Sunday, October 26, 2014

How the Daylight Savings Time Change Affects Sleep.

On Sunday, November 2, 2014 Daylight Savings Time ends for most Americans, a few days after Europe sets its clocks back an hour.
The modern idea of "daylight saving" was first proposed in 1895 by George Vernon Hudson of New Zealand, with Germany and Austria-Hungary organizing the first national implementation in 1916. Since then the concept has garnered its share of both advocates and critics from around the world; changing our clocks benefits retailing, sports, and other activities that are happy to exploit the extra hours of sunlight. Of course it can also disrupt meetings, travel and record keeping and cause multiple other scheduling issues.

On a personal level, moving our clocks in either direction changes our principal time cue -morning sunlight- which controls our 24-hour circadian rhythm track. This means that our internal clock falls out of sync with our current day-night cycle. Our ability to adapt to this depends on several things.

 Generally, "losing" an hour in the spring is more difficult to adjust to than "gaining" an hour in the fall. This is similar to the "flight lag" experienced in airplane travel; an earlier bedtime may cause difficulty falling asleep and increased wakefulness during the early part of the night. Conversely, setting the clocks back means we may fall asleep easily but can have a difficult time waking.

Our external time cues are called "zeitgeibers", and they include light, temperature, exercise and food/drink intake. It can take several days for our internal biological clock to re-synchronize with any new schedule, whether it's a clock change or a timezone difference. For some people, this can lead to disrupted sleep and feeling tired during the day (EDS).
Even if the actual time change doesn't affect your sleep, the change in seasons can; the lack of sunlight affects many people's moods despite a one hour change in time not being particularly important. For those who do feel affected, either physically or emotionally,  this misalignment between external cues and our internal body clock can also have more serious consequences.

For example, statistics have long shown that the risk of heart attacks spikes on Monday mornings. This is thought to be due to a combination of stress brought on through the anticipation of a new working week, and the sudden changes in our sleep-wake cycle. A recent study published in the AAC journal Open Heart looked at the rates of heart attacks before and after our clock changes over 4 years, and found a 25% increase on the Monday following the shift to daylight saving time; conversely, there was a 21% decrease in heart attacks when the clocks were rolled back in the Autumn.

One of the best sleep practices for the winter months is avoiding bright light exposure at night, which can delay the body's internal clock. This includes computers, tv's, cellphones and tablets - so they shouldn't be in the bedroom.
Routine is key for maintaining a consistent drive to sleep each evening. In the winter, with fewer hours of daylight overall, it’s important to seek out exposure to morning light if you can. Light is a strong cue for your  internal clock, and daylight ensures it remains synchronized to a 24-hour day even when your schedule changes slightly. Lack of light exposure during the day can result in a drift of the internal body clock to a longer than 24-hour rhythm, making it harder to get up in the morning in the winter. Here are some tips on how to make a smooth transition to the winter months:

  •  Start getting in sync early; try to eat, sleep, wake to the new time so that your circadian rhythm has a chance to adjust.
  • Exercise earlier in the day to keep your energy levels high and to ensure you’re tired enough to get to sleep ‘earlier’, but be sure to avoid the over-stimulation effect of evening exercise.
  • Get as much natural sunlight as possible: this will help adjust the body’s circadian rhythm. Dim lights in evening can help to induce sleepiness.
  •  Avoid alcohol and caffeine in the evenings and go for sleep-inducing foods and drinks.
  • Nap wisely: avoid taking naps after 4pm and try to keep naps to no more than 10 - 20 minutes.

For more information on healthy sleep habits or to get help for a sleep related problem, visit our website at

Sunday, October 19, 2014

Treating sleep problems improves conditions not typically considered by most physicians.

Over the past decade many Sleep Testing centers have opened throughout the country; most focus on evaluating patients with snoring complaints to determine if they have Obstructive Sleep Apnea (OSA). Once diagnosed these patients are typically placed on CPAP for treatment. Typically a second sleep study is performed to determine the best settings for the CPAP machine, with most centers taking the basic approach  rooted in standards developed when less was known about sleep abnormalities.

