Articles from Past Newsletters

Happy New Year!     February 2008
National Sleep Awareness Week!     March 2008
Insomnia!     April 2008
Sleep Disordered Breathing!     June 2008
What is the best sleep environment?     October 2008
Driving while Drowsy!     November 2008
Holiday Sleep     December 2008
Optimal Sleep     January 2009
Melatonin     February 2009
Sleep in America     May 2009
Sleep and Chronic Pain     June 2009
Interesting Parasomnias     July 2009
Movement Disorders     August 2009
Children’s Sleep and School Success     September 2009
Sleep and Cancer     October 2009
Drowsy Driving Week     November 2009
Nature Cure!     December 2009
The Sleep and Health of Shiftworkers     January 2010
Sleeping Like a Baby     February 2010
Family Sleep Health     March 2010
Sleep in the Elderly     April 2010
National Sleep in America Poll 2009     May 2010
Summer Sleep – Interesting Parasomnias     June 2010
Children’s Sleep     August 2010
Do I need a Sleep Test?     September 2010
Women’s Sleep Through the Ages     December 2010
Skills for Falling Asleep     January 2011
Sleep and Technology     March 2011
Sleep and Social Skills     April 2011
Teen Sleep     September 2011
Neurotransmitters     November 2011


Happy New Year!

February 2008For many people, the New Year is a time to reflect on the past year, and set goals for the next year.   One important part of New Years Resolutions are health goals – do you have a health goal for 2008?

How about deciding to get enough sleep each night in the New Year?   There are many ways you will benefit, here’s one many people struggle with.

Weight Loss
Recent research has established that when a person is sleep deprived by even just a few hours (say sleeping 6 hours a night), their appetite and metabolism are affected.   When you are sleep deprived you will feel more hungry, and want to eat more fatty and starchy foods than when you are well rested.   Also your blood sugar regulation will change, so that your blood sugar is higher than when you get adequate sleep.   For those of you who’d like to lose weight in the New Year, make it easier to make healthy food choices by getting the sleep you need.

Are you sleep deprived?
If you must always be awakened by an alarm, find yourself yawning through the day, or have low energy you may be sleep deprived.   Recent polls of Americans showed that 16% of Americans are getting less than 6 hours of sleep per night, and 27% characterized themselves as not getting the sleep they need.

To remedy sleep deprivation try going to bed slightly earlier each night, until you feel energetic and ready to start the day when the alarm goes off.   Keep your wake time the same each day, as this is most important to set your body clock.   Ideally you will get to the point that you will wake up ready to go even before the alarm!   That will be a great feeling!



National Sleep Awareness Week, March 3 to 9!

March 2008Each year the National Sleep Foundation does a poll of Sleep in America. Again this year the amount of sleep adults get declined – from 7 hours a night in 2001, to 6 hours 40 minutes in 2008! That is a total of 1 hour 40 minutes less each workweek. A full 37% of Americans said they get less sleep than they need each night.

Children are sleep deprived too.Children are also sleep deprived – 27% of children get less sleep than they need each school night.   How much sleep does a child need?   Preschoolers (ages 3 to 5) need about 11 to 12 hours, children aged 6 to 12 need 10 to 11 hours, and high school students need 9 to 9.5 hours.

If a child doesn’t get enough sleep they can have mood and behavior problems.   For example, they may be irritable, overly emotional, have difficulty cooperating or controlling impulses.   Teens especially will take more risks when they are sleep deprived.

School performance is also impaired by sleep deprivation.   It becomes more difficult to pay attention, creativity declines, and memory is impaired.   Certainly not what we want for our children in school!

Tips to help your children get the sleep they need.

If you suspect your children are not getting the sleep they need to feel good and do well in school there are steps you can take today to improve their sleep.

First, set a consistent wake up time for your child.   The time you wake up is the most important for setting your body clock.   Next, get them to bed 15 minutes earlier every couple days, until they awaken refreshed on their own.   When a preschool or grade school child is getting enough sleep they will be able to awake on their own (this may not be true of teens, more on teen sleep another time).

“Screen time” in front of a computer or television can interfere with easily falling asleep both because of the bright light and because it is mentally stimulating.   So establish a bedtime routine that does not involved the TV or computer.

Caffeine stays active in the body for 6 to 8 hours.   Ensure your child is not having any caffeine after noon to help sleep well at night.



Happy New Year!

February 2008


Insomnia!

April 2008Can’t Sleep? You may have Insomnia

What is insomnia?   It is the repeated difficulty in falling asleep or staying asleep through the night that causes daytime impairment.   This occurs despite the opportunity for adequate sleep (as opposed to the sleep deprivation we talked about last time).

Ten percent of Americans suffer from insomnia, but only about 1 in 20 insomniacs ever seek out treatment for their sleeping difficulty.   Here at The Institute of Naturopathic Sleep Medicine it’s been astounding how long clients have suffered from insomnia – an average of over 15 years!

Insomnia can cause many daytime symptoms, including impaired attention and concentration, mood problems and irritability, and even physical symptoms such as headaches.   Other research shows that insomniacs are 2.5 times more likely to have motor vehicle accidents.

How does Insomnia develop?

Frequently there is an initial stressor that causes a person to not sleep as well.   This could be either a happy event such as a wedding, or a stressor such as a job change. It is normal to have disrupted sleep for a short while.   This is called acute insomnia.

Chronic insomnia is defined as lasting more than one month.   In this case the person has frequently developed thoughts and habits that perpetuate the insomnia, even after the initial event is over.

What are treatment options?

The primary goal is to treat the underlying cause of the insomnia.   There are both prescription drug treatments and behavioral treatments for insomnia. When insomnia is due to a medical or mental disorder the underlying disorder must also be treated.

Behavioral treatment for insomnia is a well-thought out approach that addresses several contributing factors in a systematic way.   The therapeutic components include:

Relaxation techniques. Example: Focusing only on the breath, breathe in slowly for a count of three, out for a count of three.

Stimulus Control therapy. Example: Be in bedroom only when drowsy or asleep.

Sleep Restriction therapy. Example: Limit time in bed just to the time spent asleep. In other words, no long periods of lying in bed trying to sleep.

Education about sleep. Example: Waketime determines when you will get sleepy, so setting a consistent waketime will allow you to fall asleep easily at bedtime.

Research has shown that behavioral treatment for insomnia is more effective than prescription drug treatment, even two years after treatment.   For all those people suffering from insomnia, this can enable them to Sleep Well, Naturally!



Sleep Disordered Breathing!

June 2008Over the last several years awareness has been growing about sleep disordered breathing, the primary type being Obstructive Sleep Apnea.

About 4% of men, and 2% of women have obstructive sleep apnea.   In sleep apnea the upper airway relaxes to the point that the airway is blocked.   This is called an “apnea.” An apnea lasts from 10 seconds up to as much as one minute.   During this time blood oxygen levels drop, causing activation of the sympathetic nervous system, the “flight or fight” system.   Activation of the sympathetic nervous system causes the person to wake up just enough to begin breathing again.   This pattern is repeated throughout the night, sometimes with an individual having literally hundreds of apneas.

Daytime symptoms can vary, from morning headache and dry mouth to poor memory and daytime sleepiness.   The most important thing to know about sleep apnea is that it is a risk factor for high blood pressure.   Sleep apnea is also associated with diabetes and cardiovascular disease.

How do I know if I have sleep apnea?

Certain groups are at higher risk for sleep apnea – those who are overweight, smoke, hypothyroid, have enlarged tonsils or adenoids, and women who are post-menopausal.

Symptoms that might suggest obstructive sleep apnea include:
–  morning headache
–  dry mouth
–  excessive daytime sleepiness
–  restless sleep
–  snoring
–  breathing pauses while asleep
–  poor memory

It is worthwhile asking your bed partner to observe your breathing while asleep if you are concerned about sleep apnea.

Diagnosis of sleep apnea is done in a sleep clinic by doing an overnight sleep test, called a PSG (polysomnogram).   The best established treatment is CPAP (Continuous Positive Airway Pressure).   CPAP is positive air pressure delivered through a mask that goes over the nose.   This air pressure holds the airway open during sleep, thus eliminating apneas.



What is the best sleep environment?

October 2008Over the centuries, and from place to place throughout the world, sleep environments have varied widely.   I once attended a presentation on sleep environments in other cultures.   The most striking was in a nomadic culture.   The women sleep squatting down, with their skirts stretched tightly across their knees.   Their babies sleep on their skirts so as to be safe from the many poisonous snakes in the area.

