We talk about living healthier, exercising and eating whole foods. We still do not take sleep and a sleep routine seriously. We are still looking for the instant pill or the idea that will say that less sleep is better. What the studies say is that poor sleep contributes to health issues across the board.
· The studies that lead to contribution to colon, prostate and breast cancer all involve both sleep deprivation and sleep disorders that prevent sound sleep. These to conditions can be helped with therapy and possible treatment of a sleep disorder.
· Studies have shown that children have difficulty learning and learning proper behavior due to poor sleep, lack of sleep and snoring. We really do need to teach our children and teens that sleep is as important to health and good grades as studying.
· Studies have proved that we still only help 20% of those with sleep disorders. However that does not include the family that was affected by the disorder. If husband or wife cannot sleep because of loud snoring, leg movements or acting out dreams than you have more than one person affected and we need to consider all who are affected as patients. Sometimes the treatment may be time and space.
· Weight and sleep are interconnected. This is the vicious cycle the higher your weight the worse sleep disorder breathing will be, the worse the sleep disorder breathing the more difficult the body has at maintaining weight.
With all those issues you would think insurance companies and doctors would be asking more sleep questions and explaining proper sleep. The issue is they are not educated in the importance of proper sleep. In fact if you look at a medical student’s time you will see they do not live what they preach. This is a time where you need to take control. You need to go to your doctor with written questions, maybe a three to four day diary with symptoms.
Explain your desire to not just take a pill but to truly fix the problem and you may get some strong feedback. Doctors like to know a straight ahead question they can fix and that would be a sleep disorder.
The change has to start with an informed patient or at the very least a patient with relevant questions. This way we are able to work with the insurance company. Our goal ultimately is to get a good night sleep with the least amount of medication. I believe we can achieve that if we work as a team.
We all deal with pain at some point in our life. However, when we are dealing with chronic pain the issue becomes compounded because it will interfere with our sleep. This can cause the issue to become compounded and for the pain to increase.
The first issue with pain is the inability to get into deeper sleeps. Pain will actually interfere with the slower brain waves causing sleep disruptions that we may not be aware of. This slower wave sleep, also known as Delta Sleep, is when our body releases hormones such as Human Growth Hormone. If we are unable to reach that level of sleep then our body does not have the ability to heal itself or can take significantly longer than we expect it to.
The second issue is that sleep deprivation increases our perception of pain. There is really not much to say on this issue other than you can see the vicious cycle this can create for someone learning to deal with chronic pain.
The third issue is the side effect of many of the medications people take for pain. It can change the ability to sleep, the stages of sleep a person is able to achieve and the level of fatigue a person feels throughout the day. Many medication can also cause insomnia.
The last issue is that when we deal with pain it will limit our activity., This will limit our need for sleep. It will also cause napping during the day that will again cause difficulty going to sleep at night. This daytime fatigue will also limit our time outside and our exposure to the sun. This lack of sun will causes decreases in vitamin D. It has been found that low levels of Vitamin D causes us to experience increased levels of pain.
All these issues combined together will continue to increase the pain and health issues a person is experiencing rather than healing. Taking the time to take a short walk, get some sun and working with your doctor to manage your sleep will help you to get better than much faster.
This week I will be helping identify and talk about some of the interesting sleep disorders. The most common one is snoring. What the most recent studies have found is that snoring even if it is not associated with sleep apnea may be indication of health issues.
In children sleep apnea may not be present but snoring may be a sign that your child may need to be treated. Snoring alone can disrupt sleep, limit the amount of sleep your child may be getting or may just prevent your child from getting into the deeper sleeps needed to grow and to heal. If your child has symptoms of ADD or ADHD it may be due to that sleep disruption.
If you find that your child is snoring evaluation by their doctor is the best way to get to the bottom of the problem. Some dentists are also looking at sleep apnea, as they can visualize issues with their upper airway. The physician may have the child evaluated by an ENT or have them do a sleep study to evaluate the extent of the snoring and to see if their breathing is being affected.
In adults snoring is not just associated to obstructive sleep apnea. Snoring itself has been associated with high blood pressure and diabetes. They have also associated it with dementia and memory loss. Some people may only snore when they reach certain stages of sleep causing the disruptions to happen at approximately the same time each night. Usually during REM sleep, where we dream, are muscles are the most relaxed and this can bring on snoring and sleep apnea. Also it may be worse when someone is sleeping on their back because the tongue relaxes and moves to the back of the throat.
