Tag: iab-sleep disorders

8 reasons why you wake up tired, and how to fix it | CNN

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CNN
 — 

You sleep for seven to eight hours almost every night, only to feel unrested through the morning or even most of the day. How could you be following a golden rule of sleep so right yet feel so wrong?

This discrepancy is often due to a heightened state of sleep inertia, a circadian process that modulates memory, mood, reaction time and alertness upon waking, according to a 2015 study. Some people experience impaired performance and grogginess in this period after first turning off the alarm. The effects of sleep inertia usually go away after 15 to 60 minutes but can last for up to a few hours.

Sleep inertia impairs more sophisticated cognitive skills such as evaluative thinking, decision-making, creativity and rule usage, and gets worse the more sleep deprived a person is.

But even if your job isn’t saving lives or driving a truck overnight, experiencing sleep inertia for hours can still affect your quality of life.

The way to address this begins with evaluating your sleep using the “two Qs,” said pulmonary and sleep specialist Dr. Raj Dasgupta, a clinical associate professor of medicine at the University of Southern California’s Keck School of Medicine. “If you’re getting the good quantity sleep, the next question is, ‘Am I getting good quality sleep?’ ”

Dasgupta suggested seeing a sleep specialist, who can check for an underlying or primary sleep disorder. But there are other more easily modifiable factors that could be interfering with the restoration and recovery processes — such as memory consolidation, hormone regulation and emotional regulation or processing — that need to happen during sleep.

“There are a lot of conditions that cause fatigue, but they don’t necessarily make people feel like they’re ready to fall asleep,” said Jennifer Martin, a professor of medicine at the David Geffen School of Medicine at UCLA and a former president of the American Academy of Sleep Medicine.

These can include chronic pain conditions, metabolic or thyroid conditions, anemia and chronic obstructive pulmonary disease.

If you’re feeling inexplicable fatigue, “an important first step might just be a routine physical with your family doctor,” Martin said.

Additionally, the National Sleep Foundation has said healthy adults need seven to nine hours of sleep nightly, so you might need more than eight hours of sleep to feel energized. You could try going to sleep an hour earlier or waking an hour later than usual and see if that makes a difference, said Christopher Barnes, a professor of management at the University of Washington who studies the relationship between sleep and work.

If you’re sedentary, your body can get used to having to expend low levels of energy — so you might feel more tired than you should when trying to do basic daily activities, Martin said.

The World Health Organization has recommended that adults get at least 150 minutes (2½ hours) of moderate-to-vigorous physical activity weekly, while pregnant people should do at least 150 minutes of moderate aerobic and strengthening exercises per week.

Having anxiety or depression can be energetically taxing, Dasgupta said. These conditions can also negatively influence the time needed to fall asleep as well as whether (and how many times) you wake up throughout the night, he added.

And sometimes the medications used to treat depression or anxiety can have side effects such as insomnia or disruption of deeper stages of sleep, Dasgupta said.

Sometimes our schedules differ on weekdays versus weekends, Barnes said. Schedules can also fluctuate for people with shift-based jobs.

“A very common practice would be to say, ‘OK, well, it’s Friday night. I don’t have to work tomorrow morning, so I can stay up a bit later,’ ” Barnes said. Maybe you stay up even later Saturday night since you don’t have to work Sunday either, then go to bed earlier on Sunday ahead of the workweek.

But by this point, you’ve already adjusted your sleep schedule back by a couple of hours in a short period of time. “This is very much analogous to jet lag,” Barnes said. “That rapid reset doesn’t work very well.”

More than 50% of your body is made of water, which is needed for multiple functions including digesting food, creating hormones and neurotransmitters, and delivering oxygen throughout your body, according to the Cleveland Clinic. Being dehydrated has been linked to decreased alertness and increased sleepiness and fatigue.

The Institute of Medicine recommends that women consume 2.7 liters (91 ounces) of fluids daily and that men have 3.7 liters (125 ounces) daily. This recommendation includes all fluids and water-rich foods such as fruits, vegetables and soups. Since the average water intake ratio of fluids to foods is around 80:20, that amounts to a daily amount of 9 cups for women and 12½ cups for men.

