Jun 27 2017

Sleep

poor-sleepSleep is essential and yet many people get insufficient sleep or have poor sleep quality. A recent review gives the following stats:

Population studies show that sleep deprivation and disorders affect many more people worldwide than had been previously thought. A recent study found 20% of 25–45 year-olds slept “90 minutes less than they needed to be in good shape”. Insomnia is the most common specific sleep disorder, with ‘some insomnia problems over the past year’ reported by approximately 30% of adults and chronic insomnia by approximately 10%. Prevalence of obstructive sleep apnoea, characterized by respiratory difficulties during sleep, is also very high with estimates of 9–21% in women and 24–31% in men.

The CDC considers poor sleep a public health problem. As a practicing physician these statistics also match my experience. Poor sleep is comorbid with many neurological conditions I treat, such as migraine. What I find interesting is how many patients I see who are having frequent migraines, they have fatigue, have difficulty with weight control, and are having difficulty with concentration and short-term memory. Further, when asked they report having terrible sleep, and yet they did not volunteer this information or make any connection to their other symptoms.

What this tells me is that people under-appreciate the importance of sleep and the negative consequences of chronic poor sleep. In fact, many patients are initially dismissive of the idea that poor sleep could be a major explanation for their symptoms. They are used to having poor sleep and that is now their normal.

The ultimate test, of course, is what happens when you fix their sleep. Some patients have a clear sleep disorder, like sleep apnea (the airway closes when they are asleep causing obstruction leading to eventual loud snoring and gasping which wakes the patient but not fully, so they often don’t remember the event). Sleep apnea can be treated, for example with a breathing mask providing positive airway pressure (CPAP). Typically the patient’s other symptoms are dramatically improved once their sleep is improved.

For these reasons there is increased interest in the effects of sleep deprivation. One ongoing study looks at the performance of people on online tasks testing cognitive function. They are also comparing functional MRI scan when performing cognitive tasks in the rested and sleep-deprived state. This will be the largest study to date. But there are already studies looking at cognitive function and overnight work shifts or poor sleep and they consistently find (no surprise) that lack of sleep impairs performance.

Sleep Hygiene

What to do if you suspect you are suffering from poor or inadequate sleep? In many cases it may be appropriate to consult a physician. Many sleep disorders can only be diagnosed with a sleep study (polysomnography).

Everyone, however, should be aware of what constitutes good sleep hygiene, and many poor sleep problems can be fixed by making some basic lifestyle changes. Here are some basic rules:

First, try to have a regular sleep cycle. This is difficult for shift workers, which is why shift work sleep disorder is its own thing. Many people also have young children or other responsibilities that make it impossible to have an absolute priority on sleep. But prioritize sleep as much as you can.

Most people should avoid napping during the day in order to make up for lack of sleep at night. If you have general good sleep, there is nothing wrong with a brief siesta. However, it can be counterproductive to nap in order to make up for poor sleep at night. The problem is this breaks up your sleep. It is better to get all your sleep at once, so that you have time to get into the deeper stages of sleep. You are better off staying awake during the day so that you are more sleepy at night.

For the same reason, if you have trouble falling asleep, don’t stay in bed tossing and turning. Get out of bed, read a book, do something relaxing. When you feel sleepy, get back into bed. The reason for this is that while you are tossing and turning you are getting brief mini-naps, that also serve to break up your sleep and frustrate establishing a full sleep cycle.

Light levels are also important. We evolved without electricity so our brains are used to sunlight during the day and low light during the night. In fact, low light levels trigger the brain to release melatonin which induces sleep. In our modern world we have consistent light levels all day and night, then hop into bed. So, get some sunlight during the day if you can. In the evening, start to turn off or turn down lights. Get your brain ready for sleep.

Further, avoid electronic devices in bed or prior to sleep. While this is a relatively recent phenomenon, there is already evidence that screen time in the evening is bad for sleep.

By the way, the evidence for melatonin supplements in primary and secondary sleep disorders is mixed and unconvincing. There is some preliminary evidence for possible benefit, but better trials are needed.

