Over the past few years, the number of adults living with obstructive sleep apnea (OSA) has steadily increased. If you’re not familiar, OSA is a sleep-related breathing disorder that impacts one’s ability to breathe during sleep. Across the world, it’s predicted that at least a billion people have this condition, with 25 million estimated to have OSA just in the United States alone [1],[2].

Alarmingly, it’s also predicted that 80 percent of all sleep apnea patients remain undiagnosed [3]. This statistic is disturbing, especially considering the consequences associated with this common condition. If left untreated, sleep apnea can lead to serious health conditions, including high blood pressure, type 2 diabetes, and stroke – and it some cases, it can even be fatal.

Why are there so many undiagnosed OSA patients?

The sleep community is worried that the number of undiagnosed OSA patients has consistently remained so high. It is especially concerning since sleep apnea is highly treatable. There are many options out there for patients to consider. When trying to wrap our heads around this health issue, it comes down to analyzing the circumstances that perpetuate a failure to diagnose.

Related Content:
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With sleep apnea specifically, one important obstacle for diagnosis is patient fear. Fear not just of the sleep apnea diagnosis itself, but of the treatment options available. Many people have seen or are aware of CPAP devices, the main way sleep apnea is treated, and have decided that it is not for them.

A new generation of therapy

Unfortunately, these fears are rooted in past misconceptions of sleep apnea. Because of this, many OSA patients are stopping their care journeys before they even begin. What many people don’t realize is that sleep apnea therapy options have come a long way over the past several decades. Now, there are multiple solutions that have been uniquely designed using a patient-centric approach.

Newer solutions offer improved comfort, ease of use and support increased mobility for sleep apnea patients – all to ensure that patients stay adherent to their treatment plans.  Instead of being afraid of treatment, patients need to give themselves a chance to find the best solution for their unique needs.

As with most chronic conditions, there are a million questions that go through a patient’s mind after an initial sleep apnea diagnosis. As sleep experts, it’s our job to work with OSA patients to determine the best treatment plan for both their specific condition and their lifestyle.

Even in patients who do seek a diagnosis, we can face barriers with treatment. Unfortunately, patients can struggle to adhere to some prescribed treatments. This is because some therapies are uncomfortable and interfere with sleep habits.

But sleep apnea therapy has changed.

Not your father’s CPAP

Traditionally, the gold standard for sleep apnea therapy has been Continuous Positive Airway Pressure (CPAP). CPAP machines work by sending a constant flow of air pressure to the patient’s throat during sleep. This keeps the airway open and thereby treats the pauses in breathing associated with sleep apnea. As an additional benefit, many patients stop snoring, breathe regularly, and get a restful night of sleep with CPAP therapy.

However, people can find it difficult to adjust to sleeping with their CPAP equipment. Patients will sometimes complain about difficulty moving around in their sleep. They struggle with the pressure in their nose and airway. Some even struggle to comfortably watch TV before bed because of their masks.

Thankfully, there are new advancements in sleep technology that are paving the way for new options for more comfortable yet equally reliable treatment. No longer the bulky machines of the past, modern CPAPs, and their accompanying masks are:

  •  smaller and quieter
  •  portable
  •  offer greater ease of movement during sleep
  •  provide precise pressure control at the lowest effective pressures

Newer CPAP mask designs even include cushion options for additional comfort. Some have open-face masks that allow for the ability to comfortably wear glasses, read and simply relax in bed. In addition, other options and alternatives continue to present themselves.

Related Content:  How Your Dentist Can Help with Sleep Apnea [Author’s note: click the link to learn more about Mandibular Advancing devices (MADs) which are effective therapeutic options for OSA.]

Positional therapy: non-invasive and just as effective

Even with these new innovations that offer more freedom and comfort for CPAP users, sometimes CPAP therapy just doesn’t just fit in with a patient’s lifestyle. For patients living with a certain subset of sleep apnea, there is another option for successful treatment: positional therapy.

Patients with positional OSA primarily experience disruptions in breathing when sleeping on their backs. In fact, it’s estimated that up to 47% of all sleep apnea cases are positional [4]. In the past, these patients have gone to extreme efforts to avoid sleeping on their back – with some resorting to sleeping with a tennis ball sewn into the backs of their pajamas to encourage sleeping on the side.

As an alternative method to CPAP therapy, positional therapy wearables like Philips NightBalance work by encouraging users to remain off their back with gentle vibrations. As one of the most non-invasive sleep apnea therapy methods, positional devices are lightweight, portable, and easy to use. Like CPAP, they have also been proven to reduce the snoring that is typically associated with sleep apnea.

As an additional perk, positional therapy devices have demonstrated high adherence rates. A recent study in the Journal of Clinical Sleep Medicine found that short-term adherence with positional sleep apnea devices jumped from 75 to 95% when compared with other sleep apnea therapy methods [5],[6]. A clinical trial also found that these positional devices are effective in reducing Apnea–Hypopnea Index (AHI), an indicator of the severity of a patient’s OSA [7], [8].

Surgery is for sleep apnea is an option 

Some patients seek a solution that will fix or cure their sleep apnea so that ongoing therapy is not required. One such option is surgery of the upper airway.

-Surgery to enlarge the airway

Most such procedures are aimed at enlarging the airway in the area behind the palate and tongue. This is generally accomplished by removing tissue or rearranging the tissue in such a way that the airway remains open during sleep when the pharyngeal muscles relax.

However, it must be realized that these procedures do not work in everyone and an examination of the airway under general anesthesia is often required to determine in whom such procedures will work and which procedure would be best for each patient.

-Hypoglossal nerve stimulation

A new approach to OSA therapy called hypoglossal nerve stimulation (HGNS) has emerged over the last 4-5 years. This therapy involves the placement of a nerve stimulator under the skin on the chest which is connected to the nerve that controls a muscle under the tongue which opens the airway.

This device is turned on at night and, in many patients, can effectively treat OSA [9]. However, it only works in patients with very specific characteristics such as only a moderately elevated body mass index (BMI) and those not collapsing at certain places in the airway. Because of this, as described above, an examination of the airway under general anesthesia is usually required.

Looking ahead

Solutions like positional therapy and HGNS give me a great sense of hope for the future of sleep apnea diagnosis and treatment. Through years of research, sleep therapy companies have begun to develop patient-centric therapies that are fundamentally changing the way patients live with sleep apnea.

Another hope for the future is drug therapies for OSA. Although there are currently no FDA-approved therapies to treat sleep apnea, studies suggest that this may well be possible. [10]

As a result of these advances, people suffering from this chronic condition no longer have to fear diagnosis or treatment plans. Instead, they can move forward on a path to living more healthy and restful lives.

Related Content: Are You Falling for These 11 Sleep Myths?


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[1] Benjafield A, Ayas N, Eastwood P, et al. Estimation of the global prevalence and burden of obstructive sleep apnea: a literature-based analysis. Lancet Respir Med 2019, Aug 7(8):687-698.

[2] https://aasm.org/rising-prevalence-of-sleep-apnea-in-u-s-threatens-public-health/

[3] https://www.sleepapnea.org/learn/sleep-apnea-information-clinicians/

[4] Heinzer, R. et al, Prevalence and Characteristics of Positional Sleep Apnea in the HypnoLaus Population-based cohort, Sleep Medicine 2018; 48:157-162

[5] Long-term effectiveness and compliance of positional therapy with the Sleep Position Trainer in the treatment of positional obstructive sleep apnea syndrome. van Maanen JP, de Vries N. SLEEP 2014;37(7):1209-1215.

[6] Benoist, L., de Ruiter, M., de Lange, J., & De Vries, N. A randomized, controlled trial of positional therapy versus oral appliance therapy for position-dependent sleep apnea. Sleep medicine. 2017 34, 109-117

[7]  Berry R, Uhles M, Abaluck B, et al. NightBalance Sleep Position Treatment Device versus Auto-Adjusting Positive Airway Pressure for Treatment of Positional Obstructive Sleep Apnea. J. Clin Sleep Med. 2019 July 15:15(7):947-956.

[8]  Eijsvogel, M. M., Ubbink, R., Dekker, J., Oppersma, E., de Jongh, F. H., van der Palen, J., & Brusse-Keizer, M. G. (2015). Sleep position trainer versus tennis ball technique in positional obstructive sleep apnea syndrome. Journal of clinical sleep medicine, 11(02), 139-147.

[9] Strollo P, Soose R, Maurer J, et al; STAR Trial Group. Upper airway stimulation for obstructive sleep apnea. New Engl J Med. 2014 Jan 9;370(2):139-49.

[10] Taranto-Montemurro L, Messineo L, Sands S, et al. The Combination of Atomoxetine and Oxybutynin Greatly Reduces Obstructive Sleep Apnea Severity: A Randomized Placebo-controlled Double-Blind Crossover Trial. Am J Respir Crit Care Med. 2019 May 15;199(10):1267-1276.

Editor’s note: Although the author is employed by Philips Sleep and Respiratory Care and they could benefit from this article, we have accepted it for publication because it contains valuable information for our readers. This post has not been sponsored by Philips.

Bothered by pain in the neck? You’re not alone. A 2017 population-based study determined the prevalence of neck pain1 in a population of adults aged 20 and above was 20.3% or 1 in 5 people. Although a variety of risk factors for neck pain have been identified, including your posture/positioning while at work, one risk factor that isn’t often talked about how you position yourself when you sleep. A study published in the Journal of Physical Therapy Science2 on June 29, 2017, was specifically aimed at identifying the effects of sleep posture on neck muscle activity.

The authors found that the activity of the affected muscles was significantly different in each of the three main sleeping positions: supine with both hands at the side (BHS), supine with both hands on the chest (BHC), and supine with the dominant hand on the forehead (DHF). The authors concluded that

“sleep posture is important and prevents neck and shoulder musculoskeletal pain.”

