Time Zone Tips for Traveling with Children: Easy Ways to Help Reset Their Clocks

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Traveling with kids can be tiring for the whole family.  One major culprit is crossing time zones; it can wreak  havoc not only on sleep routines, but general behavior as well.    As I mentioned in  11 Sleep Tips for Traveling with Children,  you have two options: if you are only crossing one or two time zones for a couple of days,  consider remaining on your home time zone to make the transitions easier for everyone.  But if you are crossing multiple time zones for a longer period, the key to beating jet lag for children,  as well as adults,  is to shift to the new time zone as soon as possible–maybe even before you get there!

Here are my top tips to help your family get back on track fast and with as few meltdowns as possible!

Plan ahead

If you like to plan ahead, you can start the transition to the new time zone a few days before you leave.  These tips will ensure your child is at or close to the new time zone prior to leaving which can make travel and sleep easier.

Here’s how it works:  Start about 4-7 days before your departure (depending on how many times zones you are traveling), and shift nap times, mealtimes, and bedtime in 15 minute increments  either earlier or later depending on what direction you are going.

For example,  if you are traveling West crossing  two time zones, bedtime will be 2 hours later than usual.  To prepare in advance, begin to shift meal times, nap times, and bedtime later by 15 minutes per day for 7 days. When you arrive at your destination, you will already be at or close to the new time zone.

If you are traveling East by two time zones, bedtime will be two hours earlier than usual. That means that prior to  to departure, you will shift meal and sleep times earlier by 15 minutes per day for 7 days.

Advance planning isn’t for everyone, nor does everyone have the time to do it.  Don’t worry, your child will  adjust to the new time zone with the following  tips.

If you are Westward bound:

Light exposure:  Exposure to light at key times can help your child avoid jet lag and make a faster shift to the new time zone.  When traveling west, seek afternoon light and avoid bright light early morning in your new setting.  Make make sure your child’s room is as dark as possible so those early morning rays don’t wake him.  If black out curtains aren’t available,  black garbage bags can do the trick!  You can even find  an app that recommends light exposure at different times of day to help with the adjustment.

Bedtimes:  When crossing 2-3 time zones,  say a trip from one coast to another, attempt to keep your child awake until his normal bedtime hour occurs.   The more time zones  crossed, the harder this will be.  Aim  for 30-45 minutes later each night and expect your child will take a few nights to adjust.  If  you travel  from New York to California and your child usually falls asleep at 7:00 p.m, he will be tired at 4:00 p.m.  Try to keep him awake until at least 5:00 P.M.  on your first night, using late afternoon light exposure to help out;  the next night your goal should be closer  to 6:00 p.m..  By the third night or fourth night,  he should  fall asleep at close to his normal bedtime in the new time zone.

Morning wake times:  When traveling West, expect earlier wake times:  try to allow children to stay in their bed until a “reasonable” hour, but be flexible.  You will most likely be waking earlier too!  In a few days, wake times should resume to their normal time as long as you don’t respond to the  too early calls the first few days after you arrive.

Nap times:  Try to stick to a nap schedule as much as possible.  When going West, your child will probably be tuckered out earlier than usual during the day, but still try to keep her usual nap time.  If  you travel  from New York to California and she usually takes an afternoon nap at 1:00 p.m., then she will be tired as early as 10:00 a.m.  the first day or so.  Do everything possible to keep her going until as close to  1:00 p.m.as possible,  without allowing her to become  too overtired.  If you need to put her down around 10:30-11:30 a.m. the first day, go ahead, but then push her another 30-45 minutes later the next day.  Within three days she should be sleeping at her usual time.   Also, don’t allow her to nap too long, which is tempting  after a particularly long trip.  You may have to wake him from a nap no later than  3:30-4:00pm to ensure a reasonable bedtime.

If you are heading East: 

Light exposure:  When traveling east, seek morning light and avoid bright light in the afternoon, to help advance your child’s  biological  clock.

Bedtimes:  Eastward travel is always a bit more challenging for adults as well as children.  Your child may not be tired at her usual bedtime at first, though long days of travel often wear  them out!  Try to get her in bed close to her usual bedtime.  To get her to bed earlier than usual, rely on a soothing bedtime routine, a dark room, and some white noise to help you set the stage.   Again, it may take a few days of  preparation to shift the bedtime earlier in 30-45 minute increments to reach the “new” bedtime.  If you travel  from California to New York and your child usually falls asleep at 7:00 p.m., then she  may not be tired until close to 10:00 p.m.,  New York time, on the first night.  Use your bedtime cues (darkness, white noise, routines)  to help her fall asleep around 9:30p.m. the first night and then move it 30-45 minutes earlier the next night.  By the third or fourth night, she should fall asleep at  her usual bedtime.

Wake times:  When traveling East, avoid the temptation to allow your child to sleep in!  Wake your child at the usual wake time so her  body  can adjust to the new  time; also,  allow for lots of light and activity in the mornings to help reset her  biological clock.

Nap times:  Again, aim for naps at your child’s usual time.   Using the California to New York example, expect that your child won’t be tired at his usual 1:00 p.m.  nap time because it will only be 10:00 a.m. according to his internal clock.  But again, use a combination of a lot of morning light and activity, followed by a dark room,  and a consistent bedtime routine to get her to fall asleep close to that time.   If you want to put her down a bit later the first day, try to move the time as close to 1:00 pm as possible in 30-45 minute increments over a few days.

