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!

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Morgan Freeman Falls Asleep During an Interview

I can’t resist.

The other day actors Michael Caine and Morgan Freeman conducted a live interview with Bill Wixey and Kaci Aitchison from Q13 Fox News right here in Seattle.  The interview centered around their upcoming film, Now You See Me.  But as you now see here in this abridged clip, Mr. Freeman was having a bit of a struggle staying awake while Mr. Caine spoke.

I like in particular how he arouses briefly, nods his head slowly, as if he’s been fully attentive the entire time, and drifts back off.

Here is an online article, which includes Bill Wixey’s post-interview reaction and also the full video interview with Caine and Freeman.  It’s worth watching the entire interview here:  there is much more sleep time than what is seen in the brief clip above.

http://mynorthwest.com/76/2280849/Seattle-news-anchor-puts-Morgan-Freeman-to-sleep

Now, to be fair about this, this soporific faux pas is likely not Freeman’s “fault,” and is probably not due to boredom, as at least one journalist has suggested.  It appears that Caine and Freeman were interviewed from a studio in New York.  I’m guessing Freeman had flown from Los Angeles to New York shortly prior to the interview, and if this was the case he was probably recovering from jet lag.

Remember, there’s a 3-hour time difference between the west coast and the east coast.  Sleepwise, it’s particularly tough to go from the west coast to the east coast, because upon arrival your brain is essentially asked suddenly to go to bed earlier and awaken earlier than usual, setting you up for insomnia and sleep deprivation.  I know this from experience:  I fell asleep at my table and virtually fell out of my chair once during a loud, boisterous classic rock awards banquet shortly upon arriving in London several years ago.

Additionally, in general, the older we get, the less tolerant our bodies become to insomnia, sleep deprivation, and shifts in our usual sleep scheduling.  So I definitely empathize with our nearly 76 year-old Mr. Freeman, who was sitting in a comfortable, quiet environment during the interview, his uncooperative body clock begging for a snooze.

One final comment.  I’m often asked if you fall asleep during the day just because you’re bored.  The answer is no.  However, if you are prone to becoming excessively sleepy during the day (due to sleep deprivation, an untreated sleep disorder, or the like), then your sleepy tendencies will be more likely to express themselves in the form of falling asleep by accident when you are sedentary as compared to when you’re active.  When you’re bored you’re usually sedentary, so in that setting you’re therefore more likely to fall asleep.  This is an important distinction to make; many people don’t get evaluated for their sleep disorders because they believe that falling asleep frequently during the day is normal because they’re bored.

 

Have a good, wakeful day, everyone!

My Name is Maracujá!: My Interview With Eduardo Mendonça, Part 2

As those in my musical circles are aware, I have a Brazilian name.  I am Maracujá.

Maracujá is the Portuguese name of a passion fruit (Passiflora edulis) native to many South American countries, including Brazil.  It is often used in desserts and drinks (including the caipirinha, a famous Brazilian beverage, as well as bottled fruit drinks, such as depicted in the photo below).  In addition, it is known as a mild sedative, and it is an active ingredient in numerous sleep aids in Brazil.

I love the name.  It means a lot to me.  There is affection and friendship imbued in it, and as you can see it is also relevant to my career and my work.

Maracujá was bestowed upon me by my friend, Eduardo Mendonça, leader of the Seattle-based band Show Brazil!.  During an outdoor festival performance last year, Eduardo introduced me to the audience as Maracujá for the first time.  He also told the crowd that this was to be a christening:  he summoned everybody to shout out the name after him.  Three times a crowd of hundreds of people roared my new name.  All I could do was bow in gratitude and humility.  It was a wonderful experience, and I have Eduardo to thank forever for that brief but profound life moment.  Eduardo has introduced me to our audiences with this name ever since.

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During a recent chat over coffee I asked Eduardo to recount how he came up with this title that is now mine.

MC: As you know, you are the one who christened me with this name, Maracujá, which I hold sacred, personally, and which I appreciate very much. I was hoping you could talk about how you arrived at the name, and what it means historically and culturally in Brazil.

