Sleep Care

To B or not to B

2007-08-15T14:48:00.000+01:00

An article on the online Independent website http://news.independent.co.uk/health/article2841543.ece mentions the formation of the B-Society in Denmark. The B-society is a movement comprising of 5000 members campaigning for the right to be a B person. So what is a B-person?

A B- person has a natural inclination to be sluggish and bed-bound in the morning, but whose energy levels & productivity rises in the afternoon and evening. Essentially this definition of a B-person is identical to that of the chronotype ‘owl’ as described by Professor Jim Horne, a sleep researcher.

Horne says that people are often genetically predispositioned to be either larks (A- people, morning people) or owls (B-people, night people).

The B-Society is calling for "an uprising against the tyranny of early rising", and has persuaded the Danish government to support B-certified companies in offering flexible working hours. Of course, the traditional 9-5 job are ideal for larks, but surely, with the rise of the 24/7 society and shift work, now it is easier to find a position which is compatible with your natural body clock rhythms.

We are familiar with the concept of personality typing and how they are used by career advisors to help determine suitable occupations for their clients. So why not also take into account of whether these clients are ‘larks’ or ‘owls’. But then again, what if you want to take up a profession where the jobs are traditionally 9-5 and you have owlish tendencies. Should you be able to demand of your boss for the right for flexible working hours, as advocated by the B- Society? Let me know what you think?

No compensation for lost sleep

2007-08-09T11:41:00.000+01:00

A couple of bad nights sleep, or a pressing deadline – that exam tomorrow – can push us to miss much-needed sleep, but we know that after the crisis has passed we can catch up again with a long lie in. But how long can a crisis like that last, and what if we stay in ‘crisis mode’ indefinitely?

A study on mice (yes, I know it’s only mice, so you have to be careful about drawing too many conclusions!) suggests that animals may not always be able to spring back after losing a lot of sleep.

Dr Fred Turek and colleagues at North-Western University in the US sleep deprived mice and then looked at how they returned to normal afterwards. With one night of poor sleep, the mice just caught up the following night. But when they were deprived for five nights in a row, and an interesting thing happened. The mice stopped trying to catch up on sleep. And even when they were allowed to take as much sleep as they wanted for 72 hrs, they still remained on the sleep deprived timings. Turek calls this an allostatic as opposed to homeostatic response (homeostatic = tendency of a system, to return to normal, allostatic = tendency to remain in abnormal state).(http://timesofindia.indiatimes.com/HealthScience/No_compensation_for_lost_sleep/articleshow/2171115.cms)

In other words, like a piece of springy material that has been bent beyond it’s breaking point, once an animal has been sleep deprived for a long period, it’s ability to return to normal sleep patterns is reduced. We know that people who are chronically sleep deprived suffer health consequences (risk of diabetes, obesity, heart attack, stoke and so on), as well as psychological effects (reduced performance, low mood etc).

But what this suggests is that the effects of being sleep deprived are a bit like the effects of being drunk – you lose the ability to realise that you are sleep deprived and fail to catch up sleep to compensate.

Why would animals have evolved this sort of response? Turek suggests that allostatic response to chronic sleep deprivation is a stress reaction which could be very useful in disasters, like floods, which go on for many days. In this situation, an animal which stopped feeling sleepy would have a survival advantage over one that kept trying to catch up on lost sleep.

But there’s a price to pay. Like the ‘flight or fight’ stress response, this response was evolved as a short-term measure, NOT as a long-term lifestyle. By putting your sleepiness on hold, you might feel better and believe you’re coping, but the health consequences will still catch up with you – like the drunk who believes he’s safe to drive – believing it doesn’t make it true!

New viable alternative treatment for obstructive sleep apnea (OSA) ?

2007-08-08T11:25:00.000+01:00

Untreated OSA leads to severe fragmented sleep and sleep deprivation in addition to an increased risk of high blood pressure, heart attacks, strokes and diabetes as well as work-related accidents and driving accidents.

The gold standard treatment for OSA is CPAP (continuous positive airway pressure), i. e air delivered by a pump via a tight fitting mask and hose. However, it’s often not well tolerated .Common complaints include noise, inconvenience, air leakages, uncomfortable masks, and sore dry mouths. Thus, there may be a significant minority of OSA patients who are refusing CPAP treatment at all despite having being diagnosed and counselled.

I was therefore, intrigued to read the pre-publication abstract of a small study, known as proof of concept, of a possible alternative to CPAP for obstructive sleep apnea, (OSA). http://www.eurekalert.org/pub_releases/2007-07/ats-ncm071107.php

Nasal cannulas are common place in hospitals in operating rooms, and on respiratory departments, where they’re used to deliver oxygen therapy. It certainly seems less intrusive and more comfortable to wear. You can find pictures here. (http://www.glasgowfirstaid.org/images/cannula.jpg ).

If I had OSA I certainly would find nasal cannulas more acceptable than a face or nasal mask. I know I move around a lot in my sleep, often lying on my side and front. No doubt, if my nocturnal movements were limited by a hose and mask I would perceive a loss in sleep quality initially before I fully adapt.

If further studies show nasal cannulas can be a viable alternative to nose and facial masks during cPAP, then treatment compliance would be less of an issue. Certainly, it could lead to far fewer expensive cPAP machines ending up at eBay and at car boot sales!

Power Napping in New York – again!

2007-07-11T17:12:00.000+01:00

A new wellness centre, Yelo, has opened doors in the Big Apple- the city that never sleeps- offering deluxe power napping in their YeloCabs™, salon type rooms with a “zero-gravity” chairs with the option of reflexology and aromatherapy treatment as added extras. This follows the opening of MetroNaps in the Empire Building in 2004.

Is this a sign that power napping is no longer seen as a passing and laughable fad but a useful strategy to cope with chronic partial sleep deprivation due to modern living and culture of long working hours?

A New York Times reporter, Natasha Singer, writes, “Sleep is the new bottled water. Although it can be had free, it is being marketed as an upscale amenity.” Are entrepreneurs & business owners helping to make sleep a fashionable commodity? Or are they just responding to the zeitgeist? A report on TimesOnline (http://www.timesonline.co.uk/tol/life_and_style/women/body_and_soul/article1558037.ece)
seems to suggest the latter.

A recent UK poll carried out, on behalf of the budget hotel chain Travelodge, with 1700 respondents, revealed that only 3% claim that they manage the daily recommended eight hours of sleep per night. Saturday night is the main night Brits have a good night’s sleep and Sunday night was voted the worst night for sleep deprivation. When questioned about the reasons behind their poor sleeping habits, respondents listed work stress (23%) as the second biggest cause behind long work hours.

With these polls and others in mind, lack of sleep is a widespread problem in the UK and this will impact on work productivity. Enlightened employers should encourage their staff to discuss how work is affecting their sleep patterns, try to understand what is causing the problem and help them identify ways to help them improve their sleep.

My suggestion? Workers, Unite! Reclaim your sleep. Recharge with a 20 minute powernap. Boost your productivity and your wellbeing. Sleep should not be the new bottled water but seen as critical to overall health.

Sleeping at work

2007-07-09T13:07:00.000+01:00

There is a strong scientific evidence to support the argument that napping is good for your health, creativity, vigilence and fatigue management. Books have been written about napping at work, the latest by Sara Mednick, “Take a Nap! Change your life”.

Fewer errors, fewer accidents, improved job satisfication, less absenteeism will ultimately improve any company’s bottom line- that of productivity and profits. Some enlightened corporates have taken this on board and have installed facilities. The German civil service are actively encouraging their bureaucrats to sleep on the job as reported here.

But how long should one nap for? I’ve always advocated 20-30 minutes, ideally timed for the mid- afternoon slump most of us experience. This is for two reasons. One, snoozing for more than 40 minutes allows us to enter slow wave sleep and if we awaken during this stage, we experience disorientation and grogginess aka ‘sleep inertia’. Two, the mid- afternoon trough in alertness is due to a natural biological rhythm in which we feel more sleepy than awake. It has nothing to do with heavy lunches.

I recognise that for office workers it’s probably more convenient to take that nap during the lunch hour, where the time is their own and not that of the employer. Home workers, however, have more flexiblity and should take full advantage.

Sara Mednick suggests for those who wish to harness the benefits of slow wave sleep during naps for stress mangement, memory and creativity boosts to sleep in the afternoon for about 60 minutes. Intuitively, I can see corporate bosses baulking at this, 20 minutes may be more acceptable, but what if the loss of time to the company is outweighed by enhanced performance.

Famous nappers include Napoleon, Edison, Einstein, Churchill, Kennedy and Salvador Dali. I wouldn’t hardly call them workshy or non-productive, would you?

How to Improve at Sports - Get to Bed!

2007-07-04T17:05:00.000+01:00

An intriguing article caught my eye today about a little study conducted at Stanford Sleep Disorders Clinic and Research Laboratory, which appeared to show that athletes running times and throwing accuracy improved when they got a good nights sleep.

This shouldn't be a surprise to anyone with any interest or knowledge about the benefits of sleep (and the effects of sleep deprivation on performance), but it's nice to have it confirmed. In this study, a small (only six) group of college basketball-playing students aged 18-21 had their sleep patterns split into two phases. First phase was a control normal sleep phase - during which they averaged 5-6 hours a night (typical teenagers!). The second phase was a 'sleep feast', during which they were told to aim for 9-10 hours a night. Running speeds and basketball throwing accuracy was measured in both phases, and they showed a noticeable improvement in both skills during the 'sleep feast' weeks. The improvement was around 7-10%, or a second off a 100m sprint and 1 extra basket out of 10 shots - these could easily be the difference between a team winning and losing a game.

Dr Cheri Mah, in charge of the study made an interesting comment on the experience "A lot of athletes think that fatigue is normal". I'm beginning to wonder if this is a common experience of many sleep deprived people - they don't realise that their hazy, sluggish existence is abnormal, and that something better is actually possible.

Where Are All the Insomnia Support Groups?

2007-06-28T18:39:00.000+01:00

Have you ever been in a situation when two facts don't seem to fit together, and yet you know that they're both true? It's puzzling and frustrating.

I'm in that situation with insomnia. Survey after survey shows that insomnia is a very common problem - affecting about a third of the adult population, and causing long term problems for at least 10%. This is backed up by sales of hypnotics (sleeping pills), both on prescription and over the counter. So, there is fact number one - insomnia is a common problem.

As part of my research for Sleep Care, I decided it might be useful to get involved in some online forums for insomnia sufferers or give a talk at a local insomnia support group. So, I searched for insomnia support groups - both online and real world. And there aren't any! Well there are a few online forums, but most have tiny membership and only a few sporadic postings. And searching both online and at my local library found no real world insomnia support groups. So, here's the fact number two - there are no insomnia support groups.

Do you see my dilemma? Given that there are support groups for EVERY medical condition in existence, from common things like depression and obesity to the rarest of rare syndromes - where are all the people with insomnia going for help?

This is a real puzzle for me! Has my searching missed some big obvious organisations? Am I searching the wrong words? Are all the surveys wrong, and all the sleeping pills being bought for no good reason? Are all the insomniacs just too tired to form support groups (like the joke about the Apathy Support Group inaugural meeting - no one could be bothered to turned up)?

