Category Archives: Circadian Rhythm Disorders

Easy Tips to Combat Summertime Insomnia

Don’t you love summer?  All the barbecues, outdoor festivals, vacations; school’s out, with all the freedom that goes with that.

I love summer as much as the next guy.  Many of my sleep patients don’t, however.  I’ve found that there are a couple of times of the year in which my patients experience a spike in their insomnia:  during the holidays, and during the summer.

There are several reasons why summertime can trigger or worsen difficulties falling and/or staying asleep.  First, many people and many families experience lifestyle changes during the summer as compared to during other times of the year:  kids can sleep in in the morning; vacations with jet lag; modifications in work hours or work timing; late-night parties and alcohol use.  These changes tend to dysregulate sleep schedules, leading to insomnia.  Second, it’s hot!  It’s hard to sleep when you’re sweltering and sweating in bed every night; we here in Seattle have been in a month-long heatwave, a major problem because most homes here have no air conditioning!  Third, because of the tilt of Earth’s axis during the summer, it’s light out late.  As most can easily understand, if the sun is still up in the evening, it feels naturally for YOU to stay up.  Exposure of your eyes–and hence your brain–to light has a profound impact on your sleep/wake cycles.  No wonder why people tend to have insomnia during these precious summer months!

So here are some pointers to improve your sleep for the remainder of this summer:

1.  Choose a time to awaken each morning, and stick with it.  Even if you’re not in school or not working, determine a preferred awakening time, set your alarm clock or smart phone for that time, and awaken and get out of bed that same time every morning, including weekends.  Your body clock “wants” regularity, no matter what your personal situation.  Sleeping in by several hours can throw off your body’s circadian rhythms, dysregulate your sleeping patterns, and promote delayed sleep phase.

2.  Keep your sleeping environment DARK.  Usually Venetian blinds suck at keeping out substantial light from your room when the sun is out late.  I recommend getting thick black curtains that completely cover up your bedroom window.

3.  Keep your sleeping environment QUIET.  Whether it’s motorcyclists or firecrackers outside your bedroom window, summertime often means lots of noise outside your bedroom.  Insulate your bedroom from the noise the best you can.  A fan near the bed can create a white-noise effect to drown out noises from outside.  Some may resort to sleeping in another, quieter room in the home, one that is further away from the street for example.

4.  Keep your sleeping environment COOL.  The fan in the room helps with this, obviously, if you don’t have AC.

5.  Avoid naps if you can.  Naps are tempting if you have the time and opportunity, particularly if you’re chronically sleep-deprived.  However, naps during certain times of the day–particularly the mid- to late afternoon–can cause substantial subsequent problems falling asleep later at night.

6.  Don’t spend too much time in bed.  Remember, most adults need about 7-8 hours of sleep per night, and your body generally won’t let you sleep more than what your body needs.

School is starting back up before you know it.  Enjoy the remainder of your summer!

 

Alaska Airlines Cargo Worker Falls Asleep in Plane Cargo Compartment

Here’s a recent story from right here in my home base of Seattle, Washington:

Six days ago, as Alaska Airlines flight #448 took off from SeaTac International Airport, passengers heard someone pounding from below the cabin.  A cargo worker was trapped in the cargo compartment of the now airborne Boeing 737.  This as-of-yet unidentified man, an employee of contractor Menzies Aviation, called 911 upon realizing he was trapped in the belly of the plane.  Upon learning of the presence of someone in the compartment, the pilot turned around for a hasty but safe emergency landing back at SeaTac.  No one was injured.

 

Turns out that this man had fallen asleep in the cargo compartment and he later awakened to find himself–and the plane–airborne and on its way to Los Angeles.  The Federal Aviation Administration is investigating the incident, and by report the man is on administrative leave; furthermore, according to an Alaska Airlines spokesperson he has been “permanently banned from ever working again on an Alaska Airlines operation.”

It’s not clear from the news reports why the contractor was asleep in the cargo compartment; by report he passed a drug test subsequent to the event.  However, this incident took place around 2:30 in the afternoon on a Monday.  From a physician sleep specialist’s perspective, here are some important potential reasons for someone to end up snoozing in the wrong place at the wrong time:

—Irregular sleep schedules, which could be related to a wide variety of causes, from insomnia to some late weekend nights to flip-flopping work shifts (it’s not yet clear if this man’s particular work scheduling involved occasional or recent night-time work).