Fortunately we are able to organize our sleeping place to be the best it can be.   We can usually minimize stimuli that interrupt sleep.   Below are some tips you can use at home, with the reasoning behind each.

Creating a healthy sleep space at home

Doing most of these items will take 10 minutes or less – the result can be a more restful night!

–  Move your clock from the head of your bed.   Place it across the room where it cannot be seen from your pillow.   Sleep comes easier if you are not thinking about the time, or how much time you have left to sleep!
–  Find someplace else for your pets to sleep.  Of all my recommendations this is sometimes the hardest for people to do because they love their pets.   I love my pet too, but the fact is that the pets can be waking you up in the night, and leaving you less refreshed the next day.
–  Sleep in the same bed each night.   As we cycle through the five sleep stages each night we hit Stage 1 sleep every hour and a half or so.   At that time people frequently sit up, adjust the covers, scan the room for anything that needs attention, then lie back down.   If you are in an unusual room it may take longer to make sure the room is safe and return to sleep.
–  Make the room as dark as possible.   Even the light from a night-light or clock is enough to interfere with your natural melatonin rhythm.
–  Wash your bedding regularly to minimize any allergic reaction to dust and dust mites.   Sheets and pillowcases should be washed weekly; pillows, blankets and mattress covers washed at least every quarter; and pillows replaced every two years.
–  Remove any workstations from your bedroom.   This includes computers, TV, sewing or any other hobbies.   Having these activities in your bedroom conditions you to be active and alert in the bedroom instead of relaxed and asleep.



Driving while Drowsy

November 2008Have you heard the buzz about drowsy driving?   Sleep experts are now estimating that drowsy driving accounts for over 100,000 accidents each year, and causes 1550 deaths!   The number of fatigue-related accidents may actually be much higher than this estimate because is it so difficult to detect.   Fatigue-related accidents usually occur with a driver who is alone, driving at night, during the mid-afternoon lull, or at another time they are usually asleep.   As opposed to a drunk driver, the drowsy driver will not swerve, apply the brakes or take any action to avoid the accident.   They can’t, because they are asleep!

In 2005 the National Sleep Foundation conducted a large poll about drowsy driving.   60% of drivers said they had driven while drowsy, and an amazing 37% admitted to falling asleep at the wheel in the last year.   Personally, these are alarming statistics to remember whenever I get on the road.

You are at risk if you have been awake for greater than 16 or 17 hours, are chronically sleep deprived, or have had a sleepless night.   If you have an untreated sleep disorder such as sleep apnea you are also at risk.   Some groups are more at risk than others, including men aged 25 and younger, shift workers, commercial drivers, business travelers, those who drive at night, and anyone who has worked 60 hours in a week.

How can I prevent drowsy driving?

Planning ahead before driving will help you reduce your risk of drowsy driving.   Get adequate sleep the night before.   Try to travel long distances with a companion who can take turns driving and can help you stay alert with some good conversation.   Plan enough time so you can take plenty of breaks – at least every 2 hours or 100 miles on long trips.   Avoid alcohol and sedating medications while driving.

While you are driving if you are yawning, constantly blinking, or find your head nodding those are signs that you are drowsy.   Mentally you may not remember driving the last few miles, you may feel irritable, or experience wandering, dream-like thoughts.   You may drift in your lane or even hit the side rumble strip.

If you experience any of these symptoms Stop and Rest!   Even a twenty minute nap can hold drowsiness off for a while.   You can also use the alerting effects of caffeine.   A good plan is to pull over, drink a caffeinated drink and take a 20 minute nap.   Because it takes about 30 minutes to feel the effects of caffeine this plan will provide the benefits of both the nap and caffeine.   (Be aware that caffeine is less effective in people who regularly drink a lot of it).

Although it is just the beginning of November, by the end of the month the winter holidays will be in full swing.   Let’s help make this a happy holiday season for everyone by getting enough sleep to be a safe driver, and making other arrangements when those holiday festivities cut our sleep short!



Holiday Sleep

December 2008The Winter Holidays and Acute Insomnia

The winter holidays can be filled with fun activities, celebrations with friends and family, and snow sports.   But holidays can also be stressful as we both maintain our regular responsibilities and prepare for the additional activities.   This year many people are also concerned about the recent economic downturn.   The combination of the holidays and economic concerns can lead to acute insomnia, the topic for today.

What is Acute Insomnia?

Acute insomnia is the inability to fall asleep within 30 minutes, or spending more than 30 minutes awake in the middle of the night.   Acute insomnia is a completely normal response to life events, and something we will all experience periodically.   It becomes chronic when it has persisted for more than a month.   Although it is normal in times of extra activity or worry, there are still habits we can put in place to help us get the sleep we need to feel good.

Healthy Sleep Habits during the Holidays

Below are several ideas to keep you sleeping well during the holidays.   Remember the effects of insufficient sleep that we’ve talked about in other newsletters, such as having emotional ups and downs, difficulty concentrating, poor manual dexterity, and fatigue.   Getting enough sleep allows us to really enjoy this season more fully.

–  Plan a little time (20 to 40 minutes) to wind down before you get into bed.   This will allow you to fall asleep more quickly.   Spend this time doing something you enjoy that does not involve bright light like TV or computers.

–  If your thoughts start to spin once you get into bed, start the habit of journaling.   The goal here is to put your thoughts to bed before you put yourself to bed.   Spend 10-15 minutes (no more) every day putting those thoughts down on paper a couple hours before bedtime.   Then if they arise during the night, tell yourself gently but firmly “I’ve thought about that already, and I’ll have time to think about that tomorrow.   Now is the time to rest.”   Although this sounds simple, it is amazingly effective.

–  If you are going to stay up late for a party, plan to start the following day a little later, or slower.   Another option is to take an afternoon nap before your late night.   Don’t take a nap if you will be going to bed at your regular time, as it will make it more difficult to fall asleep.

–  If there are regular tasks you do that can be suspended or rescheduled until after your holiday plans, consider doing it.   This will help preserve the time you need for sleep.

–  Remember that drowsy driving can be as dangerous as drunk driving, so plan accordingly.



Optimal Sleep

January 2009The Most Common Sleep Problem

Once again, in 2008, insufficient sleep was the most common sleep problem in America.   More than 47% of adults and 57% of children get less than the recommended amount of sleep each night.   This chronic partial sleep deprivation can have global health effects, some of which we’ve discussed in past newsletters.   Here are some of the effects:

– appetite regulating hormones leptin and ghrelin are disordered, causing increased hunger, increased appetite for high caloric, high fat and simple carbohydrate foods, and weight gain
– physical agility, coordination and reaction time are impaired, contributing to drowsy driving auto accidents
– irritability and mood impairment increases
– memory, concentration and creative problem solving are impaired<-p>

The Optimal Sleep Test

To kick off 2009 we’re raising awareness of insufficient sleep by sponsoring The Optimal Sleep Test.   Sleep optimization is done by researchers to determine how much sleep is ideal.   During sleep optimization participants spend much more time in bed and allow themselves to sleep as long as they can, and wake on their own without an alarm.   Participants will commonly sleep hours extra for the first couple weeks, and then their sleep will settle into a regular nightly amount.

To do The Optimal Sleep Test:

1. Start at the beginning of your weekend, and continue for at least 5 nights.
2. Set your bedtime close to your regular bedtime, maybe 30 minutes earlier.
3. Make your room as dark and quiet as possible, consider turning down phone ringers or other sounds that may disturb you.
4. Allow yourself to sleep as late as possible in the morning, waking without an alarm.
5. At the end evaluate the symptoms above and see how they’ve improved.

You may find that the added sleep benefits you to the point that it is worth having fewer active hours in exchange for feeling better during the time that you are awake!



Melatonin

February 2009You have probably heard of melatonin, one of our bodies’ endogenous hormones.   Today we’ll talk about natural melatonin cycles, how melatonin relates to health, and also how melatonin is taken as a supplement.

Your Natural Melatonin Cycle
Melatonin is a hormone produced by the pineal gland.   It also acts as a neurotransmitter. In dim light conditions melatonin levels will start to rise about 2 hours before your habitual bedtime, and peak about 2 hours afterwards.   This increase is partly responsible for tired feelings before bedtime.   It will decline during the night and be at very low levels during the day.   Melatonin is suppressed by bright light, such as sunshine.

