Wednesday, August 31, 2011

The role of sleep is a too neglected aspect of healthcare and the pursuit of wellness. Today, too many of us who put in long hours at work, have families, and pursue personal interests simply may well be negatively impacted by the lack of quality sleep.


It’s Time to Wake up to the Value of Sleep!
John Caldwell, PhD
Fatigue Science, Honolulu, HI

Much has been said about the stress associated with the fast pace of modern life.  Shopping, taking care of day-to-day chores, attending meetings, running to the airport, taking the kids to practice or over to a friend’s house, handling some last-minute details, and just taking care of one more thing that just has to be done today all add up to a frazzled feeling that makes us wish for quieter times.  And on top of the stress and fatigue from the daily rush is the lack of sufficient recovery sleep.  Too much activity and too little sleep are growing problems in lifestyles that already are strained. 

According to the National Sleep Foundation, we are a sleep-deprived society.  Compared to the turn of the century, the average adult has stuffed almost a month of additional work time and commute time into each year.  Meanwhile, 2 hours of sleep are being sacrificed every night to keep up with the increased demands of work, family duties, personal obligations, and social responsibilities.  On average, adults are now sleeping only 7 hours per night whereas our ancestors were sleeping closer to the 8 or 9 hours that are recommended by sleep specialists.   

These days it’s no wonder people just can’t seem to find the energy, concentration, and enthusiasm that are vital to a successful career and/or satisfying home life.  One of the leading sleep experts, Dr. William Dement says: the sleepy brain is a stupid brain, and this is bad news for a society that seems to be chronically sleep deprived.  It is estimated that workplace sleepiness/fatigue is costing billions of dollars every year in lost productivity.1  But there may be even more of a personal cost.

A recent poll found that more than half of adults experience sleep problems every week, and nearly a third fall asleep or become sleepy on the job.2  Even when sleepy people manage to stay awake, their substandard alertness impairs concentration, lowers productivity, degrades work quality, diminishes general quality of life, and compromises personal health.  All indications are that the situation is getting worse with each passing year as the steady increase in work hours leads to a steady decrease in sleep.3  How did we get in this mess? 

Where did all of this sleepiness come from?

Thinking about our present predicament from an evolutionary standpoint, it makes intuitive sense that sleep loss and the resulting fatigue are inevitable consequences of today’s 24/7, highly-mobile society.  From nature’s standpoint, humans simply weren’t meant to work or otherwise remain active for the lengthy periods common today, and people certainly were not meant to work at night or to be constantly changing working and sleeping schedules.4 

 In addition, humans definitely weren’t designed for the rapid time-zone transitions that are an inescapable part of modern jet travel.  Remember that for thousands of years prior to some important technological advancements, people worked during the day and slept during the night, and they did this pretty consistently 365 days a year.  The caveman didn’t venture too far away from home in the dark because he didn’t want to increase his chances of becoming some predator’s dinner, and besides, in the absence of good artificial light sources, it was difficult to hunt and fish in the pitch black of night.  The farmer didn’t work at night for the same reason.  Plowing fields and harvesting crops is problematic when it’s too dark to work.   

Instead, for thousands of years, humans basically stuck to moving around during the day and resting at night, and this provided a high degree of synchronization between the environment’s time cues and the body’s internal rhythms as well as copious opportunities for restorative sleep.  But, after all of this evolutionary time, the last hundred or so years have seen technological advances that have dramatically changed work hours, activity schedules, and travel capabilities, while at the same time, basic human makeup has remained the same. 

Humans had been on this Earth for a long time--working during the day and sleeping during the night--before 1883 when the electric light bulb enabled us to see and to remain active and productive around the clock.  In addition, prior to the widespread availability of affordable air travel, people typically remained in the same time zone all of their lives, or if they moved to another time zone, they did so relatively slowly.  If someone wanted to cross the Atlantic Ocean in the early 1900’s, it took about 7-9 days on board an ocean liner, and this meant that only one time zone was being crossed every day.  Since this agrees with the best rate at which humans can shift their biological rhythms (one hour per day), back in the 1920’s people were able to get off the boat at their destination feeling adjusted to their new time schedule. 

