Sleep Health

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

    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 Disturbances Common in Patients Who Recovered from COVID

    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

  • ‘Why Does Alcohol Mess With My Sleep?’

    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.

  • For some women, a connection may exist between poor sleep and hormones

    Original Post | Washington Post Health

    By Leigh WeingusSeptember 18, 2021 at 9:00 a.m. EDT

    I’ve struggled with sleep since I was a teenager, and have spent almost as long trying to fix it. I’ve absorbed countless books and articles on getting better sleep that instructed me to go blue-light free at least two hours before bedtime, take nightly baths to lower my body temperature, keep my phone far from my bedroom and avoid caffeine after 12 p.m.

    In between all my diligent sleep hygiene work, I couldn’t help but feel like there was a larger force at play. My sleep seemed to change throughout my menstrual cycle, for example, getting worse in the days before my period and significantly better afterward. When I was pregnant, I experienced the best sleep of my life, and when I stopped breastfeeding, I didn’t sleep for days.

    Hormones and Women Sleep

    I finally started to ask myself: When we talk about getting better sleep, why aren’t we talking more about hormones?

    According to the National Sleep Foundation, the lifetime risk of insomnia is 40 percent higher for women than it is for men. Blaming this discrepancy entirely on hormones oversimplifies it — women also tend to take on the bulk of household worrying and emotional labor, and they tend to experience higher levels of anxiety.

    But according to Mary Jane Minkin, an obstetrician-gynecologist and clinical professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences at the Yale School of Medicine, anecdotal evidence and studies suggest that hormones likely play a role.

    If you look at the curve of hormonal secretion throughout the average menstrual cycle, Minkin says, you’ll see varying levels of estrogen and progesterone throughout the month, with a big drop of estrogen occurring right before menstruation.https://414a56c8c82860bb2b57ff47754d945d.safeframe.googlesyndication.com/safeframe/1-0-38/html/container.html

    “Many people will tell me that a day or two before their period, their sleep is terrible,” Minkin says.

    When a woman enters perimenopause, she starts to experience more fluctuations and produces less estrogen and progesterone throughout the month, which may wreak havoc on her sleep. The true correlation between these hormone dips and fluctuations and insomnia needs to be studied more extensively, Minkin and other experts say, and understanding this connection is confused by how a lack of estrogen is associated with hot flashes, which can disrupt sleep.

    Studies of women on hormone replacement therapy (HRT) and sleep strongly suggest a connection between female hormones and insomnia, Minkin and other experts say.

    HRT is often prescribed to women going through menopause (and the years after it) to help them deal with unpleasant side effects of that transition, which include sleep problems, Minkin says. Some types of HRT include only estrogen, while others have a combination of estrogen and progesterone. High levels of estrogen and progesterone occur naturally during pregnancy, which may explain why some pregnant women like me often experience blissful sleep, Minkin says.

    “During pregnancy, guess what? Your levels of estrogen and progesterone are very high,” Minkin says.

    Although postmenopausal women have very low levels of estrogen and progesterone, once the process of menopause is complete, they often begin to sleep better. “We think hormone fluctuations can be more bothersome to some women than their actual hormone levels,” Minkin says.

    She adds that if a postmenopausal woman does struggle with insomnia, low hormone levels could be the culprit, so it’s a good idea to talk with a medical professional about HRT options. A 2008 randomized, controlled study of some 2,000 postmenopausal women in the United Kingdom found “small but significant” improvements in sleep after a year of HRT vs. those taking a placebo.

    Hadine Joffe, a psychiatry professor who is executive director of the Mary Horrigan Connors Center for Women’s Health and Gender Biology at Brigham and Women’s Hospital at Harvard, says hormonal fluctuations may be a cause of insomnia for some women. But for others, she says, sleep disruptions might be anxiety-related, or caused by noisy neighbors or a snoring bed partner.

    She says that while some women experience amazing sleep during pregnancy, many others report terrible insomnia during that time of life. Her advice? If you want to figure out whether any connection exists for you, track it.

    “Try a [sleep] app or even a conventional sleep diary,” Joffe says. “If you track your sleep for several months, you may start to notice a pattern emerge, like more waking in the middle of the night right before your period.”

    If you do notice a pattern, she says, that information may be helpful going forward.

    “If you know there are two or three days in every month when you don’t sleep well, make sure that’s a time when you practice the best possible sleep hygiene, avoid alcohol, and if you have a partner you share family responsibilities with, you can ask them to get up with the baby or toddler,” Joffe says.

