Sleep Science Still in Early Stages

-Rick Nauert, PhD

A new research review finds that sleep remains an enduring biological mystery with major clinical relevance.

Thomas Scammell, M.D., of Beth Israel Deaconess Medical Center (BIDMC) and colleagues discovered that in recent decades, new technologies have allowed neuroscientists to identify multiple brain circuits that govern the sleep/wake cycle, as well as the factors that can influence it, such as caffeine and light.

But the investigators also discovered the brain’s complexity is still a stumbling block in understanding sleep.

“In the last ten years, neuroscientists have had access to new tools with which we can test the roles of very specific neurons in the brain,” said lead author Scammell, a professor in the department of neurology at BIDMC.

“When we know the specific relevant players in the brain, it allows us to develop therapies to help people get to sleep or help sleepy people be more alert during the day.”

Specifically, two technologies developed since 2000 allow neurologists to switch specific neurons on or off. In a process called chemogenetics, researchers use drugs that have an effect only in a genetically-defined group of cells to determine the neurons’ role.

Optogenetics uses laser light to turn on or turn off targeted brain cells. These techniques have revealed which neuronal circuits promote wakefulness and sleep throughout the brain, especially in the brain stem and the hypothalamus.

“We can now interrogate neurons in a more precise way,” said Scammell. “The techniques are very similar, but optogenetics works over a short time scale, on the order of seconds. With chemogenetics, we can watch over several hours what happens when we turn certain neurons on or off.”

Sleep researchers have also made important discoveries about the fundamental chemistry of sleepiness in recent years. In a major breakthrough in the late 1990s, scientists discovered a previously unknown chemical, a neurotransmitter called orexin, required for maintaining long periods of wakefulness.

The loss of orexin production causes the common sleep disorder narcolepsy, which is characterized by chronic sleepiness and irregular REM sleep. Today, pharmaceutical companies make drugs that intentionally block the orexin system to treat insomnia. Researchers are also trying to develop drugs that mimic orexin to wake people up.

“A drug that acts like orexin could be as great for patients with narcolepsy as insulin is for people with diabetes,” said Scammell.

Neuroscience research has also revealed the brain circuity governing circadian rhythms, the biological clock that synchronizes sleepiness and wakefulness with night and day.

Located deep in the hypothalamus, the suprachiasmatic nucleus (SCN) regulates circadian rhythms and is capable of maintaining them for some time even in total darkness. However, the SCN is no match for the digital environment when it comes to people’s sleep habits.

“People increasingly use their electronic devices in bed, which tricks the brain into thinking it’s being exposed to daylight,” said Scammell. “The internal clock gets reset, making it much harder to wake up in the morning.”

Phones and tablets are just one of the reasons about a third of all American adults are sleep deprived, getting much less than the recommended seven to eight hours of sleep per night.

That raises more questions about why some people need more or less than that, and why some people can tolerate a sleep deficit so much better than others. The links among lack of sleep or poor sleep and metabolic disease, cancer risk, and mood disorders also require further study.

With each of the brain’s hundreds of thousands of neurons networked to each other, scientists will need a deeper knowledge of the brain’s inner workings to understand how the circuits that regulate sleep interact.

“There’s tremendous dialog back and forth among these circuits,” said Scammell, who said today’s technology allows scientists to monitor dozens of neurons at a time within one region of the brain.

“Our ability to record activity in just a handful of neurons simultaneously is still not anything close to understanding the whole brain, but at least it’s a step in the right direction.”

10 Ways to Beat Insomnia and Get Better Sleep

-Therese J. Borchard

Two-and-a-half years ago, I experienced a terrible case of insomnia. I took the sleeping drug Lunesta (eszopiclone), which afforded me a few wonderful nights’ sleep until I realized it substantially increased my anxiety during the day. Within a week on the drug, I became addicted, experiencing more and more withdrawal (anxiety) symptoms. Other sleep aids had the same effect — even over-the counter medications like Benadryl (diphenhydramine). So I was forced to figure out how to get my sleep back on track naturally.

