Technological sleep sabotage

March 30, 2015

We’re all becoming increasingly reliant on technology for communication, reading and entertainment. But the screens that we use in everyday life (computer monitors, televisions, tablets, smartphones etc Related Site. …) have a particularly negative impact on sleep, especially when used in the evening (ie: when most of us are probably using them).

Using tech is a one-two punch of sleep sabotage. Both the content and the devices (yes, the media and the message) themselves can be detrimental to sleep.

The Content

A stressful email from a colleague or boss. The latest news from a war torn country. One last game of Candy Crush Saga. Not only are we losing sleep time to those, but we’re stressing ourselves out when we’re supposed to be relaxing and letting go. Anxiety leads to more cortisol production which further delays sleep, which can lead to more anxiety. It’s a vicious cycle.

The Devices

Here’s what you need to know about light. Pay special attention to blue light. Blue light is present in the spectrum of natural light. It corresponds to the part of the spectrum between 430nm and 500nm.

While any light can inhibit melatonin secretion, blue light does it bigger and badder than it’s other rainbow friends. A study out of Harvard compared the effects of exposure to blue light to exposure to green light. The blue light suppressed melatonin for twice as long as the green light and shifted circadian rhythms by twice as much (3 hours vs. 1.5 hours).[1] Blue light meant later and less restful sleep.

So what does composition of light does a screen typically contain?:

Yes, the majority of the light we get from our screen IS blue light. Today, 90% of flat screens are made with LEDs. A high proportion of the light those very screens are emitting is blue. And in the case of e-readers, tablets, smartphones and computer screens, you’ve probably got that screen within about 15 inches of your face. So, what does that mean for sleep? Less melatonin (which means a less quality of sleep) and more difficulty falling asleep (which means less quantity of sleep). Generally, if you’re lucky enough to fall asleep, you wake up feeling like you haven’t slept, or at least not well. The following diagram compares melatonin levels with a print book versus and E-reader.[2] You can see the melatonin levels are lower AND they clear away later; meaning it’s hard to fall asleep, sleep is not a high quality and it’s hard to wake up. So what can we do? How can we protect ourselves, and especially our older older children (teens) who are the most vulnerable?

How to protect your sleep

1) Do not use tech before bed. This is easier for the young kiddos (avoid television, tablet or computer time for a period of at least 2 hours before bedtime). For the older children (teens) and adults, let’s be serious. This probably isn’t possible. A “do not do” approach isn’t sustainable for the majority of us. While limiting it’s use is important, try rearranging tasks – finishing up your email first, then cleaning the kitchen.

2) Invert Black and White on your device Macs, iOS and some e-Readers have this function built in. There are some apps which can be downloaded to do this in your selected web browser. It’s not a perfect solution, but can help, simply by decreasing the quantity of light you’re staring at.

3) Blue light shields I’m not sure how well these work, but companies like BlueLight Shield and Ocushield offer screen protectors that claim to block or limit blue light from their devices.

4) Orange Glasses Not exactly fashionable, but blue light blocking glasses can be helpful. I ordered something similar from Amazon. Stay tuned for my evaluation.Anyone with a high amount of technology in their lives is susceptible. But you don’t have to lose sleep over it. Be sensible, take some precautions and you can balance your screen time AND a healthy sleep.

References

1 J. J. Gooley, S. M. Rajaratnam, G. C. Brainard, R. E. Kronauer, C. A. Czeisler, S. W. Lockley, Spectral Responses of the Human Circadian System Depend on the Irradiance and Duration of Exposure to Light. Sci. Transl. Med. 2, 31ra33 (2010). (available here)

2 A.Chang, D. Aeschbach, J. F. Duffy, C. A. Czeisler, Evening use of light-emitting eReaders negatively affects sleep, circadian timing, and next-morning alertness. PNAS 2015 112 (4) 1232-1237; published ahead of print December 22, 2014, doi:10.1073/pnas.1418490112 (available here)

GERD and baby sleep

March 12, 2015

GERD (GastroEsophageal Reflux Disease) is a chronic digestive disease. GERD occurs when stomach acid or sometimes, stomach content, flows back into the esophagus. This acid laden reflux irritates the lining of the esophagus and causes GERD. It looks a lot like this:

Whenever there is discomfort, that can be a significant barrier to sleep. If a family suspects their child is uncomfortable, or their GERD is not well managed, we work with that child’s physician to ensure they are comfortable before proceeding with any sleep training.

From a personal perspective, I can tell you it’s no fun to parent through GERD. From a professional perspective, I can tell you that these are the families most in need of support, sleep is clearly impacted, and in my anecdotal observations in working with families; GERD diagnosis seems to be increasing.

In the past week I’ve attended several continuing educations events, with one physician indicating that GERD is likely overdiagnosed[1] (notable pediatric gastroenterologist Warren Shapiro, MD), while the other indicated that it was underdiagnosed[2] (notable pediatric sleep expert, Judy Owens, MD). The jury is out and it’s difficult to know if the instances of GERD are increasing or if more of these cases are being caught.

Symptoms

Some symptoms of GERD include[1]:

Recurrent vomiting
Poor weight gain or even more extreme, a failure to thrive
Irritability
Poor sleep
Bad breath
Respiratory concerns including coughing, asthma, Apnea
Recurrent pneumonia
Esophagitis (inflammation that may damage tissues of the esophagus)
Dysphagia (difficulty swallowing) or feeding refusal
Upper airway symptoms (ear infections, throat infections, vocal issues, tooth enamel/dental issues)

Severity of reflux in infants is often focused on weight gain, respiratory issues and pain. If a baby is gaining well, reflux is still a significant matter, but the baby who is not gaining well is obviously a more serious concern. If your baby is exhibiting a combination of the symptoms above, please discuss the possibility of GERD with your child’s physician or pediatrician.

Treatment Options

There are some easy things parents can do to mitigate some of these symptoms[1]:

• Ensure baby is not over eating (easier for bottle fed babies than breast fed… small volumes more frequently is more desirable than larger volume less frequently)

• Consider non-prone sleeping position (elevated mattress; only for non-rolling babies. ALWAYS place an infant on their back to sleep unless you have discussed GERD with your physician and an alternative position is medically indicated)

• Consider trial of hypoallergenic formula

• Consider thickened formula (medically supervised)

There are a number of different pharmacological approaches to treating GERD[1]:

1. Antacids – effectively neutralizing the acids.

2. Pro-kinetics – which can encourage the esophogael sphincter to close, and have the stomach empty more rapidly and frequently, so the acid can’t get to where it’s a problem.

3. Surface Agents – coating the lining of the esophagus so it’s protected.

If medication is unhelpful, or the severity indicates further treatment, surgical intervention is also an option.

I encourage families to consider chiropractic treatment as well. There doesn’t seem to be a body of scientific evidence that would indicate a chiropractor would be helpful in preventing GERD. However, I can tell you in my professional experience and in an isolated case study, chiropractic adjustments have been helpful to improve symptoms of GERD.

The good news is that most babies will outgrow GERD as their digestive system matures. Until then, there are treatment options worth exploring to help make your baby more comfortable. When GERD is well managed, we can then go about addressing better sleep.

[1] Warren Shapiro, MD, The Incidence , Pathophysiology and Treatment GERD During Infancy, Presentation

[2] Judith A. Owens, MD, The Assessment and Management of Common Behavioral Sleep Problems in Children, Presentation at The Hospital for Sick Children Pediatric Sleep Symposium 2015, Toronto.

For further information:

Mayo Clinic

National Sleep Fountation

Positive Health Wellness