I'd love to hear what I'm missing here.

Let me sleep or let me die…?

2007-06-22T22:53:00.000+01:00

It is sometimes shocking when you uncover suicidal intentions in someone, but a recent study from Florida State University about the increased suicide risk in elderly people with chronic sleep disturbance.

I remember giving a lecture to a local group of pensioners about insomnia. I had told them about the causes and management of insomnia in the elderly. At the end I took questions, and one of the audience asked me “So, how do you cure insomnia?”. My heart sunk, as I felt that I had just spent an hour telling the audience how sleep disturbance in the elderly is a manageable condition, but cannot usually be completely ‘cured’. This is not an unusual situation in medicine – diabetes, chronic bronchitis, and epilepsy are all manageable conditions, but none are curable!

I started to re-iterate my message to the audience member, who quickly stopped me in mid-flow. “…because if you can’t cure it, I might as well kill myself.” She looked serious. I arranged to speak to her alone after the meeting, but it was a bit of a shock to have someone make such a forthright statement of suicidal intent.

The study from Florida suggests that this is not an isolated case, but that there is a significant, though small, risk of suicide among elderly people with sleep disturbance, even when controlling for depression. The message here is clear – especially in the elderly, sleep disturbance is a common complaint, but it is not trivial. It may not (usually) be curable, but people’s lives can be hugely improved by simple, competent sleep counselling.

RLS A Made Up Disease? – Second Report of 3rd Meeting of RLS:UK

2007-06-15T18:40:00.000+01:00

Previously, severe primary Restless Legs Syndrome (about 2.7% of all RLS sufferers) has been treated with Levodopa, used for Parkinson’s disease, and other drugs off licence by consultant neurologists. Several new drugs known as dopamine agonists have now been developed and licensed for use in severe restless legs syndrome over the last 3-5 years. Now the companies involved have mounted extensive campaigns to educate both the public and the medical profession about RLS leading some sceptical medics to claim that RLS is condition made up by the big pharmaceutical companies to fill their coffers.

The following link is a classic: http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0030170

Eileen Gill, spoke at the meeting explaining that severe RLS is not to be dismissed lightly. It’s a common cause of depression, possibly because of the degree of sleep disturbance, but maybe also because of attitudes of relatives/friends and the lack of help or understanding from the medical profession. They just do not understand how debilitating the symptoms can be. Travel by car, public transport and trips to the theatre/cinema can be impossible as the urge to keep moving /fidgeting is intolerable while at rest. Phobias of travelling are not unusual. Social isolation and withdrawal is thus common because they may avoid social events and family gatherings. Suicidal thoughts have been reported by RLS patients. In fact, at the meeting Eilleen Gill sadly told us that the ESG did lose one member to suicide.

Fortunately, the majority of RLS patients have mild symptoms only and they to learn manage their symptoms by implementing lifestyle change and trying out non -medicinal approaches. What might work for one RLS sufferer may not necessarily be effective for another and so having an open minded and experimental approach to self management is vital. There are several sources of good information on self management strategies.

In my opinion, there is a silver lining to this medical controversy. More medics are aware of RLS now and for those with the severe form, help is at hand with drug treatment. RLS information is out there on the web, accessible to all and thanks to patient support groups like the ESG, sufferers know that they are not alone and that there are practical self help measures they can take to minimise the awful effects.

Kids Get Less Sleep Than 20 Years Ago

2007-06-13T14:30:00.000+01:00

There has been a bit of a debate in the sleep world about the history of sleep deprivation. Some say that as our world gets more complex, more connected and busier, that we sleep less today that earlier generations. I remember as a child seeing the little white dot appear in the middle of the TV at about 10pm, when the broadcasts shut down for the night. My children look at me with incredulity when I describe this: "What do you mean the TV shut down? What about the other channels? What do you mean there weren't any other channels...etc"

However, some academics have expressed scepticism about all this modern concern over sleep deprivation, pointing out that the Victorian and Edwardian classified ad's were full of sleeping cure-alls, and that we really don't have any hard evidence from earlier decades to compare with.

Well, now part of this debate can be settled, as a group from Australia have taken data from a twenty year old schools survey and repeated the same study 20 years later in the same schools. Dr Jim Dollman from University of South Australia took bedtime data from the 1985 Australian Schools Health and Fitness Survey and compared it to a survey from the same schools done in 2004. In these studies, 500 children from 10 to 15 years old were studied, producing good comparable data over a 20 year period.

And what did Dr Dollman find? At least in this group, people are sleeping less now than they did in the past. Specifically, they found that getting up times (which are largely constrained by school hours, which haven't changed) stayed the same. However, bed times had pushed forward (later) by an average of 30 minutes - more so in the boys than girls, and more so in poorer families than the better off. Both genders are now getting an average of 9 hours a night, as opposed to 9 1/2 hours, twenty years ago. Because this is an average, this means that many more children will be getting les sleep than they need now, leading to poor attention at school.

So, the pattern in Australian children is clear, our 24/7 society is squeezing sleep out like a disposable luxury, rather than the essential to wellbeing and health that we know it is. Now all we need is a comparable study on adults, but I for one feel confident about what it will show.

RLS A Made Up Disease? – First Report of 3rd Meeting of RLS:UK

2007-06-08T11:23:00.000+01:00

I attended a very interesting meeting organised by the RLS:UK (http://www.restlesslegs.org.uk/) at the Royal Society of Medicine on Thursday, last week on Restless Legs Syndrome (RLS), a leading cause of sleep disturbance ,insomnia and excessive daytime sleepiness.

A massive advertising campaign by big pharmeceutical companies to make GPs aware of this common but often undiagnosed neurological disorder, has led some skeptics to claim that RLS is a made up condition so that they can sell more drugs.

Restless legs syndrome is a common, (around 10% of the population) where, people suffer uncomfortable sensations in the legs, often arising at rest or in the evening and which is relieved by movement(walking, kicking, or rubbing). If severe, people just cannot keep still long enough to fall or stay asleep. It is a leading cause of sleep deprivation. Despite its prevalence it is poorly understood and often misdiagnosed by GPs. Why?

Dr P Stillman, a GP, explained at the meeting that the main reason for this is that individual patients suffering from RLS do not give a standard description of the sensations they may be experiencing. Descriptions given by RLS patients include “the heebies- jeebie”s, “electrical current”,” coca cola bubbling in the vein”s, “ants crawling”, “itchy bones”. In addition, they complain that they go when they keep moving and that they can’t fall asleep.

Often, the immediate reaction by a GP is of disbelief. Alternatively, they may think the real complaint is ordinary insomnia, a common symtom of depression and they reach for the prescription pad for sleeping tablets and antidepressants which themselves can make the symptoms worse!. There are usually no obvious clinical signs, and no simple diagnostic testing is available.

An excellent resource for medical practioners wanting more information is here http://www.jr2.ox.ac.uk/bandolier/booth/booths/RLS.html).

There is a British patient support group founded and run by Eileen Gill since 1988 (http://www.ekbom.org.uk/). Before the advent of the World Wide Web, Eileen used to run adverts in magazines for RLS sufferers and she stated that to date she has sent out information packs to 25,000 worldwide.

Off With the Pixies in Penzance

2007-06-04T14:38:00.000+01:00

The self-imposed insomniac, Tony Wright, from Penzance, who I mentioned in my blog of 22/5/07, apparently succeeded in his 11 day record attempt for voluntary lack of sleep on Friday. According to the BBC report (http://news.bbc.co.uk/1/hi/england/cornwall/6690485.stm ) of his experience, Tony reported seeing Cornish Pixies dancing on his computer screen from day five. And apparently this wasn’t a swanky new screensaver – remember the Ally McBeal dancing baby screen saver? So cute.

No, apparently Tony was hallucinating, which is a very common symptom of sleep deprivation. This certainly sounds worrying, and apparently concern for supposed health risks have lead to Guinness refusing to recognise attempts on this record – this from the book that records the world’s most obese man, the most cosmetic surgery and the longest sword swallowed!

Apparently Tony was trying to prove some theories of his about natural food diet and being able to allow separate brain hemispheres to sleep, like dolphins have been found to do. However, interesting theories though these are, without any proper monitoring we really don’t know what was going on inside this young man’s head during the attempt, or whether the dolphin-brain split was any more real than the pixies.

Anyway, apparently, the whole 10 or 11 day record is a bit of a waste of time anyway, as I found this report in a newspaper from Thailand http://www.thanhniennews.com/features/?catid=10&newsid=12673 about a 64 yr old man, Thai Ngoc, who is reported to have gone without sleep for over 30 years following a fever. According to the report he suffers no ill effects at all. Now he would be an interesting subject for study.

Sleep Issues Go Mainstream – At Least in the USA

2007-05-30T14:12:00.000+01:00

People sometimes ask me – often relatives if I’m honest – about Sleep Care, where the idea came from and more importantly why I am confident that it will succeed. Let’s face it, any new venture is risky, but then as author Neil Gaiman said “Life is a disease, sexually transmitted and fatal”, so you have to put risks in that context!

However, an article in Sleep Review http://www.sleepreviewmag.com/sneakpeek.asp
gave me more ammunition to defend my choice of a venture to help people sleep better. It reports that sleep issues beginning to rise higher in the public awareness, and that the total ‘sleep market’ is predicted to treble over the seven years to 2011 to $4 billion! The report goes on to quote a survey of unmet need, for example only 20% of sufferers of the highly treatable sleep condition OSA (obstructive sleep apnoea) are even diagnosed.

Even more encouraging is the finding that more primary care physicians (‘GPs’ to you and me) are recognising and referring sleep disorders. Given the awful levels of awareness and training of GPs in sleep disorders (one study showed that medical students averaged 1 hour in their 5 year medical degree course!). At the same time sleep centres are closing the gap at their end, by targeting patients directly.

It is said that for many trends the UK is 5-10 years behind the US – well, in the case of poor public awareness of the importance of good sleep, all I can say is: No, not if Sleep Care has anything to do with it.

Rising to the Challenge of Jetlag using Viagra.

2007-05-29T23:51:00.000+01:00

A recent study in the prestigious science journal Proceedings of the National Academy of Sciences about the treatment of jetlag has had the media standing to attention!

Apparently researchers in Argentina have found that when Eastward travel jetlag (technically called advanced phase syndrome) was artificially induced in hamsters by turning on the lights in their cage six hours earlier, a dose of Viagra allowed them to adapt to the shift in their body clock twice as rapidly as control animals.

Now I know that the smuttier members of my readership may suggest alternative explanations to this; for example, they didn’t adapt to the jet lag, they just wanted to get up earlier to enjoy the benefits of the drug! However, the effect was not repeated for Westward-style jetlag (delayed phase), and in fact the effect remained when the dose of drug was too low to have any effect on sexual function.

The scientists who conducted the study suggest that the effect is due to the fact that Viagra blocks an enzyme which is important for speeding up the body clock, but not for slowing it down. The effect did not occur in the absence of the earlier light cue.

What does this suggest for humans? Well like any animal study, you can’t automatically extend the result to humans – our body clocks probably have many similarities, but may have differences too. Eastward travel is usually more difficult to adapt to, so this work does suggest an interesting prospect of Eastward drugs and Westward drugs. However until then, travellers can always get our advice article to keep them going!