As a result, many patients who have abnormalities during sleep are not accurately diagnosed and patients are left without an effective treatment plan. Many patients may have a subtle breathing problem during sleep known as Upper Airway Resistance Syndrome (UARS). Patients with UARS have normal oxygen levels throughout the night and do not stop breathing, but they work harder to breathe and the increased effort causes brief disruptions called micro arousals. Recently accepted minimum standards in the field miss out on the identification of abnormalities such as UARS.

Some centers differentiate themselves in their ability to properly diagnose and treat patients with sleep disturbances by using refined approaches and assessing more sensitive parameters during sleep. Additionally, many conditions not typically thought to be rooted in abnormalities of sleep are now recognized and treated more effectively. In Houston, Jerald H. Simmons, MD, a Triple Board-Certified Neurologist specializing in sleep disorders, directs several sleep centers that clearly stand out from the crowd. His centers use methods beyond what is required by sleep centers for accreditation.

Dr. Simmons points out that "Every path has a starting point and we learn new things along the way. It is great that the field of Sleep Medicine is developing standards but unfortunately the current standards fall short of being able to properly diagnose and treat patients with complicated conditions. By identifying the more subtle abnormalities, we have been successful in providing care to patients who were previously left struggling by the health care system."

In example, a common cause for recurrent morning headaches is OSA or UARS. Many of these patients also have bruxism during sleep (clenching or grinding the teeth at night) and this can lead to TMJ Disorder. Research conducted by Dr. Simmons has shown that bruxism during sleep actually helps keep the airway open by moving the tongue and jaw forward; this is the body's attempt to prevent OSA or UARS. By treating the airway problems during sleep Dr. Simmons and Dental Sleep Specialist Dr.Ron Prehn have demonstrated improvement in both bruxing and TMJ pain.
When appropriate Dr. Simmons treats patients with OSA or UARS by using dental appliances as an alternative to the CPAP machine, and is performing pioneering research on the use of combined treatment approaches using both CPAP with dental appliances.

Additionally, most patients with fibromyalgia have poor sleep. Proper treatment of their sleep problems frequently improves the symptoms of Fibromyalgia. Signals from pain nerve fibers throughout the body constantly send a low level of signals to the brain, but the brain normally filters these out. If the brain is not properly rested it loses the ability to filter these signals which results in common fibromyalgia pain.
Treatments geared to improving sleep continuity restore the brain's pain filter mechanism, and the pain symptoms resolve.

The underlying sleep disturbances causing these symptoms is not always identified by sleep centers, and the treatment opportunities are missed. In many of these patients UARS can be at the root of the problem. Once the sleep disturbance is properly treated, fatigue resolves.

The sleep centers directed by Jerald H. Simmons, MD utilize advanced methods to properly diagnose and treat patients with conditions, such as those described above. Dr.Simmons concludes that "In the future we will look back and see how much we didn't understand, but unless we embrace the knowledge of our experience we will never reach that future perspective."

For more information on sleep disorders and the sleep centers of Dr. Simmons, visit and gain the knowledge you need to obtain a better night's sleep.

Wednesday, October 1, 2014

TMJ (TMD) and sleep Bruxism associated with OSA. Diagnosis and Treatment...

Temporal Mandibular Joint Dysfuntion (TMJ) causes pain and headaches in millions of people each year. This common problem is caused by clenching and grinding the teeth, typically while asleep.
 Research conducted by Dr. Jerald Simmons and Dr. Ronald Prehn has demonstrated that bruxism during sleep is the body's attempt to open up the airway and improve breathing, particularly for people who suffer from Obstructive Sleep Apnea. When Dr. Simmons has implemented treatments for OSA, such as CPAP or dental appliances (TAP or other mandibular advancing devices), their TMJ symptoms usually resolve.

Many of these patients can not be placed on a mandibular advancing dental appliance initially because of inflammation from the TMJ; once this improves through the use of other methods such as CPAP, then a mandibular advancing appliance can be used successfully. The physiology of this has been demonstrated and is explained by Dr. Simmons in this video.
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