Having good sleep hygiene includes keeping your bedroom dark, quiet and cold at night — and only using it for sleep and sex.

Avoid consuming caffeinated drinks less than six hours before bedtime and limit the consumption of alcohol and heavy or spicy foods at least two hours before bed. Alcohol can prevent deeper stages of sleep, and such foods can cause digestive issues that interfere with restorative sleep.

“The person (or pet) with whom you share a bed has a big impact on your sleep,” Martin said.

Maybe your bed partner has a sleep disorder and snores or tosses and turns. Or maybe the person has a different schedule that’s disruptive to your sleep. Pets can also disrupt your sleep schedule since they don’t have the same sleep patterns as humans, she added.

“The most important thing — if your bed partner snores — is to get them to see a sleep specialist and have them evaluated for sleep apnea,” Martin said. Sleep apnea — a condition wherein breathing stops and restarts while someone’s sleeping — is common in people who snore, she added.

On that note, sleep disorders are another factor that can dramatically diminish sleep quality, Barnes said.

Someone with sleep apnea might wake up 50 times, 100 times or even more throughout the night, he added.

“Once you’re awake, you’re no longer in the deep sleep, and you don’t get to usually drop immediately into the deepest sleep,” Barnes said. “Bringing people out of that deep sleep by waking them up is going to generally result in less time spent in the deepest stage of sleep.”

Other sleep disorders that can affect daily energy levels include narcolepsy and restless legs syndrome, according to the US Centers for Disease Control and Prevention.

The ideal way to track sleep quality and quantity — especially if you think you could be diagnosed with a sleep disorder — is undergoing polysomnography at a sleep clinic, Barnes said.

Apps and electronic wearables — such as watches or rings — that measure sleep aren’t as accurate as clinic tests, but still provide sufficient information for healthy adults, Barnes said. “I’d want to know that it was developed and then validated against another, more accurate device.”

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Using melatonin for sleep is on the rise, study says, despite potential health harms | CNN

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CNN
 — 

More and more adults are taking over-the-counter melatonin to get to sleep, and some may be using it at dangerously high levels, a study has found.

The overall use among the US adult population is still “relatively low,” but the study does “document a significant many-fold increase in melatonin use in the past few years,” said sleep specialist Rebecca Robbins, an instructor in the division of sleep medicine for Harvard Medical School. She was not involved in the study.

The study, published in the medical journal JAMA, found that by 2018 Americans were taking more than twice the amount of melatonin than a decade earlier.

Melatonin has been linked to headaches, dizziness, nausea, stomach cramps, drowsiness, confusion or disorientation, irritability and mild anxiety, depression and tremors as well as abnormally low blood pressure. It can also interact with common medications and trigger allergies.

While short-term use for people with jet lag, shift workers and those who have trouble falling asleep appears to be safe, long-term safety is unknown, according to the National Center for Complementary and Integrative Health at the National Institutes of Health.

“In an associational study we found that older adults who reported frequent use — every night or most nights — of a sleep aid (over the counter or prescription) had a higher risk of incident dementia and early mortality,” Robbins said.

However, researchers could not determine which type of sleep aid — over-the-counter medications, such as melatonin, or prescription medications — was responsible for the findings.

Since 2006, a small but growing subset of adults are taking amounts of melatonin that far exceed the dosage of 5 milligrams a day typically used as a short-term treatment, the study found.

However, pills for sale may contain levels of melatonin much higher than what is advertised on the label. Unlike drugs and food, melatonin is not fully regulated by the US Food and Drug Administration, so there are no federal requirements that companies test pills to ensure they contain the amount of advertised melatonin.

“Previous research has found that that melatonin content in these unregulated, commercially available melatonin supplements ranged from — 83% to +478% of the labeled content,” said Robbins, who coauthored the book “Sleep for Success! Everything You Must Know About Sleep But are Too Tired to Ask.”

Nor are there any requirements that companies test their products for harmful hidden additives in melatonin supplements sold in stores and online. Previous studies also found 26% of the melatonin supplements contained serotonin, “a hormone that can have harmful effects even at relatively low levels,” according to the National Center for Complementary and Integrative Health.

