Restless Leg Syndrome May Signal Cardiovascular & Cerebrovascular Risks

A new study in the journal Sleep suggests that patients with restless legs syndrome (RLS) may be at increased risk for hypertension, heart disease, and stroke. Cerebral small vessel disease (SVD) is a known risk factor for clinical stroke. This study evaluated silent cerebral SVD by MRI in patients with RLS who had no history of stroke or known stroke risk factors.

They examined patients with RLS in two groups: those with RLS less than 10 years, and those with RLS for more than 10 years. They also had a control group of subjects with no RLS.

The results were striking. Those with  long-lasting RLS and its accompanying periodic limb movements in sleep are at significant risk for silent SVD and perhaps for the development of clinical stroke.

The term cerebral small vessel disease refers to a group of pathological processes that affect the small blood vessels of the brain. Cerebral small vessel disease is most commonly related to aging and hypertension, and can lead to vascular dementia.

Common symptoms of SVD are anxious mood, insomnia, fatigue, depressed mood, and pain.

If you’ve had RLS for more than a year, it’s time to talk to your doctor about any concerns you may have regarding SVD, especially if you have had RLS for several years.

How Cats Helped Kick-Start Sleep Research

I’ve studied cats for decades. They have always fascinated me, and the more I learn, the more I am amazed by them. I’m still learning, and while I sometimes wish I knew everything about them, a part of me looks at the hieroglyphic gaze of my Abyssinian-Burmese-Ragdoll mix and thinks that even if I could somehow magically acquire all that knowledge with a single wish, I would not want to deprive myself of the joy of deciphering those mysteries on my own.

I wrote an article for Little Cat Diaries (a site dedicated to all things cat, with a focus on new research findings as well as dispelling myths and misconceptions about cats), and I thought I would post an excerpt of it here because it does pertain to human sleep, and it’s something that most people don’t know. Hope you enjoy.

Cats, just like humans, dream in stages. The discovery of REM sleep was an extremely important step in sleep research, but the initial report of a connection between REM sleep and dreaming was met with “an outburst of apathy” by many who believed that anything involving discussion of dreams was “pop sci,” and therefore unworthy of serious scientific exploration. In fact, many scientists did not really believe in a lot of sleep research, especially REM’s connection to dreaming, until we also observed it in cats. William Dement’s 1958 discovery of REM sleep in cats, plus similar work by French physiologist Michael Jouvet, really launched the Golden Age of sleep research.

Read the full article: Little Cat Diary: Do Cats Dream?

Q&A How to Tame Racing Thoughts

Q: At night my mind races, and it takes me forever to fall asleep. Is there any way to make it stop so I can sleep?

A: Dealing with racing thoughts is difficult at night when you’re trying to sleep. I think you would benefit from keeping a journal, and writing down what’s on your mind an hour or two before bed.

There are a lot of things in my sleep hygiene checklist that will help you get into a better mindset before bed. Follow it for a few weeks, make sure to keep track of the data (it’s all in the list), so that if none of this advice helps you, you have something to show your doctor to get the help you need. They always ask you to follow a sleep hygiene checklist first anyway. Here’s my list: Insomnia Insanity’s Sleep Hygiene Musts

Now let’s address how to deal with those racing thoughts more specifically.

This is a skill, so it can take a bit of time to get good at it. It becomes easier each time, so don’t get discouraged if it doesn’t help much right away.

First, think of a place in your mind. Since it’s in your mind, it can be real or fiction. It should be peaceful, somewhere that you feel safe and relaxed. As an example, you could imagine you’re on a beach. Think about the details while you’re awake so your mind doesn’t get caught up in creating them while you’re trying to sleep.

I also want you to imagine a centering object (real or fiction) that you will mentally touch every time those racing thoughts try to take over. In the beach scenario, it could be a coconut or a sea shell. The centering object should be simple. You will use it to remind you of your mantra. You will repeat the mantra to ward off racing thoughts. Your mantra should be a phrase or a word, or even a mental image that makes you happy, relaxed, and calm. It can be anything.

I often think of a tiny cat statue as my centering object, and my mantra is just thinking about how cute my kitten is to re-center my thoughts when I’m trying to fall asleep. A simple phrase you might use could be something like “I am relaxed and drifting.” You’ll want to avoid having a negative in your mantra. Things like “Don’t think about that,” will only make you think about that. It’s like saying “Don’t think of a giant pink grizzly bear.” All that does is make you think of a giant pink grizzly bear.

Now take those thoughts (place, centering object, mantra), and when you lie down, I want you to imagine you’re just existing in this special place you’ve created. If it’s a beach, imagine lying there, the warmth of the sun on your skin, the sound of soft waves crashing on shore. There are no worries here, just existing. If you start to have negative or racing thoughts, touch the coconut in your mind and let your mantra repeat until you are relaxed again. Go back to just existing in this wonderful place. Repeat as needed.

Good luck!

Belsomra Update III

After implementing the rule of not taking Belsomra until I’m in bed, I haven’t had any issues with acute narcolepsy. Things were going well for quite awhile.

I had been on Belsomra for nearly a year when I started having more nights without sleep. Now it seems to be working no better than Ambien CR. So I decided to take some time off of Belsomra, and asked my doctor for a 1-month prescription for Ambien CR, and then I would go back on Belsomra to see if it helped.

It did.

So now I’m back on the Belsomra, and it’s working extremely well.

