Women & Insomnia: What Else Could it Be?

November 6, 2011

Here’s a not-too-surprising finding: A 2007 study front the National Sleep Foundation found that 3 out of every 10 women admit to taking a sleeping pill at least a few nights a week. Prescription sleep aids peak amongst women aged 40 to 59. Many women also report that their sleep has never been the same ever since that last pregnancy. Even with older children, being able to either fall asleep or stay asleep can be challenging for many women.

Beyond the obvious reasons for poor quality sleep in women (nighttime feedings, stresses of modern life, hormonal changes, etc.), there’s one important additional factor that wasn’t mentioned in a recent New York Times article on this subject: increasing problems breathing at night.

I’ve written numerous times about how pregnancy predisposes women to obstructive sleep apnea, but due to rising levels of progesterone, their airways are protected (as an upper airway muscle stimulant). But after delivery, progesterone drops, but you still have all that weight. Now you’re narrowed your upper airway, but without the protective benefits of progesterone. Add to this the initial sleep deprivation from routine awakenings at night, and the problem is compounded even further.

Notice also that sleeping pill use peaks around peri-menopause. This is also a period when progesterone levels slowly drop, leading to even more breathing pauses while sleeping. Add to this the typical few more pounds that women gain during menopause, and this can lead to worsening obstructive sleep apnea. No wonder women begin to catch up to men when it comes to rates of obstructive sleep apnea and cardiovascular disease as they go past menopause.

You’ll notice that most women who have chronic insomnia prefer not to sleep on their backs, since that’s then the tongue falls back the most due to gravity. Having smaller jaws create less room for the tongue, making them more prone to sleep-breathing problems. Many of these women will have one or two parents that snore heavily.

It’s also important to realize that you don’t have to have true apneas to have disrupted breathing during sleep. You can have very short obstructions and arousals that don’t count as being apneas if you did a formal sleep study. Younger and thinner women (and men) can have these more subtle events, which can manifest as upper airway resistance syndrome. You can also have different combinations of all these breathing pauses and arousals. The bottom line is that you just can’t sustain deep, continuous sleep. Waking up after 4-5 hours of sleep would be expected when you begin to enter longer periods of REM sleep in the later parts of the night. This is when your throat muscles are most relaxed, and most susceptible to obstructions and arousals.

I’m not discounting all the other reasons why women have so many sleep issues, but untreated sleep-breathing problems is is major source of poor sleep that can frequently masquerade as insomnia, especially in women.

Written by Steven Park · Filed Under Blog | Leave a Comment

Is Your Computer Screen Ruining Your Sleep?

July 30, 2011

As I’m writing this post at 9:30 PM, using my computer is likely to keep me up later into the night. It’s not so much the activity or the content that’s overly stimulating, but the type of computer screen that might prevent me from falling asleep. The newer, brighter backlit LED screens that are almost commonplace with computers these days (especially laptops and tablets) have a much higher level of blue light (460 nm), which is known to have stimulating properties on the circadian system. A study published in the Journal of Applied Physiology showed that subjects who used backlit LED screens had higher rates of attention, wakefulness, and declarative memory compared to subjects who used conventional computer screens. On the flip side, melatonin levels were significantly supressed. As you may know, melatonin levels go up as you’re falling asleep.

This has huge implications since many people (including me) use these type of screens while working later in the evening. It may be great during the day so that you can be productive and get more work done, but it’s counterproductive in the evening hours, especially just before bedtime.

Notice also that most of the newer appliances, traffic lights, cars, toys, and even medical equipment, have LED lights, which are significantly more intense than standard lightbulbs. If you have a few electronic appliances in your bedroom, it’s likely that once you turn the lights out, three or four LED lights can light up your entire room, shining much brighter than many night-lights. I cover my LED lights with black electrical tape.

For some reason, driving has been a bit more annoying for me lately, especially in local traffic, and I realized that it may be due to the fact that I have to look at the very bright LED brake lights on the car in front of me, which makes me squint. It just barely seems to give me a headache, sort of like a very mild migraine. I find myself squinting, and I know that my iris is closing down to shut out the light, kind of like clamping down on the aperture on a camera. This would likely stimulate your sympathetic nervous system (your fight or flight response).

The traffic lights bother me a bit too. If all these little things bother me, I’m sure they’re bothering many other people subconsciously, and it will manifest in different ways. It’s also likely to significantly disturb sleep for millions of Americans.

Do you work with backlit LED computers just before bedtime? Do the brighter LED light bother you too?

Written by Steven Park · Filed Under Blog | 4 Comments

The Fountain of Youth, Revealed

March 22, 2011

Ponce de Leon is well known as the Spanish explorer that searched for the fountain of youth in the early 1500s. Even today, that search continues through the multi-billion dollar cosmetics industry, plastic surgery procedures, and nutritional products. Anti-aging medicine even has a certifying organization for doctors. Some experts are even claiming that they can reverse the aging process.

