Why Do Dogs Make Such Good Alarm Clocks?

Like most everyone else, I enjoy the occasional brief distraction from whatever serious thing I’m doing by popping up a quick funny video during breaks. A friend recently sent me this little clip of dogs forcing their humans out of slumber and out of their beds in the morning.

As fun as these videos are, there’s something instructive about them:  they reveal some hidden but important messages about sleep.  Here are a couple things you can learn as you enjoy watching them:

1.  Animals have sleep cycles like humans do.  In fact, even the most primitive creatures on the planet demonstrate some form of simple, behavioral rest with measurable regularity, and usually with timing that relates in some way to the earth’s 24-hour day-and-night cycle.  Why does your dog always awaken you at 6 a.m., including on days in which you want to sleep in?  Probably because she regularly awakens shortly prior to 6 a.m. every day, right in keeping with her body clock, and wants to play.  That’s what our Maltese, Molly, does.

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2.  Your dog awakens you in the morning when you want to sleep in probably because you’re sleep-deprived.  There’s likely not a lot of published literature support for what I’m about to write here, but I would venture to guess that most dogs, not having to toil every day at work or staying out late with the guys, are usually “sleep-sated,” meaning that they get as much sleep during a 24-hour period as their bodies and brains require–through nocturnal sleep and/or by napping during the day when the humans are away.  The amount of sleep a dog needs depends on his age, size and breed.  However, the vast majority of human adults require between 7.5 and 8 hours of sleep per night–and on a regular basis–to feel fully rested during the day.  How many people do you know that get that much sleep per night most or every night?  If you routinely get less than 7-8 hours of sleep per night, chances are good that your body and brain will attempt to “make up” the lost sleep by trying to “sleep in” when they get the chance–on weekends and days off, for example.  In other words, your dog is doing what you should be doing–getting proper amounts of sleep–and he is now on your bed, lapping at your ear to remind you that obeying your innate biological needs is the natural thing to do, the best thing to do.

I say dogs make great alarm clocks:  you can’t get too mad at them, there’s no “snooze” button, and they make sure you know you should wake up and get up not only sonically, but also tactilely:  with paws, claws, and slobber.  Have you ever awakened briefly at your usual time in the morning, following a long period of sleep deprivation and though you intend to sleep in, and wondered why you awakened at that time instead of sleeping straight through?  That’s your circadian rhythm telling you it’s your natural time to wake up.  Look at your dog as a big furry biological clock “by proxy:”  she obeys her body clock every day and wonders why you’re not doing the same.  Just another reason to love your dog:  she can teach you to love your sleep and respect your sleep needs!

Finally, certain dogs, like pugs and boxers (dogs with thick necks) are also predisposed to snoring and obstructive sleep apnea, but I suppose that is a topic for another day.  Enjoy the remainder of your weekend, this first weekend of 2015!  Cheers!

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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!

 

A Connection Between Exercise and Sleep

I’m a proud dad today.  Yesterday my boys both ran their first 5K race.  One, who turns 12 next March, outran me by an entire minute!  I’ve told my boys for years now that one of my goals is for them both to end up being better than me at everything, and that’s starting to happen now!

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A lot has been made of the relationship between exercise and quality of sleep over the years.  Recently, the 2013 National Sleep Foundation Sleep in America poll demonstrated “a compelling association between exercise and better sleep.”  Paraphrasing the data, those polled who did not exercise regularly indicated their sleep quality was “very bad” as compared to those who exercised regularly by a substantial margin:  14% as compared to 3-4%.  In addition, 76-83% of those who exercised regularly felt their sleep quality was “very good” or “fairly good,” as compared to 56% of those who did not exercise regularly, despite insignificant differences in sleep duration between the two groups.  These data and additional data from the poll support the longstanding idea of an association between good sleep habits and a lifestyle involving regular exercise.

We all know that regular exercise has been associated with improved overall health across a wide spectrum of parameters, ranging from cardiovascular fitness to mood.  Here are a couple simple exercise tips as pertains to your sleep:

1.  Exercise in the morning in general can help sleep quality and reduce the amount of time it takes to fall asleep once in bed at night.

2.  Though the notion of whether late-night exercise is detrimental to sleep has been challenged in recent years, I still recommend to my patients that it’s likely best to avoid intense aerobic exercise within 1-2 hours prior to their projected bedtimes; heavy aerobic activity can promote the release of stimulatory hormones.

3.  Consider exercise outdoors early in the morning.  The combination of aerobic activity and light exposure early in the day can further increase levels of wakefulness during the day and quality of sleep at night.

4.  Keep in mind:  the promotion of great sleep habits and hygiene originates from the same mindset that generates a schedule that includes regular exercise:  discipline to maintain a lifestyle geared toward good health, happiness, and longevity.  Use the same discipline for your sleep as you do to get yourself to the gym.  Stay regular with your sleep times and sleep scheduling.  Awaken around the same time every morning to the extent that you can.

5.  Your exercise tolerance and energy levels probably will improve with proper amounts of sleep every night!  Obey your body’s intrinsic need for sleep; most adults require around 7.5-8 hours of sleep per night, regularly, to feel fully awake and alert during the day.

