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Sleep

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Addressing sleep apnea can avert serious health consequences

By David Dunaief, M.D.

Dr. David Dunaief

Quality sleep feels like it can be elusive these days. Yet, our physical and mental wellbeing depends on getting restful sleep. For those with obstructive sleep apnea (OSA), it can be particularly challenging.

Sleep apnea is defined as an abnormal breathing pause that occurs at least five times an hour while sleeping. While there are many potential causes, the most common is airway obstruction. Some estimates suggest that about 39 million people suffer from sleep apnea in the United States (1).

OSA diagnoses are classified in tiers from mild to severe. The American Academy of Sleep Medicine (AASM) estimates that roughly 80 percent of moderate and severe OSA sufferers are undiagnosed.

Most risk factors for OSA are modifiable. They include excess weight or obesity, alcohol use, smoking, hypertension, type 2 diabetes, and hyperlipidemia (high cholesterol) (2). 

How do you know what to look for?

OSA symptoms include daytime fatigue, loud snoring, breathing cessation observed by another, impaired concentration, and morning headaches. While these are significant quality of life issues, OSA is also associated with an array of more serious health consequences, such as cardiovascular disease, high blood pressure and depression.

Fortunately, there is an array of treatment options, including continuous positive airway pressure (CPAP) devices, oral appliances, positional sleep therapy, and lifestyle modifications.

Sleep apnea and cardiovascular disease risk

In a study of 1,116 women over a six-year duration, cardiovascular mortality risk increased in a linear fashion with the severity of OSA (3). For those with mild-to-moderate untreated sleep apnea, there was a 60 percent increased risk of death; for those in the severe group, this risk jumped to 250 percent. However, the good news is that treating patients with CPAP decreased their risk by 81 percent for mild-to-moderate patients and 45 percent for severe OSA patients.

Another study of 1,500 men with a 10-year follow-up showed similar risks of cardiovascular disease with sleep apnea and benefits from CPAP treatment (4). The authors concluded that severe sleep apnea increases the risk of nonfatal and fatal cardiovascular events, and CPAP was effective in curbing these occurrences.

In a third study, this time involving the elderly, OSA increased the risk of cardiovascular death in mild-to-moderate patients and in those with severe OSA by 38 and 125 percent, respectively (5). But, as in the previous studies, CPAP decreased the risk in both groups significantly. In the elderly, an increased risk of falls, cognitive decline and difficult-to-control high blood pressure may be signs of OSA.

OSA and cancer risk

There have been conflicting study results about the associations between OSA and cancer risk. To reconcile these, a 2023 study of over 62,000 patients in Sweden were followed. Researchers found that OSA was associated with cancer prevalence, independent of other confounding factors (6). 

In a previous study of sleep apnea patients under age 65, researchers also showed an increased risk of cancer (7). The greater the percentage of time patients spend in hypoxia (low oxygen) at night, the greater the risk. The authors believe that intermittent low levels of oxygen, caused by the many frequent short bouts of breathing cessation, may be responsible for the development of tumors and their subsequent growth.

OSA and male sexual function

Erectile dysfunction (ED) may also be associated with OSA and, like other outcomes, CPAP may decrease this incidence. This was demonstrated in a small study involving 92 men with ED (8). The surprising aspects of this study were that, at baseline, the participants were overweight, not obese, on average and were only 45 years old. In those with mild OSA, CPAP had a beneficial effect in more than 50 percent of the men. For those with moderate and severe OSA, the effect was still significant, though not as robust, at 29 and 27 percent, respectively.

Other studies have varying results, depending on the age and existing health challenges of study participants. Researchers have suggested that other underlying health problems may be the cause in some patient populations.

Can diet help with OSA?

For some of my patients, their goal is to discontinue their CPAP. Diet may be an alternative to CPAP, or it may be used in combination with CPAP to improve results.

In a small study of those with moderate-to-severe OSA, a low-energy diet showed positive results. A low-energy diet implies a low-calorie approach, such as a diet that is plant-based and nutrient-rich. In the study, almost 50 percent of those who followed this type of diet were able to discontinue CPAP (9). The results endured for at least one year.

If you think you are suffering from sleep apnea, you should be evaluated at a sleep lab and follow up with your physician.

References:

(1) ncoa.org. (2) Diseases. 2021 Dec; 9(4): 88. (3) Ann Intern Med. 2012 Jan 17;156(2):115-122. (4) Lancet. 2005 Mar 19-25;365(9464):1046-1053. (5) Am J Respir Crit Care Med. 2012;186(9):909-916. (6) BMJ Open. 2023; 13(3): e064501. (7) Am J Respir Crit Care Med. 2012 Nov. 15. (8) Sleep. 2012;35:A0574. (9) BMJ. 2011;342:d3017.

Dr. David Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com or consult your personal physician.

Student falling asleep at his desk. Courtesy MetroCreative Connection

By Daniel Dunaief

Imagine a typical school classroom filled with adults, listening as intently as they can to a detailed lecture about the finer points of tax law or multivariable calculus.

The adults in the room who weren’t particularly interested in the topic might struggle to concentrate, and several of them might try — perhaps unsuccessfully — to stay awake.

Now, bring a group of 8-year-olds into the same room, with the same instructor, and the same material. The likelihood that any of those younger students would fall asleep in their chair is far lower.

One reason for that difference is that the younger set, consistently, gets more sleep, while the older generation, from high school students on up the chain, typically, are not as well-rested.

“We think it’s normal, if you’re bored, to fall asleep, but it’s not,” said Dr. Steven Feinsilver, director of the Center for Sleep Medicine at Northwell Lenox Hill Hospital. “Falling asleep in a lecture that doesn’t interest you means that you either have a sleep [problem] or, more likely, are sleep deprived.”

Indeed, the percentage of the population that is sleep deprived is estimated at around 50% or more, a staggering number, which means that at least half the population needs more restorative sleep.

With the start of another academic year just under a month away, sleep experts are urging students to start shifting back to their respective school sleep schedule in the coming weeks.