 However, when modern air travel provided the capability to cross numerous time zones in far less than a day, we began our long and unwelcome affair with jet lag.  Now, instead of feeling good on the first day in Paris or Rome or Munich, the fatigue, stomach aches, concentration difficulties, and headaches associated with jet lag are more the norm.  Then, once adjustment finally occurs, the trip home starts the whole adaptation process over again.  For the business traveler, these transcontinental journeys pose a constant challenge to maintaining the alertness and sound judgment required of corporate executives.

The bottom line is that basic human biology is struggling to keep pace with modern challenges-- longer work hours, extra recreational/shopping activities, shift work, night work, and rapid time zone transitions.  The net result has been an increase in fatigue and other problems associated with shortened/disrupted sleep as well as with something called circadian desynchronosis (or disturbances to the body’s internal clock).

Is it Possible to Adapt?

Unfortunately, it is difficult (if not impossible) to adjust to the lack of sleep and constant body-clock disruptions that are now so common.  A lot of people fool themselves into believing that if they can somehow endure hectic schedules for a few weeks or months, they’ll get used to the strain in their lives in the same way that a weight lifter becomes stronger by enduring ever-increasing amounts of muscle stress.  However, learning to live with sleep deprivation just doesn’t work this way.   

As it turns out, the weight lifter is lucky because the body has a basic capability to increase physical stamina by growing new muscle tissue and expanding the blood supply when necessary to accommodate increasingly difficult workloads, but the busy adult is unlucky in that the body’s need for sleep is biologically programmed from the time of birth, and there is no known way to alter this initial programming.  Trying to adapt to getting by with less sleep is about the same as trying to learn to survive with less daily fluid intake.  You can live without proper hydration for a little while, but once the internal reserves start to run dry, weakness, illness, and even death soon follow. 

Researchers have found that people don’t adapt to sleep restriction no matter how hard they try.  Instead, the increasingly sleepy body just slows down, and the brain starts to shed tasks, loose motivation, and try every trick in the book to make up for lost sleep.  In fact, once sleep restriction reaches a certain point, the brain begins taking “micro sleeps” in an effort to keep up.  These short, uncontrollable sleep bouts last anywhere from a few seconds to a few minutes, and what’s really disturbing is that, like the other insidious effects of fatigue, these brief periods of unconsciousness often go unnoticed.   

Next time you’re in a long meeting or sitting in church or onboard a plane, take a look around and see how many of your fellow adults are “resting their eyes” or even drifting right off to sleep for several seconds at a time.  Such dozing is commonplace, and while it may not kill you in the office, the parent-teacher meeting, or the shopping center, it certainly won’t improve your chances of getting ahead in life or feeling your best.  Furthermore, if your everyday lack of sleep leads to a micro sleep on the way home from the office or the gym or the soccer game, you might join the 1500 Americans who each year lose their lives in drowsy driving accidents on the Nation’s highways.

And not only does insufficient sleep create safety and performance problems, but sleep loss impairs health as well.  Recent studies have shown that sleep-restricted people suffer from hormone regulation problems,5 increased sensitivity to pain,6 greater risk of becoming obese,7 and greater likelihood of developing diabetes.8  Sleep-deprived people utilize healthcare resources at a much higher rate than their well-rested counterparts, they are absent from work more frequently, and they suffer from more on-the-job performance problems and disciplinary actions than their well-rested, alert coworkers.

What is The Answer to the Sleepiness/Fatigue Problem?

Despite all of this bad news, there is hope for dealing with fatigue-related difficulties.  The first step is to simply accept the fact that less than 7 hours of sleep per night threatens safety, performance, and health.  The second step is to commit to following a few helpful strategies to improve sleep, better adjust to new schedules, and improve your competitive edge and quality of life.

