02/05/2012
January 30, 2012 To nap or not to nap? The US population is sleep deprived, meaning that we just don’t get enough sleep. As a result; our health, mood, and work performance suffers. Some causes for sleep deprivation include increased levels of stress, anxiety related to effects of the poor economy, and interference from electronic devices such as mobile phones, computers, and other gadgets on our sleep cycle. These are often taken into the bedroom or even into bed. It is not infrequent when interpreting the results of my patients’ home sleep studies to see awakenings in the middle of the night because of texting or emailing while in bed. The two most common reasons for not sleeping enough are: “I can’t fall asleep”, or “I don’t have enough time to sleep”. Addressing insomnia (cant fall asleep and/or stay asleep) is not part of this discussion, but lets talk about not sleeping enough and what to do about it. Most adults require 8 hours of sleep, and many medical studies have shown that our motor skills (driving for example), and mental skills (memory and problem solving) significantly deteriorate if we don’t sleep enough and improve if we sleep 8 hours, and in fact continue to improve if we can sleep 9 hours. At the same time it seems that sleeping less than 6 hours a night or more than 10 hours a night every night is not good for our health (except for a very small fraction of the population - so called “long sleepers”, and “short sleepers” defined the International Classification of Sleep Disorders). Make sure you don’t have sleep apnea, a very common and dangerous medical condition that can cause excessive sleepiness during the day. If you snore loudly or are overweight, you are at risk. Sleep apnea causes complete interruptions in breathing while asleep and results in serious damage to the heart, brain, and other organs. A convenient “home sleep test” in your own bed can determine whether or not you have sleep apnea and how severe it is. More information on the main pages of our website. This brings us to naps. Humans in their adult years compared to most other species don’t usually nap. Napping is part of the sleep cycle of infants and children, and is quite common in the elderly population. There is a natural and biological propensity to nap during the day. This is due to a dip in the circadian rhythm of the body – the 24 hour sleep wake cycle that is determined both by the daylight cycle, and by the body’s internal 24 hour cycle. (By the way circadian (from the latin “circa” and “dies”, meaning: “about 24 hours”). The 2 sleepiest points in the body’s 24 hour cycle are between 2 am and 4 am (the worst time to have to wake up), and between 1 pm and 3 pm. This afternoon dip in the cycle is due to the fact that the waking effect of daylight hasn’t quite kicked in fully, and the sleep pressure (the urge to sleep that accumulates from being awake) is starting to accumulate and make us sleepy. Add to that the effect of lunch, and this explains why a nap around 2pm might be really desirable. Of course some cultures have been napping in the afternoon for these and other reasons. In many Mediterranean countries and especially in Spain, land of the siesta, the scorching summer afternoon sun is another good reason to take a nap, … a long nap. So light affects our sleep cycle? Yes- light, especially light from the blue part of the spectrum is captured by specialized cells on the retina in the back of the eyes, and travels to a part of the brain within the hypothalamus called the Suprachiasmatic Nuleus (SCN for short). Light is the trigger for turning on many biological processes in the body including turning on production of hormones such as cortisol (the body’s own steroids), adjusting body temperature, and many other functions. Light helps us wake up and light can be used to help adjust our sleep wake cycle if it becomes disrupted. Jet lag and shift work affects our sleep cycles, and light is used to help us get back on track. Bright lights in the work place for night workers helps them stay awake, and early morning sunlight helps travelers suffering from jet lag when travelling from the US to Europe for example. Teenagers have disruptions in their normal circadian rhythms causing them to go to sleep very late and wake up very late (if they can … on week-ends). Bright light in the morning, and dim light in the evenings can help with that. Lets not get side-tracked … The short and long (about) naps. Many studies have confirmed that napping is good for our health, and improves mood, memory, productivity and creativity. Irritability (or burnout) from overwork can be reduced by napping. In 2007, a study from the Harvard School of Pubic health looking at over 24,000 subjects showed that napping at least 30 minutes a day 3 days a week decreased mortality from heart disease by 40 %. Shorter naps reduced mortality by 12%. This is likely because napping decreases production of the body’s natural stress hormones. NASA conducted studies on sleepy pilots and astronauts and found that they made made fewer errors after taking a 40 minute nap, pointing to the positive