Caffeine is probably one of the worst enemies of sleep. Caffeine directly disrupts the brain’s sleep cycle, and also frustrates sleep onset. Further, daily caffeine use rapidly develops dependence. Even caffeine consumed earlier in the day (as late as noon) can be disruptive to sleep onset. Anyone with disordered sleep should try to completely remove caffeine for at least 6 weeks to see what effect it has.

Other recommendations include to avoid eating or drinking right before bedtime. Eating can cause reflux when lying down. You should also try to empty your bladder and time your fluid intake so that you can get through the night without waking up to pee. Of course, there are conditions that make this impossible, but otherwise that’s the goal.

Make sure your pillow and mattress have enough support and are comfortable for you. Back pain from a saggy mattress is an easy (if expensive) problem to fix. You may also be able to get away with a mattress top for extra support or comfort. Essentially, do what you need to do in order to get through the night comfortably. If you do wake up during the night, try to figure out why.

There is also evidence that exercise during the day improves sleep quality.

This is all generic advice for good sleep hygiene, but of course individuals may have medical issues or specific problems that need to be addressed. There is no reason not to have good sleep hygiene, however, and it is always a good start when addressing poor sleep. When in doubt, however, consult your physician.

The start, however, is to think about your sleep. Chronically poor sleep is often the cause, or at least is a significant exacerbating factor, in many common “symptoms of life” like fatigue, muscle pain, headaches, and poor concentration. Don’t ignore poor sleep or fail to address it as a real problem.

 

46 responses so far

46 Responses to “Sleep”

  1. edamameon 27 Jun 2017 at 9:10 am

    “Caffeine is probably one of the worst enemies of sleep.”

    Right after kids.

  2. mumadaddon 27 Jun 2017 at 9:51 am

    “Right after kids.”

    Argh. My first is die to arrive in 5 weeks. I’m taking advantage of the lie in time I have left.

  3. mumadaddon 27 Jun 2017 at 9:51 am

    *due* to arrive…

  4. SteveAon 27 Jun 2017 at 10:10 am

    I went through a period of being very sluggish during the day. Because I snore (to wake the dead) I thought I might be suffering from sleep apnoea, so my GP sent me to a sleep clinic and they fixed me up with a strap-on gadget that tests for it.

    Turned out that I don’t have it, so I tried some other stuff. I brought a sleep mask to block out the early morning light (a problem in the summers) and I gave up booze-before-bedtime, both for the bladder issue and the fact that alcohol apparently reduces the quality of sleep.

    I’m doing a lot better. Sticking to a regular routine really helps.

  5. NotAMarsupialon 27 Jun 2017 at 10:13 am

    Mumadadd,
    *Due to arrive*

    We’ll excuse the error, but it seems like you may need to get some sleep.

  6. tb29607on 27 Jun 2017 at 11:23 am

    I think most doctors would include “being on call” on the list of worst enemies of sleep.

  7. RedMcWilliamson 27 Jun 2017 at 12:32 pm

    Is it true that you carry a sleep debt if you’re not getting enough sleep and that you have to sleep extra to get back to ‘normal’?

    E.G, you should be getting 7.5 hours of sleep a night, but one week you only get 5.5 hours. That means you’re 14 hours in debt, and so would need to sleep 8.5 hours a night for the next to weeks to get caught back up.

    Does it really work that way? Does the time spent in each stage of sleep matter?

  8. Npsychdocon 27 Jun 2017 at 2:18 pm

    Thanks for focusing on sleep hygiene. I cant believe how often I see patients with sleep problems tried on all kinds of sleep meds who have never heard of sleep hygiene.

  9. edamameon 27 Jun 2017 at 4:23 pm

    >My first is [due] to arrive in 5 weeks.

    Enjoy your freedom now while you have it. Your life will never be the same. In a good way, for the most part. 🙂 Fourth trimester (the one they should still be in the womb) are brutal because of sleep deprivation, but then they start to show signs of intelligence, more each month, and it’s a lot of fun.

    /mansplain

  10. edamameon 27 Jun 2017 at 4:30 pm

    Sleep hygiene is a constant struggle for me. I am a night owl by nature, preferring a 2am-10am sleep schedule since I hit puberty.