 

Author: Dr. Rebecca Kempton, M.D.

 After graduating with a B.A. in Psychology from Dartmouth and an M.D. from Cornell Medical School, Dr. Rebecca Kempton worked for several years as a medical director for healthcare technology and pharmaceutical companies before becoming certified as a pediatric sleep specialist and starting her own business, Baby Sleep Pro.  Using a variety of behavioral techniques, she customizes sleep solutions based on individual family goals and childrens temperaments and coaches families to a better nights sleep.  Dr. Kempton works with clients both nationally and globally by phone, Skype, and email and with home visits.   She lives in Chicago, with her husband and three children, ages 8 and under. For more information, email rhk@babysleeppro.com; visit www.babysleeppro.com and follow her on facebook.com/babysleeppro and twitter @babysleeppro

How Lack of Sleep Affects Cholesterol

sleep health and heart

In previous studies, it has been found that sleep deprivation can negatively affect the immune system, metabolism, inflammatory process, and regulation of the hormone that controls appetite.  In a recent study out of the University of Helsinki, scientists have discovered that lack of sleep can also lead to problems with cholesterol metabolism.

The purpose of the study was to review the impact of sleep deprivation on cholesterol metabolism in both lipoprotein levels and gene expression.  With a tiny blood sample, scientists can find out about all gene activations and the different metabolites.  It is now possible to search for and find metabolic pathways and regulatory factors that partake in different bodily functions.

Vilma Aho, a researcher on the Sleep Team Helsinki group, states that they examined the changes lack of sleep caused on the body’s functions and what changes could lead to an increased risk for illness.

It was found that the genes responsible for cholesterol transportation are not as active in someone who has suffered with sleep deprivation as they would be in someone getting good, quality sleep.  This finding was noted on both a laboratory sleep loss experiment, as well as at the population level.

The different metabolites that were reviewed showed researchers that at the population level, people with sleep deprivation had lower HDL (high-density lipoproteins).  This is considered the good cholesterol level.  This finding was not present in those who got sufficient sleep.  Adding this to other risk factors of poor sleep, these findings add to the understanding of the higher cardiovascular disease risks that are seen in those with sleep deprivation.  The study has helped researchers further comprehend the mechanisms that cause the increased health risks in sleep-deprived persons.

It is of interesting note, Aho states, that the sleep deprivation components that are contributing to the development of atherosclerosis (changes to cholesterol metabolism) are found in both the laboratory experimental study and the epidemiological data.

Once again, we have a study that indicates the impact sleep has on our health.  The researchers of this study emphasize that education should focus heavily on the need for good sleep in order to prevent long-term health consequences.  This is in addition to a healthy diet and exercise regimen.  It is notable that even a small reduction in the number and severity of illnesses would result in extreme healthcare cost savings, which would impact the economic status of the society as a whole.

Just one week of poor sleep can lead to changes in the body’s immunity and metabolism.  The next goal of these researchers is to find out how small the sleep deficiency would need to be to cause such changes in the body.

 Background of the study:

This research out of the University of Helsinki is focused on studying the impact lack of sleep has on the body’s immunity and metabolism, especially with regards to cholesterol and lipid metabolism.  Hundreds of previous studies have shown the higher health risks in those who do not get sufficient sleep, but the Sleep Team Helisinki is looking to determine the mechanisms behind the risks on cholesterol metabolism in order to guide better education and understanding.

Heart diseases are linked to both the immune system and the body’s metabolism.  Lack of sleep has been found to cause an inflammatory reaction, and this may be contributing to the higher risk of developing a chronic illness.  Additionally, carbohydrate metabolism is thought to be affected by sleep deficiency in a way that resembles type 2 diabetes.

The impact that sleep has on cholesterol and lipid levels has been studied less frequently, which is why the researchers here are focusing their efforts on those mechanisms.

Reference:  http://www.eurekalert.org/pub_releases/2016-04/uoh-sld042116.php

 

Author: Rachael Herman is a professional writer with an extensive background in medical writing, research, and language development. Her hobbies include hiking in the Rockies, cooking, and reading.

Men Who Eat a High-Fat Diet Have Poorer Sleep

junk food

A new study out of the University of Adelaide has found that men who take in high-fat diets are more likely to report having problems sleeping at night, feeling excessive daytime sleepiness, and are more likely to be diagnosed with sleep apnea.

This study, titled the Men Androgen Inflammation Lifestyle Environment and Stress (MAILES) study, aimed to review the link between sleep and a high-fat diet, which was ultimately conducted by the Population Research and Outcome Studies unit at the University of Adelaide School of Medicine.  The Freemasons Foundation Centre for Men’s Health played a role in conducting the research as well.

More than 1800 Australian men between the ages of 35 and 80 were part of the study, which included an analysis of their dietary habits over a one-year period.  The results have been published in the journal, Nutrients.

One of the study’s authors from the University of Adelaide, Yingting Cao, said that even after adjusting for lifestyle factors, chronic diseases, and demographics, the results still showed that those who consumed a higher fat diet were more likely to have excessive daytime sleepiness.

Cao believes that these results have significant implications for concentration and alertness, which, of course, is of great concern to employers and employees.  In addition to these findings of excessive daytime sleepiness, Cao and her team found that men taking in high-fat diets were also more likely to have a diagnosis or suffer from sleep apnea.

