Tag: sleep

Are There Alternatives to CPAP?

ghordianknot

Short answer: Maybe. Under certain circumstances.

Longer answer: How you manage your breathing, your diet, your schedule, and even what position you sleep in can make a difference!

If you have severe obstructive sleep apnea, you probably don’t have an equally effective alternative to CPAP. And you need to get in front of this thing. It can really damage your heart. Sorry. You will have to make peace with this appliance. It can be done. I promise to write a post on that soon!

If your obstructive sleep apnea is mild, and you are certain that you don’t have a form of central sleep apnea, (your brain is stopping you from breathing while asleep), there are some alternatives less disruptive than CPAP, stomach stapling, and getting a divorce from your bedmate.

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  • Try sleeping on your side.  Your tongue and your uvula (that thing that hangs down in the back of your throat) are less obstructive in this position.
  • Avoid drinking alcohol at night.  The sedative effects of alcohol can make the tissues in your throat floppier, creating more of an obstruction.
  • Eat a lighter dinner and a bigger lunch.  Filling your belly late at night and then thinking that it won’t make it harder to breathe isn’t logical.
  • Make sure you aren’t congested.  Use a saline nose spray and perhaps use a humidifier if your central air system can’t moisturize the air well enough.
  • Get enough sleep.  This is a desperate cycle, in which short sleepers eat more and want to use alcohol to quell their anticipatory anxiety around insomnia.  Work on all the other aspects of your sleep to boost both the quality and the quantity.  

You should always discuss any type of treatment for sleep apnea with a trusted medical provider.  Not every idea is a good one.  Not every strategy is as safe as it seems.  

Many of my clients are surprised when they discover that strategies that seem innocuous could harm them.  Weighted blankets, for example.  If you have osteoporosis, placing something heavy on your bones when you are unconscious isn’t smart.  Or magnesium supplements;  it is possible to buy the wrong type.  There is a formulation of magnesium supplementation that easily gives you diarrhea.  Talk about not being able to sleep;  you could end up seriously dehydrated and admitted to the hospital overnight for IV fluids!  

Pay attention to the responses you receive from your healthcare providers when you mention alternative strategies to address mild OSA.   Their responses will vary from dismissive to open and curious to rapidly enthusiastic.

 Beware the dismissive provider as well as the immediate embracer.  Neither of them are giving your ideas enough attention.  The best responses are either in the category of “I will investigate and get back to you.” and “Here is what I know about your diagnosis and symptoms that makes me concerned about/interested in  the X approach.”   

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Want to do sleep coaching with me online?  I  make it easy !  Go to my “Contact ” page and send me an email today.    

We work on your specific sleep goals together, using the latest techniques drawn from sleep science and behavioral health.  

Don’t compromise…optimize!

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Should You Use a Light Box to Improve Your Sleep?

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Here in the northeast, it gets pretty dark pretty early these days (late November).  The days can be rather gray as well.  For people in higher latitudes, the days are even shorter.  SAD (seasonal affective disorder) has already begun for those who are vulnerable to this issue.  They often sit in front of a light box to life their mood.

But what if you don’t have SAD.  You feel mentally fine.  Your sleep isn’t terrific, and you have heard about getting enough full-spectrum light exposure in the morning to support a strong circadian cycle.  In the northeast, you could wait all day for the sun and go to bed having never seen it peek out.

Should you get a light box?

Not necessarily.

Light boxes aren’t prescription-only.  You can grab one on Amazon and it will be at your doorstep in a few days.  You should know, however, that they do create risks for certain people, and aren’t helpful for even more folks.  Most of us get far more sun exposure by going outside than using a light box for a short period in the morning will provide.  Access to sunlight at the right time of the day should be sufficient for most people.

Light boxes need to be used at the right time of day to get the right results.  Most people with SAD, depression, and advanced sleep phase disorder use them within 60 minutes of awakening.  Use later in the day can push bedtime far later into the night.  Using them inconsistently, for short periods of time, walking too far away from them during use, even turning away from them will make them ineffective.

Clinicians struggle to do research on light boxes because getting people to use them consistently and correctly is harder than simply handing out a pill.

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Who should not use a light box without checking with a physician?