“We cannot be certain of the purity of melatonin that is available over the counter,” Robbins said.

Taking too much serotonin by combining medications such as antidepressants, migraine medications and melatonin can lead to a serious drug reaction. Mild symptoms include shivering and diarrhea, while a more severe reaction can lead to muscle rigidity, fever, seizures and even death if not treated.

Because it is purchased over the counter, experts say many people view melatonin as an herbal supplement or vitamin. In reality, melatonin is a hormone made by the pineal gland, located deep within the brain, and released into the bloodstream to regulate the body’s sleep cycles.

“There is a view that if it’s natural, then it can’t hurt,” Robbins told CNN in an earlier interview on the impact of melatonin on children. “The truth is, we just really don’t know the implications of melatonin in the longer term, for adults or kids.”

Another reality: Studies have found that while using melatonin can be helpful in inducing sleep if used correctly — taking it at least two hours before bed — but the actual benefit is small.

“When adults took melatonin, it decreased the amount of time it took them to fall asleep by four to eight minutes,” Dr. Cora Collette Breuner, a professor in the department of pediatrics at Seattle Children’s Hospital at the University of Washington, told CNN in 2021.

“So for someone who takes hours to fall asleep, probably the better thing for them to do is turn off their screens, or get 20 to 40 minutes of exercise each day, or don’t drink any caffeinated products at all,” Breuner said.

“These are all sleep hygiene tools that work, but people are very reticent to do them. They rather just take a pill, right?”

There are other proven sleep tips that work just as well, if not better than sleeping aids, experts say. The body begins secreting melatonin at dark. What do we do in our modern culture? Use artificial light to keep us awake, often long past the body’s normal bedtime.

Research has found that the body will slow or stop melatonin production if exposed to light, including the blue light from our smartphones, laptops and the like.

“Any LED spectrum light source may further suppress melatonin levels,” said Dr. Vsevolod Polotsky, who directs sleep basic research in the division of pulmonary and critical care medicine at Johns Hopkins University School of Medicine, in an earlier CNN interview.

So ban those devices at least an hour before you want to fall asleep. Like to read yourself to sleep? That’s fine, experts say, just read in a dim light from a book or use an e-reader in night mode.

“Digital light will suppress the circadian drive,” Polotsky said, while a “dim reading light will not.”

Other tips include keeping your bedroom temperature at cooler temperatures — about 60 to 67 degrees Fahrenheit (15 to 20 degrees Celsius). We sleep better if we’re a bit chilly, experts say.

Set up a bedtime ritual by taking a warm bath or shower, reading a book or listening to soothing music. Or you can try deep breathing, yoga, meditation or light stretches. Go to bed and get up at the same time each day, even on weekends or your days off, experts say. The body likes routine.

If your doctor does prescribe melatonin to help with jet lag or other minor sleep issues, keep the use “short term,” Robbins said.

If you are planning to use melatonin for a short-term sleep aid, try to purchase pharmaceutical grade melatonin, she advised. To find it, look for a stamp showing that the independent, nonprofit US Pharmacopoeial Convention Dietary Supplement Verification Program has tested the product.

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Sleep apnea raises risk of long Covid by up to 75% for some, study says | CNN

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CNN
 — 

Adults who have obstructive sleep apnea have up to an 75% increased risk, on average, of developing long Covid after a SARS-CoV-2 infection compared with people without sleep apnea, a new study found.

Women with obstructive sleep apnea had up to an 89% increased risk, while men had a 59% higher risk, according to the analysis of electronic health data on nearly 1.8 million people.

Obstructive sleep apnea is a potentially dangerous disorder in which breathing stops for about 10 seconds multiple times during the night due to a blockage of the airways by heavy or relaxed soft tissues in the mouth and throat.

A second analysis of medical records of a smaller group of 330,000 adults found the risk to be only 12%, according to the study, which is part of RECOVER, or Researching Covid to Enhance Recovery. RECOVER is a National Institutes of Health initiative dedicated to understanding why some people develop long Covid and how best to detect, treat, and prevent the condition.

