In a minute, I’m going to tell you about which sleep gifts people enjoyed most from my gift guide.
But first …
Did you know that writing to do lists or “worry lists” can actually help you get more sleep?
Time magazine reported on a Study from the Journal of Experimental Psychology showing:
“writing down worries, in general, can reduce stress levels and help people perform tasks more efficiently.” This was not a big surprise but psychologists at Baylor University wanted to see if writing down future-focused thoughts, specifically, could help people sleep.
To test their theory, they recruited 57 healthy adults, ages 18 to 30, to have their sleep patterns monitored overnight in a lab. Half of the people were asked to take five minutes to write down, in bullet points or in paragraph form, “everything you have to remember to do tomorrow and over the next few days,” the study authors write. The other half were asked to write down tasks they’d completed earlier that day and in the previous few days. Data from the participants’ sleep studies, including eye movement and brain-wave activity, showed that people who wrote to-do lists fell asleep nine minutes faster than those who wrote about completed tasks. What’s more, people who wrote longer and more specific to-do lists fell asleep faster than those who wrote shorter, more general ones.
“Nine minutes of extra sleep may not seem like a lot, but that is what we see in clinical trials for some prescription sleep medications currently on the market, says Scullin (Study Author).” –Time Magazine
Why is this so interesting?
A few reasons, first this study was not done with people who have sleep difficulties.
This data may get better for those with higher levels of anxiety, since we know this technique helps reduce anxiety. Next, it is a non-addictive, non-drug way to improve sleep. Now here is what is really interesting, I didn’t participate in the study but I’ve been successfully using this technique with patients for many, many years!
So, here are the steps:
• Each night take five minutes and write down in detail what you need to remember to do tomorrow and the next few days.
• DO NOT write about what tasks you completed during the day, stay focused on the future
• You can write out a simple bullet point list but try and be thorough, the people who wrote down longer, more thorough lists fell asleep faster than those who wrote the simple bullet point list.
• Try this process for two weeks and see what you notice.
• I like using this journal at night because as a psychologist, I like going back through my weeks and months of writing and looking for patterns of things that reoccur to see if I can optimize or improve. Having all of that in one place makes reading and finding them easy.
If you want to learn how to incorporate a “Worry Journal” into your sleep routine, you may want to check out my sleep course. Not only will you learn this technique, but you will learn relaxation techniques, supplements to try, and even a bedroom makeover for better sleep. Check it out here.
Ok, now for the Christmas Roundup and some deals that are still going.
First of all, pillows, glasses, and food, were all the rage!
The curved, fill adjustable, shredded memory foam pillow was a hit, people love how it curves around your shoulder and cradles your head. And, if you hurry, you can still get a $29 discount by entering DRBREUS at checkout. Go to V&R Naturals to get yours today.
People are getting the message about blocking blue light before bedtime. These stylish blue light blocking glasses flew off the shelf and you can still get
Feeling uncomfortable and not like yourself? Sleep problems and other symptoms might be involved.
Poor and disrupted sleep are common symptoms of menopause. Insomnia, and changes to typical sleep patterns, are often an early signal of a woman in perimenopause, who is experiencing changes to estrogen, progesterone and other hormones that influence sleep.
So many of my patients cope with other symptoms of menopause that affect sleep. But it’s not always easy to make the connection between those menopause symptoms and the impact they are having on your nightly rest. I’ll run through some of the most frequently experienced symptoms of menopause, and talk about how they might be exacerbating your sleep issues—in ways that might surprise you.
These nighttime hot flashes, a surge of body heat accompanied by intense sweating, are the body’s response to drops in estrogen. For many women, Hot flashes and night sweats begin during perimenopause, and tend to increase in frequency until a couple of years into post-menopause, before beginning a gradual decline.
Night sweats make sleep uncomfortable and difficult. I treat many patients who, throughout menopause, are regularly awakened from sleep drenched in sweat and have trouble falling back asleep, or wake feeling tired and unrested because of restless sleep caused by night sweats.
Night sweats can also make sleeping with a bed partner difficult, and put stress on relationships—sometimes, women experiencing nighttime hot flashes are uncomfortable sleeping close to another person.
New research indicates a link between night sweats, hot flashes and obstructive sleep apnea in menopausal women. Obstructive sleep apnea and other sleep disorders become more common in women as they age, and move through menopause. A recent study shows women with severe hot flashes during the day or night may be at significantly higher risk for obstructive sleep apnea than women who experience mild hot flashes, or none at all.
Wearing the right clothes for sleep and investing in good bedding—natural fabrics, layers that can be removed, not overdressing for bed—can help improve sleep when you’re contending with night sweats.
Anxiety, depression, and mood swings
I often see women in the menopausal transition who are struggling with sleep issues as well as anxiety and erratic, unpredictable changes to mood. In addition to mood swings that take you from sadness to anger to fear, women in menopause are also more likely to experience panic attacks and other physical symptoms of anxiety, including sweating and heart palpitations.
One of estrogen’s functions in a woman’s body is to regulate other hormones and neurotransmitters, including several that affect mood. Serotonin, dopamine, and norepinephrine are hormones and neurotransmitters that work to lift and stabilize mood. They also play direct roles in regulating sleep-wake cycles. When estrogen levels are irregular and erratic, that creates changes to levels of these mood-shaping hormones that can affect how you feel throughout the day—and how you sleep at night.
The decline in progesterone, with its calming, relaxing, estrogen-balancing effects, can also contribute to feelings of anxiety, irritability, and restless agitation. One of the most common complaints I hear from women in perimenopause is, “I can’t turn off my mind at night.” Racing thoughts, and persistent feelings of stress, make it difficult for many women experiencing menopause to unwind.
Anxiety, depression, and sleep have what’s known as a bi-directional relationship. Anxiety and depression can trigger sleep problems, and sleeplessness exacerbates both depression and anxiety. Women going through menopause may develop sleep issues as one symptom of mood problems—and they may be more likely to face struggles with mood because of poor sleep.
If you have a history of anxiety or depression, or are facing high levels of stress in your life, you may be more likely to experience mood swings and the development of a mood disorder in menopause—and therefore at greater risk for sleep problems. It’s important to discuss all of these symptoms with your doctor, so they don’t get worse when left un-treated.
Lack of concentration, focus, and memory
The foggy-headed forgetfulness and difficulty maintaining focus are some of the most frustrating symptoms for many of my patients who are in the menopausal transition. Estrogen helps keep the mind sharp, fueling the production of neurotransmitters that not only support mood, but also support a woman’s executive functioning—complex thinking, reasoning, and decision making. Estrogen plays a critical role in memory, and supports the overall health of the brain. One way appears to do this? By its influence with BDNF, a protein in the brain that is essential for maintaining healthy neurons.
Progesterone also aids in brain health and function—and it’s a hormone that’s important to successful healing in the brain after injury. A recent study found progesterone levels in post-menopausal women are linked to verbal memory and to overall cognitive abilities.
Testosterone in women also contributes to mental sharpness and memory, and decreasing levels of testosterone with age are linked to problems with memory and concentration.
The shifts and declines in these hormones throughout menopause can interfere with waking performance. Many of the women I see in my practice are regularly frustrated by these changes to their focus, memory, and thinking—and say it affects their productivity, and the outlook with which they approach their work. This frustration over a lack of mental sharpness frequently creates stress that directly interferes with their sleep.
Changes to sex drive
As with all symptoms of menopause, changes in sexual drive and sexual function don’t happen for every woman. But for many, decreasing estrogen, progesterone, and testosterone that come with menopause create a reduced interest in, and pleasure from, sex. Some women experience pain during intercourse. Estrogen helps to keep vaginal tissues elastic and lubricated, and low estrogen can lead to thinning of vaginal tissue and vaginal dryness that may make sex uncomfortable.
Among my patients who experience this common symptom, the change in sex drive often creates frustration and confusion, as they wonder why their interest in sex feels different—and wonder how to revive that interest. This change associated with menopause also can create tension and distance in women’s relationships with their partners. These emotional and relationship challenges generate worry, frustration and anger that can compromise sleep.
It’s also worth noting here that sleeplessness itself can trigger conflict in relationships. When one or both partners is struggling with sleep issues, tension is more likely. Lack of sleep makes women and men more emotionally reactive, more likely to focus on negative feelings, and less empathic in relationships.
The menopausal transition is accompanied by a broad range of potentially painful and uncomfortable symptoms—all of which can interfere with sleep:
• During perimenopause, when estrogen, progesterone and other hormones are fluctuating sharply, some women experience severe PMS and heavy periods, accompanied by cramping, bloating, and breast tenderness.
• Headache and migraine can be a sign of low estrogen. Painful headaches and migraine arise for some women during pre-menopause, when estrogen levels drop at points during their monthly menstrual cycles. Often women in perimenopause experience headaches in response to the erratic fluctuations and overall decline of their estrogen levels.