Are You a Potential Fatigue Casualty?

To begin, take just a minute to reflect on whether your nightly sleep is as good as it should be in order to maintain peak alertness and health.  Ask these questions:
  • Can you easily wake up in the morning without the help of an alarm clock?
  • When the clock goes off, do you find yourself pressing the snooze button?
  • Are there times during the day when you really want a nap?
  • Do you tend to nod off in meetings, while listening to presentations, when riding as a passenger in the car, while flying in a plane, while sitting in the waiting room at the doctor’s office or while watching TV?
  • When you go to bed, do you fall asleep in seconds rather than minutes?
  • During the week, do you long for the weekends so you can “catch up on sleep”?
  • Do you tend to sleep 2 or more hours later than usual on your days off?
Affirmative answers to two or three of these questions suggest a significant sleep debt.  This means that the pressure to fall asleep is higher than normal because the body is sensing that its sleep reservoir is lower than it should be.  As long as this imbalance exists, the brain and the body will be in “energy-conservation mode” in an attempt to survive under less-than-optimal circumstances, and it will be constantly seeking opportunities to drift off to sleep.  Even though sleep-deprived people deny it (because fatigue is clouding their judgment), they seriously need to get more sleep!

Sleep experts have found that the average person needs about 7-9 hours of sleep every night in order to achieve optimal functioning during the day.  This isn’t just 7-9 hours in bed, it’s 7-9 hours of real sleep!  Research has shown that even the loss of 1 hour of nightly sleep rapidly affects the body and the brain, that people don’t adjust to the reduction even after several days, and that they don’t recover from sleep restriction quickly even after they return to a normal 8 or 9 hour sleep schedule. Clearly, sleep deprivation is Enemy Number One for the corporate “Go-Getter”, the “weekend warrior”, and the “harried housewife”.

Solid Sleep Habits for Everyday Life

Sometimes, despite the best of intentions, a good night’s sleep is difficult.  Even though people have a natural tendency to fall asleep easily and to sleep well throughout the night, they often thwart this inborn tendency with poor sleep habits, chemical substances, or unhealthy life styles.  However, developing good sleep habits can overcome self-defeating routines.9  For optimal sleep:
  • Stick to a consistent bedtime and wakeup time as much as possible every day of the week (including weekends).  This will keep the body’s clock regular.
  • Use the bedroom only for sleep and sex (and when staying in a hotel, work at the desk, not in the bed).  This eliminates non-sleep-related associations with the bed.
  • Develop a soothing and consistent nighttime routine.  Watch TV, take a walk, read for a while, take a hot bath, and then go to bed.  Following this sequence every night sets up a behavior chain that prepares the body for sleep.
  • Resolve daily dilemmas before going to bed.  If worries are present, decide a course of action, write it down, and then forget it until tomorrow.
  • Once in bed, avoid watching the clock, even if it requires putting the clock in a drawer.  Worrying about what time it is will only create sleep-robbing anxiety and it won’t add another minute to the night.
  • Set aside 30 minutes a day for aerobic activity.  Research has shown that aerobic exercise accelerates sleep onset and promotes deeper sleep.
  • Avoid caffeinated coffee, colas, teas, or foods in the afternoon or evening.  Caffeine’s stimulant properties affect some people even 12 hours after consumption.  And don’t forget that some medications interfere with sleep.
  • Avoid smoking within an hour before bed.  Nicotine is another stimulant that can delay or disrupt sleep.
  • Don’t consume alcohol within 4 hours of bedtime.  Although alcohol can promote sleepiness, the sleep is highly disturbed because of alcohol’s effect on sleep architecture.
  • Avoid large meals late in the evening.  Discomfort from a heavy meal will have a negative effect on sleep quality.
  •  Lastly, once in bed, if sleep doesn’t occur within approximately 20 minutes, get out of bed and do something relaxing for a while.  Then, when sleepiness returns, give the bedroom another try.
These are proven strategies for optimizing sleep.  But remember, it will take a while to establish new habits that will cancel the effects of long-term inappropriate nighttime routines.  Like anything worth having, restful slumber is worth working for.  Give the plan at least a three week trial before making a final decision about whether or not it’s working.