Overall, the research showed that 41% of men who had dietary and sleep data available to review reported excessive daytime sleepiness, and 47% of men reported having poor sleep quality at night.  Mild to moderate sleep apnea was reported in 54% of participates, and 25% were found to have moderate to severe sleep apnea.  This was determined through a sleep study in those who had a previously reported diagnosis of sleep apnea.

The poor diet and sleep pattern is a vicious cycle, Cao and her colleagues say.  Feeling sleepy throughout the day because of poor sleep leads to one having less energy, which in turn is related to increased cravings of high-fat and sugary foods, which is further associated with poor sleep.

Quite simply, these results yield a common-sense message, and the researchers believe it is important for people to pay attention to it.  Frankly, they believe we need to have a healthier diet to have better sleep and more energy, which ultimately leads to higher concentration and daytime productivity.  Unfortunately, sleep quality is not often a consideration in the investigation of how the body is affected by various diets and weight loss.

Cao and the other researchers are hopeful that their work will help educate and guide interventional studies, which would enable people to lose weight in a healthy way, while also improving their sleep.

 Reference:  http://www.eurekalert.org/pub_releases/2016-04/uoa-fdl042016.php

Author:  Rachael Herman is a professional writer with an extensive background in medical writing, research, and language development. Her hobbies include hiking in the Rockies, cooking, and reading.

11 Sleep Tips for Traveling with Children

child travel sleep

When a friend told me she packs a suitcase full of her daughter’s favorite stuffed animals when they travel, I wasn’t surprised.   My family resembles a traveling caravan at airports as we transport all our gear.  Although trips with kids aren’t quite as blissful and relaxing as those pre-kid vacations,  advance planning helps.

With summer vacation season around the corner,  here are my  sleep tips for babies and toddlers  to alleviate some stress while on the road.

Start your trip well-rested.  Travel, whether by car, plane, or train,  can rob anyone of shut eye,  but it especially takes  its toll on young children and babies who accumulate sleep debts quickly.   Aim to have your child well-rested before leaving for your trip, taking restorative naps, and sleeping well at night for the days preceding your departure..  Babies and children whose sleep tanks are full  can adapt much easier to schedule changes and a little lost sleep here or there.

Plan travel time around sleep time.  Because children are naturally excited, or even stimulated, by travel plans, it’s often hard for them to sleep en route.  So, try to plan your departure and arrival times around naps as much as possible.  If your child still naps in the morning,  then plan to leave after the morning nap, not before.  Remember the first nap is usually the most restorative and helps curb over-tiredness for the rest of the day.  Also, transit naps are never as restful.   As much as possible, try  to arrive  at your destination in time for the usual  bedtime;  if the naps were shorter than usual, aim for an earlier bedtime.

Think ahead about sleeping conditions. Going from having their own bedrooms to crowding everyone into one bedroom can spell disaster for everyone’s sleep.   If you plan to stay in a hotel, splurge on a suite to give you some extra living space with a pull out or a crib.  This will allow you to enjoy the evening while your little ones sleep nearby; it may  even save you on food expenses if you also have a kitchenette  to store your own milk and snacks.   Finding a condo or private home has become easier than ever with sites like vrbo.com and airbnb.  Extra sleeping space makes for a more relaxed vacation  for everyone.

But if you are in a one room hotel room, all is not lost!  Get creative and think about where you can put a crib or small bed that is separate from you as possible. .  Sometimes it may mean the bathroom, a hallway, or even a large closet.  Rearranging the furniture can help as well as hanging a sheet from the ceiling to create a physical separator.  Hotel staff are usually more than willing to help you “redecorate” in the name of sleep.

All is not lost if your toddler ends up in your bed even though that is not your ideal  sleeping arrangement.  The key to a successful transition back home is communication ahead of time:  tell them this is a special sleeping arrangement just for the trip but when you return, you will be back in your own bed,  and he will be in his.  Frequent reminders  about sleep rules, even on the trip home,  are important to avoid the temptations to join you in bed upon return.

Buy, rent or reserve the beds you’ll need.   If you stay with family on a regular basis,  buy, or ask family members to borrow or rent,  a portable crib.    If you are staying in a hotel, call in advance, so the cribs or extra pull out beds will be ready when you check in. If you’re traveling by car, BYOB, or  bring your own bed;  a pack n play or  travel bed or sleeping bags  are great portable options which you’ll use many times.

Do practice runs.  Trips cause a lot of disruptions to familiar routines, whether it’s at a hotel or your  in law’s house. And you don’t want to arrive only to have your child  go into meltdown mode.   If you take your own travel bed or portable crib, allow your child to sleep in it a few nights before you leave to get used to it.  Also, prior to departure,  talk with toddlers about the plans, including new sleeping arrangements..

Take along helpful sleep accessories. Have you ever packed a suitcase full of toys only to never unzip the bag?  I have!  But these days I have  exchanged the extra toy bag for one with some helpful sleep accessories.

