Tagged Sleep

Grind Your Teeth? Your Night Guard May Not Be the Right Fix

Grind Your Teeth? Your Night Guard May Not Be the Right Fix

Some experts say tooth-grinding is a behavior rather than a disorder, and the dentist’s chair isn’t the best place to address it.

Credit…Jon Han

  • Feb. 16, 2021, 5:00 a.m. ET

Everyday stressors like a report due at work, the refrigerator breaking and the dog throwing up can sometimes make you want to grit your teeth. But layer on top of that a pandemic, economic uncertainty and political upheaval, and you might start to give your jaw a serious workout — gritting and grinding with as much as 250 pounds of force.

Dentists have reported an increase in patients with tooth fractures since the start of the pandemic, which they attribute to bruxism, the technical term for gritting, grinding or clenching your teeth. Thought to be precipitated or exacerbated by stress and anxiety, bruxism is largely subconscious and often occurs during sleep. Most people don’t know they grind their teeth unless a dentist tells them so, based on tooth wear. Less obvious indicators include itchy or plugged ears, neck pain and even premature aging of the face.

Expensive acrylic or rubber mouth or bite guards — often called night guards — are typically prescribed as a prophylactic.

While night guards may help to prevent some dental wear and tear, some studies suggest they can be ineffective or even make the problem worse. This has led some experts in the fields of dentistry, neuroscience, psychology and orthopedics to say there needs to be a paradigm shift in our understanding of the causes and treatment of bruxism. They say it is a behavior, like yawning, belching or sneezing, rather than a disorder.

“It’s not abnormal to brux,” said Frank Lobbezoo, a bruxism researcher and professor and chair of the Academic Center for Dentistry Amsterdam in the Netherlands. “In fact, it can be good for you.”

Sleep studies indicate that the majority of people have three or more bursts of activity in the jaw’s masseter muscle (your major chewing muscle) during the night. It also happens during non-REM sleep. So, contrary to popular belief, you’re not doing it while you are dreaming.

Moreover, the evidence suggests that this muscular activity can have the salubrious effect of opening up your airway to allow in more oxygen. Clenching and grinding also stimulates salivary glands to lubricate a dry mouth and neutralize gastric acid. As a result, experts say it can be dangerous to wear a night guard or splint if you have sleep apnea or severe gastrointestinal reflux disorder, or GERD.

“There’s tremendous overtreatment for a non-problem,” said Karen Raphael, psychologist and professor at New York University College of Dentistry, referring to the widespread use of bite guards, tranquilizers and even Botox injections to prevent bruxism. “There is no evidence that tooth wear patterns reflect current grinding.” Indeed, she said, tooth wear is more often associated with an acidic diet, which both erodes enamel and triggers bruxism to increase the pH in the mouth. Treating bruxism in this instance would be treating the effect rather than the cause.

Of course, an overproduction of stomach acid and reflux often occur during times of stress, which might in part explain why dentists and patients are reporting more cracked teeth and jaw pain since the start of the pandemic. Also, people tend to drink more alcohol when they are anxious. Even mild intoxication leads to more flaccid neck muscles, which can cause an increase in both the duration and force of bruxism to restore airflow.

Other factors that may increase bruxism are poor sleep hygiene and bad posture. If you are a light or poor sleeper, you spend more time in non-REM sleep, which is when people naturally brux. This might be caused by stress, but also consuming caffeine or sleeping with your phone.

And we tend to take our postural habits to bed with us. If you’re tight and clenched when you are awake, you’re likely also tight and clenched when you are asleep, or at least it takes you longer to unwind. This is especially true now as people spend so much time hunched over their devices with head, neck and back forming a taut and orthopedically ill-advised “C.”

So the question is not so much whether you brux, but why you might be bruxing more than is normal and possibly causing jaw or dental problems. “Bruxism is not a disease,” said Giles Lavigne, a neuroscientist, dentist and professor at the University of Montreal. “It’s just a behavior, and like any behavior, when it reaches a level that it’s bothersome you may need to consult someone.”

Perhaps a physical therapist who can teach you how to relax your jaw and do abdominal breathing. And maybe a psychologist can help you modify behaviors that lead to an increase in bruxism, like eating too much before bed and drinking more than your share of wine and whiskey.

But simple awareness of the position of your mouth, tongue and teeth throughout the day may go a long way toward preventing tooth-grinding. “Nobody knows where their tongue is when they are at rest,” said Cheryl Cocca, a physical therapist at Good Shepherd Penn Partners in Lansdale, Pa., who treats patients with bruxism. She recommends continually checking to make sure you are breathing through your nose with your mouth closed, your tongue resting on the roof of your mouth, and your teeth apart. Set a timer if you need to remind yourself or do it every time you stop at a red light or get a text alert.

Part of the problem could be our modern diet. A growing body of evidence supports the once-fringe notion that, following the agricultural and industrial revolutions, as humans began eating foods that are more processed and easier to chew, we came to have smaller jaws than our ancestors and underdeveloped orofacial muscles. A result, researchers say, is that we tend to breathe through our mouths, with our tongues resting on the bottom of our mouths.

“Watch people on subway, watch people on the bus, they’re all on their phones, their mouths are slightly open breathing in and out. Particularly kids, they all are,” said Dr. Tammy Chen, a prosthodontist in New York City who has written about the increase in tooth fractures. “As soon as the mouth is open, the tongue is down. The tongue should always be on top of the mouth pushing up and out,” which strengthens face and neck muscles, widens the jaw and opens the airway.

At night, our modern penchant for soft pillows and mattresses, rather than lying on the ground as our ancestors did, makes our mouths more likely to fall open and for us to drool, leading to a drier, more acidic mouth microbiome, not to mention sagging neck muscles, which further obstruct the airway.

A firm pillow, or a folded blanket under the head, can help, as can committing to an orofacial, neck and airway stretching and strengthening routine. Ms. Cocca recommends daily repetitions of pulling your head back into your neck as if you were trying to retreat from someone leaning in for a kiss and also nodding your head down until your chin touches the base of your throat.

Other good exercises are squeezing your shoulder blades together and holding, as well as putting your arms up like a goal post and leaning into a doorway to stretch out your chest.

Research also indicates diaphragmatic breathing and singing can strengthen and expand your airway muscles to reduce both snoring and bruxism.

While bite guards worn during the day or night won’t stop you from grinding, Dr. Chen said, they can act as a bumper to protect teeth. But only if they are carefully designed according to the size and shape of your mouth, and of materials specific to whether you are a grinder, clencher or chomper. Hard acrylic guards are thought to be better for grinders and chompers while softer rubber guards are better for clenchers. However, experts caution guards can sometimes make the problem worse, particularly if they are poorly made.

“Bruxism often comes down to a breathing or airway issue,” Dr. Chen said. “Night guards are a band aid, but if you want to stop grinding, you have to get to the root cause of the issue.”


How to Recognize and Address Seasonal Depression

How to Recognize and Address Seasonal Depression

Despair in the winter months can point to a serious condition. Experts recommend light boxes, earlier wake-up times and therapy.

Credit…Pablo Amargo

  • Feb. 5, 2021, 2:38 p.m. ET

Seeing friends was normally the highlight of Kendra Sands’ week. One night in January 2018, she had plans to meet two for dinner, but instead, Ms. Sands, who lives in Charlotte, N.C., crawled into bed. She wanted to go out, but she was stuck in a dark room, sobbing.

“I forced myself to put on different clothes, touch up my makeup and get in the car,” she said. “But driving to the restaurant, I realized hibernating in bed had been a pattern for weeks.”

Sands initially blamed PMS for the crying episodes, but after a month she still had no relief. After asking about her mental health pattern in previous years, Ms. Sands’ therapist eventually diagnosed her with seasonal affective disorder. “I knew I didn’t like the cold or dreariness of winter, but I never thought I had a form of depression,” Ms. Sands said.

According to Vaile Wright, senior director of health care innovation and practice directorate at the American Psychological Association, seasonal affective disorder (S.A.D.) is a type of major depression. What makes S.A.D. unique is its timing: “It has a distinct seasonal onset, typically in winter, and a spontaneous remission of symptoms,” she said.

S.A.D. patients experience classic depression symptoms: sadness, irritability, trouble concentrating, lack of interest in activities and increased sleep and appetite. It doesn’t have to be cold or snowy, people can experience S.A.D. in sunny climates like Florida or Southern California.

“The important consideration for all forms of S.A.D. is the effect of your surroundings,” said Dr. Amit Etkin, a professor of psychiatry and behavioral sciences at Stanford University. “The light you experience, how you interact with the world when you get up, and when you go to bed all have a disproportionate effect on your mood.”

Recognize S.A.D. in yourself.