If you have snoring and you have been tested for sleep apnea with a mild or negative result than you may still want to treat it. An oral appliance made by a dentist who specializes in sleep would be your best option. Because different oral appliances work for different people I would make sure that the person you are working with knows how to create more than 1 appliance. You may also want to attempt to use positional therapy so you do not sleep on your back. You can use a wedge pillow which will allow you to sleep with your head elevated. The more productive way however is the tennis ball method, where you create a pocket on the back of a t-shirt, place a couple of tennis balls in them and sleep in it for about a month. This will help encourage you to stay off your back when you sleep.
Snoring, no matter how we look at it, is not a fun for the person who has it or the person who has to listen to it. You should do what you can to deal with it to keep yourself and your family as healthy and well rested as possible.
One of the first issues I hear when a person comes into a sleep lab to be introduced to a CPAP is that they have claustrophobia; that you cannot stand to have anything on your face. There is always an excuse for not tolerating therapy. Most of the reason has to do with feeling out of control. There are so many ways that can create a successful experience.
Let’s start with the mask. It is probably the most important piece of equipment you will use and the easiest to change. If you are unable to use the mask during the night of your study tell your tech, however, what usually happens is that they use the mask for 1-3 days at home and find that it is not the best mask for them. It may move too much causing leaks, it might cause your skin to mark or breakdown, it might make your eyes dry; all these issues can be handles with a change of mask. It is also common for people who are claustrophobic to be much more successful with a full face mask due to the ability to breathe through both the nose and mouth which will make anyone more comfortable. Your insurance will pay for replacement mask during the first thirty days of the therapy. After the first thirty days a new mask must be ordered. At many centers they will allow you to trial or borrow masks to find one that will work for you.
Knowing how to perform relaxation techniques will allow you to be successful when you are trying to fall asleep the first few days. It can also help on days where your stress level is high. The two techniques I have found that help are progressive relaxation. This is easy to learn and allows you to focus on relaxing as well as helping you to focus your thinking.
1. Start at your feet and tighten them as tight as you can, hold for the count of ten and then allow them to relax and go limp
2. Progressively move up the body focusing on one muscle group at a time.
3. To reach the top of your head should be having spent about 10 minutes on deep breathing and your muscles may be relaxed. This centered concentration helps increase oxygen levels and allows the mind to camp down preparing it for bed.
Diaphragmatic breathing is another exercise that will allow you to relax and breathe deeply with a technique that takes focus. Lie flat on your back with your hand on your stomach just below your ribs. As you take a slow deep breath in push your hand out; when you exhale draw in your abdominal muscles so you are pulling your hand in. I usually like to hold the breath 3-5 second between peak inhalation and exhalation. Having to concentrate allows the mind to calm and it increases the oxygen level from doing nice slow inhalations.
If relaxation techniques do not work for you medication or working with a councilor that practices Cognitive Behavioral Therapy. Your physical can help you to find assistance that will work for you. It is not unusual for someone to need a little extra support, this is long term therapy and sometimes it takes a little time to become compliant with it.
Some accessories can help you with some of the small issues. Chin Up strips can help a mouth breather minimize the leak. A Gecko will help with sores on the nose and leaks into the eyes. A heated hose might help with mouth drying.
Overall working with a patient technologist or physician is the best way to be successful when using PAP. The more you communicate about your issues the sooner a solution to help you be successful on your machine, and sleeping a healthy sleep.
As we start the New Year we always make resolutions or goals we would like to achieve during the year. This past year we have all learned that sleep affects all aspects of your health and so you may want to add a better night sleep as one of your goals for the year. The problem is how to approach this to make it practical. Creating SMART goals are usually the most successful goals.
Let’s look at some small changes you can make and add to your daily life that can improve your sleep. These are not big things but small changes you can add to your routine and as you build one on the other you will find that you will sleep better and have more energy during the day.
· Give you your electronics 40 minutes before bedtime. The light given off by your electronics confuse your brain and make it believe it is daytime. If you turn them off 40 minutes prior to bedtime you give you mind time to relax and allow Melatonin to be releases helping you to sleep. Melatonin is released when you are exposed to darkness. So turning down the lights, turning off the electronics and enjoying the quite time during the evening helps to allow this hormone to be released.
