OPINION: How apps and influencers are changing the way we sleep, for better or for worse

From newsroom.unsw.edu.au

Fixating on sleep can make your sleep worse. But some people crave the connection online sleep communities provide 

Insomnia is not just a personal issue that affects an individual’s health and wellbeing. It’s a public health issue, affecting public safety. It’s a socioeconomic issue, as poorer sleep is linked to a lower education and income. And, increasingly, it’s a commercial issue.

The global insomnia market is expected to reach US$6.3 billion by 2030, driven by increased diagnoses and therapy, as well as sleep aids, including sleep apps. 

There’s an app for that

There are numerous digital devices and apps to help people sleep better. You can buy wearable devices, such as smartwatches and smart rings or wristbands, to digitally monitor your sleep. You can download apps that record how long you sleep and where you can log your tiredness and concentration levels.

Some devices are designed to promote sleep, by generating white or brown noise or other peaceful sounds. You can also buy “smart” pillows, mattresses and a range of smart light-fittings and lightbulbs to help track and improve sleep.

Such technologies operate to “digitise” sleep as part of "the quantified self". They render sleep practices and bodily responses into data you can review. So these devices are promoted as offering scientific insights into how to control the disruption to people’s lives caused by poor sleep.

You can listen to “sleep stories” – bedtime stories, music or guided meditations meant to help you sleep. Then there are the sleep blogs, podcasts and social media content on TikTok, YouTube and Instagram.

Where there is social media content, there are social media “influencers” sharing their take on sleep and how to get more of it. These “sleep influencers” have accumulated large numbers of followers. Some have profited, including those who live-stream themselves sleeping or invite audiences to try to wake them up – for a price.

                                 The global insomnia market is expected to reach US$6.3 billion by 2030. Photo: Ridofranz / Getty Images

Sharing and connecting can help

There may be benefits to joining online communities of people who can’t sleep, whether that’s in an online forum such as Reddit or a specially designed sleep improvement program.

Sharing and connection can ease the loneliness we know can impact sleep. And technology can facilitate this connection when no-one else is around.

We know social media communities provide much-needed support for health problems more generally. They allow people to share personal experiences with others who understand, and to swap tips for the best health practitioners and therapies.

So online sharing, support and feelings of belonging can alleviate the stresses and unhappiness that may prevent people from finding a good night’s sleep.

What is this fixation costing us?

But there are some problems with digitising sleep. A focus on sleep can create a vicious cycle in which worrying about a lack of sleep can itself worsen sleep.

Using sleep-tracking apps and wearable devices can encourage people to become overly fixated on the metrics these technologies gather.

The data generated by digital devices are not necessarily accurate or useful, particularly for groups such as older people. Some young people say they feel worse after using a sleep app.

There are also data privacy issues. Some digital developers do not adequately protect the very personal information smart sleep devices or apps generate.

Then, there’s the fact using digital devices before bedtime is itself linked to sleep problems.

Are we missing the bigger issue?

Other critics argue this intense focus on sleep ignores that sleeping well is impossible for some people, however hard they try or whatever expensive devices they buy.

People living in poor housing or in noisy environments have little choice over the conditions in which they seek good sleep.

Factors such as people’s income and education levels affect their sleep, just as they do for other health issues. And multiple socioeconomic factors (for instance, gender, ethnicity and economic hardship) can combine, making it even more likely to have poor sleep.

Sleep quality is therefore just as much as a socioeconomic as a biological issue. Yet, much of the advice offered to people about how to improve their sleep focuses on individual responsibility to make changes. It assumes everyone can buy the latest technologies or can change their environment or lifestyle to find better “sleep health”.

Until “sleep health inequalities” are improved, it is unlikely digital devices or apps can fix sleep difficulties at the population level. A good night’s sleep should not be the preserve of the privileged.

https://newsroom.unsw.edu.au/news/social-affairs/how-apps-and-influencers-are-changing-way-we-sleep-better-or-worse

How can I get some sleep? Which treatments actually work?

From theconversation.com

Do you have difficulty falling asleep? Do you stay awake for a long time at night? Do these sleep problems make you feel fatigued, strung-out, or exhausted during the day? Has this been happening for months?

If so, you’re not alone. About 12-15% of Australian adults have chronic insomnia.