    If I don’t plan my life around healthy sleep habits, as Dr Novella said, I don’t maintain them well. This means I have to think about it during the day: I literally set multiple alarms at night to remind me to get off the computer, to stop playing Destiny, or whatever. Unfortunately, my mind is most awake and acute and astute and alert and productive after 11pm. This was fine before child, but since the child was born…I’ve had to adjust things a tad. It’s rough I can’t lie. I get fewer than 6 hours most nights.

  11. David Twitchon 27 Jun 2017 at 6:40 pm

    Lack of proper sleep took a huge toll on my mental and physical well being for years and the reason it’s so insidous is it happens very slowly over time and it becomes so normal you don’t know anything’s wrong. In my case I was diagnosed with severe apnea and realized I had probably not know what normal sleep was most of my adult life.

    I had mistakenly written off poor sleep and constant exhaustion as stress. I’ve been told by doctors that apnea is one of the most undiagnised conditions there is, because patients don’t know that sleep is the cause of their problems, and doctors have to be like detectives to find out.

    After successful treatment for apnea my memory and energy and several other things improved.

    The last step was giving up caffeine. I always had difficulty falling asleep and didn’t think caffeine was involved because I’d not have coffee 8 hours before bedtime. I gave it up and while it was initially unpleasant, a few days later I was quickly falling asleep for the first time I could remember in my adult life.

    However giving up coffee can be next to impossible if a person hasn’t also addressed other issues such as apnea. In my case I also started to exercise a lot, which actually became my new caffeine. But I had tried that many times in the past with failure when I had apnea – if you’re exhasuted all the time you’re not going to be able to exercise.

  12. David Twitchon 27 Jun 2017 at 6:45 pm

    BTW, I’m pretty sure the 8 hours of sleep message that gets repeated endlessly is about as bogus as needing to drink 8 glasses of water a day. 8 hours is just a guide and what matters is what you need to be refeshed. For some that is 6 hours and for some it’s 9 hours (or whatever).

    Now that my apnea is treated and I’m eating and exercising better, I feel more refreshed on 6-7 hours of sleep than I used to on 10 hours.

    Stress is also a sleep killer – but it’s the ultimate catch 22. Bad sleep can cause stress and stress can cause bad sleep. So both should be addressed.

  13. Robert Christon 27 Jun 2017 at 8:39 pm

    I find timing of meals to be a big help. One at 11am-ish and another at 5pm-ish. No snacks in between. Timing when I go to bed. Always at 12am. Stay away from high fat and high carb foods unless their packed with nutrients. Like I’ll eat raisons and peanuts for instance. Just try to do so in moderation.

    And I’ll never quit drinking coffee! Just not after 5pm.

  14. Nidwinon 28 Jun 2017 at 3:29 am

    @David Twitch

    I think those 8 hours are a good guide or starting point for most people but 6-7 can certainly be enough for adults with a good sleep hygiene.

    From what I understood you need 4 completed sleep cycles, 90 minutes each, for a good night of sleep.

    My case is a bit different as I partially or fully wake up after every sleep cycle so I need more time spent in bed to have a full night of sleep. For a complete “refresh” I also require 3-5/6 micro cycles after the fourth 90 minutes cycle, especially when I’ve a sleep gap, happens often between the second and the third cycle, of 2-4 hours. I’m used to dig in early so no big deal for me.

  15. SteveAon 28 Jun 2017 at 5:29 am

    Sleep apnoea can be disturbing.

    I have an acquaintance who suffers from it (I’m guessing the cause is his obesity) and on occasions when I’ve been round to his house I’ve experienced it first-hand. He’ll doze off on the sofa and his resonant snoring will soon fill the room…

    Then it will stop.

    And it will stay stopped.

    And it will stay stopped until everyone in the room is looking at him. And you’re thinking, ‘Oh my god, he’s dying. What should I do?’

    Then he coughs into life like an ancient motorcycle and the snoring resumes for another half a minute. Till it stops again, and so on…

    One regular visitor told me that they once timed one of his ‘pauses’ to 45 seconds. I don’t know how he’s managed to stay alive for so long.

    He knows he has apnoea and knows he should lose some pounds, but appears to have zero interest in taking care of himself.