  • Anyone with diagnosed retinal disorders.  This isn’t nearsightedness.  This would be macular degeneration and a few more things.  Most people over 65 should speak directly with their eye doctor as well as their PCP.
  • Anyone with bipolar illness.  Strong full spectrum light can trigger a manic episode in some people.  It isn’t the most common reaction, but because the cost of a manic episode can be high, a physician should be involved in choosing a protocol and monitoring use.
  • Anyone that has a history of light sensitivity, including people with brain trauma, seizure disorders, etc.  You have a lot to lose if things go south.  A physician can help you decide what your risks are.  Most clinical-grade light boxes filter out about 99% of UV rays.  But that doesn’t mean ALL light boxes you can buy on Amazon do that.  The clinical-grade light boxes run 3-4x the price of the cheapest boxes, and you get what you pay for.
  • Anyone with conditions that can create retinal damage, such as diabetes.  You don’t have damage yet.  You don’t want to risk developing some.
  • Anyone taking medications that render them more sensitive to light.  This includes some antibiotics and seizure medications, but the list is far longer and includes some very common antidepressant meds and NSAIDs.

Who could benefit from using a light box?

People with circadian rhythm disorders and SAD, primarily.  Some people with insomnia, shift workers, and people who aren’t able to get sun exposure for various reasons will also benefit.  This is one of those treatments that should be used with input from a medical provider as well as a sleep therapist.  Using a light box isn’t plug-and-play.  Identifying the timing and the set up to get the best results mean that most people need more guidance than they can find online.

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What are some alternatives?

There are light glasses and full-spectrum lightbulbs that allow people to have either more mobile exposure or less intense exposure.  These should not be used in the evening if you want a good night’s sleep!  And neither have been studied as treatment for SAD or circadian rhythm disorders due to their difficulty in measuring consistent light exposure to the retina.  Blending sleep strategies that include strong wake up routines and wind down routines can be as effective as a light box for people who do not have circadian rhythm disorders or SAD.

Read more about sleep treatments here: Are You “Wired and Tired”?  and How to Dim Your Screens to Reduce Blue Light at Night  .

How to Dim Your Screens to Reduce Blue Light at Night

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Change your nighttime screen settings now to improve your sleep tonight.  It is simple.  It only has to be done once.  Ever.

My favorite sleep strategies are the ones I call “crockpot solutions”.  Set it and forget it.  Things that you don’t have to remember and prioritize.  You take an action and it’s done.  Willpower is overrated.  It is hard work.  Easy habits and crockpot solutions will triumph over willpower all the time.

Altering your screen settings is easy and effective.  Reducing the amount of full spectrum light hitting your eyes in the evening will help your brain secrete Melatonin, the neurohormone that induces sleepiness.  Leaving the lights on will delay Melatonin secretion and make it harder to fall asleep.

Is it as effective as turning the screens off or being many feet away from them?  No.  But lots of people will need some time and creativity to alter their screen use habits.  This can start them off on the path with a few clicks.

Yes, viewing a screen that isn’t using full spectrum light looks slightly strange.  Particularly for skin tones.  If your goal is to sleep better, the less-than-desirable coloring should make viewing less enjoyable and help you turn it off and go to sleep.  These settings automatically revert to full spectrum light after dawn if you use the auto settings.

For Macs/iPhones/iPads:

  • Go into System Settings.
  • Click on Displays.
  • Select Night Shift.
  • Make your choices for timing and appearance.  These include custom settings.  The warmer your screen, the less full spectrum light you receive when looking at your screen.  

 

For PCs/Android devices:

  • Select Settings.
  • Now select System.
  • Click on Display.
  • Select Night Light.
  • Turn on Schedule Night Light.
  • Select Sunset to Sunrise or Set Hours for custom times.

 

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Sleep Trackers: Do They Help? Should You Get One?

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Many of my new clients tell me that they have been using sleep trackers and sleep apps that promise to measure sleep.  They aren’t always certain that the information they receive is accurate or even useful.  They want to know my opinion(s).  And anyone that knows me is aware that if you ask my opinion, you will absolutely receive it.  In detail.

Well…..

These are mostly either apps that sense your body movement while you are in bed, or wearables that monitor your heart rate, breath rate, and more.  Some are attached to CPAP machines.  What they DON’T measure is what a somnograph does:  brainwaves.

They can’t measure brainwave activity.  That happens in a sleep clinic.

This means that your app and your wearables are using secondary signs of sleep to provide feedback about your sleep.  Not getting the whole story makes taking action harder.

This is like checking the shelves in a store to measure whether the business is making money or not.  Something is selling.  Money is changing hands.  Whether or not profit is being made can’t be definitively determined by shelf stock numbers.  You have to look “under the hood” to know for sure.

