Tag Archives: sleep

How to Cope With the Back-to-School Routine

'tired' photo (c) 2008, nigelpepper - license: http://creativecommons.org/licenses/by/2.0/Here it is almost September again. How is that possible? Wasn’t Memorial Day just last weekend? It’s time for the start of another school year, which is a stressful time in my house and I’m guessing yours as well.

It isn’t exactly a secret when school starts; we’ve known the date for months. We’ve been hitting the back-to-school sales for weeks, so it’s not like we weren’t thinking about it. One would think with all this advanced warning and preparation, we would have this down to an art. However, my third and eighth grade kids will tell you we don’t.

Why is the start of the school year so physically and emotionally challenging? Perhaps it is sleep, specifically the lack of it. Bedtimes for most students slowly drift into the late evening hours as summer progresses, and the kids never see a sunrise.

Despite the best of intentions, bedtimes do not adjust easily or painlessly when school begins. The two- or three-hour sudden change in bedtime amounts to a good case of Jet Lag; colorfully named “desynchronosis.” The rule of thumb is it takes one day to adjust for every hour changed. Common symptoms of desynchronosis include fatigue, irritability, headache and mild depression. This describes how my kids feel on the first few days of school – and you thought it was normal.

But what time they go to bed isn’t the whole story. When they get up is important, too. “Sleep latency” is the medical term for being awakened and feeling like “something the cat drug in.” This depends on when in a sleep cycle you wake up. Being awakened during deep sleep or REM sleep is disorienting and amplifies sleep latency (the cat thing).

If you wake up during light sleep you feel almost human. There are actually alarm clocks that monitor your sleep and wake you up only when you’re sleeping lightly. So a wake up range would replace the wake up time. Have to get up at 7 a.m.? Set your range for 5:30-7 a.m. and it might make you feel better. Counterintuitive isn’t it?

But sleep patterns are not the only thing to consider when kids go back to school; change in activity is a factor as well. During the summer, kids move rapidly from interest to interest to keep themselves amused. They are working with an attention span that is as short as five minutes in young kids and 20 minutes for teenagers. When school starts they are suddenly trapped like rats for hours on end. Their activities are chosen by their teachers, who share neither their restlessness nor their short attention span. This too takes several days to readjust.

What about summer meals? What summer meals? The kids are going five different directions and grab something when they occasionally make a pass through the kitchen. Frequent small feedings, heavily loaded with “carbs” and taken at liberty, are the rule. Their young digestive systems tolerate this surprisingly well. With the start of school and scheduled, regulated meal times, blood sugars are predictably plummeting. The result is more restlessness, fatigue and irritability.

Like so many other things in life, the solution to adjusting to the back-to-school routine is practice, practice, practice. Think about the school day, wake up times, meal times and bed times. You can still fit in some fun and readjust your sleep and meal schedules at the same time. A two- or three-day head start will make all the difference. No, that doesn’t mean you have to do homework before school starts. Let’s not be ridiculous.

Take care, and good luck with your new wake-up regimen.

Dr B

The Best Path to a Healthy Night’s Sleep

Do you feel refreshed and alert in the morning after a good night of sleep?

Maybe that doesn’t happen often enough. Perhaps, it has been so long since you’ve felt that way that you’ve forgotten how you’re supposed to feel in the morning.

Chronic sleep deprivation appears to be a growth industry in the U.S. where someone has said, “We are a country that is open for business 24/7.” As a modern society, we definitely sleep less than in decades past.

Numerous artificial factors have influenced our sleep patterns. Life is busier and more demanding. Innovation has created a vast array of opportunities in communication and information technology that profoundly affect our daily lives. And with round the clock news cycles and instant messaging to any place on the planet, demands on our time and stress have increased.

Angel Sleepsphoto © 2007 planetchopstick | more info (via: Wylio)

Further, more people than ever work around the clock on shifts that conflict with our normal circadian rhythm. The ubiquitous television, computer screens and artificial lighting are more stimulating than people realize.

In turn, this adversely affects our sense of fatigue and interferes with our ability to get to sleep and rest in a normal physiologic manner. We are no longer synchronized to the cycles of day and night in conjunction with our internal bio-rhythms.

Research has shown the large majority of adults require seven to eight hours of sleep each night. Younger children need considerably more, but teens are notorious for burning the candle at both ends. Science has shown that they too need an average of 8.5 to 9.25 hours of sleep to be adequately rested and recharged.

Adequate quality sleep is not a luxury or simple matter of convenience. Numerous studies have shown an inadequate amount of sleep in adults leads to serious metabolic and mental changes: greater risk of heart disease, stroke, high blood pressure, diabetes, compromised immune system, weight gain, car accidents and other injuries due to impaired judgment occur more with inadequate sleep.

Overall, less productivity in school and the workplace is connected to sleep deprivation. In teens who do not get enough sleep, there is a strong correlation with depression, suicidal thoughts, poor impulse control, substance abuse and violent behavior. These tendencies in all ages begin to come into play with less than seven hours of sleep on a regular basis.

