For those who are unable to naturally maintain this rhythm—or those who have difficulties breathing, resting, or staying asleep—there are a growing number of new technologies that aim to make the process of resting well more accessible.

Sunnybrook is home to a state-of-the-art research, education, and sleep laboratory that combines brain science-based clinical abilities, teaching, and research, as part of the Clinical Neurophysiology program.

At the most recent edition of our Speaker Series community education session, “A Good Night’s Sleep,” Sunnybrook experts Dr. Andrew Lim (highlighting circadian rhythms), Dr. Mark Boulos (focusing on restless legs syndrome), and Dr. Anu Tandon (sharing about sleep apnea) presented to community members about a range of sleep-related health issues and also had the opportunity to provide real-time feedback and information to participants in the live webinar moderated by Dr. Brian Murray.

A common topic and point of interest: the use and benefits of positive airway pressure therapy.

CPAP, APAP & BIPAP

There are three main types of positive airway pressure therapy:

• CPAP: Continuous Positive Airway Pressure delivers consistent pressure maintained throughout the respiratory cycle to improve oxygenation.
• APAP: Automative Positive Airway Pressure automatically adjusts to meet each person’s specific needs, changing throughout the night to constantly measure resistance.
• BIPAP: Bilevel of variable Positive Airway Pressure is low-range pressure, that delivers higher air pressure when you breathe in.

In addition to these familiar therapies, there are also dental and nasal options, surgical alternatives (nasal or jaw), and nerve stimulation.

Technological sleep innovations

Sleep technologies that collect information while resting in a natural environment and recording information over an extended period of time can also include various pedometers and related trackers. Fitbit® (for example), or similar devices can measure metrics like heart rate, temperature, oxygen levels, and assesses quality of sleep and physical activity.

To assist in discovering sleep abnormalities, Sunnybrook’s Dr. Lim highlighted a few innovative wearable technologies, including:

• MUSE is a brain sensing headband that uses real-time biofeedback to help refocus during the day and recover overnight; it determines when psychology and physical problems arise within the body, with guidance for combatting stress and overcoming fatigue.
• The ANNE^TM ONE system, for the diagnosis of obstructive sleep apneas in adults, is worn over multiple nights in a row, monitoring and predicting when breathing stops during sleep.
• WRIST ACTIGRAPHY devices are wrist-worn monitors that record movement and sleeping or talking patterns over an extended period.

How is your sleep hygiene?

“Healthy sleep is paramount to a healthy lifestyle.” Dr. Mark Boulos, Sunnybrook Neurologist

Here are a few things to consider when monitoring and improving your sleep hygiene:

1. Establishing a fixed wake up time
2. Prioritizing your sleep over other activities
3. Making gradual adjustments to your routines
4. Limiting the amount of naps taken during the day
5. Winding down before going to sleep
6. Dimming lights for a quiet and relaxing sleep environment
7. Unplugging from electronics before bedtime
8. Getting as much daylight exposure as you can
9. Optimizing your bedroom (limiting use for sleep and sex only)
10. Refraining from eating or drinking before going to sleep

Sunnybrook’s Sleep Disorder Clinic

For those who would like to visit Sunnybrook’s Sleep Disorder Clinic, ask your family doctor for a referral if you are experiencing symptoms of concern, including:

• Sleepiness or features of narcolepsy
• Loud snoring or stopping of breathing in sleep
• Restless legs syndrome
• Abnormal sleep behaviours

Have your family doctor fax a brief request to “assess sleep” to 416-480-6092, to arrange clinical assessments and necessary sleep studies: click here for our Outpatient Sleep Assessment Request Form.

Coming soon from the Hurvitz Brain Science program

Sunnybrook’s Hurvitz Brain Science program is growing, with a new Circadian Rhythm Lab on the horizon. To learn more about sleep research taking place within the Hurvitz program, or if you are interested in supporting fundraising efforts, please visit link here for more information.

The post Healthy lifestyle, healthy sleep appeared first on Your Health Matters.

During the pandemic, getting a good night’s sleep has reportedly been more difficult with reports of increased insomnia.