Michael Terman, professor of clinical psychology at Columbia University and founder of the Center for Environmental Therapeutics, said it’s common to gain weight and feel lethargic in winter, but only around three percent of the population has S.A.D.

To be diagnosed, you need to experience at least five of nine clinical symptoms for at least two weeks, said Paul Desan, assistant professor of psychiatry at Yale School of Medicine. If you don’t, you could have subsyndromal S.A.D., a milder version Dr. Desan said people often call “winter blues.”

A distinct, seasonal pattern is key to recognizing S.A.D., feeling normal during spring and summer, then dwindling in energy and mood as days get shorter — almost like you want to hibernate. If you have a family member with S.A.D., you might be more likely to develop it, and Dr. Desan said the disorder is three times more common in women.

According to Dr. Terman, S.A.D. prevalence increases as you move north, until you hit 38 degrees (around Washington D.C.). Anywhere farther north is essentially equally affected at maximum severity. The likelihood also rises near the western edges of time zones, where dawn occurs later.

Experts agree it’s important to treat S.A.D. if you think you may have it. Here are some of the most common treatment methods they recommend.

Start with simple changes.

Many forms of depression, Dr. Wright said, benefit from changes to sleep schedule, a nutritious diet, exercise and social interaction. If you have S.A.D., put a winter spin on these behaviors.

For example, even if you want to sleep later, set an alarm each day so you can experience early-morning sunshine, which helps with S.A.D. symptoms. “Engaging actively in the world, as if you already had those rhythms, is a good way to help reset your circadian rhythm,” Dr. Etkin said.

What you do at night matters, too. Dr. Etkin suggests basic sleep hygiene like avoiding screens (and any artificial light). Try to keep your bedtime consistent — not too late — and avoid too much caffeine or alcohol, which can interfere with your quality of rest and ability to get up.

Try a light box.

Light activates a bodily signal that informs your cells what time of day it is. Morning light causes cortisol to spike, giving you energy. The time of that initial spike determines when your brain releases melatonin, a hormone that makes you sleepy before bedtime.

During winter, people often get less light in the morning and too much artificial light at night, which throws off these signals, affecting sleep and mood.

Light boxes — devices that produce artificial light similar to sunlight — may be an effective way to correct that. In a meta-analysis of 19 studies, bright light therapy was superior to placebo; another small study found 61 percent of light-therapy patients saw their depression symptoms ebb in four weeks.

There is some evidence that sitting in front of a 10,000-lux (the measure of light intensity) light box for 30-45 minutes every day around sunrise during fall and winter decreases S.A.D. symptoms. If you’re currently experiencing S.A.D. symptoms, it’s not too late to start. You can also begin treating next season’s symptoms in the fall.

As tempting as it is to hit the snooze button on weekends, Dr. Desan said your mood will start to sag again if you don’t do your treatment every day around sunrise, so build light therapy into your life. Most research-grade light boxes allow you to sit at arm’s length and move your head, so you should be able to eat breakfast, drink coffee or read.

An effective light box is usually at least $100, but not every option is equally effective. Of the 24 devices Dr. Desan tested in 2019, only seven met clinical criteria. The rest weren’t as effective as research-grade boxes.

Get outside.

According to Anna Wirz-Justice, professor emeritus in the Centre for Chronobiology at the University of Basel, in Switzerland, natural light isn’t only cheaper than a light box, it’s also brighter. Sunrise light is equivalent to 1,000 lux. A rainy morning provides around 10,000 lux, and snow on the ground is even brighter, at 50,000 lux.

Aim to go outside within 30 minutes after sunrise. “You don’t need to see the sun cross the horizon,” said Dr. Huberman. “What you’re looking for is the quality of light that happens when the sun is low in the sky.”

Duration depends on where you live and the weather. Dr. Huberman suggested around five minutes outside if it’s bright or 10-15 minutes if it’s cloudy. It’s OK to wear glasses or contacts, but skip sunglasses and never look at the sun directly.

See a psychotherapist.

Since 2000, Kelly Rohan, a psychology professor at the University of Vermont, has been conducting clinical trials comparing cognitive behavioral therapy (or C.B.T.) to light therapy. Her work suggests both treatments are effective for people with S.A.D. — especially after a new diagnosis. But when she followed people with S.A.D. for two winters, C.B.T. worked better than bright light therapy to prevent recurrences.

Dr. Rohan said C.B.T. may reduce symptoms more effectively because it provides long-term coping skills for changing negative thought and behavior patterns — whereas light therapy only works when you do it.

For Ms. Sands, the combination of lifestyle changes and psychotherapy made a significant difference in reducing her symptoms. But nothing helped more than naming the debilitating dip in her mood every winter. “Because I have a diagnosis, I can be proactive,” Ms. Sands said. “I don’t have to wait until spring to feel better.”


Ashley Abramson is a freelance writer based in Milwaukee, Wis.

The Best Time of Day to Exercise

Phys Ed

The Best Time of Day to Exercise

Men at risk for diabetes had greater blood sugar control and lost more belly fat when they exercised in the afternoon than in the morning.

Credit…Getty Images
Gretchen Reynolds

  • Jan. 27, 2021, 5:00 a.m. ET

Is it better for our bodies to work out at certain times of day?

A useful new study of exercise timing and metabolic health suggests that, at least for some people, the answer is a qualified yes. The study, which looked at men at high risk for Type 2 diabetes, found that those who completed afternoon workouts upped their metabolic health far more than those who performed the same exercise earlier in the day. The results add to growing evidence that when we exercise may alter how we benefit from that exercise.

Scientists have known for some time that the chronology of our days influences the quality of our health. Studies in both animals and people indicate that every tissue in our bodies contains a kind of molecular clock that chimes, in part, in response to biological messages related to our daily exposure to light, food and sleep.

These cellular clocks then help to calibrate when our cells divide, fuel up, express genes and otherwise go about their normal biological work. Tuned by our lifestyles, these clocks create multiple circadian rhythms inside of us that prompt our bodies’ temperatures, hormone levels, blood sugar, blood pressure, muscular strength and other biological systems to dip and crest throughout the day.

Circadian science also shows that disrupting normal, 24-hour circadian patterns can impair our health. People working overnight shifts, for instance, whose sleep habits are upended, tend to be at high risk for metabolic problems such as obesity and Type 2 diabetes. The same is true for people who eat late at night, outside usual dinner hours. More encouraging research suggests, though, that manipulating the timing of sleep and meals can improve metabolic health.

But much of this research focused on when we eat or go to bed. Whether, and how, exercise timing might influence metabolic health has been less clear, and the results of past experiments have not always agreed. Some suggest that morning workouts, for instance, amplify fat burning and weight loss.

But those experiments often manipulated the timing of breakfast and other meals, as well as exercise, making it difficult to tease out the particular, circadian effects of workouts. They also typically involved healthy volunteers, without metabolic problems.

A much-discussed 2019 study, on the other hand, found that men with Type 2 diabetes who completed a few minutes of high-intensity interval sessions in the afternoon substantially improved their blood-sugar control after two weeks. If they did the same, intense workouts in the morning, however, their blood-sugar levels actually spiked in an unhealthy fashion.

Patrick Schrauwen, a professor of nutrition and movement sciences at Maastricht University Medical Center in the Netherlands, read that 2019 study with interest. He and his colleagues had been studying moderate exercise in people with Type 2 diabetes, but in their research, they had not considered the possible role of timing. Now, seeing the varying impacts of the intense workouts, he wondered if the timing of moderate workouts might likewise affect how the workouts changed people’s metabolisms.

Fortuitously, he and his colleagues had a ready-made source of data, in their own prior experiment. Several years earlier, they had asked adult men at high risk for Type 2 diabetes to ride stationary bicycles at the lab three times a week for 12 weeks, while the researchers tracked their metabolic health. The scientists also, incidentally, had noted when the riders showed up for their workouts.

Now, Dr. Schrauwen and his colleagues pulled data for the 12 men who consistently had worked out between 8 and 10 a.m. and compared them with another 20 who always exercised between 3 and 6 p.m. They found that the benefits of afternoon workouts decisively trumped those of morning exercise.

After 12 weeks, the men who had pedaled in the afternoon displayed significantly better average insulin sensitivity than the morning exercisers, resulting in a greater ability to control blood sugar. They also had dropped somewhat more fat from around their middles than the morning riders, even though everyone’s exercise routines had been identical.

“I believe that doing exercise is better than not doing exercise, irrespective of timing,” Dr. Schrauwen says. “However, this study does suggest that afternoon exercise may be more beneficial” for people with disrupted metabolisms than the same exercise done earlier.

The study, in Physiological Reports, involved only men, though. Women’s metabolisms might respond differently.

