The Insomnia Blog - Sleep Doctor Michael Breus, PhD

Pilot trouble in the skies: did lack of sleep play a role?

This story of a veteran Jet Blue pilot’s breakdown during a cross-country flight made headlines recently. Now we’re learning more about the details of what happened during the flight, and about the investigation into this frightening and disturbing episode. It’s no surprise that investigators are exploring the role that fatigue, depression, and possible use of medications, including medications for sleep, may have played in the incident.

The pilot, a captain and a 12-year veteran of the airline who according to news reports had an exemplary professional record, is alleged to have begun behaving strangely in the cockpit early in the flight. After ranting and speaking incoherently to his co-pilot and air traffic controllers on the ground, the pilot left the cockpit. He is alleged to have run through the cabin, shouting about a possible crash and the threat of terrorist attack. At the co-pilot’s request, passengers apparently restrained the pilot, and the New York to Las Vegas flight made an emergency landing in Texas, where the pilot was taken into custody.

This incident is sad, disturbing and scary all at once. Obviously this is a frightening story for any and all of us who fly. It’s also sad story for a pilot who by all reports had an exemplary record of service and who has been described in news stories as a “consummate professional.”

And it’s disturbing because of the frequency with which we’re seeing problems in the airline industry, especially those related to sleep, fatigue and mental health.

Ever-changing shift schedules, long hours, and short rest periods put pilots and other airline professionals at high risk for sleep deprivation, sleep disorders, and the health risks associated with chronic sleep problems, including mental health issues like depression and anxiety. The National Sleep Foundation in March released a survey that examines transportation workers’ sleep. The results show transportation workers in the U.S. struggling to get adequate sleep—and pilots among the most sleep challenged:

• 23% of pilots surveyed reported that sleeplessness had affected their job performance within the past week
• 20% of pilots said they’d made a “serious” error as a result of sleepiness
• 50% of pilots reported rarely or never getting a good night’s sleep on work nights
• 37% said their work schedule did not allow time for adequate sleep
• Only 6% of pilots surveyed work the same schedule every day

Sleep deprivation causes fatigue, poor judgment, difficulty with memory and learning, and a slowing of reaction time. There’s also increasing evidence of a link between sleep problems and depression, as well as anxiety. Recent research has explored the complicated relationship between sleep and depression. In particular, the connection between disruptions to circadian rhythms and the incidence of depression and other mental health problems may have particular relevance for those who work in the airline industry, as well as anyone who does shift work.

The lifestyle of the Jet Blue pilot involved in this incident seems to have been typically fragmented. He is reported to have shared a small New York City apartment with several other pilots—these crash pads are places where pilots and other in-flight airline personnel grab what shut-eye they can during their off-duty hours.

The FAA has recently made some changes to its regulations for pilot rest and time off, raising the minimum time off between shifts to 10 hours, from the current 8-hour minimum. These regulations, however, will not take effect until 2014.

The FAA also has recently changed its regulations regarding the use of prescription medication for depression, allowing its pilots the use of 4 antidepressants. Permission to fly while taking these medications is granted on a case-by-case basis, and pilots must be under doctor supervision. Side effects of these medications—rare but real—can include hallucinations and panic attacks.  Nearly all sleep medication is prohibited by the FAA for pilots—but that doesn’t mean that sleep medications aren’t being used by pilots who may be self-medicating to ward against fatigue. Sleep medications have their own set of side effects, which can affect behavior. Sleep medications can be an important and effective tool, but they must be monitored in order to ensure they’re working appropriately and without side effects that can be disruptive or dangerous.

The FAA has made changes in response to several incidents in recent years involving pilot fatigue:

• In 2008, a flight to Minneapolis overshot the runway by 150 miles after pilots fell asleep at the controls.
• Also in 2008, a charter jet crash in Minnesota that killed 8 people was blamed in part on sleep deprivation of both pilot and co-pilot.
• A crash of a commercial jet in Buffalo, New York that killed all passengers and crew was ultimately blamed in part on pilot fatigue.

Of course, the problems of the airline industry are not confined to pilots. I wrote recently about ongoing issues with air traffic controllers sleeping on duty. This has been a recurring problem in the industry for years. As with pilots, the FAA has recently revised its rules for air traffic controllers—raising minimum time off between shifts, limiting the ability to swap shifts, controlling overnight shift schedules—in an effort to address the problem of sleep deprivation and fatigue.

What we’re seeing is that the efforts made so far are not enough. We don’t know what was behind the breakdown of this particular pilot in this latest incident—and we may never know. What’s clear is that there is a problem within the industry at large with regard to sleep, fatigue and the rigors of shift work that has yet to be fully and adequately addressed.

Sweet Dreams,

Michael J. Breus,
PhD 

The Sleep Doctor™ 

www.thesleepdoctor.com

The Sleep Doctor’s Diet Plan:  Lose Weight
Through Better Sleep

Everything you
do, you do better with a good night’s sleep™ 

twitter: @thesleepdoctor 

Facebook: www.facebook.com/thesleepdoctor

 

 

Insomnia on the rise in the UK

Insomnia is a difficult and persistent sleep disorder, one that can come about for many reasons and, once evident, can linger for months or even years. It’s also a sleep disorder that is on the rise in the United Kingdom. The results of a recent, large-scale and long-term study show that over the past decade and a half, insomnia has increased among UK residents.

Researchers from several universities around the United Kingdom collaborated on this broad and long-term study, which sought to track the prevalence of insomnia, examine patterns of sleep medication use, and analyze the demographic traits associated with higher risk for insomnia and sleep disturbances.

