I feel like I can empathize with Edward Norton’s character in the movie Fight Club.”When you don’t sleep, everything is just a copy of a copy.” Or better yet, “When you have insomnia, you’re never really asleep… and you’re never really awake.”

Though, I had the opposite problem of this character. In the movie Edward Norton’s character goes to his doctor and asks him to prescribe him something because he was suffering. In my world, I had doctors prescribing me many things.

Let me go back a decade, to the day I incurred my spinal cord injury. I was sleeping just seconds before the car rolled. In the 5 months I was in the hospital I would wake several times a night, scared out of my mind. I woke, terrified, because I could not move, and a machine was breathing for me. In the hospital, the doctor increased the amount of drugs I took. I was discharged from the hospital with, in my mind, I ridiculous amount of medications sending my brain and my body in many different directions, depending on the pill I took.

Over a few weeks, I took myself off of many of the drugs I was discharged to take, because I feel that the body would try its best to heal itself; given it has the opportunity. It was not a pleasant few weeks and in the end I found that I still would wake several times a night…terrified. It took me 8 years to discover that waking several times a night, terrified, was not normal. It was one of the many symptoms of Post Traumatic Stress Disorder (PTSD) I was living with daily.

The brain is amazing, and when something happens that the brain recognizes as life threatening to self or others, the memory is put into a place where, when triggered the brain will go into a life persevering mode of fight or flight. The treatment for PTSD is EMDR. A very basic definition of EMDR is it helps an individual reprocess a traumatic event into every day memories so the brain is not stuck in life preserving mode when triggered.

I recently decided that since I have been sleeping through the night, I should take myself off of this final drug. I have been on it for ten years and I want my brain to be mine once again, not getting pharmaceutically enhanced. It has been a rough couple of days and I miss sleep.

Some people do not eat meat; they will not eat meat.  The reasons are many.  They range from concern for their own health to concern for the health of the planet, as eight pounds of grain is usually needed to create one pound of meat.  Yet even vegetarians of 40 years standing may sometimes break the habit of a lifetime and eat meat.

Especially when they do it in their sleep.

Ambien Made Me Do It

A gracious, very friendly patient of mine had been taking benzodiazepines (valium like drugs)  for anxiety and a variety of different sleep problems.  One day, she discovered she had run out of all her pills.  The prescription was at the pharmacy, but there were difficulties in getting over there.  And  company was coming.

So instead she took pills from an old prescription of ambien – for three nights.

One morning she woke and walked down to the kitchen.  Raw chicken and mozzarella cheese were strewn verywhere.

She had no idea how.

Why This Mess?

It took a while to clean up the mess, but it still puzzled her – how could someone have taken mozzarella and chicken from the freezer and just dumped it on counter tops?

The next night she awoke, recognizing  she did not feel quite  right.  She remembered awakening during the night, but all other recollections were vague.

Her company had noticed her lying on the floor with her head against the bed frame at  2:30 that morning.  They found her sleep position curious, but were too polite to say anything – just yet.

The next morning dawned with stranger experiences.  Something was filling the spaces in her teeth.

She went to look.  She saw small brown flecks – hamburger crumbs.  She had not eaten meat in over 40 years.

Why was she eating hamburger?

She went down to have breakfast.  Pieces of hamburger were strewn throughout the refrigerator shelves.

It had been her husband planned lunch that day.  Now at least she knew the origin of the hamburger in her teeth.

She turned to the Net, and began looking up sleepwalking and ambien.

How Often Does This Happen?

According to the manufacturer, ambien (zolpidem) may provoke sleepwalking in less than 1% of patients.

They may be correct.  However, clinicians in sleep labs, who see a far more problematic population, feel the numbers are higher. And people underreport their problems with sleepwalking.

Lots of them, like my patient, often don’t know they’ve done it.

What Do People Do While Sleepwalking?

Pretty much anything – drive, eat, turn on the TV.  One Canadian man claimed that he had gotten drunk while asleep, slugging back a quart of vodka he kept normally in his freezer – under the influence of ambien.  He was a sleepwalking drunkard.

Why Does Ambien Cause Sleepwalking?

In part because it does not cause “normal” sleep, but rather a sort of pre-coma state that may make it easier for sleep to follow.

People think of waking and sleeping as some kind of magic light switch which turns on with a flick from one to another.

That’s wrong.

To get from waking to sleeping large parts of the brain have to coordinate their activities and act correctly – together.  If they don’t, you can stay awake; have a brain that is partially awake and partially asleep; or go into an “in-between” state that is quite different from normal sleep and wake.

Sleepwalking generally occurs in deep sleep – when the brain is as close to coma as it normally gets.  Ambien may be provoking some in-between states where most of the brain is “asleep”, but the motor controls on muscle actions are not yet turned off.

So people keep moving – and can do almost anything.

Did Ambien Unlock An Unconscious Desire to Eat Meat?

Probably not.  Sleepwalking folks often act in ways that are inexplicable when they are awake.  Chances are that hungry thoughts were easiest to fulfill with the prepared hamburger right in front of her unconscious, deep-sleeping eyes.

And how well did she sleep?  Outside of eating meat, roaming through the house, and filling the kitchen with frozen chicken and mozzarella, she thought she slept surprisingly well.
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Insomnia is quite often a symptom of something greater than just not being able to sleep. There are numerous reasons why a person might either have a difficult time getting to sleep, staying asleep, or both. And the length of time that someone suffers from insomnia depends upon the insomnia being a symptom of something else or a primary “illness” all by itself.

Most People Deal With Insomnia at Some Point in Their Life… Common Causes

Insomnia will most likely hit you at some point in your life. One of the most common causes of insomnia is for emotional reasons. In fact most disease or illness has it’s roots based to some extent in emotional turmoil. It may be something as simple as what you can easily identify, such as a work or relationship issue, or it may be just an overall unhappiness or medical depression. Two of the most common reasons for insomnia are because of over thinking due to daily disturbances in life that get complicated enough that you lie awake at night trying to figure out how to solve them, or because of depression. Either one of these can either be a passing phase that are eventually balanced out, or they may become debilitating over time left unchecked. One of the most easily-solved reasons for insomnia may be your mattress, so don’t rule that out, and get a new one if that is the matter.

More Common Causes of Insomnia

Another common reason for insomnia is because of pain syndromes. If you are one of the unlucky ones that suffers from a chronic pain disorder, you know that pain can keep you awake at night. Pain killing drugs may help, but some people suffer from some level of pain 24 hours a day, which makes it very difficult for them to sleep comfortably. That little time which they do fall asleep can often not be enough sleep or restorative enough to make them feel rested and actually feel human during the day.

Those who overuse or abuse either over the counter drugs or caffeinated beverages (or even illegal drugs) can expect to have problems with their sleep cycle. Yes, insomnia can be directly related to your intake of caffeine for those who are heavy coffee drinkers or caffeinated soda drinkers. Especially if the spout doesn’t turn off several hours before bed time.

These are some of the most common reasons for insomnia, but there are a lot more reasons for it that we have not covered here. Insomnia can also be caused by either a side effect of a prescription drug. Talk to your medical care practitioner if insomnia complicates your life for more than a couple of weeks, and especially if it is something that has been affecting your normal everyday functionality. Nip it in the bud so it doesn’t become overwhelming to you, because like most things insomnia can be helped more easily early on, but gets more difficult as time marches on.

Should you take aspirin to prevent cancer?