These sleep experts suggest that students who may sleep until 9 a.m. or later during the summer, but will soon get up for school at, say, 6 a.m., are experiencing a type of jet lag people often feel when they travel across the Atlantic.

Sleep experts say that changing an adolescent’s schedule to an earlier waking routine, a week or more before school starts, can ease that school-year transition, while others recommend shifting up wake-up time, by an hour earlier per day during the September lead-up.

“If you know you’re going to have to be waking up at 6 a.m. for the first day of high school, you should be starting to wake up within that hour, within three days or so, before that so your body gets used to it,” said Lauren Hale, professor of preventive medicine and sleep behavior expert at Stony Brook Medicine.

Routines, including getting enough sleep, are important in preparing for the mental effort required to meet daily learning challenges.

“Our brains like a consistent schedule,” said Brendan Duffy, director of Sleep Services at Catholic Health, which includes Port Jefferson-based St. Charles Hospital and Smithtown-based St. Catherine of Siena. “It’s important to get up at the same time,” even on weekends.

Teenagers need more sleep

The academic age group that needs the most sleep is the one that is often getting the least.

High schools often start just after 7 a.m., in part because after-school activities such as athletic practices and events, as well as other extra-curricular activities, take up the hours between the end of school and the onset of darkness.

“Between 15 and 25, everybody’s clock tends to run slow,” Feinsilver said.

The school districts that have pushed high school start times back have seen their test scores go up, added Feinsilver.

He acknowledged that it’s challenging for parents who are managing their own work schedules to balance their children’s academic hours. Parents and schools can and should try to compromise, he urged.

Benefits on the athletic field

Boy chases a soccer ball. Pixabay photo

A return to school also means the restarting of athletic programs, some of which begin before the first day of the new academic calendar.

Student-athletes are pushing their minds and bodies, as they juggle demanding academic requirements with training and competition.

Sleeping the estimated optimum of seven to nine hours per night not only helps improve an athlete’s competitive skills but also helps prevent physical problems.

Sleeping enough is a “way to avoid injuries,” said Duffy, who has been talking to students in a range of ages all the way through college.

Duffy added that professional teams are also encouraging athletes to budget for the sleep their minds and bodies need.

Additionally, he suggests sleep is a form of prehab, as sufficient rest can prevent injuries that would require rehabilitation.

Duffy has spoken with several area teams about the importance of sleep, including the Stony Brook women’s soccer team.

“For 90% of the players, this is the first time” they hear about the importance of sleep athletically, said Tobias Bischof, the head coach of SBU women’s soccer team. “My players are 18-to-22 years old and it’s not on their radar yet how important sleep is.”

He describes sleep as “probably the greatest recovery tool we have” and believes it’s “super important for injury prevention.”

As a coach, Bischof has started journaling his sleep patterns and believes he and others can be better coaches with enough rest.

He suggested that coaches are under tremendous pressure and sleep helps him become more patient.

Numerous factors contribute to success on and off the field with these student athletes, including nutrition, hydration, self-care and relationships with their families, as well as sleep, Bischof added.

The soccer coach doesn’t ask about sleep when he’s speaking with high school players who might join the SBU team, but it comes up when athletes ask about ways the school works with athletes beyond training.

He describes mental health support as well as sleep education.

“You always want to make them a better version of themselves,” Bischof said.

Jim Taylor, who specializes in the psychology of sports and parenting and who has been a consultant to the U.S. and Japanese ski teams, met Duffy when they were on a podcast panel related to sport psychology in 2022. Taylor suggested that sleep is much more than a physical process, as it has psychological and emotional implications.

“One of the most powerful tools that athletes have is sleep, which impacts them in so many ways,” he explained in an email.

Taylor, who competes in triathlons, has seen his results improve from top 20 in his age group to two national championship titles and three world championship podiums.

“Of course, I’m sure other factors contributed to my improved results, but I know that improved sleep was a key contributor,” he explained.

Mental health

Sleep can also be a sign of, or a contributing factor to, mental health issues.

In a Sleep-to-Rise campaign, the Sun Belt Conference suggests that talking about sleep is a gateway to discussing mental health.

Not getting enough sleep or poor sleep quality can increase the risk for mental health issues, while poor sleep itself can reflect mental health challenges.

In its sleep-to-rise online effort, the conference urges athletes to consider sleep a “competitive advantage.”

“With student-athletes, we emphasized the importance of prioritizing your sleep,” Lauren Shear, assistant commissioner of Championships & Sports Administration at the Sun Belt Conference, explained in an email. “This meant highlighting how sleep affects both mental health and physical health.”

Shear added that the conference tries to provide educational resources on mental health, nutrition, sleep and other factors to equip the student-athletes with the information they need to succeed in and outside competition.

She tries to get seven to eight hours of sleep per night and has noticed that when she gets six or less, she’s more irritable and lethargic. She’s also more likely to get sick.

Stony Brook’s Hale added that sleep, unlike diet or other life changes, can provide a noticeable benefit.

“People can see immediate results quicker than other behaviors,” Hale said. “If you choose not to have dessert, you might feel like you lost something and you don’t see a benefit the next day. If you actually got a full night of sleep, you might feel the benefits that day.”

Sleep tips from SBU’s Hale

  Prioritize your sleep health

• Try to have regular sleep times, even on

weekends

• Make sure you get morning light

• Avoid substance use, like caffeine late in

the afternoon

• Put screens away before bedtime

• Sleep in a cool, dark, quiet place

• Pay attention to your body. Figure out when you get restorative rest compared with when you don’t.

METRO photo

By Daniel Dunaief

Daniel Dunaief

I’m tired, crabby, angry, annoyed, frustrated, disappointed, appalled and short tempered. 

Sleep, as a feature in TBR News Media this week suggests, will cure some of that.

But I’m just so fed up with the nonstop negativity in the country. Half the country not only wants to win, but seems thrilled with the prospect that the other half will lose. The worse the losers feel, the happier they are.

We’ve become a society of stomping toddlers, eager to crush the careful creations and ideas of those we oppose under our feet. Cut it out! This isn’t helping.