Unless other problems develop, or there is Belsomra news, this will be my last Belsomra update.

72 Hours Without Sleep

The longest I remember going without sleep was close to 80 hours when I was 17. For some reason, I thought it would be fine to work overnight (11 PM – 7 AM) while also attending high school full-time. What puzzles me more is why my parents allowed it. In any case, shortly afterward, I got sepsis and nearly died because I was too sleep deprived to realize I had a kidney infection.

What happens when you go 72 hours without sleep?

There are many things that start to go horribly wrong fairly quickly, and they vary from person to person, but we can make some general statements about what happens when you don’t sleep for 3 whole days.

First, we should briefly cover what your body does while you sleep that it doesn’t do either at all or very little while you’re awake.

As I mentioned in my last article, your brain needs to sleep in order to clear it of toxins and to deliver necessary nutrients and other chemicals. If you haven’t read it, go give it a read to understand what things happen during sleep that don’t happen when you’re awake.

Now that we have that out of the way, we can start to understand what is happening when we don’t sleep.

24 Hours Without Sleep At this stage, sleep deprivation is comparable to the cognitive impairment of someone with a blood-alcohol content of 0.10 (just losing one hour puts you on par with someone who has .08 BAC). Your memory is foggy, you’ve lost most of your ability to focus, you are more impulsive, you’re moody, your hearing is wonky, and hand-eye coordination is poor.

A 2014 study published in The Journal of Neuroscience found that, after just 24 hours without sleep, subjects started exhibiting symptoms like those of schizophrenia:

“There were pronounced attention deficits, such as what typically occurs in the case of schizophrenia,” reports Prof. Ettinger. “The unselected flood of information led to chaos in the brain.” Following sleep deprivation, the subjects also indicated in questionnaires that they were somewhat more sensitive to light, color or brightness. Accordingly, their sense of time and sense of smell were altered and mental leaps were reported. Many of those who spent the night even had the impression of being able to read thoughts or notice altered body perception. “We did not expect that the symptoms could be so pronounced after one night spent awake,” says the psychologist from the University of Bonn.

36 Hours Without Sleep At this stage, along with all the symptoms at the 24-hour mark becoming worse, cardiovascular health and blood pressure are also adversely affected. This is a critical point where your health is in danger. With an increased heart rate and rise in blood pressure, the risk of having a stroke also increases. You also get extremely hungry, and since you’re very impulsive, your food choices will be bad, and you’ll overeat.

48 Hours Without Sleep Along with all the previous symptoms, which are worsening, you begin to start experiencing microsleeps. You will startle very easily. You begin to lose any interest in sex, you start to experience headaches, and any other pain you have is exacerbated. Your immune system stops working, and your body can’t properly process glucose.

72 Hours Without Sleep Now all the previous symptoms are insanely bad. You start to hallucinate, your ability to empathize with others is very low, you have no motivation, your emotions are uncontrollable, and your risk of death is high.

So do yourself a favor, and get some sleep. If you regularly go long periods without sleep, it is imperative that you talk to your doctor about it.

What Happens When We Don’t Get the Sleep We Need?

When you don’t sleep enough (a minimum of 6 hours), your brain cannot clean itself out. The glymphatic system cleans the toxic chemicals out of your brain as you sleep (and it does its work best when you sleep on your left side). It changes the shape of the cells in your brain, allowing the unwanted waste to leave the brain.

Besides waste elimination, the glymphatic system also facilitates  brain-wide distribution of several compounds, including glucose, lipids, amino acids, growth factors, and neuromodulators. Intriguingly, the glymphatic system functions mainly during sleep and is largely disengaged during wakefulness. The biological need for sleep across all species may therefore reflect that the brain must enter a state of activity that enables elimination of potentially neurotoxic waste products, including β-amyloid (build-up of β-amyloid is linked to Alzheimer’s).

Sleep is also necessary for maintaining and creating memories. If you don’t sleep, it will be harder to learn things and to remember things.

And there are also things like muscle repair, memory consolidation, and release of hormones regulating growth and appetite that only happen during sleep.

Sleep deprivation can cause your mental state to deteriorate, and if you go for years without sleeping well, you increase your risk for dementia and other neurological disorders.

Prolonged insomnia is also linked to a much higher chance of abusing alcohol and drugs. People are desperate to get sleep, and if they can’t do so on their own, they will look for anything that can help them.

It has also been shown that people who are deprived of just one hour of sleep a night for a week are worse at basic tasks, including simple games and driving, than people who have a blood alcohol level of .08.

Many studies have been done on trying to change the amount of sleep you need. All the studies that were done using sound methodology and practices found that you cannot change how much sleep you need. You may be able to break it up into a couple of shorter periods (biphasic sleep), but you still need the same amount.

If you force yourself to sleep less than you need, you will stop feeling tired after awhile, but you will still suffer all the symptoms of sleep deprivation, both short-term and long-term effects.

There are people who feel fine on less than 6 hours of sleep, but research consistently shows that these people don’t function as well cognitively (it makes you dumb), can cause obesity, causes a much higher risk of neurodegenerative diseases, cognitive decline, heart attacks, strokes, emotional and psychological problems, car accidents, cancer, diabetes, wrinkles, and many more negative effects. People who sleep less than 6 hours a day are at least 4 times more likely to die of any cause than those who sleep more than 6.

CNN published an article last year that summed up pretty well the results of over 300 studies on sleep. It’s definitely worth a read.