—Chronic sleep deprivation.  Most adults require 7.5-8 hours of sleep per night regularly to feel fully rested during the day, and the most common cause of sleepiness in the U.S. is sleep deprivation.

—Undiagnosed and/or untreated sleep disorders.  There are about 100 sleep disorders, ranging from breathing disorders (such as obstructive sleep apnea) to movement disorders (such as periodic limb movement disorder).  Commonly associated with excessive daytime sleepiness, these intrinsic sleep disorders often can persist for many years before coming to the attention of a healthcare provider.

I should note here that it’s not necessarily abnormal to feel a little sleepy or “let down” in the mid-afternoon.  Our natural tendency to become slightly drowsy or fatigued during that time of day is called the “circadian dip” or “circadian low;” it also provides the reasoning for the “siestas” commonly found in some cultures.  However, warningless sleep attacks and irresistible urges to sleep during that time suggest that more than just the circadian low may be at work.

 

Though I understand that Alaska Airlines does not permit people to “sleep on the job,” my real concern here is why this person experienced a sudden sleep attack or felt compelled to take a nap in the compartment in the first place.  I hope that this gentleman has been or will soon be properly evaluated in this regard.

Help Your Child Sleep Well While “Back to School”

All you parents know what’s right around the corner, if it hasn’t already happened: the start of the new school year! At least for us in the Pacific Northwest, school doesn’t start for another week, so we have one more glorious week of sun and freedom before the beginning of fall classes.  But for many of you elsewhere, school has already started in earnest.

 

One of the many concerns parents have as they transition back into the school year is how their children’s sleep habits will change. Many of us know the drill, from our children’s experiences or our own: all the staying up late on weekends, sleeping in ’til noon on Saturdays and Sundays, the Herculean effort necessary to get out of bed in the morning, especially on Mondays. Though this ritual is very common, particularly for teenagers, the stress and conflict arising from this chronic problem can wreck your family life, not to mention your grades.

This pattern, called delayed sleep phase, arises from the adolescent brain’s natural tendency to cycle its sleep-wake rhythms in a timing scheme that is longer than the 24-hour day. Many of us recall what it was like to be younger and wanting to stay up later and sleep in later if given the chance. The problem with this tendency is that children and teenagers usually engage in activities (i.e., school) that obligate them to entrain their sleep-wake behavior to the 24-hour clock. This conflicts with their biological inclination to go to bed later, resulting in sleep deprivation which makes it more difficult to awaken early in the morning and be awake and alert for classes. Friday night comes ’round, they stay up late, sleep in big-time on weekend days, and then find it impossible to fall asleep early Sunday night because their body clock’s sleep-wake phase has now been delayed from all the sleeping in, so all the sleep debt and sleep deprivation then roll into the new school week, perpetuating the cycle.

There is ongoing controversy about what can and should be done to improve this problem for young people and their families. Though some schools around the country have options of starting classes later in the day, many or most of us parents are obliged to ensure that our children are out of bed and ready for school at times earlier than what they, and their body clocks, “want.”

So what can be done? We can’t change our kids’ brains, though sometimes it’d be great if we could, right? Here are a few tips to help weary parents get their kids sleeping better as we kick off this new school year. As you will see below, these recommendations may be quick to read and absorb, but whether they are easy is another matter. The unfortunate reality is that making these sleep problems substantially better likely will be difficult, at least at first, requiring communication, motivation and insight from the child and patience and support from the parent.  Ready? Here goes.

1.  Minimize the “sleeping in” on non-school days by setting the alarm clock for reasonably similar times each day to the extent you can.  Kids hate this most of all.  Sleeping in dysregulates your body clock, causing nocturnal insomnia and daytime fatigue.  Sleep schedule dysregulation is why we have jet lag, for example.  If your child has to awaken for school at 6 a.m., say, but sleeps in ’til noon on weekends, and then tries to go to sleep early Sunday night, such abrupt changes in the brain would be the equivalent of flying from the west coast to the Bahamas, for example, and back, every week.  Regulating the wake-up time may well require a hard sell to the teenager; I’d rather the teen sleep in until 8 a.m. than until noon.  This lifestyle modification (and it’s a big one) gets substantially easier if done diligently for a couple weeks, but I won’t lie, it’ll be painful for all involved at first.  The child may need some, er, parental assistance in getting up on weekends.  A second alarm clock is also an option.  Put one alarm clock on the nightstand, and then put the second one further away, set for 2 minutes after the first clock, so that your teen will need to physically get out of bed to turn it off.  Make sure the second alarm clock is loud, and the more obnoxious the better.