This study is significant because it offers the opportunity for a longer-term evaluation of the frequency of insomnia in a population. It’s not often we’re able to see the pattern of change of a sleep disorder like insomnia over this many years among a large population. The researchers relied on data from 3 separate national surveys, conducted in 1993, 2000 and 2007. More than 20,000 UK residents ages 16-64 were included. The surveys included questions about insomnia and sleep disturbances, and used the same measurement of insomnia and the same insomnia definitions. The surveys defined insomnia four different ways, to account for varying degrees of severity and symptoms:

1) Insomnia symptoms: difficulty falling asleep or staying asleep within 1 month

2) Insomnia of (at least) moderate severity: spending an hour or more trying to fall asleep or fall back asleep 4 or more times in the previous week.

3) Insomnia and fatigue: having difficulty sleeping accompanied with significant daytime fatigue in the previous week.

4) Insomnia diagnosis: experiencing insomnia of moderate severity with daytime fatigue for a period of 6 or more months.

Researchers also looked at a wide range of demographics in relation to insomnia, examining age, gender, education, employment and marital status, as well as the presence of depression.

As you might imagine, a study covering this much ground returned a lot of interesting and noteworthy results: Over the 15-year period from 1993-2007, greater numbers of people reported having sleep problems that fit each of the four definitions of insomnia:

• The biggest increase over the study period was for “insomnia diagnosis,” the most severe form of insomnia. The frequency with which this degree of insomnia was reported nearly doubled over 15 years.
• Insomnia of all four types was more likely to affect women, the unemployed, people who were divorced, separated or widowed, as well as those with the least amount of education and those at the low end of the economic spectrum.
• Age was a factor with two of the insomnia definitions: insomnia symptoms, the least severe, and insomnia diagnosis, the most severe. For these two types of insomnia, being older presented a greater risk.
• “Worry” was the most commonly reported reason for sleep problems, reported across all three surveys spanning 15 years.
• The number of people using sleep medication doubled between the 1993 survey and the 2000 survey.

These results align broadly with another long-term, national study of the prevalence of insomnia. Researchers in Finland used national survey data to analyze the prevalence of insomnia over a period of 33 years, from 1972 to 2005. They found an increase in insomnia in the working-age population during the final 10-year period of their study, from 1995-2005. 

I’ve written about the relationship between sleep disturbance and stress, and recent reports that show stress is a primary cause of sleeplessness for many adults in the UK. Even more troubling is how often these symptoms go untreated. This recent UK study found that 63%--nearly two thirds—of people with insomnia and psychological distress have not seen a doctor or sought medical help for their problems.

Sleep problems that go untreated are likely to worsen on their own and become more difficult to treat in the end. They also can cause secondary health problems, put people at higher risk for chronic
and serious disease, and disrupt relationships, personal happiness, and productivity. 

We must do a better job of identifying sleep problems and actually getting these problems treated, especially for those at higher risk: women, the elderly, the poor. Targeted treatments, both for specific demographic groups and for different types of insomnia, can help us reverse this upward trend. Treating sleep problems begins with paying attention to your own sleep and your loved ones’ sleep. Taking action before sleep disturbances grow serious can help protect your health and your quality of life.

Sweet Dreams,

Michael J. Breus,
PhD 

The Sleep Doctor™ 

www.thesleepdoctor.com

The Sleep Doctor’s Diet Plan:  Lose Weight
Through Better Sleep

Everything you
do, you do better with a good night’s sleep™ 

twitter: @thesleepdoctor 

Facebook: www.facebook.com/thesleepdoctor

 

 

Sleep disordered breathing: not just a grown up problem

Despite the old adage, “sleeping like a baby,” we know that children are at risk for many of the same sleep disorders as adults. Sleep-disordered breathing is a problem among children—even very young
children. This news reveals some of the negative consequences of untreated sleep-disordered breathing in children.

In a study of the sleep, breathing and behavioral development of more than 11,000 children, researchers at Yeshiva University’s Albert Einstein College of Medicine have found that those children with sleep disordered breathing were more likely to develop behavioral problems and emotional problems, and also to have greater difficulty with peer relationships.

Researchers relied on information gathered from parent questionnaires. Parents answered questions about their children’s sleep and breathing, starting from the time their children were 6 months old, and repeating regularly until their children were nearly 7 years old. Parents also provided information about their children’s behavioral and emotional development, in questionnaires given when children were 4 years old, and again at age 7. The behavioral and emotional development issues addressed included:

• Hyperactivity
• Anxiety and depression
• Problems with peers
• Conduct issues, including aggressiveness and rule breaking
• Positive social behaviors, including sharing and helpfulness

Researchers found that children with sleep-disordered breathing were significantly more likely to have behavioral and emotional problems than children without disordered breathing.

• Children with sleep-disordered breathing were 40 to 100% more likely to have behavioral problems by the age of one year
• Hyperactivity was the behavioral issue that increased the most with disordered breathing, but all behavioral problems showed significant increase
• Children with the most severe behavioral problems also had the most persistent sleep-disordered breathing throughout the 6-year evaluation period

The results of this large-scale study provide strong evidence of a link between sleep-disordered breathing and behavioral problems. But these results don’t tell us why sleep-disordered breathing is likely to be affecting children’s behavior and emotional development. The scientists who conducted the study believe that several factors may be involved. These factors include:

• Decreased oxygen (and increased carbon dioxide) to the child’s brain during periods of breathing-disordered sleep
• A lack of restorative sleep
• Changes to body chemistry and cell development as a result of sleep deprivation and/or the disordered breathing itself