    Weight seems to be an important factor in apnoea. When I attended a sleep clinic, there were about twenty people waiting for consultations. There was me (relatively normal sized), a gorgeous young woman who could have been a catwalk model, and everyone else was huuuge, either sat in a wheelchair or perched on a Rascal.

  16. bachfiendon 28 Jun 2017 at 6:10 am

    SteveA,

    I have (mild) obstructive sleep apnoea. I’m not overweight. My body mass index is towards the lower normal limit of around 20.

    Neil Shubin in ‘Your Inner Fish’ noted that one of the evolutionary trade offs for humans was being prone to sleep apnoea as a result of having having floppy highly mobile throat muscles to allow vocalisation.

    My sleep apnoea was worse while I was still working, so it seems as though stress made it worse. After I retired I went away for a weekend and because I didn’t take my CPAP machine with me (I wasn’t certain that there was going to be power in the accommodation provided at an adventure camp), I went without it. I found that I slept just as well without the CPAP machine as with it, and I then had to decide whether I wanted disturbed sleep due to sleep apnoea or disturbed sleep due to the CPAP machine (and mask).

    I decided that the disturbed sleep due to the sleep apnoea was preferable.

    Agreed. Being overweight does make sleep apnoea more frequent (and severe), but it also occurs in the lean, in whom the diagnosis will be missed if it’s only looked for in the overweight.

  17. Egstraon 28 Jun 2017 at 9:50 am

    For those who want more information, there’s a pretty decent workbook available that looks at both sleep hygiene and at psychological factors.

    https://www.newharbinger.com/insomnia-workbook

  18. Charonon 28 Jun 2017 at 9:06 pm

    Novella: “Sleep apnea can be treated”

    Sometimes. I guess that’s true of any condition, but I wonder how well CPAP machines are actually tolerated on average. I couldn’t sleep with one, at all.

    Novella: “Many sleep disorders can only be diagnosed with a sleep study (polysomnography)”

    If then. The objectively observable signs and the subjective symptoms aren’t well correlated for sleep apnea, or so I was told at the sleep center. Also, being in an unfamiliar sleep lab with wires glued to your head, on your back (never how I normally sleep), is rather poor (albeit necessary) study design for observing your actual sleep.

    Now that I can no longer get a good night’s sleep regardless of what I do, I’m incensed at my younger self for voluntarily getting poor sleep so often. Sigh.

  19. David Twitchon 28 Jun 2017 at 10:32 pm

    @Steve A, weight is a factor, but many scientists now thing the causal link goes both ways. People are more likely to have apnea if they become overweight, but they are also more likely to become overweight if they have apnea. The lack of proper sleep impacts everything.

    “I wonder how well CPAP machines are actually tolerated on average.”
    @Charon, the answer is NOT well. The rate of failure is high, over 50%, though that’s probably no worse than other diseases that require lifestyle changes.

    The sad thing is most people could adapt, but they receive so little support that they never get there. They are handed a cpap machine and that’s about it. For instance, it can be critical to try several masks to find one you can tolerate. It took me several months before I was able to tolerate cpap therapy well. Now it’s easy. I advise you to check out some of the Internet forums where people share info, post your challenges and people who have been there will help.

    As far as sleep labs, they generall do pick it up, especially in cases where it’s not mild, as long as someone falls asleep. It’s much more apparent than you might think.

  20. bachfiendon 29 Jun 2017 at 7:20 am

    David,

    I used a CPAP machine for years, replacing the mask annually, with very good support and follow up. I eventually decided that the sleep disruption due to the sleep apnoea was preferable to the sleep disruption due to the CPAP machine and the mask.

    About the only thing I do nowadays regarding the sleep apnoea is ensuring I don’t gain weight – although, as has been noted, sleep apnoea may cause weight gain rather than the reverse.

  21. David Twitchon 29 Jun 2017 at 11:37 am

    “I eventually decided that the sleep disruption due to the sleep apnoea was preferable to the sleep disruption due to the CPAP machine and the mask.”

    @Bachfiend, if that works well for you great, but for people with severe apnea not wearing CPAP is not an option, unless they want to experience serious physical problems, often which lead to early death from stoke, heart attack and other issues.

    Many people adjust well to CPAP and eperience no sleep disruption at all. Just the opposite, because they are no longer starving for air they sleep better than they ever have.

