Vicki Cohn

  • Sleep Health

    Have trouble grinding your teeth? Here’s how to control it.

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    By Sally Wadyka | June 20, 2022 featured in Washington Post

    Dr. Vicki Cohn was interviewed for her professional insight regarding the issues with grinding your teeth at night. Below is the article including Dr Cohn’s input.

    Dentists reported a 69 percent jump in patients who clench or grind their teeth during the pandemic, according to the American Dental Association (ADA). And most of these people are probably unaware that they’re doing it. “It’s an almost completely unconscious behavior,” says Vicki Cohn, chair of the American Academy of Sleep Medicine’s Dental Assembly.

    The condition, called bruxism, can apply up to 200 pounds of force to the teeth. “The bite strength of grinding can be up to six times greater than normal chewing,” says Ada Cooper, a dentist and a spokesperson for the American Dental Association. So it’s no surprise that it can wear down or even break teeth. And for older adults — whose teeth may be more fragile — bruxism may be especially troubling.

    Wearing a mouth guard can help protect teeth from grinding at night.

    In these trying times, dentists are seeing more people with teeth-grinding and jaw-clenching — a.k.a. bruxism

    A host of causes

    Bruxism can occur during the day or at night. Stress can be a significant factor, either in moments of acute tension or during sleep, when elevated levels of stress hormones may still circulate after a difficult day, Cohn says. Habits such as alcohol and tobacco use hike the likelihood, too. “Smokers are about twice as likely to grind their teeth as nonsmokers,” Cooper says. Certain medications — such as some antidepressants and antipsychotics — can also increase the risk.

    Conditions that affect the central nervous system, such as dementia, Parkinson’s disease or stroke, can cause or exacerbate bruxism. And it often goes hand in hand with temporomandibular joint disorders, which cause pain around the jaw. Finally, there’s obstructive sleep apnea (OSA), where the upper airway becomes repeatedly blocked during sleep, leading to numerous breathing pauses at night. This can cause people with OSA to “unconsciously overcompensate and grind their teeth as they thrust their jaw forward to open the airway,” says Manar Abdelrahim, a dentist at Cleveland Clinic. (If you’re told you have OSA, ask about being evaluated for bruxism.)

    Untreated sleep apnea may worsen markers of heart health and diabetes

    Spotting the signs

    A cracked tooth, crown or filling may be a clear signal something is amiss, but there are less dramatic signs to watch for. People with sleep bruxism, for instance, may wake up with a sore jaw or neck, a headache, a stiff jaw, ringing in the ears, or marks around the edge of the tongue where it pressed against clenched teeth. If you notice these, see your dentist, who will check for tooth wear, fractures and gum recession. But “if the only evidence is wear on your teeth, you might not have active bruxism,” Cohn says. Chronic severe heartburn is a common cause of tooth wear in older adults.

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    A video recording in a sleep lab or electromyography can definitively diagnose sleep bruxism. For the latter, electrodes attached to the skin check for repetitive jaw muscle movements.

    Need a quick stress-reliever? Try one of these surprising science-based strategies.

    Treatments to consider

    While bruxism can be hard to remedy, the following may help:

    • A plastic mouth guard: “Wearing a guard at night is usually the number one line of defense,” Abdelrahim says. “A guard puts space between the upper and lower teeth to protect them and allows the jaw muscles to relax.” A guard customized for you ($324 to $788) is usually more effective than an over-the-counter product, and is sometimes covered by insurance. Neither breaks the habit but will prevent further tooth damage.
    • Botox: Botulinum toxin injections into the jaw muscles that control chewing may reduce the pressure you exert on teeth.
    • Stress reduction: Relaxing activities (such as yoga and meditation) may help. So can increasing your awareness of the behavior. A tip: “If, during a stressful moment, you feel your teeth touching, gently allow your jaw to open and the teeth to float away from each other,” Cooper says.
    • Physical therapy: A physical therapist trained to treat bruxism can teach you exercises to stretch, strengthen and relax neck and jaw muscles, which can reduce the muscle tension that may lead to clenching and grinding.
    Copyright 2022, Consumer Reports Inc.