• Muscle and joint pain and stiffness also occur for many women during menopause. One of estrogen’s functions in the body is to control and reduce inflammation. When estrogen declines, so does the strength of its work as a natural anti-inflammatory agent. This is one reason women may start feeling arthritis-like pain during menopause.
Sleep and pain influence one another in powerful ways. The presence of pain makes it harder to fall asleep and to stay asleep throughout the night, reducing both sleep quality and sleep quantity. My patients in menopause often remark about how muscle stiffness and pain has come to be part of their nightly sleep experience, to the detriment of how much and how well they sleep. Pain also creates more fragmented, restless sleep, and can cause you to spend less time in slow-wave sleep and REM—two sleep stages when the body is hardest at work in healing itself at the cellular level.
Many of my patients are surprised when I tell them a lack of sleep actually lowers pain thresholds, making you more sensitive to pain. Short on sleep, your pain perception intensifies, and the body aches, headaches, and other physical pain associated with menopause feel even more uncomfortable.
Weight gain during menopause happens to many women. Every woman is different, and weight gain with age can result from several factors, including individual genetics, daily habits of diet and exercise, and other health conditions. The hormone changes associated with menopause do also contribute to weight gain and changes to appetite. Research shows estrogen helps control appetite in the same way as the hormone leptin, triggering feelings of fullness and signaling to the brain that the body has sufficient fat and energy (aka calories) stored. Declining estrogen levels can bring about what are often puzzling, frustrating changes to women’s appetites, making them feel frequently hungry, and increasing cravings for fatty and sugary foods. Low estrogen can also make it more likely for women to gain fat in the abdominal area.
Sleep has a powerful connection to weight, a connection that just becomes more important with age. Short on sleep appetite tends to increase, as does the desire to eat junk food, thanks to changes in brain activity in areas that govern judgment and reasoned decision making. Sleep deprived, studies show we tend to consume more calories throughout the day. Lack of sleep may also push you to eat a greater share of those calories later in the day—especially if you’re already a night owl. Insufficient sleep throws off balance hormones that regulate appetite. Not getting enough sleep reduces levels of leptin, the satiety hormone, and elevates production of ghrelin, a hormone that promotes hunger. Lack of sleep is linked to higher BMI and to greater risks of obesity and metabolic disorders, including type 2 diabetes.
For women in menopause, already coping with declining estrogen, poor sleep can make even harder to avoid weight gain. I tell my patients who are struggling with weight gain during menopause to do all the things they associate with weight management—eating healthfully and moderately, exercising regularly, managing stress—AND to make sleep a priority on equal footing.
I hear from a lot of my patients their irritation at having to pee often both day and night, and feeling the need to urinate even if their bladder isn’t really full. A persistent need to urinate and incontinence are frequent symptoms for women going through menopause. The thinning of vaginal tissue, as well as the tissue’s diminishing elasticity, make bladder control an issue for many women in menopause. So does a weakening of the pelvic muscles. Urinary tract infections also become more common in menopause.
Waking at night to go to the bathroom can feel like a tedious habit—but it’s also an interruption to sleep that interfere with sleep quality and reduce sleep amounts. I remind my patients not to overlook this menopause symptom as a challenge to their healthy sleep routine. It helps to stay hydrated throughout the day, to keep alcohol consumption very moderate, and to avoid drinking too much of anything very close to bedtime.
The constellation of symptoms women experience during menopause often add up to real struggles with sleep. Without enough sound sleep on a regular basis, every part of your life can suffer—your health, your relationships, your energy levels, your work and your daily performance. Sleep and your quality of life are deeply connected. It’s important to pay attention to what is happening in your body, take note of the symptoms that you’re experiencing and remember that in addition to being frustrating in their own right, many of these symptoms may also be compromising your sleep.
Next, I’ll talk about the health risks that women during menopause face, and how sleep plays a role in those concerns. From there, I’ll talk about solutions: therapies and strategies to sleep better and feel better during menopause and beyond, and how you can use natural remedies to help.
Michael J. Breus, PhD, DABSM
The Sleep Doctor™
With the New Year, of course we are all looking at how to get, maintain, or improve our sleep ( at least I am). And with that idea in mind this week I saw some very interesting research you may find helpful: your genetics may determine how much sleep deprivation effects you, and eating fish can increase your IQ, if you sleep well!
The first was a study from Washington State University researchers shows that certain genes will tell us if we are more of less effected by sleep deprivation. I personally found this fascinating. DO you know that person who seems to never sleep and is always productive, energetic, and on the move? I do, and I can tell you its not usually me! But now it seems like there is some interesting genetic research behind what we all see in some people. The research showed that people with particular variation in their DRD2 gene, were actually “resilient to the effects of sleep deprivation when completing tasks that require cognitive flexibility (the ability to make good decisions based on changing information). “ This gene effect dopamine, and appears to show that sleep deprivation effects specific tasks, not the general human condition, as we once thought.
The second study I discovered was one we can all get a New Years Resolution around, eating healthier ( i.e., more fish). In this study, conducted at Penn State University, looking at children, Eating habits, IQ and sleep, they discovered that “Compared with children who “rarely” or “never” ate fish, those who consumed fish at least once per week scored an average of 4.8 points higher on the IQ test, while children who “sometimes” ate fish scored 3.3 points higher.Furthermore, children who ate fish at least once weekly had fewer sleep disturbances than those with lower fish intake, which the researchers say is an indicator of “better overall sleep quality.” The researchers think that sleep seems to effect how fish oil effects IQ, this is called a mediating effect in science, and it is a VERY important factor to understand.
That said, I thought it would be a good idea to bring out an old recipe from my second book The Sleep Doctor’s Diet: Lose Weight through better sleep, with one of my favorite recipes:
Roasted Salmon with Mustard-Dill Glaze
3 tablespoons mayonnaise
1 tablespoon grainy mustard
1 tablespoon chopped fresh dill
1 1⁄2 teaspoons dark brown sugar
1 teaspoon fresh lemon juice
4 center-cut salmon fillets (4 ounces each)
1⁄2 teaspoon salt
1⁄8 teaspoon ground black pepper
Preheat the oven to 400°F. Line a baking sheet with foil.
Combine the mayonnaise, mustard, dill, brown sugar, and lemon juice in a small bowl. Place the salmon on the baking sheet and season with the salt and pepper. Spread the mayonnaise mixture on top of the fillets and roast for 12 to 15 minutes, or until just cooked through.
Serves 4 per serving: 298 calories, 21 g fat (3.5 g saturated), 71 mg cholesterol, 444 mg sodium, 4 g total carbohydrates (3 g sugars), 0 g fiber, 23 g protein
It’s one of the most frequent questions that I’m asked, by patients and non-patients alike:
What’s the deal between menopause and sleep?
What’s happened to my sleep? Why is it so much harder for me to sleep well?
What can I do to sleep better while I’m going through menopause—and after?
Let me say first: women’s sleep problems in their middle adult years aren’t only about menopause. These years in women’s lives are often profoundly busy and complicated. They may be deeply immersed in demanding careers, raising children, caring for aging parents, volunteering in their communities—or all of the above. And of course, other health conditions can impact sleep, apart from menopause.
With jam-packed schedules, layer upon layer of responsibility, and often a lot of stress, sleep issues for women in their 40s, 50s and 60s would be likely even without a major biological change unfolding over a period of several years.
But major biological transition is what’s also happening to women in during these years. And menopause can bring with it significant challenges to sleep. In order to protect your health, keep your performance sharp, and maintain your quality of life and relationships, it’s essential for you to know how menopause affects your sleep, and what you can do to sleep well throughout all its stages.
To get this important menopause-sleep conversation started, I’ll talk first about how the hormones estrogen and progesterone influence sleep and other aspects of women’s health. I’ll also break out the stages of menopause, and the sleep difficulties that arise within each.
Women’s hormones and sleep
Menopause is driven by the decline in production of hormones, most significantly the hormones estrogen, progesterone, and testosterone. These hormones work together to regulate a woman’s reproductive function and menstrual cycle. They also affect mood, energy, sexual drive, cognitive and emotional abilities—and sleep—throughout a woman’s life. Let’s quickly take a closer look at each.
Estrogen is the primary sex hormone in women, the hormone that plays the most significant role in regulating a woman’s reproductive function and her monthly menstrual cycle. Many women I talk with don’t know about the many other ways estrogen contributes to their health and performance. Estrogen supports women’s cardiovascular health, their cognitive performance and mood, their strong bones and their healthy weight management.
Estrogen also promotes healthy sleep. Estrogen helps the body use serotonin and other neurochemicals that assist sleep. Estrogen contributes to higher-quality sleep, with fewer awakenings throughout the night, and less time needed to fall asleep. When I talk to my patients about estrogen, I describe it as a great protector of women’s sleep and overall health.