effects of naps on critical motor and mental skills. Other studies have found that longer naps (up to 90 minutes) can improve creativity and executive decision making skills. Some have worried that napping can interfere with the circadian rhythm (as discussed in the previous paragraph), and cause poor sleep at night. This has not been found to be true as long as naps are kept short and not too close to bedtime. The power nap is a short nap usually 20-30 minutes in a dark quiet environment designed to provide a brief rest without entering deep sleep. A long nap can cause the sensation of grogginess or disorientation upon awakening (called sleep inertia in medical lingo) that can actually interfere with mental and motor performance up to several hours after awakening. We usually don’t enter deep sleep within 20 minutes of napping unless we are extremely sleep deprived or have a sleep disorder such as narcolepsy. Power naps have been shown not to interfere with the circadian rhythm as long as they are not too close to bed time. Also, they have been shown not to effect total sleep time during the night’s sleep. Where and how to powernap? At your desk, in your parked car, on a sofa, in a comfortable armchair, or in an Energy Pod (made by Metronaps). This is an example of the perfect nap environment: very comfortable, dark, and quiet. You may also benefit from some relaxing and calming music played at low volume. The importance of relaxation for napping led us to create Music for Dreams, soothing piano music performed and recorded especially for the purpose of inducing sleep. You don’t have to nap every day, but certainly on days where you have missed out on some sleep the night before, you might plan on a nap before you get too sleepy, a “planned nap”. If you have to drive, consider a “caffeine nap”. A cup of coffee just before your power nap, the caffeine kicks in just about when you awake from your nap. If you are driving and are overcome by fatigue, pull over immediately and take an “emergency nap”. Medical uses of naps. Naps are recommended in the treatment guidelines of the American Academy of Sleep Medicine for the treatment of Narcolepsy. A serious sleep disorder which causes extreme sleepiness, and often uncontrollable episodes of sudden sleep (cataplexy). Napping can help control the disorder but is usually just part of the overall treatment which usually includes medications to stay awake. Another new medical use of naps is the PAP-NAP. A 60-90 minute nap in the sleep specialist’s office used to help sleep apnea patients who are on CPAP treatment. CPAP (Continuous Positive Airway Pressure) is a medical treatment that prevents collapse of the breathing passage at night and also prevents snoring in patients suffering from sleep apnea. During the PAP-NAP, a sleep technician can help the patient try different CPAP masks, and adjust settings on the CPAP machine. This desensitization process has been shown to improve the success of CPAP treatment. To Nap! Just 20 minutes can help reverse some of the effects of too little sleep, and can help your mood, your work performance, and your general health. You’re in good company: JFK and Ronald Reagan napped, so did Salvador Dali. He didn’t have an Energy Pod, so he napped sitting in a chair with a spoon in his hand and a plate on the floor; as soon as he fell asleep the spoon fell on the plate and woke him up … the Dali nap! Please share your nap stories with us at: www.BLUESLEEPmusic.com, and we will send you copies of Music for Dreams Vol 1 and Vol 2 for your next nap. Jordan Stern, MD for the entire BLUESLEEP team.
Sleep and Reflux
01/16/2012
January 15, 2012 Sleep “chief nourisher of life’s feast” (Macbeth, Shakespeare). Good sleep is critical to all physical and emotional functions. In search of good sleep, or as part of the remedies for poor sleep, consideration of reflux is almost always overlooked. Only recently have some medical research papers discussed the association between sleep disorders and reflux, particularly the association between sleep apnea and reflux. To discover the importance of the link between these two conditions, and a guide to their treatment, read on ! Sleep apnea (Greek: apnea – no breath) may affect 20% or more of the adult population. It is caused by repeated episodes of collapse of the throat and nose at night causing actual interruptions of breathing, sometimes up to 50 or more times an hour. The result is very poor sleep quality, with multiple arousals during the night and excessive sleepiness during the day. In addition, the stress caused to the body from insufficient breathing and oxygenation of tissues (low oxygen level in your body) causes myriads of medical problems ranging form high blood pressure, heart disease, and diabetes, to anxiety, depression, and sexual dysfunction. Much of the health affects are related to damage to the smaller blood vessels in the body. Signs and symptoms of sleep apnea include snoring, headaches, difficulty concentrating, memory loss, and ... reflux! In fact a recent study found that almost all patients with significant sleep apnea had