People who are either “larks” or “owls,” have a melatonin rhythm that is different from the norm.   This causes them either to get sleepy much earlier in the day – “larks”, or much later than usual – “owls.”   An example is found during puberty in teenagers whose melatonin rhythm shifts later, causing their sleep and wake times to shift later.

Uses of Melatonin
Melatonin can be taken as a supplement to improve sleep.   In the past, higher doses (5-10mg) were used like a pharmaceutical drug, and some people experienced a hang-over effect the next morning.   Newer research has shown that much lower doses (.3-3mg), which are in line with the levels naturally found in the body, are just as effective.

– Precisely timed melatonin can be used to shift the habitual sleep time for those people who are “owls” or “larks.”   Exposure to bright light can also be used to shift sleep times as it will suppress melatonin.
– Melatonin can be used by travelers to reduce jet-lag symptoms.   It is especially effective when used in combination with a well-thought out sleep schedule, bright light exposure and limiting light with sunglasses.
– Melatonin can be a gentle aid in promoting sleep for those who have sleep onset insomnia.   There are also time-released formulas for people who have difficulty staying asleep through the night.

You can always take advantage of your endogenous melatonin rhythm by going to bed at approximately the same time each night, and getting bright light exposure in the morning.   This is one way to naturally keep your sleep healthy!



Sleep in America – National Pole

May 2009Each year the National Sleep Foundation conducts a study of Sleep In America. This year they studied the effect of the economic downturn on our sleep – and Wow! What an effect it is having!

Economic Worries Ruin Sleep

A full 27% of Americans reported that their sleep has been disturbed at least a couple nights each week because of economic concerns. People are losing sleep over their personal finances, the state of the US economy, or employment concerns. More than half are also having problems with their feelings several days each week.

Compared to those who sleep better, these people are less able to do the following because they are too sleepy:

  • – work effectively
  • – exercise
  • – eat healthy
  • – have sex
  • – do leisure activities

Those who lose sleep over economic concerns are more likely to cancel fun social events or hobbies because they feel too sleepy. They are also more likely to turn to unhealthy behaviors such as smoking or eating sugary foods to compensate for sleepiness.

Sleep Well in this Economy

There are skills you can use at home to improve your sleep. When you sleep well you will be able to think more clearly, and have the emotional balance to deal with the stresses that come your way.

One skill that patients invariably say has helped them is to do some journaling each day. The goal is to put your thoughts to bed before you go to bed. The instructions are to spend 10-15 minutes (no more) each evening putting down the thoughts that arise in the night. Do this several hours before bed. Then in the night if those thoughts come up, then tell yourself gently and firmly “I already thought about that, and I’ll have time to think about it tomorrow. Now is the time to sleep.” The more you practice this the more effective it is.

Another survey finding was that people whose sleep was disturbed by economic worries got were more likely to sleep only 6 hours. So ensure that you are getting adequate sleep. It appears that most adults need between 8-9 hours each night. If you are getting less, move your bedtime 15 minutes earlier every 4 days or so until you are able to wake up without an alarm, and feel refreshed.

If these skills don’t improve your sleep, you may need to consult with a sleep specialist to ensure that you have the sleep you need to think clearly and cope with this challenging economy.



Sleep and Chronic Pain!

June 2009How Chronic Pain and Sleep Interact

Do you know someone who suffers from chronic pain?   It may be back pain, headaches, pelvic pain, fibromyalgia . . . many types of pain sufferers also experience sleep disruption.   Unfortunately, people can get into a cycle in which pain disrupts their sleep, and insufficient sleep makes pain worse.   This may seem logical, but let’s look more specifically at pain and sleep interactions.

A few chronic pain conditions are known for sleep disruption.   One of them is fibromyalgia.   70% of fibromyalgia patients have sleep complaints, and one study found that 27 of 28 had sleep-disordered breathing.   When the breathing was treated with CPAP, patients had a 23-47% improvement in symptoms.   80% of cluster headache patients are found to have obstructive sleep apnea.

For those patients who experience insomnia due to pain, it’s been shown that Cognitive-Behavioral Treatment (CBT-I) will improve their sleep, and may slightly decrease pain.   For more information about CBT-I please refer to ourNatural Sleep Medicine Adult Care web page.

How to Minimize the Effect of Chronic Pain on Sleep

  • When people are in pain and their sleep is disrupted, they may feel like they need to catch some ZZZs whenever they can, even during the day.   As best you can, maintain the difference between daytime activity and nighttime rest. Stay awake and engaged during the day, and be sure to get bright light, preferably outside.   During the night, keep lights out, and minimize your activity.   This will help consolidate your sleep in the night.
  • If you need to rest or lay down because of pain do so somewhere other than your bed or bedroom.   Make yourself a comfortable spot in the living room, maybe an easy chair or day bed.   This maintains a strong association of your bed as someplace to sleep.
  • Get tested for sleep disorders if necessary, especially as discussed above.
  • If you are taking prescription pain medications, be aware that some of them can cause sleep disruption.   You may want to ask your prescribing doctor to review your medications, and switch them if appropriate.

Institute News

A couple months ago I had the pleasure of talking with a journalist from Health magazine.   You can read a few of my strategies for relaxing and falling asleep in their June issue.   You can read the article by going to theblog.bodybuilding.com web page.

Now is the time of year to schedule fall and winter presentations on sleep health.   If your PTA or other parenting group would like to know how to help children get the sleep they need to do well in school and other activities, please give me a call.

Testimonial of the Month

“I have had sleep issues since I was 15.   I tried all the herbal remedies (on my own) with no success.   I didn’t want to use pharmaceuticals.   Dr. Darley helped me in three visits-without any medication.   About two weeks after my last visit with her, my husband got laid off.   Normally this would totally mess up my sleeping habits.   I haven’t missed a good night’s sleep.   Thanks so much, Dr. Darley!”

K. is a 43 year old with a 28 year history of insomnia.



Interesting Parasomnias

July 2009Summer Sleep and Interesting Parasomnias

What a glorious summer it has been so far!   In the spirit of summer and taking things easy in the sun, this issue is a discussion of some of the more interesting and rare sleep disorders.   This is not to say though that these disorders are not important, just a more interesting read than others.

What are Parasomnias?

In sleep medicine we define parasomnias as ‘undesirable events that accompany sleep.’   What makes these disorders so interesting is that they can involve more complex and apparently purposeful behaviors than other disorders of sleep.   There are parasomnias that occur in REM sleep, and some in nonREM. Below are just a sample.

Sleepwalking

As an 11 year old child, I had a champion sleep walking event – let me tell you about it.   Growing up in the suburbs, we lived in a one story rambler.   We were friends with the neighbors, who were our age, and also lived in a rambler.   One night, after having the flu, I walked down the long hall, out our front door, around the side of the house, up a 2’ rockery, and into the neighbors’ walk.   From there I pulled the string to open the wooden gate, up the 6 stairs to their backdoor, in and through their house to the parents room.   There I stood until they woke up, I woke after being walked to their kitchen, and my parents woke when the neighbors pounded on the door delivering me home.

Sleepwalking typically does occur in children, and resolves as they go through puberty. Sleepwalking tends to run in families.   As you can see from the story above, safety is a primary concern.   If your child sleepwalks, you need to make sure that doors and windows are locked, stairs are safely blocked, and other hazards are contained.   You can hang a bell over the door, so it will alert you when the child gets up.   When someone is sleepwalking it is best to simply guide them back to bed gently.

REM Sleep Behavior Disorder

During REM sleep your muscles are usually inhibited so that you don’t move during dreams.   In this disorder, however, muscle tone is maintained, so the person ends up acting out their dreams.   For an unknown reason the dreams that are acted out are usually unpleasant, action-filled and violent.   The eyes usually remain closed, and people have been known to sit up, leap from bed, shout, swear, grab, flail their arms, punch, kick, and talk.   As you can imagine, sleep-related injury is common for both the patient and their bedpartner.   This disorder is more common among men over aged 50, and among those with a neurological disorder such as Parkinson’s disease.   If you suspect REM Sleep Behavior Disorder then consult with a sleep clinic.

These are just two of the many types of parasomnias that people can experience.   Feel free to email me with questions about other abnormal sleep behaviors if you wish.

Testimonial of the Month

-A 35 year old woman with a 10 year history of insomnia
“I tried it all. Lavender, baths, melatonin, warm herbal tea, Tylenol PM, Nyquil, Unisom, reading, listening to music, warm milk, a sound machine, even cutting caffeine completely out of my diet, nothing worked.   I was frustrated and exhausted.   After struggling with sleep issues for over 10 years and trying it all, Dr. Darley has officially cured me in just three visits.   I am eternally grateful to her for giving me my life back.   I tell everyone to go see her!”