 7 Ways to Relieve Neck Pain from Sleeping in the Wrong Position

Based on these findings and other research detailed below, here are 7 ways to relieve neck pain from sleeping in the wrong position:

1. Don’t sleep in the supine DHF position

If you’re one of those people who put one hand on their forehead while sleeping, you’re may be contributing to your neck pain. When you sleep in this posture, the upper trapezius and scalene muscles are activated on one side. The imbalanced activation of the muscles causes a rotation in the neck, and that leaves you with a misalignment of the cervical spine.

      2.  Avoid the supine BHC position

The supine BHC position is more symmetrical than the DHF since you have positioned both hands on the chest while lying on your back. The difference in the activity between the scalene and upper trapezius muscles is lower. Still, this position of the arms causes some level of tightness of the upper trapezius, which can cause numbness and neck pain.

3.  Get used to the BHS position

The researcher found that the difference in muscle activity was the smallest in the supine BHS (both hands at the side) position. When you go to a relaxation course, they tell you to lay in the so-called Savasana or corpse pose3.

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You lay on your back, with the legs slightly separated and both arms relaxed by the side. The head is in a straight continuation of the neck, without falling to either side. It’s a balanced position, and it turns out it’s the best posture for sleep.

4. Your pillow makes a difference

According to a 2019 article in the Physical Therapy, the Journal of the American Physical Therapy Association, the “ideal” pillow should have the following characteristics:4

      • soft 
      • moderately high (about 10 cm)
      • support cervical lordosis in supine
      • prevent neck lateral flexion in the side position. 
      • allergy-tested, lightweight, and washable. 

Other factors that the cited in the article as influencing neck pillow acceptability are the degree of thermal dispersion, the material, the shape, and the length of time it has been used.

There is no clear winner when it comes to the best pillow to avoid neck pain. You need to find the right one that works for you. To get you started, check out the list of the best pillows for next pain that was compiled by the Sleep Foundation5.  

5. Do something about insomnia

If you suffer from both insomnia and neck pain, you may be interested to learn that there is apparently a reciprocal relationship between these two factors:

Neck pain can interfere with sleep and insomnia heightens your perception of pain the next morning.

A 2015 study published in the journal Pain6 found that sleep problems “significantly increase the risk for reduced pain tolerance.” So, if you suffer from insomnia, you should seriously consider taking action to address the problem.7  Some experts feel that the most reliable improvement in the quality of sleep comes from psychological and behavioral therapy8.

Related article: Sleeping Pills Not Working? Here’s What You Need to Know

6. Try stretching in the morning

If you’re waking up with stiffness in your neck and the entire body, morning stretches can help. Gentle Hatha yoga, for example, will improve the mobility of all muscles and joints and will make you feel relaxed. A randomized controlled trial identified the effects of home-based yoga practice for chronic neck pain.9

The participants who practiced yoga reported significantly less neck pain when compared to the participants who did another type of exercise. Yoga seemed to influence the functional status of the muscles in the neck area as it improved the physiological measures of neck pain.

9. Consider acupuncture

If you suffer from chronic neck pain that doesn’t go away no matter how much you try to improve your sleeping position or the pillow, perhaps it’s time to consider acupuncture which can be an effective treatment for cervical pain. A controlled trial showed that relevant acupuncture treatment combined with heat resulted in a reduction in neck pain.10

The bottom line

There’s no doubt that neck pain causes a huge amount of discomfort. When you wake up with stiffness and pain, your entire day can be impacted by how you feel. But remember that you do have options to make the pain go away or at least reduce it to a significant degree. Hopefully, the eight methods suggested above will help.

If you have tried something that worked for you and is not on this list, please share it in the comment section below.


  1. Caio Vitor Dos Santos Genebra, Nicoly Machado Maciel, Thiago Paulo Frascareli Bento, et al. Prevalence and factors associated with neck pain: a population-based study,  2017 Jul-Aug; 21(4): 274–280.
  2. Won-Hwee Lee, PT, Ph.D. and Min-Seok Ko, Ph.D. Effect of sleep posture on neck muscle activity,  2017 Jun; 29(6): 1021–1024.
  3. Nikki Costello.  The Subtle Struggle of Savasana, Yoga Journal, Nov 2013 https://www.yogajournal.com/practice/beginners/corpse-pose/
  4. Carla VantiFederico BanchelliClaudia MarinoAndrea Puccetti, et al.   Effectiveness of a “Spring Pillow” Versus Education in Chronic Nonspecific Neck Pain: A Randomized Controlled Trial.National Library of Medicime 2019 Sep 1;99(9):1177-1188 https://pubmed.ncbi.nlm.nih.gov/30939188/
  5. Best Pillows for Neck Pain, the Sleep Foundation.  Updated April 2, 2021.  https://www.sleepfoundation.org/best-pillows/best-pillow-for-neck-pain
  6. Børge SivertsenTea LallukkaKeith J PetrieÓlöf Anna Steingrímsdóttir, et al. 

    Sleep and pain sensitivity in adults, National Library of Medicine, Pain 2015 Aug;156(8):1433-1439. https://pubmed.ncbi.nlm.nih.gov/25915149/

  7. Patricia Salber, MD, MBA. How Aging Affects Your Sleep and What To Do About It.  The Doctor Weighs In, Aug 2017 
  8. Charles M. Morin, Ph.D., Richard R. Bootzin, Ph.D., Daniel J. Buysse, MD, et al.

    Psychological And Behavioral Treatment Of Insomnia: Update Of The Recent Evidence (1998–2004), Oxford Academic. Sleep, Volume 29, Issue 11, November 2006, Pages 1398–1414, https://academic.oup.com/sleep/article/29/11/1398/2709225

  9. Cramer, Holger MSc; Lauche, Romy PhD; Hohmann, Claudia MD; Lüdtke, Rainer MSc; et al.  Randomized-controlled Trial Comparing Yoga and Home-based Exercise for Chronic Neck Pain, The Clinical Journal of Pain: March 2013 – Volume 29 – Issue 3 – p 216-223 https://journals.lww.com/clinicalpain/Abstract/2013/03000/Randomized_controlled_Trial_Comparing_Yoga_and.4.aspx
  10. Controlled trial of Japanese acupuncture for chronic myofascial neck pain: assessment of specific and nonspecific effects of treatment. 31 Aug 1998, 14(3):248-255 https://europepmc.org/article/med/9758075

Running is a great way to improve your fitness and maintain your physical condition. Further, a great thing about running is that it is portable. So, even if you travel a lot, you will still be able to continue exercising. And, it is one of the most accessible sports out there. All you need to hit the road is a good pair of running shoes. Finally, even though it is possible to run at any time of day, morning runs may be preferable for a variety of reasons.

Seven reasons why you should improve your life through morning running

1. Morning running is more likely to get done

How many times have you told you yourself that you will go on a run after you finish work but you didn’t do it? You were too tired or distracted. Or you simply forgot.

Here are some of the things that can get in the way:

      • You might have to stay late at the office
      • You feel like you need to complete assignments that you think are more important than lacing up your shoes and going out
      • Your co-worker wants to take you out for a drink
      • Your kids need help with their homework

Sound familiar? 

Rather than putting your daily exercise at risk because life gets in the way, you could plan to run in the morning instead. Make it a habit so that the first thing you do after you get up and brush your teeth is to put on your shoes and go for a morning run.

2. You will start your day happier and more confident

If you run first thing in the morning, you will feel happier and more capable throughout your day. According to health psychologist, Kelly McGonigal as quoted in a recent article on CNET:

“When you exercise, it increases endorphins, dopamine, adrenaline, and endocannabinoid — these are all brain chemicals associated with feeling happy, feeling confident, feeling capable, feeling less anxiety and stress and even less physical pain,” 

Exercise and depression

As a matter of fact, a study on exercise and depression published in the Journal of Psychiatric Research found the following result:

“Exercise has a large and significant antidepressant effect in people with depression (including Major Depressive Disorder or MDD).” The authors concluded that “Our data strongly support the claim that exercise is an evidence-based treatment for depression.

Another study published in the Journal of Affective Disorders, concluded that exercise could also be a viable adjunct treatment in combination with antidepressants. 

[Editor’s note: you should always consult with your doctor to determine if exercise is a reasonable addition to your depression treatment regimen.]

Surely, being motivated to run every single morning is near impossible. We all have our ups and downs. But force yourself to put on your gear and get out of the house. Everything will feel easier after you take a couple of steps. And you may arrive at your office with a big smile on your face, ready to tackle any problem. 

3.   Exercise may help you sleep better

Although more and better studies are needed, a systematic review of published meta-analyses (a review of reviews) on the impact of exercise on sleep quality, suggests that exercise may improve some measures of sleep including overall sleep quality and subjective sleep.

However, If you have never run in the morning, you may need to change up your sleeping schedule a bit. You might need to go to bed earlier in order to wake up in time to complete your workout. You want to be sure to get the recommended six to nine hours of sleep each night.

While it seems hard, your body will soon adapt to the new habit. And you might even enjoy rising with the sun. So as soon as you feel tired in the evening, don’t hesitate to go to bed. Getting up early is a part of a natural cycle, and you will catch more daylight as well as vitamin D.

4. You can think about your day

Morning runs are usually quiet and calming. Everyone may still in their beds and you find that you have the road all to yourself. This is a perfect opportunity to zone out and think about the things you need to do after you finish your morning run.

If you are working on a new project and you need to solve a problem, brainstorm it as you run. Your head will be fresh because you just had a good night’s sleep and you haven’t been to work yet.

You might get a new idea or discover a unique approach that never crossed your mind. Some people see running as a form of meditation because it helps them mute the distractions. There will be no interruptions, only you, the ground, and your thoughts. So relax and think.

5. Morning running can fire up your metabolism

There are many reasons why people run, but losing weight is certainly one of them. Sitting a lot at work and consuming fast food is a sure-fire way to gain weight. A good workout can help increase muscle mass.

Muscles burn more calories than fat. So, increased muscle mass usually means that more calories are burned. More calories burned can lead to weight loss as long as you don’t increase your calorie intake (aka food).

6. Running may strengthen your bones

Running is essential for having a strong physique. But it works more than just your muscles. As a matter of fact, your bones may become stronger. Further, the myth that running damages your knees is completely false.