EM: Sure. To baptize you with this name was very much an honor for me, because giving a Brazilian name to someone requires a very strong connection, a connection with what you do and what kind of person you are. To best represent you, I came up with the Maracujá name because of the work that you do, helping people with sleep disorders and making life better, right? That’s very important, you thinking of the well-being of someone. How I could connect that, your work and yourself as a person helping others with a Brazilian meaning that could represent you very well? Maracujá is used in Brazil as a natural medicine to relax people. Some people put in a lot of sugar, even though sugar doesn’t go well with relaxing.  But if you put in the right dose of sugar, it would be fine, and would really create a natural relaxing time and relaxing moment, to help you with sleep, to help you calm down, and that’s how I came up with the name for you. It was not difficult at all to connect it to what you are, what you do, with something in Brazil that is a function that can make things good for somebody.

MC: There’s clearly a deep connection between relaxation and sleep. Is it known in the Brazilian culture that the passion fruit or its derivatives can help a person sleep? Does it really have a sedative property, actually make you drowsy?

EM: Yes.  Of course it depends on the quantity that you have. Definitely I remember my parents, when I was a kid, preparing the passion fruit, the maracujá juice to make a very energetic kid calm down. It helped me sleep. If you give it a few hours before you go to bed, and of course if you don’t have anything else in your body to cut that effect, it definitely helps you relax and sleep.

MC: Again, I’m honored to have the name, and I wear it proudly.  Thank you, Eduardo.

Show Brazil! plays all year ’round, and the summer season promises to be great this year!  Obrigado, Eduardo!

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“What’s With This Big Body Jerk Out of My Sleep?”

Tell me if this has ever happened to you.

 

You’re lying on your couch one night, watching a movie. An hour into the show, you gradually start to drowse. Your eyes are getting heavy; it’s increasingly hard for you to concentrate. You want to keep watching, but finally you start to give in: your eyes are closing.  A familiar, dark, fuzzy, comfortable sensation enshrouds you, mixed with a vague feeling like you’re falling into some kind of void. There is a brief reverie; you are asleep. Then, shortly thereafter and out of nowhere, BOOM! There’s a sudden shock-like sensation and an abrupt awakening. Your entire body jerks violently, like someone sucker-punched you, but there is no pain. That singular jerk almost sends you off the couch. The person you’ve been watching the movie with looks over, wondering what the hell is wrong with you.

Sound familiar? Most (up to 70%) of us have had that experience at one time or another in our lives. This phenomenon is called a hypnic jerk, or sleep start. Much is not understood about why or how it occurs, but a hypnic jerk consists of a single, sudden simultaneous contraction of multiple body muscles, basically the manifestation of a full-body reflex occurring shortly upon entering light stages of non-REM sleep and resulting in a sudden arousal from sleep.

Hypnic jerks tend to happen more in the setting of sleep deprivation or irregular sleep schedules. I vividly recall that during my residency training days, I abruptly awakened with these jerks all the time, probably because of the frequent sleep deprivation to which I was subjected at the time. It drove me nuts. Now that I’m allowed to get my 8 hours per night most of the time, only rarely now do they occur.

There are several reasons why it’s worth writing about hypnic jerks. First, some people freak out about them. The jerks in and of themselves generally are benign and aren’t harmful per se. Secondly, some may wonder if the jerks indicate an underlying medical problem, such as epilepsy. A generalized convulsion that involves jerking movements of the entire body are usually associated with repetitive jerking instead of a solitary body jerk, and you would be unconscious during the seizure. Finally, if the hypnic jerks are frequent or bothersome, there is often something that can be done about them. If you’re chronically sleep deprived, do what you can to gradually increase your total sleep time per night; most adults require about 7.5 – 8 hours of sleep per night. Regulate your sleep schedules by awakening around the same time every morning, including between workdays and non-workdays. Consider tapering down things that can disrupt sleep, like caffeine or alcohol. Sometimes stress or particularly strenuous activities late at night may also increase the likelihood of having hypnic jerks, so relaxing prior to your bedtime may be helpful as well.