The researchers also did not delve into why the later workouts might affect metabolism differently than earlier ones. But Dr. Schrauwen says he believes moderate afternoon exercise may have an impact on the foods we consume later in the evening and “help to faster metabolize people’s last meals” before they go to sleep. This effect could leave our bodies in a fasted state overnight, which may better synchronize body clocks and metabolisms and fine-tune health.

He and his colleagues hope to explore the underlying molecular effects in future studies, as well as whether the timing of lunch and dinner alters those results. The team also hopes to look into whether evening workouts might amplify the benefits of afternoon exertion, or perhaps undercut them, by worsening sleep.

Ultimately, Dr. Schrauwen says, the particular, most effective exercise regimen for each of us will align “with our daily routines” and exercise inclinations. Because exercise is good for us at any time of day — but only if we opt to keep doing it.

Working From Bed Is Actually Great

Working From Bed Is Actually Great

A perfect metaphor for a year of giving up and giving in.

Credit…Photo Illustration by Justin J Wee for The New York Times
Taylor Lorenz

  • Dec. 31, 2020, 3:00 a.m. ET

For years, sleep experts have held one piece of common wisdom above all else: that devices have no place in the bedroom.

Yet since the pandemic began in March, millions of Americans have defied that guidance and begun working precisely where they sleep. They are drafting legal documents, producing events, holding client calls, coding, emailing, studying and writing, all from under the covers.

This wasn’t always the plan. Early on, many of them invested in desks and other equipment meant to make their homes as ergonomically sound and office-like as possible.

When New York City shut down in March, Vanessa Anderson, 24, set up a small desk for herself in her living room. She was working for an agency that manages private chefs and wanted to keep some semblance of separation between work and sleep. “For a while I was really committed to not working from my bedroom at all,” she said.

In May, Ms. Anderson moved her desk into her bedroom for more light. “My bed was just sitting there, taunting me,” she said. She set ground rules for herself: She’d only get in bed after 2 p.m., but that start time shifted earlier and earlier. Come July, her bed had become her full-time office.

Ms. Anderson has since switched jobs — she works in e-commerce for a spice shop now — and only works remotely part of the week, but still from bed. Talking to others, she’s discovered how commonplace the practice is. “I’ve been on calls with people where we were both in bed,” she said. At the end of the call it’s like, ‘How’s the pandemic going? Oh, you’re in bed right now too? So am I!’”

Working from bed is a time-honored tradition upheld by some of history’s most accomplished figures. Frida Kahlo painted masterpieces from her canopy bed. Winston Churchill, a notorious late riser even during World War II, dictated to typists while breakfasting in bed. Edith Wharton, William Wordsworth and Marcel Proust drafted prose and verse from their beds. “I am a completely horizontal author,” Truman Capote told The Paris Review in 1957. “I can’t think unless I’m lying down.”

Along with fueling creative thinking, the bedroom can be a refuge from the chaos of home life. Parents retreat there to hide from their homebound children. Others are fleeing roommates.

“I think one of the things we’re learning is that we’re all in tight places figuratively and literally, especially if you have a roommate or spouse, there just isn’t enough real estate in your home to have the privacy to get your work done,” said Sam Stephens, 35, a singer and songwriter in Nashville.

Working from bed may also be symptomatic of collective malaise. “I spend way more time working from bed even though I have a computer, office chair and desk,” said Abelina Rios, 26, a YouTuber in Los Angeles. “I think everybody is feeling depressed from the pandemic, and when you’re depressed one of the harder things to do is to get out of bed.”

Plenty of people, though, are unabashed about their choice to stay in bed all day. Poulomi Banerjee, 26, a fund-raiser in Maryland, said that she’s worked this way since middle school. “I was unable to focus unless I was super comfortable,” she said.

Daniel Peters, 45, a marketer in San Francisco, specifically works on his wife’s side of the bed during the day. (Because sleep hygiene?) He posited that working from bed could be an expression of denial. “I wonder if we almost subconsciously don’t accept this is real life,” he said. “Does sitting at a table or desk make it feel more like real life? We all felt like this pandemic would only take so long and it’s still going on. If I sit at my desk all day, does that mean this is how it is going to be full time?”

Credit…Photo Illustration by Justin J Wee for The New York Times

Liz Fosslien, 33, an author of “No Hard Feelings,” a book about how emotions affect work, brings her computer into bed with her every morning, wireless mouse and all. “I use my mattress as a mouse pad,” she said. Her advice to anyone doing the same these days: “Don’t beat yourself up for it. It is easy to be like, ‘Ugh I’m in my pajamas, I haven’t washed my hair, what am I doing,’ but it’s really about the quality of your output.”

A primary argument against using devices in bed is that it can further erode the boundaries between work and home, and disrupt your sleep cycle. But even Arianna Huffington, the media executive turned sleep evangelist, has found herself working from bed since the pandemic hit.

“I think it can work great for people, but it’s critical to have certain boundaries,” she said. Ms. Huffington suggests keeping your night stand clear of clutter and ensuring that you have a hard stop on work hours where you get out of bed and store your electronics in another room.

“I highly recommend a real transition,” she said. “I have a hot shower and bath to wash away the day, change what you’re wearing, have a different T-shirt for sleep. I love beautiful lingerie. It makes you feel like, ‘Hey, you’re going to sleep.’”

Proponents of desk culture have argued that there’s no way someone can be productive from bed. “I don’t know anyone who works actually in a prone position, but I know tons of people who work in bed (my husband, for instance). I think they’re all a bunch of lazy, bedsore-prone, rapidly deteriorating slobs,” the writer Susan Orlean told The New Republic in 2013. “Or maybe they’re much, much happier (and smarter) than the rest of us.”

But what many homebound workers are realizing during the pandemic is something chronically ill and disabled people have known for years, that working from bed doesn’t mean you’re lazy or depressed. In fact, it’s perfectly possible to hold down a job remotely from bed, provided your employer is flexible about remote work.

“We have data showing time crafting is good for happiness, if you’re able to work from anywhere and you choose to work from bed this is one example of time crafting,” said Ashley Whillans, an assistant professor at Harvard Business School. “Picking where to work and how to get work done can improve employee satisfaction.”

Tessa Miller, 32, the author of the book “What Doesn’t Kill You,” about her struggles with chronic illness, has been working from bed since she was diagnosed with Crohn’s disease at 23. “I think that the pandemic is highlighting all these things that chronically ill and disabled people have been doing for a long time, and now everyone is doing them as well and working from bed is one of them,” she said. “I know a lot of highly productive, intelligent, talented people who have to work from bed as a necessity.”

Those with chronic illness or disabilities say that they hope that, much as the way the pandemic has made companies more open to remote work, the stigma around working from bed will also be broken. “I hope one of the things that come out of this is it reveals you can still do good work from your bed, or bathtub, or living room sofa with a heating pad and I hope that will create opportunities for people who are chronically ill or disabled n fields they maybe didn’t feel welcome in before,” Ms. Miller said.

Amy Patel, 34, a product manager for a life sciences software company in Austin, was forced to work from bed in the early months of the pandemic when she was placed on bed rest during her pregnancy with twins. She did not love it. However, proper gear helped. “My husband bought me a really nice desk that you could put your laptop with a mouse on,” she said. “I did everything on there.”

If you want to replicate the feeling of working in bed without actually being in bed, you could purchase an Ergoquest Zero Gravity Workstation for $5,995 or buy one of the many, much cheaper computer mounts made for reclining in bed. Supportive pillows are also key for avoiding back pain. Having a spill-proof cup or a mug with a lid helps too, as some have learned the hard way.

While some people turn on computerized backgrounds to avoid revealing their bedroom workstations on video calls, others have embraced their cozy surroundings. Ms. Stephens said that she’s decorated the wall behind her bed with children’s artwork to make a more engaging background for her Instagram Live performances.

Abie Sidell, 27, a filmmaker in New York, often works from bed because of his chronic illness, but he has found it helpful even when he’s not having a flare-up. “I think that being horizontal is conducive to creative thinking,” he said. “When we’re horizontal, whether it’s sleeping or dreaming, is when we’re doing a lot of subconscious or unconscious creative work.”

If Mr. Sidell is stuck on a project or needs to think, he’ll go lie down. “Being in bed is great,” he said. “I wish, in general, there were fewer norms and standards around where it is and isn’t acceptable to work.”

If this year doesn’t shatter them, what will?

Sleep Better in the New Year

Sleep Better in the New Year

Advice from Well on how to get more and sounder sleep in 2021.