I asked anyone I knew who had ever suffered from sleep problems for tips on catching some quality ZZZs, and spent lots of time researching ways to get some shut-eye without taking drugs. Although it felt like I was the only one awake at night, I certainly wasn’t alone. According to the Centers for Disease Control and Prevention (CDC), more than one-quarter of the U.S. population occasionally does not get enough sleep, while nearly 10 percent experience chronic insomnia. Sleep problems are associated with a number of chronic illnesses and, according to the CDC, are a real threat to our nation’s health.

For the last month I’ve been battling the beast of insomnia again — it’s common when you taper off of any medication — so I’m back to compiling techniques I’ve learned from other folks who lie awake at night.

Here are some natural remedies that have allowed them to get a better night’s sleep.

1. Herbal Teas

Many of my friends who suffer from sleep problems have benefitted from drinking different kinds of herbal teas an hour or two before they go to bed at night. You can make your own from dried herbs: Put a teaspoon of your mix into a tea ball or tea bag and add to hot water, or try some tea bags from a trusted boxed brand. You want to include or look for ingredients such as lavender, valerian, chamomile, passionflower, lemon balm, ashwagandha, holy basil, rosemary leaf, and dill seed. Some popular tea brands include Sleepytime, Yogi Tea (I like their Honey Lavender Stress Relief tea and Calming tea) and Traditional Medicinals (especially their organic Nighty Night tea and Cup of Calm tea).

2. Essential Oils

For nearly 6,000 years, essential oils have been used for therapeutic purposes — sleep issues included. Several people in my online depression community use lavender oil to help them relax before bed and to help them sleep. They either apply a few drops to their temples before going to bed at night or spray a lavender mist on their pillow. I’ve used lavender oil myself for about a year now, and I do think it’s helpful. Other calming essential oils include valerian, vetiver, roman chamomile, and marjoram.

3. Meditation and Relaxation Tapes

A few years ago when my daughter couldn’t sleep, we would listen to calming meditations by Lori Lite designed for children. They were very effective in helping her to relax her body and mind enough to drift off to sleep. There are all kinds of sleep meditations and apps on the market today. Mashable published a good list awhile back. Personally, I like the meditations by Jon Kabat-Zinn, PhD, founding director of the University of Massachusetts Medical School’s Center for Mindfulness in Medicine, Health Care, and Society in Worcester, as well as its stress reduction program.

Dr. Zinn’s voice soothes me more than any other meditation guide. A friend of mine swears by the meditations found on the free app CALM. Of course, you don’t need a guide to meditate. Sometimes just paying attention to your breath on your own — concentrating on your belly as it rises with each inhale and lowers with each exhale — or concentrating on a bodily sensation is a great way of calming yourself down.

4. Soothing Music and White Noise

Many of the apps listed above come with soothing music and white noise. Some nights, I’m not up for listening to instructions on how to relax each of my muscles or reminders to pay attention to my breath. I simply visualize myself lying by the ocean, listening to the waves on the shore, or I concentrate on my breath as I listen to nature sounds. So I have a few apps and soundtracks of just ocean waves and rain and water streams that are helpful for unwinding. Other people I know like to listen to soothing music, instrumental melodies, or simple white noise.

5. Cooler Temperatures

According to California-based clinical psychologist Arlene K. Unger, PhD, becoming overly heated is a common cause of sleeplessness. As one of the many helpful hints in her book Sleep: 50 Mindfulness and Relaxation Exercises for a Restful Night’s Sleep, she advises wearing lighter pajamas, keeping the window slightly open, and possibly ditching the heavy covers. I know people who sleep much better with a fan. The breeze and white noise create a conducive sleeping environment.

6. Melatonin and Other Natural Supplements

There are several natural supplements that can help relax the nervous system and assist sleep. The most common are melatonin, which regulates the sleep-wake cycle, and the amino acid l-theanine that’s typically found in teas. Valerian, GABA, kava, and 5-hydroxytryptophan (5-HTP) are others. I’ve found the combination of magnesium and calcium to be effective at times. Some natural sleep aids that combine various supplements include Neuroscience’s Kavinace Ultra PM, Genestra’s Calm-gen, and Nature Made’s Sleep supplement.

7. Epsom Salts Baths

Taking an Epsom salts bath in the evening has been one of the more effective parts of my sleep hygiene routine. Epsom salts are a mineral compound containing magnesium, sulfur, and oxygen. When used in a warm bath, they allow magnesium to be easily absorbed into the skin, which promotes a feeling of calm and relaxation.