Sleep is the new sex – or is it?

2007-05-24T17:14:00.000+01:00

My husband Phil tells me that there was an item on radio 4’s Today programme this morning (13 min. into this recording)about Arthur Spielman’s pronouncement that “Sleep is the new sex – we all talk about it, everybody thinks they’re not getting enough and that everyone else is getting more than us”. He contends that. like sex, we talk about it more now than earlier generations did.

In the programme, Prof. Jim Horne of the Sleep Research Centre at Loughborough University was doubtful about the supposed changes in our sleeping patterns over the years. He cited the popularity of sleep-related adverts in Victorian newspapers, and quoted a British Medical journal editorial from the 1890’s talking about eh fast pace of life ‘nowadays’. Prof Horne believes that our modern society is probably no more sleep deprived than out great-grandparents’.

However, I’m not really sure that this is the important point. It may or may not be that our lives are faster paced, and with more night-time distractions than 100 years ago. But to me, as a sleep counsellor helping people in 2007, what I know is that many, many people suffer from the effects of insomnia. Ten million sleeping pill prescriptions a year serve as testament to this, and also to the poor management of many insomniacs by some GPs. Sleeping pills are a short-term fix only, as many research studies have shown, talking therapy is the way to get lasting relief from insomnia, not a pill.

Is sleep the new sex – or has is always been? It really doesn’t matter how much your neighbour or your grandfather got. For the individual, as long as you are getting enough, you’ll be alright!

Sleepless in Penzance

2007-05-22T15:23:00.000+01:00

Right through last week, and for the rest of this week, Tony Wright, from Penzance in Cornwall on the South Coast of England will be trying to stay awake.

His goal is to break the world record for sleep deprivation without the use of stimulants, which was previously set in 1964 by 17 year old Randy Gardner, an American high school student, who stayed awake for 264 hours (11 days and nights) as a science project. History does not record what grade Randy was awarded for his project!

It’s difficult for anyone who hasn’t experienced the effects of prolonged sleep derivation at first hand to appreciate the difficulty of the task. My husband is one of the generation of doctors who experienced the ‘good old days’ of 96 hour weekends – working without a break from Friday morning to Monday evening. He tells me that on a busy weekend, by the early hours of Sunday morning, he would sometimes struggle to remember his own name when signing prescriptions – a fact which most of the patients at the time were blissfully unaware of!

The effects on memory and thought processes of sleep deprivation are well established. The 1989 Exxon Valdez oil tanker disaster off Alaska, the Challenger space shuttle explosion and the Chernobyl nuclear accident have all been put down to human errors in which sleep-deprivation was a major contributor.

So what are we to make of Tony’s record attempt? Well, it’s not clear that it will really add anything important to the science of sleep. Watching a video of him after 7 days without sleep, he does seem to be bearing up remarkably well. His online diary does admit to some ‘near misses’. Without continuous EEG monitoring, it is impossible to say how much he is in fact lapsing into micro-sleeps, some of which he will be aware of, but most of which he probably won’t notice.

However, it would be churlish to downplay the guts and sheer determination that it takes to attempt a record like this. So I say – well done Tony, but for goodness sake, don’t drive home afterwards!

Don't drive tired! UN Global Road Safety Week 23 -29th April 2007

2007-05-10T14:36:00.000+01:00

I was out travelling on the M1 last weekend to see friends in Derby. I noticed signs at the motorway services stations that it was Road Safety Week. As I'm passionate about helping sleepy drivers become safe drivers once more, I "googled" it and to my surprise it was an United Nations sponsored initiative rather than a British one. Not only that, it has come and gone! That has gone under my radar, that one. The British road safety week organised by BRAKE , a charity, is scheduled for 5-11 November 2007

Despite the likes of me going on and on about it, it seems that the message is still not getting across to the majority of people that driving whilst sleepy is dangerous and irresponsible. I suppose that we need to accept that these kind of message take a while to filter through to the public consciousness.

Thirty years ago drinking and driving was a bit of a trivial issue – “Don’t drink and drive – you might spill it!” Now most people see driving under the influence as socially unacceptable. However, there still seems to be a macho image of ‘handling’ sleepiness or just getting on with it. This will change.

Driving whilst tired causes at least as much loss of motor co-ordination and judgement as drinking alcohol. Fortunately, the authorities are taking the matter more seriously. We all remember the Selby rail crash where the tired driver ran his car down a railway embankment causing a derailment. A case was reported recently of a lorry driver diagnosed with sleep apnoea (OSA) who refused to use his CPAP treatment, but carried on driving despite being chronically sleep deprived due to his untreated OSA. He is alleged to have fallen asleep at the wheel and killed a mother and son after his lorry crashed through the central barrier of a road and crushed their car coming in the opposite direction.

Apparently, police say that drivers who fall asleep at the wheel do not swerve at all, and eyewitnesses ' report and tyre track marks provide evidence for this. Having a diagnosed sleep disorder does not give an affected driver an excuse in the eyes of the law.

Driving tired is like driving drunk – don’t take the risk.

‘Real Men’ Sleep Better

2007-04-26T16:58:00.000+01:00

There was at one time a macho saying going around “Sleep is for wimps”. However, a recent study shows that actually the opposite may be the case – the more macho a man the better his sleep.

Ok, so the study didn’t actually macho men sleep better, but it did show that men who sleep better have higher testosterone levels than sleep deprived men. We know that testosterone, the male sex hormone, responds to levels of stress and other factors in a man’s life. It is also known that testosterone levels tend to drop as men get older.

In this study from University of Chicago, a group of healthy volunteers had the depth and length of their sleep measured in a sleep lab, and then had tests the next morning to measure the levels of testosterone in their blood. The quality and quantity of sleep was found to predict the testosterone levels.

What isn’t clear from this study is which was cause and which effect – did a good night’s sleep cause testosterone levels to rise, or did higher testosterone levels help men sleep better?

Whichever way around it is, I think it’s safe to say that sleep is definitively NOT for wimps!

British Sleep Society meeting April 17th & 18th 2007 Part 2

2007-04-25T11:57:00.001+01:00

I attended 3 workshops and 5 lectures. The 2 most interesting lectures I felt were on “Parasomnias- the spectrum of things that go bump in the night” ( a quick review of abnormal behaviour during sleep such as sleepwalking, night terrors etc) given by Paul Reading of James Cook University Hospital in Middlesbrough and on “Psychological Approaches to Sleep and Insomnia Management” by Kevin Morgan of Loughborough University. The latter of course, is the bulk of what I do as a sleep counsellor with Sleep Care, and therefore of most interest to me personally.

In this presentation, he gave a summary of why chronic insomnia develops. He defines Chronic Insomnia as insomnia reported by the patient which is persistent i.e. 3 incidences a week for the previous month resulting in having a detrimental effect on the patient, for example, social withdrawal or poor performance at work. Interestingly enough, according to Morgan, 80% of people with insomnia do not experience either subjectively or objectively excessive daytime sleepiness.

The latest scientific outlook, nevertheless, is that insomnia is best understood in terms of:-
1) Predisposing factors- such as whether you are an older female who tends to be anxious outlook on life,
2) Precipitating factors- such as distress due to bereavement, pain e.g. from arthritis, environmental change e.g. house move.
3) Perpetuating factors – unhelpful activities, e.g. spending longer in bed than necessary, competing nightime demands e.g. overactive racing mind, and maladaptive learning.

Morgan describes maladaptive learning as “‘normal learning’ unlearned”. This is most relevant to the treatment of chronic insomnia by psychological means. Chronic insomniacs ‘learn’ to associate night time and being in bed with being wakeful. The key approach to helping such people overcome chronic insomnia is to facilitate them to re-make the connection with being in bed at night with being asleep.

This is exactly what I what I do when sleep counselling with insomnia. It takes time and involves “coaching” the patient to acquire thoughts and behaviour that is compatible with sleeping well at night. It is just not about dispensing advice and expecting the patient to change overnight just like that. We are creatures of habit after all.

If you have any comments on this approach to managing chronic insomnia, I would love to hear from you.

Here to sweet dreams tonight. :-z

British Sleep Society meeting April 17th & 18th 2007 Part 1

2007-04-19T22:50:00.000+01:00

I have just arrived back from an excellent conference organised by the British Sleep Society (www.sleeping.org.uk )at Loughborough, a multidisciplinary membership body comprising of people involved in sleep such as:-

psychiatrists
psychologists
chest physicians
sleep physicians
physiologists
polysomnographers (specialists in setting up and interpreting sleep studies involving EEGs and other biological data like heart rate, muscle tone, oxygen levels)-to name but a few.

It was great to meet up again with people I had met at previous meetings, in particular Lyn Davies of Stowood Scientific Instruments (www.stowood.co.uk), supplier of EEG and sleep monitoring equipment to hospitals and sleep centres all over the UK. What he doesn’t know about such instrumentation and sleep analysis software isn’t worth knowing. Last year he gave such a wonderful karaoke rendition of Tom Jones’ “Delilah” at the evening social, that he was persuaded again by popular demand to give an encore. Wonderful stuff!

I also have had the pleasure of making new contacts, in particular, Delphi Ellis, (a qualified therapeutic counsellor) from Bedford. Dreams feature so strongly in her counselling sessions and because of her ability and skill to interpret her clients’ strange and sometime nonsensical dreams sensibly and therapeutically for them, she has carved out a niche for herself and calls herself a Dreamologist. She struck me as a wholly professional and ethical counsellor. She has her website here (www.DelphiEllis.com).

In my next blog I’ll describe briefly the workshops and presentations I attended. There’s too much to describe all in one blog entry. I don’t want to send you to sleep, do I? Well, perhaps I do, if you are an insomniac looking for a quick fix. :-)

I Fall Asleep When I Try To Meditate

2007-04-17T15:38:00.000+01:00

In a recent blog, the author, Sanjay Agrawal, talks about a common complaint amoungst people who are starting out with meditation - that they often fall asleep as they relax. This is perhaps an annoying thing to happen when you're trying to learn a new skill, and I suppose could be rather embarrassing if you're practicing your meditation during a coffee break at work - to be discovered by workmates, snoozing away in the corner of the staff room!

However, as Sanjay points out, this common problem is just a sign that you are paying off a sleep debt (which most of us in today's busy world tend to have), which can hardly be a bad thing. And since at least part of the point of meditation is to relax and be rejuvenated, a short kip will achieve this just as well as completing your visualisation or mantra, or whatever meditation method you have learnt.

The thing that really struck me about this blog though, was the way an unwanted 'side effect' in one context can be the main purpose of a therapy technique in a different context. In my clinic, I often get people who have difficulty initiating sleep (in other words, difficulty falling asleep rather than difficulty staying asleep). In this situation, anxiety is often the culprit, and a great way of dealing with this is by teaching the clients relaxation techniques, like meditation.

For these people, falling asleep during meditation is the goal, not the problem. Maybe I need to find out what Sanjay's clients are doing 'wrong', and teach it to my clients!

Men and women’s sleep.

2007-04-10T23:34:00.000+01:00

A couple of interesting articles caught my eye today – both on the same theme, but almost opposite in conclusion.

In the first, a survey was carried out by the University of Vienna and reported in the New Scientist on men and women’s experiences of sharing a bed. Apparently they found that men tend to sleep more lightly and feel less refreshed when they share a bed, whereas women tend to sleep better with a bed partner.