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This means that you need to take an app’s/wearable’s interpretation with a grain of salt and interpret the interpretation.  This confuses people, and they often prefer to take the readouts and the interpretations at face value. Do that, and you could end up with inaccurate beliefs about the quality of your sleep.  In both directions.  Without somnography, we have to look at your subjective sense of being rested and renewed, your sleep diary and compare it  with your chronotype, and your overall ability to function during the day.

This is one of the best reasons to get a sleep coach.  We drill down and work with you so that you can eventually do your own assessment of your sleep.  You learn so much about sleep that you can figure out how to tweak things months after we finish our CORE sessions.

Being able to look “under the hood”  tells us a lot more about the quality of your sleep than a sleep tracker can offer you.  After all, the older you get, the more likely it is that your sleep issues are complicated.  There is no way that a movement sensor or a breath counter is going to help you solve a complex problem.

So What Can a Sleep Tracker/Sleep App Do?

  1. Motivate you.  Some people like to have numbers.  They like something to record or graph.
  2. Provide information to your doctor or sleep coach.  They have the training to interpret the interpretations.
  3. Give you early warnings that your new sleep plan isn’t working, or your new medication/ CPAP machine isn’t giving you the results you want.
  4. Remind you how important sleep is to your health.  Life is complicated.  Keeping sleep as a priority isn’t easy when you are being pulled in a million directions.  Your app/wearable is a reminder that sleep is important.

Want more information about sleep coaching?  Get in touch with me!

 

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Do You Need an Alarm to Improve Your Sleep?

 

dog sleeping

Simple answer:  Only if your current sleep quantity and quality could use a boost.  If you wake refreshed at the same time every morning after 7.5-9 hours of continuous sleep (short pee breaks excepted) then you might not need an alarm clock.

Longer answer:  If you have problems sleeping or don’t feel refreshed when awakening, using the right alarm and ditching the snooze function can be the cornerstone of getting better sleep.   

Alarm clocks help us get up when we need to, but they also set our circadian rhythm on its path to triggering tonight’s sleepiness at the best time.  Waking at the same time every day, weekends included, supports sleep and health.  The studies are out there.  This isn’t conjecture.  And it could be the easiest action to take to improve your sleep.  

I like that.  Telling people to use a complicated routine is the fastest way to turn them off of sleep therapy.  This is a “crockpot” strategy.  Set it and forget it.  Work with your body instead of against it.  But use the sleep science to refine your actions and boost your success rate.

How to choose a clock

There are a lot of alarm choices out there.  It used to be one choice:  a little box with a clock face.  Now you can have lights, phones, vibrations, and more.  They will wake you with anything from your fave song to birdcalls to gradual illumination.

If your sleep is satisfying and long enough, be creative.  Pick what appeals to you, because it probably won’t make much difference to your health.

alarm-clock

 If you fail to wake quickly enough with gentle sounds or lights, you need something more intense.  Remember; waking doesn’t mean that you won’t be fully awake right away.  That is normal.  Your brain is shifting brain wave states and coming to fully alertness.  You may shuffle around the house a bit and even feel slightly disoriented.  

Some people prefer not to hear a harsh buzz or even the first notes of a song.  For people with cardiac issues or dysautonomia, which we see with POTS and sometimes with long COVID, that could be an undesirable physical shock. That is fine; there are alerting choices that won’t be so intense.  Many alarm clocks offer a variety of frequencies and patterns. Find one that is alerting enough without shocking your system or putting you in a grouchy mood first thing in the morning.   If your bed partner tells you that your new “gentle dawn” clock has been at full light for 30 minutes and you just opened your eyes, it isn’t doing much for you.  

 

If you fail to wake with TWO loud alarms, you should probably be wondering why you sleep so soundly in the morning that you cannot rise without shock.  This automatically has me thinking medications are sedating you or you are experiencing such a severe sleep deprivation from little sleep in the preceding nights that your brain is “starved” for sleep.  The third option is a medical sleep disorder or the prodrome to something neurological.  That requires a physician’s evaluation, so tinker with the other two first.   That way your doctor will have a clearer path for their evaluation procedures.

Where do I place an alarm clock?

That depends on how you respond to it.  If it is next to your bed and once you shut it off you get up, done and done.  If you ignore it, then it needs to be far enough away that you must rise out of bed to turn it off.  If you can go across the room, turn it off, and get back into bed, then you need something like an app that makes you answer a series of questions before it shuts off.  Or the clock that has mag tires and rolls around the floor to be caught by YOU!  Don’t forget that any device that has an illuminated screen should be dimmed in some way to lower the amount of light in your bedroom.  You can turn the light to the wall, cover it with an adhesive dimming film, or adjust the illumination on the the clock. 

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