reflux. In most cases, when sleep apnea was treated, the reflux improved. Reflux can result in sleep disturbances by causing arousals every time a reflux episode occurs. In other words, reflux episodes occurring in the middle of the night, wake you up, and then, yes: your mind will start racing and falling back asleep can be very difficult. Reflux can also be one of the causes of night - time breathing interruptions, if the reflux episodes lead to laryngospasm (a medical term meaning that the vocal cords close completely and prevent you from breathing until you wake up gasping for air). Very few in the medical world are aware that reflux may be causing these symptoms, and often attribute them to anxiety, asthma, or heart abnormalities. It is very important to consider that reflux may be causing these nighttime events, and that treating your reflux will certainly improve some aspects of your sleep. Sleep apnea can now be diagnosed in the comfort of your own home using devices smaller than mobile phones. Usually one night sleeping with the device will determine whether or not you are suffering from sleep apnea, and how severe it is. If you already have been diagnosed with sleep apnea, treating your reflux will likely improve your sleep, and may decrease the severity of your sleep apnea. Of course losing weight will help both conditions, and the reflux diet will help with all: reflux, weight, and sleep apnea! Remember, if you have tried everything to control your reflux, including our reflux diet, you should probably have a sleep study to rule out sleep apnea as an underlying cause of your persistent reflux. You may even need to undergo simultaneous acid pH testing and sleep testing. Very few centers perform this type of testing. We are the only group of doctors currently offering this new technique, and our technology allows for simultaneous testing of sleep apnea and reflux at home! What else should you know about sleep and reflux? Avoid eating at least 3 hours before lying down, and make sure you have the head of your bed elevated. Remember that drinking enough alcohol to make you sleepy will also cause reflux, and also cause a subsequent alcohol withdrawal (hangover) about 4 hours into your sleep. You will wake up feeling irritated or anxious, sweaty, thirsty, and you will have great difficulty falling back asleep. That’s why drinking alcohol to help you sleep (a night cap) is not recommended. Foods that help you sleep? There’s no magic. Even if some foods have substances in them such as melatonin that can help us fall asleep, we would have to eat so much (cherries for example – very bad for reflux) that the side effects of eating so much of the foods would be far worse for your sleep problems. Chamomile, or a warm glass of low fat milk (as long as you can tolerate milk and lactose), as part of your bedtime routine can be helpful. It is very important to establish a healthy sleeping routine which includes powering down all electronics one hour before bedtime (you really don’t need to text in the middle of the night!), dimming the lights, taking a warm bath, and avoiding any strenuous exercise (except sex which will help you fall asleep!) Soft, quiet calming music can also help (www.BLUESLEEPMUSIC.com). Make sure your eyes and ears are protected form excessive stimuli and use earplugs and eye masks if necessary. Take your sleep seriously. If you constantly feel sleepy or tired during the day, discuss this with your physician. You can get more information at BLUESLEEP.com where Dr. Stern discusses his holistic approach to sleep disorders as well as new technology and treatments for snoring, sleep apnea, and other sleep disorders. The BLUESLEEP dietary recommendations for reflux are described by Dr. Stern and his co-authors Dr. Jamie Koufman and Chef Marc Bauer in their book ‘Dropping Acid: the Reflux Diet Cookbook and Cure” available at Amazon. http://www.amazon.com/Dropping-Acid-Reflux-Diet-Cookbook/dp/0982708319 Jordan C. Stern, MD And the BLUESLEEP medical staff
01/10/2010
 BLUESLEEP Opens the Sleep Apnea and Snoring Clinical Center in New York's Financial District.
65 Broadway, suite 901, NYC 10006.
tel: 212-683-0174
Our Mission:
To diagnose and treat Sleep Apnea and Snoring in a multi-disciplinary state of the art center staffed by medical, surgical, and behavioral specialists. To offer educational programs to the medical and lay communities, and advance diagnosis and treatment through research and clinical trials.
Our Facility:
Located at 65 Broadway, one block south of Wall Street where we offer consultations with Ear Nose and Throat Specialists, Medical, Dental, and Nutritional specialists. We perform in office video-endoscopy of the nose and throat, and send our patients home with home sleep apnea monitoring devices for a diagnosis in 24 hours or less. Treatment is tailored to each patient's needs and includes, medical and surgical treatment of the nose and throat, dental interventions with oral appliances when appropriate, and dietary and behavioral programs if necessary.
Our Staff:
Jordan Stern, MD. Head & Neck Surgeon, Founder and Medical Director.
