How can he fall asleep so easily? She is staring at the ceiling, making “to do” lists, and worrying about her kids, her parents and a host of other things she can’t get out of her mind. One minute she’s hot and the next she’s cold, while he is sleeping like a baby. Of course, getting a good night’s sleep can be a problem for both men and women of all ages, but women, across the board, do report more sleep problems than men.

 A National Sleep Foundation poll reported that of the women who responded:

  • 31 percent complained of sleep problems
  • 75 percent often got two hours less than the recommended eight hours of sleep per night
  • 63 percent of women experienced symptoms of insomnia at least a few nights a week, compared to 54 percent for men
  • Women are more likely to have daytime sleepiness
  • Women are more likely to suffer from nighttime pain
  • 31 percent had taken drugs to stay awake and 13 percent had taken drugs to go to sleep.

Why do so many women have trouble getting a good night’s sleep?  Various biological, psychological and socio-cultural factors come into play to affect the way women sleep.

Hormones, hormones, hormones
Women’s hormones get the blame for a lot of things, but when it comes to sleep they really can cause trouble. Conversely, lack of sleep can affect our hormone levels, so there can be a vicious cycle of sleeplessness. When hormone levels spike and drop during and after pregnancy, during the menstrual cycle and at the time of menopause, women may experience higher rates of sleep problems.

The female hormone estrogen is related to REM (rapid eye movement) sleep, and it helps to increase sleepiness and need for more sleep. Progesterone, another female hormone, increases non-REM sleep and too much progesterone can cause fragmented, interrupted sleep. Progesterone also causes a woman’s body temperature to rise during ovulation, which can disturb sleep.

Before, during and even after menopause, the loss of hormones, particularly estrogen, can cause hot flashes and irritability, making sleep difficult. Hormonal fluctuations associated with PMS (premenstrual syndrome) can also affect a woman’s mood, cause bloating and increase stress – all three bad for sleep. While we observe these things anecdotally all the time, the science isn’t really there to prove there are differences in sleep between women who are “PMSing” and the controls who are not. And, while  American women report the highest rates of sleep problems during menopause, among Mayan women menopausal problems are unheard of. More research is needed.

Socio-cultural factors
I have joked that a big difference between men and women is that men have one “on/off” button, while women have lots of buttons and switches. They are complicated and prone to multi-tasking and taking on more than they should.

The pressures of working and child rearing while sometimes also caring for aging parents can put undue stress on women that affects their mood and their sleep. Working moms may find it difficult to meet all of their family and work responsibilities and still have time to relax and enjoy themselves.

Tips to promote better sleep for women
Before considering pharmacological solutions for sleep disorders, there are a number of things women can do:

  • Cool the ambient temperature of the bedroom to help regulate core body temperature
  • Dress in layers so you can peel down when you get too hot
  • Drink something cool at bedtime but try to avoid tobacco, caffeine, alcohol and spicy food
  • Lose weight: body fat holds onto estrogen and can release it at sporadic times, which can cause hot flashes
  • Try relaxation techniques like yoga or meditation
  • Get more exercise, but early in the day is better than in the evening
  • Try to establish regular sleep and wake times.

If you still need help, talk to your doctor to see if an underlying cause such as depression, anxiety, reflux, bladder problems or pain may be aggravating your sleeplessness. He or she may prescribe estrogen replacement therapy or other medications or botanicals. And you may want to talk to a sleep specialist to get help with sleeping as well as he does.

Charlene Gamaldo, M.D., is the director of the Johns Hopkins Center for Sleep at Howard County General Hospital.

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Easy Fixes for Better Sleep

sleeping african princessAre you tired of counting sheep, getting up three or four times during the night and always feeling tired and unrested in the morning? If you have had difficulty falling asleep and staying asleep for more than 90 days, you may need to get professional help, but there are a lot easy things we can all do – or not do – on our own in order to get a better night’s sleep.

The first thing to consider is how to make your bedroom a sleep-friendly environment.