2.  Don’t go to bed until substantially sleepy.  If the first step is done properly and done the same way every day, then this second step should fall naturally into place eventually, because the resulting sleep deprivation should make your teen become drowsy gradually earlier in the evening on weekends.  Force your child to go to bed too early, however, and residual insomnia results.  Taking advantage of children’s sleep needs allows them to fall asleep quickly and earlier (including on Sunday nights) and at the same time get proper amounts of sleep (which for children and teens can be 9-10 hours per night), both of which are important in physical and cognitive development and proper performance in school.

3.  Declare a curfew from light and technology.  Light exposure greatly impacts our levels of wakefulness and alertness; add to this the perceived need to always be constantly “plugged in” socially through mobile devices, and you have a recipe for “up all night.”  Shield your child’s bedroom from outside light and noise, such as with black thick curtains, particularly as these summer months continue to wane.  Start dimming your home’s ambient light several hours prior to the projected bedtime.  And, finally and importantly, I recommend laying off lit-screen gadgets (including iPads, laptops, and smart phones) 2-3 hours prior to the projected bedtime.

Now that I think about it, I’m pretty sure this last recommendation is actually what kids hate the most.  But complete these 3 steps, and utilize them consistently, and chances are your child will sleep better.

Best of luck to students and parents alike this upcoming school year!

 

Happy Insomnia Awareness Day!: Insomnia, Defined

The American Academy of Sleep Medicine (AASM) has declared today, March 10, Insomnia Awareness Day this year.  The timing of this auspicious occasion is in keeping with the daylight savings time change from over the weekend.

We in sleep medicine circles call today “Black Monday,” the first workday following the one-hour time change each spring.  Our body clocks don’t like making changes in their sleep shifts, even if only by a mere hour; anyone who has experienced jet lag knows what I mean.  As you know, “springing forward” one hour means having to get up one hour earlier than what our body clocks are accustomed to and thus “prefer.”  For those who do not adjust their bedtime schedules accordingly, getting up to get to work, school, or appointments on Black Monday becomes all the more difficult.  At the same time, the mild dysregulation of sleep scheduling can also lead to insomnia, particularly if there is already baseline insomnia to begin with.

 

I’ve covered insomnia in previous posts, and I will go over it and its management in future posts too, because it is such a huge, prevalent clinical problem and growing public health concern.  For the purposes of today’s Insomnia Awareness Day post, however, I will concentrate simply on what insomnia means.

The definition of insomnia, as accepted by the AASM, is the “subjective perception of difficulty with sleep initiation, duration, consolidation, or quality that occurs despite adequate opportunity for sleep, and that results in some form of daytime impairment.”  [Schutte-Rodin S; Broch L; Buysse D; Dorsey C; Sateia M. Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med 2008;4(5):487-504].

As such, insomnia is by its very nature subjective, meaning that you can have insomnia no matter how much actual sleep you really get, and implying that the time spent awake in bed is bothersome.  Among the many impairments associated with insomnia are a feeling of unrefreshing sleep, low energy levels during the day, daytime sleepiness, emotional problems (like depression and anxiety), morning headaches, difficulties with memory and concentration, reduced work productivity, and a propensity toward industrial and motor vehicle accidents.

This definition is important.  You can have insomnia even if you get a full 8 hours of sleep each night (such as if you are spending 12 hours trying to sleep each night).  Conversely, 4 hours spent in bed spent awake each night casually watching television but not trying to sleep do not constitute insomnia.  Note also that the definition does not address potential causes, of which there are hundreds–causes can range from a can of Mountain Dew at 10 p.m. to one’s mental perception of dread and frustration associated with previous difficulties falling asleep.  The definition of insomnia also helps provide a rough roadmap to therapy.  My own practice philosophy for patients with chronic insomnia (i.e., insomnia that lasts for a month or longer) is to identify the underlying causes and to improve the insomnia by improving or resolving the problems causing it.

From a clinical perspective, chronic insomnia management can range from relatively straight-forward to extremely challenging.  Doctors that identify themselves as “physician sleep specialists” should have the expertise and willingness to handle cases of insomnia, including the tough ones.  Enlist their help should your insomnia become sufficiently problematic.  Help IS available.

Sleep well tonight, everyone.  Black Monday is almost at its end!

Does Your iPad Lead to Insomnia?