So if you are worried that you might lose bone mass as you age, running might be your solution. Deciding to run in the morning ensures that you don’t miss your workout.

Some of us might feel sluggish after a workday, so we skip evening runs because we simply want to stay at home and rest. But if you do your run early, you will actively work on improving your body, and, hopefully, your bones will become stronger as time goes by.

Related Content: Does Running Actually Cause Knee Osteoarthritis?

7. You will be more disciplined

Waking up early to go on a run is very difficult, especially if you love sleeping in. It might sound almost impossible to you at the beginning, but as time goes by, running in the morning will become easier. You will form a habit and your personal discipline will increase.

The chances are you will start feeling the same about other areas of your life, especially work where self-discipline can get you far. In addition, you may find yourself more inspired to live a healthier life and take care of your body properly. After all, you need to eat better things in order to fuel your muscles and perform better every single morning.

The bottom line about running in the morning

While becoming a morning person might be scary for you, the benefits that come with lacing up your running shoes as soon as you wake up might convince you otherwise. You will improve both your physical and mental condition as time goes by.

Being committed and focused on a run is not an easy task, but it will start to feel natural to you after a couple of weeks. So don’t give up! Instead, improve your life through morning running!

Initially published April 13, 2018, this article has been reviewed and updated by the Medical Editor to reflect recent scientific literature on the topic.

Have you ever considered the definition of health? The dictionary tells us that it’s the absence of illness or injury. However, if you think a bit deeper about it, you might decide that merely being free of disease doesn’t make you healthy.

Your health is a continually evolving state. You might feel good today and not so much tomorrow.

How you treat your body affects your overall
health and wellness for years to come.

So, when it comes to health, making the right decisions every day is probably your best strategy. To do this, many experts believe that using a holistic preventive medicine approach can help you achieve maximum function and well-being. 

What is preventive medicine?

If you’re looking for ways to boost your immunity and avoid illness, preventive medicine might be able to help. This lifestyle health approach centers around practices that focus on prevention, promotion, and maintenance of health and wellbeing.

Preventive medicine can be formal, like when you go to see your physician for health screenings and immunizations. But it also includes lifestyle changes that you can undertake your own.

In this tech-oriented era, these changes likely involve wearable, and in-home technologies can help keep you healthy. These come in a variety of forms, such as smartwatches, that can track your steps, monitor your heartbeat, and remind you to take deep breaths periodically. But they also include digital home blood pressure monitors, glucose monitors, electronic scales and other devices that can port your data into a tracking app.

What is holistic medicine?

Holistic medicine focuses on the whole person. Instead of just treating one condition or body system, it takes into account the body, mind, and spirit. Holistic practitioners believe that if one part of your body isn’t working as it should, then all other parts will be affected, too.

Further, they believe that staying healthy requires that you must always be in a state of balance. This involves intention and practice. Also, it may mean you need some therapeutic techniques if you lose this delicate state of equilibrium.

Why is holistic preventive medicine necessary?

Six out of every ten adults in the United States have a chronic health disease. Four out of ten have two or more long-term conditions.

The following are the most common and costly illnesses:

  • cancer
  • heart disease
  • diabetes
  • chronic lung disease

All of these conditions have one thing in common: the impact of your lifestyle. Choices like too little physical activity, poor eating habits, and tobacco use can increase your risk of long-term health conditions.

The Centers for Disease Control and Prevention reports that practicing prevention can lower your healthcare costs. Americans spend $3.3 trillion on healthcare each year. Ninety percent of this total arises from chronic physical and mental health conditions.

When you choose preventive healthcare, you’re placing your long-term health over your short-term lifestyle decisions with the goal of healthy living. This is especially true for women who are pregnant or planning on becoming pregnant, as having a healthy pregnancy is vital for the long-term health of two.

Five advantages of engaging in holistic preventive care for your body

The Case for Health Screenings

As you age, life seems to get busier. This might leave you struggling to find time for routine checkups and tests. Remember, health screenings are a crucial part of holistic health and prevention.

Health screenings can detect chronic conditions and infections early so that you can get proper treatment and slow down the progression of these diseases. These types of exams are essential as you age, especially in the middle-adult and senior years.

Have you ever thought about how essential your heart is to daily life? There are many things you should know about your heart. One of the most critical components of healthy living is taking good care of your heart by making heart-healthy decisions daily.

Simple steps like getting your blood pressure checked routinely, seeing your doctor every year for a thorough exam, and following through with any laboratory tests your provider recommends can decrease your overall risk of heart disease and high blood pressure.

The Case for a Healthy Diet

Choosing to eat a healthy diet decreases your risk of developing conditions like obesity and high cholesterol. Eat fruits, whole grains, vegetables, and fat-free or low-fat dairy products to get on the right track.


If you have any chronic health conditions, like diabetes or gastrointestinal reflux disease (GERD), your diet is a critical step to control. If you have GERD, be sure to steer clear of foods that agitate symptoms. This includes spicy foods, coffee, tea, and fatty or fried foods.

Try eating small, frequent meals to avoid the added pressure that a large meal might place on your stomach and esophagus. If you’ve been diagnosed with diabetes, sticking to a healthy eating plan. 

Related Content:
Why All the Confusion About Healthy Diets? 
The Definitive Debunking of the Cranberry-UTI Myth

A healthy eating plan can help you control your blood sugar and slow the progression of the disease and other complications. A few diet modifications to consider with diabetes includes

  • choosing complex carbohydrates over simple ones
  • eating heart-healthy fish
  • opting good fats, like avocados and nuts.

The Case for Controlling Stress

When you think of a healthy lifestyle, you might only consider things like diet and exercise. However, the amount of stress in your life is critical to overall well-being. Having a small amount keeps your body performing well, but too much stress can cause headaches, stomach upset, chest pain, and decrease your ability to fight colds and infections.

Related Content:  19 Fun Activities That Help Relieve Stress

If you’re looking for holistic ways to get your stress under control, consider practices like mindfulness and meditation. You might also think about joining a local yoga or pilates class. Another strategy to help ease stress and anxiety is the use of CBD. This component of marijuana doesn’t cause any psychoactive effects.  But, it has been shown to reduce tension and decrease stress, especially when it’s part of an overall healthy lifestyle.

The Case for Catching Shut-Eye

Sleep is restorative. So walking around in a sleep deprived or deficient state will leave you functioning at a suboptimal level. Unfortunately, too many people think they can run on four or five hours of sleep each night.

However, research has proven that getting about eight hours of sleep every day improves physical health. It also keeps you safe and performing at your best. When you get enough sleep and good quality rest, your overall state of mental, physical, and emotional health will improve.

The Case for Plenty of Activity

We get it. Some days you don’t feel like running 10 miles or engaging in a two-hour long exercise class. The good news is that to get the benefits of regular physical activity, you don’t have to spend a lot of time doing it. If you commit to a minimum of 30 minutes of exercise each day, you’ll get several benefits such as:

  • weight control
  • combating illness 
  • boosting your energy levels

The bottom line

If you’re ready to give holistic preventive health a try, you don’t have to make all of these changes at once. Instead, choose one of these strategies and stick with it for a few months before adding in the next one.

One of the easiest ways to begin is to make an appointment with a holistic preventive medicine practitioner for a check-up. Work with her to establish a plan of action to get your health back on track. Then, follow that plan as you gradually discard unhealthy habits and incorporate new health-promoting ones. The next thing you know you will be on the path towards health and a more balanced lifestyle. Good luck! 

You could throw in the towel and blame everything on your gene pool, or you could take the time to learn what it is that separates the slim folks from the rest.

The truth is, there are some habits of people who always stay fit that you should incorporate into your daily routine. They go well beyond transforming your body:

They’re about embracing a whole new way of life.

1. They Start Their Days Early

Early bird gets the worm – or, in this case, a fit body.

Early risers tend to be more proactive!

habits stay fit

Photo Source: Unsplash

Instead of letting sleep inertia get the best of them, they use the extra time each morning to exercise, meditate, and have a healthy breakfast, among other things. And, more importantly, they stick to it during the weekend, as well!

The number one habit you need to work on is changing your sleep pattern.

But before you set your alarm one hour earlier than usual, be sure that you move your bedtime, as well. You should still aim to get the recommended amount of sleep each night.

Stick around to find out why!

2. They Don’t Skip Breakfast

I know I risk sounding like your mom here, but:

Breakfast is the most important meal of the day.

Photo Source: Unsplash

And while there are plenty of reasons why you should never skip breakfast. These include a reduced risk of heart disease, enhanced cognitive functions, and a reduced risk of diabetes. But I’ll focus on the one that probably interests you the most:

It helps keep the weight off for good.

However, eating breakfast isn’t a magic weight management solution – your food choices still play a significant role:

Aim to have a healthy, wholesome meal consisting of proteins, healthy fats, whole grains, and fiber, first thing in the morning.

3. They Don’t Shy Away from Routine

Whether you admit it or not, humans are creatures of habit.

I’m not talking about fully scheduled days, of course, but bringing a little structure and organization to your daily life couldn’t hurt.

Starting your day with a plan means you’re planning on getting things done and accomplishing something.  This automatically leads to a more positive outlook on life. It is an often overlooked, but important factor for improving your health and wellness.

And just like any other chain reaction, the more happy and optimistic you feel, the more likely you are to engage in healthful habits.

4. They Truly Enjoy Exercise

Most fit people don’t fall into the category of die-hard fitness fanatics.  However, they still make an effort to include exercise into their daily life – and you should, too.

Seriously, if there’s one habit you should pick up, it’s this one.

Whether it’s yoga, running, or hitting the gym for a resistance training session, the trick is in finding something that you truly enjoy. And don’t mind doing – even if it’s Sunday, even if you’re on vacation, even if your favorite show is on.

Continue reading, and you’ll see what I mean.

5. They’re Active Outside the Gym, Too

habits stay fit

Photo Source: Unsplash

Generally speaking, fit people choose to spend their free time doing something, rather than doing nothing. They do this because they respect their body and its needs more than anything else. They think of movement as a way of life, not a means to an end.

You’ll rarely catch a fit person spending their free time slouching in front of the TV.