Why the huge difference in numbers? People in the larger study had additional health concerns, or comorbidities, such as obesity, diabetes, high blood pressure and heart disease, said senior study author Lorna Thorpe, co-lead of the RECOVER Clinical Science Core at NYU Langone Health.

“The range of 12% to 75% is likely due to a combination of different study populations and different levels of comorbidities, but also different definitions of long Covid,” she said. “We didn’t even have a diagnostic code for long Covid until October 2021.

“I believe the risk is likely to be in the middle, but we will need additional studies to tease that out,” added Thorpe, a professor and director of the division of epidemiology at NYU Grossman School of Medicine.

A third analysis of medical records of 102,000 children with sleep apnea found no correlation between sleep apnea and long Covid after the various confounding health conditions were factored out, “which, of course, is great news,” Thorpe said.

“By using three very large networks of electronic health records, we were able to do this study three times, which is one of the strengths of the research,” she added. “This study is the first collaboration of this focus and scale to find that adults with sleep apnea are at greater risk for long Covid.”

This is an “important study” on long Covid, said Dr. Sairam Parthasarathy, a principal investigator of the University of Arizona Health Sciences RECOVER Adult Study and professor of medicine.

“Research needs to be done in a prospective study to verify this association, and if found to be true these findings have implications for treatment of long Covid,” said Parthasarathy, who was not involved in the study.

“It is important to note that some of the symptoms of long Covid such as fatigue may be related to obstructive sleep apnea, and that the treatment of obstructive sleep apnea may improve such long Covid-related symptoms,” he added.

The study, published Thursday in the journal Sleep, is one of a several studies released since Congress allocated $1.15 billion to NIH in January 2021, to study the long-term effects of Covid over a four-year period. To date, the agency says it has used about $811 million to fund research.

Researchers wanted to investigate the role of sleep apnea in long Covid due to the well-known association between the condition and poorer outcomes after a Covid infection.

“People with sleep apnea are at higher risk for a more severe case of Covid-19, admission to intensive care at the hospital and for mortality,” Thorpe said.

“Obstructive sleep apnea can result in increased inflammation, potentially disrupted sleep leading to an increased propensity to develop infections and reduced immunity,” said Dr. Bhanu Prakash Kolla, a sleep medicine specialist in the Center for Sleep Medicine at the Mayo Clinic in Rochester, Minnesota.

“This could potentially explain the pathway by which obstructive sleep apnea leads to an increased risk of having Covid and also … (long Covid),” said Kolla, who was not involved in the study.

Sleep apnea is an underdiagnosed condition regardless of gender, said the University of Arizona’s Parthasarathy.

“It is conservatively estimated that 80% of patients with obstructive sleep apnea (OSA) are not diagnosed,” he said. In addition, “an assumption with these analyses is that patients with OSA are likely to be treated. However, nearly half of them are not using the treatment.”

Why would women have up to an 89% higher risk compared with 59% in men? The study did not address that issue.

However, “one can postulate this difference may be based on what we know about sex differences in sleep and immune responses,” said Dr. Phyllis Zee, director of the Center for Circadian and Sleep Medicine at Northwestern University Feinberg School of Medicine in Chicago.

Zee, who was not involved with the new research, coauthored one of the first published studies on the link between sleep apnea and serious Covid infection.

“Women typically have stronger immune responses to viral infections, and thus also vulnerability for post-infection inflammation,” Zee said. “Women in general have more insomnia and with long Covid tend to present with fatigue and insomnia symptoms, which are also common symptoms of long Covid.”

Another reason could be that sleep apnea has historically been considered a male disease, Thorpe said, which could mean that by the time a woman is diagnosed her apnea is more advanced.

“It could be that the women who are documented in electronic health records have more severe sleep apnea because physicians more often look for sleep apnea among men,” she said.

As scientists continue to learn more about long Covid, further information will become available, Thorpe said. In the meantime, people who have sleep apnea — or who snore, snort and stop breathing at night, which are all signs of the condition — should be exceedingly careful when they contact Covid.