The Lancet, one of the world’s most prestigious medical publications, has just published a series of articles on aspirin and the prevention of cancer.  The one getting the most international attention is a “meta-analysis” by Professor Martin Rothwell of Oxford and his team, looking at many studies pooled and analyzed as a unit.  His new conclusion:  taking aspirin decreased the risk of metastatic spread of colon cancer perhaps as much as 50%.  His old, contested conclusion:  taking aspirin for only 3-5 years seemed to decrease the risk of getting colon cancer.

Can We Trust These New Studies?

Only if we understand the statistical underpinnings that exist for them, and apply suitable “fudge factors”.  Meta analyses take disparate populations over disparate periods with wholly different environments, set up specific inclusion criteria, and then treat the many different study subjects as if they were equal.  The large grouping allows for more fine tuned statistical analysis of overall risk, but also can put apples and oranges together.

That’s because population studies try to control the innumerable health variables that exist in the environment and with medical illness – but sometimes  can’t.  What if unknown risk factors – like foods rarely eaten – are a major cause of colon cancer?  What if the patients enrolled in one group were enthusiastic users of all kinds of new treatments, a group which whose higher health consciousness tends to get them better results overall?  You can try to control some of these problems effectively in single studies.  However, they’re much harder to control when you pool many disparate studies together- and many of these studies tested aspirin’s effect on vascular disease, not cancer.

What Have Other Studies Shown?

A large review of studies done in Annals of Internal Medicine in 2007 found large population follow-ups supported the idea of using aspirin to prevent colon cancer.

However, two important randomized controlled trials – supposedly the gold therapy of treatment – did not show a useful effect of aspirin and colon tumors.  Both studies, the Physician’s  Health Study and the Woman’s Health Study gave fully negative results.  More recent trials – using aspirin for 4.5 and 6 years – have also given negative results.

Are There Problems with Aspirin Use?

Plenty.  In the study performed in 2007, estimates of GI bleeding were 2.7% per year for those taking more than 200 mg of aspirin a day.  The standard aspirin dose sold in stores is 325 mg. The dose recommended for stroke and heart attack prevention – in people with history of heart disease or clear risk factors – is 81 mg.

Even that low-dose group will show more hemorrhagic strokes when using aspirin.

And chemoprevention of cancer by aspirin – in most of these studies that supposedly demonstrate effectiveness – found doses had generally to be 325 mg a day – or more.  The recent Oxford study however found lower doses effective, in contradiction to almost all previous studies.

Shouldn’t We Recommend Aspirin Use to Some Groups?

Yes.  Some people with family history of particular kinds of tumor, like Lynch’s syndrome, have a much clearer reason to use aspirin to prevent colon cancer.

But aspirin is not the only way to decrease colon cancer deaths.  Hemoccult testing – looking for occult bleeding – cuts the risk.  And if colonoscopies are done carefully – many GI physicians now pride themselves on getting through the study in six minutes or less – they may cut the risk of colon cancer by half or more.  Sadly, many tumors spread along the side of the bowel wall and are very hard to spot on colonoscopy.

All in all, aspirin prophylaxis has to be considered as part of other prevention strategies – which include not just colonoscopy, but diet and physical activity, which also affect colon cancer risk.

Why Are These Things So Complicated?

Because the human body and our society is complicated.  We know of many variables that affect colon cancer risk.  There are probably dozens more of which we presently know little or nothing.  That the bacterial biome – the 100 trillion bacteria living in your bowel, with their 3-9 million individual genes versus humanity 27,000 – has no effect on cancer risk, particularly colon cancer risk, is hard to believe.

Who Then Should Take Aspirin for Cancer Prophylaxis?

This is just the sort of issue that independent committees, like Britain’s NICE or America’s National Institute of Medicine, need to consider in order to create guidelines.  The issues are complex and demand long consideration.

Bottom Line:

If you have a family history of colon cancer, it’s worthwhile to talk with your primary care doctor as to whether you should take aspirin to prevent colon cancer.  Recognize you will probably need to take 325 mg for many years to improve your odds, and risk increased rates of bleeding in your gut and brain.
Rest, sleep, Sarasota Sleep Doctor, well-being, regeneration, longevity, body clocks, insomnia, sleep disorders, the rest doctor, matthew edlund, the power of rest, the body clock, psychology today, huffington post, redbook, longboat key news

A recent Sleep In America poll found that a quarter of pilots feel sleepy on the job.  Another 60% nap on the job, and 20% feel they have made serious errors as a result of sleepiness.

Why Is This Happening?

Shift work.  Similar problems occur with train drivers.  Only about half of pilots get a decent night’s sleep on work nights, compared to about two-thirds of train drivers.

Is Anything Being Done About It?

The NTSB  has recently extended the time between shifts so that pilots have more rest time between work assignments.  However, despite calls to allow napping in the cockpit while co-pilots take over, as is allowed in Europe, no napping is allowed for American pilots.

About 20% of pilots surveyed said they napped three to five times a week – on the job.

What Is the Effect on Pilots’ Lives?

Pilots and train drivers have six times the car crashes commuting to and from work as workers in other fields.  Shift work itself is associated with greater heart disease, stroke, depression, and a tendency to greater tumor formation.  It also tends to cause weight gain.

Has Anyone Gotten Killed Due to Pilots Falling Asleep?

Yes. Most famous in the US is a Continental Connection flight to Buffalo in 2009 when 49 people died.  Overall, however, flight safety in the United States – despite our cattle car approach to air transport and  remarkably outdated air traffic system – has an excellent safety record.

Why Are There So Few Crashes?

Redundancy, protocols,  and training.  There are two pilots on most every flight.  Pilots – generally in violation of regulations -  allow each other to nap and remain sharp, avoiding the “sleep inertia” problem of getting back to acuity following sleep. There is someone else up there to fly the plane if something goes wrong.

The system is not foolproof.  One SAS flight a couple of years ago between Stockholm and Copenhagen was complicated by a pilot falling asleep and locking the door.  The co-pilot tried to get back after going to the bathroom. Despite anti-terror doorproofing, he finally managed to get back in the cockpit.

Are There Other Rest Problems Among Public and Emergency  Shiftworkers?

Most shiftworkers fall asleep.  Police do that frequently, as appeared in a recent Harvard study of North American police forces.  Sleepy police made a lot of mistakes.

Moreover, shiftwork may produce a real problem for shiftworkers in terms of high sleep apnea rates.

In the example of the policemen study, several researchers, including Dr. Charles Czeisler, chief of sleep medicine at Harvard, lauded the Massachusetts State Police for demanding physical fitness tests each year.  The State Police weighed less and complained of sleep problems far less frequently than other police forces.

Objective sleep testing provided a less laudatory story.

When Massachusetts State police were screened for sleep apnea, people screened to have and not have sleep apnea were studied. Among the police felt to not have apneas, fully 47% had more than 10 stopped breathing episodes each hour.  In other words, in the healthiest group of police, in a subgroup further screened to not have sleep problems, almost half had 10 apneas an hour.  Sleep apnea is diagnosed when people have just 5 or more apneas per hour.

Should I Be Worried About Sleepy Transport Workers?

Certainly.  Rules should be changed so transport workers can nap under controlled conditions where others are performing their job.  Works need to restore and refresh themselves so as to be able to work in the wee hours of the morning when humans are meant to be asleep.  This should result both in less accident, and better health for shift workers.

Yet the general population also suffers from sleep problems producing transport disasters.   Many thousands of people die or are maimed in transport accidents  each year – as drivers, passengers, bikers or pedestrians – due to excess sleepiness.  The bigger public health problem probably is occurring with the sleep deprived general population. Pilots and truck drivers are professional who may be more capable of catching themselves driving or piloting poorly  than average folk.

What Can Be Done to Make People Less Sleepy?

