The Facts on Falling Back and Sleep

Man and Woman Sleeping [Credit: Monkey Business Images] / []

Most of us love the extra hour we gain when daylight savings time ends in the fall. However, feeling better rested may not result from simply sleeping in an extra hour. Rather, aligning your waking time more with daylight – a physical cue that makes all the difference – is the more likely explanation.

Your biological internal clock, known as circadian rhythm, responds to light and darkness. When your activity does not correspond with sunlight cues, it throws off your circadian rhythm, causing your sleep to be disturbed. The extra hour helps with resetting your body’s exposure to sunlight.

Getting a good night’s sleep is important. If you are wondering how important, consider the risks associated with poor sleep and the benefits of good-quality sleep.

Risks from Poor Sleep

  • Weight gain
  • Heart attack
  • Stroke
  • High blood pressure
  • Diabetes

Benefits from Good-quality Sleep

  • Feeling better
  • Looking younger
  • Experiencing improved memory and concentration
  • Feeling less moody and grouchy

While seven to nine hours is optimal for most adults, you can achieve big improvements in your sleep quality by practicing consistency, which is going to bed and waking up at the same time every day.

If you are not currently doing this, try testing it. Make a point of going to bed and waking up at the same time for a couple of weeks. I did this several years ago. For two weeks, I went to bed at 11 p.m. every night and woke up every morning at 7 a.m. After five days, I felt like the last time I had slept so well was in middle school.

However, if you think you are getting enough good-quality sleep, but are still very tired, that is a signal for getting evaluated. Start by contacting your primary care provider who may be able to treat your sleep condition or recommend someone who can. The good news is that common sleep disorders can be treated.

Rachel Salas, M.D. is the assistant medical director for the Johns Hopkins Center for Sleep at Howard County General Hospital.

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The Sleep and Exercise Connection

exercise and sleep“There is a reciprocal relationship between sleep and exercise,” said Charlene Gamaldo, M.D., medical director of the Johns Hopkins Center for Sleep at Howard County General Hospital. “Most of us recognize the fact that when we sleep well we feel better and have more energy during the day, which includes feeling more motivated and having more energy to exercise. Those who sleep well tend to lead a more active lifestyle.”

On the flip side, studies show that the average person who exercises regularly has a tendency to fall asleep more quickly and go into deeper sleep stages. “These individuals also appear to prime their body and brain to be better and more efficient sleepers, which results in waking up feeling more rested and restored,” noted Dr. Gamaldo.

Exercise and insomnia
People suffering from insomnia are unable to fall asleep or struggle with staying asleep. For those who don’t respond to treatment, recent data suggests that exercise may help.

In one study, participants suffering with long-standing insomnia exercised moderately (with an increase in heart rate) for 50 minutes, three times a week, for six months,” said Dr. Gamaldo. “The results showed a significant improvement in their insomnia. This was not just a subjective measurement on how they felt, but also based on their sleep quality as measured in a sleep lab. This is exciting news, and there is no downside of exercise, no bad side effects. Patients also reap the health benefits that come with increased physical activity along with better sleep.”

Exercise when you can!
Although this study showed that the time of day that people exercised didn’t negatively impact the participant’s sleep, Dr. Gamaldo warns that everyone is different.  “I encourage my patients to exercise and, if they can fit it in more practically in the evening without hampering their sleep, then they should do so. For a long time we felt you shouldn’t exercise in the evening before sleep, and for some people that may still be the case. Listen to your body and try to incorporate physical activity at some point in your day that works for you.”

Charlene Gamaldo, M.D., is the medical director of the Johns Hopkins Center for Sleep at Howard County General Hospital and associate professor of neurology at Johns Hopkins Medicine. For an appointments, call 800-937-5337.

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Men and Women are Different, Even in Sleep

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

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Sleepless in Columbia…what it means for your health

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

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

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Losing Weight Improves Sleep Apnea

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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