The second study is from womenshealth.gov in the States where they found that almost twice as many women suffered from insomnia as men. They suggested that a social difference, such who is more likely to get up to look after children, was part of the reason. Other factors included medical issues like pregnancy and menopause. Also, since fragmented sleep, which is often seen as insomnia, becomes more common with old age, and since there are more old women than old men, this may be another cause.

However, it got me thinking, if women have more insomnia than men, and women need a bed partner to sleep well – are all the men sneaking off to the spare room for a solitary night’s kip after we’ve dropped off?

It doesn’t seem very likely, but you never know…

Broken sleep lowers pain threshold

2007-04-05T23:45:00.000+01:00

First of all, for those of you who didn't guess, I suppose I have a responsibility to tell you that the previous blog on Sleep Care's new breakthrough sleep medicine 'Ursotonin' was actually an April Fools joke. For those of you who worked it out, well done & hope you enjoyed it. For those who didn't - well maybe you need to get a better nights' sleep!

Today, I'd like to write about an interesting study published in Sleep journal recently (1 April 2007 about the effects of sleep fragmentation on pain thresholds. Interestingly this study showed that those in the study who had broken sleep were more sensitive to pain than participants who go the same total amount of sleep, but without breaks. We know that some pain syndromes, especially fibromyalgia, are associated with poor sleep. It may also be that other painful conditions might be improved (if not cured) by improving sleep.

Why the fragmentation of sleep is more important that the total length is unclear, although we do know that sleep occurs in regular cycles (each lasting roughly 90 minutes), so whether disrupting this affects the natural pain control mechanisms of the brain (the opioid and enkephalin systems) is anyone's guess.

It is clear that broken sleep lowers your pain threshold and may lead to other health consequences, which more research will hopefully reveal. I wonder if the quantity or quality of sleep affects gullibility?

Breakthough sleep medicine announced - ursutonin

2007-04-01T12:01:00.000+01:00

Scientists at the Sleep Care laboratories in North London announced a new completely natural, sleeping medicine ursutonin; based on a traditional native medicine, used by Inuit (Eskimo) tribes during their customary winter hibernation.

Melatonin is a natural sleep hormone, produced in the pineal gland at the base of the brain of most mammals. Human melatonin is used by many people as a remedy for jet lag. Although melatonin produced by different species is similar, there are subtle differences. Animals with long periods of hibernation tend to produce larger amount and more potent forms of melatonin.

For many years, anthropologists dismissed stories of Inuit (Eskimo) tribes' winter hibernation as myths. However, research by Portuguese scientist Prof. Abril Tolo confirmed that traditional peoples living in the far northern parts of Canada and Siberia used a potion derived which included extracts from the pineal glands of polar bears. Scientists were able to extract the active ingredient - a highly potent form of melatonin, called ursutonin - and reproduce it artificially in the laboratory.

Linda Zack, Sleep Care managing director said "We're really excited about this new medicine, which could allow sleep deprived people to sleep for a whole weekend, or even a week, and completely catch up with their sleep debt."

"In the northern reaches of the arctic circle, winter temperatures can drop to minus 60 Celsius and food is scarce," explained Prof. Tolo, anthropologist at Lisbon University "traditional Inuit tribes used polar bear extracts to induce deep sleep lasting several weeks at a time."

Sleep Care medical director, Dr Philip Zack said, "We hope to have this medicine through the safety trials and on the market within 2 to 3 years. It has taken us several years of hard work to get to this point, and we look forward to making this incredible product available to everyone."

Sleeping pills are good for you?

2007-03-30T20:42:00.000+01:00

People sometimes misunderstand the mission of Sleep Care and think that we are ‘anti-sleeping pills’. Actually this is not true at all – at Sleep Care we are FOR sleeping pills, but only when used appropriately.

A case history illustrates the point. I saw I young man some time ago, who attended the clinic suffering from chronic insomnia of several years duration, which was driven by a variety of factors (as is usually the case), but one of the main things was anxiety about his job, which was a high pressure sales job with targets to ‘meet or die’. When I saw this chap in my clinic, he was exhausted. Chronically sleep deprived, he had got into a vicious cycle of sleeping poorly, struggling to cope at work due to tiredness, and then being unable to sleep because he was worried about his work. He had seen his family doctor, and received a prescription for hypnotics (sleeping pills), but used them on an occasional basis – a night here and a night there – whenever he got desperate! He really didn’t want to get dependent on them to sleep, and so avoided taking them as much as possible.

In this situation, my client was almost falling asleep in front of me in the clinic – I wasn’t surprised he couldn’t function at work! Something had to be done to break the cycle, and so, much to his surprise, I told him to take his sleeping pills every night for a fortnight, and then come back to see me. He was reluctant, and said he was worried that he might become addicted to them, until I explained that this was a temporary measure aimed at getting him off them in the long term. Eventually he agreed (reluctantly). A fortnight later, and a new man walked into my clinic, bright, alert and full of beans. Now, I told him, we could work on normalising his sleep habits, getting him off the pills and back to sleeping naturally. Over the next two weeks, he tailed off the pills, while putting in place my advice on sleep and relaxation techniques.

As I try to tell people, hypnotics have a place as short term measure. Beyond 2 or 3 weeks, they become less and less effective, but to break a vicious cycle they can be a godsend.

Sleep Apnoea video

2007-03-28T23:15:00.000+01:00

It can be difficult to really describe what happens when a person has sleep apnoea or at least to really get across the seriousness it the condition. But this short video, posted on the video website YouTube demonstrates it beautifully (perhaps not quite the right adjective, but you know what I mean!).

In this 2 minute clip of an overweight middle aged man undergoing an overnight sleep study, we see him go through 2 cycles, which he probably continues to have all though the night – every night!

In the video, we see this man wired up for the night lying on his back (which makes snoring & sleep apnoea worse) snort & snore for a few seconds and then go quiet. Watch the video closely for the next 30 seconds or so and you can see his chest continues to rise and fall, but no air is moving in or out of his mouth or nose – his upper airway is blocked by the slack muscles of his throat. After about 30 seconds, he rouses from deep sleep into light sleep, his throat muscles tighten and he snorts & breathes for 10 or 20 seconds. Having replenished his oxygen supply, he slips back towards deep sleep, the throat muscles loosen and the cycle of futile chest movements against a blocked airway repeat.

Watch this video and it’s not difficult to see why people with sleep apnoea feel tired all day, keeping up this kind of performance hundreds of times a night – just try holding your breath along with the man as you watch the video, if you don’t believe me!

Finally, if you look really closely at his chest in the video, you can actually see his heart straining to cope with the lack of oxygen too – see the pounding in his left chest just above the chest strap. No wonder sleep apnoea leads to medical complications too. The risks of strokes, heart attacks, hypertension, and diabetes are known to be magnified in the untreated apnoeic patient.

Take home message of this video is that if you or your partner is doing anything similar to this at night, get help – you’ll feel better and be healthier if you do.

The $50,000 bed

2007-03-15T17:20:00.000Z

According to several news reports, (e.g. CNN) an american company has just brought out a luxury bed for $50,000 (£26,000). The same report goes on to say that bed manufacturers have woken up in recent years to the demand for luxury beds & matresses, with 21% of American bed buyers willing to spend over $1000 ($520) on a new bed in 2005, compared with 14% in 2000.

So, do you think I'm going to suggest you should spend $50,000 on a new bed? Well, if you're a millionaire and find the Vividus bed comfortable, then why not. But then if you're wealthy & fancy a pair of Jimmy Choo shoes, I would say 'go for it', but do you need a pair of hand made shoes to have comfortable footware? Of course not.

'How much should you spend on a bed?' is a question I'm sometimes asked. However, I think that's the wrong question. I believe that people should value the imporance of a good night's sleep, and that means getting a bed that allows you (and your partner if you sleep with someone) to sleep well. I just replaced my pillows after about 6 months, and really noticed the difference, as the old ones were getting saggy and not supporting my head well. I feel better and more alert as a result.

Did I buy silk lined, goose down pillows at £120 each? No, I got a pair of £5.95 synthetic filled pillows at the local supermarket. But - and here's the key - I fluffed & plumped my way through their whole selection, until I found a pillow that suited me. And that's the key - get a bed that really suits you (and your partner). If you're buying a bed it's the investment in time and effort that matters at least as much as money - lay on bed, roll around, & be really fussy.

If you can afford a £26,000 bed and it gives you a great night's sleep - fine. But if you sleep well on a £500 divan, that's great too.

Coffee and naps work together.

2007-03-09T17:14:00.000Z

Ever been tired but needed to carry on – who hasn’t? So in that case should you have a nap or a cup of coffee? A cup of coffee will give you a kick of about 100-200 mg of caffeine – a brain stimulant which takes about 20-30 minutes to take effect and lasts for several hours. A nap will provide you with a short burst of stage 1 or 2 sleep giving a boost to concentration. If you’re really sleep-deprived you may even dip into REM sleep for a few minutes.

Luckily for all my indecisive readers (I used to be indecisive, but now I’m not so sure!), the latest research suggests that you don’t have to choose – both work. A study from France looked at the driving performance of young fit men during the day and at night. Performance was measured counting how often the car drifted across a line on the road. They found that, compared to placebo (decaffeinated coffee) drivers who took coffee were about 3½ times less likely to cross the road markings and those who had a 30 minute nap were about 3 times less likely. What they didn’t do, which I think would have been more interesting, was to measure the performance of those given a nap AND coffee.

There have actually been a number of laboratory based studies which have shown that coffee and napping work together to produce a combined effect better than either one alone. So if you’re tired but need to perform, take my advice, have a ‘caffeine nap’. Drink something containing caffeine (coffee, cola etc) then take a short nap while the caffeine kicks in. But do remember, even this is a temporary fix – if you’re not fit to drive or work, don’t.

Losing sleep from snoring

2007-03-08T21:35:00.000Z

Snoring is the butt of many jokes, like this one:

Q: Why do black widow spiders kill their mates after love-making?
A: To stop the snoring before it starts.

However, in reality snoring is a really common condition - it affects about 1/3 of adults, and it can be a major problem. Severe cases of airways obstruction have direct effects on the health of the person affected (a condition called obstructive sleep apnoea or OSA). However, for the majority of people, the main effects of snoring are second hand. For most people, snoring doesn’t affect their health or disturb their sleep, but it does affect the health and sleep of their bed partner. The health effects of snoring are contagious!

According to a recent survey the average bed partner of a snorer loses 2 hours of sleep a night – equivalent to 2 years of sleep in an average long term relationship.

It can be difficult to persuade a person who snores of the severity of the effects of their condition on their long-suffering partner. In my experience, a voice activated tape recording can be worth its weight in gold!

Does sleep deprivation make you a bad person?

2007-03-02T10:36:00.000Z

A fascinating study published this month looks at the effect of sleep deprivation on moral judgements. The study was conducted by a US military institute, but has more general interest for anyone who has to make decisions with a moral element whilst sleepy. Volunteers were asked to decide on appropriate course of action in three moral dilemmas when they were well rested and after 2½ days without sleep. What they found was that when sleep deprived the subjects took longer to reach a decision and found it harder to do so.