Okay, let’s take a step back from politicians and discuss us, you know, John and Joan Q. Public.

We are generally sleep deprived, according to statistics and people who pinch themselves not out of sheer joy but out of the necessity of staying awake each day.

More than one out of two people in the cars next to us may not only be texting and/or talking on the phone, but is also likely struggling to stay awake. That’s not good for them or for us.

Think about it: when you go to a store for stuff, call a company to send someone to fix your air conditioners in overbearing heat, or need someone to provide a skill set that you don’t possess, you don’t ask a long list of questions to make sure they were on the winning political team or that they believe everything you believe or even that they got enough sleep the previous night.

But, wait, what if the help we need is part of the other political team or, even going outside the realm of politics, is a devoted fan of the Red Sox, believes in red herrings, or is a fan of the color red?

You might privately enjoy the victory of your team or your would-be political leader, but are you really eager for them — you know, the “others” who are a part of our lives — to be miserable?

Their misery could become your misery.

It might tickle you to watch them cry and to ponder the existential threat that the person you support won and the person they supported lost, but you still need them even if you have no use for their political leaders.

If they lose sleep and are worse at their jobs, you might have to wait longer in line, deal with an incorrect bill you have to keep fighting, or suffer through the consequences of getting a meal that contains an allergen you told the waitress you couldn’t eat.

Even if you feel a momentary satisfaction that people who are supporting the wrong candidates  lost, you shouldn’t be too eager to push their head in the mud or to throw tomatoes at them. You might need those people and your tomatoes.

What happened to agreeing to disagree, to the art of compromise or even just to listening?

If whichever side loses feels like they still have a seat at the table, an ability to affect policies, an opportunity to help our children learn — is anyone on this campaign talking about education, ever? — and confidence that someone will listen to their ideas, the political and cultural temperature wouldn’t be so high and we the people would sleep and work better.

Yes, the extremes on each side can be absurd and frustrating, but even those people with the most ridiculous signs can be agreeable and helpful outside the context of political ideology.

So, just to recap, we might want to consider this great experiment in democracy as a team effort. We don’t always say and do the right things and we don’t always back the right horses, but, together, we can be greater than any one election or one would-be leader.

Unless we’re ready to live on a farm and eat our own food, educate our children, provide our own energy and entertainment and perform necessary surgeries on ourselves, we need each other. Once we remember that, we might have a better chance of sleeping well at night, which will make us better at our many roles, from parenting, to working, to contributing to our communities.

METRO photo

By Leah S. Dunaief

Leah Dunaief

We seem to be living at a higher level of anxiety. Maybe not all of us. Somewhere there might be one or two souls who are still calmly oblivious to the world around us. Those are the ones who have turned off their televisions and radios, who don’t read newspapers and have put away their cellphones. But from conversations I have had, that’s not the rest of us. The rest of us are quietly, or not so quietly concerned.

What’s wrong? Let’s make a list. Better yet, let’s not. Instead, let’s think about how to cope.

One way to start is to divide what troubles us into two lists: those we can do something about and those we cannot. Then concentrate on the former. When confronted with hate, we can respond with kindness. We can listen rather than scream. We can do our tiny bit to help make our neighborhood a better place.

A psychotherapist I was interviewing recently told me she instructs her anxious clients to concentrate on their breathing, taking deep breaths for ten minutes to calm the body. The usual trio of eating, sleeping and exercising properly are critically important to maintain. Meditation, and even aromatherapy may also help. 

Specifically:

Exercise regularly. It’s good for both body and mind. One recent study revealed that “people with physically active lifestyles had about 60 percent lower risk of developing anxiety disorders,” according to healthline. This study was done over 21 years and followed 400,000 participants.

How does exercise work? For one, it provides a distraction from whatever is worrying. Also, getting the heart rate up changes brain chemistry, encouraging the secretion of anti-anxiety brain messengers like serotonin and gamma-aminobutyric acid (GABA). According to the American Psychological Association, “regular exercise leads to an enhancement of concentration and willpower, which can help certain anxiety symptoms.” 

Plus you feel good, especially when you stop. Walking is the simplest and perhaps most enjoyable way to exercise, particularly at this time of year, when it is not too hot nor too cold, and the changing colors of the foliage are a delight.

Eating a balanced diet, and eating it calmly, is important. Low blood sugar levels, dehydration and chemicals in processed foods, such as artificial flavorings, artificial coloring and preservatives can cause mood changes. A high-sugar diet can also have a negative reaction. So what should we eat? Fruits and vegetables, especially those leafy dark green ones rather than those high in starch, are ideal. After that, complex carbohydrates and beans, are a good source of nutrition. I happen to like fish, the white fleshy kind like sea bass, rather than lean meat, for animal protein. But remember, there is plenty of protein in veggies and beans.

Sleep is so important. A good night’s sleep leaves me feeling as if, the next day, I could “leap tall buildings at a single bound,” to borrow from the Superman tagline. Ah, but how to get a good night’s sleep? I am a good sleeper, and I will tell you what I do—most of the time.

I don’t watch television or use my computer or cellphone before going to bed. Something about that blue light wakes me up. I don’t even have those in my bedroom. I will sometimes read a bit, but not a page turner. My room is the coolest in the house, and I will frequently have the window open, even a tiny bit, in winter. I know that going to bed the same time each night is recommended, though I don’t always follow that advice. Also no alcohol before bedtime is also advised. It helps put me to sleep but I will be wide awake when the alcohol wears off in the middle of the night. And, I invested in a comfy down comforter years ago that, with its plushness, invites me into bed.

Better not to nap during the day, and that leaves me sufficiently tired by bedtime, especially if I have exercised. At least, it should. If it doesn’t, I will empty my thoughts onto a list, put the pad on the bedside table, then doze off.

Sleep clears toxins from the brain. METRO photo
Exercise and sleep are crucial to clearing the clutter

By David Dunaief, M.D.

Dr. David Dunaief

Considering the importance of our brain to our functioning, it’s startling how little we know about it. 

