A Good Night’s Sleep Can Be a Matter of Life and Death

Over the past three years, I have been writing the Wake Up! You’re Snoring blog with two main objectives: first, to educate you, the public, about sleep disorders, and second, to provide compelling reasons—preferably scientific evidence—why a person who may have a sleep disorder should get diagnosed and, if necessary, properly treated.

There is no shortage of scientific studies being released on a regular basis showing links between obstructive sleep apnea (OSA), insomnia, and other sleep disorders, and myriad negative health conditions, from daytime sleepiness to increased depression.

I wasn’t surprised to see a new study showing a link between insomnia, the loss of hope, and an increased risk of suicide. In a study led by Dr. W. Vaughn McCall, chair of the Medical College of Georgia at Georgia Regents University, researchers studied the mental state of 50 depressed patients between the ages of 20 and 80. More than half of the patients had attempted suicide, and most were taking an antidepressant.

It is established that insomnia and nightmares often go hand-in-hand, and are both known risk factors for suicide. The new study reaffirms that link, but researchers also wanted to find out what effect feelings of hopelessness about sleep had on suicide risk.

In the study, the researchers specifically focused on the relationship between insomnia and suicide risk by asking questions about dysfunctional beliefs about sleep, such as, “Do you think you will ever sleep again?” The scientists used psychometric testing to objectively measure the mental states and personalities of the 50 depressed patients.

Dr. McCall published the results of the study in the Journal of Clinical Sleep Medicine, the journal of the American Academy of Sleep Medicine. In the report, Dr. McCall stated, “It turns out insomnia can lead to a very specific type of hopelessness, and hopelessness by itself is a powerful predictor of suicide.” Dr. McCall also said, “The likelihood of being suicidal at least doubles when insomnia is a symptom.”

McCall and his colleagues have, in effect, discovered a new predictor for suicidal thinking. But why the link between lack of sleep and suicidal thoughts? Dr. McCall explained that, “It turns out insomnia can lead to a very specific type of hopelessness, and hopelessness by itself is a powerful predictor of suicide.” He continued, “If you talk with depressed people, they really feel like they have failed at so many things. It goes something like, ‘My marriage is a mess, I hate my job, I can’t communicate with my kids, I can’t even sleep.’ There is a sense of failure and hopelessness that now runs from top to bottom, and (insomnia) is one more thing. It was this dysfunctional thinking — all these negative thoughts about sleep — that was the mediating factor that explained why insomnia was linked to suicide,” said McCall.

The significance of this study, like many others, is that it not only educates people about the risks associated with insomnia and other sleep disorders, but it challenges the medical community to look at things a little differently when diagnosing and treating.

In this case, examine lack of sleep and insomnia when treating depression and suicidal thinking.  The finding also is a reminder to physicians that depressed patients who report increased sleep problems should be asked if they are having suicidal thoughts, McCall said.

If you’re having trouble sleeping, here are some tips to increase your chances of getting a good night’s sleep.

• Use the bedroom for sleep. With so many electronic distractions in our lives, it’s important to re-claim your bedroom for its intended purpose: rest and sleep. Move the TV and computer out of the bedroom, or at the very least, do not watch TV, work on the computer or check your blackberry close to bedtime.
• Stick to a bedtime routine. Try to go to sleep before 10:00 pm at night, and wake up around the same time every day, even on weekends. Try to keep to within 20 minutes of the same time each morning and night.
• Do activities that will get you ready for bed. Before bed, do activities that will promote sleepiness, such as a taking a warm bath, or reading a book or magazine.
• Maintain a cool temperature in your bedroom. A cool but comfortable temperature is ideal for sleep. Too warm and you will be fitful, too cold however can be uncomfortable and disturb your sleep.
• Exercise regularly but not after the late afternoon. Even though exercise helps regulate sleep, rigorous exercise causes endorphins in the body to circulate which can have a stimulant effect, and keep you awake longer at night.
• Stay away from caffeine at night. The effects of caffeine are different from person to person, and may last hours after your last cup of coffee, so make your last cup of coffee, regular tea or soda earlier in the day.
• Avoid alcohol and medicines that make you drowsy. Even if you think it is helping you fall asleep initially, alcohol and medicines that makes you drowsy may affect your sleep throughout the night.

Remember, people need an average of 7-8 hours of restful sleep to fully take advantage of its restorative power and avoid daytime symptoms of fatigue. If a regular, peaceful routine incorporating the tips above doesn’t help you start sleeping peacefully throughout the night, contact your doctor. You may have a more serious cause of sleeplessness such as snoring, sleep apnea or chronic insomnia. Getting treated could prevent heart disease, hypertension and stroke.

Can more sleep help ease pain? Yes, says new study!