Movement Disorders

August 2009Sleep Related Movement Disorders

Do you know someone who twitches their leg all night?   Or someone who feels like they just have to move their legs in the evening, or when sitting in a cramped theater?   Chances are, they may be suffering from a movement disorder.

What are Movement Disorders?

It is normal to move some during sleep, to change position, or have a few rhythmic movements.  In Sleep Related Movement Disorders a person moves part of their body involuntarily.   When these movements are associated with sleep disturbance or impaired daytime functioning they are classified as a disorder.   Commonly the arms or legs move, but in some cases the whole body is involved, as in Sleep Related Rhythmic Movement Disorder.   Tooth grinding at night, called Bruxism, is another movement disorder.   Let’s touch on the most common disorders.

Restless Legs Syndrome (RLS)

5-10% of Americans are thought to suffer from this disorder.   There is an irresistible urge to move the legs or feet, often accompanied by an uncomfortable or painful feeling deep in the legs.   RLS is usually worse in the evening or in cramped places like airplanes, and is better with movement or in the morning.   These symptoms can make it difficult to fall asleep at the beginning of the night, or return to sleep after awakening.   Restless Legs Syndrome tends to run in families.   RLS can be associated with iron deficiency, and for some people treating the iron deficiency will resolve their symptoms.

Periodic Limb Movement Disorder (PLMD)

About 80-90% of patients who have RLS have Periodic Limb Movements of Sleep.   These are repetitive, stereotypical movements of the lower extremity which may be as subtle as flexing the big toe.   These movements will disrupt sleep by causing brief awakenings that break up the normal sleep cycle, causing less restorative sleep.   Patients frequently will be unaware of these movements, it is only during the overnight sleep study that it is diagnosed.   Patients will however be aware of being fatigued during the day, and also have higher rates of depression, and attention deficit.

Because these disorders on our daytime health and well-being they need to be taken seriously and effectively treated.   Since people are unaware that these movements occur, please bring it to your bedpartners’ attention if they are moving excessively in his sleep.   Who knows, you just might be able to get a better nights sleep too!

Testimonial of the Month

-S. 55 year old woman with insomnia and previously undiagnosed sleep apnea.
““Of all the money I’ve spent over the years trying to feel better, this is the one thing that has helped.””


Children’s Sleep and School Success

September 2009Children’s Sleep and School Success – How they are related

It’s time for school to start!   For those with children this can be a busy time, doing those last minute summer activities, getting school supplies, and preparing children for a successful year.   Let’s take the time to get children on a good sleep schedule that will help them in school

Children’s Sleep

Why is it important to think about children’s sleep?   To start, a majority of children simply don’t get enough hours of sleep.   Here’s how much sleep kids need:

  • children 3 to 5 years old need more than 11 hours
  • children 6 to 12 years old need 10 to 11 hours
  • teenagers need 9 to 9.5 hours

Looking at the school start times here in Seattle, and allowing just one hour from wake-up to being at school, grade school children should be sleeping by 9pm, middle schoolers by 9:30p, and high school students by 9:30-10pm.   (If your child needs more than 1 hour from wake-up to school start time then move bedtime earlier accordingly).   Are your children getting to sleep at that time?   If not, your child is probably feeling the effects of insufficient sleep.

Impacts of Insufficient Sleep

Impacts of Insufficient Sleep Going to school can demanding, children are asked to concentrate, learn physical skills, and develop socially with their peers. Here’s some highlights:

  • Only 20% of children grades 6-12 get the necessary amount of sleep (>9 hrs)!   Can you believe it?!   In younger children, only 47% get the sleep they need.
  • Increased playground injuries in children who sleep <10 hours.
  • Children with insufficient sleep are more likely to be angry, depressed, or overly emotional.  Kids who sleep less take more risks, and this is especially true in teens.
  • Cognitive effects include impaired memory, creative problem solving, and decreased verbal fluency, all skills that your child needs in school

What you can do to improve your child’s sleep:

  • Establish bedtimes for your children, so everyone in the household knows the standard.   You may want to have a time when everyone finishes their activities and starts to “wind down.”
  • Start a trend in your social group of starting activities early enough that they usually end an hour before bedtime.   This gives you time to travel home safely, and wind down a little before going to sleep.
  • Remove electronic media from your child’s bedroom so they are not tempted to continue with homework, TV, or texting after bedtime
  • Kids (and parents) can get excited about activities.   Emphasize quality wake hours rather than quantity.   Is it really fun to stay up late if you are so tired that you can’t think or are teary the next day?
  • Allow your children to catch up on sleep on the weekends or vacations if necessary.   The golden standard is to wake up on their own, feeling refreshed and energetic throughout the day.   If your child sleeps a lot more on weekends, consider moving their school night bedtime earlier in 15 minute increments until it evens out.

Testimonial of the Month

Mother of 9 year old son suffering from circadian phase advance for 3 years.
“You looked at it from a different point of view.   Everyone else was trying to fit my son into their model, telling him ‘You feel this way’ when it’s not how he felt.   This is the first time he’s felt good about his sleep. ”



Sleep and Cancer

October 2009Sleep and Cancer

p>In honor of October being Breast Cancer Awareness Month, this issue of “Sleep Well, Naturally” is about the connection between sleep and cancer.   This is a complex issue, as getting poor sleep increases the risk of cancer, and sleep in cancer patients is disturbed.   Let’s look at each situation more closely.Poor Sleep Increases the Risk of Cancer

In the last ten years research has been done looking at the life-long sleep histories of breast cancer patients.   It’s been found that being awake at night (usually for shift work) increases the risk of developing cancer.   This is thought to be because the light suppresses melatonin, which is highest during the dark night.   In turn, when melatonin is low estrogen levels are increased, thus increasing risk of breast cancer.   Colo-rectal cancer is also increased in women who have done shift work for 15 years or more.   In addition to melatonin, cortisol patterns are irregular when a person is not sleeping well.   Cortisol is important for our immune system.

It’s not only shift workers who suffer increased risk of cancer.   Among physically active women, those who sleep less than 7 hours per night have a 47% increased risk of cancer compared to those who sleep more.

Sleep in Cancer Patients is Disrupted

Cancer patients experience sleep problems at a high rate.   About 30-50% have insomnia, which worsens with repeat courses of chemotherapy. They also experience irregular sleep-wake patterns.

Sleep Habits for Immune Health

There are many ways that healthy sleep supports a healthy immune system.   And remember, our immune system is constantly working to rid our bodies of foreign bacteria and abnormal cells.   To strengthen your immune system:

  • Be sure to get adequate rest most nights.
  • Sleep in accordance with the natural light-dark cycle.   When the light bulb was invented and became widely available it significantly changed our way of life.   Occasionally think to yourself “Would I be up right now if there was no electricity and light?”   This question can help you stay in sync with natural light-dark cycles
  • The techniques and skills we’ve discussed in past issues of this e-newsletter will help a cancer patient sleep better.   Those include making the bedroom a good sleep environment, keeping a regular schedule, etc.   Past issues can be found at Natural Sleep Medicine Newsletter Archives..

Testimonial of the Month

A. 46 year old woman with 18 year history of insomnia.
“I’m sleeping through the night, and more importantly, I am no longer anxious about going to sleep! ”



Drowsy Driving Week

November 2009Drowsy Driving Week is Now – November 2 to 8th!

Drowsy Driving is such an important public safety issue that we’re talking about it again this year.   Sleep experts are now estimating that drowsy driving accounts for over 100,000 accidents each year, and causes 1550 deaths!   The number of fatigue-related accidents may actually be much higher than this estimate because is it so difficult to detect.   Fatigue-related accidents usually occur with a driver who is alone, driving at night, during the mid-afternoon lull, or at another time they are usually asleep.   As opposed to a drunk driver, the drowsy driver will not swerve, apply the brakes or take any action to avoid the accident.   They can’t, because they are asleep!

In 2005 the National Sleep Foundation conducted a large poll about drowsy driving.   60% of drivers said they had driven while drowsy, and an amazing 37% admitted to falling asleep at the wheel in the last year.   Personally, these are alarming statistics to remember whenever I get on the road.