Stay healthy, everyone!

 

How I Remember 9/11

 

“This must be a joke,” I muttered.

My alarm clock has gone off at 6:30 a.m. virtually every morning for years now.  I follow my own clinical advice and do everything I can to keep my sleep schedules regular, including on weekends.  The morning of September 11, 2001 was no exception.

The alarm provoked my arousal at its usual appointed time.  As my waking cortex struggled to climb out of its sleepy haze, I listened lazily for a few moments to the muffled words on the NPR station to which I kept my clock radio dialed.  I could tell immediately something was different this morning, even prior to my comprehension of the words.  There was an urgency to the voices, staccato, quick and breathless, unscripted and frightened.  Whatever was the topic at hand, this clearly was not a normal news day.  Then the words started to register in my brain:  “planes,” “World Trade Center,” “attacks,” “explosions.”

My first coherent thought was that what I was hearing was a hoax, a modern-day War of the Worlds.  A couple minutes of listening and then the first images on television terminated any hopes I had that it was so.  I jostled my wife awake and the two of us stared at the TV in mute, open-mouthed horror.  At that moment, I knew our country would never be the same.

My brief drive to work–under beautiful cloudless blue Seattle skies eerily similar to those above Manhattan that same morning–was a blur.  I walked into my clinic.  Not a single person said a thing.  We all just looked at each other in disbelief, our eyes all saying to each other, what is happening to our world?  

Not surprisingly, few of my patients chose to show up to clinic that morning, so I had some extra time on my hands.  I and my co-worker, Lamont, found our old little rabbit-eared lab TV, and we spent most of the morning staring at the fuzzy images, still trying to comprehend it all.  Needless to say, I didn’t sleep very well that night and for several nights thereafter.  Neither did my patients.  In the months to follow, I was bombarded by insomniacs filling my clinic.  The entire country suffered from collective insomnia as well as collective grief.

During my life there have been several events that I remember with clarity, defining moments in our country’s history.  I remember lying on the front bench of our family’s big ol’ sedan, watching my father stare at the AM car radio as Nixon’s resignation was announced.  I remember being in class hearing about John Lennon’s assassination and Ronald Reagan’s near-assassination.  In college I stood in a crowd in our student lounge after morning classes, watching images of Challenger exploding on television.  9/11 was one such moment, of course, and probably the most notable single historical event of my working adult life.  Twelve years later, it remains difficult for me to believe that such a thing even happened.

I must admit I grumble about some things from time to time:  the miserable state of our country’s health care administration and reform; traffic; the interminable meanness and passive aggression of some people; all the hassles and noise of modern life.  Each 9/11 brings me back to center, reminding me of how privileged I am to be alive now in this time and place, enjoying the family, friends, and prosperity with which I somehow, undeservingly, have been blessed.

As it is for millions of other Americans, 9/11 is and always will be a day of reflection for me.  As horrific as 9/11 was, it did crystallize in my mind some of my life’s most basic philosophies:  love fiercely, live boldly, and protect yourself and those you love from those who seek to harm you, whether they be silent or loud in their intent.

Sleep Well This Summer, Part 3: Keep Your Bedroom Quiet

It’s been a while since my last entry; too much going on this summer!  I hope you all are staying cool; it’s been a scorcher throughout most of the U.S. this month.

In recent entries we tackled how to keep your bedroom dark and cool.  I’m finishing off this summer sleep writing triad today with some tips on how to keep your sleeping environment quiet during these summer months.

Summer presents some challenges to sleeping in a peaceful quiet place.  It’s light out late, it’s vacation time, the kids are out of school, and the heat’s got people a little crazy.  So there are block parties, summer traffic, teenagers out raising a ruckus in their back yards, barbecues that run late . . . you know, all the stuff that’s great fun when you’re in the fun, but not so fun when you’re in your bedroom trying to get some winks.

As I’ve mentioned before, sleeping during the summer months is best achieved if you keep your sleeping environment dark, cool, and quiet.  Here are some suggestions to make for a quiet place in which to sleep.

1.  Fix broken or uneven windows and door and window frames, basically anything that can cause a draft.  Things that leak in unwelcome air will also leak in unwanted noise.  Doing so will probably reduce your energy bills too.

2.  Fortify your windows to insulate them from noise.  Try thicker glass or double-paned glass.  A cheaper and easier alternative would be to place thick, black curtains in front of the windows.

3.  Try a little “white noise,” particularly if you live in an area in which outside noise is unavoidable (train tracks, a busy intersection, or what have you).  A fan works well, because the convective effect of the circulating air cools you down as well.

4.  If you live in an apartment, request a corner apartment farthest away from the street.  And preferably as far away from loud, selfish, obnoxious neighbors as possible.

5.  Sleep in a room closest to the center of your dwelling.  The more drywall that separates you from the outside world, and the fewer windows in the room, the quieter in general your sleeping environment will be.

6.  Sleep in the basement, if you must.  Nothing like surrounding earth to insulate you from the noise and heat in the summertime.