Here are some lightweight and useful options:

  •  A White noise app:  Download a white noise app, such as  “Relax Melodies” .  White noise is not only extremely soothing for both babies and toddlers,  but can help drown out ambient noise which may  be unavoidable away from home.
  • A favorite stuffed animal or lovey:  Bring one or two portable stuffed animals, lovies, or dolls  your child won’t sleep without.  But not a whole menagerie!
  • Sheets:  Even when traveling without the crib, consider taking your own sheets.  The  familiar patterns, the feel, and smell can help a child transition to a new sleeping environment..  Tip:  hotels (or even family) may not have appropriately-sized  sheets, so it’s better to take along your own.
  • Black plastic bags and some painter’s tape: They won’t  win any design awards, but garbage bags make great black out “curtains”  in a pinch and can help recreate the darkness that is essential for melatonin release and hence sleep.
  • Strollers: With travel more uncertain than ever, expect delays.  Even toddlers old enough to walk easily may benefit from rest on wheels, especially at an airport when there are flight delays..  Pushing a stroller is a whole lot easier than giving shoulder rides through the airport or amusement parks.

 Recreate bedtime routines.  Despite  changes of schedules and scenery, try to keep bedtime routines constant.   If bath, books, and song are parts of your normal routine, stick to them. If Grandma or Uncle Bob want to participate, let them join in  or take over!  It’s not so much about who does it, but that the routines are as consistent and predictable as they are at home.

Squeeze in naps as much as possible.   Whether walking  through Disney World or spending time with  your family,  it’s tempting to eliminate the nap while on vacation..  But  skipping routine naps spells trouble!   If your schedule necessitates a skipped nap one day, try to schedule a  lighter schedule the next to allow for crucial day time rest.   If you do miss a nap, compensate with an earlier bedtime.  The more the sleep deficit  accumulates, the more you head for dreaded meltdowns—even if you’re at the zoo!   Be flexible, but accommodate the daytime sleep needs as much as possible,  even if it is limited to napping  in the stroller or car or at the beach.  And when your child naps, take advantage of a midday siesta yourself!  It’s a great fix for the whole family.

Anticipate time differences.  If you are traveling across time zones,  the best advice is to move your schedules to the new time zone as soon as possible. And allow a few days to get sleep back on track both when arriving or returning home.   If you are only traveling for 2-4 days across one or two time zones, it is sometimes easiest to stay on your home time zone.  If you are traveling for a longer period to a different time zone, consider shifting to the new time zone during the week before your travel.  So modify your children’s sleeping and eating routines 15 minutes earlier, or later, each day prior to the trip.  This may  take 3-4 days, so plan ahead.

If you don’t make the adjustments prior to leaving, aim to  shift your child to the new time zone from day one.  So wake your child as close as possible to the new time zone or as the case may be, leave him if he wakes early and aim to do bedtimes at your usual time in the new time zone; the same goes for  naps.  Exposure to bright light early in the morning and dim light in the early evening if you are traveling East and doing the opposite  traveling West can help shift their circadian rhythms and make the transition easier.

 Break some rules and have fun!  Try not to stress out  about strict sleep habits on vacation.   Kids are surprisingly resilient:  if they  miss a few naps and go to bed too late a few nights,  they will survive and so will you!.  Let the kids have  fun doing something they don’t usually do.   And if you disturb a few people—fellow passengers or other hotel visitors– along the way, you won’t see them again, so don’t worry!

Get back on track as soon as you get home.  Sometimes the hardest part of a trip is to resume normal routines when you return.  Staying up late eating popcorn at grandma’s is so much more fun than hitting the hay at 7:00pm every night.  But don’t bring vacation habits home with you. Try to get back to nap and bedtime routines as soon as possible – knowing that it might take a few days and cause a few tears.

Author: Dr. Rebecca Kempton, MD

After graduating with a B.A. in Psychology from Dartmouth and an M.D. from Cornell Medical School, Rebecca Kempton worked for several years as a medical director for healthcare technology and pharmaceutical companies before becoming certified as an infant and toddler sleep consultant and starting her own business, Baby Sleep Pro.  With her three children, aged  seven and under, along with thousands of clients globally,  Rebecca has honed her sleep coaching skills.  Sleep training is never one size fits all!  Using a variety of behavioral techniques, she customizes sleep solutions  based on what she learns about you, your child, and your family’s goals. Rebecca  works with clients globally by phone, Skype, and email.  For more information, email rhk@babysleeppro.com; visit babysleeppro.com and follow her on facebook.com/babysleeppro and twitter @babysleeppro

Shifts in Sleep-Wake Cycles Affect Women More than Men

alarm clock  (3)

The Surrey Sleep Research Center at the University of Surrey has performed a new study that shows shifts in the sleep-wake cycles (circadian rhythm) has a greater impact on women than it does on men.  This study was published in the journal, Proceedings of the National Academy of Sciences (PNAS).

The study involved the assessment of the participants’ performance who were placed on 28-hour days with their circadian rhythm (sleep-wake cycle) shifted out of phase with the brain.  The cognitive performance, as mentioned, was more affected in women than in men.  This research indicates that there are significant implications for women who work nightshift hours, especially nurses, police officers, and security guards.

In this study, performed at the Surrey Clinical Research Centre, the researchers utilized a controlled environment without the natural light-dark cycles and placed 18 women and 16 men on a 28-hour day.  This was an effective way to desynchronize the brain’s 24-hour circadian clock, which is similar to a shiftwork scenario or jet lag.