Cinemagraph
CreditCredit…By Till Lauer

  • Dec. 30, 2020, 5:00 a.m. ET

For many, 2020 was a year that provided lots of worries that kept us tossing and turning at night. Tara Parker-Pope’s guide, How to Get a Better Night’s Sleep, is packed with advice:

We spend about one-third of our lives asleep, and sleep is essential to better health. But many of us are struggling with sleep. Four out of five people say that they suffer from sleep problems at least once a week and wake up feeling exhausted. So how do you become a more successful sleeper? Grab a pillow, curl up and keep reading to find out.

Here are more articles from the past year in Well that may help you start the new year with better sleep.

How Foods May Affect Our Sleep

By Anahad O’Connor

With the coronavirus pandemic, school and work disruptions and a contentious election season contributing to countless sleepless nights, sleep experts have encouraged people to adopt a variety of measures to overcome their stress-related insomnia. Among their recommendations: engage in regular exercise, establish a nightly bedtime routine and cut back on screen time and social media.

But many people may be overlooking another important factor in poor sleep: diet. A growing body of research suggests that the foods you eat can affect how well you sleep, and your sleep patterns can affect your dietary choices.

Researchers have found that eating a diet that is high in sugar, saturated fat and processed carbohydrates can disrupt your sleep, while eating more plants, fiber and foods rich in unsaturated fat — such as nuts, olive oil, fish and avocados — seems to have the opposite effect, helping to promote sound sleep.

Let the Sunshine In

By Richard Schiffman

A daily dose of sunlight won’t fend off or cure coronavirus, though researchers continue to explore the effects that warmer weather and ultraviolet rays might have on the virus. But scientists are finding that exposure to the sun has numerous other benefits that may be especially important now — including helping to elevate mood, to improve the quality of our sleep and to strengthen the body’s innate defenses against a variety of pathogens.

Exposure to daylight is critical for accurately setting our internal circadian clock, which in turn regulates sleep and waking, said Mariana Figueiro, the director of the Lighting Research Center at Rensselaer Polytechnic Institute in Troy, N.Y.

Without adequate light, we can go into a kind of permanent jet lag, Dr. Figueiro explained, where we get more easily irritated and depressed, our immune function is suppressed and our overall health may deteriorate.

Whether You Are a Night Owl or Early Bird May Affect How Much You Move

By Gretchen Reynolds

People who are evening types go to bed later and wake up later than morning types. They also tend to move around far less throughout the day, according to an interesting new study of how our innate body clocks may be linked to our physical activity habits. The study, one of the first to objectively track daily movements of a large sample of early birds and night owls, suggests that knowing our chronotype might be important for our health.

In recent years, a wealth of new science has begun explicating the complex roles of cellular clocks and chronotypes in our health and lifestyles. Thanks to this research, we know that each of us contains a master internal body clock, located in our brains, that tracks and absorbs outside clues, such as ambient light, to determine what time it is and how our bodies should react. This master clock directs the rhythmic release of hormones, such as melatonin, and other chemicals that affect sleep, wakefulness, hunger and many other physiological systems.

Your Most-Played Song of 2020 Is … White Noise?

Your Most-Played Song of 2020 Is … White Noise?

Ambient music, background noise and calming sound effects have soothed the anxious, isolated and sleep deprived this year.

Credit…Matt Schwerin for The New York Times

  • Dec. 24, 2020, 3:00 a.m. ET

The soundtrack to Maya Montoya’s year was white noise. Specifically, a track on Spotify called “Celestial White Noise”: three whole hours of warm, soothing fuzz.

Ms. Montoya, who is 27 and lives in Everett, Wash., had been a nanny up until the pandemic. But when she found herself out of work in April, she began indulging in daytime naps, which ruined her sleep schedule. “I’ve been listening to the white noise all the time,” she said.

Despite playing the track most nights for the better part of 2020, Ms. Montoya was still surprised when “Celestial White Noise” appeared at the top of her Spotify Wrapped chart this month. She posted a screen shot from the app on Instagram, which was met with a deluge of affirmation from her followers.

“So many people messaged me saying they got the exact same thing,” she said. “It was nice to know I wasn’t the only one blasting white noise into the ether so that I could sleep throughout all this.”

In an average year, Spotify Wrapped is a sharing-optimized novelty hinging on nostalgia for a time that’s barely passed. But in 2020, this data mirror instead presented many users with unexpected empirical evidence of their pandemic coping mechanisms: a strange hit parade of ambient music, background noise and calming sound effects that soothed them through an unusually anxious and sleepless time. (Spotify declined to comment on this trend.)

While thousands of users posted in disbelief about their stress-inflected results, the situation made sense to Liz Pelly, a cultural critic who has written extensively about how Spotify and its competitors work to shape our listening habits. “It says a lot about the ways that corporate streaming services have ingrained themselves into our lives and facilitated music listening becoming more of a background experience,” she said.

Credit…Matt Schwerin for The New York Times

Some listeners have used sound as a coping mechanism for years but became more reliant on it over the last nine months. Isobel Snellenberger, a 21-year-old in Fargo, N.D., has anxiety and is neurodivergent (a category that includes a range of neurological differences including autism spectrum disorder and dyslexia), both of which she manages in a variety of ways, including with music.

“Especially toward the beginning of Covid, my mind was riddled with intrusive thoughts about my friends and family’s safety, and my brain would go into panic mode,” Ms. Snellenberger said. So, she began playing rain sounds almost round-the-clock, which helped her turn off the cognitive noise.

When her Spotify roundup arrived, nine of her top 10 tracks were rain sounds. “Even though I listen to them a lot, I was still caught off guard,” she said, noting that Harry Styles and David Bowie typically dominate her list. Like Ms. Montoya, she found the results both sad and funny.

The findings of some forthcoming research about pandemic coping mechanisms suggest ambient listening may be part of a larger pattern. Pablo Ripollés, a professor at New York University who studies music and the brain, was part of an international team of researchers that surveyed lockdown habits in Italy, Spain and the United States.

Of 43 activities mentioned in a survey the team conducted, like cooking, prayer, exercise and sex, listening to or playing music had one of the biggest increases in engagement during lockdown, as well as the highest number of respondents who said it was the activity that helped them the most.

“People realizing from their Spotify Wrapped that they were listening to a lot more background music to cope with the pandemic fits with what we saw,” Dr. Ripollés said.

But not everyone wants to have the darkness of this year reflected back at them. With the pandemic expected to endure, at least in some countries, well into 2021, a few savvy subscribers are using a workaround to ensure that next year’s recap is a little less grim.

Dylan River Lopez, a 29-year-old video editor who uses non-gendered pronouns, has relied throughout the pandemic on a track called “Brown Noise — 90 Minutes” to drown out many distractions, including their partner’s phone calls in a newly shared office and nighttime restlessness similar to Ms. Montoya’s. “I pretty much developed a relationship with the noise,” Mx. Lopez said.

When it appeared as their No. 1, Mx. Lopez searched online about how to block Spotify from counting those minutes. The answer: a feature called Private Session, which they now turn on along with the brown noise.

“The main thing I learned from this experience,” Mx. Lopez said, “is how to stop Spotify from tracking it.”

Yes, Many of Us Are Stress-Eating and Gaining Weight in the Pandemic

Yes, Many of Us Are Stress-Eating and Gaining Weight in the Pandemic

A global study confirms that during the pandemic, many of us ate more junk food, exercised less, were more anxious and got less sleep.

Credit…Lorenzo Gritti
Anahad O’Connor

By

  • Dec. 4, 2020, 5:00 a.m. ET

Not long ago, Stephen Loy had a lot of healthy habits. He went to exercise classes three or four times a week, cooked nutritious dinners for his family, and snacked on healthy foods like hummus and bell peppers.

But that all changed when the pandemic struck. During the lockdowns, when he was stuck at home, his anxiety levels went up. He stopped exercising and started stress eating. Gone were the hummus and vegetables; instead, he snacked on cookies, sweets and Lay’s potato chips. He ate more fried foods and ordered takeout from local restaurants.

“We were feeding the soul more than feeding the stomach,” said Mr. Loy, 49, who lives in Baton Rouge and is the executive director of a tech incubator. “We were making sure to eat things that made us feel better — not just nutritional items.”

Now a global survey conducted earlier this year confirms what Mr. Loy and many others experienced firsthand: The coronavirus pandemic and resulting lockdowns led to dramatic changes in health behaviors, prompting people around the world to cut back on physical activity and eat more junk foods. It drove anxiety levels higher and disrupted sleep. And those who are obese, who already face increased health risks, may have fared the worst, the researchers found. While they tended to experience improvements in some aspects of their diets, such as cooking at home more and eating out less, they were also the most likely to report struggling with their weight and mental health.

The findings, published in the journal Obesity, offer a cautionary lesson for many of us as coronavirus cases continue to surge and renewed calls for lockdowns and other restrictions again take hold. With months to go before a vaccine becomes widely available and we can safely resume our pre-pandemic routines, now might be a good time to assess the healthy habits we may have let slip and to find new ways to be proactive about our physical and mental health.