“People with sleep apnea who get infected with Covid should seek early treatment and consider getting Paxlovid, the oral medication prescribed to reduce risk of severe outcomes,” Thorpe said. “They should also keep up with their vaccinations to lower the risk of infection in the first place.”

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What happens if you wake up before your alarm? Tips from sleep experts | CNN

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CNN
 — 

Many people dread the blaring sound of an alarm clock, signaling the start of a busy workday. Others wish they weren’t already awake and that the sound had actually woken them up.

Waking up many minutes or even hours before the alarm is not a new phenomenon, sleep experts tell CNN, but it can cause people discomfort.

More than a third of Americans get fewer hours of sleep a night than the minimum recommendation of seven hours, according to the US Centers for Disease Control and Prevention. According to the National Institutes of Health, studies across the globe show anywhere from 10% to 30% of the population struggles with insomnia, defined as the consistent difficulty falling asleep and the inability to return to sleep after going to bed.

Those experiencing insomnia can have a combination of “nocturnal awakenings” and what’s categorized as “early morning awakenings,” according to a 2009 study from the Stanford Sleep Epidemiology Research Center and other universities. The study finds that some people may experience early awakenings without other insomnia symptoms such as “difficulty initiating sleep,” “nocturnal awakenings” and “non-restorative sleep,” meaning sleep that isn’t substantial even with the recommended hours.

While insomnia treatments include cognitive behavioral therapy and medication, other daily tips can have an impact on early morning awakenings. An acute sleep disorder could be at play for someone not experiencing chronic insomnia but waking up early.

The constant waking up before that daily sound is coupled with an immense frustration about not falling back asleep. The stress can feel isolating and all-consuming, taking more precedence than the initial sleep problem.

“You start ruminating about it, and then you start doing things that make insomnia worse,” said Dr. Rajkumar Dasgupta, associate professor of clinical medicine at the University of Southern California Keck School of Medicine in Los Angeles.

“Don’t start telling yourself … ‘I’m going to make myself stay in bed until I fall asleep,’ ” he said.

So, what can you do about it?

If you wake up suddenly — in what feels like the early morning hours — resist checking the clock. Finding out it’s 3 a.m. when you set the alarm for 7 a.m. can cause increased worry about the hours of sleep you hoped to attain.

“The anxiety and the frustration build,” said sleep specialist Wendy Troxel, a senior behavioral scientist at Rand Corp. “Clock watching becomes habitual, and that habitual response of frustration and anxiety also causes a stress response in the body.”

When anxiety and worry take precedence, cortisol levels increase, and the body becomes alert. This process is counterproductive for maintaining drowsiness, as the brain becomes hyper-engaged.

“You look at the clock. It’s 3 o’clock in the morning like clockwork, and immediately might grit your teeth. You think of all the demands … how awful it is going to be when you’re sleep-deprived,” Troxel said. “All of this mental processing and agitation is antithetical to the sleep state. It’s making you more alert and aroused … versus sending the signal to the brain that it’s OK to drift.”

If your alarm is on the phone, checking the clock can pose an even more significant trigger. Consider getting an alarm that isn’t attached to your phone.

“Our phone is our strongest signal to our waking lives,” Troxel said. “You’re getting the light exposure from your phone, which can directly stimulate your circadian signal for alertness. The content of what we are consuming on our phones can be very activating, whether it’s scrolling through social media or reading the news. These can all stimulate emotional states that are more activating rather than relaxing.”

Paradoxically, experts say to get out of bed. Yes, even at 3 a.m.

“Abandon the idea of getting back to sleep,” Troxel said. “When you do that, when you let the pressure go that sleep isn’t so effortful, sleep is more likely to come back.”

In a stimulus control technique, you can distract your brain with a mundane task to help bring back drowsiness faster than staying frustrated in bed.

Mentally assigning the bed with sleeping helps people associate positive sleep thoughts with their space. Leaving the room when agitation sets in can separate the frustration from the bed.

Anything from reading a book to knitting or listening to soft music (but not using a phone) can positively distract the brain. Once drowsiness sets in again, head back to bed.

