Nov
13
2021

How to Fall Asleep Quicker

By | alcohol, Circadian rhythm, Diabetes, Insomnia, melatonin, Pain, sleep, Sleep apnea

Early October 2021 CNN had an article about how to fall asleep quicker. Most people take 15 to 20 minutes to fall asleep.

Sleep environment

It is important to arrange a sleep environment where you can sleep well. This includes bedroom darkening and keeping the room temperature of 60 to 67 degrees Fahrenheit (15 to 20 degrees Celsius). Make sure your bed is comfortable and use your bedroom only for sleeping and sex. Do not read in the bedroom, keep your cell phone in another room and do not have a TV or computer in the bedroom. These produce blue light, which stimulates your brain. This is exactly what you do not want to have in your bedroom.

Normal sleep duration for different ages

There are always exceptions to rules. In this case there is a rare gene that allows the carrier to sleep only 5 hours at night and still have normal energy during the day. It is called short sleep gene.

Here are the hours of sleep that everybody else needs every night in different age groups:

  • Adults: 7-8 hours
  • School-age children: 12 hours
  • Teenagers: 8-10 hours

If you get the proper hours of sleep, but you are still tired during the day, you may have a lack of quality of sleep. Older people often have to go to the bathroom several times during the night. As it takes some time to reach the deepest level of sleep at night (REM sleep) older people often miss significant amounts of REM sleep during which they dream. The end result is a lack of energy during the day.

Conditions that interrupt your sleep

There are some medical conditions that can interfere with a good night’s sleep. Obstructive sleep apnea is one such condition that 25 million Americans have. A person with this kind of condition snores, gasps, chokes or stops breathing periodically during the course of the night. Restless leg syndrome is another condition, which interferes with a restful, deep sleep. Other conditions are chronic pain, heart disease, diabetes, asthma and gastroesophageal reflux. Medication can affect sleep depth as well.

Falling asleep naturally

Despite many studies it is not clear why some people have no problem falling asleep while others find it difficult. Taking 10 to 20 minutes of falling asleep is normal. If you cannot fall asleep after 20 minutes of trying, go to a dim room and do something calming until you feel drowsy again. Then return to your bed. Follow the same procedure, if you wake up in the middle of the night and you have difficulties falling asleep again. Deep breathing, yoga and meditation are proven remedies to pipe down and help you to fall asleep.

Monitoring sleep at a sleep clinic

A sleep study can be very helpful in diagnosing sleep disturbances.  The sleep expert measures several body functions simultaneously. These are heart rate, air flow, blood oxygen level, breathing rate, brain wave activity, muscle movements and eye movements. During a night sleep study, a polysomnogram records all these body functions automatically. The finding helps the sleep expert to diagnose and treat the sleep disturbance.

Self-help supplements for insomnia

My regular sleep supplement every night is 3 mg of melatonin.

Sometimes this is not enough, because I watched an exciting movie or I wrote too much for Quora online. When I can’t fall asleep within 30 minutes, I take a capsule of 500 mg of valerian root. I would say that this helps in 95% of the nights to fall asleep.

If for some reason I still can’t fall asleep, I use 25 drops of  Passion Flower Extract:  I find that this is very reliable and puts me to sleep within 15 to 20 minutes of taking it. This way I am avoiding prescription narcotics and I am not getting addicted to benzodiazepines. The last step (Passion Flower Extract) I require only once or twice a month. The chemical in the Passion Flower Extract is very similar to benzodiazepines, which means you don’t want to take this every night or your system could get addicted to it.

How to Fall Asleep Quicker

How to Fall Asleep Quicker

Conclusion

Falling asleep is something we all can learn. It starts with a quiet and relaxing bedroom ambience. We need to allow for enough sleep duration. Adults need 7 to 8 hours of sleep, children and youth more. Deep breathing, yoga and meditation are proven remedies to prepare you to fall asleep easier. When all fails there are a number of self-help supplements you can take to help you ease into sleep. If you still have problems falling asleep a sleep study can be very helpful in diagnosing sleep disturbances. In a sleep clinic your heart rate, air flow, blood oxygen level, breathing rate, brain wave activity, muscle movements and eye movements are recorded with a polysomnogram. The doctor from the sleep clinic can formulate the diagnosis of the sleep disorder and help you overcome any identified problems.

The subchapter “Self-help supplements for insomnia” was published by me earlier here.

Jun
26
2021

Being A Morning Person Can Prevent Depression

By | Anxiety, Cancer, Cardiovascular disease, Circadian rhythm, coffee, depression, Gastrointestinal Disease, heart attack, Insomnia, Lung Disease, Mortality, neurological disease, telomeres

A British study concluded that being a morning person can prevent depression. It was reviewed also in CNN. The study used sleep data from 85,000 UK participants in the Great Britain Biobank Study. They wore wrist activity monitors that provided sleep data. Researchers compared the sleep data with the self-reported mood changes. They found that if the sleep pattern is misaligned with the circadian rhythm, those who are night owls are at a higher risk of developing mood disorders. The controls were those who were morning persons. They were not affected by the misalignment effect.

Normal sleep pattern

Natural sleep habit or the circadian rhythm starts between 10 PM and 11 PM and continues for 7 to 8 hours. Your hormones are replenished during your sleep. This helps your body’s hormones and the immune system to restore itself overnight.

“The health problems associated with being a night owl are likely a result of being a night owl living in a morning person’s world, which leads to disruption in their body’s circadian rhythms”. This is what sleep specialist Kristen Knutson said. She is an associate professor of neurology and preventive medicine at Northwestern University Feinberg School of Medicine.

Reclaim your natural sleep habit

The key is to learn to live within your circadian rhythm pattern. Caffeine is a powerful stimulant and will stop you from falling asleep. For this reason, it is best to avoid caffeine-containing beverages. If you cannot live without your favourite cup of java, switch to the decaffeinated version. Stop using LED lights (from TV, computers, tablets or smartphones) 2 hours prior to your bedtime. Use dark curtains and enjoy a comfortable bed. Maybe read that thriller, earlier in the day instead of making it your bedtime story. And do yourself a favour: you do not need the eleven o’clock news on TV!  They will probably stop you from falling asleep. Go to sleep between 10PM and 11PM.

Children can have problems with sleep disturbances and depression

Another study published March 22, 2021 in the Jama Network showed that depression had an association with sleep disturbances in youth and children.

A meta-analysis of 16 publications looked at depression and disturbed sleep. It showed that depression was 1.5-fold higher in sleep disturbed youths/children compared to controls with a normal sleep pattern.

Other studies re. being a morning person can prevent depression

Another study with Dr. Knutson as the lead author appeared in 2018. The authors found that various health conditions, mood disorders and mortality were on the increase the more the sleep rhythm deviated from the circadian rhythm. Morning persons were protected from this effect. But night shift workers and night owls were at a higher risk of disease. Specifically, they found the following associations for evening types.