The study, carried out by researchers at the Pennington Biomedical Research Center in Louisiana, surveyed almost 8,000 adults across the globe, including people from 50 different countries and every state in America. The researchers found that the decline in healthy behaviors during the pandemic and widespread lockdowns was fairly common regardless of geography.

“Individuals with obesity were impacted the most — and that’s what we were afraid of,” said Emily Flanagan, an author of the study and postdoctoral fellow at the Pennington Biomedical Research Center. “They not only started off with higher anxiety levels before the pandemic, but they also had the largest increase in anxiety levels throughout the pandemic.”

The findings shed light on exactly how people altered their routines and behaviors in response to the lockdowns that were implemented in countries around the world this year to slow the spread of the virus. The pandemic disrupted everyday life, isolated people from friends and family, and spawned an economic crisis, with tens of millions of people losing jobs or finding their incomes sharply reduced.

Dr. Flanagan and her colleagues assumed many people were experiencing enormous levels of stress. But they were not sure how the pandemic and stay-at-home orders were impacting how people slept, how much they exercised and what they ate. So they designed an extensive survey and recruited people on social media to answer questions about how their mental and physical health had been affected.

“This was such a drastic and abrupt change to everyone’s daily life that we needed to see what was going on,” said Dr. Flanagan. “We wanted to put some data to the anecdotal behaviors we were seeing.”

From April through early May, about 7,750 people, most of them from the United States but also from countries such as Canada, Australia and Britain, completed the survey. The average age of the respondents was 51, and a majority were women. Based on their body mass indexes, about a third of the people were overweight, a third were obese, and a third were considered normal weight.

The researchers found that most people became more sedentary, which they said was probably related to less daily commuting and more time spent indoors. But even when people did engage in structured exercise, it tended to be at lower intensity levels compared to before the pandemic. Many people also said they had given in to their food cravings: Consumption of sugar sweetened beverages and other sugary snack foods, for example, went up.

That might explain another finding: About 27 percent of people said they had gained weight after the initial lockdowns went into effect. The figure was even higher among people classified as obese: About 33 percent said that they had gained weight, compared to 24.7 percent of people considered normal weight. People who gained weight also had the largest declines in physical activity.

There were some bright spots in the findings. About 17 percent of the study population actually lost weight during the pandemic; perhaps not surprisingly, they tended to be people who increased their physical activity levels and improved their diets. And despite snacking on more junk foods, many people showed an increase in their “healthy eating scores,” a measure of their overall diet quality, which includes things like eating more fruits and fewer fried foods. The researchers said that the overall improvements in diet appeared to be driven by the fact that the lockdowns prompted people to cook, bake and prepare more food at home. Other recent surveys have also shown a sharp rise in home cooking and baking this year, with many people saying they are discovering new ingredients and looking for ways to make healthier foods.

But social isolation can take a toll on mental wellness, and that was evident in the findings. On average, people reported significantly higher anxiety levels. About 20 percent said that their symptoms, such as experiencing dread and not being able to control or stop their worrying, were severe enough to interfere with their daily activities. About 44 percent of people said that their sleep had also worsened during the pandemic. People on average reported going to bed about an hour later than usual and waking up roughly an hour later than usual. Only 10 percent of people said that their sleep had improved since the pandemic began.

The greatest spikes in anxiety occurred among people who are obese. It was unclear why exactly, but one reason may have been concerns about the virus. The survey took place at a time when studies were first beginning to show that excess weight puts people at a much higher risk of being hospitalized with Covid-19. “We don’t have data to back this up, but our hypothesis is there was a lot more anxiety about their own health,” Dr. Flanagan said. “A heightened fear of the virus would most certainly increase their anxiety levels.”

Dr. Flanagan said it was perhaps not surprising that people tended to engage in less healthful habits during the pandemic, as so many aspects of health are intertwined. Stress can lead to poor sleep, which can cause people to exercise less, consume more junk foods, and then gain weight, and so on. But she said she hoped that the findings might inspire people to take steps to be more proactive about their health, such as seeking out mental health specialists, prioritizing sleep and finding ways to exercise at home and cook more, in the event of future lockdowns.

“Being aware of how our health behaviors change during these stay-at-home orders could help us combat that if another lockdown is enforced,” she said. “Being aware is really the No. 1 thing here.”

It’s Time for a Digital Detox. (You Know You Need It.)

When is enough enough?

Even though the presidential election is over, we’re still doomscrolling through gloomy news about the coronavirus surge. The rest of your daily routine is probably something like mine while stuck at home in the pandemic: Divided among streaming movies on Netflix, watching home improvement videos on YouTube and playing video games. All of these activities involve staring at a screen.

There has to be more to life than this. With the holiday season upon us, now is a good time to take a breather and consider a digital detox.

No, that doesn’t mean quitting the internet cold turkey. No one would expect that from us right now. Think of it as going on a diet and replacing bad habits with healthier ones to give our weary eyes some much needed downtime from tech.

“There’s lots of great things to do online, but moderation is often the best rule for life, and it’s no different when it comes to screens,” said Jean Twenge, a psychology professor at San Diego State University and the author of “iGen,” a book about younger generations growing up in the smartphone era.

Too much screen time can take a toll on our mental health, depriving us of sleep and more productive tasks, experts said. I, for one, am experiencing this. Before the pandemic, my average daily screen time on my phone was three and a half hours. Over the last eight months, that has nearly doubled.

So I turned to psychology experts for their advice. From setting limits to finding alternatives to being glued to our phones, here’s what we can do.

Come Up With a Plan

Not all screen time is bad — after all, many students are attending school via videoconferencing apps. So Step One is assessing which parts of screen time feel toxic and make you unhappy. That could be reading the news or scrolling through Twitter and Facebook. Step Two is creating a realistic plan to minimize consumption of the bad stuff.

You could set modest goals, such as a time limit of 20 minutes a day for reading news on weekends. If that feels doable, shorten the time limit and make it a daily goal. Repetition will help you form new habits.

That’s easier said than done. Adam Gazzaley, a neuroscientist and co-author of the book “The Distracted Mind: Ancient Brains in a High-Tech World,” recommended creating calendar events for just about everything, including browsing the web and taking breaks. This helps create structure.

For example, you could block off 8 a.m. to read the news for 10 minutes, and 20 minutes from 1 p.m. for riding the exercise bike. If you feel tempted to pick up your phone during your exercise break, you would be aware that any screen time would be violating the time you dedicated to exercise.

Most important, treat screen time as if it were a piece of candy that you occasionally allow yourself to indulge. Don’t think of it as taking a break as that may do the opposite of relaxing you.

“Not all breaks are created equal,” Dr. Gazzaley said. “If you take a break and go into social media or a news program, it can get hard to get out of that rabbit hole.”

Create No-Phone Zones

We need to recharge our phones overnight, but that doesn’t mean the devices need to be next to us while we sleep. Many studies have shown that people who keep phones in their bedrooms sleep more poorly, according to Dr. Twenge.

Smartphones are harmful to our slumber in many ways. The blue light from screens can trick our brains into thinking it’s daytime, and some content we consume — especially news — can be psychologically stimulating and keep us awake. So it’s best not to look at phones within an hour before bed. What’s more, the phone’s proximity could tempt you to wake up and check it in the middle of the night.

“My No. 1 piece of advice is no phones in the bedroom overnight — this is for adults and teens,” Dr. Twenge said. “Have a charging station outside the bedroom.”

Outside of our bedrooms, we can create other No-Phone Zones. The dinner table, for example, is a prime opportunity for families to agree to put phones away for at least 30 minutes and reconnect.

Resist the Hooks

Tech products have designed many mechanisms to keep us glued to our screens. Facebook and Twitter, for example, made their timelines so that you could scroll endlessly through updates, maximizing the amount of time you spend on their sites.

Adam Alter, a marketing professor at New York University’s Stern School of Business and author of the book “Irresistible: The Rise of Addictive Technology and the Business of Keeping Us Hooked,” said that tech companies employed techniques in behavioral psychology that make us addicted to their products.

He highlighted two major hooks:

  • Artificial goals. Similar to video games, social media sites create goals to keep users engaged. Those include the number of likes and followers we accrue on Facebook or Twitter. The problem? The goals are never fulfilled.

  • Friction-free media. YouTube automatically plays the next recommended video, not to mention the never-ending Facebook and Twitter scrolling. “Before there was a natural end to every experience,” like reading the last page of a book, he said. “One of the biggest things tech companies have done was to remove stopping cues.”