What, exactly, is sleep-disordered breathing? It’s actually a group of conditions, each of which interrupt or diminish airflow. Sleep-disordered breathing conditions include snoring, mouth breathing, and sleep apnea. These may seem like issues for adults only, but in fact they’re all-too-common problems for children as young as toddlers, and even younger. This recent study found sleep-disordered breathing in children as young as six months. Observing children ages 6 months to 6.75 years, the study found:

• Chronic sleep apnea among 1-2% of children at all age levels
• “Habitual” snoring among as many as 21% of children
• An increase in the frequency of snoring in children between the ages of 1.5 and 2.5 years
• Mouth breathing in 25% of children by the age of 6

Recent research, including this latest study, is giving us a clearer picture of the negative effects of sleep-disordered breathing and poor sleep on child development and behavior. Other recent research has shown:

• Children who exhibit aggressive behavior at school are twice as likely to have a sleep-disordered breathing condition as children who don’t show aggressive behavior.
• Children with sleep-disordered breathing are more likely to have cognitive deficits compared to children without breathing disorders. These deficits existed regardless of the degree of severity of the breathing problem.
• By the time kids reach adolescence, sleep problems are associated with a long and troubling list of risky and unhealthful behaviors, including fighting, smoking cigarettes and marijuana, drinking alcohol, and coping with feelings of sadness, hopelessness and suicide.

This is a critically important area of study that needs more attention. The more we know about how sleep-disordered breathing affects children’s behavioral, emotional and intellectual development, the better we’ll be at stepping in to treat and prevent the problem before it becomes serious.

As parents, there are some basic, and important, steps you can take to help protect and improve your children’s sleep:

• Set a sleep schedule and stick to it. Regular bedtimes, and nighttime routines that help a child prepare for bed, are a critical part of helping our kids develop strong sleep habits.
• Make their bedrooms sleep friendly. I can’t say this enough: keep the electronics out of the bedroom. Kids’ bedrooms should be dark, quiet places for rest—not a haven for television, video games, laptops and cell phones.
• Talk to you doctor. Make sleep a regular part of the conversation with your child’s physician. Get specific—ask your pediatrician about sleep-disordered breathing, and what steps to take if your child is exhibiting symptoms.

Sleep-disordered breathing in children, no matter how mild it appears, should never be ignored. By addressing these issues before they become serious, we can help keep our kids sleeping well and growing well.

Sweet Dreams,

Michael J. Breus, PhD 

The Sleep Doctor™ 

www.thesleepdoctor.com

The Sleep Doctor’s Diet
Plan:  Lose Weight Through Better Sleep

Everything you do, you do better with a good night’s sleep™ 

twitter: @thesleepdoctor 

Facebook: www.facebook.com/thesleepdoctor

 

 

 

 

 

 

 

 

 

Sleepless in the City

Real Age has just published its ranking of the best and worst cities for sleep in the U.S., part of its 2012 Oldest and Youngest Cities report. There’s good news for residents of cities like Charlotte, NC, Philadelphia, and Austin Texas—you are among the urban dwellers getting the most consistently good sleep. Now, let’s take a closer look at that “worst” list. These are the top 10 worst cities for sleep, according to Real Age:

1. Louisville, KY
2. Memphis, TN
3. Knoxville, TN
4. New Orleans, LA
5. Jacksonville, FL
6. Las Vegas, NV
7. Tampa-St. Petersburg, FL
8. Portland, OR
9. Los Angeles, CA
10. Providence, RI

It’s pretty clear why Real Age would create a list like this: sleep is a fundamental aspect of long-term health and wellness. Their age-determining algorithm calculates that getting the recommended 7-8 hours of sleep per night can make your “real age” as much as 1.5 years younger than your actual age.

How did they determine the worst cities for sleep? The cities that made the worst list were the ones where people reported the most change in the amount of sleep they got on a nightly basis, a change of more than 2 hours in either direction, compared to the first time they took the Real Age test. Most people who took the test reported being short on sleep. But people who sleep too much are also
at risk for health problems: in Real Age terms, too much sleep can age you as much or more than too little sleep.

Interestingly, the Real Age worst cities list shares many of the same entries with another recent ranking of cities struggling with sleep. Bert Sperling recently released his own list of the most sleepless cities. Sperling, who researches quality of life issues in cities and towns, used a different methodology to compile his list, one that considered life circumstances such as employment and marital status, and daily commute time. Still, the two lists share several of the same apparently sleepless cities, including Louisville, New Orleans, Las Vegas, and Tampa-St. Petersburg.

Back to the Real Age rankings, this ranking was looking at the DIRECT effects on change in the amount of nightly sleep (not looking at other factors which may affect sleep).

What are some possible causes of such a substantial change—more than 2 hours, up or down—in the amount of sleep one gets per night?

 People who are sleeping too much are often dealing with one or more of the following issues:

• Depression. Depression is linked to both sleep deprivation and to excess sleep. Lethargy, feelings of being overwhelmed, and fatigue are all hallmarks of depression and can they themselves lead to too much sleep.

•  Illness. Excess sleep can be both symptom of and a risk factor for an underlying illness.

•  Unemployment. In today’s difficult economy, many people are facing unemployment
       and under-employment. Being without a job can cause depression, stress and
       anxiety, which can wreak havoc with sleep. Losing a job also often means
       losing the schedule that goes with employment, and that loss of routine
       can lead to irregular bedtimes and wake times, and too much sleep.

• Loss of a loved one. Difficult losses—whether by death,
       divorce or separation—take a deep toll, both physically and emotionally.
       These events can cause immediate and significant problems for sleep,
       including an increase in sleep to unhealthful levels.