Studies have demonstrated how these changes start happening in healthy volunteers when they are sleep deprived for as little as four days in a row. It is very difficult to compensate for a regular nightly sleep debt. You cannot overcome this without changing the regular pattern of sleep. You cannot just “catch up on the weekend.”

An interesting fact about modern society is the more people drive a car daily, the less likely they are to get enough sleep. There is direct correlation between driving more than a total of 40 minutes a day and getting less sleep.

Since sleep is so profoundly important, what can you do to ensure a restful night of restorative sleep? Here are a few tips:

•  Adopt a regular routine at night and make it a priority to stick to it.
•  Go to bed at the same time week nights and on weekends.
•  Don’t take naps during the day unless you are really desperate.
•  A short 30-minute power nap can be a resource if you are sleep deprived to recharge; however, regular daytime naps are counterproductive to a good night of quality sleep.
•  Avoid caffeine, alcohol, a big meal or vigorous exercise in the evening.
•  Minimize your fluid consumption for 2-3 hours prior to bedtime.
•  Regular daytime exercise is an excellent tool for general conditioning and contributes to good sleep hygiene.
•  Use the bedroom for only sleep and sex – do not eat or watch TV in bed.
•  If you cannot fall asleep after 30 minutes, get up and go to another room. Do something relaxing like reading or taking a warm bath. Do not check your email or watch TV.

Invest in rest! It will pay big dividends. As the Irish proverb goes, “A good laugh and a long sleep are the best cures in the doctor’s book.”

– Dr. Bruce Kaler

Working the Night Shift and Getting Enough Sleep

The struggle to get adequate daytime sleep when working nights is familiar to many of us. In fact, 15 million workers – or 20% – of the American workforce work other than the typical 9 to 5 shift. Some are swing shift, some graveyard and some even rotate shifts between days and nights. Many people simply do not acclimate to this unnatural pattern of waking and sleep. The resulting sleep deprivation leads to increased short-term illness and long-term medical problems. A much higher incidence of accidents and mistakes are associated with sleep deprivation. The loss of productivity alone is estimated to be in the billions of dollars.

Night shift workers simply get less sleep. In many industries, rotating work schedules often do not allow for adequate time off. Most notable are the transportation industries such as railroads, commercial trucking and airlines. The National Highway Traffic Administration estimates more than 100,000 police-reported crashes occur annually due to driver fatigue, resulting in 1,550 deaths and 71,000 injuries in 2008. The monetary losses exceeded $12 billion. Motor vehicle accidents are more likely after 11 p.m. and greatest between 1 a.m. and 7 a.m.

In non-transportation industries, 25% of night shift workers reported that their work schedules do not permit sufficient sleep time, and 33% reported getting less sleep than needed to do their best work.

Asleepphoto © 2008 David Joyce | more info (via: Wylio)

All shift workers do not suffer from sleep disorders; however, the longer a given individual is on the night shift, the more likely he or she will suffer some medical consequence or have issues with productivity. The effects of sleep deprivation on alertness, judgment and productivity have been quantitatively compared to the effects of alcohol. Just the loss of several hours of sleep can result in impairment comparable to several drinks. This worsens with increasing sleep loss. The message is that sleep deprivation from night shift work is fairly common and associated with physical and emotional distress. The net result is increased accidents, injuries and loss of productivity.

Since night shift work is necessary, how can we manage the side effects and prevent some of the problems that arise? Educating management and workers regarding the risks and being proactive can have a positive impact. Workers will benefit from healthy habits, diet and exercise. If they are having difficulty sleeping, they should consult a health care provider to asses any underlying medical conditions or medications that can influence sleep patterns.

Good sleep hygiene can be very beneficial in acclimating to night shift work. Some tips include:

• Have a quiet sleep area with black-out curtains.
• Avoid caffeine, nicotine or alcohol before sleep.
• Try using sunglasses during the morning drive home to minimize light exposure.
• Refrain from a large meal, excess fluids or vigorous exercise prior to sleep.
• Avoid radio and TV when attempting to get to sleep.
• Although melatonin has been touted by some as a sleep aid, it is not FDA-approved and has inconsistent results as a sleep aid. It does not provide any improved alertness during the subsequent work shift.
• Sometimes, short-term use of a prescription hypnotic drug can be beneficial for those struggling with disordered sleep.
• Controlled and timed exposure to light during the work shift has also been beneficial in some to reset circadian rhythms and restore a better sleep/wake pattern.
• Power naps before the work shift increase alertness, increase reaction times, productivity and do not usually interfere with the daytime sleep for the night shift worker.

Although somewhat unnatural, the night shift has become a necessary part of our working lives. Getting adequate sleep is integral in keeping alert, staying productive and reducing the risk of injuries while on the clock.

– Dr. Bruce Kaler