Dasgupta recommends keeping track not only of when you went to bed and woke up on a given night, but also the calming techniques, environmental factors — and even nutrition and exercise routines that seemed to help you sleep that day.

“Perfect sleep is like having a puzzle, and you need all the right pieces,” Dasgupta said. “People who have insomnia, they’re missing one of those sleep hygiene pieces. When you make your recommendation, like a muscle relaxation, maybe that’s not the thing that they were missing. Maybe sound wasn’t the key part. Maybe you need more of that weighted blanket.”

It also depends on our given circadian rhythm, or the 24-hour solar cycle the body runs on that alerts us when sleepiness sets at night. If any environmental factors change — such as travel, work schedule or lighting — the body’s circadian rhythm may be thrown off, signaling an uncomfortable early wake-up before the alarm, Dasgupta said. In this case, changing the lighting in a given room or getting alternative lighting could help.

Progressive muscle relaxation may work — start at the toes, clench the given muscles for three seconds and release. Breathe through this process. The 4-7-8 breathing exercise coupled with muscle relaxation can be successful, Dasgupta said. Breathe in for 4 seconds, hold it for 7 seconds and breathe out for 8 seconds.

Relaxing breath

Follow along as Dr. Ellen Vora guides you through the 4-7-8 breathing technique.

Source: Courtesy Dr. Ellen Vora

Others may find that yoga, meditation or reading can help when they wake up before their alarm. The same techniques don’t work for everyone, but practicing various strategies that may affect sleep is critical, ultimately building a well-followed routine.

If the problem continues beyond three times a week for three months, experts recommend talking to a sleep specialist. It may require more than a simple habit change.

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Marijuana may make sleep worse, especially for regular users, study finds | CNN

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CNN
 — 

It’s a common assumption among marijuana users: Using weed will help you fall asleep and stay asleep. Scientists, however, aren’t so sure that’s true.

“This is an understudied but important area, as many people are increasingly turning to cannabis products as sleep aids,” said sleep specialist Wendy Troxel, a senior behavioral scientist at Rand Corp., who was not involved in the study.

“But we really lack solid evidence demonstrating whether cannabis helps or hurts sleep,” Troxel added.

Use of weed may actually harm sleep, a December 2021 study has found. The research, published in a BMJ journal, revealed adults who use weed 20 or more days during the last month were 64% more likely to sleep less than six hours a night and 76% more likely to sleep longer than nine hours a night.

Optimal sleep for adults is defined by the US Centers for Disease Control and Prevention as seven to eight hours a night.

Moderate consumption — using weed less than 20 days during the past month — didn’t create short sleep problems, but people were 47% more likely to snooze nine or more hours a night, the study also found.

Why is short and long sleep a problem?

“Large population-based studies show that both short sleep and long sleep are associated with an increased risk of heart attacks and strokes, as well as the long-term progression of things like atherosclerosis, diabetes, coronary artery disease and any of the major cardiovascular diseases,” said lead study author Calvin Diep, who is resident of anesthesiology and pain medicine at the University of Toronto.

“It seems with sleep there’s kind of this ‘Goldilocks phenomenon’ where there’s an amount (that’s) ‘just right,’” Diep said.

One in three Americans don’t get enough sleep, according to the CDC. In addition, 50 million to 70 million Americans struggle with sleep disorders such as sleep apnea, insomnia and restless leg syndrome, which can ruin a good night’s shut-eye.

The CDC calls that a “public health problem,” because disrupted sleep is associated with a higher risk of conditions, including high blood pressure, weakened immune performance, weight gain, a lack of libido, mood swings, paranoia, depression, and a higher risk of diabetes, stroke, cardiovascular disease, dementia and some cancers.

The December 2021 study analyzed use of marijuana for sleep among 21,729 adults between the ages of 20 and 59. The data was gathered by the National Health and Nutrition Examination Survey, and is considered representative of over 146 million Americans.

In addition to issues with short and long sleep, people in the study who used weed within the last 30 days were also more likely to say they have trouble falling asleep or staying asleep, and were more likely to say they have discussed sleep problems with a health care provider, Diep said.