We do know that certain drugs, head injuries and lifestyle choices negatively impact the brain. There are also numerous disorders and diseases that affect the brain, including neurological (dementia, Parkinson’s, stroke), infectious (meningitis), rheumatologic (lupus and rheumatoid arthritis), cancer (primary and secondary tumors), psychiatric mood disorders (depression, anxiety, schizophrenia), diabetes and heart disease.

Although these diseases vary widely, they generally have three signs and symptoms in common: they either cause altered mental status, physical weakness or change in mood — or a combination of these.

Probably our greatest fear regarding the brain is a loss of cognition. Fortunately, there are several studies that show we may be able to prevent cognitive decline by altering modifiable risk factors. They involve rather simple lifestyle changes: sleep, exercise and possibly omega-3s.

Let’s look at the evidence.

Clutter slows us down as we age

The lack of control over our mental capabilities as we age frightens many of us. Those who are in their 20s seem to be much sharper and quicker. But are they really?

In a study, German researchers found that educated older people tend to have a larger mental database of words and phrases to pull from since they have been around longer and have more experience (1). When this is factored into the equation, the difference in terms of age-related cognitive decline becomes negligible.

This study involved data mining and creating simulations. It showed that mental slowing may be at least partially related to the amount of clutter or data that we accumulate over the years. The more you know, the harder it becomes to come up with a simple answer to something. We may need a reboot just like a computer. This may be possible through sleep, exercise and omega-3s.

Get enough sleep

Why should we dedicate 33 percent of our lives to sleep? There are several good reasons. One involves clearing the mind, and another involves improving our economic outlook.

For the former, a study done in mice shows that sleep may help the brain remove waste, such as those all-too-dangerous beta-amyloid plaques (2). When we have excessive plaque buildup in the brain, it may be a sign of Alzheimer’s. When mice were sleeping, the interstitial space (the space between brain gyri, or structures) increased by as much as 60 percent.

This allowed the lymphatic system, with its cerebrospinal fluid, to clear out plaques, toxins and other waste that had developed during waking hours. With the enlargement of the interstitial space during sleep, waste removal was quicker and more thorough, because cerebrospinal fluid could reach much farther into the spaces. A similar effect was seen when the mice were anesthetized.

In another study, done in Australia, results showed that sleep deprivation may have been responsible for an almost one percent decline in gross domestic product for the country (3). The reason? People are not as productive at work when they don’t get enough sleep. They tend to be more irritable, and concentration may be affected. We may be able to turn on and off sleepiness on short-term basis, depending on the environment, but we can’t do this continually.

According to the Centers for Disease Control and Prevention, four percent of Americans reported having fallen asleep in the past 30 days behind the wheel of a car (4). And “drowsy driving” led to 83,000 crashes in a four-year period ending in 2009, according to The National Highway Traffic Safety Administration.

Prioritize exercise

How can I exercise, when I can’t even get enough sleep? Well there is a study that just may inspire you.

In the study, which involved rats, those that were not allowed to exercise were found to have rewired neurons in the area of their medulla, the part of the brain involved in breathing and other involuntary activities. There was more sympathetic (excitatory) stimulus that could lead to increased risk of heart disease (5). In rats allowed to exercise regularly, there was no unusual wiring, and sympathetic stimuli remained constant. This may imply that being sedentary has negative effects on both the brain and the heart.

This is intriguing since we used to think that our brain’s plasticity, or ability to grow and connect neurons, was finite and stopped after adolescence. This study’s implication is that a lack of exercise causes unwanted new connections. Human studies should be done to confirm this impact.

Consume omega-3 fatty acids

In the Women’s Health Initiative Memory Study of Magnetic Resonance Imaging Study, results showed that those postmenopausal women who were in the highest quartile of omega-3 fatty acids had significantly greater brain volume and hippocampal volume than those in the lowest quartile (6). The hippocampus is involved in memory and cognitive function.

Specifically, the researchers looked at the levels of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in red blood cell membranes. The source of the omega-3 fatty acids could either have been from fish or supplementation.

It’s never too late to improve brain function. Although we have a lot to learn about the functioning of the brain, we know that there are relatively simple ways we can positively influence it.

References:

(1) Top Cogn Sci. 2014 Jan.;6:5-42. (2) Science. 2013 Oct. 18;342:373-377. (3) Sleep. 2006 Mar.;29:299-305. (4) cdc.gov. (5) J Comp Neurol. 2014 Feb. 15;522:499-513. (6) Neurology. 2014;82:435-442.

Dr. David Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com. 

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Sophia Zhukovsky, a Stony Brook University sophomore and Ward Melville High School graduate, addresses the school board Sept. 18. Photo by Andrea Paldy

By Andrea Paldy

Activism is strong in Three Village.

At the Sept. 18 Three Village school board meeting, parents, students and alumni came out in support of an issue that has concerned many members of the community: school start times.

“It’s very strenuous to strive for academic and personal success on half the medically recommended sleep time for people my age.”

Sophia Zhukovsky

Earlier in the month, the board heard from parents in favor of later start times for the district’s three secondary schools. Last week, the board heard from Ward Melville graduates and students, themselves.

“Sleep deprivation does not have to be a part of Ward Melville culture,” said Sophia Zhukovsky, a sophomore at Stony Brook University and a Ward Melville graduate.

“Ward Melville has a great deal of high-achieving, dedicated and bright students, but it also has a great deal of exhausted students,” she said. “It’s very strenuous to strive for academic and personal success on half the medically recommended sleep time for people my age.”

Student and parent speakers echoed Zhukovsky’s sentiments. They described mornings as a “time of family anxiety and stress” and shared personal stories about the impact of sleep deprivation on family time and emotional health.

“Even 30 minutes would do a lot for students at the school in terms of both mental health and for fostering community,” wrote Kirti Nath, 2017 Ward Melville valedictorian. Nath couldn’t attend the meeting, but her letter was read to the board by high school student Natalia Newton.