  • Evening types compared to morning types had a 1.94-fold risk of psychological disorders
  • The risk of diabetes was 1.30-fold for evening types
  • Neurological disorders had a 1.25-fold risk in evening types
  • Gastrointestinal/abdominal disorders occurred 1.23-fold more often in evening types
  • respiratory disorders were 1.22-fold more common in evening types
  • Evening types had a 10% increased risk of all-cause mortality

The researchers concluded that externally imposed timing of work and social activities has potentially serious health consequences.

Circadian misalignment responsible for disease

Dr. Knutson also said: “Circadian misalignment could also lead to inadequate sleep duration and quality, which could also impair mood and exacerbate mood disorders.”

In other words, circadian misalignment to circadian rhythm problems. This can cause mood disturbances, but eventually lead to the diseases listed above.

Evidence of health risks in night shifts workers

The medical literature is full of examples that the health of night shift workers is significantly affected by circadian misalignment. Here are a few examples.

1.Here is a random selection to illustrate the health risks of night shifts workers. A study from 2015 examined the sleep patterns of 315 shift nurses and health care workers in Iranian teaching hospitals. They found that 83.2% suffered from poor sleep and half of them had moderate to excessive sleepiness when they were awake.

2.This South Korean study examined 244 male workers, aged 20 to 39 in a manufacturing plant. Researchers compared blood tests from daytime workers to blood tests from night shift workers. They also obtained inflammatory markers like the C-reactive protein and leukocyte counts. Night shift workers had significantly higher values. The investigators concluded that shift workers have increased inflammatory markers. This is a sign of a higher risk of developing cardiovascular disease in the future.

Higher mortality and higher cancer risk in nighttime workers

3. A Swedish study found that white-collar shift workers had a 2.6-fold higher mortality over a control group of daytime white-collar workers.

4. Another study compared night workers in the age group of 45 to 54 with daytime workers and found a 1.47-fold higher mortality rate in the night shift workers.

5.In a study from China 25,377 participants were part of a study that investigated cancer risk in males with more than 20 years of night shift work. They had a 2.03-fold increased risk to develop cancer compared to males working day shifts. Women with night shift work in this study showed no effect with regard to cancer development.

Healthy telomeres with healthy sleep pattern

It is true that you can suffer multiple health problems, as all of your hormones depend on the resetting during your deepest sleep between 2AM and 4AM triggered by the nighttime melatonin response. Even your telomeres, the caps of chromosomes in every cell get shortened from too much stress and too little sleep.

One example of such a study comes from Milan, Italy. https://oem.bmj.com/content/75/Suppl_2/A480.1

In this 2018 study researchers compared 46 nurses who had worked in night shifts with 51 nurses working day shifts. Among the night shift workers breast cancer was common, but not among day workers.

Shortened telomeres, hypomethylation of BRC1 gene and p53 gene

In the night shift nurses from Milan there was hypomethylation of the breast cancer gene BRC1. There was also hypomethylation of the general cancer gene p53. At the same time significant telomere shortening occurred in night shift nurses who had worked night shifts for more than 15 years. This likely all worked together in causing night nurses to develop breast cancer more frequently.

Shortened telomeres mean a shortened life span. The reason for this is that people with shortened telomeres develop heart attacks, strokes and cancer. This is what shortens the life span. How do we avoid this risk? Go back to healthy sleep habits. As mentioned above it is best to start going to sleep between 10PM and 11PM and sleep for 7 to 8 hours. Night owls delay going to sleep by 2 to 3 hours.

Being A Morning Person Can Prevent Depression

Being A Morning Person Can Prevent Depression (click image to enlarge)

Conclusion

A publication in Molecular Psychiatry demonstrated that evening person (night owls) are more likely to develop depression. This is in comparison to morning persons. As discussed, other researchers showed that evening persons also can develop diabetes and neurological disorders. In addition, respiratory disorders and gastrointestinal disorders are more common in night owls as well. When it comes to mortality, evening persons have a 10% increase of mortality over morning persons. There is a large body of literature regarding diseases of night shift workers. Night Shift work is perhaps the most extreme example of a circadian misalignment. It leads to poor sleep, inflammation in the body, increased cancer risk and higher mortality compared to day shift workers.

Prevent telomere shortening

Even the telomeres get shortened in night owls and night shift workers. We can prevent problems like these by going to bed in time and sleeping according to our circadian rhythm. If you had a poor night’s sleep, make up for it with the help of an afternoon nap. Do not sleep all afternoon though; half an hour or one hour will be enough. Even a short, restful nap after coming home from work can restore your feeling of wellness.

Jan
09
2021

Melatonin Is More Than a Sleeping Aid

By | Alzheimer’s disease, Anti-aging medicine, Autism, autoimmune disease, Cancer, Cardiovascular disease, Circadian rhythm, Dementia, Diabetes, Health, heart attack, Heart Disease, Hormones, immune system, Inflammation, Insomnia, melatonin, Menopause, mitochondria, Multiple sclerosis, neurological disease, Osteoporosis, Parkinson’s disease, sleep, Stroke

Notably, the January 2021 issue of the Life Extension magazine informs you that melatonin is more than a sleeping aid. It contains an interview between Dr. Roman Rozencwaig and a Life Extension (LE) magazine reporter. It must be remembered that Dr. Rozencwaig dedicated much of his career to the healing effects of melatonin. Another keypoint is that in 1987 Dr. Rozencwaig published a paper together with two other researchers. Specifically, it showed that melatonin production by the pineal gland declines in older age. Markedly, they stated that this is the reason why people age and why diseases of aging develop. Another key point is that Dr. Rozencwaig also stated that taking oral melatonin can promote a healthier life.

Melatonin deficiency causing aging and various illnesses

With the aging process the pineal gland calcifies and melatonin production is steadily declining. Surely, along with this is a deterioration of the circadian hormone rhythm. Meanwhile, the neuroendocrine system in the brain gets disorganized. Accordingly, this causes various diseases to occur. To emphasize, Dr. Rozencwaig says that a proper balance between melatonin and neurotransmitters is what we need to maintain health and longevity. As a result, a daily intake of melatonin supports healthy aging and longevity.

The many clinical effects of melatonin

Oral melatonin tablets help you to fall asleep easier, particularly the population that is older than 60 years.

But besides that, melatonin has many other clinical effects.

  • Melatonin improves immunity, which improves resistance against infections. It helps also in cancer prevention
  • Melatonin maintains the circadian hormone rhythm by synchronizing pituitary and hypothalamic hormone production
  • It protects the brain and may prevent Parkinson’s disease, Alzheimer’s disease, multiple sclerosis, autism, and others
  • Melatonin modulates anti-inflammatory cytokinins in different diseases

Dr. Rozencwaig mentioned that melatonin slows down the aging process. There are multiple intertwining reasons for this. 

Melatonin’s actions against the aging process 

  • Melatonin regulates gene expression. This means that some signs and symptoms of aging can be reversed through genetic switches
  • Because melatonin regulates the immune response, the body is more protected against viral, bacterial and parasitic infections
  • Melatonin helps to overcome chronic inflammation that produces cytokines
  • Melatonin is also liver-protective through stimulation of an enzyme (AMPK). This enzyme regulates cellular metabolism.
  • There are other processes that melatonin is involved in: energy metabolism by protection and restoration of mitochondria.
  • Melatonin protects against osteoporosis by balancing and regulating bone formation versus bone loss.