 At the other end of the spectrum, what are the most common circumstances that lead to a
change toward too little sleep?

•  A new baby. Bringing home an infant is a wonderful event—and notoriously challenging
       for the sleep habits of parents.

• Stress. This might be the most common cause for a decrease in sleep. Whether chronic or acute, stress is disruptive for sleep and bad for your health. Remember, too, that stress is not only caused by negative circumstances and events. Exciting, positive changes—think weddings, job promotions, and moving house—can still be stress-inducing.

• Exercise. There’s plenty of evidence that exercise enhances sleep. But exercise too close to bedtime can interfere with your nightly rest. I’m NOT suggesting you give it up! Rather, move your exercise too early in the day. Morning is an ideal time for exercise, when it will help strengthen your circadian rhythms and help you sleep better at night.

 Whether you’re living in a Los Angeles high rise or a townhouse in New Orleans’ French Quarter—or anywhere that you’re struggling to get the right amount of sleep—here are some simple steps you can take to help improve your nightly sleep: 

1.  Calculate your bedtime: Determine the time you need to be out of bed. Now work backward 7.5
        hours. That’s your ideal bedtime. Set an alarm to remind you to go to
        bed—just make sure to reset it for your wake up time.
2. Nap during the day: Midday are rejuvenating for mind and body. Creating time for a short nap during the day—20 minutes is ideal—is not laziness, its smart sleep strategy! Just be sure not to
        nap too late in the afternoon. Napping after 3:30 p.m. could interfere with your overnight sleep.
3. To help stave off daytime drowsiness, try my Nap-a-Latte™ technique: quickly drink a small cup of cool-drip coffee, and then take a 25-minute nap. The Nap-a-Latte™ reduces your drowsiness and the caffeine will wake you up, but taken no later than early afternoon will not keep you awake at night.
4. Reduce your caffeine: Limited use of caffeine is okay, but too much caffeine can interfere with falling asleep even several hours after it’s consumed. If you’re short on sleep, keep your caffeine intake to a minimum, and don’t consume caffeinated beverages after 2 p.m.

So we now can use this “RealAge” information to change our sleep and change our lives!

Sweet Dreams,

Michael J. Breus, PhD 

The Sleep Doctor™ 

www.thesleepdoctor.com

The Sleep Doctor’s Diet
Plan:  Lose Weight Through Better Sleep

Everything you do, you do better with a good night’s sleep™ 

twitter: @thesleepdoctor 

Facebook: www.facebook.com/thesleepdoctor

 

 

Sleepless on Wall Street

Wall Street jobs are coveted and highly competitive: they’re also notoriously demanding. It’s not a stretch to imagine the long hours,intense pressure and grueling pace of Wall Street work could take its toll on sleep and overall health. A new study confirms just that.  This in-depth research also sheds some interesting and detailed light on a complicated work culture that drives its young professionals to forgo sleep and compromise their health,ignoring signs and symptoms of stress and illness along the way.

Alexandra Michel, a business professor at University of Southern California, spent 9 years studying groups of investment bankers at two large (and unnamed) U.S. banks. Michel’s subjects were young—their average age at the start of the study was 28—and evenly split between male and female. For
these bankers, 120-hour work weeks were typical. In the 9 years that Michel spent researching their work habits, none of her subjects ever worked fewer than 80 hours per week. In addition to the long hours, employees were expected to be available 24 hours a day, 7 days a week, via cell phone or PDA. Long hours, combined with faced-paced, high-pressure and the highly competitive nature of the work, created a stress-filled work environment. Bankers themselves described their work environments as “boot camps” and “grind mills.”

Under these conditions, it’s not surprising that any attempt at separation between work life and non-work life would collapse, which is exactly what happened. Over a period of years, Michel’s research shows that her subjects’ sleep and health collapsed as well. Insomnia and depression were commonly reported among the investment bankers. The finance workers also reported relying on alcohol and drugs as relief from the pressure, stress and fatigue of their work.

For a period of three years, these young workers were generally able to ignore the toll that lack of sleep and long, intense work conditions had on their bodies.

After year three,however, employees reported having a much harder time bearing up against
constant sleep deprivation, grueling work hours, and intense stress.

News of sleep problems, stress and health risks associated with high-pressure finance work aren’t really new or surprising. I wrote about another study—this one in the UK—about sleep problems and stress among financial workers. In this study, insomnia, depression, and anxiety were found to be widespread among finance workers. These conditions affected employees at all levels, from top
executives to new recruits. Like the US investment bankers in this latest research, finance workers in the UK often ignored their symptoms, and often resorted to alcohol and drugs as coping mechanisms.

The risks of overwork to sleep and overall health are by no means limited to Wall Street or to work in the financial industry. We’re seeing a lot of research these days about sleep problems and health risks for
employees in demanding and high-pressure jobs:

• This study of software engineers in India found that 56% suffered from insomnia, a rate twice as high as the general population. Among the subjects, women were more likely to have mild to moderate insomnia, while men were more likely to suffer from severe insomnia.

•  A recent study of law enforcement in the U.S.and Canada revealed widespread sleep problems among its officers. Forty percent of law enforcement officers had some type of sleep disorder, with 33% suffering from obstructive sleep apnea. Officers who had sleep apnea were 148% more  likely to also suffer from depression, and 61% more likely to have diabetes.

•  Firefighters and other shift workers also struggle with the effects of long hours and irregular
  sleep schedules.

 These are all regarded as high pressure and demanding jobs. But whose job these days isn’t? You don’t have to be a Wall Street hotshot to know the challenges of long work days, the pressure to be available to your employer on a near-constant basis, and the feeling of needing to always be doing more. You also know what kind of toll this non-stop work mode can have on your body, your sleep and your health.

