Category: Sleep Health

4 Common Causes of Sleep Issues (VIDEO)

Posted on September 4, 2020 by - Sleep Health

4 Common Causes of Sleep Issues

If you have trouble sleeping, going to bed can start to feel overwhelming and sometimes downright stressful. There’s so much information out there about supplements and pills for insomnia, cutting down on caffeine, finding the perfect mattress, not watching TV in bed, getting the right kind of noise cancelling ear plugs, and so on. Although some of these things can help, it won’t do any good unless you understand why you’re not sleeping in the first place.

Whenever I see someone in my practice for sleep issues, the first thing we try to figure out is what’s causing their difficulty sleeping. Until we understand that, focusing on sleep hygiene measures can feel like an endlessly frustrating game.

These are four common causes of poor sleep quality that everyone should know about

1. Stress

This is one of the most common causes of insomnia, it both precedes and perpetuates sleep problems. Stress leads to a state of “hyperarousal”. Think of this as your nervous system in overdrive. Physical symptoms of hyperarousal include shortness of breath, heart palpitations, or feeling “wired” or edgey. Hyperarousal is also associated with cognitive symptoms like excessive worrying, ruminating, or an inability to turn your mind off when you go to bed. When left untreated, stress then leads to anxiety about not sleeping, which then feeds into the sleep issues. The act of going to sleep then shifts from a passive to an active process. This is why trying to use sleep medications, substances, cocktails of sleep supplements for stress-related insomnia don’t work in the long run, because they only address the physical symptoms of insomnia without actually dealing with the root cause.

2. Irregular sleep times

Our internal body clock, called the circadian rhythm, regulates our sleep-wake patterns. Going to bed and waking up at different times everyday confuses the body clock and contributes to insomnia and poor sleep quality. It creates a jet lag-like state called social jet lag. Shift workers are at particular risk of this. Irregular sleep times lead to issues with feeling heavy or foggy, getting sleepy at the wrong times, or feeling “wired but tired”. Realigning the body clock to ensure that it is on a regular schedule and aligned with our body’s “sleep drive” is a crucial step in restoring healthy sleep.

3. Delayed sleep phase syndrome (DSPS)

A “night owl” sleep pattern is a common sleep issue that is often misdiagnosed as insomnia. Around the time of puberty, melatonin secretion is delayed by 2 hours. DSPS causes an inability to fall asleep, but once asleep, people sleep well and tend to wake up too late. This explains why lots of teenagers and young adults have so much trouble getting to sleep on time and then getting up for class. Many people grow out of this as adults, but it may persist into adulthood. DSPS is often misdiagnosed as depression, ADHD, chronic fatigue syndrome, or fibromyalgia, and people may be prescribed medications unnecessarily.

4. Breathing issues

Obstructive Sleep Apnea (OSA). This is a condition that affects nearly 1 billion people worldwide. It’s estimated that in North America, up to 30% of males and up to 15% of females have OSA. It affects all genders, ages, and body types, from infants to the elderly. Signs and symptoms include snoring, waking up with dry mouth or a headache, restless sleep, teeth grinding, jaw clenching, mouth breathing, unrefreshing sleep, choking or gasping in sleep, and difficulty falling or staying asleep. Left untreated, OSA can cause long term sleep issues, difficulty losing weight, anxiety, depression, ADHD-like symptoms, and even cardiovascular issues like high blood pressure, heart disease, and increased risk of stroke.

At IntraBalance, we specialize in finding the root cause of your sleep problems and providing you with effective and personalized interventions to sleep better and wake up feeling refreshed.

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The Sleep Disorder You Might Be Missing

Posted on September 4, 2020 by - Sleep Health

The Sleep Disorder You Might Be Missing

Every living creature, from deep sea fishes to microscopic single-celled terrestrial organisms, has an innate biological clock. For us surface dwellers, our rhythms undulate to the beat of the earth’s dark and light cycles.

Light is the most powerful zeitgeber, or time giver, that regulates the internal clock. In this era of breaking news and binge watching, we are bombarded with constant exposure to artificial light, resulting in disruption of our natural body rhythms.

Disturbances in the circadian rhythm can result in metabolic diseases, obesity, cancer, and mental health disorders. Despite the growing appreciation of chronobiology, circadian disorders are frequently missed in clinical practice.