More actions of melatonin

  • An important function of melatonin is the stimulation of antioxidant enzymes like glutathione peroxidase and superoxide dismutase (SOD)
  • Melatonin regulates sirtuins, which are proteins that maintain cellular health. They protect you from obesity, type 2 diabetes, cancer, heart attacks and strokes, dementia and more
  • As already mentioned, melatonin is a neuroprotective agent and may prevent Alzheimer’s and dementia
  • Melatonin stimulates apoptosis of cancer cells.
  • Oral health and melatonin are related. Melatonin suppresses herpes infections and periodontal disease. Melatonin prevents oral cancers to a certain degree. In addition, dental implants survive better when melatonin is present in saliva.

Prevention of cognitive decline

Dr. Rozencwaig mentioned that melatonin stops much of the cognitive decline of aging. To achieve this the following processes take place.

  1. Melatonin improves the sleeping pattern and increases the amount of REM sleep.
  2. During sleep melatonin removes toxic amyloid and tau proteins. We know that with Alzheimer’s disease these are the proteins that accumulate in the brain.
  3. Melatonin improves myelination of white matter in the brain. This prevents brain atrophy of old age.
  4. The brain is metabolically very active and produces toxic free radicals. But melatonin is a strong antioxidant dealing with free radicals. Melatonin can cross the blood brain barrier and stimulates enzyme production to eliminate toxic reactive oxygen species.
  5. Chronic inflammation also increases with age, but melatonin deals with this condition in the brain.
  6. Here are 3 subtypes of melatonin receptors. The body integrates the multitude of actions of melatonin with the help of these receptors.
Melatonin Is More Than a Sleeping Aid

Melatonin Is More Than a Sleeping Aid

Conclusion

Melatonin is a powerful antioxidant that has many other useful protective qualities as explained. The body integrates various functions like anti-aging, anti-free radical activity, neuroprotection in the brain and more. Melatonin even synchronizes pituitary and hypothalamic hormone production. This helps to integrate the effect of melatonin, which benefits the body in many ways. Melatonin prevents Parkinson’s and Alzheimer’s disease, multiple sclerosis, autism, obesity, type 2 diabetes, cancer, heart attacks, strokes and dementia. Melatonin production deteriorates from the age of about 60 onwards. It is important to supplement with melatonin at nighttime from that age on. Usually, you only need small amounts of melatonin, between 1mg and 3 mg at bedtime. This prevents most of the serious diseases of old age, stimulates your immune system and lets you age gracefully.

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Oct
17
2020

What can Happen to Your Body Over Months of Isolation

By | Cardiovascular disease, Circadian rhythm, diet, exercise, fasting mimicking diet, Fitness, heart attack, melatonin, Obesity, Processed food, sleep, Stroke, vaccinations

A recent article by CNN describes what can happen to your body over months of isolation at home. The article is rather negative showing all the possible things that can go wrong. I have been isolated as well since March 2020. I handle the isolation differently than described in the article. I will comment to each point what can be done differently to avoid the complications mentioned.

Muscle loss

The CNN article makes the point that inactivity can make you lose muscle bulk within only one week. A lack of exercise weakens your muscle strength. And muscle strength has been associated with longevity.

My comment:

I do a brisk walk of 5 to 7 kilometers daily. This maintains my muscle bulk. But I have a treadmill in the basement and a couple of weights that I can use, if it rains outside.

There is a danger that heart and lungs get weaker

You need to raise your heart rate and you also need to perfuse your lungs through exercise. Many people do not like exercise. They sit in front of the TV for hours or they surf the net on the computer. Even just reading a book does not give you enough exercise to get your heart rate up and increase your lung perfusion.

My comment:

A brisk walk with proper distancing gives you fresh air, exercises your muscles, your heart and your lungs. It maintains your cardiovascular fitness.

Weight gain

Being home all the time allows you to look into the fridge more often and eat snacks that are processed. People tend to eat more often than 3 times a day. The end result is that you gain weight. In the beginning of the epidemic people stocked up on non-perishable foods. Often they contain more sugar and carbohydrates. Consuming these foods leads to weight gain. Wearing masks, frequent hand washing, isolation practices and change of normal routines makes people get stressed. Stress leads to overeating and weight gain.

My comment:

In the last 6 months that I did home isolation my body mass index (BMI) stayed in the 21.0 to 22.0 range. I ate three meals a day. I avoided processed foods as they are overloaded with sugar, salt and refined carbs. Once a month I do a 5-day fasting mimicking diet according to Dr. Longo. This ensures that my BMI stays within the range I indicated. Otherwise I eat a Mediterranean diet, which is anti-inflammatory.

Your posture could suffer

When you are seated in front of the computer or the TV you tend to engage in poor postures. This can lead to strains of your back, neck, shoulders and hips. Staring at the computer screen or the TV can also give you eye strain.

My comment:

The key is movement, such as getting up and walking around; doing other activities like lawn mowing, weed eating or doing dishes. This interrupts any longer stretch of bad posture.

Your sleep quality can suffer

The more exposure to sunlight during the day you get, the more vitamin D you produce in the skin. Some people lack the necessary enzymes in the skin to convert cholesterol into vitamin D. But exposure to sunlight also helps to reinforce your diurnal hormone rhythm. This is also called circadian rhythm. Avoid blue lights (TV, computer, iPhones etc.) in the evening before bedtime as this can interfere with a deep sleep later. Also go to bed early enough (between 10 and 11 PM) to allow your circadian rhythm to take over.

My comment:

Some people (above the age of 60) benefit from 3 mg of melatonin at bedtime. After the age of 60 people no longer produce enough melatonin in the pineal gland. If I wake up in the middle of the night, I take another 3 mg of melatonin prior to 3AM. Caution: after 3 AM melatonin can give you a bit of a hangover in the morning.

Your brain can slow down

The brain needs nutrition and exercise. Exercise can eliminate certain amino acid by-products that otherwise turn into neurotoxins. With exercise you even prevent neurotoxins to enter the brain.

My comment:

I find that I must at least do a brisk walk of 4 kilometers a day. It prevents back pain, helps me sleep better and keeps my mind clear. But as mentioned earlier I prefer doing a brisk walk for 5 to 7 kilometers a day. In the past (prior to March 2020 when the Covid-19 pandemic started) I went to the gym every day. When it finally reopened, they had one Covid-19 case at the gym. I decided that it is too dangerous to go back to the gym until a safe Covid-19 vaccine is available in the summer of 2021. I feel the same way about flying. It is not worth the risk. I can just stay local and do my own program. The pleasure of traveling can wait until the summer of next year.