I would recommend that anyone who is unable to sleep for at least 6 hours a day to talk to their doctor about it.

Further reading:

Uncovering Residual Effects of Chronic Sleep Loss on Human Performance

Brain may flush out toxins during sleep

sleepdex.org

The Glymphatic System and How Metabolic Waste is Removed from the Brain

Sleep Deprivation

The Glymphatic System: A Beginner’s Guide.

About Sleep’s Role in Memory

http://www.sciencedirect.com/sci…

Sleep Habits: More Important Than You Think

Principles and Practice of Sleep Medicine

Human Sleep and Cognition: Basic research

Insomnia Insanity’s Sleep Hygiene Musts

Remember when I said I wasn’t going to give you the same old sleep hygiene lists that everyone has already read? Well, I’m going to give you a sleep hygiene list, but I’ve tweaked it using my decades of insomnia as inspiration, and I hope that this will prove useful for you. If not, well, you can at least tell your doctor you tried the best sleep hygiene checklist.

Before we begin, I think it’s important to emphasize that your sleep needs are different from other people’s needs. What works for some may not work for you. These aren’t strict rules; they are suggestions. If you have not tried them, they may help you. If you find ones that don’t work, then you’ve learned something valuable about what does and does not work for you. The ONLY solid rule is that you need to be kind to yourself. Being unable to get the sleep you need is torture enough without beating yourself over the head.

1. Keep a journal. This is going to be a journey, and like any journey worth taking, it’s going to have its highs and lows. You’re going to be disappointed, you’ll be pleased, you’ll be crushed, and you’ll be elated. You’re most likely exhausted already, and by the end, I hope you get some rest.

a) Whether you use pen and paper, a computer, or a phone to keep your journal is up to you, but there are things you definitely want to keep track of in your pre-bedtime journal

• What time you went to bed (there will likely be more than one time to start off with, and that’s to be expected), when you got up, and how much sleep you got.
• How you feel. Make your own scale of fatigue (I use 1 as “I’m too tired to move” and 10 as “HYPER!”)
• What and when you eat and drink. Every single thing and the time is going to be important as well.
• Medications, including dosage and what time you took it. Include everything: prescribed, over the counter Include supplements), and illegals.
• Your thoughts before bed (get it all out so your brain has less to sort through while it’s trying to sleep).
• Quality of Life – This is the most important thing you will write in your journal, so you need to get it down. How is your insomnia affecting your quality of life? Couldn’t go out with friends because you’re a zombie? Write that down. Had to get someone else to walk your dog? Write that down. Because if this list doesn’t help you, you’re going to need to express to a doctor how severely your insomnia is impacting your quality of life. It’s the only language they speak.

b) If you have frequent nightmares, excessive dreaming. or sleep paralysis, you can also keep a dream diary. You should write in it first thing in the morning, before you even get out of bed.

2. Get an app. I find that ones that work with a Fitbit or other smart watch work best, but the phone-based apps work well enough. This will give you valuable data. I use Sleep As Android with my Samsung Gear2, but there are many apps out there to choose from. Five Best Sleep Tracking Gadgets or Apps

3. Stick to a sleep schedule. For most people, this means the same bedtime(s) and wake up time(s), even on the weekends. No sleeping late, no unscheduled naps, and get to bed on time. This helps to regulate your body’s clock, and could help you fall asleep and stay asleep. If you fall asleep better at daybreak than 10 PM, and your schedule allows for it, go ahead and do that. If you do well sleeping for 4 hours, then being up for awhile, then going back to sleep, do that. Whatever you feel is most natural for you.

a.) If you have a Non-24 sleep-wake cycle disorder (AKA Non-24, which is extremely rare in sighted people), it isn’t about the time on the clock, it’s about sticking to the schedule that works best for you. I do best when I’m up for 20 hours, then sleep 9.5 hours. Find what works for you.

4. Practice a relaxing bedtime routine. A relaxing, routine activity 30 minutes to an hour before bedtime, away from bright lights, helps separate your sleep time from the rest of your day. Meditation, writing (in your journal or otherwise), reading or listening to a book, lying beneath the stars, some soft music, hanging out with a furry friend, a quiet conversation about non-stressful, non-exciting things, knitting, any activity that calms your mind. Sometimes you just need to brush your teeth, clean your face, get into your PJs, feed the cat, and other truly routine stuff.

5. Take work/school materials, computers, and televisions out of the sleeping environment. I know, it’s hard, but it’s important. These objects have weight, not just physical, but mental. It can make a marked difference.

6. Exercise daily. Vigorous exercise is best, but even light exercise is better than no activity. Exercise at any time of day, but not at the expense of your sleep.

7. Think of your bedroom as your Sleep Palace. Reserve your bed for sleeping and sex only. Design your sleep environment to establish the conditions you need for sleep.

• Keep it cool. Some new studies have shown that body temperature is actually more important than light (or lack thereof) for initiating sleep. The body’s core temperature needs to drop by about 2 to 3 degrees Fahrenheit to initiate sleep. Your bedroom should be cool. Between 15-19°C (60-67°F) is ideal for most people, but if you like sleeping under a heavy blanket, you could go lower. If you find you feel too warm at night, sticking your feet out from under the blanket will help cool you down. More info here: Keep It Cool for a Good Night’s Sleep
• Your bedroom should also be free from any noise or light that can disturb your sleep. Consider using blackout curtains, eye mask, earplugs, white noise machines or apps, humidifiers, fans, purring kitty, or other devices.
• Make sure that your room smells good. Bad smells can cause nightmares and prevent you from getting quality sleep. Clean up anything that is causing bad odors, but also don’t overdo things like using strong chemicals. Air out your room as often as possible, but take precautions if you have seasonal allergies. Find out more about the effects of indoor air quality here.