    Consumer Reports is an independent, nonprofit organization that works side by side with consumers to create a fairer, safer, and healthier world. CR does not endorse products or services, and does not accept advertising. Read more at ConsumerReports.org.

  • Sleep Health, Sleep Study

    Sleep Disturbances Common in Patients Who Recovered from COVID

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    Original Article | Jun 6, 2022 | Sleep Review Magazine

    Nearly all patients who recovered from COVID-19 report lingering fatigue, while half experience sleep disturbances, according to a recent analysis from Cleveland Clinic. Researchers found that race, obesity, and mood disorders are contributors. 

    Investigators analyzed data from 962 patients from the Cleveland Clinic ReCOVer Clinic between February 2021 and April 2022. The patients were recovered from COVID-19 and completed the sleep disturbance and fatigue questionnaires of the Patient-Reported Outcomes Measurement Information System. More than two-thirds of patients (67.2%) reported at least moderate fatigue, while 21.8% reported severe fatigue. Eight percent of patients reported severe sleep disturbances, and 41.3% reported at least moderate sleep disturbances.  

    “Sleep difficulties are highly prevalent and debilitating symptoms reported in patients with post-acute sequealae of COVID-19,” says Cinthya Pena Orbea, MD, a sleep specialist at Cleveland Clinic, in a release. “Our study suggests that the prevalence of moderate to severe sleep disturbances is high and that Black race confers increased odds to suffer from moderate to severe sleep disturbances highlighting the importance to further understand race-specific determinants of sleep disturbances in order to develop race-specific interventions.” 

    Patients with moderate-to-severe compared with normal-to-mild sleep disturbances had higher body mass indices, were more likely to be Black, and had worse general anxiety disorder.  

    After adjusting for demographics, Black patients were three times more likely to experience moderate-to-severe sleep disturbances. 

    The research abstract was published recently in an online supplement of the journal Sleep and will be presented June 6 and 7 during SLEEP 2022.

    Photo 188719463 © Robert Knesc

  • Sleep Food

    Why Potatoes Are the Perfect Food for Sleep 

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    Original Article | by Stephanie Eckelkamp · March 8, 2022, The Wellnest

    If you struggle with sleep, chances are you’ve tried it all: eye masks, reducing nighttime screen time, guided meditations, and more. But did you know nutrition can be another tool to help you slumber?

    Sweet potatoes, in particular, are a lovely little package of good carbs and sleep-promoting micronutrients. While it may seem like a strange pick, there are a few reasons why potatoes are some of the best foods to eat for better sleep. 

    1. POTATOES HELP STABILIZE BLOOD SUGAR

    A study in the Journal of Sleep Research found carbohydrates were associated with less difficulty staying asleep—but only complex carbohydrates. Complex carbs are carbs composed of fibers and starches (think: the kind you find in whole plant foods such as potatoes and other veggies, legumes, and whole grains). They digest more slowly than the simple carbs present in sugary foods, refined grains, and baked goods. This means complex carbs lead to a slower, steadier rise and fall in blood sugar, not the type of blood sugar surge and subsequent drop that interferes with sleep. 

    Sugary foods and refined carbs, on the other hand, can cause a blood sugar spike and subsequent drop about four hours later—and this drop is associated with increased production of the neurotransmitter norepinephrine, which promotes alertness. Translation: Not a recipe for good sleep.

    2. POTATOES HELP YOUR BODY PREPARE FOR SLEEP

    Sweet potatoes still have a moderate impact on blood sugar, but that isn’t a bad thing. In fact, the nutrients they contain make them one of the best tryptophan foods for sleep. “They have the right amount of complex carbohydrates to elicit an insulin response that clears the way for the amino acid tryptophan to flood the brain with less competition from other amino acids,” says Judes Scharman Draughon, MS, RDN, author of 12 Fixes to Healthy. “More tryptophan in the brain helps promote more serotonin production and consequently more of the sleep-enhancing hormone melatonin.” 