Chalk another one up for the benefits of sleep. Researchers at the Sleep Disorders and Research Center at the Henry Ford Hospital in Detroit have found that getting more sleep improves daytime alertness and reduces pain sensitivity in healthy adults.

The study was led by Timothy A. Roehrs, Ph.D. of the Sleep Disorders and Research Center at the Henry Ford Hospital and supported by the Fund for Henry Ford Health System. Roehrs and his colleagues studied 18 pain-free, but mildly sleepy volunteers.

For the study, the participants were randomly assigned to four nights of either their normal amount of sleep, or extending their sleep time to 10 hours in bed per night. Their daytime sleepiness was measured on days one and four using the Multiple Sleep Latency Test (MSLT), a tool that measures how quickly a person falls asleep. Their pain sensitivity was also measured using finger withdrawal latency pain testing to a radiant heat stimulus.

The first study to prove sleep reduces pain.

The results of the study were published in the Dec. 1 issue of the journal Sleep. It is the first research of its kind to prove that extended sleep in mildly sleep-deprived adults can significantly reduce their sensitivity to pain.

The results showed that the extended sleep group—those who slept more than normal—slept 1.8 hours more per night than the normal sleep group. It also showed that they experienced less daytime sleepiness. This increase in sleep time during the four nights correlated to increased daytime alertness, as well as less sensitivity to pain.

Regarding the pain test, the extended sleep group showed a greater tolerance for pain/reduced pain sensitivity. The length of time before participants removed their finger from a radiant heat source increased by 25 percent. The researchers noted that this increase in “finger withdrawal latency” is greater than the effect found in a previous study where participants used 60 milligrams of codeine.

In their report, the researchers stated that the results, combined with data from previous research, suggest that increased pain sensitivity in sleepy individuals is the result of their underlying sleepiness.

Timothy Roehrs, PhD, the study’s principal investigator and lead author said, “The results suggest the importance of adequate sleep in various chronic pain conditions or in preparation for elective surgical procedures. We were surprised by the magnitude of the reduction in pain sensitivity, when compared to the reduction produced by taking codeine.”
Read the press release for the study, “Extended sleep reduces pain sensitivity.”

Lack of sleep and an increase in strokes.

Roehrs’ study adds to growing evidence that more regular, restorative sleep can help reduce the risk of health problems, and the opposite is true, as well.

Last June, the University of Alabama at Birmingham released the results of a study that regularly sleeping less than six hours a night significantly increases the risk of stroke symptoms in middle-age to older adults who are of normal weight and at low risk for obstructive sleep apnea (OSA). That’s worth repeating: Less than six hours of sleep per night increases the risk of strokes in adults of normal weight and not at risk for OSA.
It seems that under six hours of sleep per night is the critical variable, but why? Let’s take a look at the study. The University of Alabama researchers followed 5,666 people  for up to three years who had no history of strokes or stroke-like symptoms, transient ischemic attacks (when blood flow to the brain stops for a brief period causing stroke-like symptoms), or high risk for OSA at the start of the study.

For a period of three years, the researchers followed and studied the subjects’ first stroke symptoms, stroke risk factors, depression symptoms, demographic information and other various health behaviors. What they found was—after adjusting for body-mass index (BMI)—there was a strong association between daily sleep periods of less than six hours and a greater incidence of stroke symptoms for middle-age to older adults, even beyond other risk factors. Interestingly, the researchers did not find any link between short sleep periods and stroke symptoms in overweight and obese participants.

Still, the connection between short sleep and strokes is worthy of great attention from the medical community and general public. I agree with the Alabama study’s lead author, Megan Ruiter, PhD., who said, “The results of the Alabama study provide a strong argument for increasing physician and public awareness of the impact of sleep as a risk factor for stroke symptoms, especially among persons who appear to have few or no traditional risk factors for stroke.”

It looks like the medical community is taking this message to heart, no pun intended. Another study announced in late July is going on at the Alberta Health Services and the University of Calgary. There, Dr. Patrick Hanly of the university’s Hotchkiss Brain Institute is leading a study to learn more about the physiological connection between sleep apnea and stroke—specifically, the brain’s blood flow response in people with and without sleep apnea.

For the study, participants with sleep apnea stay overnight in the sleep laboratory at Calgary’s Foothills Medical Centre, where their breathing and cardiovascular responses are continuously monitored while they sleep. The next day, their brain blood flow response to reduced oxygen levels is assessed while they are awake. Then, the participants receive supplemental oxygen during sleep for two weeks, and are tested again to see if their cerebral defense mechanisms have improved. The researchers are also studying people without sleep apnea to see if their cerebral defense mechanisms function better than in those with sleep apnea. Hanly and team’s theory is that it is the lack of oxygen, or hypoxia, that people with sleep apnea experience during sleep that impairs the body’s normal defense mechanisms in the brain. A better understanding of this connection will lead to better prevention and treatment strategies.