“Ward Melville is undeniably one of the best public high schools that I know of, and I am incredibly grateful to have gotten my start there,” said Nath, a University of Pennsylvania sophomore. “I write this because I think that the Ward Melville experience can be even better.”

Annemarie Waugh, a local artist, P.J. Gelinas parent and founder of Sidewalks For Safety, said allowing students more time to sleep would “level the playing field” both athletically and academically. She added yet another concern.

“The system now encourages inexperienced teenage drivers to be driving in the dark at the same time other students are waiting on busy roads with no sidewalks in the dark,” she said. “This arrangement doubles the risk of tragedy.”

In addition to drawing even more supporters than the previous board meeting, the It’s About Time: Three Village Parents For A Later School Start Time movement gathered more than 1,400 signatures in a little more than a week.

But breaking through the chorus of support for a later secondary start time was Vincent Sperandeo, a parent of Ward Melville graduates. “Changing us would also mean that other districts would have to change as well,” he said.

He pointed out that Ward Melville was within the range of start times for surrounding school districts and changing Three Village’s junior high and high school start times would have to be done “in coordination with other districts.”

While Ward Melville starts at 7:05 am, nearby districts range in start time from the 7:02 a.m. warning bell at Miller Place High School to 7:10 a.m. at Comsewogue High School, 7:20 a.m. in Smithtown and 7:30 a.m. in Commack, Port Jefferson and Mount Sinai.

“The real world out there is not starting at 9 o’clock,” Sperandeo said. “The real world out there is starting when your job is telling you to start.”

Although districts in the immediate area have start times well before 8 a.m., schools across the nation have been taking a serious look at delaying start times.  Ever since the American Academy of Pediatrics recommended in 2014 that secondary schools start no earlier than 8:30 a.m., attention to the issue has grown. The State of California has even gone so far as to propose a bill pushing back start times for all of its secondary schools.

According to research, biological changes in the adolescent circadian rhythms make it difficult for them to fall asleep before 11 p.m. Waking up to catch an early bus interrupts the later part of their sleep cycle, preventing them from getting the recommended 8 to 10 hours of sleep their developing bodies and brains need.

Researchers at Seattle’s University of Washington and the Salk Institute for Biological Studies in La Jolla, California, found that students at two Seattle high schools that changed to later start times got more sleep during the week, had fewer tardies and absences in their first period classes and had improved academic performance.

“Changing us would also mean that other districts would have to change as well.”

— Vincent Sperandeo

Despite the abundance of information favoring later start times, most U.S. high schools start before 8:30 a.m., and some schools that considered change decided against it because of logistics.

That’s why Barbara Rosati, founder of It’s About Time, has suggested that Three Village officials attend the Adolescent Health and School Start Times Workshop, in Pennsylvania, which would cover the “science, strategies, logistics and tips” for making a shift.

The Nov. 13 workshop is already full. However, the website indicated that the organizer — the national group, Start School Later — was considering a second session.

Superintendent Cheryl Pedisich, who described the research on later start times as “cogent, valid and reliable,” said last week that the district would begin phase 1 of its investigation into the shift. This would mean “data gathering” so that there could be “meaningful conversation,” she said.

This process, the superintendent said, would include surveys of parents, staff and students, as well as conversations with districts that have made the time change and those that considered it, but decided against it. Pedisich estimated that if the board moved forward with a committee, it would take shape in January.

“The last thing in the world we want to do is give the impression that we’re not listening,” said board president William Connors during a telephone interview. “Fourteen hundred signatures is compelling and shows we have to listen and do our due diligence.”

But there are also a lot of factors to consider, he added, such as the “domino” effect on other grades and the fact that a shift could cost the district “literally millions of dollars” in additional transportation costs.

“I don’t like the idea of kids getting up at 5 in the morning, but we have to look at the alternatives and establish our priorities,” Connors said.

Sleep researchers say students who get even 30 minutes more sleep a night will see huge effects on overall performance. Stock photo

By Kyle Barr and Rita J. Egan

Come September, middle and high school students across the North Shore will wake up to the harsh sound of alarms, sometimes hours before the sun will rise.

Some will wake up late, and rush in and out of the shower, sometimes not having time to eat before they make it to the bus stop, often in the dark where the cicadas continue to buzz and the crickets chirp.

Port Jefferson high schoolers will shuffle through the front doors before 7:20 a.m. Students at Ward Melville High School will hear the first bell at 7:05, while Comsewogue students will be in their seats at 7:10.

Some scientists across the North Shore have said that needs to change.

The science

Brendan Duffy has worked in St. Charles Hospital’s Sleep Disorders Center for nearly a decade, coming out of working at Stony Brook University as a sleep technician. As he worked in the field, he started seeing significant connections between the effectiveness of individuals during the day and how much sleep they got the night before. For teens, he said, the importance is all the greater. Sleep, he said, has a direct impact on risk-taking versus making smart choices, potential drug use, obesity and depression.

“The science is irrefutable,” he said. “Basically, anything you do, whether it’s mentally or physically — it doesn’t directly cause [these harmful decisions], but there’s connections and links.”

While some parents would simply tell their kids to get off their phone or computer and go to bed, scientists have said the bodies of young people, specifically teenagers, have internal clocks that are essentially set two hours back. Even if a young person tries to fall asleep at 9 p.m., he or she will struggle to slumber. Duffy said scientists call it the delayed sleep phase, and it directly affects the timing of the body’s melatonin production.

During sleep, the body enters what’s called “recovery processes,” which will regulate certain hormones in the brain and effectively flush all waste products from daily brain activity. Without enough sleep, these processes do not have time to work.

“The science is irrefutable.”

— Brendan Duffy

That is not to mention rapid eye movement sleep. REM sleep is a period during the night where heart rate and breathing quickens, and dreams become more intense. Lauren Hale, a sleep researcher and professor of preventive medicine at Stony Brook University, called this period critical to sleep. The longest period of REM happens in the latest part of the sleep cycle, the one deprived by waking up early. 

“For decades, scientists have known young people are sleep deprived,” she said. “It’s not that they can get by on six or seven hours of sleep … teenagers are the most at risk of not getting the sleep they need.”