They’re too busy having fun outside, be it by going on a hike, riding a bike, or simply walking around the park, and enjoying the fresh air.

Related Content:  
Want to Know Why Exercise is So Good for Your Brain?
How to Spot a Senior-Friendly Gym

6. They Eat “Real Foods”

Sure, it’s nice to order some take-out or go to a restaurant every once in a while, but as it turns out, one of the many habits of people who always stay fit is that they generally prefer a home-cooked, whole-foods meal over anything else.

That said, two things should be on your daily menu are:

Protein, which reduces hunger, increases feelings of fullness and helps you consume fewer calories throughout the day.

Fiber, and viscous fiber in particular, which helps you feel fuller for longer by forming a gel, increasing nutrient absorption time, and slowing down the emptying of the stomach at the same time.

7. They Know Better Than To Make Unrealistic Diet Changes

In a perfect world, you’d eat a 100-percent clean diet. You’d also stick to it at all times. But we both know that’s not how the real world works.

Fit people know that staying slim isn’t about drastically restricting their calorie intake or cutting specific food groups out of their diet. It’s about finding what works in the long run, and embracing the right mindset:

Eat everything in moderation.

8. They Drink Plenty of Water

Heart and lung function, digestion, body temperature regulation, joint lubrication, and anything else that goes on inside your body requires one vital nutrient – water.

After all, it’s common knowledge that the human body is around 60 percent water.

But did you know that drinking more water throughout the day – and especially before a meal – affects not only your hydration levels but your weight, as well?

More importantly, when it comes to water-drinking habits of people who always stay fit, it seems that they’re more likely to swap calorie-packed drinks for water, too.

9. They Don’t Need a Reason to Get In Shape

One of the habits of people who always stay fit is that they tend to prioritize their health and fitness – even when it seems like there are not enough hours in the day to get everything done.

Unfortunately, though, most of us only remember to watch our diets or hit the gym when we have an important event coming up in a few weeks.

You shouldn’t need a date on the calendar to motivate you to take care of yourself – the fact that you only have one body should be a reason enough!

10. They Understand the Importance of a Good Night’s Rest

Photo Source: Unsplash

You can embrace a clean diet and an active lifestyle, but if you fail to keep your sleeping pattern in check, all your efforts go straight through the window.

There’s a quite intimate relationship between sleeping comfortably and fitness:

When you’re sleep deprived (and more than a third of adults are), your hormone levels take a severe blow. This includes those vital for keeping your body fit and healthy – hunger hormones, ghrelin and leptin, growth hormone, and insulin.

Related Content:  How Important is Sleep for Women’s Health?

Final Thoughts about Staying Fit

If getting to the end of this list of habits of people who always stay fit left you feeling a bit overwhelmed, take a deep breath and relax – no one expects you to start implementing all these new habits at once.

Rome wasn’t built in a day.

Tackle one aspect of your daily life at a time, ditch the fad diet mentality, and take as much time as you need:

You’re building life-long habits here – and that’s a journey, not a race.

Pregnancy is a taxing time for a woman. All that energy you get from food is being used to sustain the unborn life inside you. As a result, pregnant women feel tired all the time. Unfortunately, it is surprising how despite feeling this way, sleep doesn’t come easily to pregnant women.

Luckily, with a bit of understanding of the types of changes you will go through each trimester, and the reasons for these changes, it is possible to find a solution to your sleep woes. Read on to find out!

Pregnancy-Related Lethargy

First, let’s tackle why you might be feeling more tired than usual. Researchers haven’t been able to pinpoint what exactly causes pregnant women to feel this way. There might be several reasons to explain why this happens:

Hormonal Changes
An increase in progesterone levels will cause you to feel more relaxed and slow you down.

Physiological Changes
During pregnancy such as the growth of the uterus, weight gain, bloating etc. The body is being pushed harder to keep up with the increased demand for energy and blood flow by the fetus.

Emotional Changes
You might feel extra worried about the health and wellbeing of your baby. This increased level of anxiety can be energy draining.

What Causes Insomnia During Pregnancy?

The last thing you would expect to have when you are tired all the time is insomnia. Unfortunately, it is not uncommon to suffer from this when you are pregnant.

This section describes some of the reasons for your insomnia by stage of pregnancy:

During First Trimester

The first stage of pregnancy is a period of rapid changes in your body.  A variety of physiological and hormonal alterations are taking place. You may begin to notice the following symptoms and feel more drained due to poorer sleep quality.

Frequent Urination
Since you are in your first trimester, your baby is still very small. However, your uterus is growing to accommodate the developing fetus. This increase in the size of your uterus puts pressure on the bladder.

Moreover, throughout pregnancy, blood volume keeps increasing until it is 50% greater than usual. This massive increase means that the kidneys process more body fluids. Hence, more urine is produced.

Unfortunately, the combined effect of these changes leads to frequent urination which can ruin a good night’s sleep.

Morning Sickness
Another reason for insomnia might be due to sudden attacks from morning sickness. Researchers are unsure why pregnant women suffer from this condition. A popular theory states that it may be a reaction to increased levels of hCG hormone in the body.

Breast Sensitivity
Women find that breasts are more sensitive during pregnancy. Unfortunately, it can be painful to sleep in your favorite positions such as lying on your stomach or sides if you have breast tenderness.

The culprits behind this are the hormones estrogen and progesterone. This hormone duo causes breasts to begin growing larger. To facilitate growth, fat deposition, and blood flow to the area increases which results in increased sensitivity.

Higher Body Temperature
Metabolic rate increases to provide the body’s greater need for energy during pregnancy. Unfortunately, this means you will begin to feel warmer than usual.

To combat a high body temperature, try using a ceiling fan in your room. It will keep you cool as well as drown out any background noises that disturb sleep.

Pregnant women might realize that they have suddenly begun to snore. This is because pregnancy hormones cause mucous membranes to swell resulting in nasal congestion. This is exacerbated by lying down. If you are an obese or overweight woman, the extra tissues in your head and neck can worsen snoring.

During the Second Trimester

Unlike the first trimester where your body undergoes rapid change, the situation is very different during the second trimester. This is the period in your pregnancy when you will be most well rested.

The reason for this is that your body isn’t changing quite as fast. Unfortunately, there are still some interruptions.

Restless legs
During the second trimester, you might experience a sensation that feels like tiny insects crawling inside your leg. The only relief is moving your legs until this feeling goes away. This condition is called restless leg syndrome.

It begins during the evening hours of the second trimester but gradually worsens as you approach the third trimester. The exact cause of restless leg syndrome in pregnancy is unknown, but imbalances in brain dopamine, deficiencies of folate or iron, and rising estrogen levels have all been suggested as causes.

Gastroesophageal Reflux Disease
As your pregnancy progresses, your uterus grows bigger and heavier. When lying down at night, the heavy uterus puts pressure on the stomach forcing food up the esophagus. There is a valve in your esophagus that prevents digested food from coming back up.

Progesterone causes this valve to relax. Hence, food mixed with stomach acid travels up the esophagus and causes a painful burning sensation. This is called gastroesophageal reflux disease.

Sleep on your left side with your knees bent reduces the risk of a heartburn attack at night. Alternatively, you can sleep in a sitting up position with your back propped up by a stack of pillows for support.

Vivid Dreams
Pregnancy is an emotional rollercoaster ride for women. You might spend most of it constantly worrying about the health of your baby. This anxiety can translate into your sleep and lead to bizarre dreams.

Furthermore, if you wake up in the middle of a REM stage, you can vividly recall what you saw in your dreams.

During the Third Trimester

The last stage of your pregnancy is the most difficult. Sadly, you will suffer from the poorest quality of sleep because it is harder to fall asleep. You may also be awakened by numerous interruptions during this time.

Back Pain
You are heaviest during your third trimester. Throughout your pregnancy, you will gain 25-35 pounds. Your uterus will grow to almost full size by now. Thus, there is a lot of strain on the spine which has to support all this extra weight.

To make things worse, your body produces a hormone called relaxin which loosens ligaments to prepare your body for labor. This hormone loosens spinal ligaments making it more difficult for the spine to carry the burden placed on it.  This eventually culminates in back pain which might keep you up at night.

Increased Snoring
The weight gain from pregnancy worsens nasal congestion which leads to increased snoring. According to a study, mothers who snore are at high risk of developing pregnancy-related high blood pressure than mothers who do not.

Tips on How You Can Get a Decent Night’s Rest

Although your quality of sleep will suffer during pregnancy, you can reduce the frequency of interruptions and catch some z’s by following the tips below:

Schedule Your Sleep Sessions
A night full of running to the bathroom and waking up from bizarre dreams will certainly leave you exhausted by the morning. Many times through the day you may want to ditch the chores and have a lie in.

Well, seize the opportunity for a little nap whenever you want! Take as many naps as you need especially when you are running low on energy.

Experts advise avoiding the use of sleeping pills including ones which contain melatonin, during pregnancy.

Don’t Drink Fluids Right Before Bedtime
Stay hydrated during pregnancy to keep constipation and bloating at bay. However, you may want to reduce water consumption from the evenings up until bedtime. And, lay off caffeine which worsens insomnia.

Keep a Packet of Saltines or Dry Cereal on Hand
Keeping a packet of saltine or dry cereal on your nightstand will help you fight against morning sickness. Simply, pop in a cracker whenever you begin feeling queasy to ease nausea.

Use Pregnancy Pillows
When pregnant, you may have had to forsake your favorite sleep position to reduce any discomfort due to your changing body. Fortunately, pregnancy pillows come in a variety of shapes for all your support needs.

These pillows support the head, chest, back, and knees to help ease body pains and allow you to assume any sleep position you want.

Eat Healthily
If you suffer from heartburn, fatty food should be completely off limits. Consuming fat and oil-rich food causes the stomach to produce more acids and aggravates the digestive system. Eat a balanced diet that is rich in fruit and vegetables.

Moreover, eating a healthy diet during pregnancy is vital to having a healthy baby. Maternal nutrition influences the nutritional habits of the fetus for the rest of its life.

Furthermore, the baby’s predisposition to certain illnesses and its birth weight and development depend on the kind of nutrition it receives from its mother.