8. Dress for Success. It’s more than just staying cool or warm, it’s about feeling good. Get yourself some PJs that make you feel cozy (and cute, if you like). You want to engage as many senses as possible with the idea of sleep.

9. Build your nest. Make sure your mattress is comfortable and supportive. Have comfortable pillows. And make the room attractive and inviting for sleep, but also free of allergens that might affect you. Clean sheets and a comfy blanket or comforter can help make you feel relaxed.

10. Use bright light during the day to help manage your circadian rhythm, then dim light in the evening. Avoid bright light in the evening and expose yourself to sunlight in the morning if possible. If your schedule doesn’t permit sunlight first thing in the morning, a happy light might work. This will keep your circadian rhythm in check (at least it will if you have a normal circadian rhythm). After sunset, use as little light as possible. If you can, make sure all your screens (TV, computer, phone, etc.) are as dim as possible. There are apps for your phone and computer that will block blue light, which is the kind of light that is believed to keep you awake. Use those if you must use electronics, especially within 2 hours of bed time.

11. Avoid alcohol, cigarettes, and heavy meals in the evening. Alcohol, cigarettes, and caffeine can disrupt sleep. Eating big or spicy meals can cause discomfort from indigestion, and digestion alone can keep you from falling asleep. Eating just before bed also really can give you nightmares.

12. Tame Racing Thoughts If you just can’t get your brain to calm down, see my post on a strategy that has really worked for me: How to Tame Racing Thoughts

13. Don’t Watch the Clock. Staring at a clock in your bedroom, either when you are trying to fall asleep or when you wake in the middle of the night, can intensify sleep dread, making it harder to fall asleep. Turn your clock’s face away from you.

14. If you can’t sleep, go into another room and do something relaxing until you start to feel sleepy. Read (unless that stimulates your brain too much, listening to an audiobook is best for me, personally, when I want to relax), try a crossword puzzle, meditate, just do something soothing and relaxing. Sometimes a bath or shower can work wonders.

15. Good Sleep Doesn’t Begin at Bedtime. The thing about getting good sleep is that there are many things that contribute to or damage your ability to get good sleep, and those things are happening all day and night. What you eat: avoid too much sugar, eat healthy, and avoid processed foods when possible; your views; your mood; your physical activity; stress; health issues…everything in your life is in some way related to when you sleep; how well you sleep; and how much you sleep. Look at your daily life, your routines, your friends, everything, and figure out whether those things are impacting your sleep. It might be time to stop talking to that Negative Nancy friend of yours, or to really try to get to that morning yoga class more often.

16. Stay Positive. This is difficult, but you have to look at each new day as one step closer to your next night of fabulous sleep, and that night could be tonight. Not getting enough sleep (including not getting enough quality sleep) affects your mood. If you feel you’re getting depressed or anxious, you should schedule time with a licensed therapist. Sometimes just talking about it with someone can help you think about things in a more positive way.

If you have followed this for a few weeks and still aren’t getting the sleep you need, take all that data (from the app and your journals) to the doctor.

Good night, and sleep however you can.

Did I miss something? Let me know what advice you would add.

Nocturnal Mouth Breather? Time for a Trip to the Dentist.

From researchers at the University of Otago, Dunedin, New Zealand, published in the Journal Oral Rehabilitation, comes a study that shows dental erosion and decay may be more pronounced in people who sleep with their mouths open.

Those who suffer from dry mouth, whether from a condition like Sjögren’s syndrome  or medication, have likely heard that tooth erosion and decay are common. It turns out that breathing through your mouth while you sleep can cause the same situation.

Saliva plays a very important role in preventing the mouth from becoming too acidic. When you breathe through your mouth, it dries out, and without saliva, that acid will slowly eat away at precious tooth enamel. From there it’s just downhill into cavities, pain, and—if left untreated—could lead to tooth loss.

If you have difficulty breathing through your nose while you sleep, it’s important to talk to your doctor and your dentist. Resolving this issue will give you better sleep, better teeth, and will save you a lot of trouble down the road.

The Puzzle of Morning Migraine

Migraines occur most frequently in the last stages of sleep and into the morning, which can make getting ready for your day impossible. If you’re like me, the pain might wake you hours before you’re ready to wake up, and it’s impossible to get back to sleep with that kind of pain.

And so it goes: Another morning, another migraine. About once every two months I have two or three weeks where I am constantly battling a migraine. During this time, I wake with a migraine about 4 times a week. I’ve read everything I can get my hands on, but there is very little consensus when it comes to what causes morning migraines, and some of it is absolutely maddening.

Join me on my super frustrating journey through the internet to find out why this keeps happening. That’s right, it’s time for another Web Adventure, so let’s go!

Let’s start with the maddening: Take the WebMD article entitled “Do Your Sleep Habits Trigger Migraines?” as an example. It claims that morning migraines are caused by “poor sleep habits”. The word “habits” implies a pattern of behaviors. Behaviors can be changed. As someone who suffers from chronic insomnia, I am absolutely disgusted with health care sites and professionals assuming that everyone with insomnia need only follow that stupid sleep hygiene checklist that everyone with chronic insomnia (and chronic fatigue) has already seen and read a hundred times (I’ve actually seen it more than a hundred times because chronic insomnia leads to many hours of desperately searching the internet for something, ANYTHING to help one sleep).