Consider the recent words of Lynn Parramore, a writer who had some understanding of the importance of rest:

“As we learn more, we may realize that giving sleep and rest the center stage in our lives may be as fundamental to our well-being as the way we eat and the medicines that cure us. And if we come to treasure this time of splendid relaxation, we may have much more to offer in the daytime hours.”

Remember, rest is necessary to survival.  We need rest to regenerate our bodies in order to live.

Sleep is as necessary to life as food.
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I’m probably moving again soon. I have no idea where we are going. Maybe michigan, maybe somewhere else. Where ever I go…It has to be easier than here

The Romans knew it two thousand years ago – everything in life is timed.  Your body is a hive of interlinked clocks.   Some operate over less than a second, others work over seasons or years.

Yet the most studied internal clocks are those that control our 24 hour day.  Called circadian – for circa dia, Latin for around a day, they let our body time everything to the cycle of night and day, light and darkness.

Including everything we do biologically and physiologically – including how we regenerate ourselves.

It’s long been hypothesized that many changes of aging are induced by changes in our clocks, and their overall effectiveness. The prime time setter for our bodies and their clocks is light – particularly sunlight.

Could our circadian clocks become poorly set by the eyes’ aging lens?

That’s exactly what recent research argues: change the lens and you also change your inner time.

Aging and Regeneration

Without a timing mechanism you don’t get things to work right.

Recent work at the University of Kansas, discussed in the New York Times and elsewhere, shows that the eye’s ability to respond to blue light changes with age.

A lot.

Data are that a ten year old has 10 times the photosensitivity of a 95 year old. There is lots of evidence now that blue light especially makes us more alert, more aware, more productive – even when people are unconscious of how much blue light they’re getting.

And when the lens grows older it gets more yellow.  That cuts out much of incoming blue light.

The decreases are so severe that short bursts of light that make young people more alert – and stop their melatonin production, the hormone of darkness – have no effect at all on middle aged folk.

How is it that your two eye lenses change so much?

Unlike most of your body that remakes and redoes itself within weeks, the lens you get is the one you were born with.  The lens lasts as long as we do – or until a cataract operation replaces it with something new and clear.  (You can gauge that by looking at infants’ eyes.  They look big – because they don’t grow with age, like almost all the rest of our body.)

And now the evidence is that once that happens, older folk have less insomnia.  Less depression. More alertness.

Al because their clocks are better timed.

Infection, Immunity, Sudden Death and Cancer

Screw up animal’s circadian rhythms and they get sick.  The same is true of people.

Folks who do shift work – about a quarter of the working population –experience higher rates of heart attack, stroke, depression, GI disturbances, and some tumors.

Now some of the reasons are coming out.

It was known for a long time that morning is the peak time for sudden death.  Monday morning is particularly lethal, as people blow out their body clocks over the weekend, going to bed late and getting up late.

Till Sunday comes.

Now recent work shows a particular protein, which changes heart rhythms, follows the same rhythm as does sudden death incidence in people.

It’s also been known that many infections – including serious ones like sepsis – are more prone to occur in the late hours of the night.

And yet another protein, named TRL 9, follows the same pattern of activation/infection.  Give immune vaccinations when TRL9 peaks – at least in animals – and sepsis markedly declines.

Similarly, many tumors grow up faster in the night.  Oncologists in France and Britain have shown much better responses when the tumors are hit when they’re growing fastest.

Time your drugs accurately and they work better. Statins are virtually useless at decreasing cholesterol unless given at night.

Because night is when we make the cholesterols that flow through our blood and line our cells.

Bottom Line

Everything follows a pattern in time.  Run your life according to a schedule that fits your body’s rhythms and things work better.

Light is an impressive drug.  It can treat depression, change immunity, potently reset our clocks.

And the power of light declines with age.  So we need more light.

Older folks should get more sunlight on their eyes – especially in the morning – to reset their clocks.

There really is a reason to live in the Sunbelt.
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while memories of passion and its throes
fade slowly as will other sort of stain.
night lingers dreamless tho her eyes may close

this pall is all she feels these days or knows;
dark ghostly presence habiting her brain
lasts longer to enslave her i suppose.

black canvass grants no star to juxtapose
‘gainst other constellation in its reign.
night lingers dreamless tho her eyes may close,

staid as a granite statue her repose
grants naught of respite. while in soft disdain
night lingers dreamless tho her eyes may close
lasts longer to enslave her, i suppose.

Due to some medical reasons and the choice to make changes in my career journey late last year, I’ve spent the past several weeks doing a lot less than what’s normal for me. Partly due to my physical recovery and partly my need to mentally slow down and recharge my batteries. But that has left me with a lot of non-busy time on my hands and I’ve realized that just maybe I’ve been defining myself too much in the “doing” rather than defining myself in “being”. See I’m great at doing.  Just give me some project, job or task and I’m off. I’m discovering that when that is minimized, simply being creates a certain amount of anxiety for me. Inactivity cuts at the issues of self-worth and value.  Internally, questions surface like “if I’m not doing anything, what use am I? What value do I bring to the table?”

Now before you all start emailing, tweeting and calling to make sure I’m okay, I’m fine.  I don’t live in the space of anxiety all of the time but enough lately to take notice.  I have to intentionally reaffirm my self-worth and value simply because I’m here.  What I know is that I am enough and that I have inherent value regardless of what I’m doing and even if I’m not doing anything. But when you’re use to being very busy with all of the responsibilities of life, you can begin to define yourself by those activities and other people will define you by them as well. Ever notice how many people want to be around you when you seem to have lots going on? That’s not a bad thing. We’re all drawn to energy. But when the momentum is interrupted, things and people fall away. That’s not a bad thing either.  What’s bad is that we turn on ourselves because we internalize the belief that doing trumps being.

This time of transition and slowing down has been great for me…a sabbatical of sorts. It’s helped me to recognize some great and not so great things about myself and sometimes the constant introspection has kept me up nights, like right now:-). 

I’d encourage everyone to take some time to slow down, recharge your batteries and get to know yourself better.  Recognize that you are enough simply because you ARE. The “doing” is merely an expression of who you are.  Plan to take a week or two off this year to be with yourself and maybe even be by yourself.  Don’t fill the time with lots of activities….just BE.

And with that…..good night (or morning depending on where you are in the world).

Trellis

Rest is as necessary to life as food. Without it the body does not restore and regenerate.
Hospitals don’t seem to fully understand that connection.
A new study of noise in hospital rooms, published in the Archives of Internal Medicine, was not good news. The average hospital room ran about 50 decibels during the day – much more than the suggested 30. Alarms and intercoms sometimes can blast noise levels up to 80dB.
Try sleeping when it’s 80 dB in your room. No wonder hospital patients claimed to sleep an hour less in hospital than while ill at home.

Noise and Health
Humans pay vast attention to all our senses, generally first visual and next aural information. What we hear goes all over the brain.
Even if we don’t pay conscious attention to it.
Our world is noisy in a way unknown to our ancestors. Normally we could hear the sound of air – now it’s hard to hear our cell phone.
In previous generations doctors worried about how rock concerts increased deafness. Indeed, hearing loss is occurring early. Many in their fifties and sixties cannot hear well.
And what of today’s youth with ears hooked into iPods producing vigorous, chromatically dense stereo? Not to mention our streets and homes filled with the noise of leaf blowers?
We should expect that deafness will come early to many. The potential results in terms of depression, anxiety, and disillusionment have not been toted up. Yet as people like Harvard researcher Jo Solet have explained, the costs will be enormous. Now consider a particularly vulnerable group – the ill. What do patients want in a hospital bed?
Calm. Quiet. A restful place to recover.
Instead, especially in an ICU, you get the equivalent of treading the tracks at Grand Central Station.
Beyond the noise of IV machines and beeping sensors, the sweeping sounds from the hallways, alarms and intercoms, patients are frequently interrupted during sleep for “monitoring.”
Blood pressure and heart rate can be taken by machine. Yet many a patient wakens from deeply desired REM sleep at 4:30 or 5 AM to have their blood drawn. Or gets sent down for an imaging study that perhaps may start in two or three hours.