Delayed Sleep Phase Syndrome (DSPS), also known as Delayed Sleep-Wake Phase Disorder, is one of the most commonly encountered circadian rhythm disorders in clinical practice and is often misdiagnosed as sleep-onset insomnia. DSPS should be suspected in those who complain of consistent patterns of sleep onset significantly later than the desired or conventional time. Patients with DSPS may also complain of problems with social and occupational functioning such as chronic tardiness to work or school, impaired academic or work performance, conflicts with parents or partners regarding wake time, and sleep deprivation. Common psychiatric comorbidities include depression, seasonal affective disorder, bipolar I disorder, obsessive compulsive disorder, and attention deficit hyperactivity disorder. A higher degree of circadian misalignment may be correlated with more severe depression and poorer response to treatment with antidepressant medications. Furthermore, it has been shown that patients with DSPS have a threefold higher prevalence of comorbid seasonal affective disorder compared to controls.

So, how do we differentiate DSPS from insomnia? A good clinical history is the cornerstone of psychiatric diagnosis and the diagnosis of DSPS is no different.

Diagnostic criteria according to the third edition of the International Classification of Sleep Disorders (ICSD-3) is as follows:

  • The phase of the major sleep episode shows a significant delay in relation to the desired or required sleep time and wake-up time, as evidenced by a chronic or recurrent complaint by the patient or a caregiver of inability to fall asleep and difficulty awakening at a desired or required clock time.
  • The symptoms are present for at least three months.
  • When patients are allowed to choose their ad libitum schedule, they will exhibit improved sleep quality and duration for age and maintain a delayed phase of the 24-hour sleep-wake pattern.
  • Sleep log and, whenever possible, actigraphy monitoring for at least seven days demonstrate a delay in the timing of the habitual sleep period. Both work or school days and free days must be included within this monitoring.
  • The sleep disturbance is not better explained by another current sleep disorder, medical or neurological disorder, mental disorder, medication use, or substance use disorder.

Zeitgebers and lifestyle should be also assessed including use of caffeine and stimulants, diet, the timing of meals, exercise, work/school/activity schedules, evening light exposure, and use of screens. Sleep diaries are useful adjunct to the clinical history and are recommended to evaluate the sleep schedule. The AASM sleep diary is free to download and provides two weeks’ worth of data. Actigraphy provides an accurate measure of sleep-wake cycles but may not be readily available in clinical practice. Polysomnography is not indicated unless there is clinical suspicion for another sleep disorder such as obstructive sleep apnea.

Once a diagnosis is established, behavioral modifications should be initiated in order to facilitate advancement of the circadian phase. Patients should be advised to minimize use of stimulants, avoid daytime naps, reduce light and screen exposure in the evenings, and avoid stimulating activities at least 2 hours before the time of desired sleep onset. Along with behavioral changes, melatonin and light are powerful body clock regulators that may be considered in the treatment plan. Short-term (<3 months) use of melatonin at a dose of 0.5mg, timed strategically 1.5 to 2 hours before the desired time of sleep onset can “pull” sleep earlier. Morning light therapy with a light box is effective for “pushing” back the wake time. It is recommended that patients start with using the light box at their natural wake time, then advance use of the box by 15 to 30 minutes each morning until the target wake time is reached. Use of hypnotics or sleep aids is not recommended. Consistency in following these strategies is the key to successfully shifting the sleep-wake cycle to align with one’s work or school schedule.

By recognizing and treating circadian rhythm disorders, we can help improve quality of life, reduce the risk of medical and psychiatric comorbidity and restore a natural, balanced body rhythm. Now, that’s something that will help us all sleep better at night.

Source: Psychiatry Network
Read the full article -> The Sleep Disorder You Might Be Missing

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4 Common Causes of Insomnia

Posted on August 31, 2020 by - Sleep Health

IntraBalance, Integrative Psychiatry & Sleep Specialist in San Francisco, California

Difficulty with sleep and insomnia doesn’t have to be overwhelming. Figuring out the root cause of the sleep issues is the first step in getting restful sleep. In this video, we’ll look at 4 common causes of sleep issues.

Sleep issues? We can help

Posted on August 23, 2020 by - Sleep Health

IntraBalance, Integrative Psychiatry & Sleep Specialist in San Francisco, California

At IntraBalance Integrative Psychiatry & Sleep, we specialize in getting to the root of cause of sleep issues, helping you find rest and restore balance. Holistic. Science-based. Personalized care. Proven results.

Misdiagnosing Sleep Disorders

Posted on July 24, 2020 by - Sleep Health

Misdiagnosing Sleep Disorders

The quality of sleep we obtain during the night affects how we feel during the day, our mood, and our emotional and mental well-being. However, issues we may have during the day can be misdiagnosed as other conditions even though they may be caused by sleep disorders.