 

Our old, well-worn first-gen iPad has gotten a LOT of use over the years, and admittedly much of the use has been in bed at night.  I read quite a bit, and though I still prefer good old-fashioned paper print books (I’m always in the middle of 2 or 3), our iPad has also become a regular staple in my routine prior to turning off the lights for the night, primarily for e-mails and this blogsite adventure I started several months ago.  My wife and I have never had problems falling asleep as a result of iPad use, but many of my patients have found their insomnia improves with modifications in their habit of using electronic devices involving bright backlit screens in bed.

We’ve all experienced activities that cause us to end up going to sleep later than what we intended.  However, backlit electronic pads can contribute to difficulties falling asleep if used shortly prior to bedtime, and there are a couple reasons why.  First, the content of what you’re doing or reading can obviously play a role.  Whether it’s an exciting video or the discovery of the latest shoe sale on Zappos, anything that you’re exposed to that is visually or emotionally stimulating or is of emotional importance to you can create an alerting effect that delays the onset of drowsiness.  Second, and importantly, the light exposure from the backlit screen (particularly when full-color) can also have a stimulating effect.

 

Light tends to inhibit the release of melatonin in your brain.  There is a thin band of neurologic tissue–called the retinohypothalamic tract–that connects your eyeballs to the hypothalamus, the seat of your body block.  This tract is stimulated when the back of your eye–the retina (the cells of which are illustrated above)–are exposed to bright light, and the resulting signal to the brain leads to a sensation of wakefulness and alertness, the exact opposite of what you want when your goal is to fall asleep for the night.  This is why it’s important to avoid bright light late at night and to expose yourself to bright light early in the morning if you have insomnia.

The problem is that modern backlit e-readers are not only capable of emitting very bright multi-colored light, but also held very close to your eyes:  unlike your television set, which is across the room, your iPad is on your lap or held right in front of your face, bathing your retinas with light.

So here are some suggestions for you if you’re having difficulties falling asleep following backlit e-reader use at bedtime:

1.  Turn down the intensity or brightness of the screen.
2.  Try an e-reader without a backlit display, such as a basic Kindle.
3.  Call me old-fashioned, but you could always go back to paper books, and save your e-mail for tomorrow morning.
4.  Read in relatively dim light.
5.  In general, avoid intense light for about 1-2 hours prior to your projected bedtime.

Happy reading, everyone!

What About Naps?

Thank you, everybody, for your recent inquiries.  I’m happy to help!

The other day I was asked about daytime naps:  “is it better to take a nap when you are feeling really tired that day or try to go to bed earlier instead and skip the nap?”  In order to best answer the question, it’s important to know what is causing you to want or need the nap in the first place.

 

The science of sleep regulation is quite complex.  Sleep intensity is mediated by what is called the homeostatic mechanism of sleep, the specifics of which are beyond the scope of this blog entry.  Simply stated, the principles of sleep homeostasis dictate that sleep deprivation results in a compensating increase in intensity and duration of sleep, and excessive sleep (such as related to a daytime nap) reduces the inclination for sleep.  Taking a nap during the day implies daytime sleepiness, so let’s explore why one may be sleepy during the day.

One of the most common causes of daytime sleepiness is simple sleep deprivation.  If you’re getting 5 hours of sleep per night, for example, when your body needs 8, then likely you will not need to take a nap during the day any longer if you then gradually increase your sleep time to 8 hours per night, because by satisfying your body’s natural sleep needs consistently you should eventually feel substantially more awake and alert throughout the day.

Another common cause of daytime sleepiness is insomnia.  If you get less sleep at night because you’re awake a lot in bed, an obvious consequence would be feeling fatigued and drowsy during the day.  The problem is that taking a nap during the day can cause or worsen insomnia, particularly if the nap is prolonged and/or taken in the mid-afternoon to early evening; you tend to get a “second wind” and feel more awake and alert later than what you desire, resulting in further sleeplessness at night.

Finally, you could be sleepy during the day due to a problem with the quality (as opposed to the quantity) of your sleep.  Numerous sleep disorders can cause substantial drowsiness during the day even if you get your 8 hours per night:  obstructive sleep apnea, upper airway resistance syndrome, periodic limb movement disorder, and narcolepsy to name a few.  A good general rule to follow:  if you regularly get 7-8 hours of sleep per night and you’re consistently struggling to stay awake during the day when 7-8 hours per night used to satisfy your sleep need in the past, and if the sleepiness can’t be explained by some other factor (like medications or alcohol), you may want to see a specialist like me.