You might have tried breathing exercises, calming music, white noise, going to bed in a dark and quiet bedroom, eating different foods in the evening, maintaining a regular sleep pattern, or reducing caffeine. But after three to four weeks of what seems like progress, your insomnia returns. What next?

What not to do 

These probably won’t help:

• spending more time in bed often results in more time spent awake in bed, which can make insomnia patterns worse 

• drinking coffee and taking naps might help get you through the day. But caffeine stays in the system for many hours, and can disrupt our sleep if you drink too much of it, especially after about 2pm. If naps last for more than 30 minutes, or occur after about 4pm, this can reduce your “sleep debt”, and can make it more difficult to fall asleep in the evening

• drinking alcohol might help you fall asleep quicker, but can cause more frequent awakenings, change how long you sleep, change the time spent in different “stages” of sleep, and reduce the overall quality of sleep. Therefore, it is not recommended as a sleep aid.

What to do next?

If your symptoms have lasted more than one or two months, it is likely your insomnia requires targeted treatments that focus on sleep patterns and behaviours.

So, the next stage is a type of non-drug therapy known as cognitive behavioural therapy for insomnia (or CBTi for short). This is a four to eight week treatment that’s been shown to be more effective than sleeping pills.

It involves education about sleep, and offers psychological and behavioural treatments that address the underlying causes of long-term insomnia.

You can do this one-on-one, in a small group with health professionals trained in CBTi, or via self-guided online programs.

Some GPs are trained to offer CBTi, but it’s more usual for specialist sleep psychologists to offer it. Your GP can refer you to one. There are some Medicare rebates to subsidise the cost of treatment. But many psychologists will also charge a gap fee above the Medicare subsidy, making access to CBTi a challenge for some.

About 70-80% of people with insomnia sleep better after CBTi, with improvements lasting at least a year. 

What if that doesn't work?

If CBTi doesn’t work for you, your GP might be able to refer you to a specialist sleep doctor to see if other sleep disorders, such as obstructive sleep apnoea, are contributing to your insomnia.

It can also be important to manage any mental health problems such as depression and anxiety, as well as physical symptoms such as pain that can also disrupt sleep.

Some lifestyle and work factors, such as shift-work, might also require management by a specialist sleep doctor.

What about sleeping pills?

Sleeping pills are not the recommended first-line way to manage insomnia. However, they do have a role in providing short-term, rapid relief from insomnia symptoms or when CBTi is not accessible or successful.

Traditionally, medications such as benzodiazepines (for example, temazepam) and benzodiazepine receptor agonists (for example, zolpidem) have been used to help people sleep.

However, these can have side-effects including a risk of falls, being impaired the next day, as well as tolerance and dependence.

Melatonin – either prescribed or available from pharmacies for people aged 55 and over – is also often used to manage insomnia. But the evidence suggests it has limited benefits.

Are there new treatments? How about medicinal cannabis?

Two newer drugs, known as “orexin receptor antagonists”, are available in Australia (suvorexant and lemborexant).

These block the wake-promoting pathways in the brain. Early data suggests they are effective in improving sleep, and have lower risk of potential side-effects, tolerance and dependence compared with earlier medicines.

However, we don’t know if they work or are safe over the long term.

Medicinal cannabis has only in recent years been studied as a treatment for insomnia.

In an Australian survey, more than half of people using medicinal cannabis said they used it to treat insomnia. There are reports of significant benefit.

But of the four most robust studies so far, only one (led by one of us, Jen Walsh) has demonstrated an improvement in insomnia after two weeks of treatment.

So we need to learn more about which cannabinoids – for example, delta-9-tetrahydrocannabinol, cannabidiol or cannabinol – and which doses may be beneficial. We also need to learn who can benefit most, and whether these are safe and effective over the long term.

https://theconversation.com/how-can-i-get-some-sleep-which-treatments-actually-work-212964

Here's How Weighted Blankets Can Help You Manage Your Anxiety and Why You Should Get One

From cnet.com

Could a heavy blanket be the answer to your stress, insomnia and anxiety? Here's what to know 

Weighted blankets are hardly new. Companies have been making them for decades and they've long been used to help soothe children with autism spectrum disorder. 

These days though, the list of conditions that weighted blankets (and other weighted products, like vests) purportedly help span from insomnia and restless leg syndrome to anxiety and ADHD.