So, how does this relate to migraines? Rapid eye movement (REM) sleep provokes migraines in those who don’t get enough sleep. If you have short REM latency, or you enter REM, but don’t enter deeper stages of sleep, which are necessary for the production of sufficient serotonin and dopamine, that can trigger headaches by causing instability of serotonin and a lowering of dopamine levels.

I don’t think this one explains my morning migraines. I have actually been getting more sleep than I used to (thanks to my new sleep medication), and there has been no corresponding reduction in frequency or severity of my morning migraines. While I’m still not getting all the sleep I need, it seems doubtful that this is the cause of my morning migraines.

Next up, we have hypoglycemia. Skipping meals, eating a high sugar snack before bed, some diets, and taking too much insulin can lead to a drop in blood sugar, which can cause morning migraine. (Source)

This doesn’t explain my morning migraines either. Moving on…

Morning migraines caused by fasting may not always be due to hypoglycemia. They can be caused by the stress-hormones released by the body during fasting. Migraines are also often triggered by dehydration, changes in caffeine intake, and changes in smoking frequency also often trigger migraines. (Source)

Yeah…no. None of these apply to me. What we’re left with are the hundreds of different migraine triggers that are specific to each person.

If you suffer from migraines, you probably already know your triggers. The most common triggers include sudden changes in weather or environment, too much or not enough sleep, strong odors or fumes, emotion, stress, overexertion, loud or sudden noises, motion sickness, tobacco, depression, anxiety, head trauma, hangover, some medications, hormonal changes, bright or flashing lights, medication overuse or missed doses, aspartame, caffeine (or caffeine withdrawal), wine and other types of alcohol, chocolate, aged cheeses, some fruits and nuts, fermented or pickled goods, yeast, and cured or processed meats. (Source)

My most common migraine trigger is pain. Unfortunately, I also suffer from chronic pain. It’s bad enough that my brain incorporates the pain into my dreams. I often have dreams of being stabbed in the abdomen, or getting kicked, even being attacked with a drill. I’ve been overdoing it the past few weeks, and that leads to a lot of pain.

So, at the end of this journey I have found that I can probably blame my morning migraine on the same thing that causes most of my other migraines. Hopefully you have learned more than I did.

“Sleep Node” Found?

Harvard Medical School neuroscientist Patrick Fuller and his team, including scientists at the University at Buffalo School of Medicine and Biomedical Sciences, NY, claim to have discovered a cluster of neurons in the brainstem that activates sleep. They also created a “remote control system” to activate select neurons inside it.

Fuller’s team began the hunt for the “sleep node,” a decade ago, but didn’t strike gold until 2012. After closing in on the cluster, they tested its function by completely destroying the cluster in mice. The mice became insomniacs, indicating the node did control sleep.

They were also able to develop a chemical that could be used as a switch that, when turned “on” could make mice instantly fall into deep sleep.

The discovery, published in Nature Neuroscience, could lead to the development of more effective sleep aids, though there are still many unanswered questions. They can’t yet explain how/when/where the interaction between the so-called sleep node and other regions of the brain that control sleep takes place.

To learn more, click here.

Bill Nye Explains Dreaming

This is pretty basic stuff, but it’s Bill Nye, and who doesn’t love watching Bill Nye explain things?

Belsomra Update II

I wrote back in July that I was suffering some acute narcolepsy since starting Belsomra. These episodes have continued.

Before I get into the side effects I’ve experienced, I want to state that Belsomra has helped me far more than any other sleep aid I’ve ever tried. Most people who have insomnia only suffer with it for a period of time, and then they get better, and they may relapse later on. The kind of insomnia I have is chronic. It never lets up, and I’ve had it since I was a small child. This kind of insomnia runs in my family. My daughter has suffered insomnia since birth.

Since I started taking Belsomra, I only have one sleepless night every 10 days or so. I get an average of 6 hours of sleep per night using Belsomra. Compared to when I was on Ambien CR, and had 3-4 sleepless nights every 10 days, and was averaging only 4 hours a night when I did sleep, it’s a significant change. I never thought I would be able to sleep almost every night. Despite the side effects I’m having, I definitely think the benefits outweigh the drawbacks.

My purpose here is to inform. If you’re considering taking this medication, or you’re already taking it, this is something to watch out for. If you start experiencing these symptoms, it’s imperative that you talk to your doctor.

That said, the acute narcolepsy is getting worse. The thing about narcolepsy is that you begin to dream the moment your eyes are closed. At first I was able to tell when I was having these episodes most of the time. Now I can’t. The bits of dreams are seamlessly knitting together with reality, and I can’t tell which is real and which is the dream.

Last night it was happening for about an hour before my daughter came in and told me I was talking and moving, interacting with objects that I was dreaming were something else. My pill organizer was a tray, and my daughter said I was talking about something while my eyes were closed during one of the dozens of episodes I had in a one hour period.

Usually I try to take the Belsomra right before I get in bed. I have a 20 minute rule: I have to be in bed no later than 20 minutes after I take it. Sometimes I get distracted, like last night, and the acute narcolepsy kicks in, and those episodes pose a danger to me. I’m very lucky that I live with a very responsible and loving 20-year-old daughter who checks in on me. And after last night, I am going to make a new rule: no Belsomra until I’m in bed.

