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Part II of II

Difficulty sleeping during the COVID-19 quarantine has become a common problem and can be manifested in a variety of ways; insomnia, fragmented sleep and nightmares. National prescription providers have reported a 21% increase in anti-insomnia, anti-anxiety and antidepressant medications since March of 2020. The past two weeks in Health & Exercise Forum” have been dedicated to sleep wellness.

Last Week in 'Health and Exercise Forum'

We discussed the importance of sleep for health and wellness. Sleep is crucial to us as a species, but it is not always easily attained. For many individuals across the globe, sleeping properly can be a challenge. The trial and tribulations of the human experience can lead to restless nights and early morning risings without adequate sleep. This week, we will discuss how lack of quality or quantity of sleep can impact our lives in many ways and make suggestions to improve your sleep hygiene.

Cognitive Performance

Although it may be tempting to sleep in on weekends after a long week of classes, some studies report that this habit results in a smaller volume of the gray matter of the brain in adolescents. Also, in this report, students who altered their sleep pattern on weekends had a lower grade average than those who did not. Therefore, it seems that it is not only important to maintain an average healthy average amount of sleep each night, but also to stay consistent with the hours that you are asleep.

Physical Fitness

There are many studies that have linked unhealthy sleep patterns to obesity. Inadequate sleep causes irregular levels of the hormones that are responsible for telling our brains when we need to eat. Therefore, this hormone imbalance can lead to obesity and thus make us vulnerable to the dangerous effects dramatically increased body fat.

Longevity

A healthy sleep schedule has been shown to reduce the risk of heart disease and stroke, which are two of the leading causes of death in the United States. For example, interruptions in sleep due to disorders like sleep apnea have been shown to be a risk factor for stroke and that persistent tiredness often preceded heart disease.

Physical performance

Whether you are a high school or collegiate athlete, or simply enjoy some daily exercise, a healthy sleep schedule can help maximize performance. It is worth noting that it is possible that athletes require different sleep patterns than the general population to reach peak performance. Moreover, it has been shown that sleep loss is linked to a decreased ability in athletes to store sugar in the muscle to use as energy during a workout.

Needless to say, there are a plethora of things that can negatively impact our sleep. Even one night of poor sleep can drastically impact our performance and ability to concentrate the following day. So how do we combat this? There are several simple habits that can improve sleep hygiene and increase the likelihood of getting a good night’s sleep.

TIPS TO IMPROVE SLEEP HYGIENE:

  • Set a routine- Going to bed and waking at the same time every day, even on weekends, strengthens our circadian rhythms. Our brains become accustomed to the routine and allow us to fall asleep quicker, reach more restful sleep faster, and wake up feeling refreshed rather than startled by the blaring of our alarms.
  • Limit screen time before bed- As stated earlier, the light from our devices tricks our eyes into believing it is day rather than night. Try to stop using your devices an hour before you head to bed to allow your brain to naturally power-down for the day. This means limiting falling asleep to Netflix as best we can. An even better idea would be to remove TVs from the bedroom all together.
  • Exercise earlier in the day- While frequent exercise is essential to our health and helps us fall asleep, working out right before bed can result in poorer sleep. Avoid strenuous exercise at least one hour before bed.
  • Meditation- Alright, I can hear the groans already, but it works- especially in individuals who have difficulty quieting their minds after a hectic day. An article released by the Journal of the American Medical Association (JAMA) demonstrated significant improvements in the quality of sleep in those who practiced mindfulness meditation and compared to those who did not.
  • Moving when you have difficulty falling asleep- If you find yourself unable to fall asleep within 30 minutes of lying down, get out of bed. Go to another room and read in dim lighting or listen to music until you feel tired and try again. 

There are thousands of other resources that can help us achieve a great night’s sleep. Apps like “Calm” and “Headspace” have guided meditations and relaxation techniques to help us unwind before bed. More useful information about healthy sleep and why it is important can be found on Harvard Medical School’s Healthy Sleep website. And there are hundreds of thousands of YouTube videos with relaxation techniques and informative healthy sleep videos to be discovered. If these interventions do not improve your sleep, talk to your primary care doctor and see which next steps are right for you.

 Sleeping well is not always easy and there will undoubtedly be nights on which rest eludes us despite our best efforts. But with consistent healthy sleep habits, we will be on our way to a healthier and better tomorrow.

For More Informations:

-http://healthysleep.med.harvard.edu/healthy/

-https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2110998

-https://www.sciencedirect.com/topics/medicine-and-dentistry/insomnia

Timothy Farrell, MD3

Tim Farrell is a third year medical student at Geisinger Commonwealth School of Medicine. Originally from Clarks Summit, Pennsylvania, Tim received his bachelor’s degree from Loyola University Maryland in Baltimore, MD. Currently a 2nd Lieutenant in the US Army, he enjoys listening to music, running, and spending time with his two dogs. He volunteers with the Cody Barrasse Foundation in the Organ Transplant Assistance Program, where he helps patients receive grant funding as they await their transplant surgery. He hopes to pursue a career in General Surgery.