Rest and Recovery
How can people fully recover in such noisy hospital beds?
The answer: Slowly and fitfully – less effectively than they should.
Lack of sleep is related to higher rates of infection; ineffective immunity; more coronary artery disease; greater insulin resistance.
Could the high glucose readings in hospitals be related simply to lack of sleep in rest interrupted patients? Perhaps more than is surmised. Chronically sleep less than five hours and diabetes rates more than double.
So what is to be done?

Protect Yourself
There are many options for patients coming into a hospital who know that sleep is required for their recovery – and that pain, uncertainty, discomfort and bizarre hospital schedules will make that difficult at best:
1. Bring noise cancelling headphones, or regular headphones or ear plugs.
2. Carry with you an eyemask for sleep. Light often leaks into hospital rooms, even in the dead of night.
3. If you can bring in favorite books or just books that are calming, optimistic and soothing – which can then double as sleep aids.
4. Prepare to catnap in the afternoons – you have to sleep sometime.

Other Remedies
Humans are meant to sleep in the afternoons, even if we rarely do so these days.
The hours between 1 and 4 PM should be designated nap times in hospital wards.
Some medical actions will need to be done immediately – yet not everything.
Letting people sleep in the normal afternoon nap slot of the human body clock can help them recover from the sleep lost at night.
Similarly, the hours between midnight and 5 AM should be considered sleep times in most wards.
Many wards indeed try to make such hours longer – from around 11 PM to 6 AM.
But with nurses and doctors treating charts preferentially to people, often the early morning hours are not treated as true sleep times. There is too much noise about.
Music may sooth the savage beast, but noise can wake the moribund.
Patients need peace. Night-time should be quiet indeed.
Everybody needs to sleep – especially the ill. When ill you need more time to rest and recover – and sleep.
Rest, sleep, Sarasota Sleep Doctor, well-being, regeneration, longevity, body clocks, insomnia, sleep disorders, the rest doctor, matthew edlund, the power of rest, the body clock, psychology today, huffington post, redbook, longboat key news

Paula Deen may be getting the headlines, but diabetes is a threat to America’s health – and to our economy.  If present trends continue – in some ways things are getting worse – perhaps one third of Americans will become diabetic by 2030.

Diabetes means that our main fuel source – glucose – is out of whack.  The problems it causes are numberless – heart attack and stroke; blindness and loss of limbs; sleeplessness, fatigue, and lack of productivity.

Much of the blame for our increasing diabetes numbers is placed on our national obesity epidemic.   Indeed, type II diabetes – what used to be called “adult onset” until it started showing up in many kids – is considered primarily weight related.  Type I diabetes is mainly felt to be autoimmune – something kills off the cells in the islet of Langerhans comfortably pouched inside the pancreas.

Yet type I and type II diabetes are not necessarily separate, and many of the “causes” of diabetes are not clear cut.

Here’s one you may not be aware of – sleeping less.

Sleep Your Way to Diabetes?

Much research recently has gone into demonstrating how sleep loss deregulates glucose control.  Admirably performed by Dr. Eve van Cauter and her group at the University of Chicago the data have shown convincingly that sleep interruption – even relatively brief – markedly disrupts insulin and glucose control.

But what about in normal populations?

The Sleep Heart Health Study, with parts performed at Boston University,  looked at people aged 53-93 in the population, their breathing, sleep, and heart function.

Who got diabetic?  People who slept less than 6 hours a night.

For those who did, their rates of diabetes increased 60-70%

Sleeping less than 5 hours a night?  Diabetes rates became 2.5 times as great.

Sleeping Less Changes Glucose Metabolism

Certainly there are healthy people out there who normally sleep 3-4 hours and have no health problems. Their bodies are built to sleep little and simply need less sleep than the rest of us.

But they’re pretty rare.

For much of the population sleeping less than 7 hours a night is routine – absolutely normal.

And that is not necessarily the total amount of sleep.  Most people apportion time in bed as sleep time.

Which is not their actual amount of sleep.   Even “perfect” sleepers may sleep only 95% of their time in bed – or less.

It’s normal for the body to wake up 15-20 times a night – and for people not to recognize it.  We normally have to be up around 6-7 minutes to remember being awake.

So the amount of sleep you think you actually get may not be accurate.  My personal record – a woman who walked out of the sleep lab and thanked us for her “best sleep” in 4 years.

She claimed she did not awaken once.

She actually woke up 1200 times. Her longest period of sustained sleep – 90 seconds.

And then we come to shift workers.

Shift Work

Shift workers often take away the letter f when describing their work.  Humans are not built well to work through the night.

We’re even less well adapted to swing shifts.

Yet they are common today in America – especially with 24/7 job demands in an economy where jobs are scarce.

Do shiftworkers have more diabetes?  Apparently  – along with more heart disease, strokes, hypertension, weight gain, and depression.

Lack of proper sleep is a systemic problem for the body.

Sleep and Diabetes

Human bodies are  complex information systems.  One element does not necessarily “cause” another – but interacts with many other body systems to potentially cause multiple troubles.

Sleep is necessary to life because rest is necessary to life.  If you don’t rest, you don’t restore – and more critically, regenerate your body.

As most of your body regenerates within about 4 weeks, you need rest like you need food.

So it makes sense than sleeping less than 6 hours increases your rate of diabetes.  Not getting enough time to regenerate basic cells and organs has an impact on your ability to control energy metabolism.

Plus a lot of other things.

Protect Yourself

To protect your health you have to do some basic things. First is use your body the way it’s built.

We’re built to sleep.

Lots of Americans are sleeping around 6 hours – or a little more – each night.

But that level of sleeping may be a big mistake – especially for our internet attached young folk, who need far more sleep to function than adults – particularly for the learning required by their rapidly reorganizing brains.

Diabetes is a real scourge.  Even people who don’t weight much – especially Asians – are increasingly experiencing it these days. Preventing diabetes involves moving, eating whole foods, having a reasonable program of eating, physical activity, and rest throughout the 24 hour day.

People should be strongly encouraged to do what they can to not  become diabetic.

Protecting sleep time looks like a reasonable price to pay.
Rest, sleep, Sarasota Sleep Doctor, well-being, regeneration, longevity, body clocks, insomnia, sleep disorders, the rest doctor, matthew edlund, the power of rest, the body clock, psychology today, huffington post, redbook, longboat key news

No, it's not the stress....I think this is why I can't sleep at night.

Dear Makers of Electronics and Small Household Appliances,

What is your obsession with blue L.E.D lights?  I have three items in my bedroom that, at night-time, make it appear as thought I am asleep in an aquarium.  My room is bright and blue and it’s because these three things have those stupid L.E.D lights in them.

1. Humidifier.  Why?  I don’t need to see the vaporized water. My lack of a midnight nose bleed is enough to know it’s working. I am not seven and I do not need a night-light. I just want to sleep peacefully in a climate controlled room with a decent percentage of humidity.
2. Speakers. Why? I sleep with music on. It lulls the dudes in my brain back to sleep when I wake up in the middle of the night thinking about a credit card bill I may have  forgotten to pay. (One night, I couldn’t rest until I went online to check my accounts. Turns out I actually did forget one.) But I don’t want a radio in my room, so I have my zune and a set of speakers. But the bottom of these speakers glow a ghostly , eerie ,blue so bright that I actually opened up the speakers and snipped the wires to the lights. It was so bright, it was laughable. Great speakers made extremely annoying by an unnecessary light. Not everyone is 19 in their first apartment. Some of us just want some quiet tune-skies to fall asleep to.
3. USB power outlet. WHY!?! In order to charge my zune or power anything else that has a usb connection I have a usb power adapter. Plug it in the wall…boom…charge it without a computer. But it has the same blue l.e.d light. Why? Again, seeing that my item is working or charged is enough for me. I don’t need mood lighting!