Sleep Positions: Which One Is Best?

I’ve been looking into sleep positions lately, mostly because I see posts on Facebook from one highly questionable source or another, claiming that a particular sleeping position can cure everything from fibromyalgia to migraines. These articles are always full of false mysticism and garbage, but what position you sleep in can affect your health. Here are just a few reasons science has come up with to consider one position over another:

Left side:

Alzheimer’s and Other Neurological Disorders Not only does getting poor sleep lead to worse outcomes in Alzheimer’s and dementia, how you sleep could factor in as well. A study in the Journal of Neuroscience showed that the brain’s cleaning system (the glymphatic system) works much more efficiently when sleeping on your left side than when sleeping on your front or your back, and also more than on your right side. Over an extended period, this could mean a much lower chance of Alzheimer’s and other neurodegenerative diseases for those who sleep on the left side. And for those that already have such a disease, changing what position you sleep in could slow progression. (Study: The Effect of Body Posture on Brain Glymphatic Transport)

Acid Reflux and Digestion This is one I know firsthand. There have been several studies showing that sleeping on your left side can ease heartburn symptoms. In this position, the stomach is positioned below the entrance to the stomach from the esophagus. This is important because symptoms of heartburn are caused when the stomach contents back up into the esophagus, so sleeping on your left side can prevent that from happening. In addition to heartburn, gastroesophageal reflux may also be associated with nocturnal wheezing, chronic nocturnal cough and sleep apnea. (Study: Aspects of Sleep on the Digestive Tract, and another study in JAMA Internal Medicine)

Decreased Risk of Stillbirths It is highly recommended for pregnant women to sleep on their left side, especially in the last trimester, the most important reason being that a couple of studies have shown a decrease in stillbirths in women who reported sleeping on their left side. It can increase blood flow to the placenta, ease acid reflux and nausea, and aid in digestion. (Study: Association between maternal sleep practices and risk of late stillbirth)

Either side:

Back and Neck Pain Chronic pain is one of the leading causes of insomnia, and we know that not having enough sleep can lead to more pain, so it’s no surprise that it can lead to a vicious cycle. (See my previous interview with Dr. Jon Robertson on chronic pain and sleep disorders) Sleeping on your stomach will only make matters worse. Try sleeping on your side with a pillow between your legs.

Snoring and Sleep Apnea If you snore or you have sleep apnea, you probably already know that sleeping on your side is best, but I wanted to cover all the bases here. (University of Maryland Medical Center)

Sinus Pain This is another bit of old news, and if you’re like me, you discovered long ago that sleeping on your side can help with the pain. Lay on your side, propped up (also hugging a pillow can help in this position). (American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015)

Sleep Paralysis It has been shown that those who are prone to sleep paralysis are far more likely to experience an episode while lying on their back to sleep. If you’re prone to SP, it’s best to sleep on your side. (The Sleep Paralysis Project)

Right side:

If You’re At Risk for a Heart Attack Sympathetic nervous system activity is lower in patients with chronic heart failure and in those who have had a heart attack when they lie on their right sides versus their left. The sympathetic nervous system controls heart rate and blood pressure, so the thinking goes that lying on the right side reduces the heart rate and blood pressure, which is ideal for patients at risk. (Journal American College of Cardiology)

Back:

Back Pain If you naturally sleep on your back, and the previous things on the list don’t apply to you, then sleep away! (Link) But be careful. There is some evidence that sleeping on your back may worsen lower back pain.

Wrinkles If your biggest concern is wrinkles, then congratulations! You’re quite healthy, and have no family history of Alzheimer’s, other neurodegenerative diseases, or heart disease.  The bad news is that you’re reading this blog, which means you’re probably having sleep issues, which means you should go back and read the bit about Alzheimer’s and neurodegenerative disorders because not sleeping well puts you at higher risk for those.

Fetal Position:

• If you absolutely can’t sleep on either side without pulling your knees up and bending your back, then you have an excuse to sleep in this position. But you should try to gradually wean yourself from this sleep position (pillows often help to keep you positioned correctly and comfortably).

Stomach:

• Don’t do it. It may help with snoring, but so does sleeping on your side. Sleeping in this position puts stress on muscles and joints, and can lead to back and neck problems, as well as irritating nerves, which can cause numbness, tingling, and lots of pain.

Combination positions:

• You’ve read this far, so let’s face it, you’re probably suffering some serious sleep issues. What’s important to remember is that, if none of the really serious things above apply to you, and if your sleep position works for you, then that is your major concern right now. You can work on positioning when you can actually get some real sleep.

Belsomra Update

I’ve continued to take Belsomra, and the most unusual thing happened last night, so I thought I would share it with you in case any of you take Belsomra, so that you can be on the lookout for symptoms.

Last night I experienced what I can only describe as an acute narcoleptic attack. I vaguely remember sitting at my desk and falling asleep a several times (nothing like this has ever happened to me before. I have insomnia so bad that the idea of just randomly falling asleep somewhere is laughable) before one episode in which I fell asleep for just a few seconds, and had a dream about my daughter. According to her (I do not remember this), I was telling her about it when I seemed to be falling asleep standing up, and she made me sit down. So I sat, and was continuing to tell her about the 3 second dream when I again fell asleep for a few seconds, and then woke up and, instead of continuing to tell her about the dream I had, I began describing another dream (I’m guessing the one I had when I fell asleep the second time). 