Moral decisions are interesting because they are not purely logical or purely emotional, but a combination of the two. This means that the brain has to bring together different types of information and find some way to reconcile them. Because of this, moral decision making tends to be affected more than other types of thinking like mental arithmetic or artistic appreciation.

So does this mean that tired people are bad people? Clearly not.

People who are sleep deprived do not lose or change their moral sense or moral code, but it does make it more difficult for people to exercise ethical choices when tired. Bad people are still bad when they’re tired, but good people may find it more difficult to tell good from bad when they haven’t slept well.

Kids that go bump in the night – or childhood parasomnias

2007-02-22T19:17:00.000Z

According to a recent article in the journal Sleep, parasomnias are much more common in children than have previously been recognised. “Para-what-ias?” I hear you say! Parasomnia is a collective term for those unusual behaviours that people can exhibit during sleep such as sleepwalking, night terrors and confusional arousals. They are often thought of a rare, but are probably much under-reported to doctors, as people who are affected (and their loved ones) often just put up with them.

Night terrors in particular can be very frightening for the parents, as the child will appear to wake shouting and screaming in terror, but actually the child is asleep. Some people misinterpret night terrors as nightmares, but again this is incorrect. They do not usually occur in the dreaming part of sleep (REM), and the child remembers nothing of the event. Night terrors usually settle as the child gets older, and the main task of the sleep specialist is to reassure the parents that the child is not suffering from some terrible nightmares or worse.

Other parasomnias, particularly sleepwalking, can start in childhood and continue on into adulthood, and sleepwalking in particular seems to have a hereditary component, as parents often report sleepwalking too. Like with adult sleepwalkers, the condition itself is benign, but people need to be protected from harm during the sleep walk.

It is important to raise awareness of Parasomnias, and given the worry they cause parents, it is reassuring to know that they are not as rare as was previously thought. Parasomnias are not a sign of madness, deep psychological upset or portents of dooms!

For your Valentine – Stop snoring and improve your love life.

2007-02-15T18:00:00.000Z

Studies have shown that snoring can hurt marriages. The wife tries to fall asleep as the snorer lies apparently oblivious to the deafening rumblings emanating from his mouth. She may seethe with frustration and resentment. More often, than not despite frequent elbow nudges to shut him up, she may be forced to retire to the couch in the lounge. Some snorers are so loud that even moving to another room doesn’t help. No wonder their sex lives can go down the drain. The wife will be exhausted from chronic sleep deprivation and will not find the husband attractive after what she has been put through.

Furthermore, if the snorer has sleep apnoea, a medical disorder caused when the soft tissue in the back of the throat collapses during sleep, and is not treated, it can make matters worse. It makes people very tired during the day as it prevents people from entering into a deep sleep. Left untreated, the oxygen deprivation caused by sleep apnoea can cause high blood pressure, heart disease, stroke, memory problems, mood swings and impotence.

Snoring and sleep apnoea can be treated. Options include weight loss, alcohol avoidance, and surgery, dental devices (aka mandibular advancement devices) to open up the airway, and continuous positive airway pressure (C-PAP) machines. The nasal masks worn for CPAP may not be sexy, but it does wonders for a flagging libido.

Show your Valentine your love. Get help in finding the best way to stop snoring. You won't regret it. ;-)

Sleep Deprivation Makes Children Fat.

2007-02-07T16:17:00.000Z

According to a recent article in the Metro, a study has just been reported from Northwestern University, Illinois. It confirms from direct observation of children, what we would expect from our emerging knowledge on sleep and appetite hormones on adults (see my blog on this from October 06 : http://sleepcare.blogspot.com/2006/10/sleep-deprivation-and-obesity.html).

In a study of 2000 children from 3 to 13, it showed that the more sleep deprived the children, the higher their chances of becoming obese, in addition to the effects on behaviour, mood and school performance. An extra hour in bed reduced the risk of a child being obese by around a fifth (from a risk of 36% to 30%).

Sleep scientists are constantly learning about the complex functions of sleep and the effects of sleep disruption on our health and well-being. For those of us who already understand the vital importance of sleep to a long and healthy life, each new revelation is a welcome piece of ammunition to 'fight the good fight'.

Children need up to 11 hours of regular sleep, and teenagers may need 9 or 10 hours (often shifted to late bedtimes & late rising). But all children need more sleep than adults - bedtimes matter!

Waking up to sleep in France

2007-02-01T21:52:00.000Z

A speech by the French minister of Health, Xavier Bertrand, was reported yesterday. In this he unveiled a major new public health policy in France to make the prevention and treatment of sleep disorders a national priority. Of course, some newspapers tried to trivialise this, but focussing on his recommendations that people consider taking a short afternoon nap to improve productivity, but actually if you look at the speech:(www.sante.gouv.fr/htm/actu/33_070129xb.pdf – en Français seulement!), he actually has suggested an awareness program for the general population, education for GPs, a reorganisation of sleep centres and further funding for sleep research.

Like Britain, and most other Westernised countries, sleep disorders and their medical and social consequences are at epidemic proportions – hundreds die on our roads every year due to tiredness, many more die from medical complications of poor sleep. And that’s not even mentioning the largely avoidable depression and general reduced quality of life. So I say ‘très bien Monsieur Bernard’, and come on Britain!

Could you sleep for money?

2007-01-30T14:33:00.000Z

A blog from Relax and Sleep tells the story of an American TV show called Truth or Consequences that once offered a contestant $5000 if they could go to sleep at a particular agreed time. Apparently they were allowed to spend two weeks preparing by getting themselves tired and sleep deprived, but of course, come the big day, the contestant couldn’t fall asleep on demand, and the show’s money was safe.

For anyone involved in treating people with insomnia, this story has a familiar ring, although I for one don’t offer clients cash prizes to fall asleep! The reason why the Truth or Consequence contestant couldn’t win the prize was, of course, because the whole process of falling asleep requires relaxation and psychologically letting go, and making it a big event with lots at stake would tend to be a very strong force preventing relaxation and letting go. The two week ‘preparation period’ probably made the challenge even harder, by giving the contestant a longer time to think about the importance of having to fall asleep on that day.

This seems like a paradox, but falling asleep is one of those activities where active, conscious effort tends to impede rather than help. For this reason I sometimes use what is known as a ‘paradoxical assignment’ with people who have got stuck in a cycle of building up the importance of sleep and ‘trying’ to make themselves fall asleep. The paradoxical assignment consists of giving them an instruction that they MUST stay awake every night (perhaps until a particular time, like 1am). Strangely, a lot of chronic insomnia sufferers find that they are unable to achieve this goal – oh well, at least they tried!

Air crew sickness – permanent jet lag?

2007-01-25T14:37:00.000Z

A big story in the news at the moment is the decision by British Airways air crews to go on strike is in the news at the moment, due to a number of issues, but chiefly due to management attempts to control sick leave which is claimed to be excessive. According to reports, BA crews’ annual average sick leave has been brought down from 22 to 12 days over the 18 months, but is still above the national average of 7 days. However, this is an average figure for all occupations in the UK, and like any average there will be variations on either side of the average. We wouldn’t expect, say, accountants to take the same amount of sick leave as miners; or at least we wouldn’t expect them to take leave for the same sort of problems.

So the first thing that I wonder about this news report is how do the BA sickness figures compare with comparable figures from within the same industry? If BA crew take more sick leave than the air crews’ average this might mean something. But comparing a particular occupation with the national average for all occupations is comparing oranges and pears.

I’ve done a quick Google search, but can’t find specific figures for average sick leave amongst air crews. However, I would expect them to be higher than the national average due to the effects on air crews’ working environment on their health. Air crews work in cramped conditions, breathing extremely dry, often recirculated, air (which dries out a person’s airways, leaving them vulnerable to infection). However, more importantly, is the effects of shift patterns and constant jet lag on the crews’ body clocks, which will have a knock on effect on their bodies' hormone balance and immune systems.

If you want to know more about the effects of Jet Lag and how to minimise it, Sleep Care has a free leaflet, that you can download: http://www.sleepcare.co.uk/DownloadGateway.htm

Sleeping your way to happiness – if you’re British!

2007-01-17T22:11:00.000Z

An interesting study looked at differences between American and British people’s attitudes, and in particular what they felt made them happy.

Americans, perhaps predictably, listed things like fame, fortune and staying slim (ironic given the obesity epidemic currently sweeping the US). But the British top tips for happiness were being married and getting enough sleep! Avoiding obesity came 7th on the British survey.

Does this mean that the British are more level-headed and sensible than their American cousins, or that Americans are too concerned with the superficial fluff of life? Frankly I don’t know that a survey like this can answer that question, which sounds anyway rather like pandering to hackneyed stereotypes.

But I think it is interesting, and from the point of view of Sleep Care, reassuring that ordinary people, at least in the UK, recognise the importance of sleep for quality of life. Well done Britain!

Learning while you sleep

2007-01-10T17:03:00.000Z

The massive growth in the wellbeing and self improvement industry has spawned a plethora of products that promise benefits and improvements without you having to put any work or effort to achieve change. Among these are products that claim that learning while you sleep is the easy way to learn languages or to cram for examinations. Do they work? Below is an excerpt from this online article:

Dr. Jerome M. Siegel, a professor of psychiatry at the Center for Sleep Research at the University of California, Los Angeles, said that most research he has seen indicates that subliminal sleep learning is of little or no value because “the sound had to actually wake you before you would benefit.” Dr. Siegel recalled rigging a speaker system under his own pillow in junior high school in a failed effort to learn French. “Even when you’re sleepy, but not asleep,” he added, “you don’t learn very well.”A study in 1992 by the British Psychological Society dismissed the concept of sleep learning, finding that it can “only occur if the sleeping person is partly awakened by the message.” But such findings did not kill off interest in the concept and its seductive, something-for-nothing allure.

Powernapping and sleep in general promotes learning as shown by several scientific studies such as this. In my opinion, subliminal sleep learning is no subsitute for regular, persistent good quality study habits in conjunction with good sleep habits. Yes, I'm a cynic!

For those preparing for examinations, ensure you do not become sleep deprived in the run up to exam day. I know how tempting it is to cram overnight- I've been there-but you'll remember more and perform better if you are well rested. I believe in not doing very much the evening before the exam. You'll wind down properly and be more relaxed at bedtime. Thus, you'll fall asleep more easily than if you try to swot right up to lights out. Sweet dreams.

Happy New Year – getting back into synch

2007-01-05T17:58:00.000Z

Well it’s the end of another long winter holiday and the struggle to get back to work is upon us! If you’re anything like me, the holiday has been a time to watch late films, and pay back some sleep debt, as well as eat and drink a bit too much.

So now, I’ve spent a week getting used to going to bed at 2am and sleeping in till 10, but work’s now upon us and the adjustment has to be made. The technical name for this slippage in my (and probably millions of other people’s) body clock is delayed phase syndrome – the phase of the circadian rhythm has been delayed, so you’ve got used to going to bed later, getting up later, maybe even having your meals later. It’s a bit like being jet lagged without having travelled anywhere.