    Sometimes targeted treatment for those days can help, too, she adds. For example, supplementing with a few milligrams of melatonin before bedtime — the hormone our brains naturally produce in response to darkness — can help signal to the brain that it’s time to sleep. Or if you have a prescription for a sleep aid, this could be the time to use it, she says.

    While it’s not always possible due to work or family responsibilities, Kin Yuen, a sleep medicine specialist at Stanford Medicine, suggests trying your best to honor your natural daily hormone fluctuations to help keep your sleep on track. To do this, you’ll have to try to figure out when your body naturally releases cortisol (the hormone we produce in the morning that helps us wake up) and melatonin (the hormone we produce at night to help us fall asleep).

    By figuring out when you have the most energy — are you an “early bird” who wakes up full of energy, or a “night owl” who still feels sluggish at 9 a.m.? — you can better pinpoint when your body naturally releases these hormones. If you adjust your schedule to honor these rhythms, you may experience fewer sleep disruptions even in the face of constantly fluctuating female hormones, Yuen says.

    Finally, while HRT is not prescribed for women who have not yet gone through menopause, both Minkin and Joffe say that if someone is sure that their insomnia is hormone-related — preferably by having kept a diary for a while and after having tried other techniques without success — it’s worth talking to their doctor about taking a birth control pill.

    “Hormonal birth control can smooth out the ups and downs that just aren’t good for some people’s brains,” Joffe says. “It has to be the right treatment for the right person, but it can help.”

    Of course, there are side effects to birth control. Some women report nausea, headaches and lower libido. Although rare, more serious side effects have been reported, too, such as blood clots.

    But for many women suffering from what seems to be hormonally related insomnia, the benefits may outweigh the risks.

    Minkin says that even for patients going through menopause, if they are otherwise healthy, she’ll often prescribe birth control pills. Birth control pills have higher levels of hormones than traditional HRT, and if a woman has used them in the past and hasn’t experienced negative side effects, this can be a good indication that they will work well for her.

    “The only drawback is that we have no way of knowing when a woman is done with menopause, because the pill will artificially give her a period,” Minkin says. “So in order to find out if she’s done with menopause, she has to stop the pill.”

    At this point, Minkin and other experts say more research needs to be done to truly understand how the ebbs and flows of female hormones impact sleep.

    Sleep diaries, trackers and apps can be powerful tools to help a woman understand whether a connection exists for her, and they can help her act accordingly, the experts say.

    The pandemic is ruining our sleep. Experts say ‘coronasomnia’ could imperil public health.

    It’s not just the pandemic. The moon may be messing with your sleep, too.

    Poor sleeping, no energy, low libido: Is it aging?

  • Body Clock Off-Schedule? Sleepless Nights?Prebiotics May Help

    Original Article Posted by Sleep Review Staff | Sep 16, 2021 | Jet Lag Disorder

    Whether it’s from jetting across time zones, pulling all-nighters at school or working the overnight shift, chronically disrupting our circadian rhythm—or internal biological clocks—can take a measurable toll on everything from sleep, mood and metabolism to risk of certain diseases, mounting research shows.

    But a new University of Colorado Boulder study funded by the U.S. Navy suggests simple dietary compounds known as prebiotics, which serve as food for beneficial gut bacteria, could play an important role in helping us bounce back faster.

    “This work suggests that by promoting and stabilizing the good bacteria in the gut and the metabolites they release, we may be able to make our bodies more resilient to circadian disruption,” senior author Monika Fleshner, a professor of integrative physiology, said in a statement.

    Woman Suffering from A Sleepless Night

    The animal study, published in the journal Brain, Behavior and Immunity, is the latest to suggest that prebiotics—not to be confused with probiotics found in fermented foods like yogurt and sauerkraut—can influence not only the gut, but also the brain and behavior.

    Naturally abundant in many fibrous foods—including leeks, artichokes and onions—and in breast milk, these indigestible carbohydrates pass through the small intestine and linger in the gut, serving as nourishment for the trillions of bacteria residing there.

    The authors’ previous studies showed that rats raised on prebiotic-infused chow slept better and were more resilient to some of the physical effects of acute stress.

    For the new study, part of a multi-university project funded by the Office of Naval Research, the researchers sought to learn if prebiotics could also promote resilience to body-clock disruptions from things like jet lag, irregular work schedules or lack of natural daytime light—a reality many military personnel live with.

    “They are traveling all over the world and frequently changing time zones. For submariners, who can be underwater for months, circadian disruption can be a real challenge,” said lead author Robert Thompson, a postdoctoral researcher in the Fleshner lab. “The goal of this project is to find ways to mitigate those effects.”