In closing, I just wanted to inform you, dear manufacturers of consumer products, not everyone thinks L.E.D lights up the coolness factor on every product by a thousand fold. In fact, i would argue that it makes some things tacky. So please, turn off the lights on unnecessary L.E.D’s

Thank you.

Can you get addicted to internet use? A new Chinese study in PLoS 1 argues that it certainly happens; that it clearly changes brain and behavior; and that the brain changes seen are in many ways similar to what happens with drug addiction and gambling.

Kids Who Can’t Stop

The adolescents – aged 14 to 21 – studied in Shanghai and Wuhan- were a rather special group. Their preoccupation with the Internet was encompassing. They took more and more time on the Net; tried to cut back but could not; felt restless and irritable when they did; stayed on longer than they should. Many also lied to their families about their use of the Net, and jeopardized school or job performance.
They really couldn’t stop.
But they were not depressed. Previous researchers had argued that kids addicted to the internet were simply depressed, drug addicted or psychotic, or suffering severe anxiety disorders – their compulsive Net use was just an outlet for other problems. The Shanghai adolescents were clinically excluded from having such problems. They were then matched with a control group age and  sex matched kids – and sent off to be tested in the MRI machine.
Were the compulsive internet users truly comparable to the controls? No. On at least one questionnaire the unstoppable internet users were more anxious than the control group. Yet anxiety was certainly implied in their inability to stop using the Net – and in its deleterious social results.

Different Brains

The compulsive internet users certainly looked different from the control group. Previous work had shown decreased grey matter in the cingulated cortex, insula and lingual gyrus – areas involved with emotion and executive decision making.  Earlier studies argued that information processing and  impulse control were adversely affected.  The Shanghai-Wuhan researchers were interested in white matter – the connections between different brain areas. And they were different.

Major changes were seen in the corpus callosum – which connects hemispheres – and areas like the internal capsule and precentral gyrus. The authors argued that white matter was disrupted in a host of areas involving emotion, decision making, and repetitive behaviors. The results were fairly similar to what was seen in people who frequently used alcohol, marijuana and cocaine.

Implications

1. There are kids using the Net who truly can’t stop. Though clinicians argue about whether they’re behavior is “compulsive” as opposed to addictive, it really messes up their lives.
2. Though the adolescents looked at in this study were truly extreme – and overall may be few in number – their brains were distinctly different in unhealthy ways.
3. Internet use is probably like most behaviorally defined actions – a continuous variable – not a dichotomous, yes or no one. Lots of adolescents may not be as compulsive as these Chinese kids, but fear being disconnected from the Net and deeply dislike having to focus their attention elsewhere. Many kids may be able to get away from the Net much of the time – but not all the time.
4. As noted by Dr. Henrietta Bowden-Jones in an interview with BBC News, behavioral “addictions” led to the same brain changes as pharmacological ones.
5. China is advancing rapidly in biological and medical research, as it has in other arenas. Problems with plagiarism and overzealous publishing should not obscure excellent scientific work.

Bottom Line:

What you do changes your brain function and anatomy – rather quickly. Compulsive internet use can appear – at least sometimes –  as functionally destructive as compulsive drug use or gambling.

And compulsive internet use may become a preferred outlet for much of the society suffering from depression and anxiety disorders.

In this case, continous connection may ultimately create disruptive disconnection – social, psychological, and emotional.

What we do is what we become. The Net continues to change human brains, as Nicholas Carr pointed out in his book “The Shallows.” The changes will most probably become more profound as virtual reality technologically improves.

Will kids appearance on their Facebook page become more important to them than their real appearance?

We may soon find out.
Rest, sleep, Sarasota Sleep Doctor, well-being, regeneration, longevity, body clocks, insomnia, sleep disorders, the rest doctor, matthew edlund, the power of rest, the body clock, psychology today, huffington post, redbook, longboat key news

You can’t sleep and you must.  You start to take sleeping pills.

They work – for a while.  Then you find you need more.

You try some nights without those pills.

You can’t sleep at all – until you take the pills again.

You’ve got rebound insomnia.  Join a very large group.

When Work and Family Stress Become Too Much

Let me introduce a client of mine.  She enjoyed her job but was induced to do the same work for another company.

Her new co-worker did not play by the rules.

She missed her old job but could not go back.  To keep up with the new one she worked 8 AM to 7 PM six days a week.

Her mother came in to help raise her daughter.

For the first time in her life she could not sleep.  She tried different sleeping pills.

They were great – until they didn’t work.  She took more.

Soon she was on more than one benzodiazepine – drugs like valium originally devised for anxiety and sleep.  She added zolpidem (ambien) to the mix – not knowing that zolpidem hits one of the same brain receptors as the benzodiazepines.

Now she can’t sleep without multiple pills.

According to a friend of mine who has longed worked at health insurance companies, the use of anxiety and sleeping pills in 25-40 year old female workers is skyrocketing. People are scared of losing their jobs. To many companies competing in this economy, if  work is making people anxious, sleepless, and crazy, that’s their problem.

Now it’s our problem.

Can You Get Rebound Insomnia with Over the Counter Sleeping Pills?

Definitely.  A recent study at Henry Ford Hospital claimed that 30-40% of people  taking sleeping pills – for short periods or a year – had rebound insomnia.  The rates were the same whether they took zolpidem or placebo.

Yes, you can get habituated to non-prescription sleeping pills – easily.

I like this research group very much, but my clinical experience is that it’s still often much harder for people to get off prescription benzodiazepines and others, like zopiclone and zolpidem, than it is Benadryl or “relaxation” drinks.  Often you need to a physician’s help to stop using the pills.

Some things you can do on your own.

Getting Off Sleeping Pills I:

If even placebo can cause rebound insomnia, it’s clear behavioral cues are pretty important in keeping people on sleeping pills drugs.

For many pill=sleep.  No pill means no sleep.

First order of business – do natural things that help you sleep:

1. Create a sleep ritual – floss your teeth, brush teeth, put out your clothes for the next day. Condition your brain that a set hour is sleep time – and a set wake time, too.

2. Rest before sleep.  Take at least an hour before bed time to turn down the lights, turn off all those electronic devices, and do something that helps relax and regenerate the mind – using active rest techniques like listening to music, yoga, paradoxical relaxation, meditation, and reading.

3. Get fitter.  Walking in the morning – especially in sunlight – helps people sleep.

Getting Off Pills II:

Determine if your lack of sleep is due in part to  overarousal – too much work stress, family stress, impossible  scheduling and personal demands.

If so, use cognitive behavioral homework to calm things down.  You’ll probably also need to make your schedule accommodate enough time for rest – without it your body won’t properly regenerate.

However, if you suffer from pain, depression, anxiety disorders, or have multiple medical disorders, you may need to treat them effectively to help you get off sleeping pills.

Off Pills III:

If things are medically uncomplicated – you’re pretty healthy except for inability to sleep – most people try slow tapers.

I emphasize the word slow.

Cutting your dose of pills with a knife, paring down the amounts, often helps – especially if you have a new, decent sleep ritual going.