Higher levels of estrogen are associated with a more positive mood, clear, elastic skin, greater energy and mental sharpness, and sound sleep. Low estrogen is associated with anxiety and low mood, fatigue, difficulty concentrating, physical pain including headache and migraine, weight gain, and disrupted sleep. One of common early signs of menopause is insomnia.
Estrogen levels fluctuate significantly throughout the menopausal transition, then eventually fall to low levels, where they remain throughout a woman’s post-menopausal life.
Progesterone works to balance the effects of estrogen, and to prepare a woman’s body for pregnancy with each monthly cycle. This hormone plays a key role throughout pregnancy and in preparing a woman’s body for labor as well as breast feeding. Progesterone helps regulate mood, protecting against anxiety and depression. It also promotes the growth of new bone tissue—the loss of progesterone contributes to the risk of osteoporosis among post-menopausal women.
I think of progesterone as largely a sleep-promoting, “feel good” hormone for women. Higher levels of progesterone tend to promote a sense of calm, boosting relaxation and facilitating sleep. High levels of progesterone–especially during pregnancy, when a woman’s progesterone levels surge–can also make you feel sleepy during the day. Progesterone increases production of GABA, a neurotransmitter that helps sleep. Low progesterone can bring about anxiety and restlessness, and trouble sleeping, including a tendency to wake frequently during the night.
Testosterone is produced at lower levels in women than in men. Many of my patients are surprised when I talk about how testosterone is important to women—particularly to their sex drive. For women, testosterone plays an important part in helping the body produce estrogen. It also boosts sexual desire, as well as energy levels, and contributes to greater muscle and bone mass. A woman continues to produce testosterone throughout her life, but levels decline with age.
As these hormones fluctuate and decline throughout the stages of menopause, sleep often becomes increasingly disrupted. By the time they reach perimenopause, many women are routinely having a hard time falling asleep and sleeping soundly throughout the night.
The stages of menopause and sleep
Menopause is one part of a lifelong shift in women’s hormone balance. Through each phase of her life, a woman’s sleep and health face different risks and challenges. Let’s take a look at the stages of menopause, and what they mean for sleep.
Pre-menopause and sleep
During a woman’s reproductive years, when she is not experiencing the symptoms of menopause, she is in what is technically considered pre-menopause. Hormones shift throughout women’s lives, and changes to estrogen, progesterone and other hormones can lead to recurring sleep problems well before the transition to menopause actively begins.
Fluctuating estrogen and progesterone, especially shortly before and during menstruation, cause difficulty sleeping, as well as headaches, cramping, anxiety, and low mood—all symptoms that can compound sleep problems. I see many patients in their 20s and 30s experience insomnia and other sleep troubles linked to their monthly menstrual cycle.
During pregnancy, women frequently experience significant sleeplessness—even if they’ve been sound sleepers in their pre-pregnant lives. Changes to the body and intensely shifting hormone levels lead to many pregnant women feeling sleepy during the day, and restless and uncomfortably awake throughout the night.
In 2017, the Centers for Disease Control released new scientific findings about the sleep activity and sleep quality of women throughout the different stages of menopause. For pre-menopausal women, the study found:
• Nearly one-third—32.5 percent sleep less than an average of 7 hours a night. That’s broadly on par with the estimates of the sleep habits of the general population, which indicate about a third of adults are regularly sleeping TK.
• Among pre-menopausal women, 16.8 percent have trouble falling asleep regularly—four or more times in a week
• Almost one-quarter of premenopausal women—23.7 percent—have trouble routinely staying asleep throughout the night
• And nearly half—47 percent—wake feeling un-rested at least four days a week
Perimenopause and sleep
This is the transitional stage that leads eventually to menopause. Often, for women, perimenopause begins in their 40s—but I’ve had several patients begin to experience the signs of perimenopause in their mid-to-late 30s. The amount of time a woman spends in perimenopause can vary widely—this stage of the menopause transition typically lasts between 3-5 years, but it can last for as long as 10.
It’s throughout perimenopause that many of the symptoms of menopause begin to flare. During perimenopause, levels of estrogen, progesterone, and testosterone start to decline significantly—but also fluctuate sharply along that overall decline. Estrogen levels in particular may shift erratically during perimenopause, and this hormone’s perimenopausal highs and lows can contribute to a range of symptoms—from hot flashes and night sweats to anxiety to headaches—that interfere with both sleep and waking performance.
In my practice, I see many women for the first time when they’re experiencing the challenges of perimenopause to their sleep routines, as physical, mental, and emotional symptoms begin to disrupt their sleep on a regular basis.
According to the 2017 CDC survey, sleep problems tend to increase significantly during perimenopause.
• More than half of perimenopausal women—56 percent—sleep less than 7 hours a night, on average. That’s a big jump from the third of pre-menopausal women who are sleeping less than 7 hours nightly.
• Nearly one-quarter—24.8 percent—of perimenopausal women say they have trouble falling asleep four or more times in a week.
• Even more common than trouble falling asleep? Difficulty staying asleep. Among women in perimenopause, 30.8 percent say they have trouble staying asleep at least four nights a week.
• Half of perimenopausal women—49.9 percent—wake in the morning feeling tired, rather than rested, four or more days in a week
Post-menopause and sleep
A woman has reached menopause when she has not had a period for 12 consecutive months. Beyond this point, a woman is now in post-menopause. What happens to hormone levels at this point? Progesterone—a particularly sleep-friendly hormone—is no longer produced by a woman’s body after she stops menstruating. Estrogen—with its sleep-protective benefits—continues to be produced, but at very low levels, once fluctuations subside. The symptoms that begin for many women during menopause—hot flashes, headaches and other physical pain, anxiety, lack of focus, mood swings—often ease after a woman reaches post-menopause.
That’s true for sleep problems, too. With the settling of hormonal fluctuations, insomnia and other sleep problems may gradually improve for some women after menopause. But the post-menopausal experience—like each phase of the menopausal transition—is highly individual, can vary greatly from woman to woman.
I’ve treated women who struggle deeply with sleep and performance throughout perimenopause, and who relatively quickly find a “new normal” and improved sleep as they move into post-menopause. But I also see many women continue to wrestle with poor quality sleep and contend with new sleep disorders, such as obstructive sleep apnea, in their post-menopausal lives.
As the recent CDC study shows, a great many women during their post-menopausal years continue to struggle with sleep issues—and the symptoms of insomnia may actually increase:
• Sleeping less than 7 hours a night, four or more nights a week, occurs among 40.5 percent of post-menopausal women
• For post-menopausal women, symptoms of insomnia become somewhat more common than during perimenopause, with 27.1 percent having regular trouble falling asleep and 35.9 percent having routine difficulty staying asleep throughout the night
• More than half—55.1 percent—are sleeping poorly enough to wake feeling tired, not rested, four or more times a week
There’s a lot to talk about, when it comes to menopause and sleep. In a recurring series over the next several weeks, I’ll discuss the role of sleep in the symptoms of menopause and in menopause-related health risks. I’ll also talk about effective therapies for menopause and its sleep-related issues—including how you can treat sleep and menopause symptoms naturally, with supplements.
Michael J. Breus, PhD, DABSM
The Sleep Doctor™
I love naps. I think most of us do. Especially on Saturday afternoon, while watching golf. Have you ever noticed that golf is the perfect show for napping? Must be all that soft talking they do…
To get all the potential benefits—and avoid the pitfalls—naps need to be used correctly. I can’t count the number of patients I have who try to catch some rest during the day, only to have their naps interfere with their nighttime sleep and throw their sleep-wake cycles out of sync! And all they wanted was some much-needed rest.
Quickly, let’s talk through good napping. Then I’ll show you nine types of naps you can choose from.
Here’s a quick recap on the benefits of napping, which are pretty powerful. Naps can:
• Boost your brain function, including focus, accuracy, and concentration
• Enhance your creativity
• Improve your critical thinking skills
• Lower your stress levels and lift your mood
• Give you more energy and improve your physical performance
When it comes to napping, choose wisely. Know first what you want to get out of your nap, before you decide when and for how long you’ll sleep.
• Are you looking to re-claim mental sharpness in your busy working afternoons?
• Want to have more power and energy for your end-of-day gym session?
• Need to prepare for—or recover from—a long-distance trip?
The timing and duration of your nap depends a lot on your individual needs and circumstances. Those needs and circumstances change over time—which mean your nap needs change, too.
What nap is right for you?
The CEO nap. If you’re looking for a boost to your daily energy, focus, and mental performance, then a short power-nap (25 min) in the mid-afternoon (1-3pm) is a good napping option for you. Any longer and you will feel terrible. Whether you’re the CEO of a start-up or your family’s household, you can stay sharp throughout the day with a brief rest between 1-3 p.m. Just don’t stop paying attention to getting the nightly rest you need.
The Nap A Latte™. This is my favorite strategy for those days when your energy is really lagging and you need a quick lift. The Nap A Latte™ combines a moderate amount of caffeine with a short period of rest, to deliver you the benefits of both at once. Here’s how it works:
• Drink a 6-to-8-ounce cup of coffee, quickly. (Add ice cubes to cool it down, if you’d like.) You want about 90-100 mg caffeine, which is roughly the content of a regular cup of coffee—not a super-sized version.