“Many people can successfully manage their insomnia without drugs or medications by following a few key habits,” says Dr. Andrew Lim, sleep neurologist at Sunnybrook.

Tips to help deal with insomnia:

• If you can’t fall asleep, don’t stay in bed. Get up and go into another dark quiet room and do something that doesn’t require bright light such as listening to the radio or reading by a dim light until you feel drowsy.
• Avoid screens such as smartphones or tablets which simulate the brain.
• Set your alarm and get up at the same time every morning. This routine will help your body develop a sleep rhythm.
• Avoid daytime naps. They can disrupt sleep patterns. If needed, don’t nap for more than 30 minutes.
• Limit caffeinated foods and beverages such as coffee, tea, soft drinks, and chocolate. Caffeine is a stimulant and may make it more difficult to fall asleep.
• Limit alcohol as it causes sleep to be more broken and less refreshing than normal.
• Try regular moderate exercise such as walking, swimming or bike riding. Being active can help improve sleep quality.
• Trouble sleeping over a long period of time may be a sign of other health issues. Reach out to a family doctor who can help provide support.

The post What to do if you can’t fall asleep appeared first on Your Health Matters.

Dr. Mark Boulos, a staff neurologist at Sunnybrook who specializes in sleep and stroke, offers some insight into the importance of sleep for children and how parents can encourage good sleep habits in their children.

Why good sleep matters

“Sleep is really important at all ages, but particularly for children because their bodies are going through so many changes,” says Dr. Boulos.

He says while a child who doesn’t get enough sleep might not fall asleep on their desk, sleep deprivation can cause irritability, behaviour issues or even difficulty in school.

“It will manifest in different ways,” Dr. Boulos says. “There’s important things your brain is developing at that time. It’s a really, really important age to be sleeping well.”

During the holidays, getting enough sleep will help children’s behaviour and moods to remain well-balanced. And the return to school in January will be an easier transition if children aren’t sleep deprived, says Dr. Boulos.

Establishing a sleep routine

One way parents can help kids struggling with sleep is to create some stability and routine around sleep. Dr. Boulos says now is a good time, shortly before school starts, to begin practicing that sleep routine with kids.

“Establishing a routine as far in advance as possible makes it feel more natural,” he says.

He suggests having a set bedtime for children and sticking to it as much as possible, even over the holidays, keeping in mind that school-aged children need nine to 12 hours of sleep per night.

“You have a set time: brush teeth, get tucked in, have some sort of relaxation technique to settle kids,” he says, giving the example of reading stories before bed.

He emphasizes that every family is different and it’s important to establish a sleep routine that works for your family, just keeping in mind what time kids need to be up in the morning.

And, as much as possible, have kids turn off their screens an hour before bedtime.

“When light shines in your eye, it has a waking effect. At night, if lights are flashing in your eyes from the screen, your brain actually thinks you need to be more awake and it can make you have a harder time falling asleep,” Dr. Boulos says.

Don’t forget physical activity

Encouraging kids to be physically active throughout the day will also help with sleep.

“If they’re physically active [and] intellectually active, by the time they reach nighttime, they will be so exhausted and they will fall asleep and sleep the whole night,” Dr. Boulos says.

He says if children are still struggling to fall or stay asleep with a good routine and physical activity during the day, parents shouldn’t hesitate to reach out to their family doctor.

“[Sleep] is very important. Healthy habits early in life will really project into healthy habits later as an adult,” Dr. Boulos says.

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Imagine being evaluated for a sleep disorder from the comfort of your own bed. For those seeking insights into their sleep habits, this concept is becoming a reality.

Researchers at Sunnybrook’s Sleep Disorder Clinic are increasingly using in-home devices, like movement and heart-rate monitors and tracking apps, to make it happen.

Home monitoring allows people to be assessed without having to come to the hospital’s sleep clinic for conventional in-laboratory sleep testing. It also allows Sunnybrook to help far more people than it otherwise could, and the early trial results are showing in-home testing to be as successful as some in-hospital techniques.