According to a 2012 study in the journal Neuropharmacology, magnesium deficiencies induce anxiety, which is why the mineral is known as the original chill pill. I simply add two cups of the lavender-scented Epsom salts with added potassium and zinc to my bathwater. I then turn off the bathroom lights and use a lavender candle.

8. Prayer Beads and Mantras

You need not be a devout Catholic to use prayer beads: They’re employed in all of the world’s religions as part of meditative practices. The process of repeating a prayer or mantra over and over again while thumbing the beads can be very relaxing and soothing. Personally, I’ve slept with a rosary since I first experienced insomnia two years ago. The prayer beads have become my safety item, much like a child’s blankie, and give me comfort in the middle of the night when I wake.

9. Yoga

Any kind of yoga primes the parasympathetic system and promotes relaxation, taming the stress responses that cause insomnia. I’ve found hot yoga to be especially beneficial for sleep because, in addition to doing the healing postures, sweating releases stored toxins (so it’s very cleansing). Certain postures like these 19 listed in Yoga Journal are especially helpful for sleep. Doing them in the evening, or even when you wake at night, can soothe your central nervous system. Practicing Savasana (Corpse Pose) in particular before sleeping can promote deep rest, according to yoga instructors I know. There are also some apps you can download, like Yoga for Insomnia, that will help guide you through the postures.

10. Audiotapes and Free Lectures

Reading in periods of sleeplessness helps many folks I know doze off into slumber. But as a highly sensitive person, the light wakes me up. According to some Harvard research, all light-emitting e-books and screens negatively affect our sleep — even the Kindle. I therefore prefer to listen to audiotapes. Lately, I’ve been listening to the book Wherever You Go, There You Are by Kabat-Zinn. It’s a collection of small chapters about mindfulness that is effective at calming me down. Since audio books can be expensive, you might consider downloading university lectures, which are free content, from iTunes U — the section of Apple’s iTunes music store devoted to higher education.

Sleep Plays Key Role in Reducing Emotional Trauma

-Rick Nauert, PhD

Does sleep help individuals process stress and trauma, or does it actually intensify emotional reactions and memories of the event?

This previously unanswered question was addressed in a recent University of Zurich study.

Investigators discovered sleep, especially during the first 24 hours after a trauma, appears to play a key role in helping individuals manage the stress and emotional impact related to the event.

Experts say the knowledge is highly relevant for the prevention of trauma-related disorders, such as post-traumatic stress disorder (PTSD).

The way in which extremely distressing experiences are processed right at the outset can influence the further course and development of post-traumatic stress disorders.

PTSD patients experience highly emotional and distressing memories or even flashbacks where they feel as if they are experiencing their trauma all over again. Sleep could play a key role in processing what they have suffered.

In the new study conducted by a team from the Department of Psychology at the University of Zurich, researchers sought to determine the impact of sleep during the first 24 hours after a trauma.

To do this, investigators showed test subjects a traumatic video. The recurring memories of the images in the film that haunted the test subjects for a few days were recorded in detail in a diary.

Virtually out of the blue, the test subjects would see a snapshot of what they had seen in their mind’s eye, reawakening the unpleasant feelings and thoughts they had experienced during the film.

The quality of these memories resembles those of patients suffering from post-traumatic stress disorders. Other than after a traumatic event, however, they reliably disappear after a few days.

Investigators randomly assigned study participants to two groups. One slept in the lab for a night after the video while their sleep was recorded via an electroencephalograph (EEG); the other group remained awake.

“Our results reveal that people who slept after the film had fewer and less distressing recurring emotional memories than those who were awake,” explains first author Birgit Kleim.

“This supports the assumption that sleep may have a protective effect in the aftermath of traumatic experiences.”

On the one hand, sleep can help weaken emotions connected to an existing memory, such as fear caused by traumatic experiences, for instance.

Sleep also helps contextualize the recollections, process them informationally and store these memories. However, this process presumably takes several nights.

According to the authors of the study, recommendations on early treatments and dealing with traumatized people in the early phase are few and far between.

“Our approach offers an important non-invasive alternative to the current attempts to erase traumatic memories or treat them with medication,” says Birgit Kleim.

