Thursday, 16 January 2025

Wake-up call: six ways to change your attitude to insomnia

From theguardian.com

By Annabel Abbs

Waking up at night is natural and even beneficial, so we should embrace insomnia and learn to enjoy it

Sleep: we know it feels good, we know it’s necessary. But the deluge of guidance, whether from well-meaning sleep scientists or bio-hackers on TikTok, has made falling asleep more fraught than ever. We are now instructed to sleep for seven to eight hours in an undisturbed stretch, with perfectly proportioned REM and Non-REM sleep. We are encouraged to track, count and monitor to achieve perfect sleep. We are told that failing to sleep well raises our risk of heart disease, type 2 diabetes, Alzheimer’s, obesity, depression and death. Little wonder so many of us (37% according to the Sleep Charity) are struggling to sleep. And little wonder that today’s anxiety-fuelled sleep industry is worth a staggering $585bn.

For anyone suffering from less-than-perfect slumber, being constantly reminded that sleep is our superpower has done little more than amplify our sleep anxiety. I was one of these. So when a series of bereavements sent my mild insomnia into overdrive, I took the advice of a sleep scientist who suggested I treat it as a luxurious gift of extra time. Viewed like this, my sleepless nights became a chance to metaphorically travel through new lands, and no longer a “condition” that threatened to kill me.

I used this gift of extra time to investigate the history and science of slumber. And eventually I began to sleep again. This is what I learned:

No one died of insomnia

We humans have always experienced periods of short, broken sleep. Letters, diaries and anecdotal evidence going back centuries show night as a time of vigilance, celebration and regular interruption. Be it because of burial ceremonies, bed-sharing, after the Church’s canonical hours, or the age-old disruptions of fire, predators, enemies, storms, caring for babies and the sick, our ancestors routinely incurred periods of sleep deprivation.

Dr Tim Hearn at Newnham College, Cambridge, speculates that the ability to withstand sleep deprivation gave our earliest female ancestors an evolutionary advantage. Those who could endure repeated circadian disruption (think newborn baby) and still function made more resilient (and therefore more desirable) partners. Interestingly, several studies into the effects of sleep deprivation have found no adverse effects for women.

Being awake in the middle of the night is quite normal

Sleeping in two chunks was common until the Industrial Revolution, according to historical research carried out by Professor Roger Ekirch. In Mediterranean countries, it was common until very recently, thanks to the siesta. Many Indigenous people still sleep biphasically.

An interval between first and second sleeps was an opportunity for spiritual or creative reconnection, with many journals revealing that praying was a popular middle-of-the-night activity. For women, night was often a valuable, private time when they could study, write, sketch and reflect. Discovering the night paintings of Lee Krasner and Joan Mitchell, the Insomnia Drawings of Louise Bourgeois and the night writings of dozens of authors encouraged me to follow suit.

Meanwhile, I took heart from Prof Roger Wong, of New York’s SUNY Upstate Medical University, who investigated the effects of wakeful nights. Much to his surprise, he discovered that people who spent time awake (known as sleep maintenance insomnia) were 40% less likely to develop dementia than people who slept solidly all night long.

                                                                     Illustration: Simone Massoni/The Observer

Stop fretting that you won’t function

Tied to the tyranny of global capitalism, school timetables and a 24-hour internet, few of us can catch up on our shut-eye the following day. This adds to the anxiety of our wide awake nights: as we toss and turn, we fret that we will be too tired to perform. Granted, we may not feel at our best. But the anxiety we sense at night is rarely reflective of reality. I have given many (error-free) speeches after being awake for 35 hours, I have sat and passed exams after sleepless nights, I have raised four children on a decade of threadbare sleep. I’m still here – and it was never as bad during the day as I imagined it would be during the night. Reminding myself of this helped me shed my next-day-performance anxiety.

Meanwhile, studies indicate that how we perceive our broken sleep can affect how well we perform. Which is to say, if we tell ourselves a short night will have no adverse effects on our performance, we function better than if we repeatedly announce that we can’t think properly because we’ve had a bad night.

Understand that we are wired to ruminate at night

It’s quite normal to catastrophise at night. New studies have revealed that the “mind after midnight” is different from its diurnal counterpart. We have evolved to feel more fearful at night. And because some brain regions go into rest mode, we’re less able to control our emotions, to think in a rational and orderly way. Altered hormones hold sway at night, making us feel less cheerful. Now, when I start catastrophising at night, I remind myself that this is my “after midnight mind” – and things will look very different tomorrow.

Look up and out

Re-thinking my insomnia as a “gift of extra time” was the catalyst for discovering the night sky. I took an astronomy course, got a telescope and used my wakeful nights to study the stars, planets and phases of the moon. I found this both distracting and immensely relaxing. I’m not alone: research carried out by Dr Chris Barnes at the University of Derby has found that looking at the night sky makes us feel calmer, happier and more connected. “It provides a sense of place and purpose within our wider universe, and generally in life,” he said. “Being in a place where you feel comfortable with the darkness is a deeply tranquil and restorative experience.”