It once took me three years to get a patient off sleeping pills.  True, she had been on multiple pills for 60 years, and was 95 when I first met her.  Her rebound insomnia was intense, but gentle changes worked.

Most people get off pills more easily when they don’t have a deadline measured in days or a few weeks.

Off Pills IV:

Sometimes you simply can’t get off what you’re taking.  Your doctor may help you by shifting you to another agent that can be more easily tapered.

Some people get off benzodiazepines by going on trazodone, a sedating antidepressant which can also treat anxiety.  Many physicians use a variety of approaches – as every individual requires different techniques.

Bottom Line:

Rebound insomnia is common.  It afflicts many – whether they’re on prescription or non-prescription sleeping pills.

There are many ways to get off pills. Getting normal sleep – as described in my book “The Power of Rest” – is a worthy first step.

Most people sleep more naturally and fully without pills.  Sleep is too much fun to require “mommy’s little helper” each night.
Rest, sleep, Sarasota Sleep Doctor, well-being, regeneration, longevity, body clocks, insomnia, sleep disorders, the rest doctor, matthew edlund, the power of rest, the body clock, psychology today, huffington post, redbook, longboat key news

My internist cousin says he knows who will live and die among his older patients:  those who own dogs.

The Centers for Disease Control (CDC) provisionally agrees. They believe the data show that dog (and cat) ownership can lower:

Blood pressure

Feelings of loneliness

Cholesterol and triglyceride levels

While increasing -

Chances for exercise and socialization

So how do we get all these benefits from another species?

Two Different Species of Social Animal

In “Dog Sense” anthrozoologist John Bradshaw argues we should not look at dogs as small wolves.  Humans and dogs have co-evolved for at least 20,000 years.

And both of us were – and are – very social animals.

Humans pack themselves into cities where thousands  live in the same building – and millions in the same congested space. Wolves can run in packs, but often operate in cooperative, multigenerational families.  Wild dogs living near humans appear less hierarchical and more prone to cooperation than wolves.

Each species views the other through its own preconceptions.

A recent Hungarian study shows demonstrates dogs are constantly watching their owners, looking for body language for signs of what they will do next.  Stare at a dog and it may follow your eyes wherever they gaze.

Bradshaw argues that dogs now respond to humans with a sort of arrested development – failing to develop the maturity they possess in the wild.

Humans in turn often respond to dogs as if they were infants or children.  We smile when we see them.  We hug them.  We even dress them like small kids.

Both species are aided by such exchange.  Humans can receive sometimes unconditional love, while dogs receive shelter, food, affection, and stability.

Social support is a major factor in human survival.  It can decrease cardiovascular disease, depression, perhaps some tumors.

Yet dogs “see” the world very differently from us.

Smell Brains and Visual Brains

Dogs have a powerfully developed rhinencephalon – smell brain.  Their sense of smell can be 10,000 to 100,000 times more acute that ours.

For humans it would be as if we could see on the microsopic level simultaneously visualizing with exceptional clarity for fifty miles in every direction.

Dogs live in a different sensory universe.

We come to a field and see – a field.  A dog senses its present inhabitants – and many that have been there over the past few days or weeks.  Most of its fellow dogs have left traces, making that space a giant social networking field – a sort of olfactory Facebook.

Much of the information received by the human body and brain is not conscious.  We create and respond to pheromones, hormones sent through the air – yet we don’t know we do.

Dogs sense those hormones.  They can smell our skin and sense our stress levels.  They’ll know many things about us we don’t  – because they smell them.

And that sense of smell also makes them like to walk.

Walking for Health

Humans are natural walking machines.  Yet many of our present social arrangements – whether it’s computer monitors, cars, or desk jobs – suppress this natural tendency.

At great loss to our health.

Dogs can overcome this huge public health error.  They like to roam, travel, weave, trot – and sniff.

We owe them the opportunity to fulfill that sense of adventure.

Dogs often cause their owners to walk.  Walking can improve mood, heart function, biological clock syncrony, plus  our natural capacity and pleasure in social existence.

Dogs can help humans a lot. (Cats are wonderful, too; they just don’t tend to walk their human compatriots quite as much.)

Interspecies Synergy

To get the most pleasure from dogs it probably pays to try and think like your dog – at least now and again.

You can try to see the world the way a dog does – as visual, social – and powerfully olfactory.

Getting out in the environment is immensely useful to dogs.  They find out about the rest of the community – human, canid, and other. They need to sniff the world.

When they go out we go out – increasing the information flow into our lives.  Walking twenty to thirty minutes a day can make you grow new brain cells – in memory areas – that you can really use.

By walking with your dog you create new information – and new information storage.

That walk can calm and pleasure your dog – and provide you new adventures, too.
Rest, sleep, Sarasota Sleep Doctor, well-being, regeneration, longevity, body clocks, insomnia, sleep disorders, the rest doctor, matthew edlund, the power of rest, the body clock, psychology today, huffington post, redbook, longboat key news

Americans are severely rest deprived.  Combine 24-7 electronic availability with fast changing (or disappearing) jobs plus kids and elderly parents, and Americans are regularly slipping to around 6 and a half hours of sleep a night.  Those are levels at which weight gain, increased cardiovascular disease, more flues, colds, and other infections and depression become more likely.

It does not have to be this way.  Flexible work – looking at results rather than hours in the office – may aid workplace productivity and social cohesion – and make people more rested.

If Results Are the Only Things That Count

Best Buy recently tried new work arrangements for their “Results Only Work Environment” project.  Reported by Drs. Kelly and Moen in the December issue of Journal of Health and Social Behavior, they gave more than 600 headquarter employees  the option of working when and where they decided.  They did not have to ask supervisors about their chosen workplaces and times beforehand.

The end effect – they got to decide where, when, and how they worked – but only if the job results were satisfactory.

Their personal results were:

Better job satisfaction.

More work-family balance

Better self reported health

Better self-efficacy

Better energy

Less feeling of burn-out

Last but not least – 52 minutes more sleep each work night.

Why Flexible Workplaces Work

When you control where and how you work people feel more in control.

They like that – a lot.

Those employees also feel more motivated.  If the end result is what matters rather than merely appearing at the office, people are incentivized to get the job done.

Controlling time also becomes a major benefit.  If work can get done flexibly, family affairs can be tended to – especially uncontrollable emergencies like illnesses of  children or parents.  People can get to see each other more often rather than quickly run away to work and school.

They also get more time to control their rest – sleep and active rest – and further their body’s regeneration.

Burn out is not only a psychological entity.  Without sufficient rest and physical activity, body regeneration does not properly progress.   People age faster than they should – and feel it.

Sadly, even in an age of cloud computing and continual  internet access, flexible workplaces will face an uphill slog.

Economic Uncertainty and Work Flexibility

Many things these days are uncertain – politics; international economics; the state of health care; credit and banking; health insurance.

With so much uncertainty, people want to stick near the office – if only to preserve their jobs.

Uncertainty also tends to decrease reform and progressive actions – even if industry needs greater and more continuous innovation than ever  to globally compete.

And many jobs – including mine, as a private practice physician – still need regular schedules in order to proceed.  Patients can and will be scheduled flexibly – but regular work hours make the process much simpler and more effective.

So flexible work environments face at least temporary roadblocks.  If editors at the Economist are correct, workplaces will soon be more regular, more formal, and more tense.

It’s rather like the situation with health as opposed to our national obsession with health care.  National health can really improve if you look at the truly important outcomes – like overall survival and job productivity  rather than how much money gets spent.  Once you consider health versus health care, far, far cheaper ways of improving our personal and collective health become possible.

Let’s hope similarly new ideas will engage industrial and commercial industry.