Of course, it is not to say modern technology has not affected young people. Duffy said phones and computers have meant the brain is never given time to rest. Even in downtime, minds are constantly active, whether it’s playing video games or simply scrolling through Facebook.

“They’re not given a break,” Duffy said. “Their brains are constantly processing, processing, processing.”

Sleep and sports

“I looked at all the school athletic programs that have been decimated by changing their start times, and I couldn’t find anything,” Duffy added. “It’s hard for athletes to perform or recover if they’re not sleeping well at the high school level.”

In research, college football teams looked at which kids were likely to be injured, and those who received less than eight hours of sleep were 70 percent more likely to be injured, according to Duffy.

That research led him to find Start School Later, a nonprofit national advocacy group to change the minimum school start time to 8:30 a.m., at a minimum. Duffy communicated with the nonprofit to provide data on the effect lack of sleep has on players. He has become its athletic liaison.

He points to professional sports teams, many of which have sleep professionals whose jobs are to set sleep schedules for their players and help reach peak effectiveness.

History of sleep and schools

Dr. Max Van Gilder is a retired pediatrician and coordinator for the New York branch of Start School Later. He said that while most schools traditionally started at 9 a.m. for most of the 20th century, the move toward earlier start times was relatively recent, only beginning around 1975 with busing consolidation. Schools started doing multiple bus runs for different grade levels, and high school students would be the first ones on these routes.

For decades, the early start became more and more established. Start School Later was created little more than a decade ago, but it’s only recently that some states have started to try later times.

In 2016, Seattle passed a law moving start times from 7:50 to 8:45 a.m. A study of the effects of that change showed students got an average of 34 more minutes of sleep a day or several hours over the course of the week. It also showed an improvement in grades and a reduction in tardiness. The study gave examples that in some classes average grades were up 4.5 points more than previous classes at the earlier start times.

“We need to work with the superintendents.”

— Max Von Gilder

In California, a bill that would have moved minimum start times to 8:30 a.m. was supported by both houses of the state Legislature before being vetoed by the governor last year. A similar bill is currently going through the legislative process again. Other states like Virginia and New Jersey have started to experiment with later start times.

On Long Island, very few districts have made significant increases in start times. Van Gilder said two-thirds of the high schools in New York state (excluding NYC) start before 8 a.m., with an average start time around 7:45. Only 2 percent of high schools start after the recommended time of 8:30, according to him.

The main difficulty of encouraging later start times is due to districts being so largely independent from both the state and each other. While this gives each district particular freedoms, it also means cooperation is that much harder. A district that changes start times would have to renegotiate with bus companies and find ways to navigate scheduling sports games between schools with different start times.

“The state constitution makes it very difficult for the State of New York to pass a law to say when you can start,” Van Gilder said. “We need to work with the superintendents.”

However, proponents of late start said the benefits easily outweigh the negatives.

“There are ways around it and, to me, this is a strong evidence base for opportunity to improve adolescent medical health, physical health, academic outcomes, safer driving — there is such a positive range of outcomes,” said Hale of SBU.

Parents working together

In the Three Village Central School District, more than two dozen parents filled a meeting room in Emma S. Clark Memorial Library Aug. 23. Barbara Rosati, whose daughter is an eighth-grader in P.J. Gelinas Junior High School, organized the meeting to discuss the benefits of teenagers starting school later in the day.

Rosati, a research assistant professor at SBU’s Renaissance School of Medicine in the Department of Physiology and Biophysics, said during conversations with Van Gilder she discovered there are only four high schools in New York that begin school as early or earlier than Ward Melville’s 7:05 start time. Because of their internal clocks, she described the teenagers as constantly being jet lagged.

“Older kids — adolescents, high schoolers, junior high school students — for them it’s much more difficult to get up early in the morning, and this has a physiological
basis,” Rosati said.

The goal of the Aug. 23 meeting was to go over studies, create an action plan and then put that plan into motion. The professor pointed toward the studies that show teenagers who are sleep deprived can be more susceptible to mood swings and drowsiness, and it can affect academic and athletic performance as well as cause long-term health problems such as anxiety, diabetes, eating disorders and cardiovascular problems.

“We’re spending a lot of money in this district to make our schools better and improve their performance, and then we undermine the kids with things like sleep deprivation,” Rosati said. “We undermine not only their health but academic performance.”

“We’re doing this because we care about our children’s mental health and academic achievement.”

— Barbara Rosati

Parents at the meeting agreed they need to be sympathetic to the school board, and Rosati added that she believed, based on prior experience, that the board would be willing to help.

“We have to show them our support, and at the same time we have to make sure they are willing to do this and feel committed to such an effort, because this is not something that you do halfheartedly,” she said.

Frances Hanlon, who has a sixth-grade student in Setauket Elementary School, agreed that the parents can work with the board trustees and that it wasn’t an us-versus-them issue.

“We can’t be, ‘We know better than you and why aren’t you?’” Hanlon said. “We all have to work on this together and that’s what’s going to make a change.”

Rosati and those in attendance are set to survey how many families are in the district and, when the school year begins, will start a petition for those in favor of late start times to sign.

Among the suggestions parents had were bringing the late school start presentation that Rosati created to the school board and PTA meetings throughout the district, with further plans to record and send it by email to parents. One mother also suggested that high school students join the parents at BOE meetings. Rosati said she would also like to have experts such as Van Gilder and Hale present a talk for the board trustees.

“We can use the help of these professionals to inform the board that there is really solid scientific evidence, and we’re not just doing this because we’re lazy and don’t want to get up early in the morning,” Rosati said. “We’re doing this because we care about our children’s mental health and academic achievement.”

Reaction from districts

Both of Duffy’s kids are already graduates of the Port Jefferson School District, and he has yet to present in front of the school board, saying he wants to gain more traction in the community before bringing it to school officials. He has been trying to get support through posts on social media.

“It really can’t come just from me, it has to come from the community,” he said.