“The use of sleep might prove to be a suitable and natural early prevention strategy.”

Using Digital Devices Around Bedtime Can Disrupt Kids’ Sleep

-Rick Nauert, PhD

A new study discovers use of devices such as smartphones and tablets at bedtime more than doubles the risk of poor sleep in children.

Previous research suggests that 72 percent of children and 89 percent of adolescents have at least one device in their bedrooms and most are used near bedtime.

The speed at which these devices have developed — and their growing popularity among families — has outpaced research in this area, meaning that the impact on sleep is not well understood.

Researchers from Kings College, London reviewed 20 existing studies from four continents, involving more than 125,000 children aged six to 19 (with an average age of 15).

Their findings appear in JAMA Pediatrics.

Investigators discovered bedtime use of media devices was associated with an increased likelihood of inadequate sleep quantity, poor sleep quality, and excessive daytime sleepiness.

Bedtime use was classified as engagement with a device within 90 minutes of going to sleep.
They also found that the presence of a media device in the bedroom, even without use, was associated with an increased likelihood of poor sleep.

One potential reason for this is that the “always on” nature of social media and instant messaging means children are continuously engaged with devices in their environment, even when they are not actively using them.

It is thought that screen-based media devices adversely affect sleep through a variety of ways, including delaying or interrupting sleep time; psychologically stimulating the brain; and affecting sleep cycles, physiology, and alertness.

Sleep disturbance in childhood is known to have adverse effects on health, including poor diet, obesity, sedative behavior, reduced immune function, and stunted growth, as well as links with mental health issues.

Dr. Ben Carter from King’s College London, said, “Our study provides further proof of the detrimental effect of media devices on both sleep duration and quality.

“Sleep is an often undervalued but important part of children’s development, with a regular lack of sleep causing a variety of health problems. With the ever-growing popularity of portable media devices and their use in schools as a replacement for textbooks, the problem of poor sleep amongst children is likely to get worse.

“Our findings suggest that an integrated approach involving parents, teachers, and healthcare professionals is necessary to reduce access to these devices and encourage good sleeping habits near bedtime.”

What It Means When You Have a Bad Dream About Your Partner

Accurate or not, nightmares about your partner can be bad for your relationship.

Michelle Carr

Almost all dreams contain social situations, and most of these dreamed interactions involve friends, family, and frequently, our romantic partners. Some dream researchers believe that dreaming of a friend or partner acts as a simulation of a real-life relationship, and these dreamed simulations are a way for us to practice interacting with others and build relationships while we sleep. But could dreams also be detrimental to relationships?

A recent study published in The Journal of Social Psychological and Personality Science assessed how dreaming of a significant other may influence the way we act toward that partner the following day: Does a dreamed argument predict a conflict the next day? Does dreamed intimacy make you more affectionate the next day?

For the study, 61 undergraduate students at Stony Brook University who had been in a relationship for at least six months were selected to participate. The students kept both a daily dream diary and a daily record of their interactions with their partner for 14 days. For their dream reports, they were asked to write down their dreams immediately upon awakening and to include as much detail as possible. They were asked to specify the characters involved in the dreams, along with any thoughts or feelings they had concerning the interactions in the dream. Following the written report, subjects responded to a questionnaire about the dream’s emotion. They rated the amounts of negative emotion (anger, anxiety, stress, frustration, sadness); positive emotion (joy, affection, eroticism, calmness); jealousy (jealousy or betrayal); and guilt (guilt or embarrassment) in their dreams.

At the end of the day, subjects also recorded all of their waking interactions with their partner. They reported a daily measure of love/intimacy (e.g., How much love did you feel for/from your partner today?). They also assessed general interactions (How much interaction did you have with your partner? How much effort did you put towards your partner?). Finally, they reported any daily conflicts.

After the daily logs and dream reports were collected by the researchers, the dreams themselves were rated by judges. Judges scored the written dream reports first for the presence or absence of any content involving partners. Finally, the dreams were scored for specific content, such as the presence or absence of arguments, conflict, or infidelity.

A total of 842 dreams were collected; 53 of the 61 participants had had at least one dream of their partner. In general, the frequency of dreaming about a partner was associated with more interaction with them the following day. However, the researchers found that two dream variables predicted conflict on the next day:

Jealous dream emotion was related to more conflict on the following day.
Conflict in dreams was related to more conflict on the following day.