Putting aside all of the hype, can weighted blankets help us all feel less stressed and sleep better? Read on to find out.

                                  The Gravity blanket              

Gravity

What is a weighted blanket?

Weighted blankets are similar to a duvet or comforter, but filled with glass beads or plastic pellets instead of down or fibre-fill -- though some weighted blankets have both fibre-fill and weights.

Most weighted blankets have many compartments full of beads or pellets to provide even weight throughout. Some come with a washable cover to make them easy to clean.

How do weighted blankets work?

What is is about lying under a heavy blanket that makes us feel less stressed and more relaxed? It's all about deep pressure touch (also called deep pressure stimulation).

Deep pressure touch can take many forms, including swaddling (for babies), massage, hugs and pressure evenly applied to your body. It's been shown to reduce cortisol, the hormone our bodies release when stressed, and increase dopamine, serotonin and melatonin hormones that promote relaxation, regulate our mood and signal our brains that it's time to sleep.

It is also said to trigger our parasympathetic nervous system, which puts our body into a state of relaxation. It's the exact opposite of the sympathetic nervous system, where our bodies go into the "fight or flight" state.

Since most of us cannot get massages every day, and it's not practical to be swaddled as an adult (unless you're in Japan), a weighted blanket provides deep pressure touch anytime you want to relax.

They are celebrated as a medication-free way to manage stress and anxiety, but they are not a replacement for medication and other therapies prescribed by your doctor or other medical professional.

Can weighted blankets help with anxiety, PTSD or insomnia?

As weighted blankets grew in popularity, so did claims that they can help treat certain mental health conditions. However, weighted blankets generally fall under the FDA's guidelines for low-risk wellness devices, which means they should not claim to treat or cure any medical condition. They should only be marketed to support the well-being of someone living with attention deficit hyperactivity disorder, depression, anxiety and other mental health concerns.

That said, studies have shown that people who use weighted blankets report feeling less anxiety. One such study had participants use a 30-pound weighted blanket, and 68% reported feeling less anxious.

For anyone who struggles with easily falling asleep, or stay asleep, there is some evidence that a weighted blanket might help. One study showed that adults who slept with a weighted blanket spent more time asleep and didn't wake up as often when compared with sleeping with their usual bedding.

While there is little research that weighted blankets can help manage post-traumatic stress disorder, they've been used in hospital psychiatric departments as a tool to help calm patients with a variety of mental health conditions. 

Do I need a weighted blanket?

Given that weighted blankets are pricey, they're not an obvious choice for everyone.

Whether or not you should get one largely depends on your bank account and what you hope to get out of using one. They can be a soothing tool for helping to manage stress and encourage restful sleep, but they are not the end-all, be-all.

Personally, I like my blanket and use it to relax after a stressful day. It's easy to fall asleep under it, but I almost always push it off in the middle of the night. Do I need it? No, but it is one of many helpful tools I use to manage anxiety and stress.

The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a physician or other qualified health provider regarding any questions you may have about a medical condition or health objectives.

https://www.cnet.com/health/sleep/how-weighted-blankets-work/

Paradoxical Insomnia: Sleeping But Not Feeling Like You've Slept

From healthnews.com

Sleepless nights happen to all of us, which makes the next day a rather difficult endeavour. We've all experienced nights when we seemed to dream so vividly, that we felt we hadn’t rested even one bit. But what happens when we feel we have not slept, while we indeed did? This confusing condition is called paradoxical insomnia, also known as sleep state misperception 

Key takeaways:

• Paradoxical insomnia is a condition when a person feels like he has not slept throughout the night while actually sleeping.
• There is no clear cause for paradoxical insomnia, but stress, anxiety, pre-existing mental illness, and poor sleep hygiene are among the most common factors that can lead to this condition.
• Paradoxical insomnia is treatable, and therapy is one of the most effective treatment options.

Understanding paradoxical insomnia

Paradoxical insomnia is a condition that is categorized as a sleep disorder. As the name suggests, the paradox of this condition lies within the mismatch between reality and the feeling of reality, meaning that while objective measures, for example, actigraphy, record sleep and its stages throughout the night, an individual feels as if they have been up all night tossing and turning.