• Quickly, find a quiet place to lie down and take a 20-minute snooze. Set a timer so you don’t oversleep.
You’ll wake just as the stimulant effects of the caffeine are kicking in (roughly 20 min), having also relieved some of the sleep pressure that’s been building, making you feel tired.
The Nap A Latte™ is NOT an everyday napping strategy. I recommend using this nap no more than two times a week. If you find yourself seriously tired during the day on a routine basis, it’s time to take a close look at your sleep routine, including how much sleep you’re getting and your sleep hygiene habits.
The New Mom nap. Moms (and dads) taking care of newborns and young children not sleeping through the night: the strategy here is to nap when your child naps. Resist the temptation to try to be productive in other ways while your child is sleeping. As a parent getting the sleep you need, you’ll have more energy, more patience, and more focus for your child and all the other parts of your busy life if you’re not chronically sleep deprived.
The Sports nap. Sleep is a not-so-secret weapon in sports performance—so long as you time it right. Whether you’re playing in a cutthroat doubles’ tennis tournament, running a 10K road race, or tearing up the field in an evening indoor soccer league, a well-timed nap can give you an edge. A short, 15-20 minute nap will deliver immediate benefits to physical and mental performance for a period of time—without any sleep inertia upon waking (feeling like you just can’t wake up). A longer nap can also deliver significant physical and mental benefits, and they will last longer once they kick in—after a period of clearing the cobwebs. If you don’t give yourself enough time for sleep inertia to pass, you’ll be sluggish and groggy on the field, rather than stronger, faster and more energized.
The Disco nap. This is a classic nap strategy that comes from the days of the Bee Gees and Donna Summer. When you’re planning a late night, take a 90-minute nap before you head out for the evening. You can combine this rest with the Nap A Latte™ for an even greater energy boost. This is an effective way to give yourself the stamina and energy for an evening celebration that you know is going to run late into the night (or early morning). A couple of important caveats:
• This is a special occasion nap! A lifestyle that makes the Disco nap a regular habit isn’t good for your sleep or your health.
• Get up at your regular time the next morning. Yes, even if you stayed up until sunrise. Your day will feel long and sleepy, but you’ll be ever-so ready for sleep come nighttime, and you’ll keep your sleep schedule intact.
The Siesta. Some cultures are way ahead of the U.S. in embracing the practice of a rest period during the day. In Spain, Greece, Mexico, Costa Rica, the Philippines and other nations around the world, naps are a part of daily life. I’d love to see workplaces in the United States and other non-napping societies start to dim the lights and close the shop doors at 2:30 p.m., to give everyone time to re-charge. We’re not there yet—but I believe we will get there. If your life and culture incorporate a daily rest period, fantastic. If they don’t, be on the lookout for ways you can adjust your daily routine to make time for some downtime during the day.
The Shift Work nap. Shift workers face a number of challenges to healthy sleep, because they’re so often awake and active when their bodies are meant to be asleep. As a result, they’re more likely to be sleep deprived. They face particular risks to their health, linked to their atypical sleep-wake schedules, and they also face elevated risks for accidents and injury because of fatigue. Shift workers are more likely than the rest of us to need to break up their sleep into segments, and they can benefit greatly from strategically-timed naps.
Depending on your schedule and the requirements of your job, napping as a shift worker might include:
• A short nap before your shift begins, and/or napping on short breaks during shifts
• Scheduling sleep in two or more segments, including a longer segment (4-5 hours) at the end of a shift, combined with one or two 90-minute naps throughout the day leading up to your next shift.
Shift workers can benefit greatly from workplaces that allow—and encourage—nap breaks during a shift. But on-the-job napping is a benefit that I’d like to see for all workplaces. Companies are getting better at addressing sleep as a workplace issue, but we have a long way to go. Nap rooms and nap pods are popping up at companies including Google, Procter & Gamble, and Zappos, among others. Knowing what we do about the cognitive and psychological benefits of napping, encouraging employees to take rest periods during the workday is a smart move for employers.
The Teen nap. Teens experience a significant shift to their circadian clocks, making them biologically driven to stay up late and wake late. That biological drive to be awake and alert at night, combined with early school start times, leaves a great many teens with a chronic sleep debt. Their lack of sleep puts them at greater risk for academic, behavioral and emotional problems, as well as health problems later in life. For teens, a short, 20-minute nap after school, or some longer recovery sleep—up to 90 minutes—on the weekends, can help. Just so long as it doesn’t push their weeknight bedtimes even later, or leave them with Sunday night insomnia.
The Jet Lag nap. This is the type of nap I use most often. Travel-related naps spare me frustration and fatigue, reduce jet lag, and help me keep my energy up even with a very rigorous travel schedule. Naps can help your body transition to new time zones, can make up for lost sleep during travel, and can supplement nighttime sleep when your itinerary is very busy. The most important thing to know about scheduling sleep for travel is to adopt the schedule that fits your destination time zone. Sleep when the locals sleep. An extended nap on a long flight can help you begin to transition your body to your new time zone, provided you’re sleeping during a time when you’d be sleeping if you lived at your destination. A short, 20-minute nap can help you make it through the first, jet-lagged day in a different time zone, and still allow you to fall asleep on local time.
CAUTION: Remember, naps aren’t for everyone. If you’re suffering depression, you’re likely experiencing some type of sleep issue, and your circadian rhythms may be disrupted. Napping can make your depression worse. People with insomnia also shouldn’t nap. For insomniacs, a daytime nap can make it harder to fall asleep on schedule at night. Naps should work with your nighttime sleep routine, not undermine it.
WHICH NAPS HAVE YOU TRIED? POST ON FACEBOOK, AND YOU MAY WIN A FREE VERSION OF MY SLEEP BETTER COURSE.
Michael J. Breus, PhD, DABSM
The Sleep Doctor™
I’m not a daily napper. I travel A LOT, so I do use naps to help my circadian clock adjust to changing time zones, to minimize jet lag, and to ensure I’m getting the amount of daily rest I need. For me, that means sometimes napping on airplanes, and other times catching a nap once I’ve arrived at my destination—or back at home.
I get asked about napping all the time. Is it good for sleep, or bad? When is the best time to nap? Should I be worried—or feel guilty—if I’m tempted to take a nap?
After I walk you through the advantages of napping (and the possible pitfalls), I’m convinced you’ll start thinking about napping differently.
The biology behind napping
Do you feel your energy sag in the early to mid-afternoon? There’s a biological reason behind that slump. We’re biologically designed by evolution to sleep in a long, consolidated stretch throughout the night, and to take a brief period of rest in the middle of the day. Between the hours of 1-3 p.m., body temperature drops and melatonin levels rise. Both are cues for sleep. Even though our modern culture doesn’t support daytime naps—it actually frowns upon them—our bodies remain hard-wired for a midday re-charge. (Think of it as a biological siesta!)
The benefits of naps
Napping gets a bad rap in our culture. There’s a stubborn perception that napping is a sign of laziness. In fact, it’s just the opposite. People who get the most out of napping are very driven and highly motivated. They want to get ahead, and they know that sleep plays a big part in performing at their best in daily life—at work, in relationships, in tackling challenges and goals both physical and mental.
What can napping, as part of a healthy sleep routine, do for you?
1. Increase alertness. Even a short nap can deliver a welcome boost in energy and alertness, according to a wealth of research.
2. Improve concentration and accuracy. A well-timed nap can improve your focus and ability to concentrate. A 2009 study found that among nappers, brain activity associated with concentration was as strong in the afternoon as in the morning, while non-nappers saw a decline. A short afternoon nap can improve accuracy, as well as provide a boost to short-term memory.
3. Help you make better decisions.Naps can improve what’s known as cognitive flexibility—that’s your ability to shift your thinking among different concepts, and be adaptive to new information. This flexible thinking is critical to judgment and decision making.
6. Boost your creativity. A short nap can elevate activity in the brain’s right hemisphere—that’s the area of the brain that governs creativity and insight. Napping also fosters greater cross-communication between your brain’s right and left hemispheres—encouraging cross-talk between your creative brain and your analytical brain.
7. Reduce your stress. A short dose of sleep during the day can help strengthen the body’s ability to weather stress, especially if you’re short on sleep overall. Recent research shows naps reduce stress and strengthen the immune system in people who are sleep deprived. Napping can also keep blood pressure in check in response to stress.
8. Preserve your physical appearance. Sleep is restorative to the body, inside and out. I think of it as nature’s Botox. Sleep deprivation can make you look tired and fatigued, less healthy and less attractive, according to research. Naps that help supplement daily sleep amounts—without interfering with nighttime rest—can keep you looking young, healthy, and full of energy.