    3. POTATOES CONTAIN SLEEP-SUPPORTING VITAMINS AND MINERALS

    Think of sweet potatoes like a natural (and delicious) sleep supplement. “They have the right balance of nutrients like potassium and vitamin B6 to stimulate the production of the sleep hormones serotonin and melatonin,” says Scharman Draughon. Sweet potatoes also contain magnesium, which aids in the production of the neurotransmitter gamma-aminobutyric acid (GABA), which calms nerve activity and helps you relax. 

    What about white potatoes? They’re not as nutrient-rich, but as long as you’re not eating them in the form of French fries, go ahead and give them a try. “White potatoes produce similar sleep effects as sweet potatoes, but sweet potatoes contain more tryptophan than white potatoes and a nice dose of beta-carotene,” says Scharman Draughon.

    HOW TO EAT POTATOES FOR BETTER SLEEP

    Whatever potato you choose, don’t eat it too late in the evening. “Eating any food within 60 minutes of going to bed can negatively affect your sleep,” says Scharman Draughon. Your best bet: Incorporate it into your dinner several hours before bed, or (if you’re still hungry) have half a potato as a small late-night snack a bit closer to bedtime. 

    “Eating a potato for dinner or at least four hours before bed may promote better sleep than eating it an hour before bed,” Scharman Draughon says “It takes time for all these sleep-promoting reactions to occur in the body.” That said, everybody is a little different, so you may need to experiment to find your ideal potato-eating window. 

    And if you can stomach it, eat the potato skin, too! This provides an extra dose of fiber which promotes balanced blood sugar—and eating enough fiber every day has been associated with improved sleep. Drizzling your baked potato with a little Greek yogurt, olive oil, avocado, or almond butter—all of which provide a dose of healthy fats—helps further stabilize blood sugar and aids in the absorption of fat-soluble nutrients such as beta-carotene (which helps support healthy eyes and skin and a stronger immune system). 

    THE BEST FOODS FOR SLEEP

    Aside from potatoes and sweet potatoes, what are some other healthy bedtime snacks? Here are five foods to eat for better sleep:

    OATS

    Oats are another complex carb that may have a similar sleep-promoting effect to potatoes. They also produce enough insulin to help clear the way for tryptophan to get to the brain. Plus, they contain a healthy dose of vitamin B6 and melatonin, making them one of the best bedtime snacks. but complex carbs aren’t the only way to enhance sleep. 

    KIWI

    Craving something sweet before bed? Good news: Kiwi is one of the best snacks you can have before bedtime. That’s because they have an unusually high serotonin content, according to Scharman Draughon. 

    MILK

    Turns out, the age-old tradition of having a glass of milk before bed holds up. According to Scharman Draughon, it’s one of the best foods for deep sleep. “Drinking milk in the evening may help you sleep, as it contains a component known as casein trypsin hydrolysate (CTH), which binds to a receptor in the brain to suppress nerve signaling and promote sleep,” she says.

    CHERRIES

    “Tart cherries, with their high concentration of both melatonin and antioxidant capacity, also enhance sleep,” says Scharman Draughon. In fact, research shows that tart cherry juice before bed improves both sleep duration and sleep quality. Looking for some cherry bedtime snack ideas? Consider making a simple tart cherry smoothie with frozen tart cherries, magnesium-rich almond butter, milk (or non-dairy milk such as almond milk or oat milk), and a bit of easy-to-digest protein like HUM’s plant-based vanilla protein powder, Core Strength. In addition to sleep-promoting micronutrients, this blend contains protein, complex carbs, and fats to promote stable blood sugar. 

    CHAMOMILE TEA

    For something lighter that you can sip closer to bedtime, try chamomile tea. This cozy beverage has been shown to improve sleep quality and quell anxiety, thanks in part to an antioxidant called apigenin, which appears to promote muscle relaxation and sleepiness. For something extra dreamy,  try one of these bedtime latte recipes.