  22. bachfiendon 29 Jun 2017 at 3:00 pm

    David,

    I’d noted that I have mild sleep apnoea (based on the objective measurements of the sleep study I had).

    At the time, based on my sleep disturbance and the feeling of chronic tiredness, I wondered what severe sleep apnoea would feel like. I have a sort of vague concept of how bad it would be based on my hearing of people involuntarily falling asleep driving cars and running off the road into innocent trees.

    With my mild sleep apnoea, the cost benefit ratio of using a CPAP machine just didn’t justify using it. I found I was just as tired the next day regardless of whether I used the machine or not. It seemed to be having more of a placebo effect – I felt that I had to be better off because I was doing something, anything.

    I don’t doubt that with severe sleep apnoea the calculation would change completely. My (overweight) brother even had the surgery (with success) for severe sleep apnoea (is there a genetic component to sleep apnoea?). He’s still overweight though.

  23. David Twitchon 29 Jun 2017 at 3:44 pm

    backfiend, sorry I did read your earlier post a couple days ago, but didn’t tie it together with your last one when I replied. I’m a little sensitive on the subject because a lot of people don’t understand how serious apnea (and the need to treat it) can be.

  24. bachfiendon 29 Jun 2017 at 4:52 pm

    David,

    Agreed.

    Neil Shubin even used sleep apnoea as an argument against Intelligent Design. I suspect he must have sleep apnoea, as well as dodgy knees due to medial meniscus damage as a result of climbing over large rocks to get to the fossils (as an aside, when I read that particular section in ‘Your Inner Fish’ I wondered whether the chronic medial knee pain and discomfort I was having after doing a spell of bush walking in the Kimberley – with similar rough terrain – was due to medial meniscus damage, fortunately now gone).

    In Australia, sleep apnoea is officially treated seriously. Legally, you’re supposed to report any medical condition – including sleep apnoea specifically – likely to cause an impairment in driving ability to the appropriate licensing authority (it’s not particularly well obeyed. I’ve met people with severe sleep apnoea – who have actually fallen asleep whilst driving – who were unaware of the obligation. Treating doctors, if at all. only advise their patients about the requirement. They don’t report their patients.

    I reported my mild sleep apnoea to the licensing authority, and the reward was that my driver’s
    licence was restricted to annual renewal and I had to have a medical report signed by my GP attesting to the fact that I told him that my sleep apnoea wasn’t affecting my driving ability for the limited local driving I do.

    Sleep apnoea is big business in Australia with an enormous number of actual and potential customers (who should be treated too). My sleep physician is overworked and indicated at my last visit that he only wants to see me if I have problems. I was seeing a trained pharmacist who was reviewing the data from my CPAP machine regularly – but the licensing authority refused to accept a report from him (who’d had some idea how my sleep apnoea was doing), instead wanting one from a medical practitioner possibly with no expertise in sleep apnoea (doctors can’t be expected to be expert in everything).

    Subsequently, the licensing authority removed mild sleep apnoea as being reportable.

  25. bachfiendon 29 Jun 2017 at 5:05 pm

    David,

    Naturally, I don’t expect my sleep apnoea to disappear or to remain stable over time. I expect it will worsen as I become old and decrepit (or more accurately, older and more decrepit) as my throat muscles lose tone and become more flaccid.

    I have to monitor my sleep closely, allowing for temporary factors such as the occasional late night for a concert. Or jet lag after international travel, such as my return from Munich 2 days ago. Or the occasional painful physical injury disrupting pain free sleep. I expect that at some time or another I’ll need to return to using the CPAP machine – which wasn’t much of a problem. It was the masks that were causing all the problems, and over the years I’d tried many. Perhaps in a few years there’ll be better models on the market – I’ve often wondered why they can’t design one that’s comfortable and doesn’t shift during the night causing a leak.

  26. David Twitchon 29 Jun 2017 at 10:04 pm

    Bachfiend,

    “Neil Shubin even used sleep apnoea as an argument against Intelligent Design.” Ironically, I’ve also see a lot of the health quacks point to apnea as a disease that is caused by [insert modern evil such as GMO, not enough raw food etc.] because “do we really think this wonderful human body evolved to not be able to breathe properly?”. Then they explain what elixer is needed to cure it.