9. Improve physical performance. Elite athletes and professional sports teams have increasingly recognized the pivotal role sleep plays in physical performance. Naps can be a powerful tool for athletes at any level, and for people looking to enhance their physical skills. Napping has been shown to improve motor performance and accuracy, as well as speed, strength and reaction time.
On the other hand, when naps are poorly timed, or result in excessive daytime sleeping they can:
• Interfere with nightly sleep, triggering symptoms of insomnia
• Disrupt healthy circadian rhythms, which are crucial to sleep and to waking performance
• Interfere with mood and daily performance
The key to naps? Getting the timing right
Naps can be a useful tool in maintaining a healthy sleep routines. The trick is to know how to use naps effectively. That means timing naps correctly for your needs and your daily schedule.
How long should a nap last?
You know the feeling of waking from a nap and being disoriented and groggy? That uncomfortable, foggy-headed re-entry to the waking world is a sign you’ve ended a nap while in deep, slow-wave sleep. Waking from deep sleep isn’t going to give you the refreshing boost in focus, alertness, and energy you’re looking for. It’s going to do just the opposite: saddle you with lingering sleep inertia that can actually make your cognitive performance worse, for a period of time.
To avoid this sluggish, where-am-I mental fog, you’ll want to structure the duration of your naps so you wake from lighter sleep.
A nap of less than 20 minutes will:
• Wake you before you enter deep, slow-wave sleep
• Avoid post-nap grogginess and mental sluggishness
• Energize you and make you more alert for the next few hours
A nap of 90 minutes will:
• Take you through a complete sleep cycle, from light sleep to deep sleep and REM sleep, and back to light sleep again
• Refresh, energize, and focus you for the rest of the day
A regular 90-minute nap during the day isn’t practical for many people. That’s okay. People who aren’t shift workers, and who generally keep to what’s considered a typical day-night schedule, shouldn’t need a 90-minute daytime nap on a routine basis. That’s if you’re getting the sleep you need at night. If you do find yourself needing to sleep this much during the day, it’s a signal you’re not getting the rest you need in your nightly sleep, and it’s time to talk with your doctor.
Napping is a detrimental habit if it interferes with your nightly sleep. That includes if a napping habit leads you to pay less attention to sticking with a consistent nightly sleep routine.
What’s the best time of day to nap?
Sara Mednick, PhD, is the author of the book Take a Nap! and a psychologist specializing in sleep as an associate professor at University of California, Riverdale. To calculate their ideal nap time, I’ve encouraged my patients to use Dr. Mednick’s Nap Wheel.
According to Dr. Mednick’s research, the best time to nap is approximately seven hours after you wake for the day. Why? That’s the time you’re going to strike the ideal balance of REM sleep and slow-wave sleep in a nap, giving you both mental and physical restoration and minimizing your post-nap grogginess.
Who shouldn’t nap?
People with insomnia. People with insomnia have trouble falling asleep and staying asleep at night, and likely have disrupted circadian rhythms. If you suffer from insomnia, you might be particularly tempted to nap during the day to make up on the sleep you missed out on the night before. But a daytime nap will decrease the pressure and need for sleep at night, and prolong or exacerbate your insomnia.
People with depression. Depression and other mood disorders are frequently linked to sleep problems, including circadian rhythm disruptions, poor quality nighttime sleep, and unhealthful sleep patterns, including excessive daytime sleepiness. Napping can make these sleep issues—and depression itself—worse.
Napping requires some knowledge and some planning to do well, and not have it interfere with your nightly rest. I think of it as napping with purpose—knowing why you’re napping and making sure you’re doing for the right length of time. That’s the key to getting all the powerful potential benefits from a dose of daytime rest, and getting your best performance out of your waking day. Next, I’ll talk about different types of naps and which one is best for you.
Michael J. Breus, PhD, DABSM
The Sleep Doctor™
Dr. Michael Breus’ Ultimate Christmas Gift Guide For Better Sleep 2017
I’m doing something for the first time that I’ve wanted to do for a very long time. I’ve created a Holiday Gift Guide for those people on your list who could use a little better sleep each night. There is something for everyone in the guide and gifts that range from little gifts to things that won’t fit under the tree! Give the gift of sleep to someone you care about (or better yet, buy a little something for yourself!)
I took great care (and had a bunch of fun) curating the list this year and I hope you’ll enjoy it. The gifts are in no particular order, here goes!
“He knows when you are sleeping, he knows when you’re awake, he knows when you are about to lose your mind from your seriously annoying neck ache!” This year finding the right pillow just got a little bit easier. The pillows from V&R Naturals will change the way you sleep and what you expect from a pillow. The V&R Naturals pillows are filled with a very comfortable shredded latex that molds to your head to cradle and support it fully the moment you lay down. Next, you can choose your shape, traditional rectangle or curved. I’m a side sleeper and I love the curved shape because rather than pushing my shoulder up into a regular pillow, it fits perfectly into the curve for great, restful alignment. Finally, one of my favorite features of these pillows is the zipper which allows you to remove or add filling to totally personalize it to your liking so the pillow fits you perfectly Just be careful not to sleep through the big event on this comfy pillow or you may end up on Santa’s naughty list next year! When you add one of the Naturals Pillowsuse the code DRBREUS to get $29 off and Free Shipping in the United States.
Bedside Sleep Therapy
Sometimes falling asleep isn’t easy, maybe your mind is racing or there is noise in the house. The iHome Zenergy Sleep System is just what the Sleep Doctor ordered. The Zenergy system has 12 different relaxing sounds that help you feel sleepier, I love the Ocean Waves and Rain. And, Zenergy contains lights that have been shown to help you relax before bed and it even includes lavender aroma therapy. I love having this on my bedside table. In full transparency, I consult with iHome and still buy these as one of my favorite gifts to give people, in fact I just gave one to my friend’s girlfriend and one to his daughter last week. You can find them on Amazon here.
Choose The Right Lights For Day And For Night The right lights for your house make all the difference (and I am not talking about the ones on the outside of the house either!). If you want a better night of sleep and a more energized day, start and end with the right light. Even walking into a room with light after a certain time (about 9pm), can have a significant effect in lowering your Melatonin levels (lots of science there). The Good Night and Good Day light bulbs from Lighting Science Group are nothing short of Christmas Miracles. The scientists and engineers over there have created a filter that blocks the blue light in one, and then gives you more in the other. Grab the Good Day bulbs and put them in your bathroom to wake up the right way and to turn off melatonin production and put the Good Night bulbs in your bedroom (don’t forget your kids bedrooms and bathrooms too, if you want to help your teen fall asleep and wake up better these bulbs will help do the trick-I do this with my son and it works GREAT). These make great stocking stuffers for the handyperson in your house (or at least the elf who changes bulbs). Just use the code BREUS17 when you check out for a very special 10% discount.
Nestled Snug In Your LumaSleep Bed
I can’t think of a question I get more than “Dr. Breus, what bed should I buy?” And historically, I did not have a great answer for them until now. A few months ago I began working with LumaSleep to develop a mattress that is revolutionary. What makes the LumaSleep mattress special is that they actually followed the science around how people need to be supported to sleep. The result is a two-piece mattress, a standardized support layer and a separate comfort layer. The comfort layer allows you to change it out if your needs change or if it is too hard or too soft and you’d like to change to a different comfort layer. You NEVER have to buy another bed again, you can just call them up and get a new layer when the old one is not working for you or your partner. Let’s face it, there is no way to know if a mattress is right until you sleep on it (for a while). Luma gives you a full 100 days to try the mattress to figure out what is perfect for you. The LumaSleep mattress truly is the gift that will keep giving for many Holidays to come! Ok, and here is maybe the best part of all, just go to www.lumasleep.com and when you check out enter the discount code doctor15 and you’ll get a 15% discount, that’s a savings we can all enjoy!
Silent Night – Give The Gift That Ends Snoring
It may be the night before Christmas but if someone is snoring you know who will be stirring all night … Dr. Jonathan Greenburg invented the Zyppah, the best and easiest to use appliance I’ve seen for reducing snoring and it is guaranteed or they will give you your money back. I even did an interview with Dr. Greenburg because I was so impressed with this product. You can watch it here. If you want to enjoy the sound of silence, give the gift of Zyppah
For The Person Who Snores Because They Had A Little Too Much Christmas Cheer
Have you ever slept next too an infrequent snorer? They are the person that snores, but only when their allergies are acting up, they have gained a little weight, eaten a large meal, or had a little Christmas Cheer (alcohol)? If so you are not alone. Personally, if I have had an adult beverage, my wife turns to me and says “ put your nose thingie in!” And she is talking about a very cool product I highly recommend called MUTE. This is an internal nasal dilator (yes a small device that goes inside your nose) and the really amazing part is that it is adjustable! Look at your nose, your nostrils are different sizes, this device is highly effective and takes into account your nostril size so that the device is extremely comfortable ( I can’t feel it after about 1 min). Yes they are disposable and Amazon has a great deal on them right now, $14.99 + 15% off coupon on the site and FREE Prime shipping.