“We are using novel techniques to detect sleep apnea – the most common and disabling sleep disorder – periodic leg movements in sleep, as well as sleep-wake cycles,” says Dr. Mark Boulos, a sleep and stroke neurologist in the Sleep Disorder Clinic. Dr. Boulos is overseeing the trials, which involve hundreds of participants.

Dr. Boulos is especially excited by the data the team is collecting from watch-like devices patients wear around their ankles, which monitor leg movements at night.

“There is growing evidence of a potential link between periodic limb movements in sleep and silent and overt stroke, coronary artery disease and increased mortality,” he says.

In-home assessments also allow Sunnybrook to diagnose more stroke survivors with obstructive sleep apnea, a condition where breathing can be interrupted multiple times a night. The trials have also shown promising results among patients with cognitive impairments, a group Dr. Boulos says can be hard to treat for sleep issues.

While testing for sleep apnea at home is done in other parts of the country and the world, it is not commonly done in Ontario. That means this research could be practice-changing for the province.

“With the techniques available at home, we [can] move the sleep lab into the patient’s own bedroom,” Dr. Boulos says. “We can diagnose and treat more people, likely improving patient outcomes, which is always what we want to see.”

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Too much? Too little? Are you waking up in the middle of the night?

Are weird and vivid dreams, or nightmares disturbing your slumber?

As the COVID-19 pandemic continues, people are experiencing greater levels of stress and anxiety than ever before, which is taking a toll on people’s sleep. Experts say, in this time of distress, sleep should be a top priority.

“Good sleep can be beneficial for your physical and mental health,” says Dr. Mark Boulos, sleep expert and neurologist. “It can actually improve your immunity to help your body fight off illnesses.”

“During times of stress, it is very important to pay special attention to getting optimal sleep,” explains Dr. Ari Zaretsky, chief of psychiatry. “Sleep enhances both physical and emotional resilience to stress.”

Trouble sleeping during COVID-19

There is a lot to worry about lately and we are all facing a great deal of uncertainty which can affect normal patterns of sleep.

Sleep experts say insomnia may be more prevalent in times like these.

“Insomnia occurs when it is difficult to fall asleep and stay asleep,” says Dr. Boulos. “Sometimes people will fall asleep but wake up in the middle of the night and can’t get back to sleep. Elevated stress levels and information overload can cause sleep problems. In other cases, there may be medical issues causing insomnia such as sleep apnea or restless leg syndrome, and some medications can also interrupt a person’s sleep cycle.”

A change in routine can also make it difficult to fall asleep as many families are adjusting to a new way of life with self-isolation, children no longer attending school, and with more people working from home, or coping with unemployment. This disruption to typical daily schedules can lead to inconsistent bedtimes, wake times, or taking longer naps throughout the day which can impact normal sleep cycles.

Sleep problems: sleeping too much

In otherwise healthy adults, experts say eight to nine hours of sleep a night is typically a sufficient amount of sleep.

If you’re sleeping in more often than usual, your body may be catching up on sleep, but, if you or someone in your household is sleeping for hours and hours each day, something else may be going on.

“Most guidelines say more than nine hours of sleep over an extended period of time, could be a sign of a larger problem,” says Dr. Boulos. “Individuals who don’t want to wake up or get out of bed and spend large amounts in bed all the time may be dealing an underlying medical or psychiatric issue.”

“There is a well-known relationship between sleep disturbance and psychiatric conditions such as depression and anxiety disorders,” adds Dr. Zaretsky. “People should seek mental health assistance if their sleep disruption is prolonged and affects their functioning and also if this sleep disruption is associated with other psychiatric symptoms such as severe sadness, tearfulness, loss of appetite, emotional withdrawal, panic attacks or thoughts of death.”

Dreaming during the COVID-19 pandemic

Have you had strange dreams during the pandemic?

Worldwide, people are taking to social media and reporting having vivid dreams or nightmares and being able to remember them in detail.

Dreaming occurs during REM (rapid eye movement) sleep, a later stage of sleep when the brain is active.