    How a healthy gut may prevent jet lag

    The researchers raised rats either on regular food or chow enriched with two prebiotics: galactooligosaccharides and polydextrose.

    They then manipulated the rats’ light-dark cycle weekly for eight weeks—the equivalent of traveling to a time zone 12 hours ahead every week for two months.

    Rats that ate prebiotics more quickly realigned their sleep-wake cycles and core body temperature (which can also be thrown off when internal clocks are off) and resisted the alterations in gut flora that often come with stress.

    “This is one of the first studies to connect consuming prebiotics to specific bacterial changes that not only affect sleep but also the body’s response to circadian rhythm disruption,” said Thompson.

    The study also takes a critical step forward in answering the question: How can simply ingesting a starch impact how we sleep and feel?

    The researchers found that those on the prebiotic diet hosted an abundance of several health-promoting microbes, including Ruminiclostridium 5 (shown in other studies to reduce fragmented sleep) and Parabacteroides distasonis.

    They also had a substantially different “metabolome,” the collection of metabolic byproducts churned out by bacteria in the gut.

    Put simply: The animals that ingested the prebiotics hosted more good bacteria, which in turn produced metabolites that protected them from something akin to jet lag.

    Are supplements worthwhile?

    Clinical trials are now underway at CU Boulder to determine if prebiotics could have similar effects on humans.

    The research could lead to customized prebiotic mixtures designed for individuals whose careers or lifestyles expose them to frequent circadian disruption.

    In the meantime, could simply loading up on legumes and other foods naturally rich in the compounds help keep your body clock running on time? It’s not impossible but unlikely, they say—noting that the rats were fed what, in human terms, would be excessive amounts of prebiotics.

    Why not just ingest the beneficial bacteria directly, via probiotic-rich foods like yogurt?

    That could also help, but prebiotics may have an advantage over probiotics in that they support the friendly bacteria one already has, rather than introducing a new species that may or may not take hold.

    What about prebiotic dietary supplements?

    “If you are happy and healthy and in balance, you do not need to go ingest a bunch of stuff with a prebiotic in it,” said Fleshner. “But if you know you are going to come into a challenge, you could take a look at some of the prebiotics that are available. Just realize that they are not customized yet, so it might work for you but it won’t work for your neighbor.”

  • How to tell if it’s time for a ‘sleep divorce’

    (CNN)He snores until the walls rattle. She gives off a massive amount of body heat. One of you is a cover hog, kicks at night or takes consistent 3 a.m. bathroom breaks. Maybe you sleepwalk or suffer from insomnia. The list of reasons why your bed partner might be keeping you up at night could be long and as dreary as your mood when you drag yourself from bed each morning.

    When it comes to your health, that’s nothing to yawn at: Being deprived of a full seven to eight hours of sleep each night has been linked to a higher risk of diabetes, stroke, cardiovascular disease and dementia, according to the US Centers for Disease Control and Prevention.

    Sleep Divorce As A Result of Sleep Deprivation

    There’s an emotional toll as well, said sleep specialist Wendy Troxel, a senior behavioral scientist at RAND Corporation who authored “Sharing the Covers: Every Couple’s Guide to Better Sleep.”

    “Sleep deprivation can affect key aspects of relationship functioning, like your mood, your level of frustration, your tolerance, your empathy, and your ability to communicate with your partner and other important people in your life,” Troxel said.Poor sleep — and that resulting crummy mood — makes people “less able to engage in ‘perspective taking,’ or putting small adverse events in context,” said sleep specialist Rebecca Robbins, an instructor in the division of sleep medicine for Harvard Medical School, who coauthored the book “Sleep for Success!”

    That strain can contribute to depression, anxiety, and other emotional and relationship dysfunction, Robbins said.

    Sleep training for adults prevents depression, study findsResearch done by Troxel and her team found that a well-rested person is “a better communicator, happier, more empathic, more attractive and funnier” — all traits that are key to developing and sustaining strong relationships, she said.Sleeping apart can help couples be happier, less resentful and more able to enjoy their time together in bed, particularly on weekends when work demands are lighter, Troxel said.”I tell couples to try to think of it not as a filing for sleep divorce, but as forging a sleep alliance,” she added. “At the end of the day, there is nothing healthier, happier and even sexier than a good night of sleep.”https://www.cnn.com/audio/player?episodeguid=85e00da6-889c-4c66-a203-adb70011ee08&parentOrigin=https%3A%2F%2Fwww.cnn.com&canonicalUrl=https%3A%2F%2Fwww.cnn.com%2F2021%2F12%2F04%2Fhealth%2Fsleep-divorce-wellness%2Findex.html

    Rule out underlying sleep issues

    Sleep partners are often the ones to flag signs of sleep disorders and encourage their loved one to visit a doctor or sleep specialist. Undiagnosed, sleep disorders may well harm you and your partner’s future health.That’s why experts say it’s best to check with a sleep specialist to rule out and treat any underlying condition before you leave your loved one’s bed — you may well be the key to identifying and treating a true health issue.