Striking a balance between our work lives and personal lives, of course, is the key. So is managing stress, avoiding excessive alcohol consumption, exercising regularly, and keeping our digital devices out of the bedroom and our nighttime routines. No, finding balance is not always easy. But your sleep and your health will benefit.

 Remember my 5 steps to better sleep and better balance:

1. Stick to 1 sleep schedule, even on weekends
2. Eliminate caffeine after 2 pm
3. Stop alcohol 3 hours before bed
4. Stop exercise 4 hours before bed
5. Get 15 minutes of sunshine every morning

Sweet Dreams,

 Michael J. Breus,PhD 

The Sleep Doctor™ 

www.thesleepdoctor.com

The Sleep Doctor’s Diet Plan:  Lose Weight
Through Better Sleep

Everything you do, you do better with a good night’s sleep™ 

twitter: @thesleepdoctor 

Facebook: www.facebook.com/thesleepdoctor

 

 

 

 

 

 

Air traffic controllers asleep on the job…still

Here’s some news of workers sleeping on the job that’s downright scary. A news investigation produced this story and footage of air traffic controllers at Westchester County Airport sleeping during their shifts. The video, provided to the news outlet by an employee in the air traffic control tower at Westchester Airport, also shows controllers reading and using laptops and cell phones while on duty. The FAA bans its controllers from use of cell phones, personal reading material and electric devices while on duty. Sleeping is prohibited anywhere in air traffic control towers.

All of these violations are alarming and dangerous, and pose a serious public safety problem. It is important, I believe, to separate the issue of air traffic controllers sleeping on the job from their choice to play with laptops and cell phones when they are supposed to be working. These video images of air traffic controllers slumped over and sleeping at their stations is truly frightening. But the issue of sleep deprivation among air traffic controllers is a very real one, and means that some instances of falling asleep—however dangerous and wrong—is not entirely the controllers’ fault, or even within their control.

Unfortunately this is not a new problem. We’ve seen several instances of air traffic controllers falling asleep on duty in recent months. A few of the cases recently reported to the FAA include:

•  A controller at a Miami regional tower fell asleep during an overnight shift. This regional center is responsible for controlling air traffic for most of Florida, as well as parts of the Atlantic Ocean and the Caribbean.
• One controller slept for five hours while working a midnight shift at a Tennessee airport tower.
• A supervisor at Washington D.C.’s Reagan National airport fell asleep for nearly a half hour during a night shift. At the time, the supervisor was the only air traffic controller on duty in the tower.

In response to these and other cases, the FAA in 2011 revised its regulations for air traffic controllers to include additional time for rest between shifts. The FAA:

•  Raised the minimum amount of time off between work shifts to 9 hours from 8 hours.
• Prohibited air traffic controllers from swapping shifts without having a minimum of 9 hours off in between shifts
• Increased supervisor coverage in air traffic control towers during late night and early morning shifts
• Prohibited air traffic controllers from picking up an overnight shift after a day off

These adjustments are a step in the right direction, but they don’t go far enough. Managing schedules for shift workers in these high-pressure jobs where public safety is at stake is too important to settle for improvements that don’t actually solve the problem.

Shift workers of all types face challenges to getting enough sleep while managing long hours, overnight shifts, and changing schedules that fluctuate between day and night. Research shows that:

•  People who engage in shift work get less sleep overall than those of us who work more regular hours
• Shift workers are at higher risk for illness and chronic disease
• The sleep deprivation associated with shift work increase the risk of accidents, injuries and mistakes in high-profile, public-safety related industries like medicine and law enforcement, as well as air traffic control

In addition to making people more prone to accidents and injury, sleep deprivation causes a number of negative effects—both physical and psychological—that can impair the on-the-job performance of air traffic controllers and other shift workers. Sleep deprivation:

• Slows reaction time
• Interferes with memory
• Causes fatigue
• Compromises judgment
• Impairs the ability to retain new information

I think we can all agree that we don’t want the people responsible for guiding our planes to be sluggish, slow-reacting, forgetful, fatigued and of questionable judgment. But that’s exactly what being sleep deprived can make them!

It’s the FAAs responsibility to create workplace regulations that enable air traffic controllers to get the rest they need. This can include not just mandating reasonable time off between shifts, but also giving controllers breaks during shifts and allowing them to nap on their breaks. There are also some basic things that the controllers themselves—or any shift workers—can do to help avoid sleep deprivation:

• Make sure to get adequate rest before a shift begins. Take a nap before work, if need be.
• Limit your reliance on caffeine. While it’s okay as an occasional pick-me-up, coffee and caffeinated beverages are not substitutes for adequate sleep. And caffeine can interfere with your sleep when you actually want and need to be sleepy.
• Keep a strong and consistent sleep routine both during your workdays and your days off. It’s not always easy, but shift workers in particular need to build their off-duty schedules around making sure they get the sleep they need.

Similarly to the recent changes in health care, the FAA is moving in the right direction to help its employees get the sleep they need to do their jobs safely. As this latest incident at Westchester Airport confirms, there is a great deal of work still to be done. And it’s in everyone’s best—and safest—interest that progress continues to be made.

Sweet Dreams,

Michael J. Breus, PhD 
The Sleep Doctor™ 
www.thesleepdoctor.com

The Sleep Doctor’s Diet Plan:  Lose Weight Through Better Sleep

Everything you do, you do better with a good night’s sleep™ 
twitter: @thesleepdoctor 
Facebook: www.facebook.com/thesleepdoctor

 

 

 

 

 

 

 

 

How Much Sleep For Teens?