  • Your bedroom should be your “bat cave” – dark and quiet.
  •  It should be comfortably cool. Use a fan and a cooling blanket if you get too warm during the night.
  • A cluttered room can increase anxiety at bedtime, so try to keep your sleeping room tidy.
  • Cotton, cotton, cotton! It breathes better than other fabrics, so cotton PJs and sheets are best.
  • Allergies can interrupt sleep, so keep things as clean as possible. Use an air purifier, change sheets and clean carpets often. Your pillow is like a petri dish for germs and allergens. Change it out once a year and replace mattresses every five years.

There are also some simple behavioral changes that can help you get better sleep.

  • Unplug! Using laptops, tablets and phones right before bed or even having them in the room at night can alter your circadian rhythm, and the blue light they emit is very bad for sleep. Late night TV can also disturb sleep.
  • Avoid doing work and answering emails at bedtime. This can increase anxiety or be too stimulating.
  • Try to have a regular bedtime – within 30 minutes – every night. This helps to set your internal clock and get you ready for sleep.
  • Avoid late meals – especially spicy, fatty or acidic foods.
  • Avoid caffeine and alcohol at bedtime.
  • A warm shower or bath at night is good, but not right before bedtime, because it can raise your core body temperature.
  • Try to avoid negative thoughts that increase stress late at night.
  • Relaxation techniques like meditation, prayer, yoga breathing, and even blowing bubbles can help.
  • Get more exercise during the day.
  • Remember that there are only three things that should happen in bed: sleep, sickness and sex.
  • This may not be negotiable for some pet owners, but having Fido in bed can increase allergies and disturb sleep.
  • Make your bed every day. It’s been shown that routine bed makers are better sleepers. Mom was right!
  • Have less light at night but more in the daytime. Get sun exposure during the day or try a light therapy box in winter.
  • Quit smoking! It’s terrible for your health in general, and smoking at night can cause restlessness.

I’d like to leave you with one final tip for a good night’s sleep. Embrace the idea that sleep is vital for good health and make it a priority in your life. The benefits you’ll reap are well worth the effort.

Seema Gulyani, NP, Ph.D, is with the Johns Hopkins Center for Sleep at Howard County General Hospital. For information or to schedule an appointment, call 1-800-WESLEEP (1-800-937-5337) or visit hcgh.org/sleep.

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Man sleepingAs director of the Johns Hopkins Center for Sleep at HCGH, I am thrilled to know that so many people in Howard County care about their sleep and want to do something about it. I always tell my patients that sleep is not a luxury item – it is a minimum requirement. Sleep deprivation experiments with mice have shown that even if they get everything else they need, without sleep they will die! So sleep is an absolute must for life, and healthy sleep is essential for a healthy life.

Anyone who has suffered from insomnia or other sleep disorders knows that getting a good night’s sleep is not always easy. And when we don’t sleep well for long periods of time, the results can be devastating: high blood pressure, stroke, diabetes, cardiac problems, weight gain, daytime drowsiness that can lead to accidents, depression and even sudden death.

So…what keeps us from getting good sleep and what can we do to help us sleep like babies again? To get on the path to healthy sleep, there are some basic things we need to understand.

How sleep works

The drive for sleep is extremely powerful – even greater than the need to eat and drink. You have to consciously act to eat and drink, but deprived of sleep for long enough, you WILL sleep, whether you want to or not. The average needed amount of sleep is 7 ½ to 8 hours per day, and that average usually remains the same throughout your life. If you don’t get enough, eventually you’ll have to repay your sleep debt.

There are two kinds of sleep – REM (rapid eye movement or dreaming sleep) and non-REM, and during a sleep session we should cycle four to five times between these two types of sleep.