    KEEP IN MIND, YOUR OVERALL DIET MATTERS THE MOST 

    While some individual foods may offer sleep-promoting properties when consumed closer to bedtime, your overall eating pattern throughout the day is even more important.  

    One study in the Journal of Clinical Sleep Medicine found that even just one day of eating low fiber, high saturated fat foods negatively influenced participants’ sleep, in part, by interfering with slow wave sleep, which is considered the most restorative sleep stage. Additionally, eating a higher percentage of calories from sugar and refined carbohydrates was associated with waking up during the night, likely due to fluctuations in blood sugar.

    Eating low-fiber, high-sugar, and high-saturated fat foods during the day can also drive your urge for less healthy late-night snacking, which can further interfere with sleep, says Scharman Draughon. At meals, aim for a balance of protein, high-fiber complex carbs (veggies, whole grains, certain fruits), and a healthy source of fat (olive oil, avocadoes, nuts, seeds, salmon).

    THE TAKEAWAY

    Potatoes, especially sweet potatoes, offer a great combination of complex carbohydrates for steady blood sugar, along with vitamins and minerals that enhance the body’s production of sleep-promoting hormones and neurotransmitters. Try incorporating them into your dinner or a small evening snack for deeper, more restful sleep. Pro tip: Half a baked sweet potato slathered with almond butter and sprinkled with cinnamon is almost like dessert. 

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  • Sleep Study

    Restricted Sleep Increases Some Symptoms of Migraine, Study Finds

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    Original Article | Sleep Review

    PharmacyTimes: Using a transcranial magnetic stimulation method, researchers have found that reduced sleep alters central nervous inhibition from GABAergic and dopaminergic mechanisms differently in individuals with migraines versus those without.

    Migraine is a primary headache disorder with a well-established association with insufficient sleep. According to the study, migraine affects approximately 15% of adults aged 15 to 64 globally and is the leading cause for years lived with disability below 50 years of age. Many patients with migraine report problems with sleep, headaches upon awakening, and using sleep as a way to avoid a headache. Researchers have also found worse sleep quality compared to individuals without migraines, as well as an increased likelihood for insomnia-like sleep patterns among individuals with migraines.

    Sleep restriction with about 50% sleep for 2 nights is a human experimental model of insufficient sleep, according to researchers. In healthy subjects, sleep deprivation may alter cortical inhibitory and facilitatory systems, and seems to increase pain sensitivity. Increased sensitivity to pain has previously been discovered in patients with migraine and may be associated with both increased homeostatic sleep pressure caused by increased need for sleep as well as reduced intracortical inhibition.

    Despite these findings, both the underlying pathophysiology of the disease and its relationship with sleep are unexplained. In order to investigate this association further, researchers applied transcranial magnetic stimulation to analyze possible mechanisms of insufficient sleep in patients with migraine.

    According to the analysis, sleep restriction had an opposite effect on cortical silent period duration in interictal migraines and controls. The cortical silent period refers to an interruption of voluntary muscle contraction by stimulating the contralateral motor cortex. With sleep restriction, this period was reduced from 147.9 minutes to 139.6 minutes. This impact was still significant when replacing sleep condition with measured sleep time in minutes.

    Get the full story at pharmacytimes.com.

  • Sleep Apnea Dentist

    Why do more women struggle with insomnia than men?

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    Sleeping is an essential part of our lives. It helps us recharge for the next day. Research in this area has helped understand various sleep disorders.

    But most research has dodged the question of how different women’s sleep patterns are compared to men.

    Why is insomnia more common in women?

    The National Sleep Foundation survey, one of the first surveys in this field, found that 46% of women reported troubles with sleep almost every night. Other studies also conclude that insomnia is 40% more prevalent among women.

    A prominent reason for this difference is biological, where hormone production during pregnancy, postpartum, menopause and menstruation changes. But social and cultural reasons, like work and family, also play a role, according to the survey.