What can Happen to Your Body Over Months of Isolation

What can Happen to Your Body Over Months of Isolation

Conclusion

A recent CNN article described the dangers of passively staying in home isolation. I felt that this article was on the negative side. I found that by including a regular brisk walking program into my daily lifestyle the day got more structured. I felt I had more energy and I had no aches or pains. If I spent too much time watching TV or spending in front of the computer, I developed back aches and felt sluggish. I incorporated a 5-day fasting mimicking diet according to Dr. Longo once per month into my regular Mediterranean diet. This allowed me to keep my body mass index in the 21.0- 22.0 range. Doing what I described above I could continue to hold my weight, have energy and stay pain free for many more months. But when the Covid-19 vaccine arrives in spring/summer of 2021 I hope that things will return to normal.

Oct
10
2020

Medical Myths about Aging

By | andropause, cholesterol, Circadian rhythm, Dementia, diet, exercise, fractures, heart attack, High Blood Pressure, Hormones, lung cancer, Menopause, Mortality, Obesity, Pain, Smoking, Stroke

Medical myths about aging are easy to debunk. Many people believe that it is inevitable that they become disabled as they age, their lives become unbearable, without passion, boring and full of pain. Some aspects of your health may decline with age, none of the myths discussed below is inevitably happening in everyone. Studies showed that a positive outlook on aging and life in general will help you to live longer and stay healthier.  Here I discuss 7 common myths about aging.

Myth 1: Everyone will experience physical deterioration

It is common for people to experience reduced muscle strength, increased blood pressure, excessive fat accumulation and osteoporosis. A study with 148 older patients showed that an expectation of reduced fitness in older age actually resulted in less physical activity when older age arrived.

But you can maintain good cardiovascular function and good muscle strength with a regular exercise program.  This study showed that men and women can reduce mortality by exercising regularly, even in older age.

Myth 2: Older adults cannot exercise

There are several reasons why older people stop exercising or are afraid to start exercising. People use the excuse of their arthritis getting worse from exercise. But studies showed the opposite: joint function improves and joint pains are getting better with exercise. Your muscles get stronger and you are less likely to fall. Your heart and lungs are improving their functions and your mentation improves. Exercise increases the HDL cholesterol, which reduces the risk for heart attacks and strokes.

Myth 3: As we age, we need less sleep

For many years there was the notion that older people need less sleep. What was not known then was that people above the age of 60 have no appreciable secretion of melatonin from the pineal gland. But when they replace their melatonin deficiency by taking a nighttime dose of 3 mg at bedtime, they will sleep better and longer. They may need a second dose of melatonin in the middle of the night. We need 7 to 8 hours of sleep at night for our diurnal hormone rhythm.

This will also slow down our aging clock.

Myth 4: Your brain slows as you age

Dementia is common when you get older. 13.9% have it at age 71 and older. 37.4% have dementia over the age of 90. But the majority, namely 86.1% in the 71+ age group and 62.6% above the age of 90 do not have dementia. A Mayo Clinic study showed that when the person engaged in artistic activities in midlife or later in life the risk for mild cognitive impairment (MCI) development was reduced by 73%, involvement in crafts reduced it by 45% and engagement in social activities by 55%. In a surprise finding the use of a computer late in life was associated with a 53% reduction in MCI development. These are very significant observations.

Physical activity reduces risk for dementia

Apart from stimulating your brain, physical activities also significantly reduce the risk for dementia. A synopsis of 11 such studies showed that dementia is reduced by 30% when physical activity is started in midlife and the person is aging compared to non-exercisers.

Myth 5: Osteoporosis occurs only in women

There is a serious misunderstanding about osteoporosis. Several factors work together that can cause osteoporosis. Women in menopause are more likely to develop it due to the missing ovarian hormones estrogen and progesterone. These hormones work together and stimulate vitamin D induced calcium deposition into bone as well as decreasing bone resorption.

Vitamin K2 also deposits calcium into the bone. In postmenopausal women who take bioidentical hormone replacement, vitamin D and K2 the bone density remains strong. Unfortunately, the opposite is true in postmenopausal women who take synthetic hormones. Synthetic hormones have side chains that do not fit the natural hormone receptors of a woman. This is why osteoporosis persist. And, yes, men get osteoporosis, but typically 10 years later. Typically, they get into andropause where testosterone production declines 10 years later.

Myth 6: People stop sex as they age

With age men can develop erectile dysfunction (ED) and women vaginal dryness, both of which can interfere with having sex. A large study showed that only 0.4% of men in the age group 18-29 had ED. In the age group of 60-69 there were 11.5% who suffered from ED. What this means though is that 88.5% of men age 60-69 did not suffer from ED. Fortunately for those who have ED drugs like Cialis and Viagra can correct their problem and they can have regular sex. What a change from 25 years ago when none of these drugs were available (approval of Viagra by FDA in 1998 and of Cialis in 2003).

Bioidentical hormone replacement beyond menopause and andropause preserves your normal sex drive as well. There are additional benefits of bioidentical hormones. They have positive effects on the heart, brain, bones and the muscle mass.

Myth 7: It is too late to stop smoking now

One of the myths that many older smokers like to say is that it would be too late to stop smoking. They think the damage to heart and lungs is permanent and quitting now is too late. Fact is that quitting smoking immediately improves your blood circulation and gives you more oxygen. In just 1 year the risk of getting a heart attack is cut into half. In 10 years, the risk of a heart attack or stroke is the same as that of non-smokers. There is a reduction of getting lung cancer by half.

Medical Myths About Aging

Medical Myths about Aging

Conclusion

There are all kinds of medical myths about aging. We may think that physical deterioration is inevitable. Or we believe that older people cannot exercise. And we cannot help it, but our brain slows down as we get older. And there is the question whether we need less sleep as we age. Osteoporosis is a disease of women, is it not? These older couples, they don’t have sex any more, do they? And is it too late to stop smoking now that I am 65 years old? All of these myths exist, but there is a need to debunk them.

The truth behind the medical myths about aging

I explained in detail what the medical truths are behind these questions. Many of these myths have developed in the past. But with regular exercise, balanced nutrition (Mediterranean diet) and a positive attitude much of these old myths can be overcome. Bioidentical hormone replacement when hormones are missing is another powerful tool. Yes, we all age. But we are still living and can enjoy life as long as it lasts.

Oct
12
2019

Naps For Heart Health

By | Circadian rhythm, diet, heart attack, Heart Disease, Hormones, Mortality, Stroke

In an article published online Sept. 9, 2019 a Swiss research group mentions naps for heart health. Specifically, they observed 3462 subjects over 5.3 years. The ones who napped for 5 minutes to an hour once or twice per week had 48% less heart attacks, strokes or heart failure than those who did not take naps during the day. When the researchers constructed survival curves, people who did not nap had the worst survival curves. On the other hand, the persons who napped once or twice per week had the best survival curves. The ones who napped 3 to 5 times per week or 6 to 7 times per week were in between the other survival curves.

Naps for heart health with adrenal gland fatigue

Adrenal gland fatigue is one of the clinical conditions where we know that naps rebuild energy. This is a hormone weakness where the adrenal glands can have reduced hormone production. The location of our adrenal glands is right above the kidneys. These hormone glands have a circadian rhythm. The highest amount of adrenal gland hormones production occurs in the morning and there is a gradual decline throughout the day. Our meals (breakfast, lunch and dinner) as well as any snacks lead to mini peaks of the adrenal gland hormone production. If we get enough sleep, there is no excessive stress in our lives and we do not smoke or abuse alcohol and drugs, most people will not know that they have adrenal glands as they are quietly working in the background. However, your adrenal glands may function in the lower end of normal bordering to adrenal gland fatigue.