How you fall asleep

As the day goes on, our need for sleep builds up naturally. Our circadian rhythm, however, keeps us awake and dips at certain times of the day. Our circadian rhythm is influenced by light and darkness. Light in the morning helps us stay awake and darkness at night helps us sleep. So maybe it’s a better idea to put on those sunglasses in the afternoon rather than on the way to work in the morning.  Keep your environment bright and well lit early in the day, and lower the lights as the evening progresses. A dim night light in the bathroom is better than turning the light on full blast during the night, because that light can affect your sleep.

Unplug at night!

We’re addicted to our devices and they can adversely affect our sleep. Laptops, iPads and cell phones that are pinging and blinking and lighting up in the bedroom during the night are bad, and the blue light they emit is especially deleterious to sleep. Watching TV in the bedroom can also be too stimulating and make it hard to fall asleep. So unplug and read a good book instead. Remember! Only three things should happen in bed: sleep, sickness and sex.

What about naps?

We have a normal physiological desire for sleep between 1 and 4 p.m. Is it ok to take a nap? If it doesn’t affect your sleep at night, go for it. But giving into a nap after dinner can affect your circadian rhythm and make it hard for you to sleep through the night. Studies show that when we break the normal sleep pattern we won’t have good sleep at night.

Sleep is a safety issue

Many disasters and accidents occur during these dips in our circadian rhythm and these rhythms may differ through age. For example, among the young, car crashes are more frequent at night; for middle age, in the afternoon and night; for age 60-65, in the morning; and over 65, in the late afternoon. The highest-risk populations for sleep-related accidents are shift workers, medical residents, truck drivers and people who work hard and play hard without getting enough sleep.

Because sleep is extremely important for not only our own health and safety but also for the wellbeing of our families and community, we shouldn’t take sleep problems lightly. Remember that the first step in resolving a sleep disorder is admitting that it exists and taking positive action to get the good sleep we need.

For information or to schedule an appointment, call 1-800-WESLEEP (1-800-937-5337) or visit hcgh.org/sleep.

Charlene Gamaldo, M.D., is the director of the Johns Hopkins Center for Sleep at Howard County General Hospital.

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The Simple Steps One Man Took to Reclaim His Health

Three years ago, Robert Sorin weighed 333 pounds. His wife was concerned he seemed to be walking around in a fog. Even after a few close calls driving, Bob refused to believe there was anything wrong. Undeterred, his wife brought him to HCGH to see pulmonologist and sleep specialist Carmen Salvaterra, M.D., who admitted Bob to the intensive care unit (ICU) where he was placed on a respirator and spent weeks recovering. Final Diagnosis: obesity hypoventilation syndrome and severe sleep apnea.

“Because of Bob’s obesity, he couldn’t breathe deeply. His abdominal fat was pushing up on his lungs making it difficult for him to take a deep breath,” says Dr. Salvaterra. “His ongoing hypoventilation caused him to chronically retain carbon dioxide. To make matters worse, he also had undiagnosed sleep apnea, which complicated his condition further. He was a very sick man.”

What is Sleep Apnea?

The National Sleep Foundation estimates that nearly 18 million Americans have sleep apnea, a condition often found in overweight people. According to Dr. Salvaterra, those with sleep apnea experience one or more pauses in breathing or shallow breaths while sleeping. These breath pauses can last several seconds to minutes and reoccur numerous times in an hour. In some cases, the brain’s only safety net for obtaining a normal breath is by waking the person up; this usually occurs with a loud snort or choking sound. The ongoing stress of repeated drops in oxygen and retention in CO2 is believed to be the explanation why sleep apnea is associated with an increased risk for stroke, heart failure, abnormal heart rhythms, mood disorder, and poorly controlled diabetes and hypertension.

Often patients with sleep apnea have problems with daytime sleepiness, fatigue, difficulty concentrating and increased irritability. Some patients complain of insomnia. “Having sleep apnea made me feel like I was drunk,” says Bob. “It isn’t so foggy that you pass out; your reactions just slow down. You think it is safe to drive but it isn’t.”