What to do? For starters, we can resist the hooks by making our phones less intrusive. Turn off notifications for all apps except those that are essential for work and keeping in touch with people you care about. If you feel strongly addicted, take an extreme measure and turn the phone to grayscale mode, Dr. Alter said.

There’s also a simpler exercise. We can remind ourselves that outside of work, a lot of what we do online doesn’t matter, and it’s time that can be better spent elsewhere.

“The difference between getting 10 likes and 20 likes, it’s all just meaningless,” Dr. Alter said.

Helping Our School-Age Children Sleep Better

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Credit Getty Images

Everyone knows that getting a baby to sleep through the night can be a big challenge for parents. But sleep problems are common among preschool and school-age children, too. As we ask children to function in school, academically and socially, fatigue can affect their achievement and behavior.

Australian research on sleep problems in children has included work aimed at the “school transition” year in which children adjust to a school schedule. In a study of 4,460 children, 22.6 percent had sleep problems, according to their parents, at that transition age of 6 to 7 years. “We were surprised, we thought it was all baby sleep” that was the problem, said Dr. Harriet Hiscock, a pediatrician who is a senior research fellow at the Murdoch Childrens Research Institute at the Royal Children’s Hospital in Melbourne who was one of the authors of the study.

Those results led to a randomized controlled trial of a brief intervention for children in their first year of school. A group of 108 parents who felt their children had sleep problems was divided into two groups. One group got a consultation at school, with a program of strategies tailored to the child’s sleep issues, and a follow-up phone consultation; the other group got no special intervention and served as controls. Parents in the intervention group were counseled about a range of possible measures to improve sleep, from consistent bedtimes and bedtime routines to relaxation strategies for anxiety that might be contributing to insomnia. The children in the intervention group resolved their varying sleep problems more quickly, though sleep problems got better over time in both groups. The interventions also produced positive effects on the child’s psychosocial function and parents’ mental health.

The most common sleep issues for children around the age of school entry, Dr. Hiscock said, definitely include limit-setting issues — that is, some of them need their parents to make the rules and routines clear. But there are also children with what sleep specialists call “sleep onset association disorder,” in which a child has become habituated to falling asleep only in a certain context, requiring the presence of a parent, or needing to have the TV on, to cite two common examples. Very anxious children are also often problem sleepers. And then there are children beset by nightmares, night terrors and early morning waking.

Screen use is a major issue in childhood sleep, and more generally in childhood these days. The first recommendation is always to get the screens out of the bedroom, the same recommendation made for improving adolescent sleep, and for adults in the current best-selling book by Ariana Huffington. All of us, old and young, are vulnerable here, but it’s a good place for parents to draw the line for their children, even when they can’t quite manage it for themselves.

Reut Gruber, a psychologist who is an associate professor in the department of psychiatry at McGill University, where she is director of the Attention Behavior and Sleep Lab, said that there is a close association between sleep and a wide range of cognitive functions, including attention, executive function and memory. When children go to school, “they need to pay attention and plan and follow instructions, all of which fall under executive function, which is very much affected by sleep,” she said.

Many parts of the brain work less well when children are tired. “The prefrontal cortex is very sensitive to sleep deprivation, and it is key to the brain mechanisms which underlie executive function and some of the attentional processes,” she said. “The amygdala is affected by sleep deprivation and is essential for emotional processes.”

These different but connected brain pathways led her to be interested in the way that sleep affects many different aspects of academic performance. In an experimental study of a small group of 7- to 11-year-olds who did not have sleep, behavior or academic problems, the children were asked to change their sleep patterns, so that they were sleeping an hour less per night, or an hour more. After five days with less sleep, she said, there was measurable deterioration in alertness and emotional regulation, and after five days with more sleep, there were gains in these areas.

For the past several years, Dr. Gruber and her colleagues have worked with a school board in Montreal to develop a school-based sleep promotion program that was piloted in three elementary schools; results were published in May in the journal Sleep Medicine. The intervention involved a six-week sleep curriculum for the children, to teach them about healthy sleep habits, and materials designed to involve parents, teachers, and school principals, who were asked to consider the sleep ramifications of school schedules, extracurricular activities and homework demands.

The children in the intervention group extended their sleep by an average of 18.2 minutes a night, and also reduced the length of time it took them to fall asleep by 2.3 minutes. These relatively modest changes correlated with improved report card grades in English and math; the control group children’s sleep duration did not change, and their grades did not improve.

The goal of the intervention was to help families make sleep a priority.

“How do you make changes in your priorities, find the way as a family, as a school, as an individual, to reshuffle things, no matter how much homework, no matter how many aunts and uncles coming for a visit, that bedtime will still be respected?” Dr. Gruber asked. “We all agree in principle, but how do we actually incorporate it into daily life?”

The American Academy of Pediatrics recently endorsed the 2016 guidelines issued by the American Academy of Sleep Medicine, that 3- to 5-year-olds need 10 to 13 hours of sleep per day (including naps), while 6- to 12-year-olds need nine to 12 hours for optimal health and well-being.

Dr. Gruber advised that a child should wake up naturally, without requiring energetic parental encouragement. If after nine or 10 hours of sleep, a child still seems very tired, parents might wonder about whether a sleep disorder is affecting the quality of the child’s sleep, she said.

But for most school-age children, it’s an issue of habits and routines, screen time and setting limits. Many of us know, as adults, that we don’t get as much sleep as we should, or that we don’t practice very good “sleep hygiene,” as the experts would say when they advise us to get the screens out of our bedrooms, create regular routines and avoid caffeine too close to bedtime. Making school-age sleep a family priority is a good way to get everyone focused on what really matters: waking up rested and ready to function well, in body and mind.

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An Early Bedtime for Kids May Fight Weight Gain

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Preschool children who are in bed by 8 p.m. are far less likely to be obese during adolescence than children who stay up late, a study has found. Their risk of teenage obesity is half the risk faced by preschoolers who stay up past 9 p.m.

The research analyzed data gathered on nearly 1,000 children born in 1991 whose bedtimes were recorded when they were 4½ years old, and whose height and weight were recorded at age 15. The children were part of the Study of Early Child Care and Youth Development, done under the auspices of the National Institute of Health’s Eunice Kennedy Shriver National Institute of Child Health and Human Development.

Among the children who were in bed by 8 p.m., 10 percent were obese as teens, compared to 16 percent of those who went to bed between 8 and 9 and 23 percent of those who went to bed after 9, according to the study, published in The Journal of Pediatrics.

The researchers adjusted for such factors as socioeconomic status, maternal obesity and parenting style and still found that the children who went to bed by 8 p.m. were at less than half the risk of teenage obesity as those who were up past 9, said Sarah E. Anderson, the paper’s lead author and an associate professor of epidemiology at the Ohio State University College of Public Health in Columbus.

Although the study does not prove that early bedtimes protect against obesity, Dr. Anderson said, “there is a great deal of evidence linking poor sleep, and particularly short sleep duration, to obesity, and it’s possible the timing of sleep may be important, above and beyond the duration of sleep.”

“This provides more evidence that having an early regular bedtime and bedtime routine for young children is helpful,” she said.

Sleep Problems Tied to Diabetes in Men

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Men who do not get enough sleep — or get too much — may have an increased risk for Type 2 diabetes, a new study suggests.

Researchers studied 788 healthy men and women participating in a larger health study, measuring their sleep duration using electronic monitors and testing them for markers of diabetes — how well pancreatic cells take up glucose and how sensitive the body’s tissues are to insulin. The study is in the Journal of Clinical Endocrinology & Metabolism.

The average sleep time for both men and women was about seven hours. As the men diverged from the average, in either direction, their glucose tolerance and insulin sensitivity decreased, gradually increasing the deleterious health effects. There was no such association in women.

The researchers weren’t sure why men but not women showed this association but caution that this was a cross-sectional study, a snapshot of one moment in time, and that they draw no conclusions about cause and effect.

The lead author, Femke Rutters, an assistant professor at the VU Medical Center in Amsterdam, said that it is easy to advise men to get regular and sufficient sleep, but because so many lifestyle and health factors may contribute to poor sleep, acting on that advice is much harder.

“There has been a lot of observational work on sleep, but trying to change it is difficult,” she said. “Ideally, men should try for regular sleep.”

Parents Shouldn’t Feel Guilty About Training Babies to Sleep

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When my first child did not dependably sleep through the night, my parents were puzzled. My mother told me that to the best of her recollection, neither I nor my siblings had ever been troubled by night waking. I suspected that, back in the 1950s and ‘60s, they might have let us cry it out, but they didn’t recall. There might have been some difficult nights, but what was the big deal?