“The problem with our study is that we can’t really say that it’s causal, meaning we can’t know for sure whether this was simply individuals who were having difficulty sleeping, and that’s why they use the cannabis or the cannabis caused it,” he added.

Prior studies have also found a connection between the two components of marijuana, CBD and THC, and poor sleep. CBD, or cannabidiol, is a key component of medical marijuana, while THC, or tetrahydrocannabinol, is the main psychoactive compound in cannabis that produces the high sensation.

A 2018 randomized, double-blind, placebo-controlled study — the gold standard — found no benefit from CBD on sleep in healthy volunteers. Other studies have also found high rates of insomnia when withdrawing from nightly use of marijuana.

“At this time there still isn’t any clear evidence that cannabis is helping sleep,” said Dr. Bhanu Prakash Kolla, a sleep medicine specialist in the Center for Sleep Medicine at the Mayo Clinic in Rochester, Minnesota, who was not involved in any of the studies.

“We know that when people initiate use there is some benefit in the immediate short term, but there is quick tolerance to this effect,” Kolla said. “There currently is no good quality evidence to suggest that cannabis will help improve sleep quality or duration.”

Still, people continue to believe that weed is helping their sleep. Surveys of marijuana users show they do indeed rely on the drug for better sleep.

“The issue is that there’s a disconnect between these anecdotal reports of people reporting therapeutic benefits and the evidence behind it in terms of the data,” Diep said.

One possible reason, Kolla said, is that when people stop using cannabis after a period of regular use, the withdrawal effects from weed can cause sleep disruptions. That leads people to believe “the cannabis was in fact helping (sleep), while what they are actually experiencing are withdrawal symptoms.”

Another factor to consider is the increased potency of weed today as compared with when many of the studies on cannabis and sleep were conducted, said Dr. Karim Ladha, staff anesthesiologist and clinician-scientist of anesthesiology and pain medicine at the University of Toronto.

“A lot of the older data related to cannabis is based on lower doses of THC than what patients are using now, and there’s very little research related to CBD,” Ladha said.

“Studies tell us about what happens at a population level, but on an individual level that discussion is much more personal,” he said. “The studies just give us the possibilities that (marijuana) could hurt your sleep, but it may help and so we just don’t know until you try it.”

That’s why additional studies need to be done, he added.

“Patients are spending money and time and resources to obtain cannabis right now to help with sleep,” Ladha said. “I think as the medical community, we need to do everything we can to make sure that we enable our patients to make the best possible decisions for their health.”

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Why we have nightmares and how to stop them | CNN

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CNN
 — 

We leave behind our fears of monsters under the bed as we say goodbye to our childhoods, but one can follow us into adulthood and loom over our heads.

Nightmares are more common in childhood, but anywhere from 50% to 85% of adults report having occasional nightmares.

Almost everyone can experience nightmares.

“Dreams do usually incorporate things that happened during the day, leading some researchers to hypothesize that dreams and rapid eye movement sleep is essential for memory consolidation and cognitive rejuvenation,” said Joshua Tal, a sleep and health psychologist based in Manhattan.

“Nightmares are the mind’s attempts at making sense of these events, by replaying them in images during sleep.”

Nightmares are what the American Academy of Sleep Medicine call “vivid, realistic and disturbing dreams typically involving threats to survival or security, which often evoke emotions of anxiety, fear or terror.”

If someone has frequent nightmares — more than once or twice weekly — that cause distress or impairment at work or among people, he or she might have nightmare disorder. Treatments include medications and behavioral therapies.

Addressing frequent nightmares is important since they have also been linked to insomnia, depression and suicidal behavior. Since nightmares can also cause sleep deprivation, they are linked to heart disease and obesity as well.

Trying out these 10 steps could help you ease your nightmares and improve your sleep and quality of life.

Nightmares occur during rapid eye movement sleep, the phase during which our muscles relax and we dream. Waking up during REM sleep enables recollection of the dream and resulting distress, said Jennifer Martin, a professor of medicine at the David Geffen School of Medicine at the University of California, Los Angeles, and member of the American Academy of Sleep Medicine’s board of directors.