OK, synthesizing this down, then, here are my personal primary clinical concerns about napping:

1.  If you nap because you’re sleep deprived, there is often residual sleepiness between the time you awaken in the morning and the time your nap starts.

2.  If you nap due to insomnia, a vicious cycle can develop:  the nap can cause or worsen the insomnia, which then reduces your nocturnal total sleep time, which then makes you feel more sleepy during the day, which then makes you want to nap more.  In extreme cases people’s bedtime schedules can be completely turned around due to this problem, such that they become essentially nocturnal, sleeping throughout much of the day and remaining awake all night.

3.  Taking a nap to sustain you for the rest of day may “mask” concerns for an occult sleep disorder.

Bottom line here:  if the nap doesn’t cause difficulties falling or staying asleep at night, and if you don’t have substantial daytime fatigue or sleepiness prior to the nap, and if you’re confident you know the reason why you need the nap in the first place (such as staying up too late the night before), then I think there’s probably not much of a problem with taking that nap.  However, if you find yourself unable to stay awake during much of the day, if you are substantially sleepy during the day despite getting proper amounts of sleep, or if you are having mounting insomnia in this setting, there should be further concern about what is happening.

I’ll add several additional points before Sleep Help Desk closes for today.  First, naps can be intentional (i.e., laying down with the intention of taking a nap) or unintentional (such as falling asleep by accident in front of the television).  Second, if you doze off on the couch at 10 p.m. before you go to bed, that’s still a nap!  That late-night nap can cause difficulties falling back to sleep once you do go to bed, so try to avoid dozing off in the evening until you’re in bed intending to sleep.  Finally, to answer the original question posed to me above, I suggest not going to bed too early if you choose to not take the nap.  If you go to bed way earlier than usual, you can still have insomnia even if you’re sleep deprived, because your body clock “wants” regularity nonetheless.  The idea is to gradually increase your total sleep time such that you reliably get proper amounts of sleep every night.

Trivia question:  who is the famous person napping in the photograph above?  Write me with your answer!

Cheers, everyone!  Keep your questions coming!

“Why Do I Wake Up at the Same Time Every Night?”

I’ve been asked recently by a friend why she finds herself awakening at 2 a.m. virtually every morning.

Many people have experienced this phenomenon, a tendency to awaken at least briefly around the same time every night. There may be many potential reasons for this, ranging from your pet to a need to urinate or a spouse coming to bed for sleep later than you. The expression of certain hormones in your brain throughout the night might play a role.  However, for many people, these brief awakenings may also be related to your brain’s natural rhythms for sleep.

To describe human sleep physiology as simply as I can, human sleep is very dynamic. We sleep in cycles, called ultradian cycles, in which lighter stages of non-REM (called stage N1 and N2) sleep are followed by deeper forms of non-REM (formerly called stage 3 and stage 4 sleep, but now called stage N3, or slow wave) sleep and then, to varying degrees, rapid eye movement (REM, stage R, or dream) sleep. In general, the amount of deep non-REM sleep we have per cycle is highest during the first one-third of the night’s sleep, and the amount of REM sleep we have per cycle gradually increases as the night progresses (which explains why we tend to remember our dreams most around, say, 4-6 a.m.). Exactly how and why we have been designed neurologically to sleep in this way are a mystery. A typical human adult’s ultradian cycle lasts for about 90-110 minutes. Generally it’s most difficult to awaken fully from N3 sleep, and it’s quite easy to awaken fully from REM sleep. This explains why you often feel very groggy if you’re awakened abruptly during the first 2-3 hours of sleep, but may find yourself awakening easily and quickly from a dream later at night.

The primary point I want to make with all this is that between these ultradian cycles, there are normally and naturally periods of arousal from sleep. There can be several of these brief arousals in a typical night.  In children, adolescents, and young adults, these arousals are generally very brief, perhaps lasting for only several seconds; these awakenings are not usually enough to remember, in part because younger people tend to have a lot of slow wave sleep), leaving you with the feeling that you are sleeping uninterrupted all night long, even though you have likely in reality aroused several times. Once you reach middle age, however, such as your 40’s and 50’s, the tendency to recall these arousals from sleep can gradually increase, and the duration of the typical arousal from sleep may gradually increase as well. This may explain why some people remember awakening, say, at 3:30 a.m. on the dot every night. Finally, when you become elderly, in your 70’s and 80’s, say, still more frequent awakenings may occur due to the naturally increased sleep disruption that occurs as your brain becomes more brittle with age.