“Dreams are usually a constellation of thoughts and memories from earlier in the day, and often earlier in life.  During this unusual time of a pandemic, lots of thoughts are going through people’s minds,” says Dr. Boulos. “When people dream, these thoughts can be combined; some dreams are related to reality, but others are not and are just made up in the mind of the person while they sleep.  With all these stressors going on, dreams may be quite unusual during COVID. Part reality, part fiction, inter-twined with stress, anxiety and worry.”

“If you are woken during REM sleep, you are much more likely to remember your dream,” says Dr. Zaretsky. “Psychologically, it is believed that nightmares are dreams that pertain to stressful issues that we have not been able to resolve. During the COVID-19 pandemic, many people are experiencing vivid dreams and nightmares as they face fear and uncertainty about the future. This is a normal human reaction.”

Tips for managing sleep during the COVID-19 pandemic

If you are a health care worker, sleep is incredibly important, especially if you’re doing shift work. Here are 10 tips to help healthcare workers get better sleep during COVID-19 and some tips for healthcare workers for coping at work and home during COVID-19.

Not only is getting a good night’s sleep “physically and mentally restorative” explains Dr. Zaretsky. It is beneficial for brain health, which can help improve productivity.

“Sleep is also extremely important for proper memory functioning and proper neural function,” he adds.

Here are some general tips to help with getting more quality ZZZZZ’s:

Keep a sleep schedule or routine

Having a routine creates structure to your day, which can be reassuring and provide some normalcy when everything else is so uncertain.

When planning your sleep schedule, remember to include some time to relax before bedtime to help your brain wind down. Establish a set bedtime and use an alarm to wake up at the same time each day. Stick to your routine and avoid hitting the snooze button to help regulate your day.

Naps

Sleep experts say brief power naps can be helpful if a person is getting less than six hours of sleep at night. A short power nap of about 10 to 20 minutes, earlier in the day rather than later in the afternoon, can help give your brain a boost. Being at home, it can be tempting to nap throughout the day or for longer periods of time, but this can get in the way of a good night’s rest. Bottom line: if you’re going to nap, keep it to less than 20 minutes and avoid napping in the afternoon.

Shutdown screens before bed

Power down devices an hour or two before bedtime. The blue light emitted from electronics disrupts your internal clock and delays the release of melatonin, a hormone that prepares your body for sleep. Try leaving your smartphone to charge in another room to help avoid checking the latest headlines in the middle of the night. Limiting screen time can help manage information overload during the COVID-19 pandemic and minimize watching distressing news before bedtime which can lead to feelings of stress and anxiety.

Other tips for improved sleep hygiene

Doing something relaxing before bedtime to help wind down can help improve your sleep, such as taking a warm bath, reading a book, listening to relaxing music or meditating. Eating nutritious meals, and avoiding caffeine and alcohol in the evening, can help foster good sleep hygiene.

Stay active

Regular physical activity and moderate aerobic exercise can help you fall asleep and get a better sleep at night. Experts say exercise is best earlier in the day and to avoid working out too close to when you’re going to bed. Exercise causes the body to release endorphins which can potentially keep you awake.  Finish your workout at least two to three hours before bedtime. Check out these tips for staying physically active while staying at home.

It is important to know you are not alone. People around the world are trying to cope with change and a new way of living. Whether you find comfort in spirituality, writing in a journal, finding ways to stay connected with family and friends while physically distancing, or by learning a new hobby, there are many different ways to manage your mental health, which can help lead to improved sleep.For more resources and information about COVID-19 from Sunnybrook experts read our blog.

If you or someone you know is thinking about suicide or in severe emotional distress, please call 911 or visit your local emergency department.

If you feel like you are in crisis or need somebody to talk to, community resources are here to help.

Crisis Services Canada

• 24-hour, toll-free 1-833-456-4566
• Text: 45645 (4 p.m. – midnight ET)

The post COVID-19: Sleep problems, dreams and nightmares appeared first on Your Health Matters.

“Our study showed that older adults who sleep poorly have premature aging and abnormal activation of the brain’s immune cells,” says Dr. Andrew Lim, principal investigator of the study and sleep neurologist at Sunnybrook Health Sciences Centre.