“One of the most effective ways to treat nightmare problems in adults is actually to get them sleeping more soundly (so) they wake up less often,” Martin said.

A healthy sleep routine begets sound sleep. Develop one by exercising, setting regular sleep and waking times, ensuring your room is dark and cool, avoiding stimulating beverages after midafternoon and engaging in relaxing activities.

Alcoholic beverages can induce restlessness and awakenings throughout the night — potentially helping you remember nightmares, Martin said.

“A lot of people use alcohol as a way to wind down and feel sleepy at the end of the day, but it’s really not the right solution,” she added. Instead, try herbal teas and other beverages conducive to sleep. If drinking was the only part of your relaxation routine, chat with your partner or read instead.

One drink more than three hours before bedtime is OK, Martin said. Just pay attention to whether it causes a post-dinner nap and alertness at bedtime, and eliminate that drink if it does.

Avoid snacking before bed to prevent spiking your metabolism and activating your brain.

Snacking can boost metabolism, which causes your brain to be more active and could lead to nightmares, according to the National Sleep Foundation.

While some people sleep better after eating a light snack, you should stop eating two to three hours before bedtime. If you notice that you have nightmares afterward, try avoiding nighttime snacking or heavier meals before bed.

Some medications can prompt nightmares by interrupting REM sleep.

“If people can identify that their nightmares either started or increased when they had a change in their medication, that’s definitely a reason to talk to their doctor” about their medication schedule or alternatives, Martin said.

Melatonin, while a popular sleep aid, influences our circadian rhythm that regulates REM sleep, and can lead to more or fewer nightmares. If you want to take melatonin for better sleep, work with a sleep specialist to ensure you’re taking it at the right time and not compounding the problem, Martin said.

Calming activities can deactivate your fight-or-flight response and trigger your relaxation system.

Progressive muscle relaxation — tensing muscle groups as you inhale and relaxing them as you exhale — has been effective for reducing nightmares.

“Nightmares activate the sympathetic nervous system, the ‘fight or flight system,’ the body’s natural response to imminent danger,” said Tal via email.

“The body also has an innate relaxation system: the parasympathetic nervous system, aka the ‘rest and digest’ system.” Progressive muscle relaxation and other relaxation activities can help activate that system.

Journaling can help you release your anxieties.

Write down your worries to get them all out ahead of time, lest they rear their disquieting heads at night. Journaling can be helpful for alleviating nightmares and stress in general, Tal said.

Images from any exciting or disturbing content you watched before bed can appear in your dreams.

Since our nighttime observations can appear during sleep, “spend some energy engaging with things that are more emotionally neutral or even positive” before bedtime, Martin suggested.

During the pandemic, our everyday lives are looking pretty scary, too. “Reading the news media and then hopping into bed is more likely to trigger disturbing and upsetting dreams than looking through pictures from your last vacation with your family,” she added.

Imagery rehearsal therapy is effective “when the chronic nightmares are showing similar themes and patterns,” Tal said.

Since nightmares can be learned behavior for the brain, this practice involves writing down in detail the narrative elements of the dream. Then rewrite the dream so that it ends positively. Just before falling asleep, set the intention to re-dream by saying aloud, “If or when I have the beginnings of the same bad dream, I will be able to instead have this much better dream with a positive outcome.”

“By practicing a rewrite during the daytime, you increase your chances of having them at night while you’re sleeping instead of your nightmare,” Tal said.

Silence is key in a sleep routine, but “for people who either don’t like it to be completely quiet or who are awakened by noises they can’t control during the night,” background noise “is a good strategy,” Martin said.

Try a fan or a white noise machine or app for several consecutive nights to help your brain adapt, she added.

If nothing works and you’re still having nightmares, talk with a therapist or sleep specialist.

“Nightmares might be a sign of a larger issue, such as PTSD or a mood disorder,” Tal said. “It is possible to treat the nightmares without treating the underlying disorder, but it may also be helpful to treat both the symptom and the disorder.

“There has been great progress on psychological treatments for nightmares, insomnia, anxiety and mood disorders,” Tal added. “Do not be afraid to ask for help; psychotherapy works and it is often short term and accessible.”

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