Shai Shinhar, MD. Pediatric Ear Nose & Throat Specialist.
Ed Shin, MD. Ear Nose & Throat Surgeon.
Oleh Slupchynskyj, MD. Facial Plastic and Reconstructive Surgeon.
Robert Korngut, DDS. Dental Sleep Medicine Specialist.
Ari Klalpholz, MD. Pulmonary and Sleep Medical Specialist.
Christie Block, SLP. Speech and Language Pathologist.
Nane Cheung, MS DC. Clinical Nutritionist.
Herica Torres. Home Sleep testing.
Sleep well,
The BLUESLEEP staff.
New Year at BLUESLEEP
01/02/2010
BLUESLEEP's clinical center opened in 2009 in Manhattan's financial district. The first multidisciplinary diagnostic and treatment center for snoring and sleep apnea. Specialists include head and neck surgeons, nutritional, behavioral, medical, and dental sleep specialists.
In 2010:
-We are expanding our home sleep testing services to accommodate the greater demand.
-We will be offering a continuing medical educational course for primary care providers interested in learning more about the latest developments in the diagnosis and treatment of sleep apnea, and other conditions such as reflux and sinusitis which contribute to sleep apnea and snoring.
-We will be testing home sleep testing devices in children though a clinical trial beginning in March.
For further information contact us at: info@bluesleep.com or at 212-683-0174
Wishing you a Healthy and Peaceful year.
Dr. Jordan Stern, and the entire BLUESLEEP staff.
Esther Brunner featured Artist
07/12/2009
At 93, Esther Brunner has a busy life managing her large collection of paintings, preparing her next exhibit, and organizing her works for a retrospective. She exhibits in Zurich where she spends several months a year, and paints in Mouans Sartoux in the South of France. She complains about aging but has a mind sharper than anyone half her age.
Influenced by the works of Bonnard, who was a close friend, she has her own distinct decorative style. We were taken by a series of 3 night paintings which appear to be seen through her window. This one has been chosen for the cover of the upcoming Music for Dreams CD. The true colors are a deeper blue than what is seen on this page. The dripping blue paint and red accents remind us of the surprising themes and distortions that are the source of dreams.
Music for Dreams will be available soon at BlueSleep.com, and CD Baby.com. We will be featuring more works by Brunner in upcoming posts.
Listen, Relax, Dream, Sleep.
The BlueSleep staff.
Alcohol and Sleep
06/21/2009
Alcohol and Sleep
We recently received the following question:
“Dear BLUESLEEP Doctor: I have a very stressful job and need a drink or two in the evening. I go to bed nice and tipsy and fall asleep in two seconds, just to wake up at 3 or 4 am unable to fall back asleep. I have tried sleeping pills but they give me a hangover.”
Thank you for raising this important issue: Up to 25% of the population will use alcohol at least a few times a month as a sleeping aid. As you have noticed, having one or more drinks in the evening or just before bed (a night cap) will indeed make you sleepy and allow you to fall asleep. The problem is that the effect of alcohol is short lived, and about 3 to 4 hours after falling asleep you will feel the effects of alcohol withdrawal (a mini hangover). This will cause sweating, nausea, awakenings, and a fitful sleep. Your normal sleep cycle is interrupted and you are likely to have more vivid dreams and nightmares. The awakenings and lighter sleep in the second half of the night lead to daytime fatigue, headaches, difficulty concentrating, problems with memory, and mood swings.
Alcohol also worsens underlying sleep apnea and snoring because it relaxes the muscles in the throat and this causes a collapse of the upper airway (the upper and lower parts of the throat).
My advice: never go to sleep tipsy or drunk if you can avoid it. Spend some time walking off the alcohol, or breathing it off with some other type of light exercise ... and drink lots of water. Many of the undesirable side effects of overdrinking come from dehydration.
Don’t try sleeping pills unless they are prescribed by your doctor, and ... never mix sleeping pills with alcohol!
Sleep well,
The BLUESLEEP Doctor
Exercises to stop snoring
06/01/2009
For those of you who snore like a chainsaw but don't want to undergo surgery, tongue exercises may be the ticket! If you can breathe through your nose when you sleep, consider this: Train your tongue tip to rest on the roof of your mouth when you sleep. This creates more space in the back of your mouth, preventing the tissues from creating friction and producing snoring noises.