Knowing what we know about the importance of sleep and the havoc it can cause on your body, I can confidently say that the best way to slow down aging is to optimize your sleep quality. Sleep is known to be vital in tissue healing and regeneration, hormone regulation, as well as in helping to consolidate memories and thought processes. For example, non-REM deep sleep is important for tissue repair, growth hormone release, and other regenerative processes. REM sleep is needed for memory consolidation and creativity.

When most people read or hear about better sleep, they think about going to bed earlier or sleeping longer. People with insomnia are also inundated with “warm milk” recommendations, such as valerian, green tea, turkey, melatonin, meditation, and probably dozens of other vitamins, supplements, or relaxation techniques that help to calm or numb the mind to allow for faster sleep onset. Many of these options can work to various degrees, but won’t be helpful at all if you stop breathing at night. Once your breathing passageways obstruct while sleeping, you have to wake up. You can either wake up violently in a state of panic with sweating and your heart racing, or just get taken out of deep sleep into a lighter stage of sleep.

About 1-2 times per month, I see women who complain of various ear, nose or throat symptoms, let’s say for about 6 weeks. They also usually complains of increased fatigue, headaches, and poor sleep. They usually see their medical doctors and have tried multiple courses of antibiotics or allergy medications. They will typically say that they sleep on their backs when questioned about their preferred sleep position. Looking at their oral cavity exam, I don’t believe them. When questioned further, they all admit that they used to be stomach sleepers, but changed to back sleeping after reading an articles on various magazines, usually by a dermatologist (or sometimes a chiropractor) that recommends avoiding stomach sleeping since it can cause facial wrinkles. Almost every time, their health problems began just after they made the switch in their sleep position. Once they go back to their normal sleep position, their health problems usually resolve.

The cosmetics industry’s fight against facial wrinkles is a classic example our quest to delay aging. In the above example, the reason why some people have to sleep on their stomachs is so that they can breathe properly. Being on their backs causes the tongue to fall back due to gravity, and when in deep sleep, it relaxes completely, leading to obstruction and arousal. Having smaller jaws and dental crowding can aggravate this problem even more. Not getting sufficient amounts of deep sleep causes a generalized state of physiologic stress and adrenaline production, which tends to constrict blood vessels that supply certain parts of the body that are considered “unessential” when you’re under stress. This includes your digestive system, your reproductive organs, as well as your skin. Not receiving proper circulation deprives the tissues of oxygen, preventing proper nutrition and not allowing for healing, regeneration, and waste removal. Hypoxia also creates an environment that’s toxic to the local tissues, leading to further damage and accelerated aging. The bottom line is that not getting good sleep accelerates your aging process.

Another important concept that has profound implications is the fact that underdevelopment of the bony midface and jaw structures leads to wrinkles earlier in life. Having smaller facial bony structures does not stretch the facial skin over the bones as much compared to larger facial structures. Since elastic properties of facial skin tend to degrade over time, having smaller facial bones allows wrinkles to show up earlier, with the same degree of environmental, dietary, or genetic factors.

Two common habits that are thought to accelerate aging and even wrinkles are sun tanning and smoking. Sun tanning may make you look “healthy” temporarily, but sun damage takes a toll on your skin, especially if you’re susceptible to the sleep-breathing problems that I describe. Imagine if you already have diminished circulation to the skin, with diminished levels of oxygen. By definition, you’ll have more levels of oxidative stress, where free-radical oxygen molecules are formed, which can damage DNA. Add ionizing radiation, and it’s a double whammy.

Nicotine is a known stimulant which also has been proven to constrict blood vessels, especially in the skin. It also has a calming effect the way Ritalin helps to calm children with ADHD: Stimulants help to counteract the effects of sleep deprivation from not breathing well at night. It’s also been shown that it takes nicotine about 45 seconds to reach the brain once you inhale smoke into your lungs. This doesn’t make any sense, since most smokers will tell you that they feel more relaxed after the first one or two breaths. What’s making smokes relaxed is the relaxing properties of deep breathing, along with the stimulating effects of nicotine. But by relaxing more using deep breathing techniques to inhale a stimulant, you’re cutting off blood flow to your skin, which if already sun damaged, is more likely to suffer from wrinkles.

The basic thesis of my sleep-breathing paradigm states that all modern humans stop breathing once is a while. But as we get older, not only do we sag on the outside, but also on the inside. If you think about it, the rate at which we age is directly proportional to how narrow your upper airway gets. Add to this additional gravity and the typical weight gain that tends to occur during middle age, it’s no wonder so many people have sleep-breathing problems as we all get older. We’ll never run out of more pills, gadgets, devices and diets that tout their anti-aging properties, but without addressing how well you breathe while sleeping, you’ll continue to suffer from accelerated aging.

Struggling with an addiction? Check into a Long term drug rehab facility and get the help you deserve!

Written by Steven Park · Filed Under Articles | 1 Comment

The Truth About Sleeping Pills, Herbs, and Natural Remedies

July 3, 2009

You’ve been tossing and turning for the past two hours, and you need to get a good night’s sleep in preparation for that important presentation in the morning. Insomnia is a common condition that almost everyone has suffered from at one time or another, but for some people, it can be not only a major quality of life issue, but a source of potentially serious medical problem as well. Recent studies have shown that people who sleep less than 5 hours or longer than 9 hours have a much higher chance of suffering from depression, diabetes and heart disease. Lack of sleep also has been shown to promote weight gain.

