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Blog Post about Sleep Hygiene
Sleep Hygiene
- What is Sleep Hygiene
Sleep hygiene is defined as good sleeping habits that can help treat insomnia (). Insomnia is the continuous difficulty to fall asleep or maintain quality sleep despite adequate opportunity, resulting in impairment of daytime activities (). Patients learn about sleep hygiene as part of cognitive behavioral therapy for insomnia, or “CBT-I.” This form of therapy involves working with a counselor to understand a patient’s sleep difficulty, ways to build and improve sleep habits, and reduce negative thinking that can make insomnia worse. ().
- Why is Sleep Hygiene Important
Good sleeping habits are crucial to obtaining proper length and quality of sleep on a continuous basis (). It is estimated that upto two thirds of the adult population has occasional sleep difficulty (). To prevent the condition from developing into a long-term sleep disorder, it is important to develop and maintain sleep hygiene early on as part of cognitive behavioral therapy ().
Sleep Hygiene Tips
There are various sleep hygiene guidelines that can assist patients in achieving a good night’s sleep on a regular basis. Below is a comprehensive list of good sleeping habits ():
- Sleep schedule: Our body has an internal clock that regulates sleepiness and wakefulness through hormones (). This internal clock works best when we consistently follow a sleep schedule by sticking to the same bedtime and wake up time (even on weekends) ().
- Bedtime routine: Establish a bedtime routine that includes winding down with quiet activities that promote sleep, such as reading with dim lights (). Avoid using screens (smartphones, tablets, computers, TV, etc.) at least 30 mins prior to bedtime (). Research has shown blue light emitted from screens can decrease production of the sleep-inducing hormone, melatonin ().
- Sleep environment: A relaxing sleep environment can help overcome sleep difficulty. Research indicates people sleep better when the bedroom is optimized for temperature, lighting, noise level, and comfort ().
- Temperature: Our internal body temperature drops slightly in the evening (). Turning down the bedroom thermostat can help with body temperature regulation to promote sleep (). A warm bedroom can cause a person to become sweaty and dehydrated, resulting in fatigue ().
- Lighting: Exposure to artificial light in the evening can cause difficulty in maintaining sleep (). It is recommended to keep bedroom lights dimmed prior to sleep and avoid use of screen devices, such as smartphones and televisions ().
- Noise: Loud noises can cause severe sleep disturbances resulting in negative impacts on physical and mental health (). One should strive to maintain quietness in the bedroom by blocking outside noises. White noise generating machines, fans, or noise blocking curtains can help mask disruptive ambient sounds ().
- Comfort: It is critical to create a comfortable ambience in your bedroom based on your own preference for mattress firmness, pillow softness, and feel of the bedsheets (). Vacuuming carpet and changing sheets regularly can help in reducing the presence of allergens and dust mites in the bedroom, resulting in quality sleep ().
- Avoid napping: If you have difficulty sleeping at night, it is important to avoid naps during the late afternoon (). However, short (20 min) naps can help in reducing daytime fatigue, drowsiness, and even improve thinking ability ().
- Morning light: Research shows that regular bright light exposure in the morning creates alertness and maintains the internal clock, allowing people to sleep and wake up at the optimum time ().
- Avoid heavy meals: Eating heavy meals near bedtime can disrupt the sleep cycle as the digestive system requires energy to carry out digestion which slows down during sleep (). Eating heavy meals prior to bedtime can also cause discomfort and acid reflux, further promoting sleep difficulty ().
- Life-style Changes to Promote Quality Sleep
Insufficient and poor sleep can result in both physical and mental health problems that can negatively impact the overall personal and social well-being of the patient (). Developing good sleeping habits through life-style changes can have a positive impact on one’s health and quality of life ().
According to numerous studies, exercising regularly can promote better sleep (). Exercising on a regular basis has moderate benefits on ability to fall asleep faster and sleep quality, as well as small beneficial effects on amount of total sleep (). In addition, exercise can also improve sleep indirectly. For example, daily physical activity can reduce the risk of excessive weight gain which can cause obstructive sleep apnea (), (interrupted breathing during sleep) ().
Avoiding certain chemical substances can alleviate sleep difficulty problems. Below is a list of commonly used substances that can negatively impact the sleep cycle.