Fortunately, it’s readily fixable. To reverse a delayed phase, you obviously need to gradually shift your body clock back to its normal time by going to bed earlier. However this is easier said than done. If you’ve got used to going to bed late, getting up early is going to leave you feeling like a nap – resist that urge! It’s important to make sure that when you get to bed at your usual bedtime you are tired enough to drop off. So the trick is to fix your getting up time and then force your bed time to swing back into place by allowing yourself to build up a small sleep debt.

I know what you’re saying – "but I’ll feel miserable and tired getting up early after a late night." Luckily there are means of boosting your alertness to minimise this feeling. A cup of coffee is a good short term perk, but I would especially recommend light therapy. By exposing yourself to a very bright light for 15-20 minutes in the morning, you’ll switch off the sleep hormone, melatonin, and feel bright and alert. It really works! Sleep Care sells a really convenient little portable light, ideal for this purpose.

So come on, let's get back to it, and make 2007 a great year!

Winter Solstice – at Last!

2006-12-23T00:31:00.000Z

Firstly, I need to mention that I’ve been ill for the last week with what has to be the weirdest bug I can remember. Not only did it knock me (and the whole family) for six, it seemed to work backwards compared to all other winter bugs I’ve had before – starting with a miserable bronchitis-cough and ending with a running nose. And it caused primary insomnia to boot! Although I felt exhausted, and deliberately didn’t nap during the day, myself and my husband found ourselves sat looking at each other over hot, milky drinks at 2 am going “I’m tired but not sleepy!” Either we’d both performed some sort of bilateral insomnia-inducing hypnosis, or this particular bug was doing strange things to our melatonin levels.

Anyway, on to the main part of my blog. You may have noticed that yesterday (21st Dec) was the Winter solstice – the shortest day, and not before time, I say! No, I am not a fan of dark days and long nights, but that’s really the point. From this point onwards the days start to get longer.

As well as interfering with your circadian rhythms, these winter extremes affect many people’s (including my own) moods. In mild cases it’s called the winter blues, in more severe cases a condition like clinical depression can result. This is called SAD (seasonal affective disorder). All I can say is thank goodness for my trusty light therapy unit, and here’s to longer and longer days from here until the mid-summer (21st June).

Girl sleepwalks out of bedroom window

2006-12-15T19:14:00.000Z

A recent article in the Evening Standard describes a nine year old girl who fell from a 10m high (30 ft) loft bedroom window, whilst sleep-walking. Fortunately, young Jasmine Clark was lucky enough to survive with only minor injuries, as her parents had not yet disposed of an old carpet in the front garden, which gave her a soft landing. Her parents were frustrated because the girl had a history of sleep-walking, but building regulations prevented them from putting a window lock on the second storey window, as it was deemed to pose a fire hazard.

There are a lot of myths surrounding sleep-walking. Sleep-walking is a relatively common parasomnia (sleep disorder), which occurs when REM intrudes into non-REM sleep stages, usually in the earlier part of the night. It is not, as some people think, people acting out their dreams. It mostly occurs in children, more commonly in boys than girls, and most out-grow it by their early teens. It often runs in families. People do not typically walk around like zombies with their eyes closed and arms stretched out in front!

Most sleep-walkers move around with eyes open, even though they are still asleep. There have been a tiny number of well publicised cases of sleep-walking murders; and a person awoken from a sleep-walk, like anyone suddenly awoken from deep sleep, can lash out in a confusional state. However, as Jasmine’s lucky escape illustrates, in the vast majority of cases any danger from sleep-walking is to the person doing it, rather then other people.

Sleep-walking is a much misunderstood condition. I can only hope that in this case, the planning department can find a compromise over fitting window locks in Jasmine’s new bedroom – she might not be so lucky next time

Meeting with Dame Anita Roddick

2006-12-13T13:05:00.000Z

Dame Anita Roddick, founder of the Body Shop, has just completed a series of one-to-one surgeries aimed at entrepreneurs and start up businesses at the British Library’s newly launched Business & IP centre in London.When it was announced back in March this year, we applied along with no doubt, hundreds of others. Therefore, it was of no surprise but nevertheless a disappointment when we got a reply that Anita’s advice sessions were over subscribed.

However, at the beginning of November we received an email offering a session with Anita on the 7th December. Someone has pulled out and would we like to come along? By heck, of course, we replied (sic). We were then asked if we could be filmed by a television crew. We hesitated before replying yes. I’m shy and do not enjoy being in the limelight. I hate being in front of a video camera and so does my husband. We even rejected outright the idea of our wedding captured on film when we got married in 1990.

As it turned out, there were no T.V cameras present (phew!) Of course, being on television would have been a fantastic PR opportunity for Sleep Care. We have realised now that we need to overcome our reticence and go for PR in the media as much as possible. We raised this with Anita during our session. She was sympathetic but encouraged us to get on with it.

We left our session energised and buzzing with ideas. She was so enthusiastic and gave us so much inspiration with her creative approach and practical suggestions to move the business forward. Thank you very much Dame Anita. So what’s coming next for Sleep Care? Please watch this space!

Napping works.

2006-12-06T21:29:00.000Z

Naps have had a bit of a revival over the last few years, which I think is great because I’m a great fan of naps.

There is still a lingering derogatory connotation to napping though. I subscribe to several Google alerts to keep up to date, including one for the word ‘nap’. About half of them are various acronyms – Network Access Protocol & so on. However, in the extracts that do actually use the word, many still talk about people being ‘caught napping’ as a synonym for being caught unawares, or they imply that nappers are dopy or lazy. Actually, as lots of research has shown, the opposite is true. It’s those who don’t nap whose performance suffers!

A recent study of medical staff at a hospital in California confirmed that young doctors on shifts of up to 90-hours a weeks were so sleep-deprived their level of function was as if they'd had three or four drinks. Taking a short nap dramatically improved this.

I think that the poor image of napping comes from two sources. Firstly, as people get older, their sleep cycle tends to fragment, so that they sleep less in one night-time block. So napping tends to be associated with old people. Secondly, if you nap for long periods of time (more than about 30 minutes), you’ll enter deep sleep (stages 3 or 4 sleep) and may wake up groggy – so called sleep inertia. This passes in less than an hour, but can give people the impression that napping reduces performance.

So, here’s how to nap:
1. Chose a time when you’re hitting a natural low (in a normal daytime routine, this is usually mid-afternoon)
2. Find somewhere comfortable and private
3. Use a sleep mask and/or sound reducers, if necessary
4. Set an alarm (e.g. on your mobile phone) for 20 minutes
5. Have a coffee just before your nap – the caffeine will take about 20 minutes to kick in
6. Just let yourself drift & don’t try to make yourself sleep
7. Wake feeling great & notice how your performance, concentration & mood are improved

Take a tip from the great nappers of history – Churchill, Edison Bonaparte & Einstein – get napping & get ahead!

Americans Say Sleep is the Best Way to Alleviate Stress

2006-12-05T12:34:00.000Z

A survey from across the pond carried out during National Stress Out Week in November this year reports that nearly half of American employees experience "persistent and excessive stress or anxiety in their daily lives".

According to the report, a variety of on-the-job situations induce stress: 55% say deadlines cause them stress, 53% say interpersonal relationships (i.e., interacting with superiors, co-workers, subordinates) are stressful, 50% cite staff management and 49% claim dealing with problems brings on stress. What’s more, employees say stress affects their performance, relationships with co-workers, peers and bosses, and the quality of their work. Perhaps most significant, 81% of those surveyed said that work stress extends to their personal life—interfering with their relationship with their significant other. One-third of respondents said stress interferes with their relationship with their children.

Furthermore, 25% report that in order to manage their stress, nervous anxiety and lack of sleep they take prescription medication. They also engage in unhealthy lifestyle habits all in response to excessive stress levels. For example, 31% said they consume more caffeine, 27% said they smoke, and 20% said they drink alcohol.

On the upside, the survey also revealed that 44% (both men and women)thought sleeping more was their top stress-busting method. In addition 25% say that exercising frequently helped alleviate their anxieties.

Exercising regularly is known to promote deep and resorative sleep, so it confirms my belief that "sleeping on it" does wonders for reducing high levels of stress hormones. Scientists also believe that creative problem solving, albeit unconsciously, is an ongoing part of dreaming sleep. Therefore, it would make sense if stressful situations impose a biological requirement for extra sleep.

Sounds plausible, doesn't it? I think I'll sleep on it.

Christmas is coming and the goose is getting fat.

2006-12-01T15:39:00.001Z

I had a wonderful glass (or two) of Sauvignon Blanc from Chile , last night with my meal (Risotto with mushrooms and pinenuts- if you must know). I felt very sleepy shortly afterwards. I struggled to sparkle during my conversation with my guest at the dinner table.

As soon my guest left I crashed out on the sofa and fell fast asleep till 1.30am. I have no recollection of falling asleep. For the rest of the night I tossed and turned in bed and was aware that I was dreaming vividly.

I overslept by 2 hours and I felt tired and unrefreshed on waking.

I knew that alcohol is sedating at high levels but after two glasses?... My husband claims that I "should practice more", as I drink very occasionally. The truth is I was carrying a bit of a sleep debt from an exceptionally busy fortnight with early morning business networking breakfasts and giving talks to groups in the evening. Research shows that alcohol does significantly speed up the transition from wakefulness into sleep, especially if you are sleep deprived.

People look forward to an extended break at Christmas. A phrase I hear a lot at this time of year is ' I'm looking forward to catching up with my sleep'. Obviously, Christmas is a boon time for most businesses fulfiling orders, finishing off projects, opening till late and on Sundays for Christmas trading. Business owners and employees will be not only fatigued as a result but also sleepy as they may have had to cut back on their sleeping time. Be aware that even when you drink only a l-2 units of alcohol at office parties, family gatherings, New Year celebrations etc, and you know that you are carrying a sleep debt you are at a much higher risk of having a road traffic accident. Not only because of alcohol's effects on road judgement but also because of the increased likelihood of falling asleep at the wheel without warning.

The bottom line, is even if you are well under the limit when drinking and driving, you have a duty of care not to drive if you feel sleepy. Aren't I a spoilsport?

Sleep or Sex?

2006-11-27T21:17:00.000Z

Ever think that someone needs to get out more? A recent article posed the question which should you choose for the most benefit for your health – sleep or sex? Hmm – perhaps it was a quiet week in the newsroom, or perhaps next week they are going to do another article entitled “Choose between breathing and drinking”

Ok, perhaps I’m being a bit harsh. The article does compare the health benefits of sleeping well and a healthy sex life. As we all know, sleeping well helps keep your blood pressure down, avoid depression, and probably prevents obesity. A good sex life improves your immune function, lowers cholesterol, and surprise surprise, improves relationships!

Of course both occur in bed, and one can help achieve the other. So would you rather have a false dichotomy or a journalistic ploy? The choice is yours.

Modafinil and co…Brave New World or a Step Too Far?

2006-11-23T17:57:00.000Z

You may have heard of modafinil in this blog and elsewhere – a drug licensed for the treatment of the rare sleep disorder narcolepsy, but also touted as the next ‘lifestyle drug’ after Prozac. Well, according to an article in the New Scientist earlier this year modafinil is just the tip of a pharmaceutical iceberg. The company which produced it, Cephalon, has a successor, armodafinil, as well as further compounds at various experimental stages. These drugs, called eugeriocs meaning ‘good arousal’ in Greek, promise to allow people to stay awake for 2-3 days with only a couple of hours sleep, little or no loss of performance and especially surprising – no sleep debt.