Help for the Weary Traveler: Hotel Sleep Tips

If sleeping at home is no problem, but difficulties arise when traveling, consider the advice presented below.  Many people find that the uncertainty and novelty of out of town hotel accommodations present challenges to sleeping well away from home. 
  • Apply all of the basic sleep hygiene tips that were outlined earlier. 
  • Make the hotel room less foreign and sterile by bringing along some items from home.  A family picture, favorite pillow, or even the favorite brand of coffee or tea can improve adaptation to temporary accommodations.
  • Become familiar with the new surroundings upon arrival.  Even minor worries can steal sleep, so it is worthwhile spending time finding the on-site meeting room (during business trips), planning next-day travel routes, locating the restaurant where breakfast will be served, finding the fitness center, or just getting the “lay of the land.”
  • Make sure the room is conducive to sleep.  Pull the drapes completely closed to block unwanted and unfamiliar light, make sure there are plenty of warm covers on the bed, set the thermostat to around 68 degrees F, and keep the air conditioner or a room fan going all night to mask out unwanted noises (and/or use foam ear plugs to promote absolute silence).
  • Minimize worries about oversleeping by requesting a wakeup call in addition to setting the alarm clock (and possibly even a wristwatch alarm).  It may seem like overkill, but reduced anxiety about missing the morning wakeup time can help promote consolidated sleep at night.
These strategies can make the difference between a night of tossing and turning versus gaining the restful sleep that is pivotal to feeling great tomorrow.  Combining good sleep habits with the hotel sleep tips, will contribute to peak health and performance while away from home.

What about Jet Lag? Here are Tips for Shifting to a New Time Zone

One final topic that deserves attention from travelers is jet lag.  Traveling more than three or four time zones away from home often takes a toll on both nighttime sleep and daytime alertness.  Jet lag is especially severe when traveling from North America to Europe (as opposed to traveling from North America to Japan or Australia).  Although the flight takes only about 8-9 hours, the readjustment period can take 8-9 days or even longer.  As already discussed, humans require approximately one full day to adjust to every one hour time-zone shift, and before full adaptation occurs, problems arise 1) from having to get up and be active when the body is used to being asleep and 2) from having to sleep when the body is normally awake. 

For example, when a traveler from the U.S. goes to bed at midnight on the first or second day in Paris, his/her brain still thinks it’s only 6:00 or 7:00 p.m, and thanks to circadian rhythms (the body’s internal clock), it’s almost impossible to go to sleep (generally speaking, going to sleep earlier than usual is far more difficult than going to sleep later than usual).  Then, when the alarm clock goes off at 7:00 a.m. Paris time, the body and the brain resist getting out of bed at the internal body-clock time of only 1:00 a.m. in the morning.   

No wonder those trips to Europe just don’t have the magic we think they will!  People might sleep fine on the first night simply because they remained awake so long traveling to the destination, but on the second day, once the prior sleep pressure is gone, insomnia during the local nighttime is likely.  Although there is no “magic bullet” for jet lag, the following suggestions will aid readjustment to a new time zone:
  • Upon arrival, fight the temptation to nap by staying physically active.  Relieving sleep pressure during the daylight will only add to sleep problems at night.
  • Maximize exposure to sunlight from about 9:00 a.m. to about 3:00 or 4:00  p.m.  Sunlight is the primary cue for the body’s circadian rhythm, so make sure bright light exposure occurs at the right time of day.
  • Quickly follow the local mealtime and activity schedules.  These provide behavioral cues that can help to reset the body’s rhythms.
  • Ask your physician for a small prescription of either zolpidem (Ambien) or zaleplon (Sonata) to help promote sleep at night.  These medications are fast-acting and quickly metabolized so they will promote sleep without creating a next-day hangover.
  • Follow the earlier recommendations for solid sleep habits as well as the ones offered under hotel sleep tips.
  • Consume more than the usual amount of caffeine after arising in the morning to artificially boost alertness, but be absolutely certain to avoid caffeine at night.  Caffeine is a safe and effective stimulant when used judiciously.
Following these steps will promote adjustment to eastward travel at a rate of about 1-1.5 days for every time zone crossed.  Although there is no immediate cure for jet lag, a shorter period of readjustment will minimize the gastrointestinal, sleep, and alertness disturbances that are so common to long-range travelers.  One final note, when planning a stay of only a day or two, the best bet is to use short-acting sleep medications at night and caffeine during the day.  There is no sense in starting down a path of shifting the internal body clock when the return trip occurs before any real progress is made.