Power naps during the day can normalize your adrenal gland hormones

When you take a power nap during the day, your adrenal gland hormone production normalizes. This makes you feel good and energetic. Patients who have adrenal gland fatigue feel more energy when they remove sugar and refined carbs from their diet. They also feel more energy when they have small snacks halfway through the morning and afternoon. Vitamin C as a supplement is useful as it stabilizes adrenal gland hormone production.

Discussion of the Swiss research regarding naps for heart health

There was no medical explanation given regarding why napping prolongs life. But it is entirely possible that those people who unknowingly have borderline adrenal gland fatigue are responding to building up their adrenal gland production. We know from the literature that stress kills. It would make sense that if the ACTH/adrenal gland hormone system is functioning better, mortality would be reduced. From people in Spain that value their “siesta” during the early afternoon we know that they are doing something right. Their life expectancy was an impressive 82.83 years in 2016 compared to 78.69 years for the US average. 

Naps For Heart Health

Naps For Heart Health

Conclusion

A Swiss study observed 3462 subjects over 5.3 years. The ones who napped during the day for 5 minutes to an hour had 48% less heart attacks, strokes or heart failure than those who did not take naps during the day. This resulted in less mortality of those who napped during the day. The researchers had no explanation for this observation. When I reviewed the literature regarding adrenal gland fatigue, I was impressed by the fact that many borderline patients get help from power naps and snacks of food between meals. Their ACTH/cortisol production can normalize this way and they survive better. At this point we do not know for sure why a nap reduces heart attacks, strokes and heart failure. 

More about adrenal gland fatigue here.

Jul
21
2018

Frequent Flying Can Increase Cancer Rates

By | breast cancer, Cancer, cervical cancer, Circadian rhythm, immune system, lung cancer, prostate cancer

A review article from June 25, 2018 discusses that frequent flying can increase cancer rates. A study showed that cancer of the breast, cervix, skin, thyroid and uterus are about twice as common in female stewardesses than in women at large. Also, gastrointestinal system cancers including cancer of the colon, stomach, esophagus, liver and pancreatic cancers are more common. This observation was true in both male and female flying personnel who engage in frequent flying. This publication comes from a scientific paper published on June 26, 2018.

Study of flight attendants

Patients from the National Health and Nutrition Examination Survey (NHANES) served as a control for flight attendants. This control group consisted of 2729 patients; they were of a similar socioeconomic status as the flight attendants. In contrast there were 5366 flight attendants with much higher cancer rates than normally expected. Specifically breast cancer had a 1.51-fold higher frequency than the control group. Melanoma had a frequency of 2.27-fold in comparison to controls, and non-melanoma cancers had a cancer rate of 4.09-fold when compared to controls. Non-melanoma cancer cases include basal cell and squamous cell carcinomas.

Cancer rates in pilots

In a meta-analysis of various studies it became obvious that pilots had 20% more prostate cancer than a non-pilot control group. However their mortality was not higher than controls.

In an interesting study spanning over 60 years Icelandic airline pilots underwent an analysis for cancer development.

83 cancers were registered. The general population (non-pilots) served as controls.  There was an increase of 2.42-fold for all cancers compared to controls. Prostate cancer was higher in these pilots by 2.57-fold. Malignant melanoma had a 9.88-fold increase in pilots in comparison to controls. The basal cell carcinomas in these pilots were 3.61-fold more common than the rates in the controls. With regard to basal cell carcinomas of the trunk there were 6.65-fold more of them in comparison to controls.

The difference between the pilots and the general population was likely due to the higher exposure to cosmic radiation. This is what the authors concluded.

How does cancer develop?

There are several ways cancer can develop. One of the known cancer causations is ionizing radiation. We know a lot about this from the atom bombs of WWII in Japan. There were many more thyroid cancers in children than were normal following the dropping of the atom bombs.

But diagnostic CT scans and X-rays are not without risk of cancer development either. There is a lag period of 10 to 20 years and even longer. But after this time the higher cancer rate becomes measurable. A person who had a CT scan done as a diagnostic test in childhood will still have a 25% higher cancer rate 15 years later. This is how powerful radiation of the DNA of our cells is despite inherent repair mechanisms that fight back to keep things normal.

Single cancers versus multiple cancers

It is interesting that female stewardesses and male pilots came down with a mix of various cancers. There were skin cancers, breast cancers, cancers of the prostate and many gastrointestinal cancers. The numbers were not big enough to show statistical significance for leukemia also being a likely cause of cancer from cosmic radiation.

If cosmic radiation was going through the body randomly hitting various DNA strands in all cell types, which could explain why a random number of cancers develop in those cells that got the highest exposure. The ones who got above average cancer were stewardesses and pilots who were longest on their jobs. A variety of cancers would develop from various tissues. This is exactly what the studies have shown. Radiation exposure following the Fukushima disaster led to thousands of thyroid cancers.

There are frequent flyers like business travelers and vacation seeking retirees who will also be at a higher risk of developing cancer. The more they fly, the higher the risk.

Other causes of cancer

Cosmic radiation is only one cause of cancer. There are many other causes of cancer. If you smoke heavily or abuse alcohol this can cause genetic mutations of cells that can develop into cancer. There is a pathway to cancer, which consists of initiation, promotion and progression. After those initial hurdles the cancer cell will multiply and start metastasizing into other areas of the body.

Carcinogens can damage the DNA of cells. In the case of pollution carcinogens enter the body through the air. But consuming processed meat and red meat has a proven link to cancer development as well, namely colon cancer.

Diverse factors all can cause cancer

Chronic inflammation from chronic infections is also carcinogenic. Chronic gastritis is caused by H. pylori. After years of infection with this pathogen stomach cancer can develop. Hepatitis viruses that are chronically present in liver cells can be the cause of liver cancer. Human papilloma virus (HPV) is the cause for the development of cancer of the cervix. The majority of cancer is caused from the environment or by poor life styles. Only 5 to 10% of cancers are inherited.

Tumor suppressor genes are important in terms of resisting the development of cancer. The TP53 gene produces a protein that interferes with the multiplication of cancer cells. Cancer cells in turn can produce a protein that interferes with TP53 function. The end result is that it will interfere with the body’s immune system to produce killer T cells. This way the cancer has the upper hand. There are some herbs that have shown anti-cancer effects, such as curcumin. https://www.askdrray.com/curcumin-and-cancer/. As I explain in this blog, there are absorption problems with curcumin presently. It is not yet primetime for curcumin, but it could be once the absorption problems are overcome. Nevertheless the research surrounding curcumin is interesting.

