Healthy Living

Sleep issues at the time of stress, anxiety   

Sleep issues at the time of stress, anxiety  

All-night study sessions, important business deals, new babies — most people will experience a taste of sleep deprivation at some point in life. While the occasional lack of sleep may not seem like a big deal, the impact of sleep deprivation can be intense and its effects can linger. In extreme circumstances, sleep deprivation can ultimately lead to death. “Sleep, along with diet and exercise, constitutes the very foundation of good health." In fact, she says, the three are so interconnected that each needs to be a priority. Chronic poor sleep puts us at increased risk for serious medical conditions, such as obesity, heart disease, and diabetes. During sleep, our bodies secrete hormones that help control appetite, metabolism, and glucose processing. Poor sleep can lead to an increase in the body's production of cortisol, also known as the stress hormone. In addition, skimping on sleep seems to throw other body hormones out of whack. Less insulin is released after you eat, and this along with the increased cortisol may lead to too much glucose in the bloodstream and thus an increased risk for type 2 diabetes.

Adults should get between 7 and 9 hours of sleep each night. And contrary to popular belief, sleeping an extra hour or two on the weekends cannot make up for the lost sleep you may be experiencing over the course of a busy week. It could also throw off your internal body clock and possibly lead to Sunday night insomnia. Sticking to a consistent sleep schedule is the best way to regulate the body's clock.


What is sleep?

Sleep is a reversible state marked by a loss of consciousness to our surroundings, and as members of the animal kingdom, our brains have evolved to respond to dangers by increasing vigilance and attention — in other words, our brains are protecting us, and by doing so it’s harder for us to ignore our surroundings.

Despite the threat of  any loss or suffering ( e g corona virus) and its rapid and pervasive disruption to our daily lives, many of us are an in a position to control our behaviors and dampen the impact of the event on our sleep. Cultivating healthy sleep is important; better sleep enables us to navigate stressful times better in the short term, lowers our chance of developing persistent sleep problems in the longer term, and gives our immune system a boost.

Daytime tips to help with sleep

  • Keep a consistent routine.Get up at the same time every day of the week. A regular wake time helps to set your body’s natural clock (circadian rhythm, one of the main ways our bodies regulate sleep). In addition to sleep, stick to a regular schedule for meals, exercise, and other activities.
  • Get morning light.Get up, get out of bed, and get some light. Light is the main controller of the natural body clock and regular exposure to light in the morning helps to set the body’s clock each day. Natural sunlight is best, as even cloudy days provide over double the light intensity of indoor lighting.
  • Exercise during the dayhelps improve your sleep quality at night, reduces stress, and improves mood. 
  • Don’t use your bed as an escape. try not to spend too much time in bed during the day, especially if you are having trouble sleeping at night. If you must take a nap, try to keep it short — less than 30 minutes.
  • Avoid caffeine late in the day.
  • Helping others may help with feelings of unease seek out ways to contribute your skills, donate money, or leverage your social capacity locally, such as providing virtual social connection to your loved ones by checking in on elderly family members or a friend, or providing in-kind donations.

Nighttime tips to help with sleep

  • Prepare for bedtime by having a news and electronic device blackout.Avoid the news and ALL electronics at least one hour before bedtime. The nonstop news cycle seldom provides new information in the evening hours that you can’t wait until morning to hear, and will likely stimulate your mind or incite fear, making it harder to fall and stay asleep.
  • Cell phones, tablets, and all electronic devicesmake it harder for your brain to turn off, and the light (even dim light) from devices may delay the release of the hormone melatonin, interfering with your body clock. You can also curl up with a book or listen to music.
  • Minimize alcohol intake.While alcohol can help people fall asleep, it leads to more sleep problems at night.
  • Set a regular bedtime.There are certain times at night that your body will be able to sleep better than others. If you feel sleepy but your brain is busy thinking, it can’t shut off and go to sleep. It may be helpful to sit down with a pen and paper in the evening and write down the things that worry you;
  • Reduce stress.The evening and bedtime hours are also a good time to perform some relaxation techniques, such as slow breathing or yoga.
  • Create a comfortable sleep environment,a place that is cool, dark, and quiet.
  • Don’t spend too much time in bed during the night .  Minimize spending time in bed in which you are not sleeping. If you are having trouble going to sleep or staying asleep, don’t stay in bed for more than 20 minutes. Get out of bed and do a quiet activity — read a book, journal, or fold some laundry.