    Gender and sleep

    Gender differences have important scientific consequences. For instance, almost a decade ago, the Food and Drug Administration reduced the recommended dose of zolpidem, a drug similar to Ambien, by half for women to treat insomnia. This came after the discovery that women metabolized the drug much slower than men — which led to gender-specific guidelines.

    “It was important to raise the issue of sex differences — which is biological differences between women and men — to point out that there are differences in sleep in both the sexes,” said Dr. Monica Mallampalli, the senior scientific adviser for Healthywomen.org and a board member for Alliance of Sleep Apnea Partners.

    For example, obstructive sleep apnea, a sleep disorder in which breathing repeatedly stops and starts, is typically found in men. But women also experience it, Mallampalli explained.Report ad

    “Usually, they’re misdiagnosed or undiagnosed, and the symptoms that they present are very different than what a typical man would present,” she said, adding, “it’s also mostly hormonal.” Fibromyalgia, a condition that causes pain all over the body, has also been linked to insomnia, peaking at puberty and menopause for women, both periods of hormonal change.

    What are the types of sleep problems women face?

    1. Depression, anxiety and stress

    Sleep is often tied to mental health and women are proven to be more likely to suffer through depression and anxiety. Studies show that women are more likely to ruminate about their concerns which can hamper their ability to fall asleep or go back to sleep.

    2. Pregnancy

    According to a study, around 30% of women say they rarely sleep and more than 50% have insomnia-like symptoms. Neck and back pain paired with difficulty finding a comfortable sleeping position can disturb the quality of sleep. These problems can persist after childbirth.

    3. Obstructive sleep apnea

    Women with sleeping problems like obstructive sleep apnea are less likely to be referred to specialized sleep clinics, according to a study on gender bias in sleep disorder diagnosis. Mallampalli explained, obstructive sleep apnea is often underdiagnosed in women.

    4. Restless leg syndrome

    This syndrome creates a strong under to move limbs, especially legs, when lying down. Restless leg syndrome is also more common in men than women. Mallampalli adds that this syndrome is commonly seen in pregnant women.

    How do you improve your quality of sleep?

    Environmental stimuli such as a bright light in the bedroom, traffic noises, music, television, room temperature, pets and bedpartners can all affect sleep. The Society for Women’s Health Research created a Women & Sleep guide which suggests darkening rooms with blackout shades and drapes, turning off electronics in the room and double-paning windows for noise cancellation.

    Earplugs, eye masks and white noise machines are also extremely helpful. Caffeine and electronic gadgets should be avoided at night time, as well as stimuli like nicotine and alcohol, according to researchers.

    Mallampalli, who was involved in creating this guide, believes that by spreading awareness, more women will be able to advocate for themselves and ask their physical care physicians about sleep health. And this is how a change can begin.

  • Sleep Health

    ‘Why Does Alcohol Mess With My Sleep?’

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    Posted by Sleep Review Staff | Jan 26, 2022 

    New York Times: Alcohol disrupts what’s known as your sleep architecture, the normal phases of deeper and lighter sleep we go through every night.

    A night of drinking can “fragment,” or interrupt, these patterns, experts say, and you may wake up several times as you ricochet through the usual stages of sleep.

    Men Raising Alcohol in A Toast

    “You pay for it in the second half of the night,” said Dr. Jennifer Martin, a psychologist and professor of medicine at the University of California, Los Angeles. Alcohol is “initially sedating, but as it’s metabolized, it’s very activating.”

    Here’s how it breaks down. In the first half of the night, when fairly high levels of alcohol are still coursing through your bloodstream, you’ll probably sleep deeply and dreamlessly. One reason: In the brain, alcohol acts on gamma-aminobutyric acid, or GABA, a neurotransmitter that inhibits impulses between nerve cells and has a calming effect. Alcohol can also suppress rapid eye movement, or REM sleep, which is when most dreaming occurs.

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