In our era of more anxious parenting, there’s a lot of debate about what has come to be called sleep training, that is, behavioral techniques for getting a baby who is 6 months old or older to fall asleep alone and sleep through the night. The debate comes when these techniques involve some periods of crying and protest on the baby’s part. Parents (and experts) who believe in sleep training feel that babies can develop “self-soothing” skills: learning sleep cues that help them comfort themselves and fall back asleep when they wake at night — as we all tend to do. Opponents of sleep training, many of whom are more generally committed to “attachment parenting,” say that in fact sleep training results in “learned helplessness,” with infants making the agonizing discovery that no matter how hard they cry, no one will come.

In a study published this week in the journal Pediatrics, 43 infants in Australia, 6 to 16 months old, all healthy, but identified by their parents as having sleep problems, were randomized to three different groups. In one group, the parents tried graduated extinction, the technique in which babies are allowed to cry for short, prescribed intervals over the course of several nights. The second group tried a technique called bedtime fading, in which parents delay bedtime in 15-minute increments so the child becomes more and more tired. And the third group, as a control, was just given sleep information.

The researchers measured the babies’ stress by sampling their levels of cortisol, a hormone indicating stress, and also looked at the mothers’ stress; 12 months after the intervention, they evaluated parent-child attachment and looked at whether the children had emotional and behavioral problems.

“What we were interested in is this hypothesis that there are these long-term consequences from doing something like graduated extinction,” said Michael Gradisar, an associate professor of psychology at Flinders University in Adelaide who was the first author on the new study.

Both sleep techniques – graduated extinction and bedtime fading — decreased the time it took children to fall asleep and graduated extinction reduced night wakings, compared to the control group. All the salivary cortisol levels were within the normal range in all three groups, but the afternoon levels in the two sleep training groups declined over time more than the controls. And there was no difference among the groups, 12 months later, in the measures of the children’s emotional and behavioral well-being.

Although critics of graduated extinction believe that strategy disrupts parent-child attachment, Dr. Gradisar said: “We couldn’t find any differences. The more studies we get, the more confident we can feel that this is actually safe to perform.”

This research builds on a follow-up study that appeared in Pediatrics in 2012, which looked at a large group of Australian children who, as babies, had participated in a controlled study of the effectiveness of behavioral sleep techniques. The original study, from 2006, had found that these techniques were effective both in reducing parents’ report of sleep problems in their 10-month-olds and also in reducing maternal depression, which has been linked to children’s sleep issues.

The 2012 research looked at those children at age 6, and checked out their mental health, stress regulation, sleep and a variety of measures of the parent-child relationship.

“We measured cortisol in saliva,” said Dr. Anna Price, a postdoctoral researcher in pediatric psychology at Murdoch Childrens Research Institute in Melbourne, who was the first author. “We also looked at parents’ mental health as well, all the effects the early program might have had on their later development and behavior, and the two groups looked very similar on all the measures.” The researchers found no differences between the children whose parents had been advised about the behavioral sleep techniques and the controls.

Another study of infant cortisol levels, published in 2012 in the journal Early Human Development, has been cited as showing that these behavioral techniques can be highly stressful for infants; it suggested that babies might be in distress even though they were not crying. Wendy Middlemiss, an associate professor of educational psychology at the University of North Texas, who was the first author on that study, said: “You have to be responsive. You can’t let them cry for long periods of time.”

But how cortisol is measured and interpreted is thus at the very center of this debate. Dr. Price and Dr. Gradisar were both among the authors of a letter responding to the Middlemiss article and challenging the cortisol methodology.

All these researchers agree that parents shouldn’t do anything that makes them uncomfortable; parents know best what their children need. But not-so-subtly, there’s a sense on one side that parents feel pressured and guilted into leaving their tiny babies to cry and cry at night, and on the other, that parents feel pressured and guilted into not letting their children cry for even a moment. And both may be true.

If what we really mean is, parents should do what they’re comfortable doing, and our job as pediatricians and pundits is to help them feel confident in their parenting, we have to accept that different families will make different reasonable choices.

There’s some good evidence that the various methods of “sleep training,” none of which should involve letting a small infant cry for hours in a dark room, work for many children and many families. There’s no evidence that they do lasting damage to the child or the parent-child bond and, in fact, some reassuring evidence that they don’t.

There also doesn’t seem to be evidence that you do harm by deciding to forgo “sleep training” and waiting for the child to outgrow the night waking — as long as that doesn’t damage your marriage or your mental health.

As a pediatrician, I think about the baby, but I also try to take into account how the parents are doing. I sometimes wonder how the people who are most strongly opposed to any form of sleep training would feel about having their children’s teachers, or doctors or bus drivers, coming to work sleep deprived after really disrupted nights. Sleep matters, as we have learned to acknowledge in medical training. Babies matter, and so do parents.

What your baby needs most is a loving family, which ideally includes parents who are enjoying the adventure. And no expert can tell whether you are enjoying the adventure better than you yourself.

See you in the morning.

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Swaddling May Increase the Risk of SIDS

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Swaddling a baby may increase the risk for sudden infant death syndrome, or SIDS, a new analysis concludes.

The practice of swaddling — wrapping an infant with a light cloth, with the head exposed — has grown in the United States with reports that it promotes better sleep.

Researchers pooled data from four observational studies of SIDS and swaddling that included 760 SIDS cases and 1,759 controls.

Over all, swaddling increased the risk for SIDS by about one-third. The risk was greatest in babies sleeping on their stomachs, less in those sleeping on their sides, and least in infants sleeping on their backs. The study is in Pediatrics.

The lead author, Anna S. Pease, a research associate at the University of Bristol in England, said that the results should be interpreted with caution, because there are few studies of the subject, and the amount of good evidence is limited.

Still, she said, “We already know that side and prone sleeping are unsafe for young babies, so the advice to place children on their backs for sleep is even more important when parents choose to swaddle them.”

The risk also increased with the age of the infant.

“We suggest that parents think about what age they should stop swaddling,” Dr. Pease said. “Babies start to roll over between four and six months, and that point may be the best time to stop.”

For a New Mom, Relentless Fatigue Could Signal a Thyroid Problem

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Credit Stuart Bradford

For six weeks after delivering my son, I had postpartum thyroiditis. Every afternoon around the same time, I would shake uncontrollably. Anxiety about night feedings and colic (which my son didn’t have) plagued my thoughts all evening. One night while my husband put our son, Jackson, to sleep, my sister put me to sleep. We watched “Romancing the Stone” and she rubbed my back until I drifted off — as if I were the baby.

Moreover, I lost all the baby weight within weeks. At my two-week checkup with my obstetrician, I had lost over 25 pounds. I left that appointment proud, feeling like I could be on the cover of Us Weekly. It must be the breast-feeding, pumping and healthy eating. But I was kidding myself. I breast-fed for all of three days. Sure, I pumped a few bottles, but Jackson got mostly formula. And I wasn’t eating healthfully. I was eating takeout.

About two months after Jackson’s birth, my thyroid burnt out. I didn’t know it at the time, but I later learned that mild hyperthyroidism had given way to Hashimoto’s disease, a potentially more serious, and chronic, thyroid condition in which the thyroid becomes underactive. Over the next few months, I gained about 30 pounds and became extremely lethargic. When I woke each morning, my first thought was: When can I take a nap today?

My body was just transitioning, I thought. And I had a baby now. Most new moms were tired, right? Still I sensed that something intense was happening: I was a different person.

My husband and I had some traumatic fights during those months. I feared that our marriage, the very foundation for loving this new child, was falling apart. He said things like “you’ve changed and “I can’t live like this anymore.” And the truth was that we really couldn’t live like this anymore.

To make matters worse, I felt that my internist largely dismissed my concerns. He ran my blood work for virtually everything except my thyroid hormone level. We spent the follow-up appointment discussing my elevated cholesterol (also a symptom of hypothyroidism). He offered me Xanax and suggested I talk to a therapist about postpartum depression. Even most friends and family members chalked up these physical changes to the stresses of being a new mom.

Finally, when Jackson was 6 months old, I saw my O.B. again. She, too, bet on postpartum depression but ran thyroid tests to rule it out. I vividly remember when the doctor called with the results, “I’m surprised you can get out of bed in the morning, much less work full-time and take care of a baby.” When I hung up, I wept. I wasn’t losing my mind. I wasn’t just having a hard time adjusting. My thyroid, this little butterfly-shaped gland in my throat that I last worried about in high school biology, was having a hard time keeping my body up and running.

The synthetic thyroid hormone Synthroid helped with losing weight and energy levels. And ever since, I’ve had routine blood work and sonograms to monitor my hormone levels and the small lumps on my thyroid. During my second pregnancy, I saw an endocrinologist and had blood taken every month. My endocrinologist told me that it was important that I have my medication adjusted every month during the pregnancy since the thyroid helps the body stay pregnant.