Conclusions
Inadequate sleep is one of the most dangerous adversaries of productivity and a healthy, high-quality life.  Don’t buy into the school of thought that suggests sleep is for sissies.  Instead, Sleep For Health and Success!

Tuesday, August 30, 2011

As I'm currently working with a company called Fatigue Science which has created a portable actigraph (ReadiBand) capable of measuring sleep quality, the following article is of interest as it should be for you or your child if a sleep problem exists:

By

American pediatricians want to help their patients with sleep problems, but a new study finds that few have the proper knowledge and training to do so. 

According to a national random survey of primary care pediatricians, only about 18 percent had ever received any formal training on sleep disorders and less than 20 percent answered more than half of eight basic questions about sleep issues correctly.

"Knowledge is lacking," said study researcher Ramalinga Reddy, a doctor at the Children's Pulmonary/Sleep Center at the Mercy Children's Hospital in Toledo, Ohio. Few medical schools and residency programs provide training in pediatric sleep problems, Reddy told LiveScience, despite the fact that 96 percent of pediatricians surveyed said they thought it was their duty to advise patients and families on sleep issues. [Read: Top 10 Spooky Sleep Disorders ]

Sleep studies
Although adult sleep disorders are more well known, children experience sleep problems, too. Studies estimate that between 10 percent and 33 percent of children and 40 percent of adolescents experience sleep problems including trouble sleeping, snoring and sleep apnea, a condition that causes people to stop breathing briefly while asleep. About 1 percent to 3 percent of youth have sleep apnea, while as many as 27 percent of children and teens snore.

Reddy and his colleagues conducted the survey by mailing questionnaires to 700 general pediatricians who were members of the American Academy of Pediatrics. About half, or 349, responded, enabling the researchers to make inferences about the total population of American pediatricians with 95 percent confidence and a sampling error of plus or minus 5 percent.

The respondents answered questions about how much formal sleep disorder training they'd had and whether they screened their patients for sleep disorders. The responses showed that doctors often do reach out to their patients about sleep: Almost three-quarters regularly asked kids and their parents about sleep problems, and more than half also asked about bedtimes, bedwetting and snoring or sleep apnea.

But the pediatricians' knowledge of sleep problems was less robust. When asked eight basic true/false sleep questions, such as "school-age children who are sleepy should be encouraged to take at least one nap per day," only 19.1 percent scored five out of eight or above. The median, or middle score in the range, was around three correct answers. (By the way, the correct answer to the nap question above is "false.")

Why sleep matters
Those low scores and the lack of formal training is a problem, Reddy said, pointing out that sleep problems in children are linked to obesity, asthma and even greater risk-taking in teens. Many people believe that "sleep debts" during the week can be made up on the weekends, but research suggests that once sleep is lost, it's lost forever.

Pediatricians should have more formal training opportunities in sleep issues, starting in medical school and continuing throughout their careers, Reddy said. His institution has started holding regular half-hour lectures on sleep for pediatric residents.

But part of the problem is that talking sleep doesn't pay for doctors, Reddy said. One respondent reported lacking the time and resources to counsel parents on sleep routines for their children, as insurance companies reimburse for procedures, not doctor-patient conversations.