What if I have been diagnosed with a sleep disorder?

If you have a history of insomnia and take sleep medications and can’t sleep, contact your doctor for medical advice, including questions about making changes in your medication. Many doctors are doing virtual visits now and they can review your current sleep problems and changes to management. You can also consider online programs for insomnia.

Disrupted sleep is a normal response to stress, and it is okay to have a few nights of poor sleep as you adjust to new routines and big changes to your work and personal life. We can’t control what’s happening in the world right now, but we can control our behaviors and dampen the impact of the emerging event on our sleep.

Migraine and sleep problems

In fact, people living with migraine are between 2 and 8 times more likely to experience sleep disorders compared with the general public. Those with chronic migraine — 15 or more headache days a month — report twice the rates of insomnia as those with less frequent headaches.  “Poor sleep is a common trigger for migraine headaches,” Dr. Rosen says. “There is good evidence that sleep disrupters, like snoring and sleep apnea, are linked to chronic migraines.”

Snoring and Sleep Apnea

Sleep apnea is a potentially serious sleep disorder in which breathing repeatedly stops and starts. Snoring loudly and feeling tired after a night’s sleep are warning signs for sleep apnea.

“People at risk for obstructive sleep apnea are usually overweight and have a short neck,” “Or with central sleep apnea, the brain doesn’t tell the breathing to drive at night. The problems with sleep apnea arise when oxygen levels drop below 90 percent during sleep, which can injure brain cells.”

This is a wake-up call for those who get 12 hours of sleep and still do not feel refreshed. Independent of obesity, Rosen says treating snoring and sleep apnea may help the chronic migraine, especially when people awaken with headache.

Here are six tips to try for prevention of migraine and  better night’s sleep:

1. Watch Eating Too Close to Bedtime

Rosen recommends watching your diet and fluids to manage your migraine. To improve sleep hygiene, he suggests the following:

  • Avoid alcohol if it causes you to wake up after falling asleep.
  • Avoid caffeine after a certain hour (this varies from person to person).
  • Don’t have a meal too close to bedtime.
  • Limit your fluids after a certain hour to avoid having to use the bathroom at night.

2. Avoid Migraine Triggers 

Not only does the timing of your meals play a role in managing migraine, but  avoiding foods that are migraine triggers is important, as well. Commonly reported migraine triggers include alcohol (especially red wine and beer), chocolate, aged cheese, cured meats, smoked fish, yeast extract, food preservatives that contain nitrates and nitrites, artificial sweeteners, and monosodium glutamate (MSG). It’s important to know your body to identify which foods affect your migraine and avoid ingesting these triggers.

3. Practice Relaxation

Many people who have migraine have difficulty falling asleep. He tells his patients to build relaxation skills with regular exercise, deep abdominal breathing, and biofeedback.

“There are many studies being done now on mindfulness and headache,” says Rosen. Practicing yoga positions while being mindful before bedtime may be just what the doctor ordered to quiet an active mind and manage migraine. “Spending half an hour in a salon getting a massage or your nails done boosts moods and helps relaxation for sleep.”

4. Turn off Electronics

It’s not just a busy mind that keeps people up ruminating at bedtime. Blue light from the television, smart phones, and tablets upsets the circadian rhythm (your body’s natural sleep-wake clock) and causes the brain to wake up, making it difficult to fall asleep. He recommends shutting down all electronics an hour prior to bedtime. 