Exercise in the Mornings
Exercising during pregnancy improves your moods, increases your stamina for labor, reduces backaches and makes you more energetic. When you exercise in the mornings, it stimulates your body to produce melatonin earlier in the evening which positively affects sleep and improves your sleep rhythm.

Related article: Exercise and sleep quality

Related article: Three best pregnancy workouts

Make Your Bedroom More Comfortable
Use night lights to provide illumination whenever you need to go to the bathroom at night without turning the lights on and ruining your chances of getting any sleep. Keep your room dark and cool to make it an optimum environment to sleep in.

Practice Self-Soothing
If you have trouble falling asleep, don’t just lie in bed fretting. Get up, read a book or do something else. Distracting yourself will ease any tensions. You can also try meditating or relaxation exercises to soothe yourself.

The bottom line

As a pregnant woman, you may feel exhausted and have trouble sleeping a lot of the time. Although poor sleep quality is one of the side effects of pregnancy, you don’t have to spend the entirety of your pregnancy being chronically tired.

Following the above advice will help you stay well rested during pregnancy. However, if lethargy persists or worsens, consult a doctor.

By now, everyone knows that sleep – both the quality and quantity – has a direct impact on physical and mental health.

As the importance of sleep has gained clinical and consumer attention, sleep apnea has been revealed as a dangerous and potentially life-threatening condition that often goes undiagnosed. At the same time, the prevalence has increased over the past ten years parallel with the growing rates of obesity and being overweight which are risk factors.

The link between sleep apnea and atrial fibrillation

Significant research now also links the most common type of sleep apnea – obstructive sleep apnea (OSA) – to atrial fibrillation (AF). In fact, both conditions share some of the same risk factors including age, weight, and having diabetes. This link has implications for testing, diagnosis, treatment, and management for both sleep apnea and AF.

What is sleep apnea?

Sleep apnea is a disorder where breathing stops or becomes dangerously shallow during sleep. OSA occurs when the muscles in the back of the throat relax and the upper airway narrows or closes when you’re trying to breathe in.

Sleep apnea affects about 60 million people in the US and 986 million worldwide.[1] Experts believe approximately 85% of all patients with sleep apnea go undiagnosed.

According to the Mayo Clinic, if you snore loudly and wake up tired after a full night’s sleep, you may have sleep apnea.

How is sleep apnea diagnosed?

There are two ways to test and diagnose sleep apnea:

  • Nocturnal polysomnography
  • Home Sleep Apnea Test (HSAT) kits.

The former is performed, usually overnight, in a sleep disorder clinic. You are hooked up to equipment that monitors your breathing patterns, heart, lung and brain activity, blood oxygen and arm and leg movements while you sleep.

Home sleep tests are generally easy to use, inexpensive, and usually measure your airflow and breathing patterns, heart rate and blood oxygen level.

What is atrial fibrillation?

Atrial fibrillation (AF) is an irregular, often rapid, abnormal heart rhythm that affects 2.5 million people in the U.S. and 33.5 million people worldwide. It’s caused by disorganized or chaotic electrical signals, which make the upper chambers of the heart (the atria) quiver, instead of contracting properly.

Those with AF have a stroke risk that is five times higher than people who do not. The risk factors for developing AF include age, being overweight and having other health conditions such as diabetes. Obstructive Sleep Apnea can now be added to the list as a relatively new defined risk factor.

The Relationship Between OSA and AF

According to the Heart Rhythm Society – a professional society of electrophysiologists (EP) – understanding the exact relationship between AF and sleep apnea is evolving. Estimates suggest that half patients with AF also have sleep apnea and patients with sleep apnea have four times the risk of developing AF.

Over time, if sleep apnea is left untreated, it increases the risk of other conditions, including

  • hypertension
  • diabetes
  • stroke
  • atrial fibrillation

There’s also evidence that sleep apnea increases the frequency of arrhythmias that occur during sleep. [1]

How does sleep apnea cause atrial fibrillation?

According to Patricia Tung, M.D. and Elad Anter M.D.

“the mechanisms by which sleep apnea precipitates AF or vice versa, remain unclear.”

They discuss the latest thinking in what they call this “dual epidemic” looking at current data linking the two conditions and suggest approaches for screening AF patients for sleep disorders. [2]

How the two conditions may be linked and how if left untreated, sleep apnea negatively impacts treatment for AF, is described by the Heart Rhythm Society:

“The heart experiences mechanical stresses and chemical changes each time a person with sleep apnea is startled awake by lack of oxygen, and that may contribute to the development of AF.

In addition, studies suggest that untreated sleep apnea impairs the ability to control AF because it reduces the effectiveness of certain AF treatments.

For example, people with both AF and sleep apnea may not respond as well to medications to control the heart rate as AF patients without sleep apnea. Patients with sleep apnea are also more likely to have AF recurrences after a cardioversion or catheter ablation compared to AF patients without sleep apnea undergoing the same treatments.

Preventing sleep apnea makes AF treatments more effective—regardless of the treatment type (medication versus procedure). New research suggests that when both AF and sleep apnea are present, treating both is more likely to result in better health overall.”*

*Emphasis is mine.

Use of Home Testing for Sleep Apnea Grows

Recent estimates suggest that approximately one-third of all sleep apnea tests are now done using home sleep apnea testing kits instead of in-lab polysomnography testing which is supervised and performed overnight.

This trend is explained by the differences in both cost and accessibility/convenience. Sleep clinic testing is expensive – as much as $6,000 in out-of-pocket expenses. It may be difficult to obtain approval for reimbursement or not be covered.

In contrast, home kits are widely covered and may be recommended as the first-line diagnosis. The cost to the patient may be a co-payment as small as $10. Payment policies vary by payer so it’s always a good idea to check.

In addition to cost, there are accessibility issues: a patient has to go to the clinic and remain overnight for the testing. Many patients prefer home testing as it’s more convenient and they can relax in the privacy of their home and may be “more likely to reflect the actual disease manifestation.”

A Sleep Specialist Perspective

Omar Burschtin, M.D. is the Medical Director of the Mt. Sinai Sleep Program. He is a sleep specialist with a special interest in cardiovascular issues and describes his experience with both patients and physicians in Cardio Sleep Review-issue #2. Dr. Burschtin underscores that sleep apnea is “a common co-morbidity to AF.”

Dr. Burschtin believes that most cardiologists are “pretty aware” of the link between sleep apnea and AF. But, he says, they may want to treat their AF patient right away using ablation or cardioversion (electrical or chemical).

The timing problem

It may literally take months for a patient to be able to arrange a sleep clinic test and, unfortunately, patients don’t always show up. It may take another couple of weeks to get test results to the cardiologist.

The cardiologist may not want to delay cardiac treatment for up to five months until the patient can get a consultation, testing, scoring and therapy for sleep issues.

According to Dr. Burschtin,

“We know that managing AF patients with obstructive sleep apnea greatly improves outcomes and patient care. If they have sleep apnea and are treated, it reduces the chance of their having recurring arrhythmias after their treatment.”

Mt. Sinai, therefore, thought it would be a good idea for cardiologists to have the results of their patients’ sleep apnea tests before performing cardioversion or ablation.

Streamlining the sleep testing process

To address the timing issue, Mt. Sinai sets up a weekly clinic to help identify patients that would be appropriate candidates for home testing. The clinic’s staff tries to expedite insurance approvals for the testing. They also give the patients a home test – Itamar Medical’s WatchPAT – for sleep testing that night.

The WatchPAT is a medical grade home sleep apnea testing device. It is only available by prescription.

PAT™ – Peripheral Arterial Tonometry, is a non-invasive window into the Autonomic Nervous System at the finger. PAT signal is an accurate measure of the Pulsatile Arterial Volume at the finger and manifests vascular and microvascular activity which depends on sympathetic activity. This signal provides critical insight for classifying sleep/wake state and detecting sleep disordered breathing events. Because this technology uniquely uses finger-based physiology it avoids the complexity and discomfort associated with traditional airflow-based systems according to Itamar Medical.

Itamar Medical's Watchpat shown on hand 749 x 427

Photo source: Provided by Itamar Medical

This Mt. Sinai Sleep Clinic process is fast: patients or someone return the device the next day, sleep professionals review the results and their cardiologist receives a report the same day.

They find using the WatchPAT home test “allows them to be efficient” and “is easy for the patients and the results are reliable.” It helps meet their goal “to provide an immediate point-of-care and try to resolve a vacuum of the presence of sleep medicine in cardiac care.”

Notes from a Cardiologist with Sleep Apnea

Rick Pummil, M.D. has a unique perspective on the issue of sleep apnea and AF: he’s a cardiologist who also has severe obstructive sleep apnea and described his experience in an interview with Cardio Sleep Review-issue #2.

He agrees with the challenges outlined by Dr. Burschtin about scheduling and timing. Also, with regard to compliance, he says

“it’s not unusual for patients to come back to his office for follow-up visits months later only to learn they never went for their sleep lab test. Or if they did go, they never got the results.”

That’s where being able to use home testing devices like the WatchPAT has “changed his practice considerably and definitely for the better.” Patient compliance is much better, and they have immediate results.

If he suspects a patient may have sleep apnea, he sends them home with a test the same day they have an appointment with him. He gets the device back the next day, and if they have sleep apnea, they’ll get set up with a CPAP machine within 72 hours to begin treatment.

Home testing benefits both patients and their doctors, according to Dr. Pummil.

Total Sleep Solution Device

Given the links between sleep problems and heart disease, Itamar Medical has developed what it calls a “total sleep solution” for cardiovascular patients. I spoke to Gilad Glick, Itamar’s President and CEO, to learn more about their approach.

The WatchPAT was developed over a decade ago and uses PAT™ (Peripheral Arterial Tonometry), a non-invasive window into the Autonomic Nervous System at the finger. It’s an accurate measure of the signal that provides critical insight for classifying sleep/wake state and detecting sleep-disordered breathing events, explains Glick.