Why is this all important? Because some people freak out over a spontaneous recalled arousal from sleep in the middle of the night, and this substantial concern or annoyance can generate enough worry or frustration to actually cause persistent wakefulness subsequent to that arousal, potentially triggering chronic insomnia.

Take-home point here: if there is a brief awakening around the same time most nights, and there is no specific symptom or problem that causes the awakening, and if there aren’t substantial problems falling back to sleep, and if there is minimal sleepiness during the day, my sense is that the awakening is probably not much to worry about. If there are substantial problems associated with the awakenings, however, it may be worthwhile to bring that to a doctor’s attention.

Have a great evening, everybody, and sleep well!

Sleep Song #3: “Shiftwork” by Kenny Chesney and George Strait

One thing I’ve always loved about country music is the recurring theme of hard work. Like sweet tea, personal freedom, trucks and cutoff jeans, getting your hands dirty and proudly carrying out your duties for yourself and your family are major topics in country songs old and new. And boy, can I relate.

 

I can also relate well to the topic of this little nugget from Kenny Chesney (with a little help from “The King,” the great George Strait). Growing up I worked late washing hundreds of thousands of dishes at a restaurant, and as a medical postgraduate trainee I was expected to work not only night call but also “night float,” in which we worked all night for weeks on end.

According to the Bureau of Labor Statistics, roughly 15 million Americans work permanently at night or regularly rotate in and out of night shifts. That’s a lot of people. People work the night shift for all sorts of reasons: it often pays better, for example, or they may simply prefer the quieter work environment, or their professions or particular stations in life may leave them no choice. Regardless, many or most of these millions of people suffer from sleep problems directly or indirectly related to the timing of their work.

A primary sleep-related problem for shift workers is fatigue. The feeling of tiredness or drowsiness can be pervasive, and when experienced during work can lead to a host of negative consequences, ranging from substantially reduced productivity to major industrial accidents. Working at night can often lead to falling asleep on the job, reduced attention and concentration, and missed time from work.

Why are such problems so prevalent in night shift workers? The answer usually lies in the difference between their weekly activities and the way we are designed to sleep. Days off from work are precious to night shift workers like they are for everybody else. The problem is, on days off, most night shift workers want to be awake during the day, because that’s when family, home, social, and leisure activities take place for everybody else around them. As a result, they end up flipping their sleep schedules around abruptly, such that now they are staying awake during the day instead of sleeping during the day on their non-workdays.

Unfortunately, your brain isn’t quite that flexible. Your body clock “wants” regularity in its sleeping patterns–which the basis for the concept of “jet lag,” for example–and completely changing your bedtime schedules around by reverting suddenly back to a night-time sleep schedule on non-workdays often or even inevitably leads to sleepiness and reduced quantity and quality of sleep.

No matter how many years you’ve put in work at night, your body clock does not biologically adapt or accommodate for your work shifts if you regularly revert back to a night-time sleep schedule when you’re not working. Instead, you adapt subjectively, accepting a certain degree of fatigue as a regular component of your life, and/or inserting a nap here and there to make up for the reduced sleep, or breaking your sleep times up into 2 or 3 separate parts in a day.

There will be more to say about shift work in future posts, because it’s not only a potential medical problem, but also a major public policy issue. Bottom line: fatigue due to irregular sleep schedules stemming from night shift work is potentially dangerous, decreasing safety at work and putting people at risk.

On that grim note, enjoy Kenny’s song! The lyrics don’t delve directly into sleep issues associated with working the night shift, but the fatigue so many shift workers feel can certainly cause “’round-the-clock pain” and make you feel like a big ol’ pile of . . . shift work.

Have a great weekend, No Shoes Nation, shift worker or not!