The study, “Sleep fragmentation, microglial aging, and cognitive impairment in adults with and without Alzheimer’s dementia,” has been published in the journal, Sciences Advances.

Dr. Lim explains immune cells of the brain are called “microglia,” which can protect the brain and “eat” pathogens and debris. When these cells are “activated” they can cause a number of concerns.

“Chronically losing sleep may cause inflammation of the brain and cause it to age faster,” says lead author, Kirusanthy Kaneshwaran, a third year medical student at the University of Toronto, who worked with Lim on this study. “This was detected through actual, identifiable changes in the inflammatory cells of the brain.”

“Those in the study who had better sleep had “younger” and less activated brain immune cells, and this was relatively protective against the negative effects of Alzheimer’s disease pathology on cognition,” says Dr. Lim.

“I hope this research helps further understanding of the mechanism underlying problems with memory and cognition, and awareness of the important role of sleep,” says Kaneshwaran.

Tips for older adults to help improve their sleep

1. Don’t simply accept poor sleep as being a part of normal aging – if you are having trouble falling or staying asleep, or if you are excessively sleepy during the day, bring this up with your doctor!
2. Keep regular sleep hours, and a regular nighttime routine, and wake-up schedule, that feels right for your body.
3. Get up at the same time every morning no matter how much sleep you got during the night. Maintaining a routine can help improve sleep.
4. Speak with you doctor about ways to maximize physical activity.
5. Try to maximize exposure to natural light during the day.
6. Limit caffeinated foods and beverages, such as coffee, tea, soft drinks, and chocolate.
7. Limit use of alcohol.

“This study provides another reason for older adults to sleep well, and to have sleep problems looked after,” says Dr. Lim. “Sleeping well may prevent premature aging of the brain’s immune cells and by doing so, may prevent impaired cognition.”

In-depth – learn more about the study: Sleep fragmentation, microglial aging, and cognitive impairment in adults with and without Alzheimer’s dementia, has been published in the journal, Sciences Advances.

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Whether it’s checking your Facebook feed or scrolling through Instagram, there’s no shortage of “stuff” to look at, and it can be easy to lose track of time. Before you know it, 10 minutes of your day — or sometimes way more minutes than you care to admit —are lost forever, thanks to social media.

Breaking up with social media

If you’ve ever felt like taking a social media time out, you’re not alone.

Even social media sensations themselves need a digital detox. Toronto-native YouTube star Lilly Singh announced her decision to take a break from social media and focus on mental health. Over the years, several celebrities have also quit various social media platforms for reasons ranging from too many negative comments or being harassed, hackers or publicity stunts, or just needing a little (or a lot) more privacy.

Why a digital detox can be a good thing

“Taking a break from anything can provide needed time for critical reflection,” says Dr. Jeremy Rezmovitz, a family physician at Sunnybrook. “We can enhance our lives and learning through real world experiences, and by taking the time to think and reflect on our feelings.”

Less time on social media can also help you connect more with people face-to-face.

“Engaging with others, in person, fulfills our senses wholly; it fulfills our needs to physically feel, hear, see, touch and smell,” Dr. Rezmovitz says. “These are primal components to living life fully.”

So, how do you know it’s time to take a time-out from social media?

Dr. Rezmovitz recommends asking yourself these questions: Is social media a problem in my life? Why would I need to take a break? Do I need to turn it off completely, or just turn it down?

The benefits of taking a break from social media

Taking time off of social media, he adds, means freeing up your time for other activities that are good for both brain and body:

1. Mindfulness: being aware of your thoughts and feelings, and being present in the moment
2. Movement: when people are online, they’re often sitting and sedentary. It’s great to get up and move!
3. Opportunity to experience nature
4. More time to learn about yourself
5. More time to sleep

Catching more ZZZs with less social media

“If an individual is experiencing stress, anxiety or strong emotions in the context of social media use, this could also impact their ability to fall asleep,” says Dr. Mark Boulos, a Sunnybrook neurologist and sleep specialist.

Ever scroll through your phone in bed when you should be going to sleep? That could mean not getting enough sleep at night, and that can have an impact on overall health.