PAT is referenced in sleep apnea practice guidelines

The use of WatchPAT is now included in the practice guidelines of the American Academy of Sleep Medicine (page 490, bottom right paragraph). In a meta-analysis used to obtain FDA clearance, “the results showed there is an 89.7% correlation between our device and polysomnography,” according to Glick.

They also conducted a large study (n=455) with a typical mix of patients, who were referred to the Johns Hopkins Sleep Disorder Center described in WatchPAT™ Scoring Guidelines Leveraging Automated Scoring with Visual Oversight; John Hopkins Report 2018; Alan Schwartz, Hartmut Schneider; p1.

The project developed a streamlined approach for reviewing and editing the automated results from WatchPAT recordings; you can read about the scoring guidelines here.

The report authors concluded WatchPAT technology

“is unique among HSAT devices in its ability to render a fully automated, validated report, which compares extraordinarily well to gold standard polysomnography.”

A personal trial

At this point in my conversation with Glick, I put on the device he had brought to the interview. I was home-tested for sleep apnea with a different type of device a number of years ago. It required me to wear straps and wires and other such nonsense that completely interfered with my ability to fall asleep and stay asleep.

In contrast, the WatchPAT’s monitor strapped onto my wrist like at Watch and the sensor slipped over my index finger like a thimble. It was lightweight, comfortable, and seemed unlikely to interfere with sleep. There was nothing to turn on or off. It is a huge improvement in terms of patient comfort compared to what I had before.

An old device, a new approach

While the device is not new, Itamar’s current approach is. Originally, the company focused on marketing the device to sleep doctors.

However, after realizing the biggest unmet clinical need is for AF patients, they have a new mission focused on making sure every AF patient receives a sleep apnea workup and is treated before having an ablation. This is in line with AF guidelines that state that all AF patients should get a sleep apnea workup and if, diagnosed, receive treatment to prevent recurrence, according to Glick.

Glick summed up our conversation saying,

“It’s simple: for anyone suspected of having AF – by their primary care physician or cardiologist – all they have to do is hand the patient the WatchPAT to take home and they’ll be able to have an initial diagnosis for sleep apnea.

That’s easier and more convenient than being sent to a sleep lab for a polysomnography although that test may still be needed based on the initial diagnosis.”

A Population Management Tool

“Our goal is to improve sleep apnea management and its effective integration into cardiac patient care. So, we made the decision to address clinical practice related to sleep apnea and AF and not just focus on selling the WatchPAT to cardiologists,” states Glick. To do this, the company created the SleePathTM program to help cardiologists across their practice with a population management tool.

The fully-automated system links the data from the WatchPAT cloud to the Phillips CPAP cloud and tracks where patients are in the care continuum:

  • Was the WatchPAT test positive?
  • If yes, are they set up with a CPAP?
  • Are they complying with CPAP or do they have residual apnea?

The data is loaded into the patient’s EHR. A follow-up questionnaire with cardiologists found positive feedback on the program explains Glick.

One desired outcome of Itamar’s new approach is to make sure that before someone has an ablation their cardiologist or electrophysiologist asks if they’ve been tested for sleep apnea.

If not, they will be handed a WatchPAT, go home and get their diagnosis. If positive, they can be treated for the sleep apnea first.

Glick notes that while the company is still collecting data and don’t have any yet that shows treating sleep apnea early in the disease progression reduces the need for ablation, there is data that shows the effectiveness of ablation and cardioversion is doubled although the latter procedure is performed less frequently.

There is data on treating apnea and ablation: NYU summarized post-ablation recurrence data that was studied with sleep apnea and without sleep apnea. The results for over 1,000 patients was that if AF patients with sleep apnea used CPAP, there was a 42% relative risk reduction in AF recurrence in patients with OSA.

And, finally, Glick notes that Itamar has created a physician portal CardioSleepSolutions with relevant literature, blogs from physician thought leaders and testimonials. The goal Glick says is to create awareness and education about the connection between sleep apnea, AF and AF treatment.


  1. Am J Epidemiol. 2013 May 1; 177(9): 1006–1014.
  2. Arq Bras Cardiol. 2014 Nov; 103(5): 368–374.
  3. J Atr Fibrillation 2016 Apr-May; 8(6): 1283

Many thanks to healthcare communication and public affairs consultant, Leslie Rose, for her expert assistance in the preparation of this story.

It’s an established fact that sleep has a profound effect on our health. In particular, some recent studies indicate that sleep issues and even schedules have some unique effects on women’s health.

Despite extensive studies, scientists have yet to fully understand the implications of sleep disorders, but each new piece of research contributes to the development of knowledge which can help with the management and prevention of some diseases on a global scale.

Early Risers Have a Lower Risk of Breast Cancer

According to a recent study by the National Cancer Research Institute, women who are early risers have a reduced risk of developing breast cancer. The so-called ‘larks’ function better during the first half of the day and have an astounding 40% lower risk of developing this particular disease.

Moreover, the study indicated that every additional hour of sleep beyond the 6-8 hours of recommended daily rest increases that same risk by 20%. While Dr. Rebecca Richmond, a member of the team behind the study, states that the matter requires further investigation, she does highlight that these results are consistent with previous research. This means that changing our sleeping habits can be an important step in the prevention of cancer, which claims over 500,000 lives every year.

This study analyzed the data of 228,951 women from the Breast Cancer Association Consortium and 180,215 women from the UK Biobank project. The team used the Mendelian randomization method during this research.

Based upon the acquired data, and previous studies of night-shift work and exposure to light at night, the team of researchers concluded that changing our sleep habits and thus adapting the entire circadian rhythm to that of a ‘lark’ can have protective qualities against breast cancer. The scientists do stress that the risk factors for the condition are far more complex and as such, this change does not offer guaranteed protection. However, the data speaks for itself and clearly shows that this is a factor important enough to make the effort of changing worthwhile.

Poor Sleep Quality Speeds Up Aging in Pre-Menopausal Women

The expression ‘beauty sleep’ is rather apt as there is no doubt that maintaining a regular sleep schedule is one of the best of enhancing your natural beauty. It acts in a similar way to a clean diet, which is another such method. This means that getting a healthy rest optimizes your body function, thereby making your look fresh and naturally attractive.

However, research indicates that the impact of sleep goes deeper than this. A study conducted by University Hospitals Case Medical Center, commissioned by Estee Lauder showed that sleep quality directly affects skin structure.

Over the course of the study, sixty pre-menopausal women aged 30-49 were separated into two groups. The group with poor sleep quality ranked 4.4 on the SCINEXA skin aging scoring system. Meanwhile, the group which maintained a healthy sleep schedule during the study received a 2.2 score. This translates into significant differences in the tangible signs of aging, such as loss of skin tone and wrinkles.

It should be noted that researchers believe the main reason behind the differential was greater UV damage. According to the study, poor sleep quality reduces your ability to recover from UV radiation and similar events. Overall, this particular problem results in a diminution of the skin’s main function, which is to be a natural barrier.

Women Who Snore Have a Greater Risk of Heart Disease

At the end of November, the Radiological Society of North America published a study provided some data which some may consider worrying. According to this information, women suffering from obstructive sleep apnea (OSA) develop cardiac issues earlier than men who suffer from the same condition.

What is even more worrying is that OSA often goes undiagnosed for long periods of time. For women, this means that they have a much greater risk of developing a cardiac function impairment which directly translates into an increased risk of mortality.

Snoring is the most common sign of OSA, but it is not a completely accurate indicator of the condition. Other symptoms include morning irritability, fatigue, dry mouth, and headache.

This study processed the data of 4,877 people registered with the UK Biobank project. There were three groups of participants: those with diagnosed OSA (118), those without any reported sleep issues (2,477), and those with self-reported snoring (1,886). Both men and women in the OSA group had cardiac issues.

However, it was the self-reported OSA group which revealed the most important data. In this group, the discrepancy between men and women showed more markedly. It was clear that women develop the cardiac impairment associated with OSA earlier in the disease than do men. Therefore, early diagnosis and treatment should take precedence.

This study also showed that an extremely large number of OSA cases remain undiagnosed. This means that many of the people at risk are unaware that they need to protect their heart health.

Researchers recommend getting a sleep analysis or at least asking partner’s to observe sleep patterns in order to catch the moment when snoring transforms into OSA. This exact transition happens when a snoring person stops breathing for a short period of time and gasps afterward.  It is this particular breathing pattern of disruption which affects the cardiac function.

Sleep Loss Causes DNA Changes Which Increase Weight Gain

A team of researchers from Uppsala University determined that acute sleep loss leads to epigenetic changes in DNA methylation. This study offers solid proof that sleep deprivation triggers tissue-specific changes, which affect adipose tissue in particular.

These changes affect ‘metabolic memory’, which means that their impact is long term. They are more pronounced in people with metabolic disorders such as type 2 diabetes. According to the data collected during this research, chronic disruption of sleep greatly increases the risk of obesity.

This study, like a lot of other sleep research, had a specific focus on shift workers. This additional piece of proof serves to reinforce the idea of how unhealthy shift work is for everyone. Both men and women are susceptible to the health issues caused by the disruption of a healthy circadian rhythm. This latest study clearly shows that sleep loss can cause tissue inflammation, which in turn has a major adverse effect on health as a whole.

Most worrying of all is that these DNA changes occurred even over the rather time short period of the study. This indicates that even seemingly minor sleep disruptions can have a long-term impact. It is therefore essential to take maintaining a healthy sleep schedule very seriously.

Related:  Click here to see all of our stories about sleep

Importance of Healthy Sleep Patterns for Women’s Health: Final Thoughts

The knowledge that getting regular healthy sleep is important for health is not new. But current research sheds some light on how women can protect their health by changing specific sleeping habits. These changes do not come easily, but their impact upon the body is significant.

Whilst it is acknowledged that an occasional break in the schedule will not have a major detrimental effect, every additional night of lost sleep or hour of prolonged sleep increases the damage.

It is important to be aware that these issues do not need to be regular in order to contribute to major health issues. Even short-term exposure can result in permanent damage. Therefore, If you want to maintain not only your beauty but your health as well, you should make an effort to keep your sleep schedule as regular and as healthy as possible.