I applaud the work of the Alabama and Calgary researchers. It’s time we all wake up to the health benefits of regular, restorative sleep

For more information, read the University of Alabama at Birmingham study, “Under 6 Hours of Sleep Tops Risks for Stroke in a Low-risk Population.”

Can Bees Teach Us About Sleep, Learning and Memory?

As I’ve mentioned in previous blogs, we live in an exciting time for sleep research—it seems that every month, new studies are being published that provide us greater insight into the causes and treatments for various sleep disorders. And this month was no exception.

In a new article entitled, “Sleep-deprived bees have difficulty relearning”  in The Journal of Experimental Biology, researcher Randolf Menzel of the Institute of Biology in Berlin, Germany explains his four-decade study with bees, and what the results are teaching us about the effect of poor sleep on memory and learning.

The phases of sleep known as rapid eye movement (REM) and slow wave sleep (SWS) are involved in cognitive memory, such as learning motor skills and consciously remembering. As a result, restorative sleep not only rejuvenates us, it also helps consolidate memories.

To learn more about this relationship between the brain, sleep and memory consolidation, Menzel spent the last four decades studying honey bees. Why bees you ask? Well, according to Menzel, they are easy to train and well-motivated. Also, the human brain is too complex to dissect the neurocircuits that are linked to our memories. With bees, Menzel could identify the tiny circuits that control specific behaviors in their brains.

For the study, Menzel and his colleague, Lisa Beyaert, investigated the ability of bees to learn new routes from their beehive to a new feeding site, and second, the effect that loss of sleep would have on the bee's ability to learn the new route.

They provided a hive with a well-stocked feeder and trained the bees to visit the feeder and return home. To track the bees' flight during the experiments, the researchers used tiny radar antennas glued to the backs of the bees.

Once the researchers saw that the bees had memorized the route from the hive to home, they intercepted some of the bees at the feeder and transported them to a new location before releasing them again to find their way home. For the second part of the experiment, the researchers shook the bees awake every five minutes at night.

The researchers found that the insects could remember the way back to the hive after they had found it one time. However, when the scientists interrupted the bees’ sleep just after they had learned a new direct route, the bees were disoriented during the second attempt to return home.

Fewer than half the disoriented bees found their way back to the hive, and it took them twice as long as the bees with the usual amount of sleep. Menzel explained, "Without sleep, the bees are not able to consolidate the memory of the previous experiences with the new experience. Formation of the new memory is only possible during sleep.”

The well-rested bees, on the other hand, were able to find the direct way home after some brief training, but the sleep–deprived bees were disoriented and struggled to find their way. As in humans, sleep helps animals to store new experiences in such a way that earlier memories can be altered and supplemented. In other words, sleep helps us create new memories that override the previous memories.

So, what can bees teach us from Menzel’s study? That healthy, restorative sleep is vital to learning and consolidating memories. So get some good sleep tonight. That goes for you too, bees.

Read more about Menzel’s study in the article, “Sleep-deprived bees have difficulty relearning” in The Journal of Experimental Biology.

Light from Tablet Computers May Delay Sleep, Especially in Teens

I admit I love my gadgets – especially my laptop and e-reader, I’m also, as a doctor, aware of the effects that the artificial light from these devices can have on our sleep, especially following prolonged and late-night use.

The artificial, short-wave light from TV and computer screens can suppress melatonin production and throw off circadian rhythm, preventing deep, restorative sleep. Prolonged sleep disruption may also lead to increased risk for diabetes and obesity.  A new study  released in late August reinforces my opinion with some data.

Researchers at the Lighting Research Center (LRC) at Rensselaer Polytechnic Institute in Troy, NY tested the effects of self-luminous tablets on melatonin suppression. Melatonin is a hormone produced by the pineal gland at night and is involved in regulating our sleeping and waking cycles.

The study was funded by Sharp Laboratories of America and led by Mariana Figueiro, associate professor at Rensselaer and director of the LRC’s Light and Health Program. Co-authors of the study are LRC director and professor Mark S. Rea, LRC research specialist Brittany Wood, and LRC research nurse Barbara Plitnick.

For the study, 13 participants used self-luminous tablets to read, play games and watch movies. The participants were divided into three groups. The first group viewed their tablets through a pair of clear goggles fitted with blue light. This was the “true positive” group because blue lights are known to be a strong stimulus for suppressing melatonin.

The second “control” group viewed their tablets through orange-tinted glasses, which filtered out the short-wavelength radiation that can suppress melatonin. The third group did not wear any glasses or goggles. Each tablet was set to full brightness.