Embracing Change

“There is nothing like being in the ICU and almost dying to make you face reality,” says Bob. When I got out of the hospital, I had a sleep study and was prescribed a continuous positive airway pressure (CPAP) mask so I could get a good night’s sleep.  I also made lifestyle changes.” Bob had been overweight since he was 13 and had type 2 diabetes for decades. “All my diets had been compete successes and total failures at the same time. I lost weight and then gained it back plus some,” says Bob. But, for the two years after his diagnosis, he watched what he ate and exercised. He lost 155 pounds and has kept his weight down for the past year. He no longer has sleep apnea and is not diabetic.

What Worked

According to Bob, the following were vital to his weight-loss success:

  • Don’t lose weight too fast – it won’t last.
  • Explore new foods – I discovered it was fun to eat new things.
  • Get familiar with the spice rack – spices add great flavor without calories.
  • Exercise can be social – do it with friends.
  • Roast vegetables – My mother boiled veggies and ruined the taste for me. Cook them the right way, and you can eat a lot of them.
  • Exercise – cycle, yoga, lift weights, walk on Columbia’s pathways – they are free!
  • Teamwork – getting better is a team effort. I had ongoing help from a trainer, nutritionist, family and physician.

“The key is to find a way to enjoy the food and the workout,” notes Bob. “Discipline with me only goes so far. I have made things enjoyable. If they weren’t, I wouldn’t have made it this far.”

Seeking Treatment for a Sleep Disorder

Sleep specialists at the Johns Hopkins Center for Sleep, located on the HCGH campus, can diagnose and treat a wide range of sleep disorders in adults and children including sleep apnea, insomnia and restless legs syndrome.


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Aging and Sleep

Sleep Like a Baby Again:                            

Q&A with Dr. Charlene Gamaldo

Dr. Charlene Gamaldo

Dr. Charlene Gamaldo

Johns Hopkins sleep specialist and director of the Johns Hopkins Center for Sleep at HCGH explains common sleep problems that come with age, and considerations for aging women.

Why is everyone concerned about sleep?

In addition to not feeling your best when you don’t get enough sleep, a lack of sleep has been shown to have a negative effect on your cardiovascular and mental health – and even weight management. People today are chronically sleep deprived. On average, Americans get an average of 30 minutes less sleep than we did ten years ago.

How much sleep does an older person need?

If you needed eight hours of sleep a night when you were 22 years old, that is also what you need as a 70-year-old; it doesn’t change. Our brain has an internal clock that sets our biorhythms, including natural sleep and wake times. For most adults, the times are about 11 p.m. to 7 a.m. A natural “morning lark” may have a schedule that is shifted earlier, and a “night owl” may have a schedule that is shifted later. Our natural sleep rhythm is like our personality; it is pretty fixed at birth although we can shift our clock times earlier as we age. Each of us is unique in our sleep duration needs. Most adults need about 7.5 to 8 hours, but some need more and some less.

Are there differences for women?

Aside from hormonal changes and “hot flashes” that can happen during menopause, women can have a slightly higher incidence of sleep disorders, like insomnia and restless legs syndrome. Another important point is that women can present differently with certain types of sleep disorders. Women with sleep apnea are more likely to complain of insomnia rather than more classic symptoms like snoring or daytime sleepiness seen in the male patient. Other factors can affect diagnosis of sleep disorders in women too – for example, a widow who sleeps alone may be less aware of signs of sleep apnea than if she had a partner who could report her sleep patterns.

 Is sleep apnea more common in older people?

Sleep apnea prevalence increases with age. Other classic risk factors include higher BMI, small chin, large neck, big tongue. Elderly sleep apneic patients are more likely to have the condition even in the absence of these other more classic risk factors. Common symptoms are: breath pauses during sleep, snoring, daytime sleepiness, fatigue, feeling irritable or unrefreshed upon waking in the morning.

How do we improve sleep as we age?

I recommend simple strategies first like: forming a regular sleep routine, allowing your body to “wind down” in the hours before sleep as opposed to drinking caffeine, exercising or working on the computer. Losing weight or limiting alcohol can also improve your body’s natural ability to obtain good quality sleep.