“Poor quality sleep could lead to lead to poor energy levels and fatigue throughout the day,” Dr. Boulos explains. “Chronically poor sleep is linked with health consequences such as obesity, motor vehicle collisions, and in the worst case scenarios: stroke, heart attack, or early death.”

To help get a better night’s rest, “We generally encourage people to avoid use of electronic screens in the time leading up to bedtime as this could lead to difficulty falling asleep,” says Dr. Boulos. “Taking a break from social media could help improve sleep by reducing anxiety levels.”

Taking some time away or limiting technology can help boost a person’s mental and physical health. It’s a great way to find more time for yourself and to get more of those lost minutes back — just one of the many benefits of taking a break from social media.

The post Why taking a break from social media can be good for your health appeared first on Your Health Matters.

Adults need on average just under 8 hours of sleep per night for good brain function (although this varies from person to person, with some needing as little as 6.5 hours and some needing as many as 10).

To find out why sleep is so important, I talked to Dr. Andrew Lim, neurologist.

“Sleep plays a key role in maintaining brain health — clearing toxins, regulating the connections between neurons, maintaining healthy brain blood flow, consolidating memories — but clearly sleep also plays a role in cardiovascular health, immune health, and other organ systems.  Sleep touches pretty much every major organ system, from brain on down.”

That includes the heart, says Dr. Anu Tandon, respirologist and sleep specialist.

“Reduced sleep may put excess strain on the heart by releasing certain hormones in the body that cause your blood pressure and heart rate to increase. Over time, this can lead to development on hypertension – one of the well-known risk factors for developing heart disease.”

Sleep fragmentation can also be a problem, she says. That’s when waking up or entering into a lighter sleep phase interrupts deep REM sleep. It can be related to obstructive sleep apnea (pauses or shallow breaths for a few seconds to a minute).

“A severe degree of apnea has been linked to increase risk of heart attacks, development of hypertension and worsening heart failure if your heart is already damaged,” Dr. Tandon says.

Talk to your doctor if you still don’t feel rested after a long night’s sleep.

So, how can we be sure to get a good rest for our brains and hearts?

• Avoid caffeine in the afternoon and evening.
• Get regular exercise.
• Keep to a sleep schedule, even on weekends.
• Avoid alcohol (it disrupts REM sleep)
• Keep the bedroom dark and cool.
• Keep electronics out of the bedroom – Oh no. My phone is practically attached to me! Let’s dig into this one a little further…

Say no to electronics in the bedroom

A TV, tablet or phone (or all three) in the bedroom can affect your sleep.

“Very similar to how one stretches before exercises, the brain needs ‘down time’ before settling,” Dr. Tandon says. “These devices engage the brain preventing it from realizing it is time to rest.”

Dr. Lim says the light from electronic devices can potentially disrupt one’s internal biological clock, making it more difficult to fall asleep. As well, the activities that you do on these devices (surfing the web, playing games, checking e-mail, doing work) are often quite activating, making it even harder to fall asleep.

For people who have trouble falling asleep (sleep initiation insomnia), it’s very important to allow the brain to decompress before sleep so it’s not over-stimulated.

Some experts suggest avoid your electronics for two hours before bedtime. If that’s not possible for you, at least try to keep them out of your bedroom or on dim.

What’s your key to a good night’s sleep? For me, it’s no caffeine after noon and a few pages of a good book to wind down before bedtime.

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Tips for a good night’s sleep

It’s not just for kids: Most adults need just under 8 hours sleep for good brain function

• Stick to a schedule
• Keep bedroom cool
• Exercise daily
• No electronics in the bedroom

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According to Dr. Steven Park at the Albert Einstein College of Medicine, a lack of shut-eye can be really harmful – to our grades, our decision-making abilities and more.

Read his whole blog post, complete with 5 tips Dr. Park says will help (along with studies to back him up), on the Albert Einstein College of Medicine Blog, “The Doctor’s Tablet”. And while he’s talking about med school in particular, same thing goes for all students in any health discipline!

So, how’s your sleep pattern? Are you managing 6-8 hours a night?

The post Why we should get more sleep appeared first on Your Health Matters.