Magnesium – While you are over at Swanwick, be sure to pick up some of their very high quality magnesium supplements . You may have seen my recent blog on Magnesium, but if you didn’t then you may not realize what a wonder mineral Magnesium can be. I’ve seen many patients benefit from increasing their magnesium intake, through diet and supplements. It’s not uncommon for people, especially women, to have less-than-optimal magnesium levels. Believe it or not, Insomnia is a common symptom of magnesium deficiency. People with low magnesium often experience restless sleep, waking frequently during the night. Maintaining healthy magnesium levels often leads to deeper, more sound sleep. Magnesium plays a role in supporting deep, restorative sleep by maintaining healthy levels of GABA, a neurotransmitter that promotes sleep. Research indicates supplemental magnesium can improve sleep quality, especially in people with poor sleep. Magnesium can also help insomnia that’s linked to the sleep disorder restless-leg syndrome. Just a few spritzes of this magnesium oil may just change the way you sleep for good.
For The Long Sleigh Ride Get These Great Travel Sleep Accessories On Amazon
This is really pretty amazing. I have been searching for a unique travel pillow, that also is supportive enough so that when I sleep on planes (which we all know I do a lot of) I do NOT get a pain in my neck. While it looked like it would never work, I tried this one and was surprised at how easy it is to use, and how effective it is at keeping my head and neck in good shape.
Sleep Tracker Sleep Score Max
Does the world really need another Sleep Tracking device? NO. I agree there are far too many trackers on the market, working with SleepScore Max, not only is this one of the most accurate contactless sleep evaluation and management systems on the planet, but it does something that no other product does, it actually gives personalized advice, based on your previous sleep and sleep-related goals you set. You can see your sleep as compared to someone your age and gender, and then the next day get tips, hacks, and tricks to IMPROVE your sleep (hint: guess who helped develop the tips!). Its what I use, and you should too.
Sleep Bracelet By Phillip Stein
Most people do not know it, but the world runs on frequencies. Electricity has a frequency, sunlight has a frequency, music, even you (your biological rhythms) have a frequency. Have you ever noticed that when you listen to music, it puts you in a particular mood? Whether its upbeat, slow, happy, whatever, music has a significant effect on our mood. I would argue that your body has tuned into a frequency that, depending upon the music, can be both calming and relaxing. A while back I worked with a company called Phillip Stein and helped run the clinical trials for a sleep bracelet. I was sure it was not going to give any useful data, but I was wrong. Literally every person in the study reported that they had some improvement in their sleep. Some people reported feeling more refreshed, other reported great dreams, it was pretty impressive. It is something certainly worth checking out, and it looks great too. If you are wondering what piece of jewelry to give this year this is it, a finely crafted Sleep Bracelet that works as good as it looks, by fine watch maker Phillip Stein.
Over the years, I’ve treated a number of patients with violent and dangerous parasomnias. In all of these cases, the stakes are especially high. Not only is my patient’s sleep and health compromised, but their safety—and the safety of other people, especially those people closest to them—are very much at risk.
As I discussed last week, sleep forensics is a branch of sleep medicine that investigates and seeks to understand violent, strange and irrational behavior related to sleep. These investigations are necessary when sleep issues may be related to crimes. But sleep forensics also helps us better understand the phenomena of sleep violence, even when the behavior isn’t criminal.
I think it’s important to understand that sleep violence exists, and how it can occur. Incidents of sleep violence happen more often than many people realize. Violence during sleep isn’t common, but it’s also not extremely rare. Estimates indicate that approximately 1.7 to 2 percent of the population experiences some form of sleep-related violent behavior.
• History of parasomnia (remember this is sleepwalking, sleep talking, etc.)
• Stress and psychological conditions (continued stress)
• Alcohol and drug use (especially within a few hours of bed)
• Medication interactions
• Lack of sleep
• Physical and mental health conditions, including epilepsy, neurodegenerative disease such as Parkinson’s and some forms of dementia, and dissociative disorders such as PTSD
Often, it’s a cluster of these risk factors together that create the conditions for sleep violence in a person’s life.
The sleeping mind is an active mind
It’s easy to think of sleep as a time when the “off” switch has been flipped in the brain. Without waking consciousness and memory, the hours you spend sleeping can seem like lost time, without activity in the brain. That couldn’t be further from the truth. The brain and body are active throughout every stage of sleep—growing and repairing cells and tissues, re-booting the immune and metabolic systems, restoring organ function, processing memory, emotion, and recent learning.
I know it may seem as though there is no consciousness during sleep. But sleep isn’t a void of consciousness. Rather, it’s a different form of consciousness—or being—with different brain activity (I’m talking about dreams here!). The main states of sleep consciousness are REM sleep and non-REM, or NREM, sleep. Each has patterns of brain activity that are distinct from one another and distinct from waking consciousness. (This is how we classify sleep stages, based on the different brain waves.)
Many parasomnias, including those that can put a sleeper at risk for sleep-related violence, occur as a person moves between NREM, REM, and wakefulness.
Patients and families who are coping with violent and disruptive sleep behaviors ask me, how is it possible for a sleeper to act out so intensely while still asleep? Understanding sleep as an active state of being, rather than a pause button, is one important step in understanding how these behaviors can come about.
How sleep works in the brain
The next step is to grasp what scientists are increasingly recognizing themselves: sleep is a local, rather than a global, condition in the brain. What do I mean by that? No single state of consciousness—REM, NREM, or waking—takes over the brain exclusively. It’s possible for these different states of consciousness to overlap, and occur simultaneously. Especially during transitions among the different states, characteristics of multiple states of consciousness—both sleeping and waking—can be active in the brain. I think of the brain when it comes to sleep like a hybrid car: sometimes it uses gas, and sometimes it uses electricity.
Here’s an example of what I mean, using a parasomnia known as sleep paralysis. When you experience sleep paralysis, you wake up from sleep and cannot move or speak. It’s a frightening and disorienting episode that can last for a few seconds, up to a few minutes. In a state of sleep paralysis, you’re actually in a combination of waking consciousness and REM sleep. REM includes a temporary paralysis of major muscle groups known as REM atonia, which is thought to keep you immobilized during an active dreaming stage. In people who experience sleep paralysis, they wake with aspects of REM sleep still active in the brain.
When different characteristics of different states of consciousness occur in the brain at once, it creates the terrain for unusual, odd, disruptive and even violent behavior to occur.
Causes of sleep violence
Let’s take a closer look at some of the conditions that are associated with sleep violence.
Sleepwalking and other arousal disorders. Some of the most well-known cases of sleep-related criminal violence have involved the so-called “sleepwalking defense.”
Sleepwalking is considered a NREM parasomnia, meaning it typically occurs during the deeper stages of NREM sleep. There’s a broad range of behaviors that can take place in a sleepwalking episode, ranging from wandering around the bedroom to having conversations, driving, and executing other complex tasks—all while still in a state of sleep.
More than 3 percent of the adult population may experience sleepwalking—and sleepwalking appears to be becoming more common, according to scientists. There’s a strong genetic component to sleepwalking—it tends to run in families. If you were a sleep walker as a child you may also be one as an adult, provided the right conditions.
Stress is one factor that may trigger and escalate sleepwalking behaviors. So, too, can sleep deprivation. In several high-profile criminal cases, sleep experts have cited stress and lack of sleep as contributing factors to violent behavior during sleepwalking. That was true in the Kenneth Parks case, one of the most well publicized cases of sleep-violence in recent times. Stress and sleep deprivation also played a role in the case of Joseph Mitchell, who in 2015 was acquitted of murder and attempted murder. The defense said Mitchell was sleepwalking during an attack in which he smothered his four-year-old son and attacked two other children. Mitchell has also been under acute stress and had suffered from a significant lack of sleep prior to the attack.
Sleepwalking is a type of parasomnia known as an arousal disorder. Arousal disorders tend to arise from non-REM (NREM) sleep. They also often first present themselves during childhood, and will frequently diminish or disappear with age. Arousal disorders typically share some common characteristics, including:
• An absence of memory
• Slowed, slurred, or strange speech
• Mechanical answers to questions
• An appearance of confusion, or a just staring off
In addition to sleepwalking, other sleep-related arousal disorders linked to violence include:
Confusional arousals. This form of parasomnia is sometimes referred to as “sleep drunkenness.” During a confusional arousal, the sleeper “wakes” into a disoriented state, and may exhibit strange behavior that they’ll have no memory of later. In 1960, American army sergeant Willis Boshears was acquitted in England of the murder a young woman, Jean Constable, after claiming he’d been in a state of sleep confusion during the attack.
Sleep terrors. In one of the cases I discussed last week, Brian Thomas killed his wife while acting out in response to what appeared to be a sleep terror. Sleep terrors are intensely frightening episodes during which a sleeper often screams and sometimes physically lashes out. In Thomas’ case, he said he believed he was attacking an intruder during what was actually the attack on his wife. Sleep terrors can put the sleeper and others at risk for accident, injury, and assault.