"Politicians and the health care industry need to look into this and provide the proper attention to sleep in children," Reddy said.

The researchers reported their results online today (Aug. 29) in the journal Pediatrics.

Friday, August 26, 2011

A good reason to eat 6 small-portioned, low glycemic index meals per day that feature high-fiber and low fat:


 

Half of Americans Projected to Be Obese in 2030

By John Gever, Senior Editor, MedPage Today
Published: August 25, 2011
Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston.
If the current "obesity epidemic" continues unchecked, 50% of the U.S. adult population will be obese -- with body mass index values of 30 or higher -- by 2030, researchers said.

Drawing on data from the National Health and Nutrition Examination Survey (NHANES) series from 1988 to 2008, Y. Claire Wang, MD, of Columbia University's Mailman School of Public Health, and colleagues projected that, compared with 2010, there will be "as many as 65 million more obese adults" in the U.S. by that year.

Obesity prevalence in both men and women in their 40s and 50s would approach 60%, the researchers indicated in the Aug. 27 issue of The Lancet, part of a series of papers on the growing worldwide burden of obesity.


Wang and colleagues also projected that, as a result of the burgeoning obese population, the U.S. will see the following health impacts:
  • 6 to 8.5 million more people with diabetes
  • 5.7 to 7.3 million more cases of heart disease and stroke
  • 490,000 to 670,000 additional cancers
  • 26 to 55 million quality-adjusted life-years lost
The economic burden of these increasing morbidities will be substantial, the researchers indicated -- medical expenditures alone will be higher by $48 to $66 billion annually by 2030, without taking into account lost productivity and other indirect costs associated with a generally sicker population.

Reduced productivity would add another $390 to $580 billion to the annual tab, the researchers said, based on a 2009 study linking obesity to lost work time.
Another country with an aging population and a growing problem with obesity is Great Britain. Wang and colleagues analyzed NHANES-like health data collected in England from 1993 to 2008, finding slightly lower prevalences of obesity relative to the U.S., but similar rates of increase.

If the current trends in England continue, they would project to obesity prevalences in 2030 of about 40% in men and 35% in women.

Both NHANES and the Health Survey for England (HSE) involve interviews and physical exams in more than 10,000 people per iteration. The HSE is repeated annually, while NHANES is conducted over two-year periods. In both programs, the individual participants change from one survey to the next, but they are selected to be sociodemographically representative of the national populations.

Wang and colleagues used epidemiological and outcomes data in the literature to estimate the disease burdens that would result from the growing prevalence of obesity.

They also calculated what would happen if everyone's BMI was 1% lower -- approximately 1 kg (2 lb) in an average adult.

"This change might sound small, but such a scenario would have a substantial effect on consequent health burdens," the researchers wrote.

In the U.S. more than 2 million cases of diabetes, roughly 1.5 million cardiovascular disease diagnoses, and about 100,000 cancers would be avoided, their models showed.
Wang and colleagues acknowledged that their calculations were "mere extrapolations from available data" and that current trends may very well not continue.

"Past trends do not always predict the future," they wrote.

An important finding was the rising burden of obesity among people 60 and older, the researchers emphasized. Of the 65 million additional obese people projected in the U.S. in 2030, 24 million would be in this age range.

This population -- already the sickest and most expensive in terms of medical costs -- is the fastest-growing in the U.S. and Britain. Therefore, the overall disease burden and economic effects of obesity may be magnified.

In addition to their caveat about extrapolating trends into the future, Wang and colleagues cited other limitations to the study: methodological issues related to the NHANES and HSE surveys; uncertainties in the relationships between obesity, other diseases, and economic impacts; and the study's 20-year timeframe, which may underestimate future impacts of pediatric obesity.
The study was supported by the National Collaborative on Childhood Obesity Research, which coordinates childhood obesity research across the National Institutes of Health, the CDC, the Department of Agriculture, and the Robert Wood Johnson Foundation.
Study authors declared they had no relevant financial interests