Though Hale has gone in front of school boards at Shoreham-Wading River and a committee in Smithtown, she lives in Northport and has two young girls at elementary school level. She has also written editorials in scientific journals about the topic.

When Rosati attended a Three Village board of education meeting in June, she said a few trustees told her that starting high school later in the day could lead to eliminating some of the music programs while teams may not be able to compete against neighboring schools in sporting games.

After her appearance before the school board, she said she researched a number of schools on Long Island, including Jericho High School which starts at 9 a.m. and saw that they could still manage to have music programs and play schools at sports with different start times.

A statement from the Three Village School District said it had commissioned a lengthy discussion regarding school start times, but while it was in support of the research, it identified negative impacts to the athletic programs, transportation, BOCES offerings and elementary music.

“You don’t have to look hard to see the benefits of this.”

— Lauren Hale

 

The district said it also conducted an informal survey of a small portion of the student population, who said they were not in favor of later starts, but Three Village added it was only used to gather anecdotal information.

There are a few things parents can do to aid their child’s sleep beyond the later start. Rosati offered some tips, including regular bedtimes, providing balanced meals, curfew on screen times, and limiting extracurricular activities and the intake of sugar and caffeine in the evening hours. She and her husband have tried their best to follow those guidelines, but she said they still kept their daughter home multiple days due to sleep deprivation last academic year.

“We should not be put in the position to choose between education and health for our kids,” Rosati said.

When asked, Shoreham-Wading River, Port Jefferson and Northport school districts all said they were not currently looking into later
start times.

Still, Hale said despite her frustrations with the reaction from some districts she’s continuing to argue for later start times.

“We need to work together with communities so that parents and teachers and school board members understand this is for the benefit of the students and the community,” she said. “You don’t have to look hard to see the benefits of this.”

Rosati plans to host another meeting Sept. 10 at the Emma S. Clark Memorial Library in Setauket from 7:30 to 9 p.m.

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If you have had a particularly nasty fight with your spouse or best friend today, consider this. How well did each of you sleep last night?

It may not come as a surprise that a good night’s sleep makes one feel calm and good natured the next morning. But how many of us consider the ramifications of poor or too little sleep one night on our behavior and relationships the next day? We may feel out of sorts, perhaps below our awareness radar, and that can lead to more difficult and even acrimonious interactions with those at work, in our daily routines and especially with our spouses. Even worse, it may affect our health.

A study at Ohio State University of 43 couples and how their bickering could influence their health tracked the subjects spouses most often argue over: managing money, spending family time together or an in-law intruding on their lives. According to an article in The New York Times Science section, “Relationship Problems? Try Getting More Sleep” by Tara Parker-Pope, Sept. 4, the study revealed that some couples argue calmly, even constructively, while others were “hostile and negative.”

The difference? The hostile couples were likely not getting enough sleep, usually less than at least seven hours. So before you give up on a relationship, consider the sleep factor. With enough sleep, you will still have disagreements, but the tone of the conflicts will probably be more patient.

The Ohio State study goes further. It purports to measure how marital discord together with sleep deprivation can negatively affect a person’s health. The way the university measured for this possible toxic effect was by taking blood samples from both members of the couple before and after an argument. The samples measured the level of inflammation in the body because inflammatory proteins have been linked with heart disease, cancer and other health problems. The results showed that “marital discord is more toxic to your body when you haven’t gotten enough sleep.”

Interestingly, when one member of the couple got adequate sleep, it mitigated the negative tone of the conflict, even if the other member was sleep deprived. So that suggests “a half-a-loaf is better than none” conclusion.

The article goes on to reveal that some 25 percent of couples sleep in separate beds, presumably in order to get more undisturbed rest. “And when one relationship partner doesn’t sleep well, his or her partner is more likely to report poor health and well-being.”

In conclusion: “The lesson, say the study authors, is that before concluding a relationship is in trouble, couples who regularly experience conflict should take stock not only of the relationship and how they are managing conflict, but also of their sleep habits.” The study was published in the May edition of the journal Psychoneuroendocrinology, hardly most people’s bedtime reading but offering an article to better understand the universal need in a marriage for adequate sleep.

In addition to all the authoritative information above, I can offer another nugget in the advice for marrieds department. Mine is anecdotal, not academic. Disagreements don’t go well if one or both members of a couple are hungry. Hunger starts out as insidious rather than full blown, and so it is often hard to identify the mood change when in the midst of a difficult discussion or even in an idyllic setting. But hunger can forcibly affect one’s outlook and certainly one’s patience.

I found this to be particularly true with my husband. (I’m not making a gender specific allegation here, just sayin’.) We could be having a perfectly lovely time at the zoo or some other outing, and for no apparent reason, he would begin to get cranky. The level of his crankiness would rise as we continued to stroll. Fortunately I eventually figured it out and began to carry protein bars in my pocket. At the right moment, I would pull two out and offer him one. Within merely a couple of minutes, all was again right with the world.

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Superintendent James Grossane file photo

Smithtown high school students may soon be collectively rejoicing everywhere.

A committee assembled in 2015 to examine the pros and cons of moving back the start of the school day for ninth-  through 12th-grade students provided an update to the board of education, district administration and the community on their findings at a meeting Tuesday.

The School Start Times Steering Committee is comprised of district administrators, parents, students and teachers. District Assistant Superintendent for Instruction Jennifer Bradshaw led the discussion Tuesday. Bradshaw said the committee watched a New York State School Boards Association webinar about the Glen Falls City School District’s shift to a later start time a few years ago and the drastically positive impacts it has had on student behavior. They also consulted with the district’s athletic director, guidance counselors, parents and principals from other schools who have made the change for their input on the impact of a later start time.

“We have an obligation to look at this for our students,” Bradshaw said. Currently Smithtown’s high schools start first period at 7:20 a.m. “Physiologically, biologically they’re not ready to learn.”

Bradshaw quoted a recent press release from the Centers for Disease Control and Prevention that indicated two out of three high school students in the United States don’t get enough sleep.