Frequent Flying Can Increase Cancer Rates

Frequent Flying Can Increase Cancer Rates

Conclusion

Several interesting studies have shown that stewardesses, pilots and frequent airplane travellers have a higher risk of developing cancer. Research groups have been careful to control these studies for lifestyle factors and other causes of cancer. Exposure to cosmic radiation is the common culprit that is behind this cancer causation. There was a multitude of cancers rather than one single type of cancer in pilots and stewardesses. This makes it more plausible that it is indeed cosmic radiation that caused the cancer increase. But cancer development is complex, and I have summarized this briefly here. It is important to be aware of all the possible causes of cancer. This allows you to minimize your exposure to carcinogens. We all get exposure to carcinogens from pollution. In addition we get exposure to cosmic radiation according to how much time we spend flying to holiday destinations or on business trips. Be safe and be informed!

Nov
05
2016

Health Risks Of Night Shifts

By | Cancer, Cardiovascular disease, Circadian rhythm, Diabetes, immune system, Mortality, Obesity, sleep

One of the news stories in 2016 was about health risks of night shifts. The Bureau of Labor Statistics reported in 2000 that 15 million workers (16.8 % of the working population) were doing alternative shifts (night shift work mixed with daytime shifts). In 2016 they reported 14.8% were working alternate shifts. Among blacks, Asians and Latino Americans the percentage of working alternative shifts was higher, namely 20.8%, 15.7% and 16%, respectively.

Shift work is more common in certain industries, such as protective services like the police force, food services, health services and transportation.

Evidence of health risks of night shifts

1.There are several publications that showed evidence of health risks of night shift workers. Here is a random selection to illustrate the health risks of night shifts.A study from 2015 examined the sleep patterns of 315 shift nurses and health care workers in Iranian teaching hospitals. They found that 83.2% suffered from poor sleep and half of them had moderate to excessive sleepiness when they were awake.

2.This South Korean study examined 244 male workers, aged 20 to 39 in a manufacturing plant. Researchers compared blood tests from daytime workers to blood tests from night shift workers. They also obtained inflammatory markers like the C-reactive protein and leukocyte counts. Night shift workers had significantly higher values. The investigators concluded that shift workers have increased inflammatory markers. This is a sign of a higher risk of developing cardiovascular disease in the future.

Higher mortality and higher cancer risk in nighttime workers

3. A Swedish study found that white-collar shift workers had a 2.6-fold higher mortality over a control group of daytime white-collar workers.

4. Another study compared night workers in the age group of 45 to 54 with daytime workers and found a 1.47-fold higher mortality rate in the night shift workers.

5.In a study from China 25,377 participants were included in a study that investigated cancer risk in males with more than 20 years of night shift work. They had a 2.03-fold increased risk to develop cancer compared to males working day shifts. Women with night shift work in this study showed no effect with regard to cancer development.

BMI and estrogen levels higher in women nighttime workers

6.A Polish study examined hormones and the body mass index (BMI) among 263 women who worked night shifts and 269 women who worked day shifts. When night shift workers had worked more than 15 years at nights, their estrogen levels, particularly in postmenopausal women were elevated compared to the daytime workers who served as controls. The BMI was also increased in the nighttime workers.

Risk for chronic lymphocytic leukemia higher in nighttime workers

7.Chronic lymphocytic leukemia (CLL): a study in Spain showed that working for more than 20 years in rotating night shifts was associated with a 1.77-fold higher risk of developing CLL. The authors noted that melatonin levels in that group were much lower than in controls that worked only day shifts. Working in straight night shifts did not show higher risks of CLL compared to daytime workers.

8. In a Korean study from Seoul 100 female medical technologist who worked nighttime had their melatonin levels tested, which were compared to daytime workers.  They measured 1.84 pg/mL of melatonin for the nighttime workers compared to 4.04 pg/mL of melatonin in the daytime workers. The authors felt that this is proof that the diurnal hormone system has been disrupted. Altering the melatonin level also changes the circadian hormone rhythm.

Flatter cortisol curves at night in nighttime workers, also increased diabetes risk

9.A group of 168 female hospital employees doing rotating nightshift work in Southern Ontario hospitals were compared to 160 day workers. Cortisol production was assessed. Cortisol production in day workers and in shift workers on their day shift was similar. However, shift workers on their night shift had flatter cortisol curves and produced less cortisol. The authors felt that this disruption of cortisol production would explain why rotating night shift workers have a higher risk of cardiovascular diseases.

10.A Danish study with female nurses followed 28,731 nurses between 1993 and 2015. Researchers measured the incidence of diabetes in rotating nighttime nurses in comparison to the data from daytime nurses. Night shift workers had a risk between 1.58-fold to 1.99-fold when compared to daytime workers to develop diabetes. The risk for evening shift workers was less (between 1.29-fold and 1.59-fold).

Diurnal hormone rhythm behind health risks of night shifts

Your body has its own rules. It rewards you, if you sleep 7 to 8 hours during the night, but it will penalize you severely, if you turn it upside down. The reason is our built-in diurnal hormone rhythm. A peak of melatonin regulates sleep during the night. Melatonin is released by the pineal gland (on the base of the skull) when it gets dark outside. Daytime wakefulness regulates the release of the stress hormone cortisol from the adrenal glands. These two hormones inhibit each other, cortisol inhibits melatonin and melatonin inhibits cortisol. All the other hormones are also regulated according to the diurnal rhythm: testosterone is highest in the morning, human growth hormone is highest between midnight and 3 AM etc.

Adjustment of the diurnal hormone system

When you work daytime shifts, your diurnal hormone rhythm works just fine. But if you work nighttime shifts, your hormones have to adapt. This is very similar to traveling east or west where you cross several time zones. Your internal diurnal hormone system has to adjust to these changes. Typically it takes 1 day to adjust to a 1-hour time zone difference.

Rotating shift workers have the highest risk of getting sick

In people who work permanent night shifts, the hormone changes stay adjusted and there is no further switching. But most employers want to be “fair” to everybody, so they introduced the rotating night shifts. The publications above show that this is the worst thing you can do. It messes with your diurnal hormone rhythm, and some people never switch completely to the new hours worked. They don’t get enough daytime sleep because the kids are loud during the day etc. The rotating shift workers are running the highest risk of getting sick. The get cancer, diabetes, cardiovascular diseases, obesity, cancer, leukemia, and they have low levels of melatonin.

Health Risks Of Night Shifts

Health Risks Of Night Shifts

Conclusion

Shift workers working constant night shifts is less stressful than the more common rotating shift work. This is where you work night shifts for a period of time. Then the schedule switches to day shift, and you keep on rotating. The least health risks occur with regular daytime work. People exposed to rotating night shifts suffer from poor sleep. They have a higher risk of gaining weight, getting obese and acquiring diabetes in time. They are at a higher risk for heart attacks, strokes and cancer. All-cause mortality is about twofold higher than for workers who work day shifts.

The underlying problem seems to be a disturbance of the diurnal hormone rhythm. Normally this regulates our waking/sleeping rhythm and keeps us healthy. But with nighttime work melatonin production weakens, there is less cortisol production and hormone rejuvenation during rest periods suffers greatly. This weakens the immune system, allows cancer to develop and leads to chronic inflammation causing cardiovascular disease and diabetes. The remedy to prevent this from happening is to catch little naps whenever you can during the day. And, if at all possible, work daytime shifts permanently.