You might think that this is a big fuss over nothing – these are prescription drugs for a rare disease. However, the article goes on to describe a 30 yr old software developer who had himself ‘diagnosed’ with narcolepsy to obtain a supply, and has been taking it as a lifestyle enhancer for 3 years. And of course, the military is investing large amounts of cash in research into sleep-controlling drugs and devices.

So should we all look forward to a brave new world, not so far around the corner, when we can sleep and waken at will with the right combination of pills? At one level the idea is appealing – how many of us have wondered why we bother spending one third of our lives unconscious? But on the other hand what would be the consequences of the ability to control sleep, or even in the long term, avoid the need for it altogether?

This is not a new question. Our ancient ancestors who left the hot plains of Africa had to learn to adapt to the cooler climates with artificial aids – clothing, shelter & control of fire. More recently, the contraceptive pill revolutionised the lives of women in the 1960’s, who could finally chose when to get pregnant, if at all. So it may be that future generations will be able to choose when to sleep, if at all. But let’s not underestimate the importance of this change – this is not a minor thing like taking a cup of coffee for a pep – but could be as revolutionary as the contraceptive pill. We need to ask as a society, are we ready and willing to accept the consequences of a true 24/7 society, where sleep is seen as a luxury or hobby, and sleeplessness is the norm?

New Website Live With Sleep Shop!

2006-11-20T22:10:00.000Z

After a few teething problems, I’m happy to say that the new website is up and running. The web address is the same as the old website: www.sleepcare.co.uk . As well as incorporating the new Sleep Care logo, I hope that you will agree the new site is more attractive, but also easier to find your way around.

Also, a totally new adventure for Sleep Care is the new online sleep shop, which currently only has a few products available, but keep coming back, because we have a lot of exciting products in the pipeline. Our philosophy with the shop has been the same as the counselling service – to favour quality over quantity. We have therefore scoured the world looking for the very best examples of sleep related products.

However, one thing which you won’t see on the Sleep Care sleep shop is any chemical sleep aids. This was a tricky decision, as there are some herbal and food supplement type products, some of which may be very good. But we decided that chemicals, even natural ones, it is so difficult to do reliable quality control that we didn’t want to expose our customers to risks that we couldn’t control. After all, even if a herb or vitamin is perfectly safe, how do we know what other contaminants there might be in a tablet? And then there’s always the possibility of someone having an allergic reaction to an additive or colourant in a tablet. So for the time being, we will not be selling any chemical products.

However, this still leaves us with a huge range of physical and electronic products which can make a real difference to people’s lives. We really hope that along with the advice and information we offer that the new website will help us to make even more of a difference to more people.

Overcoming Jet Lag.

2006-11-16T12:10:00.000Z

What is jet lag? Why and when do we get it? How to overcome this condition?

I've tried to answer these questions in the latest Sleep Care leaflet which is being put together this week. It will be available from the website by the end of the weekend.

I'm also offering personalised adaptation schedules to minimise the impact of jet lag for those who are travelling abroad to attend important events such as business meetings,conferences,and sporting competitions, where productivity, alertness and performance really matters. This is a new service and I'm so excited about it.

To give an example of how it can help a runner travelling from London to Los Angeles to run in a marathon. Los Angeles is 8 hours behind London. This means the runner who has not yet adapted, will be on the starting line (usually about 9am) when his body clock is telling his body it's the middle of the night! He will feel extremely sleepy and his body temperature will be at its lowest, and bodily processes involved in growth and renewal are ongoing. It would not be the best time to be involved in an endurance event like a marathon. He could be prone to injury and tire so much more easily. For a competing athlete this could be disastrous.

Adapting slowly over a matter of 4-5 days before the event would help sychronise the timing of the body clock with that of the destination. Sleep Care jet lag schedules would involve exposure to light and having meals at critical times as these are powerful environmental timing cues for our body clocks.

Would you be interested in such a jet lag schedule? If so,would be it for a critical event as suggested above or would it be for a pleasure trip? Either way I would be interested to hear your comments.

Sleep and blood pressure

2006-11-14T21:01:00.000Z

According to a recent paper in the journal Sleep, researcher Dr. Daniel J. Gottlieb of Boston University School of Medicine suggested that a good night's sleep should be tested as a non-drug treatment for high blood pressure. The researchers questioned more than 5,000 men and women over 40 on their sleep habits and found that people sleeping fewer than six hours had as much as a 66 percent greater prevalence of high blood pressure.

There is a large and expanding collection of evidence on the benefits of adequate sleep many aspects of physical and psychological health, which supports what we do at Sleep Care. After all it’s great to see the change in a person’s quality of life when we help them to beat their insomnia, but it’s even more gratifying to realise that improving sleep also produces real benefits to their long term health too.

Unavoidable Sleep Deprivation?

2006-11-09T10:36:00.000Z

According to a recent paper by Dr Robert Thomas of Beth Israel Deaconess Medical Center in Boston, Massachusetts, the wakefulness drug, modafinil (which is licenced for use in the rare sleep disorder narcolepsy) helps to alleviate some of the effects of sleep deprivation on memory in healthy volunteers, and has been suggested as a means of helping people cope with certain kinds of shift work.

This raises the whole question about the use of drugs to enhance performance in otherwise healthy people. Dr Thomas responded to questions about the ethical implications of his paper by saying “When sleep deprivation is intrinsic to a job, drugs like modafinil seem a reasonable option, as long as our expectations are biologically realistic.” Which sounds very reasonable, until you start to unpick it – why is sleep deprivation ‘intrinsic’ to some jobs? Use of modafinil is suggested for jobs like doctors, pilots and lorry drivers, but is sleep deprivation ‘intrinsic’ to any of these jobs? Of course not. Shift patterns can be balanced with workload in most occupations, with the exception of jobs where there are unpredictable fluctuations in demand, such as night time emergencies in medicine or the military. Of course such shifts and the personnel requirements they imply have economic consequences – this was why there was a manpower crisis in UK medicine when the EU working time directives were introduced.

Now, I am not going to explore the whole paranoia-ladened area of military applications for performance enhancing drugs, or ask questions about the funding of studies like this one. However, I think that this is an area which is going to become more and more difficult as such drugs are developed and enhanced. We all readily accept the widespread use of an additive alkaloid to combat fatigue…excuse me while I have another slurp of my coffee. But with arguments surfacing about ‘intrinsic’ or ‘unavoidable’ sleep deprivation, I think that sleep professionals need to ask people to stop and question these assumptions. Is it any more sensible to just accept sleep deprivation as part of a job than it is to accept sexual harassment, bullying, or health & safety violations?

New Sleep Care logo

2006-11-07T23:00:00.000Z

After several weeks of back and forth of pdf files, and lobbying every relative and family friend in sight for opinions, the new Sleep Care logo is finalised. Personally I love it, as I feel that it symbolises the values which I’ve always hoped that Sleep care embodies – professional, caring, rigorous and approachable.

So here it is – (cue drum roll!):

The contrasting colours are intended to indicate day vs. night. I chose deep blue for it’s professional look, and the green for it’s natural healthy look and the light shade to communicate caring, taking the harshness off the blue.

We’ve had several opinions about the 2 curved lines above the word-mark, but I’m not going to share them right now as I’m curious to hear what you think. I would also love to hear more opinions about the whole design.

Next stop – the redesign of the Sleep Care website. I’ve seen the drafts, which have been finalised over the weekend, so we should have the new website online this week – I can’t wait!

The Melatonin Conundrum

2006-11-05T22:53:00.000Z

I’m just in the middle of writing a leaflet on jet lag. It’s a fascinating subject, and gives me the opportunity to review some of the scientific literature which I’ve accumulated in my ‘Jet Lag’ file, but not had time to read yet.

Jet lag (or 'circadian dischronism' to use the technical term!) is the set of symptoms which occur due to the difference between your body clock and the time cues you are getting from the world around you (the zeitgebers). It can be treated (although not completely alleviated) by manipulating melatonin release, either directly by taking melatonin tablets at appropriate times, or indirectly by manipulating light exposure which controls release of your own melatonin.

Unfortunately there is a major problem with availability of melatonin in the UK. The same substance which can be bought as a ‘food supplement’ at any drug store (pharmacy) in the US is a prescription medicine in the UK. Of course, anybody in the UK can readily get melatonin from the Internet, but since it’s unregulated, you can never be sure what’s actually in the tablets. There is no guarantee that doses of active compound on the label are actually what are in the tablets, because the quality control rules that apply to medicines don’t apply to supplements. The argument against licensing it is that there are insufficient studies performed to know for certain how safe and effective melatonin is. But since it is not a new compound, and therefore cannot be patented by a company, no companies can protect the investment needed to perform the scientific studies. So no studies are going to be funded.

National Stress Awareness Day

2006-11-01T16:25:00.000Z

In case you hadn’t noticed, today is National Stress Awareness day; according to the International Stress Management Association.

Without getting into the whole debate about awareness days in general (did you know that National Potato Day is on 29th January?) excessive stress is an important issue which can be both a cause and effect of insomnia. To understand this it is important to be clear about what we mean by stress, which is a very overworked word these days.

Biological stress is the reaction of your body to challenges from the world around you. Different people will react to the same challenge in different ways, and so they will experience different amounts of stress. Perhaps you have noticed how some friends or colleagues seem to thrive when faced with deadlines whilst others seem to go into a tailspin. Similarly with stress and insomnia, some people will take their worries to bed and others hang them up with their dressing gown. This is a learnable skill.

There is a story about Winston Churchill who was asked about how he slept with all the pressure of leading a country at war, told the interviewer,“As I get into bed, I say in a clear firm voice ‘Sod the lot of them!’ and slip off into a deep sleep”.

End of British Summer Time.

2006-10-30T21:49:00.000Z

The clocks went forward yesterday, marking the end of British Summer Time (BST) and return to Greenwich Mean Time, and so we all got an extra hour in bed. In essence, almost every summer since the First World War the British Isles have been moved about 1000km westward, so that sun set and sunrise occur an hour ‘later’. To learn more about the history of BST look at: www.savingthedaylight.com/dst/

Of course the whole daylight savings time thing is a giant confidence trick – the sun doesn’t rise any later. Mechanical clocks are meant to be artificial representations of the appearance of the sun in the sky as the earth rotates. So our clocks should always read ‘noon’ when the sun is highest in the sky. If we still recognised this, then the con trick of BST would be easy to spot, as everyone would see that the real noon (the sun in the sky) and the clock noon were out of synch. However, most of us do not notice the discrepancy. Instead, we tend to believe that our clocks’ time is ‘real’ because that is the time we use to run our lives. This is why the BST con trick works; and why we forget the change of clocks a few days after it’s happened.

Why do we change the clocks, rather than just all agree to get up an hour earlier in the summer (which is what we are actually doing, after all!)? We could all agree that normal work hours were 8am to 4pm in the summer and 9am to 5pm in winter, couldn’t we?

Teenagers sleep – so it begins!

2006-10-27T12:29:00.000+01:00

I recently wrote a magazine article on teen sleep problems, however with this week being half term, I have had the opportunity to see my 12 year old’s sleep habits up close, and it’s not a pretty sight!