The results of the study were clear: After only two hours of exposure to electronic devices with self-luminous “backlit” displays, the participants’ melatonin levels were suppressed by about 22 percent. According to lead researcher Mariana Figueiro, stimulation of the circadian system to this level may delay sleep in those using the devices prior to bedtime, especially in teens.

The researchers also determined that the type of task being performed on the tablets also determines how much light is delivered to the cornea, and therefore the impact the self-luminous light has on nighttime melatonin levels. In other words, the researchers pointed out that it is important to measure how much light a person receives from the self-luminous device.

So, what can be done with this new information? How can we use it to improve our sleep and general health? One, we can all become more aware of how much time we—and our children—spend staring at our tablets, computer and TV screens late at night. As adults, it is up to us to monitor ourselves and our children, and have the discipline to turn these machines off at least an hour before bedtime.

LRC research specialist Brittany Wood said, “Technology developments have led to bigger and brighter televisions, computer screens, and cell phones. To produce white light, these electronic devices must emit light at short wavelengths, which makes them potential sources for suppressing or delaying the onset of melatonin in the evening, reducing sleep duration and disrupting sleep. This is particularly worrisome in populations such as young adults and adolescents, who already tend to be night owls.”

Although pre-teens and teens love their late-night electronics, as parents, it is our responsibility to monitor our children’s computer use, or at the very least in older teens, educate them and make them aware of the potential; side effects of prolonged use.

Researcher Figueiro also feels that tablet display manufacturers can use this information to determine how their products affect circadian system regulation, and as a result, design more “circadian-friendly” electronic devices that could either increase or decrease circadian stimulation depending on the time of day. For example, screens that reduce circadian stimulation in the evening for a better night’s sleep, and increasing in the morning to encourage alertness.

Figueiro had another interesting idea about tablet light therapy: In the future, manufacturers might be able to use related data to design tablets that minimize symptoms of seasonal affective disorder, and sleep disorders in seniors. People might even be able to receive light treatments while playing games or watching movies, making light therapy much more enjoyable than just sitting in front of a light box.

Until manufacturers develop more “circadian-friendly” electronic devices that increase or decrease light exposure based on time of day, Figueiro offered several recommendations to reduce the effects of self-luminous tablet light on sleep, including dimming these devices at night as much as possible in order to minimize melatonin suppression, and, as I mentioned before, limiting the amount of time spent using these devices prior to bedtime.

Here’s another idea: Why not turn off the devices before bed, and pick up a good old fashioned paper book. You’ll be out like a light before you know it.

Read the full study entitled, “Light From Self-Luminous Tablet Computers Can Affect Evening Melatonin, Delaying Sleep.”

Less Than Six Hours Sleep/Night Increases Strokes

Lack of sleep and an increase in strokes. According to new research, the two conditions are very connected, even in otherwise healthy adults.

In early June, the University of Alabama at Birmingham released the results of a study that regularly sleeping less than six hours a night significantly increases the risk of stroke symptoms in middle-age to older adults who are of normal weight and at low risk for obstructive sleep apnea (OSA). That’s worth repeating: Less than six hours of sleep per night increases the risk of strokes in adults of normal weight and not at risk for OSA.

It seems that under six hours of sleep per night is the critical variable, but why? Let’s take a look at the study. The University of Alabama researchersfollowed 5,666 people  for up to three years who had no history of strokes or stroke-like symptoms, transient ischemic attacks (when blood flow to the brain stops for a brief period causing stroke-like symptoms), or high risk for OSA at the start of the study.

For a period of three years, the researchers followed and studied the subjects’ first stroke symptoms, stroke risk factors, depression symptoms, demographic information and other various health behaviors. What they found was—after adjusting for body-mass index (BMI)—there was a strong association between daily sleep periods of less than six hours and a greater incidence of stroke symptoms for middle-age to older adults, even beyond other risk factors. Interestingly, the researchers did not find any link between short sleep periods and stroke symptoms in overweight and obese participants.

Still, the connection between short sleep and strokes is worthy of great attention from the medical community and general public. I agree with the Alabama study’s lead author, Megan Ruiter, PhD., who said, “The results of the Alabama study provide a strong argument for increasing physician and public awareness of the impact of sleep as a risk factor for stroke symptoms, especially among persons who appear to have few or no traditional risk factors for stroke.”

It looks like the medical community is taking this message to heart. Another study announced in late July is going on at the Alberta Health Services and the University of Calgary.  There, Dr. Patrick Hanly of the university’s Hotchkiss Brain Institute is leading a study to learn more about the physiological connection between sleep apnea and stroke—specifically, the brain’s blood flow response in people with and without sleep apnea.