I was surprised to find that several of my women friends also turned out to have thyroid problems. They tell the same story about discovering their condition either later in life or surrounding a pregnancy. Toni had three miscarriages in one year because of a mismanaged thyroid. Lisa was diagnosed accidentally at 41 when she saw a doctor for a double ear infection and bronchitis. “He felt my neck and noticed that my thyroid was quite enlarged,” she writes.

All the women had weight troubles. Eat less carbs. Exercise more. Take the baby out for walks. You’re getting older so it’s harder. That was the advice I got, along with speeches about the American diet of processed foods and sedentary lifestyle. But I’ve never been sedentary, and becoming a mother certainly didn’t have me sitting on the couch eating potato chips. My friend Jen remembers being patronized at her doctor’s office. “I was literally patted on the leg and told it’s just going to be hard for you to lose weight, dear,” she said. Her endocrinologist prescribed her a medication for diabetes and told her to eat 1,100 calories a day.

My takeaway from those six months is this: Even amid the huge life change that is motherhood, I knew something was really wrong with my body. And if I had put my health first, I would’ve figured it out much faster and with much less heartache. But prioritizing yourself isn’t something many new moms do very well.

Of course the early weeks with a newborn are exhausting for all parents, but if you don’t start to feel normal once the baby’s sleep schedule stabilizes, it’s worth getting your thyroid checked. A simple blood test can make all the difference.

Kristin Sample is a writer, teacher and dancer. Her novel “North Shore South Shore” is available on Kindle. Follow her on Twitter and Instagram @kristinsample or check out her blog, kristinsample.com.

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A High-Fat Diet May Lead to Daytime Sleepiness

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Credit Tony Cenicola/The New York Times

Eating a high-fat diet may lead to daytime sleepiness, a new study concludes.

Australian researchers studied 1,800 men who had filled out food-frequency questionnaires and reported on how sleepy they felt during the day. They were also electronically monitored for obstructive sleep apnea, which causes people to wake up many times during the night.

After adjusting for factors that could influence sleep — smoking, alcohol intake, waist circumference, physical activity, medications, depression and others — they found that compared with those in the lowest one-quarter for fat intake, those in the highest one-quarter were 78 percent more likely to suffer daytime sleepiness and almost three times as likely to have sleep apnea.

The connection of fat intake to apnea was apparent most clearly in people with a high body mass index, but the positive association of fat intake with daytime sleepiness persisted strongly in all subjects, regardless of B.M.I. Thestudy is in the journal Nutrients.

“The possible mechanism could be meal timing, but we didn’t have that information,” said the lead author, Yingting Cao, a doctoral candidate at the University of Adelaide. “But we have reason to believe that circadian rhythm, hormones and diet all work together to create these effects.

“Everyone knows that diet has an important effect on health,” she continued. “Extremely high fat intake is not good for sleep. So the key message here is to eat healthy. But that’s easier to say than to do.”

Parents With Sleep Problems Think Their Children Have Them, Too

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Credit Stuart Bradford

If you tell your child’s pediatrician that your child is having trouble sleeping, she might respond by asking you how well you sleep yourself.

A team of Finnish researchers found that parents with poor sleep quality tended to report more sleep-related difficulties in their children than parents who slept well. But when the researchers looked at an objective monitor of the children’s sleep, using a bracelet similar to a commercial fitness tracker that monitored movement acceleration, a measure of sleep quality, they found that the parents were often reporting sleep problems in their children that didn’t seem to be there.

“The only thing that was associated with sleeping problems, as reported by the parents, was their own reported sleeping problems,” said Marko Elovainio, a professor of psychology at the University of Helsinki and one of the authors of the study, which was published this month in the journal Pediatrics.

The study was relatively small, involving 100 families with children aged 2 to 6. But the findings suggest that parents’ report of sleep problems in their children are influenced by their own attitudes and behaviors surrounding sleep.

The researchers were inspired to do their study, in part, by research showing that mothers with depression over-report behavioral problems in their children, seeing issues that teachers do not see. In pediatrics, the researchers noted, doctors rely heavily on parental reports for information — and if that information is biased by a parent’s own experience, diagnosis becomes more difficult.

“Sleep is a good measure of stress,” said Dr. Elovaino, and it is one tool doctors use to evaluate how much stress a child is experiencing. But when making a diagnosis involving a child’s sleeping patterns, “we can’t rely on reports of parents. We need to use more objective measures.” One reason to look at sleep in this context, he said, is that unlike other possible markers of stress, it can be measured objectively.

But an accurate evaluation of sleep quality should also include an individual’s subjective perception of tiredness in the morning and throughout the day, said Candice A. Alfano, the director of the Sleep and Anxiety Center of Houston and an associate professor at the University of Houston. She and her colleagues published research in 2015 describing a similar disconnect between perceived sleep difficulties and measurable sleep. Although both anxious children and their parents reported greater sleep difficulties than children and parents with lower levels of anxiety, there was no significant difference between the measured sleep patterns of the two groups.

“Children who are anxious at night often attempt to avoid bed, ask parents to sleep with them, and complain of nightmares,” Dr. Alfano said. Those are observable behaviors for parents, but they might not be reflected in the quality of a child’s sleep once sleep is achieved, or how that child feels about sleep.

In general, said Jamie Howard, a clinical psychologist at the Child Mind Institute, a nonprofit group that deals with pediatric mental health issues, parents are better reporters of children’s external behaviors, while children are better reporters of their internal emotions. “If the parent is saying that a child seems sad or depressed, we listen,” she said. But it’s also important to talk to the child as well, in order to understand “how much is the parent’s perception and how much is actually what the child is experiencing.”

Sleep, especially when considered as a measure of stress or anxiety, sits somewhere between the external and the internal. Knowing that parents may be misperceiving a child’s sleep experience can remind practitioners to look further than a parent’s assessment of a child’s other emotional symptoms. “When we work with children, we’re really working with the whole family,” Dr. Howard said. “You have to always remember that reports of the children are coming through the filter of the parents.”

Placing the proper weight on the influence of that “filter” is a challenge for both professionals and parents, many of whom are well aware that they may see their children through a distorted lens. “I have a family history of mental illness,” says Judy Batalion, who wrote about her own anxieties and her mother’s hoarding in “White Walls: a Memoir about Motherhood, Daughterhood and the Mess in Between.” “I’m a professional worrier.”

Ms. Batalion is aware that she’s “hypervigilant” about the kinds of psychological issues she has seen in family members, and she’s also aware that she can take it too far. “When my older daughter was a toddler, there was a period where she just wanted bags, and to put stuff in bags, colored disposable spoons and straws.” The bags reminded Ms. Batalion of her mother’s bags. “I had to tell myself, she’s a toddler, not a hoarder.”

A good practitioner, experts agree, should never dismiss a parent’s concerns. Even in cases in which there is no objectively measurable sleep problem, a parent or child’s anxiety about sleep may itself be a problem. Similarly, notes Dr. Howard, if a parent perceives a child as being anxious, and the child herself isn’t feeling that emotion, the child still has to deal with a parent who thinks she’s anxious.

“Parents do such a good job of observing their children’s behaviors,” she said, but since they can’t always know what’s inside a child’s head, “they don’t know exactly what they’re thinking or feeling.”

It’s not surprising that parents might interpret a child’s actions through their own perceptions, Dr. Howard said. But, she added, “I’m much more concerned about a parent who doesn’t notice things than I am about a parent who sees things that aren’t there.”

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Sleep Problems Tied to Type 2 Diabetes

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Women with sleeping difficulties are at increased risk for Type 2 diabetes, researchers report.

Scientists used data from 133,353 women who were generally healthy at the start of the study. During 10 years of follow-up, they found 6,407 cases of Type 2 diabetes.

The researchers looked at four sleep problems: self-reported difficulty falling or staying asleep, frequent snoring, sleep duration of less than six hours, and either sleep apnea or rotating shift work. The study is in Diabetologia.

Self-reported difficulty sleeping was associated with higher B.M.I., less physical activity, and more hypertension and depression. But even after adjusting for these and other health and behavioral characteristics, sleeping difficulty was still associated with a 22 percent increased risk for Type 2 diabetes.

Compared to women with no sleep problems, those with two of the sleep conditions studied had double the risk, and those with all four had almost four times the risk of developing the illness.

The senior author, Dr. Frank B. Hu, a professor of nutrition and epidemiology at Harvard, said that sleep problems are associated with excess secretion of two hormones: ghrelin, which increases appetite, and cortisol, which increases stress and insulin resistance. Both are linked to metabolic problems that increase the risk for diabetes.

“And,” he added, “it’s not just quantity of sleep, but quality as well” that is associated with these health risks.