Not everyone has to appear in the same office  every day five days a week from 8-5.  In many cases, they, their families, and the business, will be better off if their work, workplaces, and time are more flexibly scheduled.

And everyone can become more rested, too.
Rest, sleep, Sarasota Sleep Doctor, well-being, regeneration, longevity, body clocks, insomnia, sleep disorders, the rest doctor, matthew edlund, the power of rest, the body clock, psychology today, huffington post, redbook, longboat key news

You know things are screwy if nurses can lose their jobs for talking to patients.
A nurse I know at the main regional hospital has an excellent record, plus decades of experience on medical wards. She was admonished that she was “wasting” too much time talking to patients.
“They told me to get out of the room quickly. I should tell the patient that I could get someone else to talk to them later.”
Who was this “someone else?” It might be a social worker or psychologist, but not someone with the same medical training of specific knowledge.
“The patients point out to me that I’m there right now, that they have a problem now, and I know about them.”

Directed to Distraction

The December 15th New York Times highlighted an article about how electronic devices may interfere with patient care. Neurosurgeons talk to their families while operating. Half of cardiopulmonary bypass technicians text during procedures; over half chat on cellphones. Anesthesiologists shop on eBay as they pass gas.
Are you surprised? People surf the Net and multitask in bed with their partners; in the middle of “critical” business meetings; while driving. Last week a nurse and I tried walking across the street. The white walk sign flashed right in front of the hospital. A young woman sped by and would have hit us except for our trained hesitation.
“What was she thinking?” the nurse asked me.
“I don’t know. She was texting.”
Half of young drivers text en route. Why should surgeons, nurses, or medical technicians act very differently?

Ghost Wards

Medical care is presently “data driven.” Go to wards and you’ll discover an eery silence.
Almost everybody is watching computer monitors.
They may be on mobile pads, or on towers at the nursing station. Barring the cacophony of television ads, the patient rooms are mainly quiet.
The medical types are looking at the numbers.

Number Managers

Many pain patients describe  the same experience – they’ve come into a physician’s office to be told that “we could not find anything” or that “nothing is wrong.”
“So why do I hurt so much?”
Few of them know of the study done 20 years ago in the New England Journal. A hundred MRIs of the back were reviewed by radiologists and surgeons. Of them, 39% were found to be abnormal. The surgeons wanted to operate on six of the patients, three emergently.
All of the 100 “patients” were asymptomatic.
Physicians today are more statistically literate, less prone to “hunt down” every abnormal lab finding. However, if the numbers are “good” they may question you less. If the numbers are “bad” they “have a diagnostic bias” to try and explain the innumerable symptom complaints they hear.
Putting all the data together is what clinical decision making should be about. But that requires frequent patient discussions – because people provide you information you’re not going to get from the chart.

Reasons to Talk to Patients

There are many reasons nurses, doctors and all medical workers need “face time” with patients rather than to simply peruse electronic records. Here are a few:
1. You get new, often critical information – including otherwise obvious things like bleeding or in terrible pain which patients may not offer during a quick, efficient “patient visit.”
2. While the human body is an extraordinary information processing unit an electronic medical record is a woefully inadequate one, not allowing you to access the many different forms and signs of human communication – eye contact, skin pallor, smell, physical motions, facial gestures – that exist when face to face.
3. Any medical worker can be part of the placebo effect that may be the most important factor for many in getting well.
4. Education – if health is the goal of treatment, then discussing with patients what is wrong and what they can do to prevent future problems is a critical part of care.
The outcome of health care should be health – not just good numbers.
Nurses know that. That’s one of many reasons nurses are going on strike in the Northeast this week – despite severe economic woes.
They are telling the media they need more time to do their jobs. Part of that time is required to talk with patients – to treat them and protect them.
Rest, sleep, Sarasota Sleep Doctor, well-being, regeneration, longevity, body clocks, insomnia, sleep disorders, the rest doctor, matthew edlund, the power of rest, the body clock, psychology today, huffington post, redbook, longboat key news

When you see public health advertisements placing a meat cleaver  next to a sleeping infant, it’s clear co-sleeping is no longer a simple matter. Milwaukee’s Health  Department has received has enormous flack, but officials are convinced their ads keeping infants from parental beds will save many from strangulation and suffocation.
But who can you safely and effectively sleep with? Your pets? Your spouse or partner? Is it really better to sleep alone?
On many of these issues the data are sparse and the answers complex. Here is a simple set of pros and cons you can use to make your own decisions.

Sleeping with Infants

Pros

Love
Bonding
Ease of breast feeding
Setting circadian rhythms together for the whole family
Economy
Some data that sleep comes easier to parents and infant, and infants sleep longer

Cons
Consumer Product Safety Commission recommends not sleeping with infants for up to 2 years due to increased strangulation and smothering, with 75% of deaths occurring in first 3 months; other studies highlight increased death rates in the first few months after birth
Some evidence that SIDS  increases with co-sleeping
Worse mortality if parents are smokers, greater risk with drinking and pill taking

Correctives
Put infants on their backs to prevent SIDS; keep their heads uncovered
Don’t cosleep if you smoke or drink
Set up the bed environment so that you make it impossible that the infant can get caught in the bedframe, mattress, or extraneous cords outside the bed; keep out soft items like pillows that can smother infants.

Animals
The (“http://www.wired.com/wiredscience/2011/12/get-from-pet/” target=”_hplink”) majority of US dog and cat owners at least occasionally sleep with their pets. Many single women routinely sleep with their animals. Lots can’t imagine anything wrong with the arrangement.

Pros
Love
Bonding
Warmth – especially on cold winter nights
Resynching – to a degree – pets’ circadian rhythm with that of owners
Some evidence of lower blood pressure

Cons
Zoonoses –  infections brought by animals to humans, which include intestinal parasites, toxoplasmosis, even plague  - a real problem for pregnant or potentially pregnant women and anyone with immune difficulties
Frequent waking – animals don’t have the same circadian rhythms of humans, and don’t go to the bathroom on the same schedule; cats in particular do not respond to voiced directives

Correctives
Keep your animals really clean with frequent washings
Vet visits to rid animals of parasites
Think twice before you let your dog lick your face

Spouse, Partner, or Loved One

Pros
Love
Bonding
Intimacy – and intimate conversations
Sex
Reset of circadian rhythms – to a point

Cons
Snoring – a leading cause of marital discord and surprisingly common
Infections
Allergies
Frequent movement causing awakenings – over half of people over 65 kick their legs, and people often move when getting into different sleep stages -which they can do dozens of times a night
Evidence that people (http://parenting.blogs.nytimes.com/2009/09/15/do-you-sleep-with-your-spouse/” target=”_hplink) sleep better apart than alone – generally because of what’s noted above
Sexual activity with your partner may include meeting microorganisms of all their previous partners

Correctives
Snoring can be the harbinger of sleep apnea, which is generally treatable – by weight loss, CPAP machines, or dental devices
Earplugs and white noise machines
Frequent washing

Social Connection

Two points should be made: First, that co-sleeping is probably as old as humanity, and is culturally, socially, and psychologically prized. Plus social support is a large factor in keeping people healthy and alive, as research has shown repeatedly since Berkman and Syme’s famous 1979 study demonstrating its remarkable health benefits.
Second, lots is still not known about co-sleeping. Research on sleep with animals certainly seems appropriate, as data is meager and the practice extremely widespread.
What does make sense is for families to discuss the matter – candidly and hopefully with humor. How you spend a third of your life is significant in many ways – for pleasure, health and survival.
Rest, sleep, Sarasota Sleep Doctor, well-being, regeneration, longevity, body clocks, insomnia, sleep disorders, the rest doctor, matthew edlund, the power of rest, the body clock, psychology today, huffington post, redbook, longboat key news

Who’s a perfect sleeper?  Gaze in a mirror and you’re probably not looking at one.   In Gallup polls, perhaps only 5% of the population says they sleep well every night.