You are at risk if you have been awake for greater than 16 or 17 hours, are chronically sleep deprived, or have had a sleepless night.   If you have an untreated sleep disorder such as sleep apnea you are also at risk.   Some groups are more at risk than others, including men aged 25 and younger, shift workers, commercial drivers, business travelers, those who drive at night, and anyone who has worked 60 hours in a week.

How can I prevent drowsy driving?

Planning ahead before driving will help you reduce your risk of drowsy driving.   Get adequate sleep the night before.   Try to travel long distances with a companion who can take turns driving and can help you stay alert with some good conversation.   Plan enough time so you can take plenty of breaks – at least every 2 hours or 100 miles on long trips.   Avoid alcohol and sedating medications while driving.

While you are driving if you are yawning, constantly blinking, or find your head nodding those are signs that you are drowsy.   Mentally you may not remember driving the last few miles, you may feel irritable, or experience wandering, dream-like thoughts.   You may drift in your lane or even hit the side rumble strip.

If you experience any of these symptoms Stop and Rest!   Even a twenty minute nap can hold drowsiness off for a while.   You can also use the alerting effects of caffeine.   A good plan is to pull over, drink a caffeinated drink and take a 20 minute nap.   Because it takes about 30 minutes to feel the effects of caffeine this plan will provide the benefits of both the nap and caffeine.   (Be aware that caffeine is less effective in people who regularly drink a lot of it).

Although it is just the beginning of November, by the end of the month the winter holidays will be in full swing. Let’s help make this a happy holiday season for everyone by getting enough sleep to be a safe driver, and making other arrangements when those holiday festivities cut our sleep short!



Nature Cure!

November 2009Nature Cure!

Over the last several months we’ve talked a lot about sleep medicine.   This month I’d like to share with you some interesting information about the healing power of nature.   The Healing Power of Nature is one of the principles of naturopathic medicine, which sets it apart from other medical philosophies.   As the year comes to a close, you may be thinking about how you want 2010 to be different.   Using this information will get the new year off to a great start.

Medical research has shown many ways that being in a natural environment with views of trees, birds, and plants of all kinds improves health as opposed to being in a ‘built’ environment.   ‘Built environment’ means the man-made cars, concrete, high-rises and pollution most of us are surrounded by in our urban neighborhoods.   Here’s a sample of the research findings:

  • Hospital patients recover more quickly, require fewer painkillers, and have fewer post-op complications when they have a view of trees and animals out their window.
  • Office workers report less job stress, fewer illnesses and overall higher job satisfaction when they have a view of nature outside their desk.
  • When roads are surrounded by a greenbelt drivers’ blood pressure and heart rate decrease, as does their sympathetic (fight or flight) nervous system.
  • When urban people go into a natural setting for a few days (like on a camping trip) their concentration and problem-solving improve while mental fatigue decreases.

In our modern lifestyle we spend less time outdoors than people did historically.   Recently the book Last Child in the Woods brought attention to this disconnection from nature that children experience.   In my practice many sleep patients report problems with stress and anxiety.   One of my recommendations is to cultivate a habit of being outside regularly, as lower stress, lower sympathetic nervous charge, and greater feelings of pleasure will improve sleep.



The Sleep and Health of Shiftworkers

January 2010The Sleep and Health of Shiftworkers

A full 20% of working Americans do shiftwork, performing on the job during their biological night.   What this means is that they need to be fully functioning during a time that their bodies are programmed to be sleeping.   There are many economic and safety reasons to keep business going around the clock, but there is a price to pay for those people doing the midnight shift.

Health Effects of Shiftwork

Many medical research studies have looked at the health of people doing shiftwork.   Short-term effects include fatigue, GI upset, and slower reaction time.   In the long run, shiftworkers have an increased risk of cardiovascular disease, high blood pressure, menstrual irregularities, and some types of cancer.   What’s interesting is that some of these effects are seen less in those who have done shiftwork for a decade or more.   Researchers theorize that those who can adapt to shiftwork stay with it, while those who can’t adapt stop working nights.

How to Handle Shiftwork Well

You can learn to handle shiftwork as well as possible. Here’s a few beginning steps:

  • Educate your family or roommates about what you’ll need to sleep well.   This includes quiet without interruptions during your sleep time, a dark and cool room, and as regular a schedule as possible.   Sometimes family members are eager to see you and share their news.   When setting a sleep schedule, also schedule a predictable time that you’ll be available to them.
  • Make your sleep schedule as consistent as possible over the entire week.
  • If possible, take a short nap during the middle of your shift.   Be cautious to become fully alert before performing your job duties.
  • Limit light exposure on the commute home by taking public transit and wearing blue light blocking sunglasses.

With these strategies, shiftwork should be easier. A special thanks goes out to all those folks who work nights, keeping the rest of us safe.



Sleeping Like a Baby

February 2010Sleeping Like a Baby

Giving a recent talk to new parents, I was reflecting on the popular phrase “sleeping like a baby.”   In many ways, nobody would want to sleep like a baby – waking multiple times a night, crying, needing help to fall asleep each time.   Let’s take a look at what is happening with babies’ sleep, and how to help them learn to sleep well.

Facts About Infant Sleep

When infants are 6-8 weeks old they will start to have more sleep at night, and less during the day.   Their circadian system is starting to become entrained by the environmental light / dark cues.

By 6 months of age, 70-80% of babies are capable of sleeping 5-6 hours at a stretch in the night.   Remember though, just like adults, babies will wake 4 to 5 times a night, at the end of each sleep cycle.   This is when they may have difficulty returning to sleep on their own and call out to you.

Here’s how an infant’s sleep needs change over the first years:

  • Newborns sleep 16-20 hours total
  • 3-6 mos olds sleep 12-15 hours total
  • 6-9 mos olds sleep 11.5-15 hours total
  • 9-12 mos olds sleep 11-14 hours total
  • 12-36 mos olds sleep 12-13 hours total

How to Help Your Baby Sleep Well

Once your baby starts to have more sleep at night (about 7 weeks old), you can start to teach them to sleep well.   At this point, you can observe when your child is sleepy, and put them down to sleep at that time.   The first signs of sleepiness are that your child will become quiet, will stop making eye contact, and will no longer be interested in toys.   If your baby starts rubbing her eyes or is fussy, then she is getting overtired.   Gradually the times that your child naps will become routine, consolidating into two naps after 6 months of age.

Sleep is interesting because it is shaped by both our physiology and our habits. Here are some habits that will help your baby sleep well.

  • Have a bedtime routine that is consistent each night, for instance “Bath, bottle, book, bed.”   Write this down and post it so everyone who puts the baby to bed can do it the same way.   Research shows that after just 3 weeks of a consistent, relaxing bedtime routine, babies fell asleep more quickly, woke less in the night, and return to sleep more easily
  • Put the baby to bed sleepy but still awake, so that he learns to fall asleep by himself.
  • Be thoughtful about the sleep environment your child falls asleep in, and make sure it will be the same during night wakenings so he can return to sleep easily.   For example, if the room will be dark and quiet in the middle of the night, it should be dark and quiet when he is put to bed at the beginning of the night.
  • Decide what strategy you will use in the middle of the night to help the baby return to sleep, and be consistent each time.   Again, post this strategy so you can refer to it in the middle of the night when you are tired.The most important thing to teach your infant is that when she is sleepy she goes to sleep, and the way to help her fall asleep easily is to be consistent with good sleep habits.


    Family Sleep Health

    March 2010Family Sleep Health

    Last month we discussed infant sleep health, today I’d like to follow-up with discussion of family sleep health.   Whenever I’m working with a family to help them improve their child’s sleep, I also think about the parents sleep too.   So many parents come in saying they get hours less sleep each night than they need, and they can’t think as well as they used to, or that they aren’t getting along like they used to.   Here’s some more information.

    Facts About Parents’ Sleep

    Many adults in our culture don’t get adequate sleep.   For parents, an additional sleep disturbing factor is the children who wake them up in the night or early morning.   This sleep disturbance can have a broad impact on how parents function during the day, and even on how parents get along with each other.

    In the 2004 Sleep in America poll it was found that among parents of children 10 years old and younger:

    • 58% of parents think they need 8-9 hours of sleep each night
    • But on average get 6.8 hours
    • 62% said they are not getting enough sleep
    • And 20% say daytime sleepiness interferes with their daily activities
    • 5% of parents say their childs’ sleep causes marital stress

    In mothers of infants and toddlers, after just 3 weeks of their child sleeping better, the mothers are less depressed, and able to think more clearly.

