first, these devices emit blue spectrum light, which is scientifically proven to shut off melatonin production in the brain (melatonin is a hormone that is secreted in order to prepare the body for sleep); in addition, the content of movies, television shows, Skype phone calls, video games, Facebook and other electronic communications can be tantalizing enough to make it difficult for kids to shut their minds down at bedtime. If your kids can't learn to police these activities now, the odds of their ever getting a good night's rest even beyond college life are likely to be next to nothing. Old habits die hard. Don't let them form these poor sleeping habits in the first place and they'll be healthier adults in the long run.
• Make sure your kids are not eating late or having snacks right before bedtime. Especially be vigilant about stopping their consumption of caffeine-laced products like chocolate, soda, coffee, cocoa and energy drinks after 5pm at night. 
• Put room-darkening window treatments in your kids' rooms if they have many windows which bring in a lot of light. An eastern or northern exposure window will always be darker at night than a western or southern one, but don't forget to factor in streetlights outside their rooms, house lights or any lights from passing traffic, which can continually illuminate their bedrooms just as they are trying to fall asleep.
• Make sure your kids are not physically exerting themselves until bedtime. The adrenaline rush that commands the bloodstream following a period of exercise takes a couple of hours to wear off, and that could mean your kids might end up being too hyper to sleep right afterward.
• Remove distractions from your kids' sleeping environment. That means having them pick up the clutter of their day, if possible, so that they don't have in their sight lines the reminders of interesting activities to thwart their attempts to sleep.
• Stick to a relaxing bedtime ritual. For younger kids, this could be a bath, teeth brushing and bedtime stories or prayers. For older kids, it could also be a shower or bath and other self care and reading a book, if they can't fall asleep right away. 
• Teach your children meditation. Meditation is a great way to practice mindful living, as it helps with the practice of shutting down the active mind. Meditation also involves healthy breathing practices which can be the basis for a good night's sleep if practiced at bedtime. Meditation can also be especially useful for kids dealing with the stresses of daily living: family problems, bullies, challenging subjects at school, budding romances, pressures derived from competitive activities. If kids can manage their stress levels, they will be better equipped to deal more successfully with all the very real challenges that childhood and adolescence can bring.