Sleep disorders are actually more common than people imagine. The American Sleep Association claims that between 50 and 70 million adults in the US are affected by sleep disorders. Unfortunately, many sleep disorders share symptoms with other more commonly known conditions. By learning more about specific sleep disorders, you’ll be in a better position to judge your symptoms accurately and address the root cause of the issues you encounter. And in a short period of time, you’ll be able to return to a healthy sleep schedule.

ADHD Could Actually Be Sleep Apnea

Sleep apnea is characterized by the blocking of breathing pathways in the body while someone is sleeping. They’re not blocked all the way, of course, but enough to cause an individual to snore, take breathing pauses, or even gasp for breath. Like many sleeping disorders, sleep apnea makes it difficult to have a good night’s sleep which then causes issues like mood swings, irritability, fatigue, and problems with attention and concentration. These last few symptoms are often confused with ADHD symptoms and can lead to a misdiagnosis.

Experts agree that ADHD is overdiagnosed. On the other hand, sleep apnea is underdiagnosed and can mimic symptoms of ADHD. There are some simple and advanced treatments available for sleep apnea, received after a diagnosis is obtained through a comprehensive examination.

Insomnia Could Actually Be Delayed Sleep Phase Syndrome

Do you go to bed but stay awake for hours before falling asleep? Do you not feel tiredness set in until the early hours of the morning and then have trouble dragging yourself out of bed in time for work? Many people who report this issue to their doctors call it insomnia. However, there’s another sleep disorder that is very similar: Delayed Sleep Phase Syndrome (DSPS) that may be left undetected.

With DSPS, a person does have issues falling asleep, but once they do, they find that they’re able to get normal, good-quality sleep. Usually, a person with DSPS has their circadian rhythm off or delayed, and this is what causes the issue with falling asleep. Doctors will tell you that your body is on time, it’s just not on time with everyone else!

The misdiagnosis comes in when it’s time to wake up. People with DSPS may still have to wake up early for work or school, and if they weren’t able to fall asleep when they went to bed, they probably didn’t get enough sleep, leading to the symptoms we know to associate with insomnia.

Anxiety Could Actually Be Restless Leg Syndrome

Restless Leg Syndrome (RLS) causes strange feelings in the leg and sudden urges to move them. It’s classified as a sleep disorder because most people present with more extreme symptoms at night.

RLS can cause many symptoms similar to anxiety. It can affect your concentration, memory, mood, performance at work or school, and your personal relationships. Because anxiety is more well-known and easier to understand, RLS is often treated as anxiety, and the symptoms remain because the root cause is not properly addressed. One specific cause of RLS may be undiagnosed iron deficiency. While there’s no cure for RLS, there are therapies and treatments to minimize symptoms.

Mood Disorders Could Actually Be Narcolepsy

Narcolepsy is characterized by heavy drowsiness during the day or overwhelming sleep attacks. It is thought to be an incurable sleep disorder, but due to its similar symptoms of drowsiness and weariness, oftentimes narcolepsy is misdiagnosed. Narcolepsy may present as fatigue and low motivation, which may be mistakenly diagnosed as depression or another mood disorder.

Another major misdiagnosis is between narcolepsy and epilepsy. The sudden paralysis that causes muscles to weaken and people to fall asleep during narcolepsy may be mistakenly diagnosed as seizures. The best way to find out if you have narcolepsy is to see a physician who specializes in sleep disorders, where a sleep study might be required.

Mental Health Issues Could Actually Be Poor Diet

Having read the entries above, it is no secret that many mental health issues and sleep disorders share symptoms. In other words, where a mental health issue may present itself, you may actually be experiencing a symptom of a sleep disorder. Furthermore, many mental health issues themselves could be products of poor nutrition and diet, and issues with the gut-brain axis.

Just like sleep, our diet is a major part of our lives. You are what you eat, as the old adage says, and it’s literally and figuratively true. Poor diets and problems with the gut can cause or increase symptoms of anxiety or depression, along with other mental health issues. However, an optimized diet and healthy digestion can do the opposite—it can relieve a person of those symptoms.

One of our specialties here at IntraBalance is treating sleep disorders as well as teaching our patients to align themselves with the core pillars of holistic health. If you are experiencing any of the symptoms discussed above, call us to set up a consultation where we can give you more information about how to find the root cause of your discomfort.

Want to learn more about optimizing your sleep? Click here to get your FREE sleep guide.