    Your system in Australia sounds much better than here. In the US you basicially get handed a CPAP machine by someone that works at a durable medical equipment supplier, they give you a 5-minute tutorial, and you’re on your own. Often the person is just given a mask, and doesn’t get to try any, even though not finding a good mask match is one of the most likely reasons for cpap failure. People do get follow-ups with the doctor, but little help with learning to use cpap itself, how important mask selection is and so on. And of course insurance only covers one mask, so unless you have the funds to try another one, which most don’t, you’re SOL.

    I don’t know what machine you use, but you might want to check out sleepyhead software. It works with resmed and I think Philips machines, and allows you to download and analye your own data in great detail.

    As far as masks go, I haven’t found a perfect one yet, but I have found some very good ones. What works for someone is highly individualistic. That said, if you go back to cpap, assuming you don’t need a full face mask, you may want to check out the Philips Dreamwear mask. It was a lifesaver for me, and allowed me to sleep very comfortably with my cpap. I also learned all about the different settings, and tweaked those, but the mask was the biggest breakthrough for me. There are a lot of selections now and they’ve improved treamendously over the years.

  27. bachfiendon 29 Jun 2017 at 11:54 pm

    David,

    In Australia, it’s fairly standard to be able to rent a new mask as a trial for a week at the nominal fee of $15, the rental being regarded as a deposit if you like the mask. If you don’t, then you can try another.

    Paying $15 a time to eliminate masks that don’t work is much cheaper than having to pay hundreds of dollars for a mask. And masks are very expensive compared to the machines, needing to be replaced frequently, usually yearly.

    The Dreamwear mask wouldn’t suit me. I’m a mouth breather.

    It’s not necessary to download and analyse your own data. There are people who will do it for you.

  28. BillyJoe7on 30 Jun 2017 at 7:05 am

    Why don’t they take a mould (actual or digital) of your mid-face around your nose and tailor make a mask?

  29. SteveAon 30 Jun 2017 at 10:26 am

    BJ7

    Sounds like the makings of a mail-order business. You could come up with some kind of ‘mould-pack’ that a user could press over their nose and mouth to take an impression. Then, once the pack had hardened, they’d post it back to a facility where it would be used to make a proper mask that was fitted with the right connections for whatever brand of machine was being used.

    Might not be able to handle facial-hair that well though…

  30. RickKon 30 Jun 2017 at 10:53 am

    Sounds like a perfectly reasonable smartphone app. Launch the app, which turns on the selfie camera, move the phone around in front of your face as it fills out a digital map of your face. My dentist has that now for taking a 3D image of my teeth and using it to automatically render a cap or crown.

    Obviously the camera is on a wand – he doesn’t shove a smartphone in my mouth 🙂

  31. SteveAon 30 Jun 2017 at 11:27 am

    RicKK

    Incredible. I had no idea a smartphone could do that.

  32. BillyJoe7on 30 Jun 2017 at 5:06 pm

    If you’re having trouble sleeping, this little story might help:

    https://www.nytimes.com/2017/06/28/us/arkansas-ten-commandments-monument.html?action=click&contentCollection=Books&module=Trending&version=Full&region=Marginalia&pgtype=article

    🙂

  33. Ian Wardellon 02 Jul 2017 at 5:20 pm

    For sleep apnoea, and indeed snoring, make sure you don’t sleep on your back.

  34. bachfiendon 03 Jul 2017 at 6:41 am

    Ian,

    ‘For sleep apnoea, and indeed snoring, make sure you don’t sleep on your back’.

    Ian, you’re maintaining your perfect record of providing useless pieces of advice. When I’m asleep, I don’t have any conscious control on my position. I’m asleep, remember? A person’s position is constantly changing whilst asleep, otherwise the person would get bed (pressure) sores.

    Your advice is just as useful as the instruction a sleep therapist gave me handing me a mask which covered just my nose ‘don’t open your mouth when asleep’. And when I fell asleep, my mouth promptly opened (I’m a mouth breather asleep) causing a massive leak waking me.