During the awake period, participants were asked to perform a wide range of tests every three hours.  These included tests on mood and effort, self-reported assessments on sleepiness, as well as objective scales of cognitive performance.  This last included measurements of motor control, memory, and attention span.  Throughout this study, an EEG (electroencephalogram) to look at brain electrical activity, was monitored during the sleep states.  In both women and men self-reported assessments of sleepiness and cognitive function, the results showed that they were more sensitive to the circadian clock and the effects of awake time than the objective tests of performance.  Of critical note, however, is that women’s performance, more so than men’s, was strongly affected by the circadian clock shift.  It was such that women were more impaired cognitively during the early morning hours, which generally coincides with the end of a night shift in the real world.

Dr. Nayantara Santhi, co-author of the study out of the University of Surrey, reported that for the first time, this study shows that the challenges of a shifted circadian clock affects women and men’s performance very differently.  The findings suggest that there are significant cognitive impairments and changes in mood in those who do shiftwork.  Extrapolating these results shows that women are affected more negatively than men when it comes to this type of work.

Professor Derk-Jan Dijk, senior author of the study, reports that the results actually indicate circadian rhythmicity affects the brain’s function in both men and women, albeit differently in quantitative measures.  Professor Dijk also reports that, overall, these findings illustrate the importance of including both sexes in sleep studies, as well as the importance of using a wider range of objective and subjective indicators of brain function in order to get a better understanding of how circadian rhythm affects each group.

 Reference:  http://www.eurekalert.org/pub_releases/2016-04/uos-nsf041516.php

Author:Rachael Herman is a professional writer with an extensive background in medical writing, research, and language development. Her hobbies include hiking in the Rockies, cooking, and reading.

Consolidating Memory During Sleep

sleeping

Sleep makes up about 1/3 of our lives.  Decades of research have concluded that sleep is vital for learning functions and making long-term memories.  However, knowing exactly how long-term memory is formed is not wholly understood.  It remains a primary question in neuroscience

New research from neuroscientists out of the University of California Riverside published in the Journal of Neuroscience reported that there may now be an answer to that question.  For the first time, this study will look at a mechanistic explanation for how deep sleep, or slow-wave sleep, is responsible for the consolidation of new memories.

Animal and human brains are disengaged from any sensory input during sleep.  Even so, the brain continues to be highly active, with electrical activity present in the form of hippocampal sharp-wave ripples, as well as high-amplitude slow oscillations in the cortex.  The hippocampus is a small brain region that is part of the limbic system.  The cortex is the outer part of the cerebrum.  This process reflects that there are alternating periods of silent and active neurons during deep sleep states.  During sleep, the episodic memories acquired during wakefulness are transferred from their initial spot in the hippocampus to the cortex and stored there as long-term memories.

The researchers at UC Riverside used a computational model to create the link between the neuronal synaptic connections and the brain’s electrical activity during deep sleep.  The model spontaneously generates patterns of slow oscillations in the cortex and shows that these patterns are directly influenced by the sharp-wave ripples in the hippocampus.  Additionally, the oscillations in the cortex determine synaptic changes in the neurons.  It is notable that synaptic strength is generally believed to play a role in memory storage and learning.  In this model, the synaptic changes affect the slow oscillation patterns and promote a sort of reinforcement and replay of specific memories.

Lead researcher and author of the study, Dr. Yina Wei, notes that the slow oscillations are undisturbed by input from the hippocampus.  This is interpreted as an explanation for the ability to consolidate specific memories during sleep because the traces of memory are formed within the cortex and then become completely independent of the hippocampus.

According to the computational model used, Dr. Wei explained that the hippocampal input goes to the cortex during deep sleep and then proceeds to influence how the slow oscillations are brought into the cortical network.

The influence of these slow oscillations and the input from the hippocampus activates memories during sleep, causing some memories to replay.  During this replay, synapses that correspond to these are strengthened for long-term storage within the cortex.  Dr. Wei reports that this suggests there is an important link between hippocampal sharp-wave ripples and the transfer of memories to the cortex.

As mentioned, brain activity stays high during sleep.  Normal sleep consists of rapid eye movement (REM) and non-rapid eye movement (NREM) sleep.  REM and NREM alternate several times throughout the sleep cycle, usually about four or five times in an eight-hour sleep period.  NREM occurs first, which is then followed by REM sleep, and one cycle lasts between 90 and 110 minutes.  There are three stages of NREM sleep, with the third stage being deep sleep.  Deep sleep makes up approximately 20% of the cycle and generally occurs in the first third part of the night.

It is of note that even spatially localized and weaker input from the hippocampus had an effect on the slow oscillation pattern, which then led to persistent changes of synaptic communication between neurons.  The model can make predictions, Wei believes, that can be experimentally tested, which include interventions that will either augment or suppress the process of memory consolidation.

Reference: http://www.eurekalert.org/pub_releases/2016-04/uoc–htb041416.php

Rachael Herman is a professional writer with an extensive background in medical writing, research, and language development. Her hobbies include hiking in the Rockies, cooking, and reading.

New Research on How We Fall Asleep and Wake up

sleep research

There are millions of people who have trouble with transitioning from an asleep to an awake state.  Many find it difficult to fall and stay asleep throughout the night, as well as stay awake and alert throughout the day.  The neurobiological mechanics of our sleep-wake cycle, or circadian rhythm, has remained largely unknown despite the decades of research performed on the subject.