When is it time to see a doctor about sleep problems?

If the simple strategies aren’t helping and if your inability to sleep affects work or daytime activities, relationships or mood, it is probably time to seek help. There are many reasons people have trouble sleeping and numerous sleep disorders. We have specialists in many areas of sleep medicine who can pinpoint your particular issue and provide interventions that can help you get back to sleeping well again.

To schedule an appointment call 1-800-WESLEEP.

To hear more from the specialists at the new sleep center at HCGH, watch these videosTopics include: women and sleep, depression and sleep, insomnia, restless legs syndrome, circadian rhythm disorder, sleep apnea, and new at-home technology for diagnosing sleep disorders.

 

 


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Tired of being tired?

Sleep experts say that an estimated 30-50% of the population is affected by insomnia. Insomnia can be transient, short-term, or chronic.

Sleeplessness runs deep within my family’s genetic makeup. My grandmother was a transient insomniac. She used to say;  “I’ve lost my sleep, but I’ll find it again soon.”

My 26-year-old daughter tells me that she suddenly can’t sleep. Within a few months, her 20-year-old sister asks about Melatonin. They both turn to me, because I’ve been known to occasionally wander the house late at night in search of the elusive night’s slumber.

Despite our shared genes, our shared insomnia has different triggers. My eldest daughter works varied day and night shifts of irregular hours and, until recently slept within arms-length of her cell phone and laptop. My younger daughter has a regular schedule but the pressures of school and work seep into the end of each jam-packed day. And me? My transient insomnia tracks closely with elevated stress.

Here are 6 things we’ve found helpful to “find our sleep”.

1. Dim the lights. Research indicates that exposure to light at nighttime suppresses melatonin production which in turn affects sleep. Cell phones, computers, video equipment and alarm clocks emit light. Make your room dark and, if at all possible, avoid the blue light generated by fluorescents, computer and video screens for up to an hour before your bedtime.

2. Avoid stimulants like caffeine and nicotine. Caffeine, is found in more than just coffee and tea- it naturally occurs in over 60 plants and lurks in surprising places including clear sodas, pain relievers, chocolate, ice cream, energy water, and breath fresheners. If you are a smoker, try to avoid smoking 2-3 hours prior to bedtime.

3. Watch what you eat! Pay attention to what you eat and drink before bedtime. A light snack might be beneficial but a full stomach can cause discomfort. This is especially true if you suffer from heartburn, acid reflux or indigestion. And, perhaps more obviously, avoid fluids late at night to limit trips to the bathroom.

4. Exercise! Research shows that regular, moderate physical activity promotes sleep. But, if you are sedentary, be patient- it takes time for a new exercise routine to have a positive impact on sleep. But, don’t exercise within a few hours of bedtime- your body needs time to unwind and relax.

5. Create a relaxing bedtime ritual. Habit helps signal your brain to slow down. Your ritual might include a warm shower, a chapter from a good book, a cup of warm milk and honey and/or soothing music.

6. Manage stress. Easier said then done, but successfully addressing stress improves your overall health including sleep. Read Psych Central’s excellent article on practical ways to handle stress or try one of the Wellness Center’s upcoming meditation classes.

Perhaps the most important tip of all, however, is knowing when to contact your doctor. Sleep disorders can be caused by complex combinations of environmental, physiological and psychological factors. Sometimes you need a little professional help to “find your sleep”.

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Learn more about insomnia

View our series of videos about sleep….

In these videos, Johns Hopkins neurology sleep specialist and director of the Sleep Center at HCGH, Charlene Gamaldo, M.D., and Johns Hopkins sleep specialist, Dr. Rachel Salas discuss common sleep problems like sleep changes that come with age; insomnia, especially in women; and other disorders that get in the way of restful sleep. Helpful strategies to improve sleep and available treatments are also discussed.

 

Photo taken from this photostream and used with permission of a Creative Commons license. 

 

 


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