For the study, participants with sleep apnea stay overnight in the sleep laboratory at Calgary’s Foothills Medical Centre, where their breathing and cardiovascular responses are continuously monitored while they sleep. The next day, their brain blood flow response to reduced oxygen levels is assessed while they are awake. Then, the participants receive supplemental oxygen during sleep for two weeks, and are tested again to see if their cerebral defense mechanisms have improved. The researchers are also studying people without sleep apnea to see if their cerebral defense mechanisms function better than in those with sleep apnea. Hanly and team’s theory is that it is the lack of oxygen, or hypoxia, that people with sleep apnea experience during sleep that impairs the body’s normal defense mechanisms in the brain. A better understanding of this connection will lead to better prevention and treatment strategies.

I applaud the work of the Alabama and Calgary researchers. It’s time we all wake up to the health benefits of more–and better—sleep.

For more information, read the University of Alabama at Birmingham study, “Under 6 Hours of Sleep Tops Risks for Stroke in a Low-risk Population.”

Sleepy on the Job? Tips for a Better Night’s Sleep

There’s no denying that sleep deprivation, and the health issues that result, are becoming more prevalent in our go-go, techno society. But a recent sleep study by the National Sleep Foundation (NSF) grabbed my attention as particular cause for concern.

Every year, the NSF releases a Sleep in America® poll.  For its 2012 survey, the NSF examined the specific sleep habits and work performances of transportation workers—pilots, train operators, truck, bus, taxi and limousine drivers. The transportation workers were asked about the duration and quality of their sleep, specifically on work nights, and how it affects their work performance.

Some of the results of the survey are:

• About one-fourth of the train operators and pilots polled said that sleepiness has affected their job performance at least once a week.
• One in five pilots polled—about 20 percent—said they have made a “serious error” as a result of on-the-job sleepiness.
•  One in five pilots and one in six train operators admit to a “near miss” due to on-the-job sleepiness.
• Pilots and train operators are more likely than non-transportation workers to have been involved in a sleep-related car accident while commuting.
• Among all workers surveyed, train operators and pilots report the most work day sleep dissatisfaction.
• Almost two-thirds of train operators and one-half of pilots say they rarely or never get a good night’s sleep on work nights.
• About one-third of bus, taxi, and limo drivers said they rarely or never get a good night’s sleep on work nights.

The results of the poll are some cause for alarm, and reinforce the growing problem of sleep disorders and the potential risks they pose, such as commuter car accidents and errors by public transportation drivers responsible for many people.

Persistent sleep problems left untreated can also lead to myriad health problems, including memory and concentration problems, increased risk of high blood pressure, hypertension, stroke and heart attacks, depression, diabetes and sexual dysfunction. Severe cases of sleep apnea can even be fatal.

Besides these sobering health risks, an untreated sleep disorder can also be the root cause of poor performance at work or school, car accidents and other activities that require focus and concentration.

Common Symptoms of Sleep Disorders

Many people experience some occasional difficulty sleeping and/or daytime fatigue. But how does a person know if he or she has a temporary sleep problem that can be remedied with some simple behavioral changes, or if it is a legitimate disorder such as snoring, sleep apnea, sinusitis or nasal obstruction that should be diagnosed and treated properly?

The first step is to be aware of some common symptoms of sleep disorders. Keep in mind that symptoms vary between disorders, such as snoring, sleep apnea, insomnia, restless leg syndrome, nasal obstruction, narcolepsy, so it pays to do some research based on what you are personally experiencing.

Some common symptoms of sleep disorders include:

• Trouble falling asleep at night
• Waking throughout the night
• Chronic snoring
• Morning headaches
• Poor memory
• Daytime sleepiness/falling asleep during the day/low energy
• Bad moods/ irritability
• Increased depression
• Trouble concentrating/driving/making decisions

The Link Between Lifestyle and Sleep Problems

If you or someone you know is experiencing some of the above common symptoms of sleep disorders, the next step is to examine if lifestyle habits are contributing to the difficulty sleeping, fatigue and irritability during the day and other symptoms.
Some behavioral/lifestyle questions to ask include:

• Am I watching TV or using the computer late at night and too close to bedtime?
• Am I consuming too much caffeine during the day?
• Am I taking a medication that may be affecting my sleep quality and duration?
• Is there something particularly stressful going on in my life that is causing me worry and anxiety?
• Am I exercising enough to help alleviate some of that stress and tension?

See a Specialist—And Be Specific

Many sleep problems can be remedied by making some common sense behavioral changes. However, if you or someone you know is experiencing one or more of the above symptoms on a regular basis, see a qualified ear, nose and throat doctor or otolaryngologist to get diagnosed and treated properly. There are multiple options and minimally invasive techniques available today to treat your sleep disorder.