Have a great weekend, everyone!

Post-Traumatic Stress Disorder and Sleep: My Interview With Captain Ken LeBlanc

I want to tell you about my old and dear friend, Ken LeBlanc, a Captain in the United States Army. Ken and I went to high school together and have watched our lives and careers evolve in recent years.  He lives in and is stationed in Wiesbaden, Germany, near Frankfurt, and he works at US Army Headquarters for the G-34 Force Protection Directorate at Wiesbaden Army Airfield.  He is an Operations Officer.  His responsibilities include the entire Black Sea region of eastern Europe. He assesses and mitigates risk by developing site-specific guidelines for force protection and personnel safety, including counter-surveillance, stand-offs, and personnel access.  He develops travel guidelines, working with the DIA and Department of State for any individual and group travel to foreign lands. He has been deployed several times.  I consider Captain LeBlanc a hero, not only because of what he’s done for the benefit of our country, but also how he has handled the many intense experiences he has had as part of his military duties over the years.

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Ken tells me that he has had some genuine difficulties with his sleep since relocating to Germany.  Troubled by vivid dreams, he suffers from disrupted sleep, frequently awakening with a sensation of anxiety and in a cold sweat.

Ken has been diagnosed with post-traumatic stress disorder (PTSD).  He tells me that he’s not alone:  many of his colleagues have had similar symptoms upon returning from their deployment and have been diagnosed with PTSD, reflecting recent Veterans Administration reports that indicate that nearly 30% of VA patients who served in the Iraq and Afghanistan wars have been diagnosed with this disorder.  He also believes that PTSD is still under-recognized and under-treated in the military.

PTSD is commonly associated with sleep problems, often stemming from a combination of factors:  the self-protective mode of constantly being “on alert,” worry, physical symptoms (such as chronic pain) associated with previous trauma, and frequent nightmares which may or may not be directly related to previous traumatic experiences.  Chronic sleep-onset and sleep-maintenance insomnia and daytime fatigue are commonly observed in those suffering from PTSD.

Captain LeBlanc was kind enough to agree to describe some of his experiences with Sleep Help Desk from his home in Wiesbaden.

MC:  You’ve been in the military for many years, Ken; you’ve visited many countries and you’ve seen many things most Americans never will see. How does a soldier process all of the intense experiences such as the ones you’ve had?

KL:  If possible, by processing the good and bad with groups of others. The Army has many specific programs to help deal with and process activities and experiences. As an Officer I have a duty to help younger Soldiers with any issues that might arise from their combat- and noncombat-related experiences. Sometimes being far away from your family causes things to happen such as divorce and bankruptcy, and this can be as difficult to process as combat. As Soldiers one hopes that the foundation they have morally and psychologically helps them to diffuse critical events but being with like-minded others brings a support system unlike any other I have been involved with.

MC:  How do you perceive your experiences have affected your sleep?

KL:  Sleep is a critical and performance-altering behavior. I am an older Soldier who has witnessed many things younger Soldiers have not experienced and I’ve thought from the very beginning that this would be my personal asset. They aren’t, however, like good experiences (like the birth of a child or success at work), which do not replay in your head during times of attempted sleep. It might be thunder or loud noises or strange noises, but they all bring me back to unfavorable experiences. Dreams become more vivid and after awakening one goes through a litany of questions concerning that event. After a few months it gets a little better but when one least expects it one might dream of something as innocuous as a large crowd and begin to feel the anxiety that accompanies it. My military experiences cause many sleepless nights because after waking up (usually in a sweat) it becomes hard, if not impossible, to regain drowsiness and fall back to sleep.

MC:  So let’s talk more about your dreams, Ken.  How often and how intensely do your dreams relate to your current work or previous military experiences?