Training the tongue to stay in a certain position takes practice. There are a number of exercises designed to strengthen the tongue so that it can naturally stay in the target spot.
An important first step is to create awareness of a good tongue position. When you are sitting quietly in an upright position, keep your mouth closed, with your jaw relaxed and low, and with your tongue flat and relaxed along the roof of your mouth. Is your tongue tip flat, relaxed, and right behind your front teeth? The next time you lie down to go to sleep, practice that same relaxed closed mouth/tongue position for a full minute before closing your eyes.
For more information about tongue exercises and other behavioral changes for snoring, call us at 212-683-0174.
Sleep well,
The BlueSleep staff
05/17/2009
Musical Update:
Our Music for Dreams CD is one step closer to helping you sleep soundly. The recording sessions are over and we will be editing soon. Music from Bach, Beethoven, Ravel, Schumann, Brahms, Satie, Grieg, Debussy, and Chopin.
A dreamy picture from our recording session ... can you guess which pieces we have recorded? ...
Planned release is for July 2009.
Sleep well ... sweet dreams ...
The BlueSleep staff.
Sleep Apnea, Headaches, and High Altitude
04/07/2009
Sleep apnea, Headaches, and High Altitude.
For all you skiers, cyclists, and hikers, I’m sure you’ve all experienced more sleep problems than usual at high altitudes (especially 8000 feet / 2400 meters or above)
In winter, the air in the mountains tends to be dry, and as always thinner (there’s less air hence less oxygen). My current ski trip has reminded me of this. Dry nose and throat and headaches are common the first few nights (and sometimes days). There are lots of reasons for this and some but not much that can be done about it.
Stay hydrated! Not only is the air dry and sucks the moisture out of our lungs, but when exercising in winter (especially skiing) we tend to forget to drink (I don’t mean hot wine and beer !!) – at least a few quarts or more of water or balanced hydrating beverage of your choice. Dry upper airway passages (nose and throat) tend to get sticky when we are asleep. This is not only uncomfortable but can also lead to a partial obstruction of the upper airway – ( the tongue can stick to the back of the throat).
What about the headaches? There are several reasons: dehydration (as discussed above), but also a change in pressure in the atmosphere that is not equalized in the sinuses or ears. This is especially true if the nasal passages are congested (if suffering from a cold, allergies, or chronic sinus conditions). Nasal decongestants can help. Headaches can also be caused by sleep apnea which is worse at high altitude. The explanation is quite complicated and has to do with the complex brain mechanisms that trigger our need to breathe. Several medical studies have documented that athletes at high altitude have more sleep apnea than at sea level. Lastly depending on how high the altitude, the oxygen level in the blood can take several days to get up to normal and this can also cause headaches.
http://news-service.stanford.edu/news/2001/may2/everest.html
Keep all of this in mind during your next high altitude trip. If you use a CPAP machine, make sure to take it with you ...
Sleep well,
The bluesleep staff
03/28/2009
Welcome to BlueSleep,
This is the first in a series of weekly updates and discussions on sleep apnea and other sleep disorders. Our site has been designed with you in mind and we look forward to your comments and suggestions.
Our experts will be reviewing your comments and getting back to you as soon as possible. We will be introducing our experts on this blog over the next few months. Upcoming topics include:
Relaxation exercises for better sleep
Nutrition and sleep apnea
More on the acid reflux and the sleep apnea connection
Exercises to reduce snoring
More on sleep apnea in children
Preview of the BlueSleep music for dreams CD
New technology for home sleep testing
And much more ...
About our new BlueSleep site:
It is a combination of simple clinical information on sleep apnea including self tests to help determine if you are at risk. Sleep apnea is a serious condition so if results on these tests suggest you might have this condition we urge you to see your doctor. If you are in the proximity of our New York City based location we can help you with home sleep testing and further treatment. You may contact us at: 212-683-0174
Most of all BlueSleep is a forum for discussion where those suffering from sleep apnea can find out about new treatments and learn from others’ experiences both good and bad.
We all know the impact of a good or bad night’s sleep. We also realize that getting a good night’s sleep depends on so many factors other than just the physiology of sleep or the data obtained from a sleep lab. This is why we have included sections on exercise, nutrition, cooking, relaxation, music and art, ...
With your help and feedback BlueSleep will become the complete resource for a better night’s sleep and a healthier and happier life,
Sleep well,
The staff at BlueSleep
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