Jul
30
2016

LED Streetlights Can Be Harmful

By | Circadian rhythm

The American Medical Association (AMA) has just released a new policy recommendation and statement that LED streetlights can be harmful. After meticulous reviews of the research on the effect of white LED streetlights and their effect on health the AMA decided that it needed to publish its recommendations so that city fathers have some guidelines for illuminating their cities.

Cost and energy savings from white streetlights

Many cities in the US have already switched from the yellowish traditional streetlights to the high-intensity LED lighting. The cities did this unilaterally without consulting health professionals or the public. The cities wanted to save money by using white LED lights. But as we will discover below there are serious health consequences to this.

Historic lighting solutions

We did not always have streetlights. Physicists use Kelvin units (K) to measure the intensity of light. The term“color temperature” (CT) is in us to describe color composition. Before Benjamin Franklin and Thomas Edison invented electricity we burnt candles and wood at night. This produced a light of 1800 K, which was yellow and red with hardly any blue. Next came incandescent light bulbs. They have a color temperature of 2400 K, which contains less blue and more yellow and red. The new light source is the LED light, which contains a lot more blue color and appears to us as white light. The color temperature is around 4000 K to 5000 K.

LED streetlights can be harmful to your health

Who would have thought that switching streetlights could have anything to do with your health? The newest LED street lights are emitting large amounts of blue light. Our eyes perceive this as white light, but it also creates nighttime glare, much more so than conventional lighting. Eye discomfort from blue-rich LED lighting can interfere with visual acuity and cause road hazards. The blue-rich LED streetlights happen to operate at the wavelength that suppresses melatonin during the night. Researchers believe that the white LED lamps cause interference with the important circadian sleep rhythm. This effect is much stronger with the white LED lights in comparison to the conventional streetlights. The interference with the sleep rhythm means that there is less sleep time. The sleep subjects reported that their sleep quality was unsatisfactory. There is daytime sleepiness and impaired daytime functioning. White light LED lights can even cause obesity.

Effect of white LED light on animals

Animals can also react to white LED light. The bright outdoor LED lights disturb many species that need a dark environment. Poorly designed LED lighting disorients some birds. Researchers detected that insects, turtles and certain fish species also experience disturbance in their habitat by white LED lights. US national parks have adopted lighting designs that reduce the effects of light pollution on wildlife. So far nobody has shown any concern, what light pollution does to humans!

AMA guidelines to reduce impact of white LED lights

The AMA has come out with new guidelines to help reduce the impact of white LED light. Instead of high-intensity white streetlights the AMA recommends to communities to use the lowest emission of blue light possible to reduce glare. The AMA has recommended a color temperature of no more than 3000 K. This type of light has more of a mix of blue, green, yellow and red in it and very little white. In contrast the CT of bright LED streetlights have 4000 K to 5000 K. This contains a lot of blue light, which appears as white to the eye. Seattle and New York belong to the cities that recently had their streetlights retrofitted to the white LED streetlights.

American Medical Association (AMA) recommendation

According to the AMA guidelines these lights should now be refitted again. The AMA also recommends that the lights should be shielded to minimize glare and the detrimental effect on humans and the environment. There should also be a possibility of dimming the lights in off-peak periods.

Evidence from medical literature that LED streetlights can be harmful

Here I am reviewing what has been found in the medical literature about white LED lighting that is now preferably used in street lighting.

Cataracts caused by high color temperature

A Chinese lab tested epithelial cell lines derived from human lenses under a variety of light sources. The lab had previously established that oxidative stress on epithelial cells from human lenses was the most important factor for developing cataracts in humans. Human epithelial cells were cultured in the presence of different LED light frequencies. A high color temperature of 7378 K caused damage to the epithelium while controls of lower color temperatures of 2954 K and 5624 K LED lights did not. The authors concluded that white LED light with a high color temperature could cause significant photobiological damage to human lens epithelial cells. This in turn can cause cataracts and legal blindness.

Human retinal cell cultures damaged by white LED light

Another research group studied human epithelial pigment retinal cells in tissue culture. They exposed the tissue cultures to various light frequencies, namely white, blue, green or red LED light. Reactive oxygen and DNA damage were assessed. The white light showed the highest amount of damage to the human retinal cell in culture.

Intermittent exposure to white LED light in long-term care residents

In a trial on senior long-term care home residents researchers found that intermittent exposure to bright light (versus red light) showed positive cognitive effects on the seniors. It is not clear why with respect to cognitive function there is a positive finding using white LED lights, while the other tests mentioned above showed negative effects on the lens and the retina of the eyes.

Blue light filters for night shift workers

In another investigation blue light filters were employed in night shift workers and the investigators detected beneficial health effects. In animal experiments the same results were found.

Normally in shift workers cancer, heart disease, metabolic disturbances, depression, anxiety disorders and reproductive problems are found.

 

LED Streetlights Can Be Harmful

LED Streetlights Can Be Harmful

Conclusion

Despite the evidence in the medical literature showing that yellow lights are better than the newer white LED lights, cities have been converting the yellow streetlights to white LED streetlights. It makes economic sense, but harms people. The American Medical Association is attempting to convince authorities to use common sense. The AMA wrote guidelines and hopes that city fathers will reconsider their decisions. If you are concerned, voice your opinion by talking to your political representative.

Jul
25
2015

Light Can Interrupt Your Circadian Rhythm

By | Cardiovascular disease, Circadian rhythm, Sleeep

A light bulb company from Florida has decided to put warning labels on the light bulbs they manufacture to tell you that artificial light can have health consequences: light can interrupt your circadian rhythms.We do not easily see that it should matter whether you use artificial light at night or not.

Introduction

What we do know is that in the evening when we close our eyes and shut out the light the melatonin production gets elevated, we get sleepy, and we fall asleep. During our sleep the immune system receives a boost from the higher melatonin blood concentration, while cortisol takes a rest and levels are lower overnight. Melatonin is also a powerful anti-cancer agent and this would fit in with the study that found that a loss of the clock gene in shift workers was correlating to a worse prognosis regarding their breast cancer.

There are other diseases that can develop when the circadian rhythm is not maintained. Here are a few examples: neurodegenerative disease, cancer, depression, and sleep disorders.

This link shows how the internal central clock in the suprachiasmatic nucleus of the hypothalamus is responsible for keeping time inside of us. The suprachiasmatic nucleus is situated just above the optic chiasm, hence the name.

The clock gene influences the peripheral clock via the clock genes in each organ to be synchronized. If you disregard your internal clock, expose yourself to prolonged artificial lighting and delay going to sleep in time you will create a disorganized central/peripheral rhythm, which weakens the immune system, disrupts your normal hormone rhythms, and ultimately this can lead to disease.

Breast cancer from interrupted circadian rhythm

Women in California were followed with regard to developing breast cancer and nightly exposure to artificial light.

In this study the authors found a 1.34-fold higher breast cancer risk in premenstrual women exposed to high levels of ambient light at night compared to women who were not.