  35. SteveAon 03 Jul 2017 at 8:22 am

    bachfiend

    I heard one cure for ‘back sleeping’: sew a tennis ball into the back of your pyjama-top or tee-shirt.

    I don’t know of anyone who’s tried to put it into practise.

  36. Ian Wardellon 03 Jul 2017 at 10:07 am

    I’ve noticed myself snore sometimes when I sleep on my back.

    I now sleep on my side — left side is best. I occasionally turn on my back, especially near the end of the night, but as soon as I notice I roll onto my side again.

    Or put something on your back so you don’t roll over. A tennis ball or whatever.

  37. bachfiendon 03 Jul 2017 at 11:55 am

    Steve,

    I don’t know whether sewing a tennis ball to the back of the top would work. I’m reminded of the the Hans Christian Andersen story of ‘the Princess and the Pea’. It would probably only work if you’re a Danish princess.

    I personally think having a tennis ball attached to your clothing would affect your sleep regardless of whether you’re lying on it or not.

  38. Ian Wardellon 03 Jul 2017 at 5:29 pm

    Some people with sleep apnoea continually keep half waking all the time throughout the night, and they are exhausted and falling asleep all the time the next day.

    If avoiding sleeping on your back avoids that, then you have to go for it. Wear a backpack if necessary.

  39. bachfiendon 04 Jul 2017 at 1:56 am

    Steve,

    I doubt seriously that attaching a tennis ball to the back of my shirt, assuming it prevents me from sleeping on my back, will improve my sleep apnoea, but I’ll give it a try. I persisted with a CPAP machine for years before I realised it wasn’t improving my sleep or my general alertness the next day (the best measure to improve general alertness is a session of vigorous exercise).

    It will be easy to do. I sleep in a cycling shirt with three back pockets. It’s simple enough to place a tennis ball in the middle pocket.

  40. SteveAon 04 Jul 2017 at 8:17 am

    bachfiend

    Good luck.

  41. Kawarthajonon 04 Jul 2017 at 10:30 am

    There’s some science underway regarding the issue of sleep loss and brain functioning. Anyone want to participate? Here’s the link:

    https://www.cambridgebrainsciences.com/studies/sleep-study

  42. BillyJoe7on 04 Jul 2017 at 3:06 pm

    Bachfiend, do you also sleep with your bicycle? 😀

  43. bachfiendon 04 Jul 2017 at 5:14 pm

    BillyJoe,

    That’s a silly question.

  44. Ian Tayloron 09 Jul 2017 at 1:54 am

    Thanks for the good article. When I was doing my family medicine training, I noted a paucity of attention to sleep hygiene even in the adult routine check up list. One way of raising awareness or helping to improve the matter would be to incorporate it into routine family medicine practice.

    I’ll try to track down the evidence for this particular claim but exercise even during the night (3 hours before bedtime) can be beneficial. Also, consistency and routine are very important.

    Is there any good literature on “chronotypes?” I personally would be just dandy if I could sleep from 2am to 9am every day. My surgery rotations were brutal but my ER rotations (I am a practicing ER physician now) were just great because I didn’t have to wake up early all the time. Some people may just not be meant to go to bed from 10pm to 6am (?). Would be interested to know how prevalent this is and how malleable it can be.

  45. BillyJoe7on 10 Jul 2017 at 8:15 am

    bachfiend – yeah, I know, of course you do! 😀

  46. BillyJoe7on 10 Jul 2017 at 8:28 am

    Ian Taylor.

    “sleep hygiene”.

    For some reason, I hate that phrase. Not sure why.

    “exercise…3 hours before bedtime…can be beneficial”

    The idea is that you raise your body temperature during the exercise and then you cool down through the rest of the evening and then get into a warm comfortable bed. I’ve never had the chance to put it to the test though.

    “Also, consistency and routine are very important”

    Apparently only for those who don’t sleep well. For those for whom sleep is not an issue, routine is also not an issue either.

    “I personally would be just dandy if I could sleep from 2am to 9am every day”

    The opposite for me. My ideal sleep time is 10pm to 5am, though I’m fine with six hours sleep. Interestingly, being fit and exercising regularly seems to decrease my need for sleep, though not while actually getting fit, or getting fitter in preparation for a running or cycling event.

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