    How to Get Healthy Sleep for the Whole Family

    So if you find that someone in the family isn’t sleeping well, take the opportunity to create a healthy sleep plan for the whole family.   Here are some questions you can think through for each parent.   You may want to print this out and post it so everyone will know the plan and can be involved.

    • 1. Nightly sleep need:
    • 2. Quiet (non-task) time will start at:
    • 3. Lights out at:
    • 4. Night waking responsibility:
    • 5. Wake time:

    Remember how not getting adequate sleep can affect physical and cognitive performance, and mood.   When everyone is well rested you’ll be better able to enjoy your family!



    Sleep in the Elderly

    April 2010Family Sleep Health

    You may hear people tell how their sleep has worsened as they age.   They describe lower quality night time sleep, and more need to nap during the day.   Recently I had the privilege of working with a person age 101 on sleep health.   This was a good experience, which brought elder sleep issues to the front of my mind.   This week, an important study about sleep in the elderly was published in the medical journal Sleep.

    Sleep Characteristics of the Elderly

    Over 15,000 interviews were conducted in China with people 65 years old and older, including almost 2,800 people age 100 or more.   China has an estimated 40.5 million people who are 75 years old and older.   The US has more than 18 million people in this age group.

    Looking at this population, 65% of the people reported their sleep is “good or very good.”   Total sleep time was 7.5 hours, which included naps.   Men were more likely to sleep well than women.

    An interesting finding was that the oldest (age 100+) were 70% more likely to sleep well than those ages 65 to 79.   They were also 3 times more likely to sleep 10 or more hours each night, and less likely to get only 5 hours of sleep.

    Access to healthcare and economic status also made a difference – people were 84% more likely to sleep well if they had adequate healthcare.   The people with poor health overall were less likely to sleep well, as were those with a chronic disease, anxiety, or difficulty doing the tasks of daily living.   Those with good economic stability were more likely to sleep well.

    How Can We Use this Information?

    Although this study gives us valuable information about sleep in the elderly, it does not give information on cause.   We are still left wondering “How long did these elderly people sleep in their middle age?”   “Did their sleep habits earlier in life allow them to live into their hundreds?”

    What was clear is that those with the best overall health were more likely to sleep well.   So taking good care of yourself, addressing health concerns, and getting help from a medical professional when needed will help your sleep in the long run.

    This Chinese study is ongoing, so we’ll be able to learn more about this in another couple years – stay tuned!

    Testimonial of the Month

    “Dr. Darley has, through her expert guidance, helped me move from being afraid to go to bed because of the struggle to sleep, to looking forward to relaxing in bed as my mind and body fall asleep naturally.”
    J. a 62 year old man with 20 year history of insomnia



    National Sleep in America Poll 2009

    May 2010National Sleep in America Poll 2009

    Each year the National Sleep Foundation conducts a study of Sleep In America. This year they studied the effect of the economic downturn on our sleep – and Wow! What an effect it is having!

    Economic Worries Ruin Sleep

    A full 27% of Americans reported that their sleep has been disturbed at least a couple nights each week because of economic concerns. People are losing sleep over their personal finances, the state of the US economy, or employment concerns. More than half are also having problems with their feelings several days each week.

    Compared to those who sleep better, these people are less able to do the following because they are too sleepy:

    • – work effectively
    • – exercise
    • – eat healthy
    • – have sex
    • – do leisure activities

    Those who lose sleep over economic concerns are more likely to cancel fun social events or hobbies because they feel too sleepy. They are also more likely to turn to unhealthy behaviors such as smoking or eating sugary foods to compensate for sleepiness.

    Sleep Well in this Economy

    There are skills you can use at home to improve your sleep. When you sleep well you will be able to think more clearly, and have the emotional balance to deal with the stresses that come your way.

    One skill that patients invariably say has helped them is to do some journaling each day. The goal is to put your thoughts to bed before you go to bed. The instructions are to spend 10-15 minutes (no more) each evening putting down the thoughts that arise in the night. Do this several hours before bed. Then in the night if those thoughts come up, then tell yourself gently and firmly “I already thought about that, and I’ll have time to think about it tomorrow. Now is the time to sleep.” The more you practice this the more effective it is.

    Another survey finding was that people whose sleep was disturbed by economic worries got were more likely to sleep only 6 hours. So ensure that you are getting adequate sleep. It appears that most adults need between 8-9 hours each night. If you are getting less, move your bedtime 15 minutes earlier every 4 days or so until you are able to wake up without an alarm, and feel refreshed.

    If these skills don’t improve your sleep, you may need to consult with a sleep specialist to ensure that you have the sleep you need to think clearly and cope with this challenging economy.



    Summer Sleep – Interesting Parasomnias

    June 2010Summer Sleep – Interesting Parasomnias

    What a glorious summer it has been so far!   In the spirit of summer and taking things easy in the sun, this issue is a discussion of some of the more interesting and rare sleep disorders.   This is not to say though that these disorders are not important, just a more interesting read than others.

    What are Parasomnias?

    In sleep medicine we define parasomnias as ‘undesirable events that accompany sleep.’   What makes these disorders so interesting is that they can involve more complex and apparently purposeful behaviors than other disorders of sleep.   There are parasomnias that occur in REM sleep, and some in nonREM. Below are just a sample.

    Sleepwalking

    As an 11 year old child, I had a champion sleep walking event – let me tell you about it.   Growing up in the suburbs, we lived in a one story rambler.   We were friends with the neighbors, who were our age, and also lived in a rambler.   One night, after having the flu, I walked down the long hall, out our front door, around the side of the house, up a 2’ rockery, and into the neighbors’ walk.   From there I pulled the string to open the wooden gate, up the 6 stairs to their backdoor, in and through their house to the parents room.   There I stood until they woke up, I woke after being walked to their kitchen, and my parents woke when the neighbors pounded on the door delivering me home.

    Sleepwalking typically does occur in children, and resolves as they go through puberty. Sleepwalking tends to run in families.   As you can see from the story above, safety is a primary concern.   If your child sleepwalks, you need to make sure that doors and windows are locked, stairs are safely blocked, and other hazards are contained.   You can hang a bell over the door, so it will alert you when the child gets up.   When someone is sleepwalking it is best to simply guide them back to bed gently.

    REM Sleep Behavior Disorder

    During REM sleep your muscles are usually inhibited so that you don’t move during dreams.   In this disorder, however, muscle tone is maintained, so the person ends up acting out their dreams.   For an unknown reason the dreams that are acted out are usually unpleasant, action-filled and violent.   The eyes usually remain closed, and people have been known to sit up, leap from bed, shout, swear, grab, flail their arms, punch, kick, and talk.   As you can imagine, sleep-related injury is common for both the patient and their bedpartner.   This disorder is more common among men over aged 50, and among those with a neurological disorder such as Parkinson’s disease.   If you suspect REM Sleep Behavior Disorder then consult with a sleep clinic.

    These are just two of the many types of parasomnias that people can experience.   Feel free to email me with questions about other abnormal sleep behaviors if you wish.



    Children’s Sleep

    August 2010Children’s Sleep

    Why is it important to think about children’s sleep?   To start, many children simply don’t get enough hours of sleep.   Here’s how much sleep kids need:

    • children 3 to 5 years old need more than 11 hours
    • children 6 to 12 years old need 10 to 11 hours
    • teenagers need 9 to 9.5 hours

    Looking at the school start times here in Seattle, and allowing just one hour from wake-up to being at school, grade school children should be sleeping by 9pm, middle schoolers by 9:30p, and high school students by 9:30-10pm.   (If your child needs more than 1 hour from wake-up to school start time then move bedtime earlier accordingly).   Are your children getting to sleep at that time?   If not, your child is probably feeling the effects of insufficient sleep.

    Impacts of Insufficient Sleep

    Going to school can be demanding, children are asked to concentrate, learn physical skills, and develop socially with their peers.   Here are some highlights:

    • Only 20% of children grades 6-12 get the necessary amount of sleep (>9 hrs)! Can you believe it?! In younger children, only 47% get the sleep they need.
    • Increased playground injuries in children who sleep <10 hours.
    • Children with insufficient sleep are more likely to be angry, depressed, or overly emotional.   Kids who sleep less take more risks, and this is especially true in teens.
    • Cognitive effects include impaired memory, creative problem solving, and decreased verbal fluency, all skills that your child needs in school

    What you can do to improve your child’s sleep:

    • Establish bedtimes for your children, so everyone in the household knows the standard.   You may want to have a time when everyone finishes their activities and starts to “wind down.”
    • Start a trend in your social group of starting activities early enough that they usually end an hour before bedtime.   This gives you time to travel home safely, and wind down a little before going to sleep.
    • Remove electronic media from your child’s bedroom so they are not tempted to continue with homework, TV, or texting after bedtime
    • Kids (and parents) can get excited about activities.   Emphasize quality wake hours rather than quantity.   Is it really fun to stay up late if you are so tired that you can’t think or are teary the next day?
    • Allow your children to catch up on sleep on the weekends or vacations if necessary.   The golden standard is to wake up on their own, feeling refreshed and energetic throughout the day.   If your child sleeps a lot more on weekends, consider moving their school night bedtime earlier in 15 minute increments until it evens out.