When you see a specialist, be specific about the symptoms you are experiencing. Many times, sleep apnea and other sleep disorders can be misdiagnosed as chronic fatigue, insomnia, depression, or some other non-specific condition. Some doctors, for example, still associate sleep apnea more with men than women, and are too quick to prescribe a medication, rather than do a full sleep disorder work up.

It may help to keep a sleep log (or, more accurately, lack of sleep log) next to your bed to write down what you are experiencing, when you wake and some symptoms you experience. Again, to try and avoid misdiagnosis, go to a qualified sleep specialist and be specific about your symptoms. Don’t wait — it could save your life.

To read the full report, see “Sleepy Pilots, Train Operators and Drivers”  on the National Sleep Foundation website.

The Relationship between Seasonal Affective Disorder and Sleep Problems

One of the most common questions I get in the office during the winter months has to do with seasonal affective disorder: What is it? Do I have it? And what can I do about it? Seasonal affective disorder is a very real form of depression that may affect six out of every 100 people in the United States, according to the American Academy of Family Physicians.

Symptoms of SAD generally manifest in late fall, when the days become shorter and colder, and people enjoy less natural sunlight. Symptoms include, but are not limited to, feelings of sadness, hopelessness and helplessness, lack of energy, loss of sexual interest and usual pleasurable activities, irritability and restlessness, cravings for carbohydrates and overeating (which can lead to weight gain and compound negative and depressive feelings), trouble concentrating, difficulty sleeping and/or insomnia and at the extreme end—thoughts of death or suicide. Symptoms of SAD are usually most intense during the darkest months of the year, so it stands to reason that the farther a person lives from the equator, the higher the incidence of SAD occurs.

These sleep-related symptoms are of particular interest to me, and are usually the catalyst for a person with SAD to come see me for a consultation and treatment. A person with SAD who suffers from sleep problems may go to sleep early and stay in bed for nine or ten hours, but not experience refreshing sleep.  Because of a lack of restful sleep, people with SAD are often drowsy and have trouble concentrating and working during the day.

The relationship between sleep and depression is a bit of a “chicken or the egg” relationship. Which came first? SAD-related depression, or the sleeping problems? It depends. For some, symptoms of SAD occur first—for others, sleep problems appear first. Depression may cause the sleep problems, and sleep problems may cause or worsen the other SAD symptoms.

There is a common link between people with depression and insomnia. Studies have shown that people with insomnia have a ten-fold risk of developing depression compared with people who sleep well. Further, developing depression is highest among those with both sleep onset and sleep maintenance insomnia.

People with depression may also experience insomnia symptoms, including difficulty falling asleep, difficulty staying asleep, experiencing restful sleep and daytime sleepiness. People who suffer from depression are also five times more likely to have a breathing-related sleep disorder than non-depressed people, according to a study at the Stanford University School of Medicine. The 2003 study by Stanford researcher Maurice Ohayon, MD, PhD, found that people with depression were found to be five times more likely to suffer from obstructive sleep apnea (OSA), the most common form of sleep disordered breathing. This was one of the first studies to make the connection between depression and sleep disorders.  More current research has confirmed the connection.

So, if you believe you are experiencing SAD-related depression and/or sleep disorders, please see a psychiatrist or sleep specialist about it. There are treatments such as morning light therapy that can offer some relief, so you don’t have to suffer unnecessarily through the winter blues. Call me—I’m happy to help.

Who’s Suffering More from Lack of Sleep—Men or Women?

This week, I was interviewed by WCBS-TV New York for a news segment called, “Sleep: the Battle of the Sexes.” The topic was one I am very familiar with: People suffering from lack of sleep, and how it can affect daytime mood, mental acuity, job performance and relationship intimacy.

The show drilled down a bit farther and asked: who is more likely to suffer from a sleep disorder, men or women? And of the two genders, which performs better despite a lack of sleep?

What we know is that men and women have different circadian rhythms. According to an article by the Proceedings of the National Academy of Sciences of the United States of America,  “The circadian rhythms of melatonin and body temperature are set to an earlier hour in women than in men, even when the women and men maintain nearly identical and consistent bedtimes and wake times. Moreover, women tend to wake up earlier than men and exhibit a greater preference for morning activities than men.”

In other words, women tend to go to sleep and wake up earlier than men. We also know thanks to a Penn State study that women need 6.8 hours of sleep per night, while men require just 6.2 hours. While scientific studies are interesting, there is a discrepancy between these numbers and what I am seeing in my office at the Manhattan Snoring and Sleep Center.