New research out of the University of Maryland School of Medicine (UM SOM) has recently found a key pathway to these processes; specifically, the pathway regulating that transition between sleep and wakefulness.  For the first time, this study has elucidated this process in great biophysical detail.

Researchers focused on a specific area of the brain, which is the suprachiasmatic nucleus (SCN) located in the hypothalamus.  This is where the body’s internal clock resides, and it is responsible for determining when we go to sleep, how long we stay asleep, and when we are to wake up.  Dr. Andrea Meredith, PhD, the Associate Professor of Physiology at UM SOM, focused heavily on certain ion channels within the SCN.  These are proteins that make electrical currents and relay information between neurons.  The group of channels that she focused on was the BK potassium channels.  These were most active in the SCN region.

The paper on this research recently appeared in Nature Communications, and noted that Dr. Meredith first examined mice, which happen to have the opposite schedule to humans, sleeping during the day rather than at night.  In the mice, the BK channels were much more active upon waking.  Throughout the day when they were sleeping, these same channels were inactive.  Dr. Meredith discovered that the role of the BK channels inactivity during the day was to inhibit wakefulness.

There were two sets of mice examined in this research.  There were normal mice and mice whose BK channels were altered so they could not be inactivated.  Channel activity was recorded in both through electrodes that were placed on the neurons in the SCN region.  The mice whose BK channels were altered had lower levels of neuronal activity, thereby resulting in more daytime wakefulness, which was not a good sign since mice are supposed to sleep during the day.

These findings are somewhat surprising for several reasons.  There are no known physiological processes that rely solely on inactive BK channels.  The researchers did know that the channels acted in this way; however, they did not understand how neurons used the channel mechanism to regulate the coding of information within this part of the brain.  This study is the first to show that the inactivation of BK channels is necessary for regulating the circadian rhythm.

The BK channels are known to help with the regulation of other physiologic functions, such as activating muscles and controlling heart rate, blood pressure, and bladder function.  They have also been known to regulate neuronal excitability and help with memory, learning, and motor control.  The BK channels in the brain are linked to seizures, addiction, tremors, and difficulty with memory and learning.

Now, with this new research, Dr. Meredith believes they have strong evidence to support the theory that BK channels are specifically involved in the circadian rhythm.

Additionally, researchers in the past believed that the sleep-wake cycle (day-night pattern) of neuronal firing was guided by a completely different mechanism.  They believed that it was due to the number of ion channels on the surface of neurons in the SCN region.  This new research shows that this is far too simplistic a theory.  It is not in the number of channels that exist, but that they are being activated and then inactivated at specific times.

There are clinical implications to these new findings.  The inactivation mechanism could be used to create medications that target the sleep-wake cycle. These drugs could treat many sleep disorders, seasonal affective disorder, and even jet lag, which all involve issues within the SCN clock.

Reference: http://www.eurekalert.org/pub_releases/2016-04/uoms-nsi041416.php

 

Rachael Herman is a professional writer with an extensive background in medical writing, research, and language development. Her hobbies include hiking in the Rockies, cooking, and reading.

10 Ways to End Those Bedtime Battles

Child sleeping

Bedtime battles are a common sleep issue that many parents face with their children on a daily basis.  Instead of ending the day in a calming and relaxing manner, many families struggle with bedtime protesting that could potentially last for hours before a child finally falls asleep.  Fortunately, there are many things parents can do to end those bedtime battles once and for all, and take back control of bedtime.

Set an age-appropriate bedtime and be consistent with this set bedtime.

Children (and adults, for that matter) should go to sleep and wake up at approximately the same time every day.  Children ages 4 months through 6 years of age need 11-12 hours of uninterrupted sleep per night.  Children ages 7-12 years of age need 10-11 hours of night time sleep.  Teenagers need 9-10 hours of sleep at night.  Figure out what time your child tends to wake in the morning and count backwards to determine what time your child needs to fall asleep.

Use a digital clock in your living room and in your child’s bedroom to signal to your child it is time for bed.

It is good for children to have a concrete visualization to confirm that it is their bedtime, instead of taking their parent’s word for it.  Not only is this helpful during the summer months when it is still light outside, but it also gives children a sense of control over their bedtime experience.

Make sure the hour before bedtime, if not longer, is wind down time.

After dinner is a good time to start winding down any stimulating behaviors such as rough and tumble play.  You should also dim the lights, put on soothing music, and end all screen time.  You can also incorporate bath time during this wind down time, if it is relaxing for your child.

Be prepared for bedtime.

Before you begin the sleep routine, make sure you have everything you will need for bedtime and for sleep all ready and waiting inside your child’s room.  You don’t want to have to leave your child’s bedroom once you have begun the bedtime routine.

Create a brief, consistent and non-stimulating bedtime routine.

Children thrive on consistency, so having a consistent bedtime routine is important.  Consistency allows children to know what is going to come next during bedtime and this helps lower their bedtime anxiety and creates a feeling of control.  A bedtime routine may consist of books, a song, and some special cuddle time.

Create a safe and soothing sleep environment for your child.

A child’s bedroom should be dark, a cool temperature (68-72 degrees), non-stimulating, and safe. If you have a baby sleeping a crib, all that should be in the crib is a mattress and a fitted sheet.

Start the bedtime routine early enough so that your child has time to fall asleep before becoming overtired.