When I woke in the night, I often went outside and looked up, returning to sleep with record-breaking speed and ease.

Do something creative

The “mind after midnight” often thinks differently, making wakeful nights a wonderful occasion to explore another side of your brain. Dozens of writers and artists that I interviewed while researching my book said they were more imaginative and creative at night. I started using this time to write poetry and lyrics, an experience that probably processed some of the anxieties that were keeping me awake in the first place. In a recent podcast, sleep guru Matthew Walker noted that insomnia is often a result of lingering emotional issues that weren’t addressed during the day. Purged on to the page, my thoughts and worries ceased to keep me awake and I would drift back to sleep.

Keep it dark

Several studies published in the last few months have revealed the crucial role of darkness and the debilitating place of LED lighting when it comes to sleep. For millennia, homo sapiens slept in the safety of caves or light-less shelters, and our bodies appear to benefit – even today – from low illumination during the evening and none during the night. Darkness enables our bodies to produce melatonin but it also removes the constant arousal that accompanies light. So turn down your lamps, and avoid overhead and blue-rich LEDs during the evening. Invest in blackout blinds and a sleep mask for the night.

Understanding our deep physiological and cognitive need for darkness helped me learn to love its softly soothing shades and hues. When I wake in the night and want to write, I use a candle.

It’s equally important to get plenty of sunlight during the day. But here’s the thing: once I stopped obsessing about insomnia and started enjoying my night-time sojourns, that contrary little devil, sleep, returned.

Annabel Abbs is the author of Sleepless: Discovering the Power of the Night Self, published by John Murray

https://www.theguardian.com/lifeandstyle/2025/jan/16/wake-up-call-six-ways-to-change-your-attitude-to-insomnia 

Wednesday, 15 January 2025

Want Better Sleep? Study Shows How Passion for Long-Term Goals Could Help

From msn.com/en-us

A recent study reveals that individuals passionate about long-term goals are less likely to suffer from insomnia. 

                                                                                                                 Pormezz-shutterstock.com

Professors Yoon Chang Ho and Kim Jae Rim from the Neurology Department at Bundang Seoul National University Hospital unveiled these studies.

The team’s conclusions stem from analyzing data collected from over 2,500 participants.

Untreated insomnia can lead to a host of health risks, including mental disorders, heart disease, diabetes, and a weakened immune system. While sleeping pills were once the go-to solution, cognitive behavioural therapy is now the recommended approach. This therapy focuses on correcting sleep-disrupting thoughts, behaviours, and habits.

The researchers focused on a personality trait called “GRIT.” Grit encompasses perseverance and passion for long-term goals, embodying resilience, tenacity, boldness, ambition, drive for achievement and conscientiousness.

People with higher grit scores tend to persist toward achieving goals, even when faced with frustrating setbacks.

The study found that the average grit score among all participants was 3.27. Shockingly, 75% of those with low grit scores reported struggling with insomnia.

Conversely, the insomnia rate for high-grit individuals plummeted from 9.3% to a remarkable 0%. The research also uncovered an inverse relationship between grit scores and insomnia severity.

Higher grit scores were linked to lower rates and severity of insomnia. Every one-point increase in grit score slashed the odds of experiencing insomnia by 60% and reduced the likelihood of poor sleep quality by 45%.

Yoon explained, “Grit seems to act as a buffer against insomnia-inducing factors like depression. It also boosts our body’s ability to handle pressure and stress, positively impacting sleep quality. Based on these findings, we recommend assessing patients’ grit levels when treating insomnia and incorporating therapies to boost this vital trait.”

https://www.msn.com/en-us/health/other/want-better-sleep-study-shows-how-passion-for-long-term-goals-could-help/ar-BB1rjJ23?apiversion=v2&noservercache=1&domshim=1&renderwebcomponents=1&wcseo=1&batchservertelemetry=1&noservertelemetry=1

Monday, 13 January 2025

Want to improve your sleep in 2025? These new science-based tips may help

From washingtonpost.com

By Lisa Strauss

New research provides guidance on the effects of caffeine, diet and naps on sleep. Plus there are expanded treatments for sleep apnoea 

Last January, I offered some tips to help reboot your sleep health. That list still contains my top tips. But this year, I want to add to it based on some new findings that may inform your sleep decisions and conversations with your doctor. The information offered here is not a substitute for individualized health care.

Finding a balance with caffeine


People want their caffeine and their sleep. Finding the balance can be complicated because of individual differences in sensitivity to its stimulant effects, rates of metabolism, consumption patterns, brew strength and other variables.


In addition, caffeine can have helpful as well as deleterious effects, even on sleep. For example, some of my patients use it judiciously to help them stay awake until a reasonably late hour, which can support both their desired circadian rhythm and sleep consolidation.