Besides conflict, the authors also found that dreamed infidelity predicted less love/intimacy the next day. It’s important to note that these correlations were unidirectional: It was the dreamed emotion that predicted the next days’ interactions, and not vice versa.

Overall, the results suggest that negative dream content regarding a partner—specifically jealousy, conflict, and infidelity—have detrimental effects on the next day’s interactions with a partner. On the other hand, more general emotions such as dreamed sadness were not related to the next day’s interactions.

It’s likely that dreamed infidelity and its accompanying jealousy are difficult to brush away upon awakening. Instead, these emotions may linger beneath the surface following a dream and act as a trigger for arguments during the day, or at the very least, get in the way of intimacy. Perhaps the best solution is to be aware that these emotions linger and remember to attribute them to the proper culprit—your dream, not your partner.

Dreamed infidelity may reflect underlying insecurities about a relationship that then manifest in the dream. In other words, if you are worried or afraid of losing someone, you will be more likely to have a negative dream about that person in which they leave you or are unfaithful. This only further exacerbates anxiety and insecurity in your waking life. It’s important to remember that the characters in your dreams are products of your own mind. Dreaming that your partner cheated on you does not make your partner guilty. It only says that you are worried or insecure about the relationship.

Being aware of and discussing dream content and emotions can be a valuable way to work through problems or insecurities in a relationship together. Ideally, with time, after discussing and confronting some of these insecurities, your dreams will also become more intimate and positive.

Do Your Dreams Have Meaning?

Understanding the aspects of sleep and significance of dreams.

Meir H. Kryger, MD

All people dream. Dreams, or the manifestations of dreaming – rapid eye movements (REMs), begin even before we are born and we continue to dream, usually between two to five times a night until we die. We forget almost all our dreams. Dreams can be fantastic, pleasant, frightening or mediocre, and reactions to them can be violent. Previous blogs have highlighted the sometimes violent nature of dreams. Dreams have been the stuff of philosophers, artists, writers, scientists, and therapists. Each of my books about sleep have sections about dreams. Scientists have shown us that REM sleep (when we dream) occurs in all animals studied to date and when we dream, our bodies enter a different physical state—we are paralyzed, and many body systems work differently. Our breathing and heartbeats can become erratic, for example.

Although many assume that the study of dreams began sometime in the last century, perhaps related to the introduction of psychoanalysis, this is not the case. For example, Aristotle wrote about dreams as early as 325 B.C.

In 54 B.C. Cicero in De re publica describes the Dream of Scipio. Scipio Aemilianus (the general who conquered Carthage in 146 B.C.) falls asleep and is visited in a dream by his grandfather (Scipio Africanus, the general who defeated Hannibal). In the dream, which includes images of the earth from above the universe and stars, the grandfather predicts that his grandson will defeat Carthage.

The Dream of Scipio had great impact. Macrobius, a Roman, in about 400 AD wrote a commentary about the Dream of Scipio, and described 5 types of dreams:

Somnium, an enigmatic mysterious dream requiring interpretation; think Freud and psychoanalyisis
Visio, a prophetic vision that predicts a future that comes true; think Jacob’s Dream in the Bible
Oraculum, prophetic dream in which an authority figure plays a role; think of the visions of Joan of Arc in which three saints instruct her to recover France from the English.
Insomnium, a nightmare or false or disturbing dream caused by a pathological condition; think the repetitive nightmares of PTSD
Visum, a nightmare that include apparitions and contact with supernatural beings; think Scrooge’s journeys into the past and future in Dickens’ Christmas Carol.

People in the process of dying have dreams and visions that have recently become topics for scientific research.

Visual artists have painted glorious images about dreams. These artists include Pablo Picasso, Henri Matisse, (1) Henri Rousseau (2) and many, many others, all of whom created a painting called The Dream. The images typically show a person sleeping in the foreground, presumably dreaming and at times, the rest of the image might represent the content of that person’s dream. Artists may also paint only the contents of a dream or nightmare (e.g. the fantastic jungle images of Rousseau.) Johannes Vermeer’s painting, A Maid Asleep, is gorgeous and has a prominent place on my book website.