    Testimonial of the Month

    Mother of 9 year old son suffering from circadian phase advance for 3 years.

    “You looked at it from a different point of view.   Everyone else was trying to fit my son into their model, telling him ‘You feel this way’ when it’s not how he felt.   This is the first time he’s felt good about his sleep. ”



    Do I need a Sleep Test?

    September 2010Do I need a Sleep Test?

    People frequently ask me if they might need an overnight sleep test.   There seems to be a lot of mystic about sleeping in a sleep lab, what the testing is like, and whether people are actually able to get any sleep with the monitoring equipment.   Let’s look at these questions.

    When is a Sleep Test needed?

    There are about 80 sleep disorders.   Some of these sleep disorders require an overnight sleep study, though many do not.   Here is a list:

    Sleep study is NOT required for:

    •   Insomnia
    •   Circadian Rhythm Disorders such as Delayed Sleep Phase Syndrome
    •   Most Parasomnias such as sleepwalking
    •   Some Hypersomnias
    •   Some movement disorders such as Restless Legs Syndrome

    Overnight sleep study IS required for:

    •   Sleep disordered breathing, including Sleep Apnea
    •   Periodic Limb Movement Disorder
    •   Some Parasomnias, including REM Behavior Disorder
    •   Narcolepsy

    What data is collected during the sleep study?

    There are thin electrodes placed on your scalp with paste, at the outer corner of each eye, and on your chin.   These are used to determine whether you are awake or asleep, and what stage of sleep you are in.

    Additional testing equipment includes elastic bands around your chest to measure your breathing effort, EKG pads on your chest to monitor your heart, and electrodes on your legs to monitor leg movements.   You will also have a sensor on one finger to measure your blood oxygen level.

    What can I expect, and do to make the sleep study a good experience?

    First of all, know that almost all people sleep just fine in the sleep lab.   Before and during medical school I worked as a PSG tech, so I know this is true from seeing hundreds of people sleep well.

    You’ll be asked to arrive at the lab about 7pm.   You will work with one staff called a PSG Tech throughout your stay.   He or she will show you the bedroom, and hook the testing equipment to you.   They will monitor you throughout the night and unhook the testing equipment in the morning.   If you need to use the restroom in the night, no problem, simply call out to let the Tech know.

    Most sleep labs have bedrooms that look like hotel rooms with a double or queen-sized bed.   You are welcome to bring your most comfortable pillow, and a favorite book or movie to enjoy before bed.

    The information gathered during the overnight sleep study is so valuable in diagnosing and treating sleep problems that it is well worth it.

    Testimonial of the Month

    “Of all the money I’ve spent over the years trying to feel better this is the one thing that has helped.”
    – S. 55 year old woman with insomnia and previously undiagnosed sleep apnea



    Women’s Sleep Through the Ages

    December 2010Women’s Sleep Through the Ages

    It’s when reproductive years begin that women begin having more sleep problems.   Here are some common sleep disturbances by hormonal status.

    During the premenstrual week, women report having more difficulty falling asleep, sleeping through the night and waking in the morning.   It’s common in the office for women to say “The week before my period I need more sleep.”

    During pregnancy sleep changes each trimester.   During the first trimester women typically need more sleep, and find themselves sleepier during the day.   Sleep improves during the second trimester, generally speaking.   Symptoms of reflux, leg cramps, frequent urination, and simply being uncomfortable lying down disturb sleep in the third trimester.

    During menopause, women’s sleep can be disturbed by hot flashes and night sweats.   Also, as part of the aging process, sleep is lighter with more awakenings.   It is also important to know that sleep disordered breathing (such as snoring and apnea) becomes more common in women after menopause.

    What can I do to improve my sleep?

    If you are experiencing sleep problems common to women, here are some tips to help yourself sleep well all month:

    •   – If you need to, allow yourself extra sleep time during the week before your period, so you can feel more energetic and less sleepy.
    •   – If you are having night sweats and getting too hot at night, take steps to keep cool.   (Remember, people tend to sleep better when they are cool).   So turn the thermostat down, layer blankets so you can easily adjust them, and wear fabrics that wick heat and moisture away from your body.   Be creative with your bedpartner in finding a solution to keep both of you at a comfortable temperature.   Several patients have recommended specialty products, including those from Wild Bleu and Opposheets.
    •   – If you are having hormonal problems, see a naturopathic physician who can develop a treatment plan for you to better moderate your hormone levels.
    •   – If your sleep continues to be disturbed, you may have another sleep disorder, or need specialized treatment from a sleep center.

    Testimonial of the Month

    “Of all the money I’ve spent over the years trying to feel better this is the one thing that has helped.”
    – S. 55 year old woman with insomnia and previously undiagnosed sleep apnea



    Skills for Falling Asleep

    January 2011Skills for Falling Asleep

    There are many ways a person could experience insomnia.   It could be difficulty falling asleep at the beginning of the night, or being awake for an extended time in the middle of the night, or waking too early.

    Whatever time it is, being awake in bed can often lead people to feel frustrated, angry or hopeless about their sleep.   As you can imagine, these feelings do nothing to help a person fall asleep.   Let’s talk about some strategies to use to help yourself fall asleep.

    An ‘Over-active’ Mind

    Frequently people tell me that their mind is going a mile a minute once they are awake in bed, that they have ‘buzz brain.’   In this situation, you want to establish boundaries with yourself that bedtime (from lights out to wake time) is not a time to think things through.

    So first of all, schedule time 2-3 hours before bed to jot down the thoughts that arise at night, and put them to rest.   Spend just 10 minutes on this, so you don’t get further entrenched in those thoughts.   You can use any format that works for you – a To Do list, journal, problem and solution brainstorming list, calendar system, or any other format.

    Second, if thoughts arise in the night, tell yourself that you already thought about it, and will have time tomorrow, now is time to rest.   Putting your thoughts aside like this is a skill, and like all skills, you will get better the more you practice.

    Follow this up with purposefully substituting thoughts that help put you to sleep.   Some strategies are: a sleep promoting visualization (think dozing on the warm sand at the beach), or slow deep breaths, or repeating a prayer or mantra.   For people who are also physically restless, doing progressive muscle relaxation starting with the feet can help still both the body and mind.

    Concluding Thoughts

    Almost everyone has difficulty sleeping occasionally, and these strategies can help quiet the mind and promote sleep.   Establish with yourself that during your sleep time you are “off duty” from all types of thinking or planning.   You will feel better for having a good nights sleep, and be better able to think things through well during the day.

    Testimonial of the Month

    “I have had sleep issues since I was 15   I tried all the herbal remedies (on my own) with no success.   I didn’t want to use pharmaceuticals.   Dr. Darley helped me in three visits-without any medication.   About two weeks after my last visit with her, my husband got laid off.   Normally this would totally mess up my sleeping habits.   I haven’t missed a good night’s sleep.   Thanks so much, Dr. Darley!”
    – K. is a 43 year old with a 28 year history of insomnia.



    Sleep and Technology

    April 2011Sleep and Technology

    Each March, we celebrate National Sleep Awareness week, and the National Sleep Foundation unveils its’ Sleep in America poll.   This year the poll was all about our use of technology during the hour before bed, our nightly sleep, and daytime function.   Phone surveys were conducted with 1,508 Americans between the ages of 13-64.

    How is technology impacting our sleep now?

