Archive for July, 2014

You and Your Sleep Deprived Patient

Wednesday, July 16th, 2014

By Dr Uche Phillip Odiatu BA, DMD 

woman in bed awakening

You thought you had it all figured out –  during your new patient exam health history section you ask patients what meds they take; if  they have ever been in a motor vehicle accident; and some dentists ask about specific supplements their patients are taking. Well, that is only part of the equation when it comes to your patients’ health history. Current sleep research has shown if you are regularly sleeping less than 7 hours a night you are more likely to suffer from cardiovascular disease, stroke, cancer, diabetes and any number of other inflammatory conditions. Think gingivitis and periodontitis.

Most dental professionals are aware of sleep apnea and its grave consequences on the heart and brain. If sleep apnea is severe a CPAP machine is prescribed by the patients’ health care professional. If the diagnosis is mild a MAD or Mandibular Advancement Device can be made by the dentist. This article is not about obstructive breathing issues but about patients who simply do not get to bed on time, work shift work or have evening habits that disturb their sleep quality and quantity. If you read this article you will receive insightsthat will help you expand your New Patient exam questions or it will support your own healthy living goals.

“There is plenty of compelling evidence supporting the argument that sleep is the most important predictor of how long you live, perhaps more important than whether you smoke, exercise or have high blood pressure or cholesterol levels” ~ Dr William Dement, one of the world’s most prominent sleep researcher and founder of the Stanford University Sleep Disorder Clinic.

  1. Current sleep research has shown that 4 out of 10 people reported they sleep poorly.
  2. 20-40% of Americans work some type of evening or overnight shift.  Michael Howard PhD has reported that people who do shift work spend most of their waking time in a “jet lag” state.
  3. There is an important part of your brain –SUPRACHIASMATIC NUCLEUS – that  is your brain’s circadian clock which does not function well with cross country travel / time zone changes, poor sleep habits, nights shifts, sleep apnea, etc .
  4. When working into the wee hours of the night, cross time zones with cross country air travel to “four on four off” shifts the body’s reserves do not get replenished. From wound healing to trying to recover from a cold or a flu, a sleep debt can bankrupt your good intentions.
  5. Cumulative sleep debt costs you and your patients. People with disrupted sleep from rotating shifts have 3 times as many GI problems such as constipation, abdominal pain, heartburn and reflux (think acid erosion of lower molars) than those who have regular day time work hours
  6. REM (rapid eye movement) sleep is a vitally important part of your night. For optimal emotional health, adults need approximately 100 minutes of REM a night. (This can only be measured in a formal sleep study – called POLYSOMNOGRAPHY).  REM sleep has also be shown by UC Berkeley experts to help processes stressful memories and experiences and bring enhanced well-being into your life. Are you thinking of certain patients with bruxism habits?
  7. Research has shown that visual learning , especially learning to do NEW things gets consolidated while you are asleep – especially during REM sleep. A 2010 Harvard study on memory had their 100 volunteers do a test on finding their way around a maze on a computer. During a five hour break some stayed awake another group napped before taking the test again. The group who napped did the maze 162 seconds faster than the ones who stayed awake when doing the test again. Those who actually dreamed while napping did  their second test maze 225 seconds faster. TAKEAWAY for dentists on three day intense implant courses or leadership training? Take a nap midday or after an 8 hour workshop to internalize, consolidate the information and make it your own.
  8. A prominent Canadian dental journal Oral Health had a cover story demonstrating a relationship between obesity and periodontitis. This relationship was based on the inflammatory mediators released from visceral fat. CDC reported that 30% of Americans are overweight or obese (BMI over 30). What’s the link between lack of sleep and developing an overweight condition? Case Western University research showed that women who sleep less than 7 hours a night were 15% more likely to become overweight; women who had less than 5 hours were 30% more likely to develop obesity. A 2010 JADA article reported that dentists are interested in giving wellness guidance but felt they needed more evidence that losing weight would make for a healthy oral environment. If you are reading current periodicals the evidence is arriving.
  9. Sleep is a critical time enabling the body to heal, repair, restore, and regenerate itself reports Mary O’Brien MD author of The Healing Power of Sleep. Next time when giving post op instructions after an extraction or periodontal surgery tell your patient to get 7-9 hours sleep for the next week for optimal healing and recovery.
  10. Alcohol is the most common drug people use to get to sleep. Admittedly it does get you to sleep quickly. Downside, your sleep is lighter – you don’t get enough of the DEEP SLEEP where your pituitary gland releases growth hormone (the youth hormone for fat burning and maintaining muscle mass). With a single glass of wine before bed it spikes your insulin which also takes you out of fat burning mode. Alcohol before bed encourages snoring and sleep experts report even snoring reduces valuable oxygen flow to your brain
  11. As dentists we are aware of the link between inflammation in the mouth and a diabetic condition. Did you realize that poor sleep disrupts may disrupts good blood sugar management?  Four nights of shift work has been shown in scientific studies to bring about pre-diabetic blood glucose levels in those workers during their shifts.  If someone is not responding favorably to your soft tissue management therapy, you need to question those patients about their sleeping habits.
  12. Contrary to belief older people still require 8 hours sleep if they want to age gracefully. Sleep architecture changes with age (they spend less time in DEEP SLEEP and more time in LIGHT SLEEP) and with slower wound healing people over 60 needquality shut eye.