It’s a mantra from physicians, sleep experts and other health professionals we’ve come to expect: teenagers are short on sleep. This lack of sleep contributes to a range of problems, including poor decision making and reduced academic performance. As a result, widely accepted guidelines for teens include getting in 9 hours of sleep per night.

A new study challenges these standard guidelines for how much sleep is optimal for teenagers, at least when it comes to academic performance. Researchers in the economics department at Brigham Young University found that teens perform better on standardized tests when they received 7 hours of sleep per night. That’s two hours less than the current federal guidelines, which recommend approximately 9 hours of nightly sleep for adolescents.

BYU researchers analyzed the amount that teens slept on a nightly basis in relation to how the teens scored on standardized tests. They also examined how the relationship between sleep and test scores changed as teenagers grew older. They examined sleep habits and test scores of 1,724 students ages 10 to 19. Researchers took their data from a national survey conducted in 2002-2003, which collected information from children and families on a wide range of topics, including sleep, health, and education.

What did they find? Teens scored highest on standardized tests when they had less sleep than federal guidelines recommend. They also found that teens needed less sleep with age to achieve their highest test scores. Optimal levels of sleep for teens were:

•  9 to 9.5 hours for 10 year olds
• 8 to 8.5 hours for 12 year olds
• 7 hours for 16 year olds

For teens across the 10-19 age spectrum, sleeping less than or more than these optimal amounts was associated with lower test scores.

Before you go running off to re-set your teen’s alarm clock, here are a couple of caveats to keep in mind when thinking about these results:

1)      First, we can’t know from these results that sleep had an effect on students’ test scores. The results of this study illustrate a relationship between sleep amounts and test achievement and not a cause and effect.

2)      In addition, the data that the researchers relied upon came from self-reported accounts of sleep habits from children and their parents. This leaves open the likely possibility that in some—if not many—instances, teenagers’ actual sleep habits were different than what they or their parents reported.

3)      Most important, and acknowledged by the researchers themselves, this study kept a narrow focus: to evaluate the amount that teens slept in relation to their performance on standardized tests. This research did not take into account any other aspects of teens’ mental and physical health when determining “optimal” sleep.

When we open up this question to a broader and complete consideration of teens’ sleep and their overall health, there is a great deal of evidence to suggest that 7 hours of sleep may not be enough. I wrote about a large study of teen sleep and the health risks associated with not sleeping enough. In this study researchers found that teens sleeping fewer than 8 hours per night were significantly more likely to engage in several risky behaviors, including:

•  Smoking cigarettes
• Smoking marijuana
• Drinking
• Not exercising regularly
• Spending more than 3 hours per day using a computer
• Suicidal thoughts
• Feelings of sadness and hopelessness

Of the 12,000 teens included in this study, 68.9% reported sleeping fewer than 8 hours per night.

The National Sleep Foundation recommends that 8.5 to 9.25 hours of sleep a night is an appropriate and healthful amount of sleep for teens. In 2006, the NSF conducted a national poll on teens and their sleep habits. They found that only about 15% of teens were regularly getting 8.5 hours of sleep per night, the minimum end of their recommended range. They also found symptoms of depression and anxiety were most common among teens with sleep problems.

• 73% of teens who reported having difficulty with sleep also reported feelings of sadness, unhappiness and depression
• 58% reported excessive worrying
• 56% reported feelings of stress and anxiousness

In recent years there have been numerous studies that show the risks of sleep problems and low sleep among teens. There’s evidence that indicates that sleep difficulties put teenagers at elevated risk for a range of mental and physical health problems, including:

•  Drug abuse and depression
• High blood pressure
• Obesity

The results of the study on teen sleep and test results are interesting and thought provoking. Among the things scientific inquiry does best is to challenge accepted truths and conventional wisdoms. This latest research is a great example of this, and raises questions worth further pursuit. At the same time, the stakes for our teens are high, in terms of their health and well being. I’m not ready to change that teen-sleep mantra just yet.

Sweet Dreams,

Michael J. Breus, PhD 
The Sleep Doctor™ 
www.thesleepdoctor.com

The Sleep Doctor’s Diet Plan:  Lose Weight Through Better Sleep

Everything you do, you do better with a good night’s sleep™ 
twitter: @thesleepdoctor 
Facebook: www.facebook.com/thesleepdoctor

Silent Stroke and Sleep Apnea

Silent Stroke and Sleep Apnea

Here is yet another health risk associated with sleep apnea: stroke. The news that sleep apnea is a risk factor for stroke isn’t new. We’ve known for some time that sleep apnea is associated with elevated risk of stroke. But this new research shows just how common sleep apnea is among stroke sufferers. In particular, these results reveal how frequently sleep apnea is present in patients who suffer silent strokes.  

What is a silent stroke?

• Silent strokes have no visible or outwardly identifiable symptoms.
• In most cases, people who suffer a silent stroke don’t even know they’ve had a stroke.
• Silent strokes are referred to as “silent” because they do not present the outward physical symptoms that are typically associated with stroke, including slurred speech, paralysis, and severe pain.
• Silent strokes are a serious health concern, however—they cause permanent damage to the brain, most often in the regions of the brain that govern mood, thought, cognition and memory.
• Silent strokes are themselves a risk factor for other types of stroke, including major stroke.