· Practice diaphragmatic breathing. One of the great ways to relax is to deep breathe. Lie down, put your hands on your abdomen just below your ribcage as you inhale push out against your hands, as you exhale pull your abdominal muscles in. This exercise helps you to increase your oxygen levels, increase your lung capacity and calm your brain due to your concentration on your breathing. Doing this for 5-10 minutes as part of your bedtime routine will help you especially if you have transient insomnia, or insomnia caused by a particular issue.
· Create a bedtime that is 15 minutes earlier to increase your sleep time. Large changes in bedtime will most likely lead to insomnia but a small change such 15 minutes will allow you to increase your sleep time without adding time just staring at the ceiling.
· Do not use the snooze button. You will find that if you get up at the same time every day and do not linger in bed you will have more energy during the day. It will also help you to not feel so
· Add ten minutes of sunlight to your morning routine. Open the curtains, sit out on the balcony, or take a walk. Any of these ideas will help you to feel more awake and have more energy. Your brain needs the light to tell you to be awake just like it needs the dark to tell it to go to sleep.
These are just a few ideas to add to your life during the New Year. It is not necessary to add all of these ideas or to add them all at once but when you are making a goal using the smart method is the best way to more ahead. Each of these is measurable, sustainable, and very specific. I know improving your sleep will make this year a great your for you.
I feel that part of my job as a healthcare writer is to cover issues that will affect you life. Your choice of insurance is a big choice you are making during this time of year. I was talking to someone who was saying how few of the people at her workplace choose to have health insurance, especially for their children. This is a huge issue that affects a person’s budget as well as their health.
Most people believe that insurance is essential. I do not necessarily believe that. I believe HSAs, health savings accounts, are a great way to plan for the future that may be option. I also think that people do not take advantage of the states children’s health care programs that provide low cost HMOs, health maintenance organization programs, in Florida it is called Healthy Kids. These coverages are designed to take care of emergencies but provide minimal coverage for wellness care. You can negotiate cash prices for visits or testing you may need. For someone who does not have a chronic problem this could be a compromise between cost and coverage.
If you have a chronic problem this may not be the solution. Sleep apnea may be the one chronic problem that this rule does not pertain to. I will say this for several reasons. Sleep studies are usually done once every three to five years. If you are a cash paying patient you might be able to negotiate a lower price for the test. Since the company does not have to wait for payment they might lower the price. The one exception is that they cannot charge less than the reimbursement that Medicare due to the laws surrounding Medicare. So it might benefit you to know the Medicare reimbursement.
When you need PAP equipment or supplies I will be honest you can get them a lot cheaper than the insurance company’s negotiated price. When pricing masks research the online sites and the sites that do drop shipping of supplies, this little bit of research could save you a significant amount of money. They also tend to buy in bulk and have fewer employees so they have less overhead. They then share the savings with those purchasing the equipment.
As to whether sleep apnea will end up costing you more as a pre-existing condition or less because you are treating a health issues actually varies from insurance company to insurance company. If you have been diagnosed with sleep apnea and you choose not to treat it than you will be treated as having a pre-existing condition and they could not cover other issues such as high blood pressure or diabetes as they are associated with the sleep apnea. However if you are using your PAP than many of the insurance companies may ask for proof of use and will treat you as if you do not have a pre-existing condition. You will have to shop around and ask questions about that particular plan’s policy.
When it comes to our children many of them do have sleep apnea and it can look like many things such as ADD, fatigue, hyperactivity, anger and learning disabilities. If we looked at their sleep and have a sleep study they are usually treated initially with a tonsillectomy and if still needed PAP therapy or an oral appliance. It is important that we need to help our children to be able to achieve their best and taking care of sleep problems is worth the cost of insurance. If you can not afford your children’s coverage you need to ask your state what programs they have to help you cover them. It is worth it in the end and will help them to behave better and be more successful in school
When you are looking at insurance you must take many things into consideration including the cost to you and the ability to balance your budget while paying the premiums. But when choosing not to have coverage or you are choosing minimal coverage you must consider the effects it will have on chronic issues and your ability to pay for care.
As you try to change your lifestyle you will find that you do well for a while and then something out of the ordinary happens and you fall back to your old ways. This is true whether you are changing you sleep routine, getting used to PAP therapy or trying to lose weight. Any change comes with setbacks. It is when you look at those setbacks and decide to move past them and start again that you really are making progress.