I’m pretty sure it’s just the Belsomra. I’m not sure if it can build up in your system, or maybe I took a double dose by accident. It basically works on the premise that those with chronic insomnia may have too much orexin (a neuropeptide that promotes wakefulness). People with narcolepsy have too little orexin. Belsomra promotes sleep by blocking orexin neuropeptides from binding to their receptors. While Belsomra works for me far better than any other sleep aid I’ve tried, it appears that I need to be very careful, and watch for signs that I’m getting acute narcolepsy.

The Good Stuff: All About Sleep

The Good Stuff Recently did a playlist about sleep. In the first installment, they speak to the father of sleep medicine, William C. Dement, about the discovery of REM sleep, its connection to dreaming, and how that breakthrough revolutionized the science of sleep. I recommend watching the whole playlist.

Belsomra: One Chronic Insomniac’s Experience

First, I want to assure you that I have not been paid or compensated in any way by anyone for doing this review. I want to remain as objective and transparent as possible when presenting information.

I had been following the trials of Belsomra (suvorexant) for some time, and with a little bit of hope. It finally got the FDA’s stamp of approval, so I went to Merck’s Belsomra website to get my free 10-day trial coupon (after first securing a prescription from my doctor). With the voucher, I got 10 days absolutely free, and I was prescribed the 10 mg dosage. Dosage options are 5 mg, 10 mg, 15 mg, and 20 mg. The free trial covers all dosages except the 5 mg, and you can get a free trial of a different dosage if the first one doesn’t do it for you.

Before I explain my experience with Belsomra, I need to tell you how much sleep I get in an average 10 days without medication. I’ve had chronic insomnia since childhood, and it has only gotten worse as I’ve gotten older. I will sleep for about 5 hours for two nights in a row, and then I will be up for 2 or 3 days, completely unable to sleep, before I literally pass out from exhaustion. I begin to feel overwhelming nausea, and at the same time feel like I’m going to pass out. Once this feeling starts, I have less than two minutes to get to a safe place before I pass out. I used to go longer before passing out, but it happened less frequently. I will feel tired at the end of the day, but not sleepy. This is a difficult concept to explain to someone who hasn’t experienced insomnia for an extended period of time, but it basically means that my body is tired, I’m weak, my thoughts are sluggish, and I feel overwhelmed, but that feeling of sleepiness never comes. If I lay down in this state, I only get frustrated with tossing and turning. Then I get the nausea and passing out. It’s difficult to know how long I’m unconscious and how long I’m actually sleeping, but I’m generally out for about 10 hours after being up for that 2-3 day period.

After that, I will either go back to the 5 hours of sleep for a few nights, or I will be up for 20 hours, sleep for 6, then up for a little longer, sleep for 4-6, until I get to the 25 hour mark. If I’ve been up for more than 25 hours, I will not be able to sleep until I pass out from exhaustion again. In short: my brain is simply not wired for sleep.

Belsomra is supposed to work by targeting and inhibiting the action of orexin (a neurotransmitter that promotes wakefulness, arousal, and appetite). You can learn more about orexin’s role in the wake-sleep cycle, and how orexin inhibitors work at the National Sleep Foundation’s website.

I was concerned that Belsomra might increase my sleep paralysis episodes (it is listed as a side effect, and I’m already prone to have them), but I haven’t had an episode yet.

Below is a list of the most commonly reported adverse events that occurred in 3-month clinical trials:

placebo (n=767) Belsomra 15 mg or 20 mg (n=493)

• Diarrhea (placebo 1%, Belsomra 2%)
• Dry mouth (placebo 1%, Belsomra 2%)
• Upper respiratory tract infection (placebo 1%, Belsomra 2%)
• Headache (placebo 6%, Belsomra 7%)
• Next-day drowsiness (placebo 3%, Belsomra 7%)
• Dizziness (placebo 2%, Belsomra 3%)
• Abnormal dreams (placebo 1%, Belsomra 2%)
• Cough (placebo 1%, Belsomra 2%)

Now onto my experience with Belsomra. The first night I took it, I had been awake for 19 hours. About 30 minutes after I took it, I did begin to feel a little sleepy, so I decided to go to bed. It didn’t go so well. I was developing a headache (not bad, but annoying). I tossed and turned for 4 hours before finally giving up. I wasn’t terribly discouraged. After years of struggling with insomnia, I was prepared for sleep dread (the worry that one will not be able to sleep becomes a self-fulfilling prophecy, and can be the result of chronic insomnia) interfering. I thought I was feeling positive, but after a lifetime of disappointment in sleep aids, it certainly could not be ruled out.

The second night was a little better. I got about 6 hours of uninterrupted sleep. I felt groggy and there was a definite loss of appetite the following day, but that could be explained by the fact that I hadn’t gotten enough sleep.

The third night was excellent. I slept 7.5 hours. I had a touch of foggy brain the next day, but I felt physically wonderful. No drowsiness or anything else. Nights (well, it sort of worked around into the days, but you get the idea) 4-8 were generally very good. I slept an average of 7 hours each night, and was awake for about 18 hours a day.

The ninth night was a fail. I didn’t sleep at all, despite my best efforts, but I slept for 8.5 hours on night 10, which was wonderful.