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3 Ways to Reset Your Body Clock

Posted on July 20, 2020 by - Sleep Health

IntraBalance, Integrative Psychiatry & Sleep Specialist in San Francisco, California

In this video, I’m explaining what the body clock / circadian rhythm is, why it’s so important to have a regular routine, and sharing with a few clues to help you figure out if your clock is on time along with 3 easy steps to get it back on track.

Seven Ways Sleep Affects Your Mental Health

Posted on July 18, 2020 by - Sleep Health

Seven Ways Sleep Affects Your Mental Health

1. Undiagnosed or Misdiagnosed Sleep Disorders

Sleep disturbance can be both a cause and a symptom of mental health problems. But this relationship does not imply that sleep problems are always symptoms of a larger mood disorder. They might be indicative of a standalone sleep disorder, such as narcolepsy, sleep apnea, and more.

Because sleep patterns and mental health disorders are so intertwined, sleep disorders are often underdiagnosed or misdiagnosed as a myriad of other mental health conditions, such as ADHD in adults.

This also means that not all people who experience trouble sleeping have insomnia. What might look like insomnia might actually be delayed sleep phase syndrome (DSPS). Those with DSPS complain of consistently falling asleep later than desired and difficulty waking up at the desired time. This delay in sleep onset can lead to significant distress or impairment in social and occupational functioning. However, when we’re able to regulate our sleep schedule, the quality of our sleep can improve.

2. Lost Routines

Our body keeps its own routine by regulating our circadian rhythm. Circadian rhythms are biological clocks that regulate our sleep-wake cycle and other bodily functions like digestion and hormone release. Every living thing has a circadian rhythm, including plants, animals, and microbes.

While our body naturally regulates our circadian rhythm, it is strongly influenced by signals in our environment, like light. Most people’s circadian rhythm cycles with the sun: when there is more light, like during the day, we feel more awake. When there is less light, like at night, we feel drowsy.

But in our era of smartphones and easy access to digital information, this constant exposure to light can throw off our body’s natural sleep routine and affect our mental health. A lack of routine can lead us to feel stressed and disorganized.

However, we can structure our environment in ways that help our circadian rhythm do its job. Minimize blue light exposure by turning down your screen brightness, dim your light a few hours before bed, and stay in bright light during the day.

3. Lost Productivity

Understanding your body clock or chronotype can help maximize feelings of restfulness and productivity. Chronotypes are the behavioral manifestations of our natural circadian rhythms, which influences the likelihood that we’ll fall asleep at a particular time during a 24-hour period. Chronotypes depend on genetics, environmental influences, age, and more.

Chronotypes are generally separated into morning types and evening types, but there are variations. Our chronotype dictates when we like to wake up and when we have our greatest energy or feel the most productive.

A mismatch between our chronotype and environment can have detrimental effects and lead to a loss of productivity, which means our chronotype is important to consider when planning activities and tasks. If you know you’re an early riser and feel most productive before lunch, try to plan all your meetings and deadlines during that time, especially if you anticipate a crash in the afternoon. Ensuring a good fit between our chronotype and environment can help increase our productivity.

4. Memory Problems

Think back to when you were in school. Do you remember staying up late cramming for a test? You might have considered pulling an all-nighter, but then you remember someone told you to “just sleep on it” to ensure you remember the material.

During sleep, our brain organizes and consolidates information that we took in throughout the day. This is our brain’s way of making sense of what we’ve learned and influences three specific processes:

  • Acquisition – how our brain receives and learns information
  • Consolidation – the process by which our brain strengthens and extends connections to make our memories more stable and useful
  • Recall – how our brain accesses and uses stored information and memories

Poor sleep negatively affects all three processes. We’re less likely to retain and remember information. It’s almost as if all your teachers telling you not to pull all-nighters were onto something.

5. Decreased Creativity in Problem Solving

Similarly, “sleeping on it” allows us to brainstorm creative solutions to problems. Sleep facilitates creative problem solving by granting us an incubation period, or a period of time spent away from the problem at hand.

Some research on creative problem solving suggests our brain prunes misleading information and dead ends during sleep so that we can later return to the problem at hand with a clear mind.

6. Increased Tension and Irritability

Think about how you feel when you don’t get adequate sleep. Maybe you had trouble falling asleep, tossed and turned all night, or woke up much earlier than you’d like. Are you cheerful and ready to take on the day? Probably not. We’re often pretty cranky when we don’t get enough sleep.

Even small changes in the amount of sleep you’re getting can chip away at a normally cheerful exterior. In fact, the American Psychological Association recognizes a relationship between sleep and stress, whereby a decrease in quantity or quality of sleep can lead to problems with irritability and muscle tension. No wonder it feels like we’re waking up on the wrong side of the bed.