7.  Though earplugs may be helpful, I personally advise against this, simply because you want to be able to hear potential problems around the house:  a crying baby, for example, a fire alarm, etc.

8.  If your bed partner snores substantially, discuss this with your bed partner and consider informing his or her physician.

9.  This is embarrassingly obvious, but turn off whatever beeping, pinging, whirring, droning electronic gadgets you have in your bedroom if you possibly can.

10.  Turn off TV’s, radios, and iPods.  Many people feel like they can’t sleep without background noise from such gadgets, but let me assure you that the reason why this feels this way is because of simply habituation:  your body does not biologically require such noises, but if you’ve had some sounds in the room at night for years, it feels like you need them when you don’t.  Turn off these devices and you should fairly quickly come to enjoy the silence.

11.  Particularly if you work night shifts, have open discussions with your family and loved ones about how to keep the noise of other people from disrupting your sleep.  As with most other situations, it’s always best to communicate openly and honestly about such topics!

Enjoy the rest of our summer, everyone!  I wish you deep, comfortable sleep!

 

Woman Falls Onto Train Tracks After Falling Asleep Standing Up!

Here’s another scary recent incident in the news pertaining to sleepiness.

In Prague, Czech Republic, a woman in a train station appeared to fall asleep while standing and waiting for her train.  Take a look at this.

This video is fascinating.  From a couple different camera angles you witness this woman gradually giving in to the relentless pressure of sleepiness.  She slowly leans forward as slumber starts to overtake her.  She rights herself briefly in an attempt to regain alertness, but she then walks forward a bit and eventually leans in again, knees buckling, until her body weight finally forces her to tumble onto the train tracks.  Miraculously, she lands in the deep groove between the tracks, and  though the train rolls over her she reportedly gets up, dusts herself off, and walks away after the train departs from the station!

According to reports, upon being questioned her following the incident, this woman told law enforcement officers that she was “merely tired.”  She refused a medical evaluation and breathalyzer test.

This is a dramatic example of the inevitable effects of daytime sleepiness, regardless of cause.  You may have untreated sleep apnea or you may be simply chronically sleep deprived, but the bottom line is that a primary response of your body to poor-quality or poor-quantity sleep is that at some point you will be forced to sleep, including in inopportune times or places and in very dangerous situations.  I’ve had patients, for example, who have come to my clinic because they’ve fallen asleep behind the wheel of their 18-wheel trucks, at the controls of their motorcycles on the freeway, in the cab of their cranes, and in front of industrial saws.  No matter how much you try and no matter how bad your insomnia may be, your body will give in eventually and oblige you to sleep.  Remember, sleep is a required biological requirement; you absolutely need your sleep, and your body will make you get it one way or another.

Have a great Independence Day, everyone!

Sleep Well This Summer, Part 1: Stay Cool

Hi all!  It’s getting powerful-warm out there now in most parts of the U.S., so today I’m starting a 3-part series on sleeping during the summer months.

People generally prefer sleeping in a dark, quiet, cool environment.  This can be a challenge in the summertime, when it’s sweltering at night, it’s light out late, and there’s always some loud party going on late near your home.

 

Today we’ll tackle the issue of the summer warmth.

Many of us recognize that it can be difficult to fall and stay asleep if it’s uncomfortably warm or hot in your bedroom.  The common-sense advice here is to do what you can to maintain a cool sleeping environment to the extent that you can, particularly during the first half of the night:  outside temperatures naturally continue to fall until just prior to dawn due to an increasing duration of absent direct sun exposure, and our bodies naturally cool (i.e., our core body temperatures gradually fall) the longer we sleep at night.  As such, it’s a good idea to concentrate on how comfortable you are with the room temperature at bedtime.

Some brief tips to sleep a little better in the summer:

1.  Use your air conditioner.  I understand the desire to save $ on your utility bills–I share that desire–but I suggest not skimping on the air conditioning (if you have it) if you’re miserable in bed night after night.

2.  Invest in a fan.  Large room fans can be inexpensive (particularly if purchased off-season), and the convective effect of the circulating air can make a big difference.

3.  Take a shower or bath prior to bedtime.  Using cool water may reduce your core body temperature.  For some, however, a warm shower or bath prior to bedtime makes your  bedroom temperature “feel” cooler by the time you get into bed.  Experiment to see what makes you most comfortable.

4.  Consider your bedsheets and pajamas.  This is very individually dependent, but you can obviously reduce the amount of body coverage in bed to cool things down.  The cloth materials you use can also make a difference:  you can be bothered by not only the heat, but also the degree to which you’re wet and sweaty in bed.  I suggest using materials that “breathe” and absorb or wick away moisture:  in general natural materials, like cotton, are considered better at this than synthetic.

5.  Sleep in the basement.  If you can’t do anything about the heat in your bedroom, migrating to a cool, dark underground basement may make all the difference during summer months.

6.  If you use CPAP (continuous positive airway pressure) for obstructive sleep apnea, you can turn down your heated humidity and utilize as small a mask interface as possible.

Next up:  how to keep your bedroom dark.  This is more important than you may think.

Cheers all, and stay cool this summer!