SLEEP HYGIENE TIP OF THE WEEK: Are you *still* checking your phone at bedtime?

Back in December, you may have decided you would take control over your smartphone habits and practice turning your phone off before bedtime.

Have you?

Are you still checking your phone at bedtime? And what are you checking? Your email? Your social networks? Your Twitter account?

Are you playing a game on your phone? That's part of the "checking your phone" habit. So is reading a book, looking at the week's weather, updating your calendar, catching up on your blog feed, adding notes to your grocery list, looking at pictures, sharing from Pinterest or Instagram, shopping online, writing in a phone diary app, recording your meal data for dietary purposes or texting.

Oh, and making phone calls. Especially if you use the speaker feature and stare at the screen rather than hold the phone to your ear or put it aside.

Check out Sleep Judge's  article, "The Many Different Ways Technology Affects Sleep," to clarify matters. They share some other sneaky ways that our nighttime love affair with tech can hold our sleep health hostage, including some you may have never thought about.

All of your phone tasks need to be done an hour before bedtime. If you use your phone right up to the moment you go to bed, you risk altering your brain chemistry to halt melatonin production, which is necessary for sleep to take place. And you also risk stimulating your brain precisely when it needs to relax and shut down for the night.

We at SHC understand the need to keep a phone on the nightstand for emergencies or to use as an alarm. However, pre-setting your Do Not Disturb feature and alarms before bedtime makes it easy to just plug your phone into its charger, TURN IT FACE DOWN, and leave it for the night.

No need to check it!

Even if you did not resolve to set aside your smartphone at bedtime, do yourself a solid... put it away before you go to bed. Here are some legit reasons why:

• BBC News: Phones need 'bed mode' to protect sleep
• DailyMail: Facebook at bedtime 'is damaging teens' grades': Pupils who use site within 30 minutes of going to sleep can see results fall by 20%
• DailyMail: Why you should NEVER keep your mobile in your bedroom
• Digital Trends: Is blue light keeping you up at night? We ask the experts
• Emotional Fitness/Ohio State University: Cell Phone use before bedtime might impact sleep, and daytime tiredness
• HUFFPOST Healthy Living: 7 Reasons To Banish Your Phone From The Bedroom
• Jacksonville Sleep Center: Turn On Quality Sleep by Turning Off Technology
• Shine365: Can't sleep? Blame your cellphone
• Social Science Medicine: Bedtime mobile phone use and sleep in adults

INSOMNIA || The problem with insomnia forums

SHC often schedules links in the Twitter universe between 12am midnight and 2am. Why is that?

We want to connect with the insomniac population.

Check the timestamps on any given post in any given sleep health forum on any given day and you will find that most of the insomniacs are not posting during waking hours but in the middle of the night.

It used to be that people who had insomnia either got up from bed and did something relaxing until they could fall asleep, or they cracked open a book to find a way to achieve drowsiness, or they turned the TV on to some lame cable channel full of infomercials.

These days, however, it is de rigueur to hop onto a forum or a private group in a social network like Facebook or to chase down microposts in Twitter when one can't sleep and wants to know who else can't sleep.

While SleepyHeadCENTRAL loves to be able to reach those with sleep disorders where they are at, the problem of late-night carousing online is a self-fulfilling prophecy for failure among insomniacs.

Three major things occur within the human brain during a session online in the middle of the night which practically guarantee that an insomniac will NOT achieve sleep after logging in, then logging off:

1. Blue spectrum light is the insomniac's enemy. 
So you took melatonin at 10 or 11pm and now it's 1 or 2am and you still can't sleep. So you go online? This is problematic because your brain can make its own melatonin, but only if it is given darkness to do so. Darkness signals to the pineal gland to make more melatonin; however, jump online in the middle of the night and you take in a variety of light spectra which most likely includes blue light. Blue spectrum light is the enemy of melatonin; it shuts down your pineal gland--JUST.LIKE.THAT. You can avoid some exposure to this kind of light by using a blue light filter on your device screen, or by wearing blue light filtering glasses. OR, you can avoid light altogether, which is the only real way your pineal gland is going to do its job in the middle of the night. After all, other colors in the light spectrum can also impact your melatonin production, not just blue--it just has the most impact.