KL:  After returning stateside I had incredibly vivid dreams every night. I would wake up and go through them repeatedly. I would feel foolish for having them. Most of the time they relate directly to military experiences but after a while they lose that flavor and start to relate to difficult periods in my life. It feels as if it becomes a habit:  waking up to dredge over bad experiences no matter what the setting. I would normally not associate one with the other except that in prior times this never happened. The causality of combat and dream behavior is in my opinion directly linked.

MC:  What helps?

KL:  The honest truth is that alcohol and I have self-medicated many a night in order to fall asleep. This is not a good sleep, but it is the ability to get to sleep that one desires more than any other thing. Once in the habit it is very hard to break (thankfully I have recognized this as a direction I did not want to go and have stopped drinking as a habit). It affects performance at work and weight and psychological issues so this is not something I would recommend to anyone. I have also tried prescription medications. This is not a good alternative for me either as I still wake up, unknowingly, and re-medicate. I remember one night in particular, in which I woke up the next day to find that out of 30 prescription pills, some time during the night I had ingested 20 (and lived). This was my wake-up call and I stopped all medication thereafter. Now I read as long as I can before trying to sleep. It gets me to sleep but not for very long. I awaken again, usually in a sweat, and either get up for the day or lie in bed all night until a reasonable hour and then get up. I have tried many nights to stay awake for several days and then “reset” my body clock only to find I experience the same outcome as if I had gone to bed every night. It truly makes me wonder why I can function on such little sleep.

MC:  Is there anything that happens in your current work life that triggers a worsening of your sleep, other than jet lag from travel?

KL:  As a Soldier I always have different report times as the events I manage don’t stop to allow me to get some rest. At the risk of sounding cavalier, they are life-and-death situations and as a result I never really know when I will be able to shut work out completely and rest. This is true for all Soldiers, not just me. In what other career can something happening 10,000 miles away affect your daily life? Sometimes it’s just the Army philosophy of early to rise. My days have started as early as 0345 to 0900 and there usually isn’t a cut-and-dry schedule as to when that will be.

MC:  Ken, tell me about how your colleagues handle their own problems with sleep.

KL:  Honestly, alcohol is pretty prevalent. Some medicate with sleep aids; some try relaxation techniques. Most Soldiers diagnosed with any form of PTSD is prescribed some form of selective serotonin reuptake inhibitors (SSRIs). This helps many deal with what I would refer to as “sleep anxiety.” I can only speak for myself when I say going to bed is one of the hardest events of my day. I know I’m not going to sleep, or the sleep will be lousy, but I also know if I don’t try I’ll be worthless the next day.

My deepest thanks go to Captain LeBlanc for bringing attention to this important problem, and for his honorable and courageous work in securing and protecting our country.

April Fool’s Day Wake-Up Pranks

Happy April Fool’s Day, everyone!

 

Nothing serious to write about today, really.  Instead, in honor of this very special day, I present to you some videos of people being punked awake.

Before you click on the videos below, however, please read and heed the following disclaimers:

1.  You must have a reasonable sense of humor to watch these.  If you don’t, please do not click on them.

2.  I do not condone these pranks, and I definitely do not recommend that you try any of these or similar pranks at home.

3.  A couple of these clips feature some harsh language.  Consider yourself warned.  Do not click on these videos if you’re sensitive to such things.

With all that said, let us begin, shall we?

Firecrackers can be very effective alarm clocks. (There are a couple of bad words here)

Here’s another example of the utility of firecrackers:

Air horns are also excellent awakening tools.

Sometimes an air horn wake-up prank can go terribly wrong, however–particularly if your victim happens to be a judo master.  Witness if you dare:

Not interested in getting clocked while executing your practical joke?  Well, if you don’t have access to an air horn, a machine gun allows you to awaken your loved one from a safe distance.

How about awakening to find an unfamiliar face in your bed?  (There’s a naughty word or two here)

Here’s a great one involving an “oncoming truck:”

Finally, here is my all-time favorite video wake-up prank, also from a moving vehicle.  The victim’s facial expression is priceless.

Be careful where you sleep tonight.  Cheers!

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!