- Caffeine: Caffeine has been shown to delay the onset of sleep and reduce both sleep duration and quality of sleep (). Caffeine reduces the duration of slow-wave sleep, which is the stage of deep sleep that allows us to feel refreshed after waking up (). It is recommended to cut off caffeine intake at least 6 hours before bedtime (if you go to bed at 9 pm, then avoid caffeine after 3pm in the afternoon) ().
- Alcohol: Although alcohol intake helps reduce the time it takes to fall asleep, research shows that evening alcohol intake can cause light sleep in the second half of the night and reduce sleep quality (). Prevalence of insomnia in patients with alcohol use disorder is as high as 75 percent (). A 2018 study compared the effects of alcohol intake on sleep quality ();
-low amounts of alcohol (less than two servings per day for men or one serving per day for women) decreased sleep quality by 9.3%.
-moderate amounts of alcohol (two servings per day for men or one serving per day for women) decreased sleep quality by 24%.
-high amounts of alcohol (more than two servings per day for men or one serving per day for women) decreased sleep quality by 39.2%.
To avoid sleep difficulty, it is recommended to stop alcohol intake at least 4 hours prior to bedtime ().
- Nicotine: Evening nicotine use has been shown to reduce sleep efficiency and higher awake time during the night (). It is recommended to avoid nicotine use at least 4 hours prior to bedtime ().
- Opioids: Opioids are highly addictive chemical substances that can disrupt sleep by blocking access to deep sleep and sleep efficiency (). Given the addictive nature of opioids, it is best to avoid use of opioids as sleep aids since they can lead to chronic dependence ().
Early studies indicate that sleep hygiene counseling sessions can help patients suffering from insomnia (inability to fall asleep and stay asleep) (). A group of 80 adults who were overweight and had sleep duration of less than 6.5 hours per night were randomly assigned to sleep hygiene counseling sessions to either increase sleep duration to 8.5 hours (intervention group) or continue habitual sleep (control group). After 2 weeks of counseling, the intervention group reported an increase of 1.2 hours of sleep per night compared to the control group. Also, the intervention group had reduced caloric intake resulting in weight reduction of 1.9 lbs compared to the control group. Thus, developing good sleeping habits can result in positive effects on overall well-being.
Blog Post about Insomnia
What is Insomnia?
The human body is an intricate network of biochemical reactions that resembles a perfectly functioning machine. Like any machine, the human body also needs to re-charge; this rejuvenation of our body comes through the process of sleep. However, a vast majority of the global population suffers from the often-neglected condition of insomnia (ref). The American Academy of Sleep Medicine defines insomnia as a continuous difficulty to fall asleep or maintain quality sleep despite adequate opportunity, resulting in impairment of daytime activities (ref). During the coronavirus pandemic, nearly 60% of Americans experienced sleep difficulty (ref); the heightened cost of this silent epidemic exceeds $100 billion annually due to poor workplace/school performance, increased healthcare usage, and greater potential for accident risks (ref).
Although insomnia is an umbrella term for sleep difficulty, it is further characterized into distinguishable subtypes:
Chronic vs. Short-term insomnia: Chronic (long-term) insomnia is described as a frequent and persistent inability to initiate or maintain sleep despite suitable conditions for proper sleep at least 3 times per week over a period of 3 or more months (ref). Chronic insomnia results in impairment of daily activities encompassing social, professional, and personal relationships accompanied by stress over lack of quality sleep (ref).
Short-term (acute) insomnia includes similar sleep difficulties and resulting impairments as in chronic insomnia with the exception of symptoms being present for less than 3 months and it is often triggered by stress (ref). Short-term insomnia can progress to chronic insomnia (ref).
Sleep Onset Insomnia: People with sleep onset insomnia have difficulty falling asleep at any time of night when they attempt to initiate sleep (ref). This type of insomnia can be acute or long-term resulting from stress, anxiety, and depression (ref). Due to the reduced total sleep time, patients experience fatigue. This type of insomnia is most common in younger adults (ref).
Sleep Maintenance Insomnia: This type of insomnia results from an inability to stay asleep throughout the night with at least one episode of night awakening, affecting both quantity and quality of sleep (ref). The individual often turns and twists in bed which can lead to sleep disturbance for the partner also. The added anxiety of not being able to revert to sleep often leads the individual feeling stressed and exhausted. It is most common in older adults (ref).