Researchers from the University of Alabama, Birmingham and from Germany’s University of Technology Dresden teamed up to investigate the frequency and severity of obstructive sleep apnea as risk factors for silent stroke. The results of their research revealed high rates of sleep apnea among patients with silent stroke. Over a period of 18 months, researchers evaluated 56 people who had been identified as having suffered acute cerebral ischemia, a type of stoke that interrupts the flow of blood to the brain. Within 5 days of stroke symptoms, patients were evaluated using MRI and CT scan to identify specific details of stroke effects in the brain, and were also assessed for the presence and severity of sleep apnea. Researchers found:

•  Sleep apnea was present in 51 of 56 stroke patients evaluated—that’s 91%
• Of these 51 patients, 29% had severe sleep apnea and 30% had moderate sleep apnea
• Severe sleep apnea was present in 58% of patients who had suffered a clinically silent infarct, commonly known as a silent stroke
• Severe sleep apnea was present in 38% of patients with chronic microvascular changes—these are tiny lesions to white matter in the brain that are associated with silent stroke
• Sleep apnea—and the degree of its severity—was found to be a strong predictor for silent stroke
• Patients with severe sleep apnea progressed more slowly and less successfully in the early stages of recovery than those patients without sleep apnea

What we don’t know from these results is whether sleep apnea is a factor in causing stroke, or whether people who suffer strokes are then more likely to develop sleep apnea. When a person suffers from sleep apnea, their airway collapses during sleep. This airway collapse temporarily cuts off breathing and diminishes the levels of oxygen in the bloodstream. People who suffer from moderate to severe sleep apnea have episodes of disrupted breathing dozens, even hundreds, of times per night. (In this most recent study, researchers defined severe sleep apnea as 30 or more episodes of disrupted breathing per hour of sleep). Learning more about how disordered breathing affects the brain and may contribute to stroke risk is a critical avenue for additional research.

We do know this: sleep apnea is associated with elevated risk for a range of serious and chronic illnesses. Obstructive sleep apnea has been linked to:

1.  Cardiovascular problems. In addition to being a risk factor for stroke, sleep apnea is also associated with hypertension, heart disease, and heart failure. This study found that obstructive sleep apnea increased a person’s risk of heart attack by 30% over a 4-5 year period.
2. Diabetes. There’s increasing evidence of a link between diabetes and sleep apnea. This study found high rates of obstructive sleep apnea among men with Type 2 diabetes. Even worse news: most of these sleep apnea cases were undiagnosed before the study.
3. Sexual dysfunction. Sleep apnea has been shown to cause sexual problems in both men and women. This study showed women with sleep apnea had significantly higher rates of sexual problems, both with sexual performance and satisfaction. This research revealed that men with erectile dysfunction were more than twice as likely to also suffer from obstructive sleep apnea.

We’ve got a great deal more to learn about how sleep apnea may contribute to these conditions, as well as to its role as a risk factor for stroke. What’s already clear is that sleep apnea is a red flag for stroke and other serious health problems. Screening for sleep apnea—and assessing sleep health in general—needs to be part of the diagnostic and risk assessment process for patients. If sleep apnea and other sleep disorders are ignored, we ignore an opportunity to identify at-risk patients before the worst occurs.

Sweet Dreams,

Michael J. Breus, PhD 
The Sleep Doctor™ 
www.thesleepdoctor.com

The Sleep Doctor’s Diet Plan:  Lose Weight Through Better Sleep

Everything you do, you do better with a good night’s sleep™ 
twitter: @thesleepdoctor 
Facebook: www.facebook.com/thesleepdoctor

 

 

 

 

 

 

 

 

 

Spring Forward – Are you Ready?

I write regularly about the state of sleep deprivation in today’s society. This sleep deprived situation isn’t going to be helped by the start of daylight savings time this Sunday, on March 11^th.  The time change in the spring is always more difficult than in the fall since we spring forward and end up losing an hour of our day—and since that time change officially happens at 2 AM on Sunday morning, the hour we lose is an hour of sleep. 

I know there can be great benefits to changing the clocks – we will gain an extra hour of sunlight in many cases, there are studies that have shown energy savings in the clock change.  But I hate sacrificing an extra of much needed shut-eye when we are already a society that is chronically sleep deprived!

So who do I predict will have the most difficulty with the time change? People who like to stay up late, and those in the southeast part of the United States.  Sound like a strange prediction? Well here are my reasons….

In a recent study in The Journal of Clinical Sleep Medicine we learned that sleep problems and fatigue seem to vary by STATE! I find this data fascinating.

The 10 states that currently have the most sleep disturbance in descending order include:

• West Virginia
• Oklahoma
• Alabama
• Arkansas
• Mississippi
• Louisiana
• Missouri
• Utah
• Nevada
• Michigan

When reviewing the study I noted that they controlled for things like age, sex, education, ethno racial group, income, employment, general health, healthcare access and depression, to try  and explain why these states seem to suffer so much. Whether you live in one of these states or not, anyone losing an hour will feel the effects of it, especially if you are already sleep deprived (and you know who you are).

But the good news does not stop there.

Did you know that night owls are more affected by the time change than early birds?

In a study from 2008 that I was reading on www.sleepeducation.com it turns out that night owls, during the time change, have significantly more restless sleep. Do you know if you are a night owl or a morning lark? This chart can help you decide:

Ask yourself the following questions:

	Early Bird	Night Owl
I feel Alert	In the early morning	Late in the evening
I feel the sleepiest	In the early evening	Past midnight
I enjoy waking up	At 6am or earlier	At 8 am or later
I have the most energy	A few hours after waking	A few hours before bed

So if you are a night owl from West Virginia, what can you do before disaster strikes and you only become more sleep deprived?