7. Increased Risk of Anxiety and Depression

Sleep disturbances can also increase our risk for developing anxiety and depression. People with insomnia are 10 times more likely to suffer from depression and 17 times more likely to suffer from anxiety. The hypervigilance characteristic of anxiety forces people to stay alert at all times, which makes it difficult to truly relax and have restful sleep. For depression, the relationship between poor sleep and this disorder is so clear that insomnia has long been considered a risk factor for depression.

The relationship between sleep and mental health is clearly complex, but understanding it can help us live better, healthier lives. And that’s something that will help anyone sleep well at night.

Understanding these seven principles and the importance of a good night’s sleep is just the beginning. Schedule a consultation or sign up for my upcoming online course where we will do a deep dive into the science behind a good night’s sleep and help you discover how to make it a regularity in your life.

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From Light To Dark: Transform Your Sleep This Season

Posted on April 10, 2019 by - Sleep Health

From Light To Dark: Transform Your Sleep This Season

Moving from downtown Chicago to the valleys of Marin County, California was a lifestyle change in many ways, but one change was particularly striking: it was dark at night. I was accustomed to the bright lights of Chicago’s many street lamps and neon signs streaming in through my windows as if to call out that the day was not yet over, but in Marin it felt like bedtime at 5:30pm.

Light is a powerful force that affects our sleep cycles and the enveloping darkness of my new environment was like a velvety blanket inviting me to curl up into a deep slumber.

As a psychiatrist and sleep specialist, I am acutely aware of the impact of light exposure on mood and the circadian rhythm. During the daytime, sunlight stimulates light sensitive cells in the retina at the back of the eye. This results in a cascade of information being sent to different brain regions including the suprachiastmatic nucleus (SCN), the clock center of the brain. Peripheral clocks located in other organs interact with the central clock as part of the regulatory system. External cues such as light and temperature reset our body clock, or circadian rhythm. Every living organism, from individual cells to plants and animals have a circadian rhythm, which is set approximately to a 24-hour cycle.

The circadian rhythm is what drives our sleep cycles, hormone secretion, and metabolic processes. Exposure to light, specifically blue light, suppresses our brain’s natural production of the sleep hormone melatonin and stimulates the parts of the brain involved in alertness and attention.

Before the advent of the light bulb, we were exposed to blue light only during the daytime hours and the warm glow of firelight in the evenings encouraged a state of relaxation. Now, we are bombarded by blue light at all hours as it is found almost everywhere, from our televisions to smart phones, to fluorescent bulbs and LED lights. Exposure to blue light wavelengths in the evenings alters our sleep rhythms by inhibiting our brain’s natural production of melatonin, resulting in altered sleep patterns, insomnia, and daytime sleepiness.

Research has shown that people who are exposed to blue light at night, such as shift workers, have higher rates of chronic diseases like obesity, diabetes, heart disease, cancer, and depression.

In our 24/7 society, there is no getting around technology and artificial lighting. So, what can be done? Regulating the timing of blue light exposure is a simple but critical way to reset our circadian rhythms and sleep cycle.

  • Dim the lights in your home a few hours before bedtime. This may include turning off overhead lights and using table lamps or installing dimmer switches to better control the level of ambient light.
  • Minimize blue light exposure in the evenings by turning down the brightness on cell phone screens, laptops, tablets, and e-book readers. Apps such as Twilight and f.lux filter out blue light from smart phones and computers by changing the color temperature of the screen. Wearing amber colored, blue blocking glasses in the evening is also a safe and effective way to avoid blue light. Keep TVs out of the bedroom and set a curfew for using screens in the evening, preferably 1-2 hours before bed to allow your brain time to start producing melatonin naturally.
  • Keep it dark during your sleep zone. Waking up in the middle of the night is normal and typically not a cause of concern. However, just a little burst of light from looking at screens, opening the fridge, or turning on the lights to use the bathroom during awakenings can make it harder to fall back asleep. Minimize any light exposure during the night by avoiding use of screens and using a nightlight instead of overhead lights if you need to get out of bed.
  • Maintain a consistent wake-up time and expose yourself to bright light at the same time every morning. If it is still very dark in the morning or you struggle with getting up on time, consider using a sunrise alarm that gradually simulates a sunrise in the bedroom.
  • Stay in bright light during the daytime to help with alertness and to keep the circadian rhythm aligned with your daily routines.

Source: TMO
Read the full article -> From Light to Dark: Transform Your Sleep This New Year

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