Shiftwork
(written by Troy Jones)

Shift work, hard work, tired body
Blue collar shirt and a baseball cap
Union made

He’s hot, sweat drops, ’round the clock
Door never locks
And the noise never stops
Not all day
Work seven to three
Three to eleven
Eleven to seven

Shift work, tough work for the busy convenience store clerk
Two feet that hurt, going insane
She’s mad at some lad
Drove off and didn’t pay for his gas and he won’t be the last
‘Round-the-clock pain
Work seven to three
Three to eleven
Eleven to seven

I’m talkin’ about a bunch of shift work
A big ol’ pile of shift work
Seven to three
Three to eleven
Eleven to seven

Well I work shift work,
Ten years man, I hated that work
Then I made a break with the money I saved
It took me to the beach
To have a beer by the edge of the sea
And this ’round-the-clock place
I drank my money away
We partied
Seven to three
Three to eleven
Eleven to seven

I’m talkin’ about a bunch of shift work
A big ol’ pile of shift work
Seven to three
Three to eleven
Eleven to seven

Talking about a bunch of shift work
A big ol’ pile of shift work
Seven to three
Three to eleven
Eleven to seven

Seven to three
Three to eleven
Eleven to seven

Turn the Clock Forward Tonight!

 

A week from tomorrow is “Selection Sunday,” the day in which the National College Athletic Association (NCAA) announces the participating teams in the annual national college basketball tournament, and the ways in which those teams will match up and “seed.”  Much less exciting, however, is what will happen tomorrow, which is that this year’s Daylight Saving Time (DST) will begin.  In most parts of the United States, clocks will be moved forward in time by one hour, starting from 2 a.m. overnight.  Some portions of the U.S. remain on “standard” time all year ’round:  Hawaii, some parts of Arizona, and U.S. territories of Guam, the American Virgin Islands, American Samoa, and Puerto Rico.  The idea is that advancing clocks forward a bit will provide us with more light in the evening and less light in the morning.

What this means is that the vast majority of Americans will feel tonight like we’ve “lost” an hour of time this weekend.  This one-hour shift does not truly represent a loss, of course, because we “gained” an hour in November 2012 (and will gain it again in November of this year).  But it can feel that way.  DST can be potentially disruptive to computers, various forms of equipment, medical devices, and other electronics, but it can also disrupt some people’s sleep, though usually mildly.

Adults are typically able to handle up to one hour’s worth of “shift change” in sleep scheduling per day (a critical concept in the understanding of jet leg, for example).  Everybody’s different, though, and everybody has different thresholds for feeling effects of changes in bed schedules and work schedules.  Making the change Saturday night into Sunday morning further allows for maximal societal flexibility in absorbing this time change in time for the beginning of most people’s typical work or school weeks.

For those who are particularly sensitive to effects of sleep schedule shift changes, my suggestion would be go to bed just a little bit earlier tonight (Saturday) than usual, say 15-30 minutes.  Then tomorrow night (Sunday), go to bed slightly earlier than you did tonight.  This exercise is not very taxing, and should allow you to absorb easily the time change internally in time for work or school come Monday morning.

Many basketball teams are playing their end-of-regular-season games today, so there will undoubtedly be some “bubble” teams (and their fans) that won’t be sleeping all that well tonight if they lose, independent of DST.  Most people, however, will sleep well and will find the shift change pretty easy to handle, though many (like myself) will grumble a little about the subjective sensation of the time “loss.”

Enjoy the weekend nonetheless, everybody!

Sleepy Teen? Read On

You have a teenager in the house. He’s 15. Great kid, popular, happy, fun to be around. Problem is, recently, with several months of school under his belt, he is sleepy too, all the time, falling asleep in front of you at the dinner table.

 

Excessive daytime sleepiness is increasingly prevalent in our society. Certainly social and academic pressures represent a potential cause. I’m constantly astounded with what so many parents now expect of their children: all the activities, sports, school projects, social outings . . . it is all just so different compared to when I was young:  everything is more, crazier, faster, more wired (or wireless), more complicated. My wife and I get caught up in that as well, I’m afraid, and though we do our best to maintain a reasonable balance to our children’s lives, their after-school hours remain dominated by what feels like an endless cascade of commitments: tae kwon do, basketball, skiing, adventure guides, student council, math olympiad, latin root class, on and on. For the most part our boys enjoy these activities and participate with relish, but I really do wonder how they’re going to find the time for additional activities or expanding interests as they get closer to high school, not to mention that all-important, precious time that should be spent with family.  Back in the day, we kids had time and space to relax, even laze from time to time. Time is just such a precious commodity now for us all.

Our planet’s population continues to grow, and subsequently so do the challenges for our children, who now must compete with a huge army of peers for a limited number of scholarships, college placements, internships, jobs, and resources. It thus seems natural–crucial, even–to push your kids to do more, accomplish more, dig deeper, become exposed to more things to give them a leg up in an increasingly competitive world. However, there’s still only 24 hours in a day. So what time is often easiest to sacrifice? You guessed . . . the time usually allocated for sleep.