How do you think about dreams, your’s other’s, and/or depictions of others? Like the wonderful diversity of dreams, there is a diversity in thinking about dreams. There may not be a right answer. Just as a therapist might try to tease the “meaning” and significance of a person’s description of a dream, one may try to understand an image about a dream. Following is an example based on the painting accompanying this blog post:

This painting is from a gallery which was part of an art school in Chongqing, China. The artist remains unknown despite contacts with the art school and artists in Chongqing and art experts in the US.Unknown artist

The picture shows so many wonderful aspects about sleep. It is a fluid story that tells us that before she fell asleep, the woman was reading and relaxed, admiring the peony in her hand (perhaps sent by a lover). The flower and the hand are dropping; she must now be in REM sleep (REM atonia). Her dream consists of images of peonies that are floating upwards from the real vase. The color of one of the flowers is the same as her cushion, which suggests a connection to reality. Daytime experiences can influence dreams (“Continuity hypothesis.”) (3) One can interpret or over-interpret such a picture and the dream. Freud interpreted a similar dream (From The Interpretation of Dreams, 1900, Chapter 6, Part 2, “The Dream-Work.”)

The Dream: “I arrange the center of a table with flowers for a birthday. On being questioned she states that in the dream she seemed to be at home (she has no home at the time) and experienced a feeling of happiness.”

The Interpretation: “The popular symbolism enables me to translate the dream for myself. It is the expression of her wish to be married. The table, with the flowers in the centre, is symbolic of herself and her genitals. She represents her future fulfilled, inasmuch as she is already occupied with the thoughts of the birth of a child, so the wedding has taken place long ago.”

I tend to seek a simpler interpretation of this work. It shows the beauty of sleep — and what can be better than a wonderful dream? We do not as yet know who painted this and we may never know. We do not know if the painter is a man or a woman. We do not know whether it is a self portrait and the painter is creating an image of herself, or whether the painter is the subject’s lover. The painter, whoever he or she is, beautifully expressed at once the beauty, complexity and simplicity of the dream. I wish I knew who painted this.*

Sleep Can Impact Relationship Satisfaction

-Rick Nauert, PhD

New research discovers that when husbands and wives get more sleep than on an average night, they are more satisfied with their marriages — at least the following day.

In the study, Florida State University psychology professor Dr. Jim McNulty and graduate student Heather Maranges hypothesize that sleep is linked to self-regulation or self-control, which influences how married couples feel and think about their partner.

“The universality of our findings is important,” Maranges said. “That is, we know all people need sleep. Regardless of the stage at which a couple is in their relationship or the cultural context in which they’re embedded, each member of the couple can be adversely affected by not getting enough sleep.”

The paper appears in the Journal of Family Psychology.

The researchers believe sleep influences self-control. Self-control requires energy that can be replenished when our bodies are in the resting period known as sleep. In other words, sleep offers self-regulatory benefits to relationships.

“Up to one-third of married or cohabiting adults report that sleep problems burden their relationship,” the researchers wrote in the paper.

Other sleep studies have indicated that even partial sleep deprivation can have harmful effects on processes that require self-regulation, like evaluating how you feel about your partner.

However, results in this study revealed that differences between couples’ sleep durations was not associated with differences in marital satisfaction. Because one couple gets more sleep than another does not mean that the couple that experienced more sleep viewed their marriage more favorably.

Maranges and McNulty conducted their research with 68 newlywed couples. Over a seven-day period, couples recorded the number of hours they slept and then responded to two sets of questions on a scale of one (not satisfied at all) to seven (extremely satisfied).

The first set measured overall relationship satisfaction, asking husbands and wives to respond to questions such as, “How satisfied were you with your marriage today?” The other set focused on relationship experiences in nine areas including chores, the amount of time spent together and conflict resolution.

Researchers discovered husbands especially were less negatively affected by bad experiences in those nine areas when they got more sleep. That is, sleep buffered the effects of specific negative events and evaluations on their broader, more general satisfaction with their marriages.

Although the study appears to have several important messages, a replication of the study among a wider variety of couples is necessary for universal acceptance of the findings.