Insomnia Symptoms
Insomnia can manifest as a wide variety of symptoms directly linked to inadequate and poor quality of sleep. Common symptoms of insomnia not only affect daytime function of patients, but also chronic illness risks (ref). Patients with insomnia experience fatigue, sleepiness, anxiety, and stress affecting overall quality of life (ref). Patients with severe insomnia are at a higher risk of cognitive impairment (ref). However, even those with less severe cases of insomnia overestimate their cognitive impairment related to job and academic performance which can further negatively impact their daily tasks (ref). Patients with insomnia often seek over-the-counter treatments which may lead to substance abuse; approximately 28% of insomnia patients admitted to trying alcohol as a remedy for insomnia (ref). Furthermore, insomnia has been associated with a slight increase in risk of suicidal thoughts (ref). A number of research studies have established a connection between insomnia and increase in cardiovascular disorders, including hypertension and heart attack (ref).
Causes and Risk factors of Insomnia
Insomnia is one of the most common health problems resulting in over five million physician office visits annually in the United States (ref). Insomnia often acts as a precursor to other medical and psychiatric disorders. Common causes of short-term insomnia include the following factors (ref):
Changes in sleep environment – light, noise, or temperature/climate
Sudden stress – death/loss of a loved one or loss of employment
Temporary illness or pain
Use and or withdrawal of stimulants and drugs – caffeine, medications, alcohol or illegal drugs
Jet lagged – traveling to different time zones
Shift work – night shift employees often find it difficult to adjust their sleep schedule
Chronic insomnia often occurs as a result of other conditions and can start in childhood (ref), such as:
Mental disorders – anxiety, depression, or PTSD
Medical illnesses – breathing problems, diabetes, hypertension, pain, or stress
Neurologic disorders – Parkinson or Alzheimer
Sleep disorders – sleep apnea, restless leg syndrome, or periodic limb movements
Medications or stimulants – allergy medications, caffeine, alcohol, or illegal drugs
Irregular sleep habits and poor sleeping habits
Insomnia is linked to both medical and psychiatric disorders and can be more prevalent amongst certain individuals (ref). Those with increased risk of insomnia include, older adults, females, patients with family history of insomnia, light sleepers (easily aroused from sleep), as well as individuals with patterns of sleep disruption triggered by stressful events (ref). To date, a clear genetic basis of insomnia has not been established. However, genomic studies do indicate overlap between insomnia and risk profiles for depression, anxiety, coronary artery disease, and type 2 diabetes (ref). Furthermore, chronic insomnia and psychiatric disorders often coexist; almost half of chronic insomnia patients are diagnosed with a psychiatric disorder (ref).
Insomnia Treatments
Given the complex array of symptoms that can develop as a result of insomnia, it is necessary for patients to be aware of existing treatment options that can help them achieve quality sleep and regain control of their daily functions. The most important step in treatment of insomnia is identification of the factors that underlie the condition in order to establish an individualized treatment program.
Acute insomnia treatment options include discussing the role of temporary stressors that cause sleep disruption and educating the patient to manage the level of distress. Furthermore, short-term use of appropriate medications can help reduce the impact of insomnia on daytime functions and control insomnia-related anxiety (ref).
The main treatment options for chronic insomnia include cognitive behavioral therapy (CBT) and pharmacotherapy. CBT is considered the first-line treatment option for chronic insomnia patients (ref). This form of therapy addresses common behaviors that result in poor sleep and includes both behavioral and cognitive components to improve sleep quality (ref).
The behavioral components of CBT include:
- Establishing a regular bedtime and wake up time on a daily basis
- Encouraging patients to use the bed only for sleeping (and for intercourse) when sleepy and to leave the bed if sleeplessness causes anxiety
- Sleep hygiene which includes avoiding substances that can disrupt sleep, avoiding naps to maximize sleep efficiency, and creating a comfortable sleep environment
The cognitive approaches of CBT seek to avoid:
- Anxiety related to sleeplessness
- Improper expectations about hours of sleep
- Overestimating the negative effects of sleeplessness
- Stimuli that cause sleeplessness and include a regimen for meditation, muscle relaxation, and mindfulness
Pharmacotherapy for Chronic Insomnia
Medications for insomnia are determined based on an individualized approach that takes into effect factors such as patient age, comorbidities, type of insomnia, side effects, cost, and preference of both the clinician and patient. The safety profile of the newer-generation of non-benzodiazepines renders them as the first-line choice for long-term treatment of chronic insomnia (ref). Patients who do not show a response to these first-line medications can seek other FDA approved sedating medications with physician consultation (ref).