1. Go to bed 20 minutes earlier Wednesday and Thursday; then another 20 minutes earlier Friday and Saturday. This will help your body adjust to the difference easier.
2. When you wake up Sunday morning, immediately change the time on your bedroom clock.  Help your brain visualize the time change.
3. Eat lunch and dinner 30-60 minutes earlier for 3 days before the time change to get your other daily routines in sync for the new time change.

1. Beginning a few days before the time change, stop drinking caffeine at 1:00 in the afternoon to help with the earlier bedtime.
2. Avoid alcohol during the weekend of the time change (this one can be tough).
3. Keep up your exercise during the week for better sleep quality and maybe throw in an extra work out this weekend.
4. Make sure you get sunlight in the morning the day of the time change to help reset your body clock.

And if possible, my #1 recommendation for this Monday, March 12, 2012:

Ask your boss if you can either work from home the morning after the time change, March 12, 2012, or come in late.

The roads will be filled with sleep deprived people running late for work or school!

Be aware of your bedtime routine as the clock springs forward—otherwise you might fall back asleep at the wrong time.

Sweet Dreams,

Michael J. Breus, PhD 
The Sleep Doctor™ 
www.thesleepdoctor.com

The Sleep Doctor’s Diet Plan:  Lose Weight Through Better Sleep

Everything you do, you do better with a good night’s sleep™ 
twitter: @thesleepdoctor 
Facebook: www.facebook.com/thesleepdoctor

 

 

Aging, eyes and our circadian clock: what’s the connection?

It’s not every day that a news story about circadian rhythms shoots to the top of the “most read” list in a major newspaper. But that’s exactly what happened with this story about how the aging of our eyes may affect our circadian clocks and in turn, our overall health. This New York Times piece outlines research that is working to connect the aging of the eye with disruption to the functioning of the body’s circadian clocks, and the development of many of the chronic and serious health conditions that are associated with age.

Circadian rhythms—our own internal biological “clock”—govern our sleep-wake cycle and several other daily rhythms of the body. It’s a complicated and finely tuned system of hormonal and bio-chemical reactions that helps us live in rhythm with the 24-hour day, waking in the morning and remaining alert throughout the daylight hours, then sleeping and rejuvenating at night. A key component of our circadian system is the timed release of the “sleep hormone” melatonin. When our circadian clocks are functioning properly, melatonin levels rise during the nighttime hours, promoting sleep. Melatonin levels are suppressed during daytime hours, as other hormones such as cortisol rise, helping to provide the alertness and energy we need to navigate our waking day.

Our bodies’ circadian clocks, and the rise and fall of melatonin, are driven by exposure to light. And our eyes play a critical role in capturing that light and transmitting information to the part of the brain that governs our circadian clocks.

Scientists in recent years have discovered a group of cells in the retina of the eye that are triggered by light to communicate with the area of the brain that controls the circadian clock. Researchers have determined that these light-sensitive retinal cells communicate directly with the brain’s suprachiasmatic nucleus. This small cell cluster, located in the hypothalamus, is responsible for controlling the body’s circadian rhythms.

Our circadian clocks are incredibly precise, and can be very sensitive to disruption:

Exposure to light at night. This happens most often these days through our ever-present electronic devices, which seem to be everywhere, including the bedroom. Falling asleep with the television on, leaving a cell phone, laptop or tablet on your bedside table—the light emitted from these devices can throw your circadian rhythms out of whack and disrupt your sleep.

Age. Evidence has shown that the body’s circadian clock functions less effectively as we age.

Shift work. People who work nights, or an irregular combination of day and night shifts, are frequently living at odds with their biological clocks. Firefighters, police, medical professionals, pilots and other shift workers—as well as people who travel frequently across time zones—suffer sleeplessness and other health problems as a result of disruptions to their circadian clocks.

Here’s where the aging of the eye comes into play. As our eyes age, they become less effective at absorbing light. Pupils become narrower. The lens of the eye takes on a yellow cast. Overall, our eyes become less adept at absorbing light—particularly blue light, the part of the light spectrum that has an especially powerful effect on the retinal cells that work with the brain to control circadian rhythm. This study showed how dramatically blue-light absorption decreases with age:

•  The eyes of a 10 year old have 10 times the ability to absorb blue light as the eyes of a 95 year old
• By age 45, a person’s eyes are able to absorb only 50% of the blue light needed to keep circadian rhythms functioning properly

Research into the effects of blue light exposure on the body’s circadian rhythms reveals the negative consequences of the decrease in blue-light absorption that comes with age:

•  In this study, women were exposed to blue light for a continuous 30-minute period. The younger women in the study responded to the blue light exposure with a drop in melatonin levels. Older women, exposed to the same amount of blue light, did not experience a suppression of melatonin levels.
• This research revealed that older men were significantly less affected by exposure to blue light than younger men, when researchers measured for alertness and mood. Younger men experienced a boost in alertness and mood after exposure to blue light that older men simply did not experience.

What does all this fascinating science mean in practical terms? Exposure to light, especially sunlight, matters. And it matters increasingly as we age. As our ability to use light effectively decreases, we need to increase the amount of our exposure in order to help strengthen and boost our circadian rhythms. Keeping our eyes healthy and promptly treating eye problems such as cataracts is critical. The health of our eyes, it seems, may have a profound effect on the quality of our sleep and our overall health.

Sweet Dreams,

Michael J. Breus, PhD 
The Sleep Doctor™ 
www.thesleepdoctor.com

The Sleep Doctor’s Diet Plan:  Lose Weight Through Better Sleep

Everything you do, you do better with a good night’s sleep™ 
twitter: @thesleepdoctor 
Facebook: www.facebook.com/thesleepdoctor