Read Dr. Mackarey’s Health & Exercise Forum – every Monday or at https://mackareyphysicaltherapy.com/forum/

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor  in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine.

Part I of II

Difficulty sleeping during the COVID-19 quarantine has become a common problem and can be manifested in a variety of ways; insomnia, fragmented sleep and nightmares. National prescription providers have reported a 21% increase in anti-insomnia, anti-anxiety and antidepressant medications since March of 2020. The next two weeks in Health & Exercise Forum” will be dedicated to sleep wellness.

Everyone Needs Sleep!

We do it every night, hopefully. Children are doing it. Our grandparents are doing it. Teenagers do it all the time. We sleep of course. These hours in which we slumber are vital to our ability to function during the day and to our health overall. It does not appear evolutionarily advantageous for us to be unconscious for extended periods of time. Modern science tells us that much of our body’s restoration, strengthening, and processing occurs while we sleep. Our brains consolidate the information they have learned throughout the day and enhance our memory. Additionally, sleep restores sugar storage in our brains and improves the functioning of our immune system. But science does not illuminate why we need such a prolonged period other than the fact that we just seem to get sleepy after a long day.

How much Sleep Do I Need?

Sleep is crucial to us as a species, but it is not always easily attained. For many individuals across the globe, this author included, sleeping properly can be a challenge. The trial and tribulations of the human experience can lead to restless nights and early morning risings without adequate sleep. But what is considered “adequate” sleep? The answer depends on your age. As we grow older, our sleeping requirements change drastically from infancy to elderdom. Infants are learning and processing so much information of this new world they now inhabit. Thus, their brains need enough time to analyze and consolidate the data, necessitating 12 to 15 hours of sleep. As we advance into adulthood, our sleep requirements drop to approximately 7 to 9 hours with some variability from person to person. Good indications of a restful night’s sleep include waking up feeling refreshed, functioning with enough energy for your daily tasks, and having continuous sleep- meaning there are not extended periods of time of wakefulness when we are supposed to be sleeping.

You are not alone, roughly 100 million people suffer from insomnia at some point each year!

This seems easy enough to say, but significantly more difficult to do. Current reports demonstrate that roughly 100 million people suffer from insomnia at some point each year, with 25% progressing to long-term chronic sleep insufficiency. Insomnia is described as difficulty falling asleep or staying asleep for three nights per week for at least two consecutive weeks in a three-month period. There are a lot of unhealthy sleeping habits permeating the country. We measure the quality of sleep in two different dimensions duration (quantity) and depth (quality). The duration is straightforward enough. Do you sleep for the recommended 7 to 9 hours per night? The quality is a little more difficult to quantitate. Some individuals may sleep for the proper duration of time, but the depth is not adequate. Sleep quality is determined by the number of arousals or awakenings in a given night.  As few as 5 arousals in a night can result in daytime sleepiness and performance deficits. In addition, how long we remain in certain phases of sleep also determines the quality of our sleep. There are four stages of sleep: N1, N2, N3, and REM with N3 being the most restful of the stages. When we fall asleep, we go through a predictable descent into sleep. We repeat the cycle of N1 to N2 to N3 to REM sleep every 60 to 90 minutes. The more time we remain in the restful stages, N3 and REM, the better our sleep is. As we age, we inevitably spend less and less time in restful sleep.

What causes poor sleep and why are so many Americans suffering from insomnia?

There are many factors that influence how we sleep. Everything from what we drink to the type of curtains we have can impact those crucial hours of sleep. Some of the more common culprits that disrupt our sleep are:

For More Informations:

-http://healthysleep.med.harvard.edu/healthy/

-https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2110998

-https://www.sciencedirect.com/topics/medicine-and-dentistry/insomnia

Read Dr. Mackarey’s Health & Exercise Forum – every Monday. Next Week Read, Sleep and Wellness Part II.

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor  in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine.

Read all of Dr. Mackarey's articles in our health and exercise forum: https://mackareyphysicaltherapy.com/forum/

Guest Columnist: Timothy Farrell, MD3

Tim Farrell is a third year medical student at Geisinger Commonwealth School of Medicine. Originally from Clarks Summit, Pennsylvania, Tim received his bachelor’s degree from Loyola University Maryland in Baltimore, MD. Currently a 2nd Lieutenant in the US Army, he enjoys listening to music, running, and spending time with his two dogs. He volunteers with the Cody Barrasse Foundation in the Organ Transplant Assistance Program, where he helps patients receive grant funding as they await their transplant surgery. He hopes to pursue a career in General Surgery.