This recent study found that up to 100 mg of caffeine (approximately the amount in a typical cup of coffee) could be consumed up to four hours before sleep with no negative impact. However, 400 mg (as a single dose) up to 12 hours before sleep interfered with falling asleep and caused fragmentation in sleep (and more so the closer to sleep time it was consumed).


A limitation of the study is that it was conducted in young men; older people are more sensitive to caffeine, and women using oral contraception clear it more slowly. The participants were moderately habitual users.


Effects on sleep aside, there is evidence to suggest that limiting caffeine consumption to the morning hours may benefit health and lifespan.


A diet for sleep


Insomnia patients often ask what they should eat to sleep better. This is a challenging question because the scientific consensus is still developing as to what may help and why.


No one food or dietary pattern is likely to be a silver bullet, sufficient to resolve (or cause) insomnia.

Another challenge is that most of the data are correlational, meaning insomnia could be the cause of certain dietary choices rather than a consequence of those choices (or both could be caused by some third factor).


Still, a body of evidence is accumulating that healthful diets such as the Mediterranean diet are associated with a lower risk of insomnia, and unhealthful and high-glycaemic diets with a higher risk. This careful 2024 paper concluded as much after screening more than 16,000 references to find 37 observational studies that met criteria for inclusion in the analysis.


A large-scale epidemiological study published in 2024 showed a correlation between consumption of ultra-processed foods — a broad and controversial category, not all of which may be harmful — and chronic insomnia.


Although the direction of causality cannot be established, this study did find the association regardless of overall dietary quality, mental health, lifestyle and other variables.


Nuances of napping


There is plenty of debate in the sleep field about the benefits vs. costs of napping and how best to structure naps.


This editorial in the journal Sleep by Sara Mednick urges us to take a nuanced view of napping, considering individual and cultural contexts and causes. She delineates the different reasons people nap (for example, as a restorative measure in the context of poor sleep). She notes that only napping for emotional reasons (such as to cope with stress or depression) is associated with poor health outcomes.


This recent study showed that unrestricted napping — even beyond the usual recommendation of 30 minutes — did not interfere with the benefits of cognitive-behavioural therapy for insomnia, which tends to discourage all but brief naps.


The function of sleep


New research has elaborated on sleep’s role in clearing metabolic waste from the brain, suggesting that it does so by synchronizing brain waves.


There are potential therapeutic implications. In mice, manipulation of brain waves helped to clear amyloid, which is associated with Alzheimer’s disease.


Another study, this one in macaques, showed that synchronizing brain waves to reproduce patterns achieved in non-REM (NREM) sleep led to the same subsequent desynchronization and improvements in cognitive performance that were seen after actual NREM sleep.


The finding could have implications for improving human cognitive performance and conferring restoration through means other than sleep.


Expanding treatments for sleep apnoea


There have been a few interesting developments in the past year for patients with sleep apnoea. These are poised to expand treatment options, improve continuous positive airway pressure (CPAP) usability and lower barriers to diagnosis.


Medication. The injectable weight-loss drug tirzepatide (Zepbound, with the same active ingredient as the diabetes medication Mounjaro) was approved by the Food and Drug Administration in 2024 for the treatment of moderate to severe apnoea in patients with obesity.


While the medication provides an alternative to positive airway pressure (PAP) therapy (and other standard apnoea interventions such as dental appliances and surgically implanted hypoglossal nerve stimulators), rates of remission or near-remission were higher in those who used PAP therapy along with the medication (50 percent vs. 42 percent in non-PAP users). Weight loss was also greater in those who used both.


Masks. CPAP masks are getting smaller and lighter. To improve comfort and compliance, one recent study looked at customized 3D-printed masks and found better adherence to the treatment.


More research is required on this approach, but custom masks could solve fit problems for many patients before long.


Another promising technology under development, VortexPAP, eliminates the tight seal that most PAP masks require, and indeed barely touches the user’s face.


Furniture. There are now a variety of nightstands that fit CPAP machines so you don’t have to be a carpentry hobbyist to create a cut-out for the tubing. An expensive model generated buzz in 2024, but there are cheaper options such as this one.


Wearable technology. There is a need for convenient methods for detecting apnoea. Still, consumer-grade wearable monitors such as smartwatches should not be considered adequate substitutes for laboratory polysomnography (PSG) or for physician-prescribed home testing for sleep apnoea.


But a variety of wearables are now equipped with FDA-approved software for the detection of apnoea, and the data can kick-start a conversation with a doctor. The software uses variables such as heart rate, movement and wrist temperature. Some devices can detect blood oxygen levels (SpO2), albeit with caveats. They have not generally been validated against gold-standard arterial blood gas measurements or against standard measures of hypoxia.


Machine learning paired with some consumer-grade and newer professional-grade devices can extract patterns from the data, and holds promise for assisting with both diagnosis and individualized treatment.


Lisa Strauss, PhD, is a clinical psychologist in the Boston area. She specializes in sleep disorders.


https://www.washingtonpost.com/wellness/2025/01/12/sleep-caffeine-diet-naps-apnea/