In my article, I talked about the paradox of teenage sleep patterns (which probably reflect most of the other paradoxes of teenage years) – remaining requirement for lots of sleep at the same time as a circadian rhythm delayed shift. In other words teens can’t get to sleep until later, but still need as much sleep as a younger child. In line with basic parenting advice, we have always had a firm bedtime, which over the years has move from 8pm to 8.30, and now 9pm. But this week, with the external discipline of school removed, I see my preteen sleeping in till 11am, rather than the ‘good old days’ when we were awoken at 6am by noisy playing.

Oh, dear, looks like this is a taste of things to come!

Shifting Attitudes to Shift Work

2006-10-23T12:05:00.000+01:00

When Joseph Swan invented the incandescent light bulb in 1878 (Thomas Edison patented an improved version in 1879), I doubt that he fully understood the effects which it would have on human work and health. Prior to that, after sunset, the murky light of candles or gas lamps meant that working at night was difficult and rare. Now we are constantly told we live in a 24/7 society, which creates a cycle of demand for services at night, leading to more people doing shift work.

We all have a body clock which responds to light by controlling levels of a hormone called melatonin. When the sun goes down and light dims, levels of melatonin increase, making us feel sleepy. If our body clock is roughly in synch with the environment, this is a good thing. However, if your body clock is out of synch with your environment, or if your environment is requiring you to be alert when melatonin levels are telling you to go to sleep, this can be inconvenient at best, and dangerous at worst. In some situations, for example if you have to drive, or provide health care, sleepiness, even brief micro-sleeps of a few seconds can have disastrous consequences.

Shift work is not compatible with our biological rhythms, but it is here to stay.

I will come back to coping with shift work again and again in this blog, as it is such an important subject, which we commonly encounter with Sleep Care clients. However for now I will leave you with two tips for managing shift work:

1. Make use of the power of artificial light on your body clock – if you need to be alert in the night, make sure your environment is brightly lit – not just bright enough to see by, but bright like being outside in the daytime.

2. If your work involves any potential hazards, pay attention to signs of sleepiness or fatigue, like yawning, blinking, or making silly mistakes. If you feel sleepy or drowsy, stop your work as soon you safely can and have a coffee, a short nap or talk to a colleague.

Sleep deprivation and obesity

2006-10-19T12:30:00.000+01:00

The BBC reports today research coming out of Dr Shahrad Taheri’s team at Bristol University that sleep deprivation in children is an important contributor to obesity. Anyone who has been following this research for the last few years will know that this is really a follow up study on work done a couple of years ago which found the same results in adults.

The research is clever since it doesn’t only show a statistical link between those who sleep less and obesity. Dr Taheri also looked at the levels of hormones which control appetite. Leptin is released by fat cells to signal fullness and ghrelin is released by the stomach to signal hunger. (Who thinks up these names? Wouldn’t ‘dunnin’ & ‘noshin’ have been better?)

Anyway, when people get less sleep than average (about 8 hours for adults and 10-11 for children), the fullness hormone (leptin) goes down and the hunger hormone (ghrelin) goes up. Studies on volunteers deliberately sleep deprived show us that this is a cause and effect relationship, depriving people of sleep causes these hormone changes.

So does this mean that the average 2 hours reduction in sleep over the past half century in Western countries is the cause of our obesity epidemic? You can almost hear McDonald’s lawyers sharpening their pencils! Well no. Changes in appetite hormones can’t magically generate fat out of thin air. The availability of cheap, high calorie foods means that tired hungry people will satisfy themselves with fattening foods.

Can you sleep your way to a better figure? Well it’s probably part of the solution. And given the other benefits of a good nights sleep, it’s a pretty good idea.

Basic sleep hygiene – what’s in a name?

2006-10-17T17:05:00.000+01:00

Within the world of sleep health, the term ‘basic sleep hygiene’ is a familiar everyday phrase. To clients who are having trouble sleeping despite years taking sleeping pills, it can be a revelation!

I think that it suffers from the name though. ‘Hygiene’ for many clients has connotations of dirtiness – as though we are going to discuss clearing out the dust bunnies from under their beds. And calling anything ‘basic’ devalues it for both clients and professionals. How does basic sleep hygiene differ from advanced sleep hygiene? Sleep hygiene isn’t scientifically ‘sexy’; you can’t improve it with a new sleeping pill; and it’s difficult to work up enthusiasm for the apparently mundane details of bedroom layout, bedtime routine etc.

However, ignoring sleep hygiene in the management of someone with a sleep problem is rather like ignoring the importance of diet and exercise in the treatment of obesity. Yes, you can look for the occasional rare medical disease causing someone to be fat, and you can prescribe the latest ‘2,3, alpha XYZ receptor inhibitor’ drug. But in the majority of cases of obesity changing life habits is the key to success, just as it is with the majority of insomniacs.

So yes, it might be better to talk about ‘Sleep Lifestyle Management’ or some similar phrase, but whatever we call it; sleep hygiene is the central plank to treating many, if not most, sleeping problems.

Friday the 13th and other superstitions

2006-10-13T21:03:00.000+01:00

Today’s Friday the thirteenth, and so far, so good. I was nearly hit by a car driven by a teenager who didn’t look before pulling out. Luckily I swerved in time.

Had I been a bit slower, there would have been a potentially dangerous accident. In that case, would I have put it down to today’s date? Possibly, but being a scientifically trained person, I would want to know the evidence before jumping to a conclusion.

According to an article in the BMJ from 1993 (Dec 18-25;307(6919):1584-6), hospital admissions due to road accident were significantly higher on Friday 13^th compared to Friday 6^th, despite lower total traffic. The American Journal of Psychiatry reported a similar study from Finland in 2002 (Dec;159(12):2110-1), which showed a similar finding, but interestingly reported that the relative risks of accidents were increased on Friday 13th, especially in female drivers. So what’s going on? Is Friday the 13^th really unlucky?

Well, I suppose it’s possible that there is some cosmic ‘luckiness ether’ which varies with the numbers of an arbitrary man-made calendar. However, for someone who deals with insomnia, there is a much more rational, and familiar, explanation - the self-fulfilling prophesy. Go to bed telling yourself how difficult you find it to get to sleep, how you’re going to toss and turn, and how you’re going to find it impossible to relax, and guess what – you’ll be right!

By the way did you know that in

Greece

, Tuesday the 13th is considered unlucky rather than Friday?

Decaffeinated coffee DOES contain caffeine

2006-10-12T20:47:00.000+01:00

Caffeine can be a mixed blessing. It is probably the most popular drug in the world, and a valuable stimulant for times when you need a pick up. However, sometimes its stimulant effects can become a problem – either for people with medical conditions, or for those with insomnia. Many people opt for decaffeinated coffee as a way of enjoying a tasty beverage without the unwanted effects of caffeine.

However, Sleep Review reports a study published in Journal of Analytical Toxicology (what do you mean you haven’t seen it in your local newsagent?). Researchers from University of Florida analysed normal and decaf coffee from coffee shops, and found surprisingly high levels of caffeine in the decaffeinated.

A typical 250ml cup of coffee contains about 80-100mg of caffeine, but the researchers found levels of up to 15mg in a cup of decaf. The take home message seems to be that decaffeinated means lower caffeine NOT caffeine-free! If you find 3 or 4 decafs in the evening are disrupting your sleep, it may not be your imagination.

A cup of camomile tea is my personal favourite – soothing and refreshing!

Mood and shift work

2006-10-09T16:35:00.000+01:00

In his sleep related blog, Michael Rack (aka SleepDoctor) recently describes a case of a young American woman with bipolar disorder (manic depression), a condition where a person’s mood can swing wildly from deep depression to uncontrolled (and sometimes dangerous) elation. In this case, the lady in question started a job in a sleep centre, which of course involved shift work due to need to supervise overnight sleep studies, and suffered an acute manic episode. As we all know, changes in sleep pattern can change our mood. But for those with an existing mood disorder, the effect can be more severe.

The likely cause of the young lady’s relapse and the importance of circadian disturbance were rapidly recognised in the case described by Michael, probably because her colleagues were sleep specialists. But I wonder whether this would have been picked up if her shift had been in an intensive care unit or a canning factory?

Given the widespread ignorance of even the existence of circadian rhythms, let alone their importance for health and performance, we can only ask how many similar cases go unrecognised.

Report from British Sleep Society annual scientific meeting Sept 2006

2006-10-08T16:08:00.000+01:00

I’ve just got back from the British Sleep Society conference last week in Robinson College, University of Cambridge – the annual gathering of the sleep ‘cognoscenti’ of Britain. As you might expect it’s a relatively small gathering, about 150 people were there – physicians, psychiatrists, sleep lab technicians, sociologists and research scientists.

The symposium on the first day this year was on Narcolepsy. The sleep science behind this condition is fascinating. One of the features of this condition is cataplexy. This is a sudden transient onset of muscle weakness brought on by an emotional response usually laughter on hearing a joke. It can vary from a drooping of the head or jaw to full blown collapse of the major postural skeletal muscles. Some people find it socially embarrassing and personal safety can be an issue.

Earlier on this year, the drug sodium oxybate (also known as gammahydroxybutrate, GHB, the 'date rape drug') was shown in clinical trials to be effective in reducing these cataplectic attacks and is now a licensed drug in the UK. Obviously, with this drug there is potential for abuse, but the general feeling at the conference was that the risk was low and manageable.

I agree with this because narcolepsy is rare, affecting about 5 in 10,000. It is less common than multiple sclerosis. Many individuals are in fact un-diagnosed for years. Furthermore, people with mild cataplectic symptoms tend not to report these to the GP as they assume that these are normal. Narcolepsy is diagnosed by sleep physicians according to strict criteria following extensive day-time and night-time sleep tests with EEG recordings.

Sleep Care blog – An introduction

2006-10-05T22:29:00.000+01:00

Welcome to my latest venture – the Sleep Care blog. In this blog I hope to introduce you to the two sides of sleep – a vital third of our lives. If you sleep like a log every night, and wake up refreshed, but wonder what on earth goes on during those eight hours, then we’ll discuss sleep science. That's the positive side of sleep - when you sleep well. But perhaps more importantly, there’s the other side too.

What happens when you can’t drop off, or wake up in the middle of the night? Insomnia might seem like a minor problem, until you get it! OK, so you’ll feel a bit tired if you sleep poorly – right? Wrong! Poor sleep is a hugely underappreciated cause of poor health, miserable life quality and even death. Did you know that the Dept. of Transport estimates that 20% of road fatalities are due to drivers falling asleep at the wheel? Sleep deprivation is a serious problem.

Hopefully, I’ve convinced you that sleep is important. So what do I do about people with sleep problems? I am managing director of Sleep Care - a unique service which offers a new concept that I call ‘sleep counselling’. Sleep counselling is an assessment, advice and psychological service for anyone with a sleeping problem like insomnia, snoring, sleep apnoea or restless legs syndrome.

In this blog, I will tell you about sleep counselling, sleep science, evaluate sleep aids, sleep disorders, and comments on the latest sleep related news.

I hope that you will enjoy and comment on my blogs, as I’m keen to find out what you think about my passion, but for now I’ve got to finish off as it’s my bedtime!