In some cases, fatal reactions to sleep terrors or other arousal disorder parasomnias might at times be mistaken for suicide. The death of artist and designer Tobias Wong has been pointed to as a possible “pseudo-suicide.” Wong, who hanged himself in 2010, had a long history of sleepwalking and sleep terrors. His family and friends believe he hanged himself while in a sleep state, unaware of what he was doing.
Sexomnia. This NREM parasomnia involves a person engaging in sexual behavior while in a sleep state. As with other arousal disorders, the person often has little to no memory of their actions. Sexomnia can result in instances of sexual assault, rape, and other sex-related crimes.
Like sleepwalking, other arousal disorders may be triggered or exacerbated by additional factors, including:
• Drug and alcohol use
• Medication, including sleep medications
• Lack of sleep
• Stress and emotional upheaval
REM sleep behavior disorder (RBD). This highly disruptive, potentially dangerous parasomnia occurs during REM sleep, rather than NREM. In normal REM sleep, the body becomes largely immobilized—that’s the temporary paralysis known as REM atonia. REM is a state of active and vivid dreaming, and this temporary paralysis delivers protection to the sleeper against acting out in response to dreams.
In people with RBD, there is no REM atonia, no paralysis to keep you from acting out physically while you dream. Sleepers with RBD often react violently, screaming, thrashing and jumping around, kicking and punching in reaction to disturbing dreams. Injury is an all-too-common consequence of RBD. Research indicates that nearly one-third of REM sleep behavior disorder have injured themselves, and 64 percent have injured their sleeping partners, during an episode.
What causes REM sleep behavior disorder? This sleep disorder is linked to:
• Neurodegenerative diseases, including Parkinson’s disease. (RBD sometimes occurs as a precursor to Parkinson’s disease). However, not everyone with RBD will develop Parkinson’s or other neurological disease.
• Alcohol, drug, and medication withdrawal, including withdrawal from sedative hypnotics and anti-depressant medications
In roughly half of the cases of RBD, the underlying cause is not known.
Sleep deprivation. It’s important not to overlook the risks to violence that can arise from lack of sleep. Sleep deprivation compromises reaction time, reduces focus and attention, and interferes with good judgment. Insufficient sleep makes us more emotionally reactive and more inclined to engage in risky behavior. The hazards of sleep deprivation are widespread, and can result in behavior that’s both dangerous to safety, and criminal in nature:
Accidents at home and in the work place are significantly more likely. According to research, at least 13 percent of workplace accidents are connected to sleep problems. And sleepy workers are 70 percent more likely to have an accident at work than non-sleepy workers.
Sleep and fatigue are a common cause of motor vehicle accidents. Drowsy driving is as dangerous as drunk driving, to your safety and the safety of others. At least 100,000 motor vehicle crashes are attributable to sleep and fatigue, according to the National Transportation Safety Board. And that’s a conservative estimate, based on accidents reported to police.
Sleep deprivation is a public safety hazard. Low on sleep, public transportation and public safety workers—from train operators to airline pilots, law enforcement personnel to health-care workers—are at increased risk for errors and accidents that put themselves and the public at risk. Sleep deprivation has also been a factor in large-scale environmental health disasters, including Three-Mile Island, Chernobyl, and the Exxon Valdez oil spill.
Sleep forensics explores areas of sleep phenomena that remain too-little understood. That work can help move our legal system to better address sleep-related violence, and help keep us all safer, by better understanding our capacity for dangerous behavior even during sleep. I want sleep to be a peaceful experience for you and for all my patients. But as with so much about sleep, it’s not that simple.
Michael J. Breus, PhD, DABSM
The Sleep Doctor™
OK. So, one of my guilty pleasures is CSI. I like them all, but NCIS (the military one with Mark Harmon) is my favorite. I always like to see how they use science to solve the mystery. To be 100 percent honest, I feel like a science-detective sometimes myself. It really can be a bit of a mystery trying to determine what is going on with my patients, and how to treat it. I was asked once to be an expert witness, but it’s not something I’ve done. I am fascinated by all aspects of sleep and sleep science—and one really fascinating, and relatively little-known, area of interest for me is sleep forensics.
What is sleep forensics? It’s the use of sleep medicine, science, and expertise in the investigation of violent, strange, and irrational behavior related to sleep—and crimes that may stem from these behaviors. Yep, there’s room for a sleep specialist character on your (or my) favorite crime procedural show.
Experts who work in the field of sleep forensic medicine make contributions to investigations and legal cases in a number of different ways. They perform medical examinations and sleep studies, and make diagnoses for sleep and sleep-related disorders. They work with law enforcement and legal professionals on cases where sleep may be a factor. They provide expert testimony for criminal and civil trials. The also research and study the latest in sleep science, and other physical and psychological conditions that might contribute to violent and dangerous behavior.
When sleep is violent
What could lead a sleeping person to enact dangerous, violent behavior while in some stage of sleep? The answer to that question is deeply complicated. You’ll often hear the term
in connection with sleep-related violence. I’ll talk briefly about what that term means.
Parasomnias are a broad category of disorders and conditions that disrupt sleep and lead to unwanted behaviors, psychological states, and experiences related to sleep. There are many types of parasomnias, and collectively, parasomnias occur in an estimated 10 percent of general population. The range of parasomnias is wide. Sleep talking is a parasomnia. So is sleep eating. Sleep terrors in children are form of parasomnia.
Several parasomnias carry risks for sleep-related accidents and injury, to the sleeper and to other people the sleeper comes in contact with. Parasomnias can be caused by sleep disorders, medical conditions both physical and psychological, and interactions with medications, drugs, and alcohol, or for reasons sleep physicians can’t identify. There appears to be strong genetic connection to some parasomnias, including sleepwalking.
Sleep-related conditions that can result in disturbing, dangerous, and violent behavior include:
• Sleep driving
• Sleep terrors
• Dissociative disorders related to sleep
• Medication interactions that affect sleep and dreaming
• Drug and alcohol use
• Nightmare disorder
• Confusional arousals, sometimes called “sleep drunkenness”
• REM Sleep Behavior Disorder
You might think criminal cases that require an expert in sleep happen once in a blue moon. Not so. While not common, sleep-related crimes happen more often than you may think. Breakthroughs in sleep science have deepened our understanding of the intricacies of sleep, and the complex, porous lines between sleeping and waking. Forensic experts point out that what we now can identify as sleep-related violence can be mistaken for intentional violence against oneself or others.
The earliest criminal case in the U.S. involving the so-called “sleepwalking defense” came in 1846. A man named Albert Tirrell was found not guilty of killing his mistress and setting fire to a brothel in Boston. Tirrell’s defense claimed he was a sleepwalker, with a history of agitated and violent behavior during sleepwalking episodes that began when he was a young child.
One of the most famous cases of sleep-related crime—and a case that in some ways echoes Albert Tirrell—is that of Kenneth Parks. In 1987, Parks rose one night from bed, drove roughly 14 miles to his in-laws’ house, and assaulted them. He bludgeoned his mother-in-law to death and attacked his father-in-law, who survived. Parks then drove to a local police station and confessed to the killings. Parks said he’d been sleepwalking the entire time, through the drive, the attack, and even at the police station. He said he hadn’t been aware of what he was doing and had only trace memories of the events.
Parks had a long history, dating back to his childhood, of complex and extended sleepwalking episodes triggered by stress. Around the time of the killings, Parks was under significant stress: he had a serious gambling problem, he’d been fired from his job, and was facing embezzling charges. Parks underwent sleep testing that showed irregular brain activity during his sleep, which were consistent with some types of parasomnia. Also, when he arrived at the police station, Parks had serious wounds to both his hands—but police said he did not appear to be experiencing pain. This suggested a dissociative state that can be part of sleepwalking. Parks was acquitted of all charges.
In 2000, Scott Falater was convicted of first-degree murder in the slaying of his wife, Yarmila Falater. Falater admitted to killing his wife, “stabbing [her], stashing the knife and some bloody clothes in the back of his Volvo, then dragging her to the pool at their Phoenix home and holding her head under water,” as reported in the Los Angeles Times.
But Falater said he’d been sleepwalking when he committed these acts, and had no memory of any of the events. Sleep experts who testified at Falater’s trial said he had been sleep deprived and under stress at the time of the killing, and that he had a family history of sleepwalking. Falater was sentenced to life in prison without the possibility of parole.
In 2008, Christine Thomas was strangled to death by her husband, Brian, while the British couple were vacationing in a camper in Wales. Brian Thomas was charged with murder. He said he’d been having an intense nightmare in which he was fighting off an intruder, when he awakened and realized he’d strangled his wife. Sleep experts said Thomas had experienced night terrors. Night terrors are a very intense and frightening type of sleep episode, which can be accompanied by screaming as well as sudden, violent movement or fighting. Forensic sleep evidence led to the prosecution asking for the case to be dropped and Thomas to be found not guilty.