2. Emotional/social engagement is... well... engaging.
Once you start a conversation in a forum or a social network or Twitter, you have become engaged. Your brain becomes excited by conversation, new thoughts and ideas emerge, and you are suddenly wide awake! If you are having a tense conversation or reading posts or tweets which make you upset, this will only serve to alert your stress hormones, which will encourage the wakefulness you so desperately want to trade for sleep. The intellectual and emotional brains need a break from all this engagement. You just spent all day doing these things, after all! Avoiding the online wilderness, where you can't predict what kind of tone or content you'll find while there, is the only decent solution.

3. Your rhythms desynchronize.
Going back to point #1... if you log in and exposure your eyes to blue spectrum light, you are doing more than just keeping yourself awake... you are actually resetting your circadian rhythms. If you continue to hop online every night during an ongoing period of insomnia, you will definitely knock your rhythms out of whack so that, on the night you finally decide to NOT go online, you won't be able to achieve sleep because your body and brain have been essentially re-tuned to this new, lousy sleepless schedule, completely in contradiction to the goal of getting more sleep. It will be even harder to re-tune to a normal sleep schedule once this new pattern has been established.

So while SHC is happy to engage with readers at all hours of the night, please think about shutting down the screens well before midnight, and resist all urges you have to visit forums, private groups in social networks and Twitter, even if you can't sleep. Once you go there, you will just make a bad problem worse as well as delay its resolution.

Don't worry, SHC posts about sleep will be there when you do wake up in the morning!

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

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?

----

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.  

Sleep Hygiene Tip of the Week || Step away from the [blue spectrum] light

Perhaps the biggest enemy of sleep is not chronic pain, anxiety, an uncomfortable sleeping environment or drug side effects. More people than ever before complain of having trouble falling asleep in the 21st century. What one thing characteristic of daily life in the 21st century might be to blame?

Screens.

Laptop and monitor screens. Smartphone screens. Hand-held game screens. Digital tablet screens.

Screens emit blue spectrum light, which is well known to shut off the function of the pineal gland in the brain. The pineal gland is responsible for releasing melatonin, a sleep hormone, into the bloodstream in the evening with the dimming of daylight. Endogenous melatonin (that which naturally occurs in the brain) is a critical part of the physiological landscape that allows for sleep. If you encounter even a small amount of blue spectrum light after the sun goes down, you are going to disturb the work of your pineal gland.

That means you need to avoid doing the following within an hour or so of going to bed, if possible:

• Checking email
• Watching movies or television shows on a laptop, portable DVR, smartphone or tablet
• Making Skype video calls
• Playing games on any of these same devices

Television screens may or may not be problematic as one's usual viewing distance from a TV screen may be far enough away to diffuse the emission of blue and other spectrum light.

SLEEP HYGIENE TIP OF THE WEEK: Put away your screens one hour before bedtime. I know, it's hard to do! One of the ways I relax at night is to review the next day's schedule so I know what I am going to be doing. This act is a good one for dissolving anxiety for busy working people, but doing it online in Google calendar is counterproductive. Instead of checking my gCal online, I review and print out the next day's schedule on paper before dinnertime and read my upcoming schedule in that form instead. This way I feel like I can have some control over time management without thwarting the natural melatonin production of my pineal gland.

Sleep Disorders 101 || What is Jet Lag Disorder?

Dry, bloodshot eyes can also
be a symptom of jet lag

Anyone who has traveled by air across time zones can relate to the some or all of the symptoms of Jet Lag Disorder, which can include:

• Disturbed sleep patterns (you can't sleep, you wake up too early, you experience excessive sleepiness during nonsleep periods of the day)
• Fatigue
• Trouble with focusing, attention, concentration on typical tasks
• Digestive issues (constipation or diarrhea)
• Heavy menstrual cycles
• General malaise
• Tired muscles

Jet lag is a temporary circadian rhythm disorder in which your body fails to acclimate immediately to a new time zone, leading to these potential symptoms. Generally it occurs after you cross more than two time zones. When you move forward or backward "in time," you are also moving forward or backward through cycles of sunlight, which is really where the problem comes in. Jet lag is about both time (your "body clock") and light. All living things entrain their sleep-wake (or active-inactive) rhythms to the rise and fall of the sun. Changing time zones means you are experiencing different blocks of both time and light than your body and brain are accustomed to. Another part of the brain, the pineal gland, requires exposure to light in order to produce melatonin, the hormone that helps you to fall asleep. If your travel times are at odds with your sleep patterns, it could be due to an imbalance in melatonin production caused by traveling across time (and light) zones.