All in all, I would say that Belsomra worked really well for me. I got more sleep in those 10 days than I have in any other 10-day period in over a decade. I wasn’t awake for more than 24 hours straight after the first day, and that in itself is enough for me to consider it a win. It worked much better than Ambien CR.
I would recommend that those struggling with severe chronic insomnia read more about it, and then have a discussion with your doctor. It’s certainly not perfect, it’s not a miracle cure, but it is the best sleep aid I’ve ever tried (and I’ve tried most of them).

Why do we forget our dreams? (And other stuff about sleep)

DNews explores why we forget our dreams, and touches on some parasomnia issues like sleepwalking, sleep paralysis, REM behavior disorders, and other topics.

Sleep Deprivation and its Weird Effects on the Mind and Body

Healthcare Triage’s Dr. Aaron Carroll is back with more info on sleep deprivation and its effects, and covers some of the data from scientific studies.

For links to all the studies and more information, check out the blog post here.

Healthcare Triage Tackles Sleep

This week, Dr. Aaron Carroll of Healthcare Triage discusses some of the latest findings in sleep science, and what the results mean.

Check out more of Dr. Carroll’s thoughts on healthcare here. He’s smart, practical, insightful, funny, and he makes topics that confuse many people (including healthcare professionals) easy to understand.

Flawed Sleep Paralysis Survey

I was pleasantly surprised to see an article on new sleep paralysis survey findings from DNews. Sleep paralysis hasn’t gotten the attention from the scientific community that it deserves, especially considering an estimated 40% of people will experience SP at some point. The article starts off quite interestingly:

Researchers say that sleep paralysis happens when a person awakens during a stage of sleep known as rapid eye movement (REM). People in this stage of sleep are usually dreaming, but their muscles are nearly paralyzed, which might be an evolutionary adaptation that keeps people from acting out their dreams.

It is harder to explain why a subset of people who experience sleep paralysis feel a menacing figure in their room or pressing on their chests. [Senses and Non-Sense: 7 Odd Hallucinations]

One possible explanation could be that the hallucination is the brain’s way of clearing out confusion, when there’s a disturbance in the brain region that holds a neural map of the body or the “self,” according to a recent article that Jalal and his colleague Vilayanur Ramachandran, of UC San Diego, published in the journal Medical Hypotheses.

“Perhaps, in part of the brain, there’s a genetically hardwired image of the body — a template,” Jalal told Live Science. Previous studies have suggested that such a region may be a part of the parietal lobes, which are situated in the top-middle part of the brain.

It is possible that during sleep paralysis, the parietal lobes monitor the neurons in the brain that are firing commands to move, but aren’t detecting any actual movement in the limbs, which are temporarily paralyzed. This may lead to a disturbance in how the brain builds a sense of the body image, Jalal said. The appearance of a bedroom intruder could result when the brain tries to project the person’s own body image onto a hallucinated figure, he said.

First, we know from research on phantom limb pain that the brain does have a map of the body. It might play a role in SP, but many people, including myself, hallucinate figures that are very different from the body of the sufferer, and often not even human (aliens, ghosts, monsters, etc.). Sometimes there is more than one presence. And, as stated above, not everyone who suffers from SP episodes feels the presence of another being. Some of my SP episodes involve feeling or seeing a presence in the room, but not always. To me, this idea generates more questions than answers, which doesn’t mean it’s not helpful or even correct, but it seems like a very preliminary hypothesis at best.

The portion of the article that truly bugged me was this:

In a 2013 study published in the journal Cultural, Medicine, and Psychiatry, Jalal and his colleague Devon Hinton, of Harvard Medical School, looked at the rates of sleep paralysis, and the amount of stress that people felt because of the episodes, among people of two different societies: Egypt and Denmark. They found that, compared to study participants in Denmark, the Egyptians experienced sleep paralysis more frequently, and had more prolonged episodes that were accompanied with a greater fear of dying from the experience. [Top 10 Spooky Sleep Disorders]

“These are two very different cultures; Egypt is very religious, whereas Denmark is one of the most atheist countries in the world,” Jalal said.

[…]

Jalal said he thinks finding a scientific explanation for sleep paralysis could help people who have particularly frightening and stressful episodes because they’ve culturally learned to attribute it to supernatural beings.

I’ll start by saying that, while there may be a correlation between belief in the supernatural and the frequency, length, and severity of sleep paralysis, it is far from a full explanation.

This just doesn’t ring true for me. I started experiencing sleep paralysis as a teenager. I woke up and saw a “ghost” standing at the foot of my bed. I couldn’t move, couldn’t speak, nothing. These episodes have happened to me every few weeks since then. But I didn’t believe in ghosts or the supernatural. I’m an atheist, and have always been scientifically minded.

It took me a long time to find out the cause of my weird episodes, but I never once attributed it to the supernatural. I have several family members who experience SP as often as I do, and none of them ever thought they’d been abducted by an alien, attacked by a succubus, or seen an actual ghost. Maybe my family’s SP is different for some reason. Many of us do suffer from spinocerebellar ataxia type 5, which might trigger it more often and heighten the fear. But I’ve read everything I can get my hands on relating to SP, have spoken to dozens of other sufferers from all over the world (and, yes, I realize the plural of anecdote isn’t data), and I keep up with current studies, and I’ve found no other substantial support for this idea. Leaving aside the problems of self-reporting, there just isn’t enough data in this survey to suggest a strong correlation, much less causation.