Due to the puzzling nature of the condition, it can severely affect an individual’s physical and mental well-being. In addition, the constant perception of sleep deprivation may lead to anxiety, stress, and a host of other health problems.

Sleep state misperception: a deceptive perception

At the heart of paradoxical insomnia is a phenomenon known as sleep state misperception. In essence, people who experience sleep state misperception misinterpret the quality and quantity of their sleep. The individual perception of their night rest is not aligned with recordings of objective measures, which indicate a long and normal sleep.

Normal sleep involves the cyclic exchange of different changes throughout the night, including light sleep, deep sleep, and REM (rapid eye movement) sleep. These cycles repeat several times since one cycle of stages lasts approximately 90 minutes. With each cycle, our REM sleep stage gets longer and longer.

It is very normal to have awakenings during the night (micro-awakenings) that you might not remember. However, in the case of paradoxical insomnia, individuals remain aware to a greater degree of their surroundings throughout the night and falsely believe they never truly slept.

Paradoxical sleep vs paradoxical insomnia

While paradoxical sleep and paradoxical insomnia sound very similar, they are actually very different.

Paradoxical sleep is a term that is used to describe REM sleep, which is the stage associated with vivid dreams and rapid eye movement. While the name still says paradoxical, there is nothing paradoxical about it; it's part of a normal sleep cycle. Too little REM sleep may cause you to feel poorly rested.

Sleeping but not feeling like you've slept

Individuals with paradoxical insomnia have been shown to spend an adequate amount of time in various sleep stages, including REM sleep, just like everyone else. However, in reality, they feel as though they were awake throughout the night.

People who experience paradoxical insomnia might recall being awake, remember their surroundings, for example, streetlights outside flickering, wind coming through the window, hearing noises, or even remember what they were thinking about during the night.

They often claim to have spent hours tossing and turning in bed, even if they were asleep. This skewed perception can be maddening, leading to heightened stress and anxiety about sleep itself.

Causes of paradoxical insomnia

Paradoxical insomnia can manifest differently from person to person. It is recognized as a complex disorder, meaning that there is no single cause why some people perceive their sleep differently.

However, scientific literature indicates some of the most common causes of paradoxical insomnia:

• Hyperarousal. It can be caused by stress, and anxiety can lead to heightened awareness and a false belief that one has not slept.
• Biological factors. There are natural differences between people in their sleep duration and quality, as well as their brain chemistry and functional connectivity, and unfortunately, some individuals may have a natural predisposition to misperceive their sleep.
• Disruptions during the night. Noise and other distractions can lead to frequent awakenings and contribute to the perception of sleeplessness.
• Improper sleep hygiene. Light in the bedroom, as well as the use of stimulants such as caffeine, can negatively affect sleep and sometimes lead to paradoxical insomnia.
• Neuropsychological disorders. Depression, anxiety disorders, and obsessive-compulsive disorders can affect sleep perception and exacerbate paradoxical insomnia.
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Treatment for paradoxical insomnia

Living with a constant perception of lack of sleep can be extremely challenging. Luckily, there are strategies and interventions that can help manage paradoxical insomnia:

• Cognitive Behavioural Therapy for Insomnia (CBT-I). This therapy has been shown to be a highly effective approach for managing sleep disorders, including paradoxical insomnia. It focuses on changing patterns of negative thoughts and behaviours that are associated with sleep and teaching healthier sleep habits.
• Maintaining proper sleep hygiene. It is vital to create a comfortable and safe sleep environment; for example, eliminating noise, reducing light, and adjusting bedroom temperature can improve sleep quality. It is recommended to limit or avoid stimulants such as caffeine, nicotine, and alcohol close to bedtime. Finally, establishing a consistent sleep routine, even on weekends, can help regulate sleep patterns and improve sleep perception.
• Managing stress and anxiety. Practices like meditation and deep breathing exercises can help reduce physical and psychological arousal, especially before bedtime, leading to improved sleep perception.

If you think you might have paradoxical insomnia it is important to consult with your general healthcare practitioner, who can refer you to a dedicated specialist and offer a proper treatment.