Your body has a main biological "clock" in the brain--the Suprachiasmatic Nucleus or SCN--which notifies many other systems about what "time" it is. Indeed, each and every cell in your body is theorized to have its own body clock, which synchronizes with the SCN.

The digestive system is also thought to operate by its own clock, using both food consumption and light to set body rhythms in such a way as to conveniently limit digestive processes while you sleep. This is why you might, in fact, have digestive problems as a result of jet lag, as the digestive system clock is not in sync with SCN.

Having jet lag can be problematic because the times you are accustomed to eating or sleeping may not fit comfortably inside your new schedule. You may be excessively tired in the day just as everyone else is going outside to enjoy the day, or you may want to eat an overlarge meal in the middle of the night.

Jet lag symptoms typically set in within 24 hours of arrival at your destination. The farther you travel, the more severe or long-lasting your symptoms can be. Easterly travel usually results in more severe symptoms when compared to westerly travel, as well.

Researchers indicate that it takes about a day to recover for each time zone crossed. If you crossed five time zones, for instance, it will take you five days to recover from jet lag, either because you have acclimated to the new time zone or as a result of returning to your home time zone. Don't worry too much; for most people, jet lag is temporary and repairs itself. In their case, it's not a disorder at all, but a problem that fixes itself.

However, if you're a pilot or business traveler who flies frequently, Jet Lag Disorder can become an ongoing problem for you. Elderly people can also require more time to recover from jet lag as well.

If you want to avoid the symptoms of jet lag, you can try the following:

1. Carefully time your light exposure in the new time zone to "reset" your rhythms. Wear sunglasses in the morning on eastern time and in the afternoon on western time to trick your brain into resetting its rhythms.
2. Drink plenty of water; air travel can lead to dehydration which can then exacerbate many other kinds of problems, including jet lag.
3. Avoid caffeine, alcohol, stimulants and sedatives while in the air. For sedative or stimulant prescriptions, it might be better to start take them on local time when you arrive at your destination. Taking them while traveling in flight can aggravate jet lag as well.
4. Be prepared to adjust immediately to the local light and time zone you arrive at and expect to take a day to feel out of sorts.
5. If you are traveling for an important event or meeting where you need to be alert, you might wish to travel two days ahead in order to have time to adjust prior to your appointment.
6. Pharmaceutical treatments for Jet Lag Disorder including pharmaceutical options (sedatives such as benzodiazepines--so-called "Z" class drugs such as zolpidem [Ambien]-- and nonbenzodiazepines--triazolam [Halcion]). Remember, drugs can have side effects.
7. Light therapy, which involves timing your exposure to specific kinds of light using special lamps at certain times of day, can be a great non-drug alternative. There are travel lightboxes specifically used for this. 
8. Alternative treatments for Jet Lag Disorder include melatonin (you only need .5mg for it to be effective, despite over-the-counter doses of 2mg or more) and certain proprietary herbal blends (often including valerian, GABA or skullcap). The key to using melatonin is to time it with the dimming of daylight so your pineal gland can operate more efficiently. As for herbal blends, please check drug interactions and side effects before you take them as they can be dangerous if mixed with certain prescriptions.
9. It is always more important to wake up at the same time of day than to go to bed at the same time of day. This is because your exposure to morning sunlight helps set your wakefulness drive for the rest of the day. While traveling, you might try to artificially "reset" your rise time while in another time zone to match the one you have at home in order to help lessen the impact of jet lag.
10. While there is no official "jet lag" diet, it's good to practice eating more carbs before periods of sleep and protein rich foods during the times of day when you want to be most awake.
11. It's never a bad idea to sleep a little extra prior to traveling to lighten your sleep debt before you head out.
12. You can try to stay up later gradually, prior to your trip, for westerly travel, or go to bed earlier, prior to your trip, for easterly travel, to make the transition easier once you arrive.
13. Sleep on the plane if you expect to arrive at night anyway. This can help reset your sleep drive.