With PAP it usually comes this time of year when you get a cold or the flu and you just can bot wear your mask. You usually go about 7-10 days which is how long a cold usually takes to pass. Now there is no reason you cannot wear your PAP and turn up the humidifier or maybe use a full face mask instead of a nasal mask or pillows to get through this tough time. But most people just decide to go without and then forget to go back to using their mask. What I can tell you is that it is up to you to start using it again and if you need encouragement ask for it. If not from your family than from a friend or a coach than someone who will be your best cheerleader so you will feel the encouragement of getting healthy. Another trick is to write it down. Journaling during any behavior change will always help you. It gives you visual encouragement but it will also show you the triggers you have when you are not making the change you want.
Holiday season and the children being on vacation are notorious times when sleep routines go out the window. I will never say you should always follow your sleep routine but remember that vacations will be much more fun if everyone is well rested and out brains do not know the difference between holidays and school or work days. There is one thing you can take advantage of during this time. Find out what your natural wake up time is. If my alarm is not set and I go to bed at 10pm I will naturally wake up at 6:30am. If I worked out really hard the day before I will naturally wake up at 7:30am. This allows me to adjust my sleep times to make sure I get the amount of sleep I need. I usually want to wake at 5:30am so I can exercise before work, than I know I need to go to bed at 9pm. This has forced me to learn how to use my DVR so I can record those shows I will miss but want to see.
One of the ways to change your health is to lose weight. This will affect your sleep and if you are on PAP it might help to reduce your pressure or maybe not need it at all. No matter what it will help you to sleep better if you are eating healthier and exercising more. This time of year is brutal on food plans and I will be the first to admit my plan has fallen to the wayside. But making a lifestyle change is as much about the failures and how we handle them as it is about the successes. I have learned through this failure that I tend to want to eat more when I am over tired or when I am experiencing pain. This falls right into the research that is coming out almost weekly about sleep. The problem with the research is they offer no solutions. My solution is simple I turn to friends and I journal so I can see not only what I was craving and eating but if there was a specific activity that triggered the behavior or was there a specific food that trigger the behavior. Then it is right back to what I know makes my body feel healthy.
I find that the more natural the food the better I feel. I also find that I am healthier with a high protein, low processed carb diet. I like apples and yogurt and tomatoes and cucumber as my go to foods. I could probably live on egg whites and chicken given the opportunity. But that is my body and I am sure that others have suggestions as to what makes their body feel like it is working optimally. I would love for you to share your ideas about what you do to feel optimally healthy. Do you do certain exercises, eat a certain way, or get a specific amount of sleep? Any habit that works for you may give someone else an idea to trial. We are a community of people working for optimal health. My goal is to help you add sleep to that routine but any changes that help are always welcome.
We all experience a night where we stare at the ceiling or cannot turn off our mind. Transient insomnia is something we experience when we are living with a stressful situation or maybe just a long day. The problem is that if you do not get a good night sleep you may find that it is difficult to concentrate, your hunger may increase, or you may experience more aches and pains.
One of the exercises that you can use is to use imagery along with breathing exercises to help relax and go to sleep. This exercise may also help with people who may be experiencing nightmares as well.
Let’s start with the breathing as this is what allows you to increase your oxygen levels and helps you to relax. Take a slow deep breathe imagine filling your lungs from the bottom to top. For women this is not as natural as you thing as we tend to be shallow breathers. Once you have filled your lungs hold it for the slow count of four then slowly exhale to the count of 8. This will also help you to increase the use of your longs. The breath hold allows some of the small airways we do not usually use to open.
The second step is to use imagery. Choose a place you want to be. I personally am a warm white beach person or on a flower covered meadow person. You choose an image that suits your personality. Now focus on that image. Image the smell of the air, the temperature of the sun, fell the grass under your feet. The more you can focus on the details the more it will help you to relax.
In my mind I travel to a valley between the mountains. I am lying looking up at the sky watching the clouds pass through the sky. I feel the grass under my hands and between my fingers. I smell the sweet smell of violets and wildflower. I can hear the wind across the pond and rustling in the leaves. The more I concentrate the more relaxed I become. Along with the slow deep breathing I can feel my muscles relax. I allow myself to float along and eventually I drift off to sleep.
This exercise was taught to me when I was in high school as a way to get past my test anxiety. I found that doing this exercise for just three to five minutes really reduces my stress. I use this on nights when I can not turn off my mind to ideas or to my family. It allows me to drift and it does help minimize the nightmares I experience.
Are there exercises or imagery you use to help you to relax and unwind?