    We’re dissatisfied with our sleep:
    – 63% say that during the week their sleep needs are not met.
    – 60% say they have a sleep problem almost every night.  This includes snoring, waking in the night or too early, or feeling unrefreshed.
    Most Americans use some type of technology before bed.
    – 95% of us use technology during the hour before bed a few nights a week or more.   This includes TV, computer, video game or cell phone.   Older people are more likely to watch TV during that last hour, while about 50% of people age 13-29 surf the internet before bed.   One researcher hypothesized that the ‘interactive’ technologies (like video games, cell phone and internet) promote wakefulness more than the ‘passive’ media like TV and music.- 20% of 13-29 year olds say they are awoken by a text, phone call or email several nights a week.
    The younger people are the most sleepy.
    – 22% of 13-18 year olds are clinically sleepy (they rate as ‘sleepy’ on a standard assessment questionnaire used in sleep clinics).
    – About 10% of 13-45 year olds say they drive drowsy 1-2 times a week.
    Our daytime function is impaired by sleepiness
    – Across all age groups, we drink an average of 3 caffeinated beverages each workday.
    – 74% of people who are employed and get inadequate sleep say that sleepiness effects their performance.
     
    Recommendations to reduce the impact of technology
     
    Melatonin is a hormone that helps us feel sleepy.  It is usually low during the day, and increases before our habitual bedtime.  However, melatonin production is inhibited by light.  Using the TV or computer for the hour before bed can keep us alert and shift our body clock so we are not sleepy until later.  Be in low or dim light from dusk to bedtime.
    Write down how much sleep you do the best with, then write what time you need to get up in the morning.  Calculate backwords to find your bedtime.  Lastly, count back one more hour to find the time that you should start winding down, and have your tech devices turned off.  Make this sleep schedule very routine so all your sleep processes are in sync.
    Set boundaries with family and friends that you are not available by phone or text during sleep hours.  This also helps establish with yourself that you are ‘off duty’during sleep time.
     
    Concluding thoughts
    This poll brings to my mind the questions “What would I have been doing in the evening 150 years ago?  What would the light have been like?”  As this research shows, we are just now learning about the impact electrical light and abundant technology has on human beings.  Having low light in the evening as our ancestors did may just increase our satisfaction with our sleep, and our daytime experience!
     
    Testimonial of the Month

    “I have had sleep issues since I was 15.  I tried all the herbal remedies (on my own) with no success.   I didn’t want to use pharmaceuticals.   Dr. Darley helped me in three visits-without any medication.   About two weeks after my last visit with her, my husband got laid off.   Normally this would totally mess up my sleeping habits.   I haven’t missed a good night’s sleep.   Thanks so much, Dr. Darley!”



    Sleep and Social Skills

    April 2011Sleep and Social Skills

    So we’ve been talking about the many ways our sleep – good or bad – impacts our overall health.   Just in the last year some interesting research has been done that sheds a light on what we may already suspect – Sleep also impacts our social skills and functioning.

    Here’s a summary of what’s been found:

    • Pictures were taken of people when they were well rested, and again when they were sleep deprived.   When those photos were shown, the sleep deprived were seen as less attractive, less healthy, and more sleepy.
    • Pictures were taken of people when they were well rested, and again when they were sleep deprived.   When those photos were shown, the sleep deprived were seen as less attractive, less healthy, and more sleepy.
    • When military officers in training have to make ethical decisions, their reasoning changes depending on whether they are sleep deprived or not.   When sleep deprived their decisions are more self-centered and more reliant on rules, and not responsive to the situation.   I’d be surprised if this effect is not experienced by other populations too.
    • People are less able to read others’ facial expressions when they are sleep deprived.   This is especially true for happy and angry emotions, and women are more impaired by men.   The ability to be empathetic and to communicate requires the ability to read facial emotions.   In psychology abnormal facial processing is associated with social dysfunction.
    • Sleep loss amplifies the negative emotions of disruptive events, and reduces the positive emotions of good events.

    Some of these studies were done in narrow populations.   Even so, I expect that in the next year or two we’ll be hearing that most people feel these effects.   Getting along socially with others is a very important part of life, as you know.   If you are having trouble getting along, you may want to take a look at your sleep.   Are you getting the amount of sleep you need?   Is your sleep impaired by a sleep disorder?   If so, addressing these sleep problems may pay off in smoother social functioning (along with all the health benefits).



    Teen Sleep

    April 2011Teen Sleep

    Remember your sleep in high school?   Staying up late, then sleeping late on weekends is what lots of people remember.   Unfortunately, another common memory is struggling to get out of bed for school.

    It all happens because during puberty, our intrinsic body clock shifts later.   Our body clock sets the rhythms in many of our systems, from when our melatonin and cortisol peak, to when we are most mentally sharp and physically coordinated.   New research has shown that this swing to later timing is actually one of the first things that happen in puberty, even before physical changes can be observed.

    Impact of teens sleep

    The difficulty comes when teens (and tweens) need to be on an earlier schedule than their body is programmed for.   When school starts early, students are in class, trying to pay attention and learn while their body and mind are asleep.   Challenging, eh?   Teens’ sleep basically gets squeezed between their later body clocks, and their early schedules.   When high school start times were moved on hour later in Minnesota, there was an increase in amount of nightly sleep and subsequent improvement in school success: with improved attendance and most importantly increased graduation rates.

    Other studies have looked at the amount of sleep teens get and many health parameters.   Teens who get less sleep are:

    • Less motivated to exercise, contributing to the epidemic in childhood obesity
    • Get lower grades
    • Are more depressed
    • Many other negative effects

    How to improve student sleep

    The basic principle is to sleep and wake in accordance with the intrinsic body clock.   So first of all, honor that teens are on a later schedule, and then set routines that help them be on as early as possible.

    • Avoid scheduling early morning activities when possible.   Advocate for your children when parents and coaches are scheduling events.
    • Set a sleep / wake schedule, and stick with it.
    • Get bright light, preferably outdoor light, soon after waking each morning.   This is most important in setting the body clock.

    Sometimes these measures won’t have a big enough impact.   There are medical interventions that can help teens sleep and wake on their early school schedule.



    Neurotransmitters

    April 2011Neurotransmitters: Brain Chemicals of Sleep

    Over the last newsletters we’ve talked about many behavioral skills and strategies to help ourselves sleep well naturally.  Sometimes though, we do everything in our power to sleep well, but without success.  At that time, other therapies are in order.

    One of the options is supporting neurotransmitters with specific nutrients.  Neurotransmitters are brain chemicals which help us sleep at times and be alert at others.  Some of the ones we think of which promote sleep include serotonin, dopamine, GABA, histamine, glutamate, and norepinephrine.

    In the clinic, neurotransmitter levels can be tested by doing urinary analysis.  This test has been used by holistic physicians for the last 12 years.

    When neurotransmitter levels are out of balance, the nutrients which are their building blocks can be used to increase their levels.  These are primarily amino acids (parts of proteins) and the vitamins and minerals to help form the neurotransmitters.  Some amino acids you may have heard of include L-tryptophan, 5-HTP, GABA, glutamine and tyrosine among others.  This can be a very effective treatment for people whose sleep hasn’t improved with other strategies.

    The usual format of this newsletter is to include tips you can use on your own. However, because this is a powerful therapy, it is not a treatment to try on your own.   If you would like to try amino acid therapy for yourself, go to a licensed holistic healthcare provider.  They will get a detailed history of your sleep problem and current medications, do testing as appropriate, then recommend the right combination of amino acids and other nutrients.

    In other news:

    1.  The Center for Disease Control reported in September that teens who sleep less than 8 hours nightly are at increased risk of using marijuana, alcohol and cigarettes, are more likely to be sexually active, and have increased feelings of depression and suicidal thoughts.  We take the issue of sleep deprived teens very seriously, and reach out to the community by providing education to PTAs and other parent groups.  If you’d like to learn more about how to help teens get the sleep they need, please contact us at drdarley@naturalsleepmedicine.net.  Read the CDC report here:http://www.cdc.gov/media/releases/2011/a0926_insufficient_sleep.html?source=govdelivery

    2.  The change to daylight savings time is coming up this weekend, on November 6th.  It can take up to two weeks for a person’s sleep to return to normal, so keep that in mind if your sleep temporarily worsens.  Be extra cautious during your commute, as there are increased accidents after the time change.  Drowsy Driving week is Nov 6-12.

    Testimonial of the Month

    “Dr. Darley’s presentation to our PTSA in March of 2011 was one of the best speakers we have had.   Her topic on Sleep Medicine and Student Success was universally appealing to parents, teachers and counselors.   We received favorable comments regarding her presentation’s content as well as her presentation style.   Dr. Darley’s presentation educated many on sleep’s importance in the intellectual, physical and emotional health of our children (and us adults as well)!”
    Kari, Whitman PTSA Co-President