For instance, the couples examined were primarily white, had been married less than six months and on average were 24 years old. They also said measures of sleep quality would provide more rigorous tests of the association between sleep and martial satisfaction.

Source: Florida State University

Sleep Disorders Among Vets on the Rise

-Traci Pedersen

U.S. military veterans were six times more likely to experience a sleep disorder in the year 2010 than they were in 2000, according to a new study of more than 9.7 million U.S. veterans published in the journal Sleep.

The largest increases were identified in patients with post-traumatic stress disorder (PTSD), other mental disorders, or combat experience. Veterans with cardiovascular disease, cancer, or other chronic diseases also experienced higher rates of sleep disorder diagnoses relative to those without comorbid conditions.

The findings also show that the prevalence of PTSD tripled during the 11-year study period.

“Veterans with PTSD had a very high sleep disorder prevalence of 16 percent, the highest among the various health conditions or other population characteristics that we examined,” said principal investigator and senior author James Burch, Ph.D., associate professor in the Department of Epidemiology and Biostatistics in the Arnold School of Public Health at the University of South Carolina.

“Because of the way this study was designed, this does not prove that PTSD caused the increase in sleep disorder diagnoses,” noted Burch, also a researcher at the WJB Dorn Department of Veterans Affairs Medical Center in Columbia, South Carolina.

“However, we recently completed a follow-up study, soon to be submitted for publication, that examined this issue in detail. In that study, a pre-existing history of PTSD was associated with an increased odds of sleep disorder onset.”

During the study period, the age-adjusted prevalence of sleep disorders increased from less than one percent in 2000 to nearly six percent in 2010. Sleep apnea was the most common sleep disorder diagnosis (47 percent) followed by insomnia (26 percent).

Sleep apnea is a sleep-related breathing disorder characterized by abnormalities of respiration during sleep, according to the American Academy of Sleep Medicine. The most common form of sleep apnea is obstructive sleep apnea, which involves repeated episodes of complete or partial upper airway obstruction occurring during sleep.

Insomnia is characterized by having frequent and persistent difficulty initiating or maintaining sleep that results in general sleep dissatisfaction and daytime impairment.

The study population consisted of all U.S. veterans seeking care in the Veterans Health Administration system between the years 2000 and 2010. Of the total sample of 9,786,778 veterans, 93 percent were men, and 751,502 were diagnosed with at least one sleep disorder.

Source: American Academy of Sleep Medicine

These 5 Foods and Substances Can Cause Anxiety and Insomnia

Before you reach for the medicine cabinet, take a look at your dinner plate.

Do you suffer from panic attacks or have trouble sleeping? If so, you may have tried stress reduction techniques or even medications, but has anyone ever asked you what you eat? It may surprise you to learn that certain everyday foods, some of which are considered healthy, have the capacity to overstimulate your nervous system just as powerfully as a stressful life event.

Medications may be helpful in managing your symptoms in the short term, but what if you could get to the root cause of the problem once and for all? If you identify which ingredients in your menu are working against you, you can gain control over your symptoms, avoid co-pays and side effects, and most importantly, protect your health from the damaging effects of internal biological stress.

When it comes to anxiety and insomnia, the foods listed below can be chemical triggers for anyone. Those at highest risk include women, people over 40, individuals with multiple chemical/medication sensitivities or allergies, and anyone with conditions affecting the digestive or immune system such as IBS, inflammatory bowel disease, or chemotherapy treatment.

Which foods are most likely to press your panic button?

1. Caffeine

Caffeine is a notorious nemesis in sleep and anxiety disorders. In a recent study of people with panic disorder, caffeine increased stress hormone levels in all participants and triggered panic attacks in about half of them. Caffeine keeps you awake by blocking sleep-promoting adenosine receptors in the brain. Even five hours after drinking caffeine, 50% of it remains in your bloodstream and has been shown to impair sleep. In fact, it takes a staggering 16 to 24 hours for caffeine to completely leave your system. This means that even a single morning cup of coffee may affect your sleep quality at night. To see if caffeine is your culprit, gradually cut back a little each day rather than going cold turkey to minimize withdrawal headaches, fatigue, and concentration problems.