Paradoxical insomnia is a quite rare disorder that leaves individuals feeling as though they haven't slept, despite objective evidence suggesting otherwise. Some of the most common causes are hyperarousal, biological factors, improper sleep hygiene, disruptions during the night, or neuropsychological disorders. However, by practicing good sleep hygiene, and seeking out professional guidance when needed, individuals who experience paradoxical insomnia, can take steps toward a better night's rest and a healthier life.

https://healthnews.com/sleep/sleep-disorders/paradoxical-insomnia-causes-and-treatment/

A walk before bedtime may be the secret to a better night’s sleep

From fortune.com

No matter when you lace up and step outside, walking is a win for both your mental and physical health. But if you’re someone who’s always in search of a good night’s sleep, experts say there’s a strong case for saving your daily miles for right before bed. 

Sleep troubles are ubiquitous. According to the Cleveland Clinic, about one in three adults worldwide experience insomnia symptoms, including mood disruptions, trouble focusing, and difficulty remembering things. “Behavioural factors like drinking coffee, using blue light devices, drinking alcohol, or eating right before your bedtime can impact insomnia,” says Neil Paulvin, D.O., a New York-based longevity and regenerative medicine doctor.

Biological factors may also keep you awake at night. “Many health conditions can affect your sleep, and conditions that cause chronic pain, conditions that make it difficult to breathe, and conditions that increase urinary frequency can also impact your sleep—just to name a few factors,” says  Paulvin. 

According to Paulvin, a nighttime walk is a good pre-bed practice for anyone who’s ready to defy the wide range of factors keeping us awake at night. Below, he explains the benefits of taking a walk before bed. Plus, his four best practices to follow for your first twilight stroll. 

The benefits of walking at night

While walking has so much to offer regardless of the time of day, Paulvin says there are a few specific wins when it comes to strolling at night. “In general, walking is great for longevity and helping you sleep,” says Paulvin.

“Walking before bed will decrease stress and calm down the sympathetic nervous system to help you sleep,” he explains. Because melatonin—the sleep hormone—is stimulated by darkness, taking a walk away from screens and artificial lights will send the message to your body that it’s time to prepare for some much-needed R&R.  

Research shows that walking before bed may help you fall asleep faster and may even improve sleep quality and sleep efficiency (the amount of time you spend asleep in bed). 

How to get the most out of your night-time walk 

Before you grab your walking shoes and go out for a starry walk, Paulvin has a few pro tips for ensuring your pre-bed walks help (not harm) your sleep. Below, he offers four guidelines for planning tonight’s melatonin-producing walk. 

1. Keep it light

Here’s your mantra for this walk: Take it easy. “If sleep is the goal, this isn’t the time to engage in rigorous exercise. It takes a longer amount of time for your body to cool down after intensive workouts, so save those for earlier in the day,” says Paulvin.

2. Remember, safety first 

“I’d recommend walking with a partner, wearing reflective gear and a safety light, and staying distanced from traffic whenever possible,” says Paulvin. “I’d also plan your route in advance and try to pick a route you know well, one that you’ve traversed in the daylight. This way, you know your way and will have less of a chance of running into unanticipated obstacles.” 

                                             For safety, walk with a partner and wear reflective gear and a safety light.

                                              GETTY IMAGES

If you have to walk alone, text a friend or a family member your route and ask them to check in on you when you get home. You can also use tools like “Find My” to allow loved ones to track your location. 

3. Leave your headphones at home

“Tech-wise, I’d bring your cellphone but lose the music,” says Paulvin. “Since your sight is inhibited in the dark, you want the best of the rest of your senses.” Plus, going podcast- or music-free will ensure that whatever you’re listening to doesn’t end up stuck in your head right before bed. After all, nothing will make you hate your favorite song more than hearing it on-repeat in your head at 3 a.m.

4. Leave 90 minutes between the end of your walk and bedtime

Paulvin doesn’t recommend going for a walk immediately before you crawl under the covers. 

“Based on the research, I would recommend leaving at least 90 minutes between the time you end your walk and the time you go to sleep,” he says. “Your core body temperature increases while exercising, and it takes about 90 minutes for your temperature to return back to its base.” 

Leave yourself plenty of time to shower, get ready for bed, and read beneath the covers. Avoid harsh, bright lighting and stimulating TV shows or movies. After all, you wouldn’t want to undo all the effects of your melatonin walk. 

https://fortune.com/well/2023/10/14/walk-before-bedtime-better-sleep/