Adults typically need 7.5-8 hours of sleep per night to feel fully rested during the day. Teens often need more sleep than adults, such as 9 hours per night. Teenagers need proper amounts of sleep like adults do, obviously, and in fact in many ways they need their sleep even more than adults do, considering they are still growing and developing. The effects of chronic sleep deprivation for a teenager can completely wreck one’s quality of life: daytime sleepiness, tendencies to fall asleep in class, lethargy, headaches, poor academic performance, depression, social withdrawal.

There’s another important cause of daytime sleepiness in teenagers, and it’s related to their sleep schedules. Here’s a scenario many of you will know well: Sunday night your teen has terrible difficulties falling asleep, and then finds it bloody impossible to awaken early the following morning for school. There is sleepiness all day long Monday at school, and for one or two additional nights there are residual difficulties falling asleep early, compounding the sleep deprivation. You pull your hair out as you cajole and shove your teen out of bed to get to school on time. Finally Friday night comes ’round, but your teen stays up until 1 a.m., and sleeps in like the dead until noon. This happens again Saturday into Sunday, and the cycle repeats itself, with another sleepless Sunday evening. Sound familiar?

Leaving the biochemistry out of it for now, here’s the reason why this occurs. We as humans are generally creatures of habit when it comes to sleep. Our internal body clocks are designed for us to do and feel things at certain times to coincide roughly with the 24-hour period. Our circadian rhythms dictate and regulate the timing of various inner biological processes, such as when we become sleepy or when we feel awake and alert.  When it comes to sleep, many of us have a natural tendency to become drowsy just slightly longer than every 24 hours (which can help explain why many prefer to go to bed later at night as opposed to earlier).  We are usually able to stay on the 24-hour clock because of the environmental cues (like daylight) and social cues (such as work) that “entrain” us to running our sleep every 24 hours. However, adolescents are particularly susceptible to this tendency for a delay in their bedtimes, leaving them prone to feeling awake at night and making it very difficult for them to get out of bed early for school. Things then are made worse when they allow themselves to go to bed very late on weekends and sleep in on weekends, because when Sunday night rolls around it becomes very difficult to fall asleep early. This is called delayed sleep phase syndrome.

 

So, parents, though this routine of trying to get your kid to bed at night and then fighting with them to wake up in the morning gets old quickly and can drive you bats**t crazy, in many ways what you’re seeing is the manifestation of normal adolescent brain biology, essentially a clash between teen physiology and our fast and furious society’s modern expectations.  I mean, if teens didn’t have to awaken at 6 a.m. to get ready for school, but instead could awaken whenever they please, this wouldn’t be nearly as big of a deal, right?  In this real world of ours’, though, it’s still a problem that needs to be addressed:  countless report cards, interpersonal relationships, and family dynamics have been affected negatively by delayed sleep phase syndrome particularly in recent decades.  And if there is pre-existing sleep deprivation due to all the other stuff your teen does after school, this only compounds the problem, worsening daytime sleepiness and all of the sequelae from it.

There are a couple of recommendations that can help.  One is something your kid is guaranteed not to like:  wake up around the same time every morning, including on weekends.  This is generally much easier for adults than it is for teens, but if you don’t sleep in by 3-5 hours on weekends any longer, you will naturally become drowsier sooner at night (including Sundays), making it easier to achieve more sleep and awaken in time for school; you’re essentially then forcing your body clock into regularity, which can then improve the insomnia and total sleep time at night.  The key, however, is persistence, which sometimes can be lacking in some kids.  When I am counseling my teenage patients with delayed sleep phase, I basically become their coach, working to help them understand that they can do it, that they will do it, for the sanity of everyone around them, including themselves.  The other helpful management tool is bright light therapy, such as with a light box (2000-2500 lux) early in the morning, and the avoidance of bright light in the late afternoon to evening.  Certain medications may be useful in severe cases, like melatonin or modafinil, but these are teenagers we’re talking about, and my clinical practice has generally been to try to do things as naturally as possible in this setting.

Take-home message today:  help your teen get proper amounts of sleep by examining his or her bedtime schedules and discussing openly what could be modified to make everybody happier in the house.  As with everything else within the realm of parenting, love, communication, and the constant quest to understand are cornerstones in helping your adolescent achieve good sleep.

There will be more to say regarding circadian rhythm disorders in future posts.  It’s time for dinner now, though, so ’til next time . . . sleep well!