Similarly, a 2014 study showed a difference with regard to breast cancer rates in women who were working night shifts and women who worked normal hours.

The study showed a loss of clock genes in shift workers with breast cancer that was associated with a worse prognosis of their breast cancer compared to those who were not shift workers and had normal clock genes.

Is it a good idea to tell people that light bulbs can be harmful?

Fred Maxik, the Florida based Lighting Science Group chief officer thinks it is a good idea. Dr. Paolo Sassone-Corsi, the director of the Center of Epigenetics and Metabolism at the school of medicine at University of California Irvine who has authored many studies on the negative effect of artificial lighting on the circadian rhythm also thinks that labeling light bulbs is a good idea. He cautions that there are even more powerful light sources like TV’s and computers that can disrupt the circadian rhythm the later it gets in the evening. “And think about how many people look at Facebook at 2 a.m. That is way more disruptive, but this is certainly a good start; we need to keep increasing awareness in a larger population that light at the wrong time of day can harm you” Dr. Sassone-Corsi added.

It is somewhat nebulous what effects a disruption of the circadian rhythm has in our system. But we do know that sleep deprivation can cause overeating and obesity, memory loss, short attention span, diabetes, depression, car accidents, sudden cardiac arrest and sudden cardiac death due to deadly electrical heart rhythms (ventricular fibrillation).

This 2015 study suggests that melatonin should be used to treat people who are involved in shift work. This will help to reset the circadian rhythm to normal.

Origin of circadian rhythm disorders

Sleep disorders can start in childhood, usually when school starts with structured days and normal bedtime hours, followed by school holidays and weekends where late bedtime hours or irregular sleep habits are the rule. Circadian rhythm disorders are not disorders of sleep quality, but rather disorders in timing of sleep (Ref.1). Circadian rhythm disorders start usually when the child enters school, but can develop as late as in adolescence. 10 to 18% of children and adolescents have circadian rhythm disorders. It is not known why some children find it easy to switch between the irregular sleeping habits of summer to the regular sleeping habits during school days. But others are not able to switch and have problems in school with inattention, daytime sleepiness, irritability, hyperactivity and combativeness. Circadian rhythm disorder tends to persist and can turn into adult circadian rhythm disorder. There are also morning types and evening types (in medical lingo morning chronotypes and evening chronotypes).

Delayed sleep phase disorder

One of the most frequent subtypes of circadian rhythm disorder is the delayed sleep phase disorder. This is what is often found in adolescents who push for a later and later bedtime. The fact that they sleep in until 11 AM or 1 PM reinforces it. They like to shut their windows with a black curtain to keep the sunlight out. At night they like to spend time in front of a computer or the TV. They like to go to sleep only at 1, 2 or 3 AM. They may not be aware what is happening to them: the lack of morning sunlight exposure in the early morning hours of the day leads to a delayed setting of the dim light melatonin onset (DLMO) at the end of the day, which is regulated through the suprachiasmatic nucleus (a part of the hypothalamus). By taking frequent blood or saliva melatonin levels researchers have been able to measure corresponding melatonin levels at the time of the DLMO.

We know from research with astronauts in space travel that melanopsin is produced in the blue-light-sensitive photopigment in the ganglion cell layer of the eye. Melanopsin travels from there along the optic nerve into the suprachiasmatic nucleus, where it helps to set the circadian rhythm for the day.

The day is defined by first opening our eyes when we wake up, getting the first melanopsin dose in the circadian rhythm headquarters of the hypothalamus; two yours before we fall asleep we have the dim light melatonin onset where melatonin is just starting to rise, which makes us gradually tired. Maybe the cave men and women sat around the fireplace and told each other stories. We could listen to soft music in a less brightly lit area.

Treatment of delayed sleep phase disorder

It is important to note that people with a delayed sleep phase disorder (DSPD) do not have a sleep disorder: they have normal sleep at an abnormal time (Ref.1)

Here is how the sleep specialist treats delayed sleep phase disorder.

  1. Exposure to sunlight or to blue LED light at the time of awakening for 20 minutes to 1 hour is key to resetting the circadian rhythm to an earlier point than has been the case. This involves that the child, adolescent or adult has to get used to setting an alarm clock to a desired time in the morning. In order the preserve the resetting of the circadian rhythm towards the evening it is important that from 5 to 6 PM in the evening exposure to the bright lights is avoided. This includes light emission from TV’s, i-phones or computers. The eye would otherwise reset the circadian rhythm via the melanopsin mechanism to a later time.
  2. Melatonin treatment is used to advance or delay circadian rhythms. Melatonin also has a sedating effect, but only about 20% respond to that within 30 minutes by falling asleep. The doses in commercial products override the circadian rhythm effect. Sleep experts use much smaller doses of melatonin to reset the internal clock. Thinking of an adolescent who goes to sleep at 2 AM, the DLMO would be at midnight. To phase advance an individual like that a small amount of melatonin (0.5 to 1.0 mg) would be given at 6 to 8 PM (that is 4 to 6 hours before the DMLO point or 6 to 8 hours before the previous bedtime). The morning exposure to bright light works together with the early evening dose of a tiny dose of melatonin, which by itself is not enough to put the person to sleep at that time.
  3. Supportive sleep hygiene methods: It is important that the parents understand the underlying problem. If necessary, they may have to seek the advice of a sleep expert and discuss the details with him/her. 2 hours prior to bedtime the child needs to be exposed to dim light, which is light that does not have blue light in it. The level of dimness is such that reading is difficult. No TV, no cell phone or I pad is allowed. In this dim light atmosphere melatonin is expressed normally and will be produced and released by the pineal gland in higher amounts. Establish a regular bedtime with which all family members can agree. This is best kept on school days, holidays and weekends. If you would sleep in, you would switch your time machine in your head to another time zone further west and it would be an effort to switch it back! There are many children and adolescents who can switch back and forth easily, but the person with DSPD cannot switch easily and would get stuck again in the familiar late sleeping pattern.

Avoid cola and other caffeinated beverages, including green tea, as they stimulate. The bedroom should be dark, quiet and comfortable. Sound machines have not been shown to enhance sleep (Ref.1).

Light Can Interrupt Your Circadian Rhythm

Light Can Interrupt Your Circadian Rhythm

Conclusion

Circadian rhythm disturbances are more common than previously thought of. There is a certain percentage of children who enter the school system that develop delayed sleep phase disorder. This often stays with them into adolescence and can even carry on into adulthood. Two simple tools have been shown to treat this: early morning light exposure for 20 minutes to 1 hour and a small dose of evening melatonin to reset the circadian rhythm. There likely are thousands of untreated people with circadian rhythm disorders. As not all circadian rhythm disorders are the same it is advisable to seek the advice of sleep disorder expert, if sleep patterns are problematic.

 

References:

1. John H. Herman, Chapter 5, 35-43. “Circadian Rhythm Disorders”

Principles and Practice of Pediatric Sleep Medicine

Second Edition. Stephen H. Sheldon et al., 2014, Elsevier Inc.