It’s estimated that up to 50% of people suffer from insomnia occasionally, and about 10% have chronic insomnia. There are a lot of reasons that can cause insomnia, from stress to medical conditions to external factors such as excessive noise. Yet, the most conditioned response from people whenever they can’t fall asleep is to take a sleeping pill. Unfortunately, this is not the best solution for most people.

In Search of the Best Sleep Remedy

Prescriptions for sleeping pills are at record volumes (56 million in 2008). In times of either emotional or financial stress, symptoms of insomnia rise, and so do prescriptions for sleeping pills. But how effective are they? A recent study funded by the National Institutes of Health (NIH) in 2005 showed that sleeping pills decreased the time it took to fall asleep by 18 minutes, and increased total sleep time by 28 minutes per night, on average. Pharmaceutical company funded studies show much more optimistic results, but there’s definitely a wide range of opinions within the sleep community regarding effectiveness of prescription sleep aids. Not to mention the various known side effects such as daytime drowsiness, sleep walking and sleep eating. Also, as with many studies, many people in the placebo arm also had significantly improved results.

In my experience with patients, sleeping pills are a hit or miss. The results vary depending on the individual. It’s safe to say that some people are much more susceptible than others without very many side effects. The same goes for the various natural supplements, herbs and remedies that are recommended, such as warm milk, L-theanine, valerian and melatonin. Regardless of whether or not there’s scientific evidence over which one works or doesn’t work, if it works for you, you can keep taking it, as long as there are no major side effects. Preferably, you should take a non-prescription medication, as they tend to have less side effects. The one exception is the over the counter sleep aid ingredient, diphenhydramine, which is the main ingredient in Benadryl. It’s also included alone or in combination with many other brand names. This ingredient is a strong antihistamine (used for allergies) that also can make you drowsy. Some elderly who use it have experienced mental status changes as well as other various side effects.

There have been many studies using melatonin. Melatonin is a natural hormone that your body produces more of as you fall asleep. Darkness causes melatonin to increase and sunlight stimulates receptors in your eyes that cause it to drop. Results for the use of melatonin as a sleep aid have generally been positive, but somewhat conflicting. Ramelteon is a recently introduced melatonin-like chemical that stimulates melatonin receptors in the brain. Results show that, in general, although it does help, it’s not as effective the standard sleep aids.

Another recent study showed that valerian was not better than placebo in treating insomnia. This contradicts a number of my patients that swear by valerian. Again, studies report statistical averages, which lumps together people who respond with people that don’t.

Simple Steps to Resolve Insomnia

For most people, practicing routine beneficial sleep habits is all you’ll need to avoid taking pills or medications. Setting aside at least 30 minutes to wind down and do something relaxing is one way. Avoiding anything stimulating (such as playing video games, surfing the internet, checking email, or even exercising) can help you fall asleep faster.

Everyone has different sleep needs, so don’t stress if you can’t get 8 hours of sleep. People need anywhere from 6-8 hours of sleep to function normally. It’s also important to get out of bed within 30 minutes every morning, even on the weekends. Try to get outdoors and get exposed to sunlight. This helps to strengthen your sleep clock.

If you’re not drowsy within 30 minutes of getting into bed, get out and do something that’s quiet and relaxing, until you feel drowsy. Try to reduce the total time in bed to match the total time you actually sleep. If you’re tired during the day, try taking a short nap in the mid to late afternoon.

Try practicing relaxation techniques and breathing exercises such as meditation or yoga, especially before going to bed. Use the bed for sleep and sex only—don’t read, watch TV, or work on your computer while in bed.

Lastly, don’t exercise too close to bedtime. Leave about 2-3 hours after exercising before going to bed. Elevation of core body temperature will keep you from falling asleep. As body temperature drops, you’ll feel more drowsy.

Various practitioners will tout one natural herb or supplement as being helpful for insomnia, but as I’ve pointed out previously, not everyone will benefit significantly. However, even if it works, as long as you’re not treating what’s causing your insomnia, it’s definitely going to come back. In some cases, there may be an underlying medical condition that could be presenting as insomnia. Many people with insomnia, for instance, actually have obstructive sleep apnea. That’s why taking a pill, although it seems like the path of least resistance, will only worsen the situation in the long run.

If you currently rely on sleeping pills every night to help you fall asleep, or you feel tired and lethargic no matter what steps you take, then it’s time to see a doctor about your insomnia problem.

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Cognitive Behavioral Therapy or CBT is a drug free therapy that has been effective in treating many people with insomnia. Click here to find out how you can access the download to my interview, How to Beat Insomnia Without Medications, with Dr. Gregg Jacobs, the leading authority on the treatment of insomnia and the first to develop a drug-free program for insomnia proven more effective than sleeping pills.

Written by Steven Park · Filed Under Articles | Leave a Comment