    Coping skills

    Once any serious health issue is ruled out, couples who find it emotionally bonding to sleep in the same bed may wish to try some practical coping tips before making the decision to sleep apart, Troxel said. No alcohol please. If you struggle with insomnia, cut out alcohol well before bed, experts say. It may appear to be helping you sleep, but booze actually causes middle of the night awakenings that can be hard to overcome. Snorers should eliminate alcohol as well, Troxel said, “because as everyone probably knows, if you sleep with a snorer and they have one too many drinks, the snoring will be much worse that night.” That’s because the alcohol further relaxes the throat muscles, encouraging that loud snore.

    Keep your brain sharp by finding your sleep ‘sweet spot,’ study saysThis is where partners can be powerful and beneficial sources of what experts call “social control,” Troxel said.”If you’re prone to drinking but you know that the consequences are not only going to bad for your sleep, but your partner’s sleep as well, then maybe you’ll be more motivated to cut back a bit,” she said.Raise the head. For snoring, try sleeping on additional pillows or using an adjustable bed — anything that raises the head to keep the throat open, Troxel said.”For many people snoring tends to be worse when they are flying flat on their backs, so raising the head a little bit can be useful,” she said.If the underlying issue is congestion, try adding a humidifier to the room, she added. “Some people have had success with over-the-counter nasal strips to keep the airway open.”Drown the sound. Survival 101 for dealing with a snoring partner is trying to deafen the noise, Troxel said. Try ear plugs and run a fan or white noise machine.Try sleep scheduling. A snorer who sleeps with a partner with insomnia can help that partner get more sleep by going to bed later than their partner, Troxel said.”For example, a snorer can delay their bedtime by a half an hour to an hour,” Troxel said. “That allows the partner to fall into a deeper stage of sleep and possibly stay that way once the snorer comes to bed.”Turn the snorer. Sleeping on the back is the worse position for snoring, because the soft tissues of the mouth and tongue collapse into the throat. As the sleeper unconsciously forces air past those soft tissues, snores emerge.

    How to fall asleep more quickly — the healthy way“If you can keep someone on their side, that can attenuate the snoring,” Robbins said. “I’ve heard of all kinds of creative techniques, such as putting a bra on the snorer in reverse and then putting tennis balls in the cups.”Full support body pillows may be an option, if they stay in place, said sleep specialist Dr. Raj Dasgupta, an associate professor of clinical medicine at the Keck School of Medicine at the University of Southern California.”I’m a fan of the simple things, but if you want to purchase something we’ve come a long way from sewing tennis balls into the back of our pajamas,” Dasgupta said. “You can buy a strap-on to your back that has little protruding foam-like things which are supposed to make you sleep on your side.”And there are some FDA-approved devices that strap to the throat or chest and provide vibrations designed to go off when you are on your back, prompting a move to side-sleeping.”

    Time for separate rooms?

    You’ve tried it all, and good sleep is still a distant dream. At this point, there’s no reason not to do what is best for each of you to get the quality sleep you need — especially since there are other ways to nurture a relationship besides sharing a bed.

    The best alarm clocks of 2021 (CNN Underscored)“Couples can still make the bedroom a sacred space, even if they choose not to actually sleep together,” Troxel said. “You can develop pre-bedtime rituals and use that time to actually connect with your partner instead of being independently on a phone or laptop or whatnot. “She encourages couples to spend quality time together before bed, sharing details of the day and sending positive messages to each other. “We know self-disclosure is good for relationships, it’s good for sleep,” Troxel said. “If you tell your partner you’re grateful for them, that’s a deep form of connection. Gratitude is good for relationships, it’s good for sleep.”

    Nor does a “sleep divorce” have to mean separate beds every night, Troxel said. It could be just the workweek, with weekends spent in the same bed. It could be every other night — the options are as unique as each couple. “There truly is not a ‘one-size-fits-all’ sleeping strategy for every couple,” Troxel said. “It’s really about finding the strategy that’s going to work best for the two of you.”