March 3, 2021
Sunday, March 14 is the time to spring ahead in Illinois. By moving our clocks forward an hour we start experiencing longer periods of light – bringing us out of a cold, dark winter season. There are mixed opinions about the positive and negative aspects of Daylight Savings Time, but the one thing most agree upon is that this twice yearly change affects our sleep.
It has such an impact that in 1998 the National Sleep Foundation declared Sleep Awareness Week, as a public education campaign to celebrate sleep health and encourage the public to prioritize sleep to improve health and well-being.
We decided this was a great time to take our slumber-related questions to Chris Fahey, M.D. a neurologist specializing in sleep with NCH Medical Group.
Q: At what point does snoring warrant a sleep study?
Dr. Fahey: Snoring is the vibration of the tissue in the back of the throat, while obstructive sleep apnea is the collapse or closing off of the tissue in the back of the throat. The rule of thumb is that almost everyone who has obstructive sleep apnea snores, but not necessarily everyone who snores has obstructive sleep apnea. Snoring in and of itself has not been consistently associated with bad health outcomes (other than an increased risk of carotid artery disease), while untreated obstructive sleep apnea has been associated with a variety of bad health outcomes.
Snoring warrants a sleep study when it is associated with other symptoms of sleep apnea such as excessive daytime sleepiness, unrefreshing sleep, gasping or choking arousals or bed partners observing periods of stopped breathing. In the appropriate clinical circumstances, a sleep study should also be considered in patients who snore with history of high blood pressure, obesity, heart disease, stroke or TIA and a neck circumference of 43 inches or more in men and 41 inches or more in women. Snoring intensity (loudness) has been associated with the presence and degree of obstructive sleep apnea.
Q: Are custom fit mouth pieces effective for controlling snoring?
Dr. Fahey: Yes, studies have shown that oral appliances when used for primary snoring (snoring which occurs in the absence of obstructive sleep apnea) are highly effective. The studies have indicated that when used properly, these appliances can reduce both the intensity and the frequency of snoring. The devices typically work by pulling the lower jaw forward, or pushing the tongue down, or a combination of the two. It is important to see a dentist who specializes in sleep-disordered breathing for proper fitting. Side effects can occur, particularly in the initial period of use, and may include tooth pain, headaches, TMJ pain, dry mouth and tooth migration among others.
Q: There are so many “smart sleep” products available now (pillows, adjustable mattresses, etc.) What are the pros and cons and what should be considered when purchasing any of these products?
Dr. Fahey: One of the important things to understand is that many of these products are designed to do very different things, so it is important to know what aspect of your sleep you are trying to improve. For example, some “smart pillows” are simply a form of a white noise machine, whereas others may reduce snoring, and others track your sleep (albeit likely less accurately than other sleep trackers), and others combine many of these functions into one. Some of the claims that these products make in terms of beneficial effects on sleep have not been verified with high quality studies. In fact, there are studies that indicate that many of these products may actually hurt sleep in some patients, either by encouraging excessive time in bed to improve the “numbers” or by exacerbating anxiety in patients as they attempt to optimize sleep data.
Q: I have heard power naps prefaced with coffee are good for you. Is this true?
Dr. Fahey: Yes, this actually appears to be true! Caffeine works by blocking the receptors for adenosine, the neurochemical responsible for our body’s drive to sleep. This is the process whereby the longer we stay awake, the sleepier we become. For example, pulling an all-nighter before a test will make us feel sleepier because of an increased amount of adenosine in our system. When we sleep, particularly during deep sleep, our brains “eat up” adenosine and that is what is thought responsible for us feeling better rested after we sleep.
Caffeine blocks the receptors within the brain which bind adenosine, and then adenosine can’t do its “job” of making us sleepy, and so we feel more alert. The theory behind a coffee nap is that coffee’s caffeine takes about 20 minutes to kick in (the time taken to drink the caffeine, absorb it into the digestive system and circulate it in your bloodstream, etc.) After you take a 20 minute nap, your brain will have reduced the adenosine and the caffeine will have less adenosine to compete with for the adenosine receptors. This makes the caffeine even more potent and makes you feel even more alert upon awakening.
Keep in mind that naps longer than 20 minutes may be counterproductive and cause you to awake feeling more groggy, as you are more likely to have gone into deep sleep, which makes it harder for you to awaken. Additionally, if you suffer from insomnia, napping can be a bad idea, because that reduces your adenosine and makes it less likely for you to be able to successfully get to sleep and stay asleep the following night.
Q: What are the benefits of sleeping on one side vs the other?
Dr. Fahey: There is no consistent scientific evidence that sleeping on one side versus the other is better for everyone across the population. However, there is some evidence that with certain medical conditions, sleep on one side or the other may be beneficial. For example, patients who have reflux disease may benefit from sleep on the left side compared to the right, as sleeping on the right side has been shown in one study to relax the connection between the esophagus and the stomach, leading to more acid reflux. In patients with heart conditions, sleeping on the right side may reduce discomfort and shortness of breath, as found in another study. Patients with orthopedic pain may find that sleeping on one side or the other may reduce their pain and thus reduce the disruption in sleep. In general, side sleeping compared to sleeping face up (supine) may reduce the severity of snoring and sleep apnea in some patients. There are even some animal studies which indicate that side sleeping may increase the ability of the brain to eliminate cellular debris from the brain compared to supine sleep.
Q: Why can’t you “catch up” on sleep during your days off?
Dr. Fahey: Insufficient sleep, that is, getting less sleep than needed to feel well-rested, leads to a variety of consequences beyond just feeling excessively tired. Insufficient sleep may increase the risk for insulin resistance and obesity. It may also reduce the efficiency of the immune system, increase the risk for cardiovascular morbidity, lead to cognitive and mood difficulties and increase the risk of workplace accidents. For many patients, the degree of “sleep debt,” the amount of sleep they are deficient in each night added up over time, is too large for them to make up in one or two days. Some studies have indicated that even extra sleep to try to “catch up” does not reverse some of the other negative effects of the previous sleep deprivation, including the metabolic dysregulation and weight gain.
Q: Is being a “night person” or “morning person” a real thing? Is it something that can be changed?
Dr. Fahey: Yes, being a night person/”night owl” or a morning person/”morning lark” is absolutely a real thing. Night owls are predisposed towards going to bed at a later time and waking up at a later time, whereas morning larks are predisposed towards earlier bedtimes and wake times. When these predispositions interfere with professional, personal or academic obligations this is classified as a recognized sleep disorder, such as Delayed Sleep-wake Phase Disorder (DSPD) for night owls and Advanced Sleep-wake Phase Disorder (ASPD) for morning larks. Several genes have been identified which may contribute to both DSPD and ASPD, although other factors are likely involved as well.
Although we cannot change our genetics, there are treatment strategies which can help with both DPSD and APSD. For example, timed melatonin before bedtime can act to advance the sleep phase and lead to earlier bedtimes over time in patients with DPSD. Bright light in the morning upon awakening with a light box can also serve to advance the sleep phase and allow these patients to get to sleep earlier the next night. Conversely, bright light therapy at night can help patients with ASPD delay their sleep phase so that they can get to sleep and wake later.
Dr. Fahey practices at our Kildeer Outpatient Care Center and can be reached at 847-725-8402.