Joanne Romanelli, a parent in the district who is on the start time committee and also works as a certified holistic health and wellness coach addressed the board during Tuesday’s meeting. She said that forcing teens to wake up as early as 6 a.m. creates a vicious cycle of stress, out-of-whack hormones and distorted sleeping patterns because their bodies cannot physically fall asleep before about 11:30 p.m.

“If you’re getting up earlier you’re feeling stress, you’re feeling tired, you’re not doing so well in school, you might be depressed or you have low serotonin,” Romanelli said. “There is more depression so now you’re feeling more stress. You’re having raised cortisol throughout the day. Raised cortisol makes you feel energized, it doesn’t make you feel sleepy. So now, you can’t go to sleep. So it causes more stress. It just cycles … A later start time is what’s best and it’s healthier for the students.”

School board members Louis Liguori and Joanne McEnroy said they’d like to see these updates fast-tracked from suggestions to a proposal and eventually a change because they’ve seen firsthand how difficult getting their teenagers out of bed really is.

“We pretty much have covered the gamut on all levels of educating children right down to nutritional changes that we have going on and [on a county and state level they’re] just not talking about, on a higher level, sleep deprivation or sleep patterns of our students,” Liguori said. “Who are we catering to? We’re not catering to the students at all by getting them up at 6 [a.m.].”

Some issues with pushing back the start of the high school day would include transportation, co-curricular athletics start times and changes to before and after care for elementary students if their times were affected.

Board member Jeremy Thode expressed concerns that if the high school day started later, kids would simply go to bed later and the problem would be shifted backward rather than alleviated.

“My concern as a parent and from an educational point of view is that we have some fool’s gold here in thinking they’re going to stay going to bed at 11 [p.m.] and now waking up at 9 [a.m.] or get up at 8 [a.m.], now they can stay up until 12 [a.m.], because kids are kids,” Thode said. “In an ideal world I think we’re talking about the right subject but there are some unintended consequences.”

Thode suggested that a next step could be to examine lateness patterns and grades for first and second period classes compared to the rest of the day for Smithtown high school students.

Bradshaw added she has been in contact with an organization called Start School Later Long Island, NY and that the best course of action may be for this to become a county or statewide discussion going forward. More discussion is likely to occur until the budget is adopted for the 2017-18 school year next spring.

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Professor Helen Benveniste. File photo from SBU

Sleeping doesn’t just provide a break from the daily grind, prevent you from chowing down on more Oreo cookies, or keep you out of trouble when it gets dark. It may also serve an important brain-cleaning function, getting rid of tau and beta amyloid proteins.

Merely shutting your eyes and letting the sandman sprinkle dust on your forehead may not be enough. You might actually help your brain, over the long term, with the way you sleep.

Helene Benveniste, a professor of anesthesiology and radiology and vice chair for research in the Department of Anesthesiology at Stony Brook University, recently conducted research on anesthetized rodents, tracking how the glymphatic system worked in various sleep positions. The animals were better at flushing tau and beta amyloid proteins from their brains when they slept laterally, or on their sides, than when they slept on their stomachs. Resting on their backs wasn’t as efficient as sleeping on their sides, although it was better than face down.

These proteins aren’t just a part of everyday maintenance. They likely play a role in the onset of Alzheimer’s disease and other age-related neurological problems, Benveniste said.

Since Benveniste published her study in the Journal of Neuroscience in early August, she has received a flood of emails from around the world, including from Brazil, France and Colombia, with people asking about various sleep positions and neurological disorders.

The Stony Brook professor said it is too soon after this study to come to any conclusions about sleep or preventing cognitive disorders. For starters, she and a research team that included scientists at the University of Rochester, NYU Langone Medical Center and Stony Brook conducted the studies on animal models, rather than on humans.

“In general, the rodent is a pretty good model for core aspects of human brain function,” said Dennis Choi, the chairman of the Neurology Department at Stony Brook. The specifics, however, can differ from one species to another. As a result, Benveniste said, “I don’t think anybody should panic” about the way he or she sleeps.

Scientists know that in the glymphatic pathway, cerebrospinal fluid moves through the brain and exchanges with interstitial fluid to get rid of waste. In the studies with rodents, the face down position seemed to divert the cerebrospinal fluid away from the brain, Benveniste said.

The research could be another step toward understanding how sleep might help with the human glymphatic system.

An anesthesiologist who does clinical work one day a week, Benveniste said she started thinking about conducting this kind of study a few years ago. Benveniste is a “good example of a physician/scientist,” Choi said.

Two years ago, a study by a co-author on the paper, Maiken Nedergaard from the University of Rochester, showed that sleep or general anesthesia enhances the clearance of waste from the brain of rodents.

“Since I am an anesthesiologist, I immediately thought about how body/head positions during anesthesia might affect clearance,” Benveniste said. The data took over a year and a half to collect and analyze.

“The quantitative aspect of this system should not be overlooked. To find out how these [proteins] are moving through the brain is a huge issue,” she said. The collaboration with Jean Logan, senior research scientist in the Department of Radiology at NYU “enabled us to move forward.”

Benveniste used a dynamic contrast MRI method to calculate the exchange rates between the cerebrospinal fluid and the interstitial fluid. The next step in these studies is to move toward the human brain. Benveniste said she is working with colleagues at the National Institutes of Health.

Just from observing wildlife outside the lab, Benveniste said many animals tend to sleep in what she and her team found was the optimum position for clearing waste in rodents: on their sides. “Even elephants lie down in recumbent, lateral positions,” she added.

As for Benveniste, she said she naturally sleeps on her right side. She said she’s well aware of how well she slept during the night. If she wakes up after getting enough rest, she said she thinks, “this was a good night’s sleep. This was good for my brain.”

Benveniste, who lives in Northport with her husband, Peter Huttemeier, is also an advocate of exercise for brain health, although she doesn’t suggest marathon running. “I do think this may be affecting the cerebrospinal fluid flow dynamics,” she said, adding that she wants to take up yoga.

Benveniste is eager to continue to build on this sleep study. “The workings of this system so far has been an amazing exploratory adventure,” she said.