5. Create the Right Sleep Environment

“Your bed is for sex and sleep — nothing else,” says Rosen. “This means no TV, digital screens or eating.” He recommends a cool, dark and quiet room for bedtime. “Use humidified air in the bedroom during winter months and weighted blankets or specially designed pillows if these help you to relax.” Keep your bedroom uncluttered and try blackout curtains if you are light sensitive.

Experts say consistency in all lifestyle habits, especially sleep, and are essential in managing migraines. Any change in your life — late bedtime, change in hormones, change in eating or sleep hygiene, change in weather or barometric pressure — will affect your migraine. Stay on a healthy sleep and lifestyle schedule to help keep your migraines well-controlled.


What happens if you don’t sleep?

i) At 24 Hours: Impaired Coordination, Memory, and Judgment

Scott Kelley, a 10-year Army veteran, knows about sleep deprivation. With multiple deployments under his belt, Kelley has had many instances of being awake longer than 24 hours in the field. “There were several occasions in Afghanistan and Iraq where I had just finished up 15 to 20 hours of working, got back to my hooch, and then either a rocket attack would come in or a critical mission would be called,” he says.

Kelley's military training and adrenaline-filled environment seemed enough to keep him focused and alert at this early stage of sleep deprivation. But what happens in more normal circumstances is surprising. The consequences of sleep deprivation at 24 hours is comparable to the cognitive impairment of someone with a blood alcohol content of 0.10 percent, according to a study published in the International Journal of Occupational Medicine and Environmental Health. (2) “Judgment is affected, memory is impaired, there is deterioration in decision-making, and a decline in eye-hand coordination,” Cralle says. “You're more emotional, attention is decreased, hearing is impaired, and there is an increase in your risk of death from a fatal accident.”

ii) At 36 Hours: Physical Health Starts to Be Negatively Impacted

Now your health begins to be at risk. High levels of inflammatory markers are in the bloodstream, says Cralle, which can eventually lead to cardiovascular disease and high blood pressure. Additionally, hormones are affected — your emotions can be all over the place.

Once Kelley reached 36 hours without sleep, his head started buzzing as though he were dehydrated, and he began to lose motivation. His responses were dependent on his training, and in some instances, he functioned on autopilot and lost chunks of time. Once, he was called back to duty just as he was about to go to sleep after 36 hours on the job, he recounted. "After a quick briefing, I grabbed my gear and flew out by helicopter, got dropped off in the middle of nowhere, and hiked out to the FOB [forward operating base]. The next day, we rode back through the most dangerous road in central Afghanistan, but I don’t remember leaving the FOB or hardly anything that happened until I got back to the base.”

iii) At 48 Hours: Micro-sleeps and Disorientation

After two days of no sleep, Cralle says, the body begins compensating by shutting down for microsleeps, episodes that last from half a second to half a minute and are usually followed by a period of disorientation. “The person experiencing a microsleep falls asleep regardless of the activity they are engaged in,” she says. Microsleeps are similar to blackouts, and a person experiencing them is not consciously aware that they're occurring.

Kelley experienced microsleeps during this phase of sleep deprivation. “Around 48 hours or so, my mind starts to slip into neutral sometimes, and I find myself staring off into the distance if I don’t maintain focus,” he says.

iv) At 72 Hours: Major Cognitive Deficits and Hallucinations

Expect significant deficits in concentration, motivation, perception, and other higher mental processes after many sleepless hours, Cralle says.

“Even simple conversations can be a chore,” notes Kelley. This is when the mind is ripe for hallucinations. Kelley recalled a time he was on guard duty and repeatedly saw someone standing with a rifle in the woods, ready to sneak into camp. Upon closer inspection, he determined he was actually looking at a branch and shadows.

Insomniasleep apnearestless legs syndromenight terrorssleepwalking, and other problems can affect sleep. See a sleep specialist if you experience any of the following, suggests Cralle:

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