Based on the facts, one would think women are getting to sleep earlier and sleeping longer than their male counterparts. But are women getting the sleep they need? In my anecdotal opinion, they are not, and they are suffering quietly for it. In our society, men are stressed out, but women are really stressed out. The physical demands of balancing career and family, along with the mental strain of worrying about finances and future is taking its toll on the women in our society. 

Don’t get me wrong, men worry and suffer from sleep disorders too. But they seem more willing to speak up and seek treatment. Women, on the other hand, being the selfless caregivers they are, stay focused on others and what needs to be done and power through their day. Which explains another Penn State study that found sleep deprived women made fewer mistakes compared to men in a series of computer tasks. It seems that, although women need more sleep, they do better without it because, for better or worse, they’re just more used to it.

Whether a man or woman is suffering from a lack of sleep, the fact is that a sleep disorder can lead to negative health issues, including an increased chance of hypertension, heart disease, osteoporosis and inflammatory disease.

In addition to personal health issues, a sleep disorder can wreak havoc on a relationship. The partner of a patient once shared with me how his snoring and sleep apnea had impacted their relationship. It led to weeks without quality REM sleep, and she said it left her feeling groggy with low energy, cranky, unable to concentrate for long and she was more prone to getting sick. His constant snoring caused her to start sleeping on the couch, which led to resentment, lack of intimacy and loss of connection.

I have made it clear in previous blogs that I am not a marriage counselor or relationship expert. But I can tell you unequivocally that, if you or your partner snores or suffers from a lack of sleep on a consistent basis, it will negatively affect your relationship.

In the end, circadian rhythms and who performs better and the sex of the person with the sleep disorder doesn’t matter. What matters is getting it treated and keeping the relationship healthy.

This also bears repeating: Turn off the TV when you go to sleep. Falling asleep with the TV or computer on interrupts deep REM sleep because the light from the screens interfere with the production of melatonin, a hormone that tells our bodies when it’s time to go to sleep. Do yourself a favor and turn off the TV, computer and lights at night. Your brain and body will thank you for it the next day.

To watch “Sleep: The Battle of the Sexes” on CBS2 New York, click here.

Irene’s Lessons

Hurricane Irene

In the days preceding Hurricane Irene, many East-coasters, myself included, experienced some sleepless nights. Preparing for the worst, it was hard to get the thoughts out of my head as I ran through the checklists of tasks to secure the house, and provisions to buy for the days we expected to be out of power.

Thankfully no one I know had any major damage to their homes. In fact, it seemed that almost immediately after the winds died down, there was an upside to the calm after the storm. As our workplace got back to normal, a business acquaintance of mine was still without power. She told me an interesting anecdote of her experience after the hurricane. She has realized, even though power hasn’t been restored yet in her home, there was a  benefit to the storm after all—she’s feeling more rested than she has in years.

She was surprised by this considering the anxiety and frustration she’s been going through learning to live with no electricity. However with a few questions about her normal sleep routine, I realized she had gotten into some bad habits and they had been getting progressively worse. For example, her bedroom contains her computer and television. She had been in the habit of before bedtime getting on the computer, checking email and instant messaging or surfing. This was causing her to go to bed later and later. With the need to conserve her cell phone battery, she put that down as well. Without the electronics to distract her for hours, she began going to bed at a decent hour. The result has been a bedtime of a reasonable hour, as opposed to her average time of 3 a.m.

When I asked if she usually fell asleep with the TV on, she admitted she felt she couldn’t go to bed without it. This is one of the worst habits one can have since not only does the TV interrupt deep REM sleep with noise throughout the night, but it is now understood from recent research that the light from the screen can interfere in the production of the hormone, melatonin, which is the natural sleep aid the body creates to tell us it’s time to go to sleep. As a result of the dark and quiet, she’s receiving a deeper, more regenerative sleep.

The dryer, cooler nights we’ve been experiencing in the New York area has also aided her in sleeping more deeply. Falling asleep in a dark, quiet, and cool room is ideal for the most regenerative sleep possible. Over the past few days, she has reset her internal sleep clock. Falling asleep when she feels sleepy and sleeping deeply throughout the night has allowed her to wake up on her own without the aid of an alarm clock, feeling rested and alert throughout the day—the very definition of restorative sleep. Learning the how good she feels after just a few night’s rest, she’s determined not to fall back on bad habits.

She cites some other important benefits as well. For example, the neighborhood children are playing together outside instead of through their gaming headsets. Irene has given her hours of one-on-one time with her son. Instead of computer, TV and video games, they’ve played board games and talked. Her son was set to start high school this week, and since that is delayed, she feels she’s been grateful for a few more summer days together before the hustle of the school year begins.  