Children’s bedtime routines should last no longer than 15 minutes.  Once you have determined the time your child needs to fall asleep, work backwards to figure out what time you need to start the bedtime routine so that your child is not finally trying to fall asleep once his or her body has already become overtired.  You want to allow enough time for the routine and for your child to slowly and peacefully drift off to sleep.

All children should be put down awake.

The most important tool a child must have to be a great independent sleeper is the ability to self soothe.  Once you have finished the bedtime routine you should leave your child’s room so that your child learns to fall asleep without your help.  All healthy children can learn how to self soothe and this learned skill will serve them well for the rest of their lives.  Once a child has learned to self soothe, this skill can be used both at bedtime to fall asleep independently and if waking in the middle of the night (not due to an illness or an injury).

Bedtime conversation should focus on positive and happy thoughts.

Many older children will choose bedtime to discuss unhappy experiences and thoughts from the day.  Make it a household rule that bedtime is reserved for talks such as “the best part of my day was…”  Set up a specific “talk time” during the day for discussions focused around anything troubling your child.  Your child should know that you will be available to discuss concerns and anxieties, but bedtime is reserved for talk focused around things that make us smile.

Create a sleep rule reward chart.

Behavior modification tactics such as reward charts are great ways to add a little motivation for your troubled sleeper.  Choose the one most important sleep rule and write it on the chart, which can be decorated by your child to allow participation in this reward chart process.  Your child will also choose the 99 cent type store rewards to fill up a treasure chest.  At wake up time, if your child has successfully followed the sleep rule, he or she gets to put a sticker on the chart and choose a reward from the treasure chest.

Best of luck as you begin your journey to end, once and for all, the bedtime battles.  As with any and all childhood sleep issues, consistency is key.  If you remain 100% consistent and committed to eliminating the bedtime battles, while respecting age appropriate bedtime schedules and routines, you will take back control of bedtime and be well on your way to raising a great sleeper!

Author: Whitney Roban, Ph.D.

PEDIATRIC SLEEP SPECIALIST

Dr. Whitney Roban considers sleep a necessity, not a luxury.  She lives and works by one philosophy: parenting is one of the hardest jobs, made even more difficult when a family doesn’t sleep. Her mission is to give the gift of sleep to families through her information dissemination and emotional support based sleep training system, as well as her parent and corporate wellness education workshops.

With a Ph.D. in Clinical and School psychology from Hofstra University, Whitney began her career creating psychoeducational books and games for Childswork/Childsplay. Whitney formed SLEEP-EEZ KIDZ and SLEEP WELL/WORK WELL and has helped hundreds of children and their parents sleep soundly every night.

For more information about Dr. Whitney Roban, SLEEP-EEZ KIDZ and SLEEP WELL/WORK WELL, please visit www.sleepeezkidz.com.  You can also visit facebook.com/sleepeezkidz and twitter.com/sleepeezkidz.

5 F.A.Q.s about Sleep Telemedicine

telemedicine

1.  What exactly is sleep telemedicine?

Any health care that takes place between a patient and a clinician who are not in the same physical location could be considered telemedicine.  In a sense, many sleep doctors have been practicing telemedicine for a long time by reading sleep studies remotely through virtual private networks (VPNs). Recently, there has been an explosion in the field and telemedicine has  made major inroads in several medical specialties, including stroke, urgent care, dermatology, ophthalmology, and psychiatry, among others. There are a few different models of telemedicine and some new terminology to describe them:

Synchronous: the patient and provider interact at the same time.

Asynchronous: data is obtained from the patient and accessed at another time by a provider. An example would be a patient emailing a picture of a suspicious mole to his dermatologist with the dermatologist accessing the image from a secure server at his convenience.

Telepresenter: a healthcare paraprofessional, such as a medical assistant or nurse, who facilitates a telemedicine encounter where the patient is located.

Direct-to-consumer telemedicine: the patient and provider interact directly without intermediaries.

2. Can sleep disorders be accurately diagnosed via telemedicine?

There may be room here for a healthy debate on the topic, but my answer is unequivocally “yes.” The diagnostic bible of sleep medicine is the International Classification of Sleep Disorders – Third Edition (ICSD-3). This book details the formal criteria necessary to make sleep disorder diagnoses and is consistent in delineating that the diagnosis can be made from a patient’s history in conjunction with sleep studies, although not all sleep disorders require a sleep study. This information can be readily obtained through telemedicine.

3. What are the advantages of sleep telemedicine?

There are many advantages, including decreased cost of care and convenience to patients and providers. At a minimum, patients may only need a computer or  smartphone, and an Internet connection to have a telemedicine evaluation. This may save patients from having to take time off from work and commuting to their doctor’s office. In some regions of the country that are underserved by sleep medicine, this could save a patient several hours of travel to the nearest sleep clinic. Also, there is risk involved, for the patient and from a public health standpoint, to having excessively sleepy people driving this much.

From a provider’s standpoint, telemedicine allows us more flexibility in where and when we provide patient care. It is also a novel platform for increasing access to health care and has tremendous potential for improving population health outcomes.

4. What are the disadvantages of sleep telemedicine?

Physical examination is generally limited to observation. Biometric data, such as BMI and neck circumference, is provided by the patient and the clinician is not able to validate it objectively. However, telepresenters, when available, can help this situation by taking vital signs and assisting with the physical examination. Additionally, there is an increasing array of data-transmitting telemedicine examination devices, such as stethoscopes and otoscopes, that are entering the marketplace and allowing more robust physical examinations.