2. Nightshades (potatoes, tomatoes, eggplant, peppers, and goji berries)

Plants in the nightshade family produce natural pesticides called glycoalkaloids, which are designed to kill predators like insects and worms, but are also toxic to human cells. These cunning chemical weapons block the enzyme acetylcholinesterase, resulting in overstimulation of the nervous system in sensitive individuals. Anxiety is just one of many neuropsychiatric side effects documented in humans. Common nightshade ingredients in prepared foods include potato starch, chilies, bell peppers, tomato paste, paprika, red pepper flakes and cayenne. Most people eat nightshades in some form every day, so glycoalkaloids may accumulate in your system over time. It takes at least five days for glycoalkaloids to clear your system, so you’ll need to remove these foods completely for a week or longer to see if they are bothering you. Cooking doesn’t destroy glycoalkaloids, but there are other simple ways to minimize your exposure.

3. Alcohol

Alcohol can be very effective in relaxing you and helping you fall asleep. However, as alcohol starts to wear off in the middle of the night, sleep quality suffers significantly. Metabolism varies depending on age, gender, genetic background and other factors, but the primary predictor of how long alcohol remains in your bloodstream is quantity. On average, each “drink” (1.5-oz shot, 12-oz beer, or 5-oz wine) takes two hours to clear your system: two drinks—four hours, three drinks—six hours, etc. As alcohol wears off, “mini-withdrawal” effects can range from restless sleep to bad dreams to full-blown panic attacks. If you’re in the habit of drinking every evening, cut back gradually to minimize potential for withdrawal, which can temporarily worsen sleep and anxiety problems.

4. Aged, fermented, cured, smoked, and cultured foods (salami, cheese, sauerkraut, red wine, etc.).

The way to turn a fresh whole food like beef, milk, grapes, or cabbage into a gourmet food like aged steak, brie, merlot, or kimchi is to add bacteria to it and let it ferment. During fermentation, bacteria break down food proteins into tiny molecules called biogenic amines, which accumulate as the food ages. The most important biogenic amine found lurking within aged foods is histamine, a powerful neurotransmitter that can aggravate our digestive, hormonal, cardiovascular, and nervous systems. Histamine causes anxiety and insomnia in susceptible individuals, partly through its ability to increase levels of adrenaline, our “fight-or-flight” hormone. Histamine is indestructible, so cooking and freezing don’t help. This article contains more detailed information, including meat, seafood, and beverage tables as well as food preparation tips to keep your histamine levels low.

5. Sugar, Flour, and other Refined Carbohydrates

All sugars and starches, except those that come in the form of a natural whole food like a piece of fruit or a sweet potato, are considered refined carbohydrates.

Popular breakfast foods like orange juice, sweet yogurts, and most cereals are rich in refined carbohydrates that start your day with a blood sugar spike, setting into motion a hormonal chain reaction that can affect your mood, energy, concentration, and appetite for hours. After insulin surges to bring your blood sugar down, the stress hormones cortisol and adrenaline rush in to prevent your blood sugar from crashing. Since most people eat refined carbohydrates like bread, chips, or noodles during lunch and dinner as well, they are essentially riding this invisible roller coaster 24 hours a day.

In this study, a single serving of a glucose-sweetened beverage caused adrenaline levels to double in adults and quadruple in children, not peaking until four hours after the drink was consumed.

Adrenaline causes panic symptoms like sweating, lightheadedness, and palpitations in sensitive people. These sensations are often mistaken for “hypoglycemia” (low blood glucose) even though in most cases, blood glucose doesn’t fall below normal.

The standard advice to people who feel panicky between meals is to eat carbohydrates every three hours to prevent blood sugar from dropping. However, that approach can actually worsen the problem over time by increasing your body’s dependence on sugar as well as your risk for insulin resistance.

It is much wiser to remove refined carbohydrates from the diet to prevent blood sugar from spiking in the first place. I recommend eliminating them for at least two weeks to see how you feel. It is best for all of us to permanently avoid these processed sugar sources anyway, so in taking this one small step toward identifying your dietary demons, you’ll be taking a giant leap toward overall good health.

Bottom Line

The most powerful way to change your brain chemistry is by changing how you eat. Keep a food and symptom journal to see if you notice any patterns, keeping in mind that some foods may not trigger symptoms until many hours later. What you discover may be the key to your peace of mind and a good night’s sleep.