Unobstructed by light pollution, the other night they watched the clear night sky together, and talked about constellations they could never see before. Many of us on in the tri-state region were very lucky that we had no damage. Some lost everything. Some of us simply lost power for a few days. As frustrating as that can be, as some still wait for the lights to come back on, maybe we can thank Irene for some gifts.

The Importance of Sleep

The medical community and healthy lifestyle advocates see the evidence mounting. Our spouses and children recognize the symptoms even when they don’t know the cause. They all agree: We need a good night’s sleep!

When we don’t get a full night of restful sleep, it can dramatically affect our health and impair our mental function and job performance. It can ruin our relationships with our loved ones. Research also points to a myriad of physical health issues caused by a lack of sleep including obesity, diabetes and heart disease.

How much is a “Good Night’s” Sleep?

A good night’s sleep isn’t just determined by the length of time one sleeps, but how restful, deep and uninterrupted that sleep is throughout the night. Even still, the average minimum amount of sleep required to be considered “a good night’s” sleep is between 7 and 8 hours for adults, with teenagers, children and infants needing more sleep, according to the American Sleep Association.

Lack of sleep can be caused by just not getting to bed when one should because of poor habits like watching TV until the wee hours of the night. Certain medicines, food, smoking and alcohol can all affect the ability to fall asleep, stay asleep, or the restfulness of sleep. Stress is also a big contributor. Usually a person can change their routines, and those with insomnia or stress-related causes can usually be treated by over the counter or prescription medicines. When a lack of sleep is caused by snoring, the issue becomes even more complicated, and the health consequences are much more serious.

Snoring – a Major Cause of Sleep Deprivation

Unlike a sleep disorder, snoring is a physical condition. It is caused when the throat relaxes and the tongue falls into the airway in the back of the throat causing a vibration in the soft tissue during sleep. This vibration is an interruption of airflow through the nose and throat.

It is estimated that more than 40 million Americans snore. Snoring interrupts sleep throughout the night, leaving the snorer with the same mental and physical conditions as someone who is sleep deprived.  There are numerous causes of snoring such as deviated nasal septum, nasal polyps or turbinates. Sinusitis and allergies can cause snoring as can anatomical factors such as abnormally relaxed neck muscles, a large tongue or tonsils and obesity because excessive weight can narrow the windpipe. Smoking, alcohol, sedatives or certain sedating antihistamines can lower muscle tone in the upper airways, and also cause snoring.

Sleep apnea is the most common cause of snoring and also the most dangerous. People who suffer from sleep apnea stop breathing dozens of times during sleep and it is particularly severe and life threatening when there are more than twenty or thirty events per hour. There are three types of sleep apnea, obstructive (OSA), central and mixed, with OSA being the most serious type because it effects blood pressure, the heart and lungs.

The Consequences

Without enough sleep we loose our ability to concentrate and our physical performance suffers. Sleep is necessary for the nervous system to function properly. For example the ability to do math and operate a car are compromised.  Other symptoms include daytime sleepiness, morning headaches, irritability, and poor memory. A person with sleep deprivation can burn-out easily, and it can lead to feelings of depression, mood swings and even hallucinations.

Unfortunately if lack of sleep is caused by snoring, often a person doesn’t even know they snore unless they’re told by a partner. Even when a person knows they snore, they often go untreated because they are embarrassed and hide it, or they don’t know it is a serious problem so they ignore it.

In the case of sleep apnea, there is even more of a toll on the body. Considering an apnea patient is unable to breathe many times throughout the night, their sleep is especially interrupted by episodes of waking up gasping for air. This oxygen deprivation combined with an inability to get a good night’s sleep, causes severe sleep deprivation and other health issues. Apnea can lead to high blood pressure because during apnea events, blood oxygen drops abnormally low, resulting in an increase in blood pressure which can bring about stroke. It can cause lung dysfunction because of low levels of oxygen in the blood and high concentrations of carbon dioxide in lung tissue. Since the heart is sensitive to oxygen levels in the blood, apnea is most dangerous in people who are already prone to heart disease. Arrhythmia is very common as is enlargement of the heart. An estimated 80-85% of sleep apnea patients go untreated, which is a serious health problem in the U.S. today.

Luckily, just as we have learned more about the consequences of sleep deprivation and snoring, today there is also a wide variety of surgical and non-surgical treatment available for snoring sufferers. If you suspect that you snore at night, or have been told by a loved one that you do, it is important to speak to your doctor. He or she can recommend you to an Ear, Nose and Throat Doctor or Otolaryngologist who will provide you with the correct diagnosis and start you on the path of treatment for a lifetime of healthy sleep.


For more information, contact the Manhattan Snoring and Sleep Center: (866) 835-2361 or visit www.drvolpi.com.