RECOMMENDATONS:

  1. Sleep in a cool (65-68F) bedroom for deeper sleep
  2. Create a pitch black environment so your melatonin levels remain high during the night
  3. Don’t eat before bed as it subtracts from the rejuvenating role sleep plays as your body is trying to digest a meal that should have been eaten at supper time
  4. If you have to cross multiple time zones and want to perform well in business or a sporting event, give yourself an extra day for each hour off your regular time zone.
  5. Sleep scientists say if you are going to workout 4-7pm is the ideal time in terms of supporting muscle adaptation and also to take advantage of the post exercise body temperature adaptation that sets the mood for sleep in the following 3-4 hours. Early AM workouts is still very productive  and they are the best strategy  to make time for exercise in a busy life. It’s just that current research by Michael Howard PhD has shown that late afternoon evening exercise sets the tone for a healthy sleep later that night
  6. “If you are not sleeping well it is almost impossible to heal well”  – NATIONAL SLEEP FOUNDATION
  7. Guided visualization and relaxation exercises are two of the best ways to support healthy rejuvenating sleep
  8. A clear conscious and a peaceful mind make for a short “sleep latency” (the time it takes to get to sleep – ideally 5-15 minutes).
  9. If you want to support healthy REM sleep and utilize its ability to process emotion and consolidate memory, give yourself a mental suggestion right before you sleep to focus on a specific subject or challenge you are currently undergoing
  10. Napping for 20-30min in the mid afternoon has been shown in numerous studies to enhance emotional well-being and productivity. As long as the naps don’t go longer than 30 minutes night time sleep is not impacted
  11. Find the right mattress for your body type. There is no one best type. Studies have shown that medium to firm is most likely to fit most people’s needs
  12. If you get up in the AM earlier than you wanted to, stay up. After a long continuous sleep, expose yourself to bright full spectrum light or sunlight and get your Sleep-Wake routine formalized.
  13. Don’t do anything else in bed except for the two S’s (sleep and _____). Watching TV, doing your taxes, eating  willdistract you from one of the most important health habits you might have. The brain loves cues that it is preparing to sleep. Lugging your laptop onto your lap to answer emails is highly distracting for your night-time brain
  14. Develop a bedtime ritual which cues your brain for slumber. Following the same steps before bed gets your brain ready for zzzzz.
  15. Many over the counter sleep aids are meant only for short term challenges with sleep. Prescription meds work wonders but they too have a number of side effects and many are not designed for long term use. There are herbal supplements but they too pale in comparison to learning relaxation techniques and developing good sleep hygiene rituals (evening/ pre-night time sleep habits).

This subject is new for the dental industry and I hope to share with you further information in the future. In the meantime “sleep well tonight and don’t let the bed bugs bite.”

REFERENCES:

  • Wamsley&Stickgold, Current Biology, 2010, 20(23)
  • National Sleep Foundation
  • CDC
  • Obesity and Periodntal Health: What’s the link? Should I be concernded? W. Ward et al. OralHealth October 2012
  • Sleep and Your Memory by Michael Howard PhD © 2010 Biomed
  • The Healing Power of Sleep by Mary O’Brien MD Biomed © 2012
  • “Dentists Attitudes About Their Role in Addressing Obesity in Patients” Curran et al.  JADA 2010
  • Geyer, Talachi& Carney, Introduction to Sleep and Polysomnography, 2005

 

OdiatuDr Uche Phillip Odiatu BA, DMD is the author of The Miracle of Health and Fit for the LOVE of IT! This busy practicing dentist is also a NSCA Certified Personal Trainer and a professional member of the American College of Sports Medicine (ACSM). He lectures at most of the major dental conferences in the USA, Canada, the Caribbean and England.www.fitdentist.com