All prescription sleeping pills, like other medicines, have to be shown to be more effective than placebo (‘sugar pills’) in order to be approved by the US Food and Drug Administration. Subsequently, large analyses combining many studies, and using elaborate rules of evidence, have confirmed that the older benzodiazepines (‘Valium-like drugs’) and the subsequent ‘Z drugs’ such as zolpidem help sleep in chronic insomnia at least in short term use (usually one week).

One limitation of such an approach, though, is that it gives information about a group of medicines in large groups of people, but doesn’t provide as much insight as to how a particular drug (and dose) will do in a given individual.

A clearer answer to whether sleeping pills help also involves looking at a number of smaller questions:

  • How is improvement measured?
  • How large was the improvement?
  • How long does it last?

How is improvement measured?

Usually, sleeping pills are tested in two different ways. One is by performing physiologic sleep studies. The other is by asking patients how they feel. Each approach has certain advantages and disadvantages.

Sleep recording (polysomnography) brings a measure of objectivity and a look at physiology when assessing efficacy. Patient reports are valuable because how people feel about their sleep is what we are especially interested in. It also provides a sense of overall sleep quality. So, a combination of both types of information is important.

As we will see in the next section, in general, the effects of sleeping pills on polysomnographic measures are more modest than those found on patient reports.

How large is the improvement?

One large analysis which combined the results of many individual studies of benzodiazepines and related sleeping pills found that in terms of the sleep EEG, on average they increased sleep by about one hour while decreasing the time to sleep onset by only about four minutes (1). As always, how patients felt about their night’s sleep differs from what brain waves show: in this case, they felt that they had fallen asleep about 14 minutes more quickly than when taking placebo.

Another such analysis of studies of the elderly, which included benzodiazepines as well as zolpidem and zaleplon showed more modest gains, with an increase in total sleep of about 25 minutes (2). It found no differences in sleep quality between the benzodiazepines and the Z drugs.

How long do they last?

Most studies of nightly use of sleeping pills have been limited in duration to one or two months and often less. There are a few exceptions including zolpidem, eszopiclone, and zaleplon which were tested for one year in ‘open-label’ studies. This means the investigators were aware of what medicine was being taken. Hence, the findings were potentially less precise.

There have also been studies using the more stringent ‘double-blind’ design. These showed continued effectiveness of suvorexant as measured by patient reports for one year (3) and of ramelteon as measured in sleep studies for six months.

In general, though, we are in a situation in which most drugs are assessed and shown effective in the short term. It is important to understand that is not reflective of the long term usage in the real world.

The answer to the question “how long do they last?”, then, is that ultimately we really aren’t sure. The evidence we do have available, however, suggests that they do not lose effectiveness.

This conclusion is more secure in talking about the Z drugs than the benzodiazepines because the studies of the latter have never really been done. Now that Z drugs and newer agents such as suvorexant are here, it seems unlikely that they will be.

Other issues to consider

There is also another reason to be less secure in using benzodiazepines in the long term, Studies have shown impairment in a variety of thinking processes in persons taking them for long periods of time.

We also do not know how long effectiveness lasts when taking sleeping pills in non-nightly use, though the limited information we have is that the Z drugs do not show evidence of tolerance. At this time, the drugs for aiding sleep onset which do not have formal FDA indications limited to short-term use include eszopiclone, ramelteon, zolpidem ER, and suvorexant.

The broader problem of sleeping pills being tested in the short-term, but often taken in the long-term, is also true of other types of medicines—it comes up, for instance, with antidepressants. Many researchers, including your author, believe that we need to determine who should do these kinds of studies—for instance, the drug companies (which at least so far have not done very many), a government agency, or perhaps the drug companies by government requirement.

The bottom line

  • All prescription sleeping pills have been shown to be effective in both sleep recordings and reports of how patients feel about their night’s sleep.
  • The results of patient’s reports are usually more robust than the sleep recordings.
  • In general, it is important to remember that these are not cure-alls. They can, and usually, do help sleep to some degree, but it’s best to have modest expectations.
  • Often, it’s wise to use them as part of a broader approach to improving sleep, which can include improving sleep habits, non-pharmacologic ‘talking’ therapy (cognitive behavioral therapy I), and looking into additional sources of difficulties such as other medicines which may be disturbing sleep.

Related Content: Sleeping Pills Not Working? Here’s What You Need to Know


  1. M. Holbrook et al.: Meta-analysis of benzodiazepine use in the treatment of insomnia. CMAJ 162:225-233, 2000.
  2. Glass et al.: Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits. BMJ 331: 1169, 2005.
  3. D Michelson et al.: Safety and efficacy of suvorexant during 1-year treatment of insomnia with subsequent abrupt treatment discontinuation: a phase 3 randomised, double-blind, placebo-controlled trial. Lancet Neurol. 13: 461-471, 2014.

Wallace B. Mendelson MD is a psychiatrist, sleep specialist, and author.  His recent books include Understanding Sleeping Pills (available on Amazon), from which this article is excerpted.



Every phase of our lives comes with certain burdens and difficulties. We face challenges wherever we go, and we fall down more than we want to. The same goes for being a college student. However rewarding and fulfilling the entire college experience may be, there are still struggles many students need to endure.

Unfortunately, not everyone is strong enough to power through obstacles and find their own way out. Consequentially, many students face mental health challenges and find themselves at the verge of losing it. In order to prevent that from happening or help you overcome those challenges, we’ve put together a list of 4 mental health challenges you may face as a student and ways of overcoming them.

1. Anxiety

As defined by the Oxford Dictionary, anxiety is “a feeling of worry, nervousness, or unease about something with an uncertain outcome”.

Even though we all feel this way sometimes, it can be very dangerous if anxiety overcomes our mental health and becomes the dominating state of mind.

Due to sudden lifestyle changes, piled up school projects and a lot of responsibilities- college students face anxiety in its worst form.

The most common symptoms of anxiety are:

  • feeling nervous and tense
  • feeling restless
  • breathing rapidly and trembling
  • experiencing increased heart rate
  • feeling afraid and endangered

Depending on the level of your anxiety and how far it has come, there are two ways of dealing with it:

  • On your own

If your anxiety is mild and not alarming, but still causes minor troubles for you, try dealing with it yourself. Detect what causes your anxiety. Then, try removing the source and battling it with common sense and working on yourself.

  • With professional help

If anxiety is interfering with your social life, tasks accomplishment, success in school and emotional life, you need to seek professional help in dealing with it. A mental health provider or a doctor can help you overcome it and be yourself again.

2. Sleep Disorders

If you feel that sleep disorders aren’t supposed to be taken seriously, you’re wrong.

Difficulty falling asleep and staying asleep, also known as insomnia, is a serious condition causing damage to both mental and physical health of a person experiencing it.

Lack of sleep is known to cause:

  • high blood pressure
  • obesity
  • unclear thinking
  • decrease in concentration
  • bad coordination

As reported by the Harvard Medical School “only 11 percent of American college students sleep well, and 40 percent of students feel well rested only two days per week.”

The numbers are alarming and it’s obvious that a great number of college students struggle with insomnia.

So, what causes it and how can you overcome it?

Insomnia can be caused by various medical and psychiatric factors. For college students, most common causes are:

  • substance abuse
  • unhealthy lifestyle
  • anxiety
  • improper study habits
  • lack of sleeping schedule

Overcoming insomnia is about taking control of your emotions, thoughts and striving for a more healthier lifestyle.

  • Try setting up a regular sleeping schedule and stick to it.
  • Eat healthy foods.
  • Avoid alcohol, nicotine, caffeine, and other addictive substances.
  • Exercise, meditate and work on your mental health.

Again, if you fail to succeed in overcoming insomnia on your own, reach out for professional help. Just don’t ignore it, because it won’t go away just like that.

3. Depression

It’s perfectly normal to experience sadness, disappointment and mixed emotions every once in a while. These emotions come naturally when you’re having a bad day, you’re going through a rough and emotional period in life or something bad happens to you.

However, if these emotions become overwhelming, lasting longer than they should and influencing your everyday life, you might be feeling depressed. With college students, depression prevalence rates are usually 7-9 %.

The symptoms are:

  • feeling sad, pessimistic and down all the time
  • hopelessness
  • loss of interest for anything
  • suicidal thoughts
  • feeling “empty”
  • loss of appetite or binging
  • insomnia or sleeping too much

Related Content:  Emotional Abuse Made Me Feel Like I Was Crazy

Depression needs to be taken seriously and treated by a professional. If you are experiencing the symptoms above, don’t panic. It’s not the end of the world. You do, however, need to seek guidance and help in overcoming it. Visit your doctor and talk openly about your problems. He’ll tell you what to do next.

Anxiety eating disorder student

Photo Source: Pixabay

4. Eating Disorders

“Eating disorders have the highest mortality rate of any psychiatric illness” according to the National Eating Disorders Association.


College students are likely to develop some forms of eating disorders due to rapid lifestyle changes, wanting to fit in and lose weight and the appearance of other mental health issues.  Eating disorders are not just about skipping meals.

The most severe forms include:

  • starvation
  • purging
  • binge-eating
  • over-exercising
  • obsessing over your body-image and weight

In addition, the health risks are immense and the consequences of eating disorders are:

  • risk of heart failure
  • nausea and vomiting
  • weakened intestines
  • fainting and dizziness
  • hormonal imbalance
  • kidney failure

It’s obvious that eating disorders can cause your health to deteriorate severely. This is why it’s important to know ways of overcoming them.

If you detect any of the symptoms of eating disorders and realize you or someone you know needs help, don’t hesitate in asking for it. Early detection is an advantage which is why you should act upon it immediately.  Contact a helpline or go straight to your doctor. Start fighting it as soon as you realize it’s real and it’s happening to you.


College is a stressful period of life. There’s the change of home, new people, demanding tasks, fear of failure and other factors that influence the appearance of mental health issues with college students. Even though these problems are common, it doesn’t mean they are normal and they’ll go away on their own.

Mental health issues require treatment, counseling and fighting against. Make sure you don’t push your problems under the rug but face them instead. It’s the only true way of overcoming mental health problems, so go for it.