Another drawback to telemedicine  is that, by definition, telemedicine does not allow “laying of hands” by the provider, preventing the physical connection that many doctors argue enhances the therapeutic  patient-doctor relationship. There are also theoretical privacy risks such as your protected health information (PHI) becoming  exposed over an unsecured network. It is important for your telemedicine provider to use a platform that conforms to HIPAA requirements.

5. Will my insurance cover telemedicine services? Will I be able to get the prescriptions that I need from a telemedicine consultation? What about sleep study and blood work orders?

In the majority of states, telemedicine services have been determined to be equivalent to traditional healthcare services.  There has been a rapid proliferation of “parity” laws in states requiring insurance companies to reimburse telemedicine and traditional services equally. You can learn more at americantelemed.org.

Telemedicine providers can prescribe medication and electronically send  prescriptions to your pharmacy. Diagnostic testing, including sleep studies and laboratory tests, can also be ordered.

Currently, Texas and Arkansas have been given “F” ratings by the American Telemedicine Association for restrictions placed on providers while Georgia has been given a “C” rating. These states have enacted legislation that essentially makes it impossible to practice telemedicine. If you live in one of these states, let your state congress know that it is time to change these statutes and catch up with the rest of the country.

Joseph Krainin, M.D. is the founder of Singular Sleep, a company that offers virtual, online sleep medicine consultations.

Parkinson’s Disease Worsened by Altered Circadian Rhythm

alarm clock  (4)

New research from the Lewis Katz School of Medicine at Temple University (LKSOM) suggests that irregular sleep-wake cycles and chronic insomnia may be risk factors of Parkinson’s disease. In this animal model study, circadian rhythm disturbances before the onset of Parkinson’s disease significantly worsened learning and motor deficits brought on by this disease.

Led by Professor Domenico Praticò, MD from the Center for Translational Medicine and the Department of Pharmacology and Microbiology at LKSOM, this new research is the first to suggest that an environmental factor can exacerbate pathology and symptoms of Parkinson’s. This factor is long periods of chronic exposure to light, with brief exposures to dark, altering the circadian rhythm in the animals. These findings are published in the April version of the journal, Molecular Psychiatry.

The circadian rhythm is a roughly 24-hour biological cycle in humans. This cycle is disrupted in patients with Parkinson’s disease, leading to recurrent sleep disorders and disturbances. However, it is noted that whether these disturbances lead to or impact Parkinson’s disease development and progression is still unclear. Dr. Praticò states that most doctors feel sleep problems are secondary to the disease, but these circadian rhythm disturbances are frequently reported before the onset of symptoms, suggesting that the disturbance is a risk factor.

For the most part, diagnoses of Parkinson’s disease after the age of 60 are idiopathic, or have an unknown cause. Dr. Praticò believes that it is likely in idiopathic cases that the disease comes on as a result of environmental and genetic risk factors. Environmental risk factors can include circadian disturbances, sleep disorders, and chronic stress. All of these factors affect the central nervous system functioning, likely contributing to Parkinson’s pathology.

Using a well-established mouse model of Parkinson’s, where treatment with the neurotoxin, MPTP, reproduces aspects of the disease, researchers analyzed the role of an altered circadian rhythm. The animals were divided into two groups, the first of which was a control group, maintained on a regular sleep-wake cycle and exposed to 12 hours of light and 12 hours of dark every day. The second group was exposed to an altered circadian rhythm, with exposure to 20 hours of light and only four hours of dark every day. After two months (60 days), some of the mice from each group were given MPTP.

Behavior and movement were assessed in all mice treated with MPTP. These mice developed Parkinson’s disease, but the animals that were part of the second group with an altered circadian rhythm had learning impairments. Additionally, they showed extreme motor deficits with huge reductions in motor coordination and learning skills. These deficits were far worse than the deficits seen in MPTP-treated mice that were part of group one.

The researchers analyzed the brains of the affected mice to understand how and why disturbances of circadian rhythm worsened Parkinson’s disease symptoms. One of the major molecular features of Parkinson’s disease is the loss of dopamine production. In this study, Dr. Praticò and his team looked at the region called substantia nigra, in which they saw a significant reduction in the neurons that produce dopamine.   Dr. Praticò notes that the epicenter of Parkinson’s disease is the substantia nigra. Normally, cells die naturally here; however, this study showed that an altered circadian rhythm accelerated cell death in this region.

Additionally, microglia (cells) were superactive in the mice that were treated with MPTP and had disruption of their circadian rhythm. This can actually lead to worsening neuroinflammation and speed the progression of the disease.

Going forward, the challenge will be to see if these findings can be replicated in other animal models. If they can be, then researchers will try to re-establish normal circadian rhythm in those who were disrupted to see if that will help reverse brain inflammation and cell death. These study outcomes could have critical implications for the treatment and prevention of Parkinson’s disease in those with chronic sleep disturbances.

 Reference: http://www.eurekalert.org/pub_releases/2016-04/rson-ilt032916.php

Rachael Herman is a professional writer with an extensive background in medical writing, research, and language development. Her hobbies include hiking in the Rockies, cooking, and reading.