There are at least two currently ongoing murder cases in the U.S. that involve sleep as part of the defense:
• In Atlanta, Georgia, there’s the case of 74-year-old Claud McIver, an attorney charged with murder in the shooting death of his wife Diane McIver in 2016. McIver has said the shooting, which took place in the couple’s SUV, was an accident. Falling asleep in the backseat with a gun in his lap, McIver has said, he woke up abruptly and his hand jerked to pull the trigger inadvertently. According to his attorney, McIver has been diagnosed with parasomnia. The judge in the case recently granted a request from McIver’s defense attorney to have McIver examined by a sleep expert.
• A North Carolina case involves a man who says he woke from sleep one night this September to find his wife stabbed and himself covered in blood. Twenty-eight-year-old Matthew Phelps called 911 at about 1 a.m. on September 1, and told the dispatcher he’d awakened from sleep to find his wife, Lauren Hugelmaier Phelps, stabbed in their bedroom—and that he thought he’d killed her. On the 911 call, Phelps said he remembered having a dream before he woke to see his wife’s body on the bedroom floor, blood on his own body, and a knife lying on the bed. Phelps told the dispatcher he’d taken cold medication before going to bed and he thought he’d taken more of the medicine than he should have. According to news reports, he said he took the medicine “because I know it can make you feel good and sometimes I can’t sleep at night.”
Though it remains too-little understood, sleep violence is a real danger—one the legal world is still just waking up to. Sleep forensic specialists are at the forefront of bridging the gaps between the science of sleep violence and the legal ramifications for sleep-related crimes.
Next, I’ll talk more in depth about the different conditions that can give rise to sleep-related violence, and how they’re being diagnosed and treated. Make sure you check back next week for part two!
Michael J. Breus, PhD, DABSM
The Sleep Doctor™
I often encourage my patients to drink tea. Black tea is a lower-caffeine alternative to coffee during the day, and decaffeinated tea can be a calming part of a nighttime power-down ritual before bed. Whatever time of day or night, drinking a cup of tea can be a soothing, relaxing ritual. I often drink tea myself—of course, my favorite is my personal recipe for banana tea!
In addition to its calming qualities, tea also contains compounds that deliver some real health benefits. One of those compounds? L-theanine.
Fortunately, you can also get L-theanine in supplement form, which can help with relaxation, focus, and sleep. Let’s take a closer look at L-theanine and its calming, centering, sleep-boosting abilities.
What is L-theanine?
L-theanine is an amino acid that is found in tea leaves. It was identified in tea by Japanese scientists in 1949. While tea is the most common dietary source for L-theanine, this compound is also found in some types of mushrooms. In foods, particularly green tea, L-theanine is thought to be a source of umami, the savory, brothy taste.
Scientists studying umami flavor have made some interesting discoveries. Umami has been linked to decreased risk for obesity. It may stimulate metabolism, and may boost sensations of fullness and lengthen the time before hunger returns after eating.
There’s also evidence suggesting that L-theanine, when consumed in tea, may change taste perception, specifically diminishing the taste of bitterness in foods such as chocolate and grapefruit.
How L-theanine works
L-theanine promotes relaxation and facilitates sleep by contributing to a number of changes in the brain:
Boosts levels of GABA and other calming brain chemicals. L-theanine elevates levels of GABA, as well as serotonin and dopamine. These chemicals are known as neurotransmitters, and they work in the brain to regulate emotions, mood, concentration, alertness, and sleep, as well as appetite, energy, and other cognitive skills. Increasing levels of these calming brain chemicals promotes relaxation and can help with sleep.
Lowers levels of “excitatory” brain chemicals. At the same time it is increasing chemicals that promote feelings of calm, L-theanine also reduces levels of chemicals in the brain that are linked to stress and anxiety. This may also be a way that L-theanine can protect brain cells against stress and age-related damage.
Enhances alpha brain waves. Alpha brain waves are associated with a state of “wakeful relaxation.” That’s the state of mind you experience when meditating, being creative, or letting your mind wander in daydreaming. Alpha waves are also present during REM sleep. L-theanine appears to trigger the release of alpha-waves, which enhances relaxation, focus, and creativity.
One of the appealing aspects of L-theanine is that it works to relax without sedating. That can make L-theanine a good choice for people who are looking to enhance their “wakeful relaxation,” without worrying about becoming sleepy and fatigued during the day.
Benefits of L-theanine
With its ability to increase relaxation and lower stress, L-theanine can help in sleep in a number of ways. L-theanine may help people fall asleep more quickly and easily at bedtime, thanks to the relaxation boost it delivers. Research also shows L-theanine can improve the quality of sleep—not by acting as a sedative, but by lowering anxiety and promoting relaxation.
There’s evidence that L-theanine may help improve sleep quality in children with attention deficit hyperactivity disorder (ADHD). A study examined the effects on the sleep of boys ages 8-12, and found that the supplement worked safely and effectively to improve the quality of their sleep, helping them to sleep more soundly.
Reducing stress and anxiety
L-theanine is what’s known as an anxiolytic—it works to reduce anxiety. Some anxiolytics, such as valerian and hops, have sedative effects. L-theanine, on the other hand, promotes relaxation and stress reduction without sedating. L-theanine can help foster a state of calm, attentive wakefulness.
L-theanine has positive effects on both the mental and physical symptoms of stress, including lowering heart rate and blood pressure.
Research suggests that L-theanine can help reduce anxiety in people with schizophrenia and schizoaffective disorder.
Enhancing attention, focus, memory and learning
Under stress, the body increases production of certain hormones, including cortisol and corticosterone. These hormone changes inhibit some brain activity, including memory formation and spatial learning. L-theanine helps to lower levels of the stress hormone corticosterone, and avoid the interference with memory and learning.
L-theanine may help boost other cognitive skills. Research shows L-theanine can increase attention span and reaction time in people who are prone to anxiety. It may help improve accuracy—one study shows that taking L-theanine reduced the number of errors made in a test of attention.
Sometimes, L-theanine is used with caffeine to enhance cognitive skills. Studies show that combinations of L-theanine and caffeine can improve attention span, enhance the ability to process visual information, and increase accuracy when switching from one task to another.
Helping maintain a healthy weight
The anti-anxiety and sleep-promoting abilities of L-theanine may help people to maintain a healthy weight. After all, getting enough sleep and limiting stress are both key to sticking with a healthy diet and avoiding weight gain.
L-theanine may also play a more direct role in weight maintenance. There’s scientific evidence indicating L-theanine may help to limit fat accumulation and weight gain, and pay help to protect against obesity.
L-theanine: what to know
Always consult your doctor before you begin taking a supplement or make any changes to your existing medication and supplement routine. This is not medical advice, but it is information you can use as a conversation-starter with your physician at your next appointment.
The following doses are based on amounts that have been investigated in scientific studies. In general, it is recommended that users begin with the smallest suggested dose, and gradually increase until it has an effect.
For sleep, stress and other uses: 100 mg to 400 mg
In combination with caffeine: 12-100 mg L-theanine, 30-100 mg caffeine
Possible side effects of L-theanine
L-theanine is generally well tolerated by healthy adults.
People with the following conditions should consult with a physician before using an L-theanine supplement:
Pregnancy and breast feeding.
Low blood pressure. L-theanine may lower blood pressure. If you have low blood pressure, speak with your doctor before beginning to use L-theanine.
Children. Consult your child’s physician before beginning your child’s use of L-theanine.
The following medications and other supplements may interact with L-theanine. Effects may include increasing or decreasing sleepiness and drowsiness, interfering with the effectiveness of the medications or supplements, and interfering with the condition that is being treated by the medication or supplement. These are lists of commonly used medications and supplements that have scientifically identified interactions with L-theanine. People who take these or any other medications and supplements should consult with a physician before beginning to use L-theanine.
Interactions with medications:
• Medications used to treat high blood pressure
• Stimulant medications
Interactions with other supplements: Supplements that contain caffeine. L-theanine may interrupt the stimulating effects of caffeine and herbs or supplements that contain caffeine. Some of these include:
• Black tea
• Oolong tea
Supplements that lower blood pressure. L-theanine may lower blood pressure, and combining this supplement with other blood-pressure lowering supplements may cause blood pressure to drop too much. Some of these include:
• Casein peptides
• Cat’s claw
• Coenzyme Q-10
• Fish oil
• Stinging nettle
People have relied on the stress-relieving, sleep-promoting powers of L-theanine for centuries, by drinking tea—especially green tea. You don’t have to be a tea drinker to benefit from the soothing properties of this ancient herb—and even if you already enjoy a regular cup of tea, you may find an L-theanine supplement helps with relaxation, stress, and sleep.
Michael J. Breus, PhD
The Sleep Doctor™
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