Lifestyle Sleep

11/05/2024

It’s Election Day and with all the excitement, uncertainty, anticipation and anxiety you may be wondering how you will ever get to sleep. Did you know that it is NORMAL for sleep to be shorter and lighter when our brains feel under threat, anxious, excited or trying to prepare for an upcoming event? This is your brain’s way of protecting you, processing, and preparing for the future. Sometimes in these circumstances the sleep can even be so light that you don’t feel asleep at all. Understanding and accepting these normal, stress-related changes of sleep is often liberating and allows you to prepare. Here are some of tips for how to cope, I hope they are helpful!
1. Write out your thoughts, feelings and worries before even trying to get into bed for the night. This is a strategy called “worry time” that has been shown to be helpful for insomnia in numerous research studies.
2. Don’t try to go to bed at your normal time. The sleep will be lighter and shorter so reducing your opportunity for sleep is usually helpful. A good guideline is to stay up at least 1-2 hours past your normal bedtime, then read a physical book in bed until you get sleepy. Don’t worry if you end up not getting sleepy until several hours past your normal bedtime. You can also use this time to do more writing.
3. Get up and start your day at a normal time, regardless of how you slept. Getting up at your regular time sets your clock for the day which will allow you to sleep better on subsequent nights.
4. Don’t turn to alcohol or sleeping pills if these are not something you already are using regularly. These substances may make you feel more relaxed about the night but they don’t produce natural sleep and may interfere with your brain’s ability to process whatever happened with the election.
5. In bed, focus on resting rather than sleeping. We cannot control how much sleep we get in any given night but we can try to get our brain and body in to a relaxed state. Just relaxing in bed during the night, whether you are awake or asleep, can have restorative properties. In addition, when our brain feels under threat it may preserve a bit of wakefulness, even while another part of it sleeps so you may feel that you are awake when actually a part of the brain is sleeping. To help yourself rest, try doing some deep breathing (such as 4-7-8 or box breathing) and think about happy moments from the past.
Hang in there, we will get all through this!

10/28/2024

Daylight Saving Time ends this coming weekend. Here's some advice for parents on how to make the transition as smooth as possible for your children.

As a sleep medicine physician and mother of two (currently ages 4 and 6), I’m keenly aware of the importance of good sleep to our overall…

06/28/2024

https://michelle-jonelis.medium.com/forget-about-sleep-the-night-is-a-time-for-r-e-s-t-8a185b49b70c

Ever found yourself staring at the ceiling in the dead of night, stressing about not being able to sleep? You’re not alone. In the US, we…

06/27/2024

https://michelle-jonelis.medium.com/to-fix-our-modern-sleep-we-should-look-to-the-past-432e1f03c9fa

A Critical Look at Hunter-Gatherer Sleep Challenges Our Modern Assumptions

06/13/2024

I’m loving the inspirational work that is doing to promote real life, independent interactions for children. As a sleep and lifestyle medicine physician I’m all too keenly aware of the importance of giving kids free time, ideally outdoors and with friends, to play, observe, create and be bored. How we sleep is a byproduct of everything else we do in our lives and to obtain healthy sleep both adults and children need to spend time outdoors, move our bodies and connect with others socially. One of the main problems with screen use for all of us is that replaces these other activities. What convinced me to keep my own children off screens as long as possible was when I saw how, as toddlers, watching a screen suppressed all body movements in a way no other activity was capable of doing. I also noticed that after they complained about being bored, or if they were tired after a long busy day, if I just held off on putting them on a screen they would eventually engage in self-focused, creative work instead. We are still mostly screen free at ages 9 and 11. I encourage everyone to Join the movement: anxiousgeneration.com

06/12/2024

I just finished listening to the recent Huberman Lab episode from 6/3 on menopause with Dr. Marie Claire Haver. Many great things were said, such as Dr. Haver emphasizing that alcohol use is a common contributor to sleep disruption in peri/post-menopause, and emphasizing that a healthy, very high fiber diet and regular exercise including resistance training are essential during this phase of our lives (and actually throughout all phases of life). What I whole-heartedly disagree with however, is the characterization of menopause as a pathologic hormone deficiency causing chaos to females that requires a medical therapy (ie: Hormone Replacement Therapy). The risks versus benefits of HRT have been reviewed many times by numerous medical organizations and the conclusion is almost always that the risks (in particular of breast cancer), outweigh the benefits. Yes, the modern re-interpreting of the Women’s Health Initiative data suggests that up to 5 years of HRT after menopause is safe and does not significantly increase the risk of breast cancer, but the long-term benefits of 5-10 years of HRT are unclear and anything the HRT was beneficial for (vasomotor symptoms, sleep disruption in people with vasomotor symptoms, bone density) returns to baseline once the HRT is stopped. Dr. Haver’s suggestion that HRT be continued indefinitely (“I’ll die with my estrogen patch on”) is dangerous as we know that combined HRT beyond 5 years absolutely DOES increase the risk of breast cancer and that risk continues to increase the longer you take combination HRT (please see this 2020 case control study from BMJ for one example https://pubmed.ncbi.nlm.nih.gov/33115755/).

At Lifestyle Sleep we believe that menopause is a normal phase of life that is to be celebrated, not demonized. Research clearly shows that a healthy lifestyle including copious plants and low in ultraprocessed foods and added sugars plus regular exercise will reduce adverse symptoms of menopause substantially and allow both women and men to age as well as possible. We also believe the significant body of evidence showing that cognitive behavioral therapy is effective for both vasomotor and sleep symptoms (for instance, see https://pubmed.ncbi.nlm.nih.gov/27213646/).