Yet lots of people have bad nights, with perhaps one third of Americans complaining of insomnia that goes on and on and on.

But many people don’t have prolonged insomnia – just periods where they sleep badly, for one night or a few.  They  often feel lousy the next day – and worry that insomnia might get worse.

So here’s a few techniques to help overcome a bad night’s sleep:

A. Learn to catnap.  The American “lie down and die” method of sleeping, where we go to bed, conk out immediately, and awake thoroughly refreshed is procedure enjoyed by very few.  If you look at past diaries and other historical evidence, human sleep appears naturally triphasic.  It’s normal for us to wake at night and nap in the afternoon.

Naps are among the most natural acts in the world.

So try this:  Find a comfortable place to lie down.  It can be a sofa, a floor where you can place a futon, or just a carpeted space (if it’s during work, talk first with your boss; many folks find that brief naps will improve their productivity.) Get a pillow, or if that’s not possible, wadded up, soft clothing before you stretch out.  Cover your eyes with a night mask, or if unavailable, a washcloth. The night mask’s blanketing of light  often aid sleep.

Next, use some kind of timer – whether from a cell phone, a watch, a computer or just a plain old kitchen timer. For most people, short naps of 15 to 20 minutes work best to refresh.  Let naps go too long and you may get sleep inertia – the grogginess that comes with deeper phases of sleep.  Long naps often also can impair body clocks.

B. On awakening, try to get some light – preferably sunlight – to alert you and get you going. Try physically moving as quickly as possible after waking into morning light – the brighter the better. The benefits include: 1. More alertness 2. Better mood 3. A new reset of biological clocks by morning light, which should make it easier to wake up earlier on subsequent days.  Outside sunlight, if available, is best.

After a bad night people often feel lethargic.  One of the best ways to overcome day time torpor is scheduled physical activity:

C.  Find a time during the late morning or early afternoon where you can do 5- 10 minutes of what for you is relatively intense exercise.  This can be a brisk walk to lunch; going up and down the stairs at work; walking fast or even running over to a park or a business meeting.  Sweating may not be best for office appearance, and make up smudging can be a problem. However, if the activity is short such undesired results may be finessed, and will leave many with a nice glow around the skin.

If your job chains you to a desk, explain you have to use the facilities. Find a far away bathroom and move there and back quickly, using stairs if available.

Alternating mental and physical activity usually improves alertness.  A bad night of sleep often makes people want to watch TV or videos, but try and resist – at least move around first.

D.  Sip cold tea or coffee in the morning.  Energy drinks may be popular, but lack the anti-oxidants and other useful chemicals found in tea and coffee.  Tea and coffee can lower rates of diabetes, Parkinson’s disease, and other illnesses we don’t need.

How much tea or coffee to drink? Studies of medical interns, like those done by James Wyatt, recommend an ounce every hour until early afternoon.  Later doses may decrease night-time sleep.

The Next Night

Most of us can overcome brief sleep deficits. Every night’s sleep is an opportunity for regeneration.  So if you slept poorly the night before, look forward to your recovery the next night.

And please, don’t go to bed earlier – unless you must – so you won’t impair the biological clocks that help you sleep.  Make sure to rest before sleep -  put out your clothes for the next day; floss or brush your teeth; turn off your cellphone, unless it’s used as an alarm;  and rest your mind before sleep with active, calming rest techniques like yoga or paradoxical relaxation.

There are many ways to adapt to a bad night’s sleep.  It’s even better to use ones that help you regenerate your body every day of your life.
Rest, sleep, Sarasota Sleep Doctor, well-being, regeneration, longevity, body clocks, insomnia, sleep disorders, the rest doctor, matthew edlund, the power of rest, the body clock, psychology today, huffington post, redbook, longboat key news

It’s not every day the FDA approves a new drug – especially a new sleeping pill.  Intermezzo is a term that refers to a separate piece that plays in between acts – especially in a musical performance like opera. And now it’s being repositioned to name a “new” kind of sleeping pill – one used  in the middle of the night.

Yet Intermezzo is not a new drug, and may create more of the problem it’s supposed to solve.

Old Wine in New, More Expensive Bottles

What is Intermezzo?  Nothing more than smaller doses of the old generic sleeping pill zolpidem (ambien.)  Zolpidem is very popular – especially among women – and is famous for provoking bizarre sleepwalking for those who don’t immediately get into bed.

Intermezzo will come out in two doses – 1.75 mg – recommended for women – and 3.5 mg – for men.  The lowest available dose of zolpidem is 5 mg.  People wanting intermezzo can get generic zolpidem from their doctors and cut the pills into thirds.  Voila – an old drug has become a new one – at what will presumably be far less cost.

Assuming the cost of using is worth it.

How Is Intermezzo Meant To Be Used?

Only in the middle of the night for people who cannot get back to sleep and have four or more hours of expected sleep yet to come.

That’s a problem.

One of the banes of insomniacs is clockwatching – looking at the clock throughout the night.  Most insomnia doctors and researchers will tell you that clockwatching is a great way to keep people up all night.

Not only do insomniacs who watch the clock keep themselves awake – through also get more aroused and sleepless. And clockwatchers often find themselves waking up in the middle of the night at exactly the same time  – night after night.

They’ve reset their biological clocks – and caused themselves to wake up.

Use of Intermezzo will pretty much guarantee clockwatching – how else will you know you still “have” at least four or more hours of required sleep to go? (OK, you might program your cell phone in some interesting way, but most won’t.)  And people will become conditioned to wake themselves up – to consume a pill.

The FDA’s four hour rule is presumably there so too much of Intermezzo (zolpidem) won’t be sticking around sedating people when awake. Don’t expect that rule to be followed in practice.

At least the weird sleepwalking produced by bedtime zolpidem ingestion may prove less troublesome  with low dose intermezzo.  People are not as prone to do something besides sleep between 1 and 3 AM.

Alternatives to Intermezzo

Lots of people wake in the middle of the night – pretty much all of us.  Most times we don’t know that.  Sleep itself causes amnesia, and our awakenings are so short we don’t recall them.

But if you do fully wake in the middle of the night there are plenty of alternatives to taking a pill.

Like reading and music.

Unlike when using Intermezzo it’s best not to look at a clock at night but to set an alarm and treat every moment before that alarm as sleep time.  Sleep is non-linear; deep sleep and REM sleep may make you feel far more functional than stage 1 sleep, and your biggest REM period is usually right before you wake.

So if you can’t sleep after what you estimate is 5-10 minutes, get out of bed.  Go to a different room or at least a chair – don’t condition yourself to staying in bed if you’re not sleeping.

Next, read or listen to music.  There are many playlists to help you sleep.  Middle of the night books should prove neither boring nor enthralling.  Poetry knocks out many; history works for more than a few, as do travel books, art history, books on music, autobiographies and memoirs. When in doubt, read a book you should have read in high school – but didn’t.

Bottom Line

By encouraging clockwatching and conditioning drug use during the middle of the night, Intermezzo may provoke more chronic insomnia than it will treat. Low dose zolpidem may work for some, especially shiftworkers.  But there are plenty of alternatives for middle night insomnia before you reach for a sleeping pill – and they’re much safer.
Rest, sleep, Sarasota Sleep Doctor, well-being, regeneration, longevity, body clocks, insomnia, sleep disorders, the rest doctor, matthew edlund, the power of rest, the body clock, psychology today, huffington post, redbook, longboat key news