Tips for Preventing Insomnia
Individuals with insomnia often feel helpless in combating sleeplessness; however, effective methods in behavioral change have been shown to decrease the incidence of insomnia. The following tips can help patients gain control of their sleep and overcome the debilitating effects of insomnia (ref).
Establish a daily routine schedule for bedtime and for waking up
Avoid alcohol, caffeine, nicotine, and other stimulants that can interfere with your sleep
Reduce/minimize naps because they interfere with nighttime sleep
Exercising regularly can improve both sleep quality and quantity
Limit use of bed for sleeping and sex
Avoid eating or drinking right before bedtime
Create a comfortable sleeping environment paying close attention to temperature, light, and noise
Avoid thinking of tasks and plans while trying to fall asleep
Reduce stress through meditation, breathing techniques, and muscle relaxation
When to Talk to Your Doctor
Individuals who feel they are suffering from inadequate sleep should seek medical attention if the condition does not improve with the aforementioned behavioral insomnia prevention techniques. A physician will properly diagnose the condition based on symptoms. The individual may be asked to keep a journal of their sleep routine to share with the health professional. Based on the patient’s medical history, the physician can provide an individualized plan to help treat insomnia through therapy and medications.
Blog Post about Telehealth
Paradigm Shift in Patient Care through Telehealth
The introduction and expansion of new web-based technology significantly transformed the modus operandi in almost every aspect of life, from shopping online for goods and services to working remotely. The healthcare sector also dabbled in the practice of telemedicine by replacing in-person office visits with video or audio digital technology. While the practice has been around for over a decade, it gained popularity and traction with the start of the coronavirus pandemic. In January 2020, less than 1% of primary care Medicare visits occurred virtually; by April 2020, the number increased to nearly 50% (1).
Providing healthcare through remote technology allows greater accessibility and convenience for patients who may not otherwise have a means to appear for an in-person visit (2). When there is demand for a product or service, there is money to be made. Hence, the competition for commercialization and monetization of the telemedicine market is ripe.
In the US, commercial interest in telehealth is mainly led by startups that are building their brands focused on personalized, digital healthcare providing a myriad of health-related services ranging from mental well-being, weight management, to primary care and preventive medicine. In 2021, a record $37.9 billion poured into the digital health sector in the US (3).
Leading the way in the mental health niche are BetterUp and Cerebral, with a combined valuation of over $9 billion (4). BetterUp provides coaching through behavioral scientists on its mobile app platform. Cerebral provides clients with monthly subscription-based online care and medication management for conditions like anxiety, depression, and insomnia. Another player in the market, Noom, uses a psychology-based weight loss approach to help patients lose weight through diet and behavioral changes via its mobile app. The company has a targeted valuation of nearly $10 billion (5). Teladoc remains the gold standard for primary healthcare as it provides a virtual platform in connecting patients to board certified physicians via its website and mobile app.
While these industry disruptors are busy laying the foundation for a futuristic vision of healthcare, companies like Amazon tried their hand at securing a monopoly in the telehealth market share with little success. Within 3 years, Amazon Care expanded its virtual telehealth services in all 50 states but decided to shutter its services when it couldn’t make partnerships with employer clients.
It remains to be seen how the telehealth industry will evolve over the next few years as more regulatory oversight becomes necessary to ensure virtually personalized digital medicine’s main priority remains patient care and not increased business valuation.
References
- Telehealth Is Here to Stay. Nature Medicine 7 (2021): 1121-21.
- Benefits of Telemedicine. Hasselfeld, B.W. Johns Hopkins Medicine Health.
https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/benefits-of-telemedicine
- State of Digital Health 2021 Report. CB Insights.
https://www.cbinsights.com/research/report/digital-health-trends-2021/
- 6 Digital Health Startups to Watch in 2022.
- Weight-loss Platform Noom Bulks up on $540 Million in New Funding. Tech Crunch.