I strongly urge you to read the recent Lancet series on Menopause (https://www.thelancet.com/series/menopause-2024) with describes “menopause as an ordinary, healthy phase of women's lives” and promotes “its demedicalisation”. I agree with the menopause series that ageism and industry are 2 major drivers of the recent push towards again using HRT in peri/post menopausal women. While I applaud the increased attention to menopause, I urge policy makers and public health workers to facilitate healthy lifestyle changes that will help all of us, men and women, to age as well as possible and, to quote the lancet series, “[a]ctively challeng[e] ageism and encourag[e] a more positive discourse”.

06/05/2024

Just got back from in Houston and, as always, I was inspired and humbled by all the amazing research people are doing in the field of Sleep. Some of the highlights were the Stanford Trainee Reunion, Dr. David Samson’s talk on The Human Sleep Paradox, and all the research showing worse mood and metabolic markers in teens and adults with later chronotypes. One thing I learned that I will incorporate into my practice (from a talk by the amazing Sean Drummond) is that bringing the patient’s partner into CBT-I can improve adherence and also strengthen the relationship between the couple. Thanks Houston, can’t wait to see everyone again next year in Seattle!

05/30/2024

Interesting article from the WSJ about Michael Gradisar’s recent review suggesting that blue light from screens before bed may not make it significantly more difficult to fall asleep at night: https://www.wsj.com/health/wellness/sleep-blue-light-screens-dbb796e7 (I’m quoted in the article near the end).

I agree with Dr. Gradisar’s general point, the contribution of evening blue light from screens to sleep onset timing is small to non-existent in most people. Some of the research he cites in the review article, however, does show significant melatonin suppression with evening screen use but we know that melatonin levels are only a minor factor in determining how quickly we fall asleep. Additionally, although the absolute brightness from screens is fairly low, ambient lighting containing blue light (such as that from cool and full-spectrum LED lights) can suppress melatonin levels and, in some studies, has been associated with delayed sleep timing. It is important to realize that saying blue light from screens does not make it harder to fall asleep is different than saying blue light in general has no effect on sleep. Also, kids and teens eyes are more sensitive to blue light than adults, so screen use before bed in these populations may indeed make it harder to fall asleep.

Overall, however, research suggests that exposure to sunlight during the day reduces the adverse effects of increased environmental blue light at night. The more time you spend outdoors, the greater the buffering effects. Even just working in an office with windows meaningfully improved sleep quality compared to a windowless office in one study.

What do I personally do for myself and kids?
I strive to spend as much time outdoors during the day as I can manage (again, I’m writing this post while working outdoors on my deck). The minimum I aim for is 2 hours per day but I’m almost always outdoors for at least 4 hours and frequently more than this (see another of my recent posts for advice on sun protection while outdoors). I go outdoors as soon after waking as possible (as long as the sun has already risen) and aim for at least 30 minutes of my total time spent outdoors to happen prior to 9AM. When indoors during the day, I keep the window shades open and full spectrum lights on as bright as possible.
In the evening starting around 7PM I actively try to reduce blue light in my ambient environment and screens (apart from sunlight). I use warmer colored LED lights in my home during this time and dim them a bit in the 30 minutes prior to bedtime. I don’t worry too much about looking at my phone/computer during this time but I will use the blue filter and dim the screen to the lowest comfortable level. After my typical bedtime and during the night (when the circadian system is most sensitive to blue light), I wear amber glasses if I must use a screen and keep any ambient lighting blue free and at the dimmest setting needed for whatever activity I’m doing.

The link between screens and sleep is more complicated than we thought.

05/28/2024

Great article from The Atlantic suggesting a more nuanced approach to sun protection recommendations: https://lnkd.in/gsbFfUPy

We know that spending time outdoors is essential to creating a healthy circadian rhythm. There is reasonably strong data showing that lack of adequate bright light exposure is a major causative factor in delayed sleep phase syndrome and other unusual sleep schedules as well as in mood disorders and possibly metabolic syndrome (see thread below for some references). In kids, lack of adequate time outdoors is a primary causative factor for myopia (see link below). I view it as an essential part of my job as a sleep, circadian and lifestyle medicine physician to help patients understand a more nuanced perspective of how to balance the risks verus benefits of sunlight exposure to optimize sleep and circadian health without increasing one's risk of skin cancer.

My general guidance is that you need to consider 4 factors in planning for safe sun exposure: skin Fitzpatrick type, latitude/altitude, season, whether reflective sunlight from water/snow is a factor. In summer it is wise for most people to avoid being in direct sunlight from 10AM-3PM by either staying in the shade or wearing protective clothing and a wide-brimmed hat. In the winter, people in northern latitudes with darker skin types may actually want to seek out direct sunlight during this same time to maximize vitamin D absorption. On water or snow sunglasses and sunscreen are a must. There is no one size fits all approach, we are all unique.

05/26/2024

I love this article from Slate on social prescriptions. This is exactly the kind of perspective we take at Lifestyle Sleep.

How connection, meaning, and resources can heal us.

05/02/2024

It's time to change the narrative on healthy sleep duration for adults! See my latest post on Medium.

It’s Time To Change The Recommendations On Sleep Duration for Healthy Adults