More than 22 million people in the United States suffer from sleep apnea. We know that the most common form of this condition—obstructive sleep apnea (OSA)—is more than just a nuisance; multiple studies show that disrupted sleep is connected to greater risks of dangerous diseases and conditions, including:

  • Heart disease
  • High blood pressure
  • Stroke
  • Type 2 diabetes

There are many other diseases that OSA is associated with, and it plays an outsize role in seemingly unrelated issues, too. For example, those with OSA are five times more likely to have an auto accident than people who don’t have OSA. And it’s not just the patient who endures interrupted sleep; often their partners are sleep deprived, as well, and then end up suffering from some of the same complications of sleep deprivation.

Why cleaning the CPAP is important

In my Sleep Medicine practice, almost all of my patients with OSA are prescribed a CPAP to treat their condition. It’s one of the most reliable and effective sleep apnea treatments available, and patients can see a vast improvement—if they comply with the protocol and use it regularly. So, that’s the first hurdle; effectively getting the message across as to how vital it is that the CPAP is used every night. They see the best results when they use it for the entire night, but, in my observation, even using it just four to five hours a night on a regular basis makes a marked difference in improving their health and the adverse effects of untreated OSA.

The second hurdle—after getting them to consistently follow their CPAP protocol—is to help them understand the importance of cleaning their machine regularly. I recommend daily cleaning of the mask and hose since using a machine that has not been effectively sanitized puts patients at greater risk of infection and disease. The reasons for regular cleaning are simple:

  • Oil, sweat and dead skin cells can accumulate in the CPAP mask every time it’s used.
  • The water in the machine and the moisture in the mask and hose are potential breeding grounds for bacteria and germs.

A study from Brigham and Women’s Hospital and Harvard Medical School found 2,000+ bacteria counts evident after just 48 hours on 48 percent of samples from CPAP masks they collected. Another study showed that patients who use CPAP are 32 percent more likely to get pneumonia, in part due to poor CPAP maintenance.

In my practice, I see patients who will complain of respiratory infections many times per year—and when I dig down into what could be a contributing factor, more often than not I find that they are in the group that doesn’t clean their CPAP regularly. Once I convince them of the importance of that step, and then they comply, their incidence of respiratory infections goes down markedly.

I have had patients in my practice admit to me that not only do they neglect to clean their machine regularly, but they are also using the same water for several days without changing it. When I talk to those patients who are not cleaning their machines regularly, there are a few common themes:

  • It’s too much trouble.
  • It’s too hard to keep it clean.
  • It takes too much time.

Today, with so many CPAP cleaning options available, patients should have no excuse for putting off this important step in their OSA treatment.

CPAP cleaning options

Some of the cleaning methods they can choose from include the following:

Soap and Water

The old method of disassembling the mask and hose and cleaning it with soap and water can, in fact, be time consuming and inconvenient. If it’s not performed with extreme attention to detail, it can also be ineffective, since hard-to-reach surfaces in the humidifiers, masks, and hoses may be potential breeding grounds for bacteria. Another consideration that makes this method suboptimal is that the very means of cleaning—tap water—can be a potential source of germs.


Though cleaning CPAP equipment with specially designed wipes may seem, at first glance, more convenient for users, it actually may be more dangerous than beneficial. However, wipes cannot clean inside the hose, and when researchers looked at this method just a few years ago, they found that rather than eliminate pathogens, the wipes—though formulated expressly for the purpose of cleaning CPAP equipment—tended to just transfer bacteria from one surface to another.

Vinegar and water

Similar to the soap-and-water method, this way of cleaning requires users to, first, disassemble their CPAP. Then the equipment must be soaked for at least 20 minutes, rinsed thoroughly and, finally, allowed to dry completely. So, for CPAP patients who choose this method—which in itself is a time-consuming process—there is the chance of introducing bacteria to the equipment at multiple points.                 

UV light

Because it doesn’t introduce moisture into the equipment, this method is an improvement over soap and water. But some studies have shown that the light may not reach shadowed parts of the mask and hose, and thus it potentially leaves bacteria and germs intact in those areas where the light may not get to. Also, UV light will not kill bacteria in the hose, the inside of the machine or the water in the reservoir.

Activated oxygen

Used in cleaners like SoClean, activated oxygen (ozone) has been shown to have multiple benefits over other ways of cleaning the CPAP. A naturally occurring gas, ozone is extremely safe when it is used properly. It has been used to purify water since the 1800s. Today, it’s the method that hospitals, food handlers and the hotel industry use for sanitizing, as it’s been proven to kill virtually all known forms of bacteria in air and water. As a CPAP cleaner, SoClean kills 99.9 percent of germs, without introducing moisture that could then become a breeding ground for more germs. SoClean is designed to safely use ozone, rather than sending it directly out into the room.

So, when I am working to ensure that my OSA patients comply with their treatment protocol by consistently using their CPAP machines, I also emphasize the importance of cleaning the equipment regularly. I lay out the pros and cons of each cleaning method, and an ozone device with proven efficacy rates and multiple safety features is the one that I usually recommend because it is superior on many counts.

Editor’s note: Although this story promotes a commercial product, we were not paid to publish it.

Many people looking for natural products to help their sleep have turned to melatonin. In recent years it has been taken by over three million Americans, and this number is rising, particularly with its use in children. In this article, we’ll talk about what melatonin is, and how it affects sleep.

What is melatonin?

Melatonin is a hormone, secreted by the pineal gland at the back of the brain. Its secretion is triggered by a pathway from the hypothalamus, an integrative center regulating many body functions. Inside the hypothalamus is a structure known as the suprachiasmatic nucleus, or SCN, which is thought to house the major clock-like system of the body.

Nerve cells in the SCN have their own internal rhythm, which is re-adjusted daily by a pathway from the eyes, to match the light/dark rhythm of the outside world. During the daytime, the SCN promotes wakefulness; when it is nighttime and dark, this drive toward wakefulness decreases, and the SCN allows a signal to go to the pineal gland to release melatonin.  For these reasons, melatonin has sometimes been called the

‘hormone of darkness’.

Melatonin can be purchased over-the-counter as a dietary supplement. Studies have shown its usefulness in some specialized types of sleep disturbance which are associated with disorders of the body clock (‘circadian rhythm’ disorders), such as delayed sleep phase syndrome, and non-24 hour sleep-wake disorder.

What type of sleep disorders are treated with melatonin?

1. Delayed sleep phase syndrome

 In delayed sleep phase syndrome, the body clock runs at a later time than the world outside (insomnia-and-body-rhythms).  A person with this condition will feel wide awake at, let us say, 11:00 PM because the internal clock thinks it is 8:00 PM.  Such a person will be unable to fall asleep until perhaps 2:00 AM, when the body feels it is 11:00 PM. He or she would do well if it were possible to go to bed every night at 2:00 AM and get up at perhaps 10:00 AM, but because of school or work, this is usually not feasible, resulting in difficulty getting to sleep at conventional hours, and sleepiness when getting up in the morning.

2. Non-24 hour sleep-wake disorder

In non-24 hour sleep-wake disorder, there is a dysregulation of the body clock so that it runs on a different day length than the outside world, resulting in irregular sleep. It is often found in blind persons, in whom the daily signal about light and dark is no longer transmitted to the brain, but it also occurs in sighted persons as well.

It produces a cyclic sleep disturbance: for example, a person may have a repetitive pattern of sleeping well for perhaps a few weeks, then for a few days or more have a very disturbed sleep when the body’s internal clock is maximally out of phase with the outside world. Some doctors use melatonin given in the evening on an ongoing basis for this disorder. The sleeping pill ramelteon, which stimulates melatonin receptors in the brain, has been approved by the FDA for non-24 hour sleep-wake disorder when it occurs in blind persons.

3. Jet lag

Jet lag after travel across time zones can produce not only difficulty sleeping in the new location but a variety of other problems including mood changes, daytime sleepiness, trouble concentrating, impairment of skills and gastrointestinal disturbances. Traditional sleeping pills may be of some help in improving sleep initially, but generally, do not hasten adjustment to the new location.

Melatonin is sometimes used to aid jet lag, and some limited data suggest that the use of ramelteon may do so as well. The medicine armodafinil has been reported to improve daytime wakefulness after Eastbound travel. In both of these cases, this is considered an ‘off-label’ use of these medicines (they are not specifically approved for these purposes).

Does it help with chronic insomnia?

Melatonin may be of help in several specialized disorders. In contrast, researchers differ on whether it is useful in chronic insomnia which is not related to body clock malfunction. Before setting out to buy melatonin for insomnia, then, it’s worthwhile to see what surveys of the all the available studies have to say.

Among reviews on the subject, one described its helpfulness as ‘unclear’; another found that overall it hastened the time to sleep onset by about seven minutes and raised total sleeping time by only about eight minutes. It noted that these were modest improvements compared to those of prescription sleeping pills, but suggested that it might have some role in insomnia treatment.

Side effects?

Melatonin has side effects which need to be considered as well. About 20 percent of persons taking it report daytime sedation. It can produce headaches and dizziness, though these are less frequent. It also has the potential of interacting with other medicines, notably some for diabetes, blood-thinning, and birth control.

Since it is sold as a dietary supplement and not a drug, there is less oversight into quality control in its manufacturing. One study found that actual melatonin in commercial products varied by as much as 83 percent less to 478 percent more than what the label indicated.

Melatonin is not recommended as a treatment for chronic insomnia in the most recent guidelines of the American Academy of Sleep Medicine.

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In summary:

Melatonin has a number of qualities that at first glance make it appealing:

  1. It does not require a prescription
  2. It is not dependence-producing
  3. It is a natural substance.

The data on its use in chronic insomnia, though, is not encouraging. It is also a good reminder that just because a substance is natural does not automatically mean that it is safer or a better choice. As always, the best plan is to learn as much as possible about a potential sleep aid in order to make a good decision about using it.

Wallace B. Mendelson MD is a psychiatrist and author, whose recent books include Understanding Sleeping Pills, available on Amazon. Understanding Sleeping Pills