Obstructive Sleep Apnea: Exercises

I don't know about getting rid of my CPAP machine (I've been using it every night and for every nap for 18 years) -- but I guess it wouldn't hurt to build up my face muscles...

How to Shut Your Brain Off When You Just Can't Sleep

by Shelby Freedman Harris

As our societal demands get even greater with each passing year, we find that we are "on" 24 hours a day, seven days a week. This results in greater rates of insomnia, with more and more people reporting that they just can't turn off their brains at night.

Mental over-activity is a big problem for many people, but there are some helpful techniques that might aid in quieting things down at night.

1. Give yourself some mental and physical wind-down time. 

We are so busy nowadays that there's just not enough time in the day to get everything done. As a result, many people are working (housework, schoolwork, job tasks, managing finances) up until bedtime. The problem with this is that sleep isn't simply an on/off switch. We need to unwind and dim our mind in order to set the stage for sleep. Allow for at least an hour before bedtime to be protected, relaxing, wind-down time. This can help create closure for the day and allow your brain to begin the process of shutting off. Wind-down should take place somewhere outside of your bedroom. Keep the lights dim and avoid using anything with a screen (tablets, phones, computers, TV), as this can make your brain think it's still daytime. Reading, light stretching, journaling and meditating are all great options. Find what works best for you and make it a nightly routine.

2. Don't worry in bed. 

Lying in bed with an overactive mind only serves to teach the body that the bed is a place to continue to be awake and think. Leave the bed if your mind is active and you're unable to sleep. Don't wait longer than 20 minutes to do this -- try to ballpark the time since it's best not to look at a clock during the night. When it's obvious your mind is active and you can't sleep, get up, go into a different room and sit in dim light, doing something quiet, calm and relaxing, such as repeating something you did during the initial wind-down. The act of just getting up and out of bed -- regardless of what time at night it is -- can be really helpful to stop those racing thoughts.

3. Focus on mental imagery. 

Believe it or not, there's something to be said for counting sheep. When we get in bed and our minds are overactive, it's hard to focus on anything else. Plus, the more you try not to think about all of the things on your mind, the more you actually think about it! Try finding something to imagine that takes a little effort to focus on. For example, outline the map of the United States in your mind or count backward by threes from 100. There's even been research looking at people who say the word "the" over and over again and notice how the letters and sounds morph with time as you focus on it: "the the the the the." This type of repetition can help keep constant mental chatter at bay.

4. Separate productive worry from unproductive worry. 

Worry is meant, ideally, to motivate us to complete certain tasks and get things done. Productive worry is adaptive -- when we feel anxious about something and worry about it, we take the necessary steps to solve the issue. Unproductive worry, though, is just that... unproductive. Lying in bed at night and worrying about all of the same things you stress about during the day likely doesn't help you come to any solutions. To-do lists can be really helpful in getting these things off your mind.

Shortly before wind-down time begins, which is set for at least an hour before your bedtime, take out a piece of paper. Fold the paper in half. On the top of the left column, write "Tasks/Worries" and on the top of the right column, write "Next Step Solution." Jot down all of the things that you have to do or concerns you might have on the left side and prioritize them, with one being the most important and so on. Then on the left side, think about what the next step solution might be. It is highly unlikely to be the final solution for many concerns, but it is at least the next step. For example, if you are currently unemployed and need to find a job for financial reasons, the next step solution can simply be, "Look through the help wanted ads online," or, "Send out my resume to five people." Breaking it down into smaller, more achievable goals can help keep unproductive worry from taking hold.

If it is something such as a "take out the garbage" task, write that in the next step solution: "Take out the garbage tomorrow morning." If there's no identifiable next step solution to the problem, then writing just that can help bring some acceptance to the issue: "There's nothing I can do about this, so continuing to worry about it is only serving to make me more anxious and less able to fall asleep."

Keep the paper next to your bed at nighttime, and if you begin to have an overactive mind again, remind yourself that you've written it all down and there's nothing else that can be done at night to take care of the problem. It takes practice, but this technique can be very helpful.

When To See A Specialist If you find that you have tried some of the above techniques and they just aren't helping, consider seeing a specialist in behavioral sleep medicine (BSM). BSM specialists are specifically trained in these issues and may be able to help you sleep better on a regular basis. 

Devices, Not Drugs: Part I: Sleep Disorders: A Personal Report

by Don Mangus

Here’s a start on my one-man, anecdotal report on all the devices, esoteric research, and alternative treatments I’ve explored over the last year or three.

I feel that technological, dietary, lifestyle, and mind/body treatments for physical and mental health ailments and syndromes are the preferred way to go -- whenever possible. They are underutilized, IMHO.

Why take a drug or risk an operation if you can treat an existing problem treatable with a device? There will likely be fewer harmful or irreversible side-effect/complications, or dangerous drug interactions, with the added benefits of lower cost, and most likely, less pain.

It seems likely that many of our modern health problems are really  the result of our modern lifestyle outstripping the adaptations of our biological evolution.

For instance -- it may be more common and natural for many folks to sleep at several night/day periods during the natural rise and fall of circadian rhythm/hormonal cycles rather than to force the entire sleep experience into a solid, compressed eight-hour block.

This modern-day, Western concept may be simply a cultural result of trying to squeeze more productivity out of post-Industrial Revolution workers. The same goes for the electric light, which artificially extended our wakeful hours. It’s been reported that Thomas Edison deplored sleep as “wasted time.”

Likewise, it seems our sympathetic nervous system has remained at a stage of evolution adapted for quick bursts of “fight or flight” responses to survive the short-term dangers of the Paleolithic Era, rather than the chronic situational stresses common to our modern workplace -- never-ending deadlines, societal pressures, anxiety-producing forcasts of impending crises – as well as just plain old over-stimulation of our senses and minds.

So…away we go...

Sleep Devices:

I suffer with Obstructive Sleep Apnea. This sleep disorder is best treated by the “gold standard” of medical devices -- the Continuous Positive Airway Pressure (CPAP) machine. Before I treated this pernicious condition eleven years ago, I was at my wit’s end.

I'd advise my fellow sufferers to avoid painful throat operations or oral jaw-jacking appliances, and to favor the CPAP instead. However, one way or another, the condition should be treated and never ignored.

Not treating chronic OSA can lead to heart damage or even sudden death from arrhythmia-induced cardiac arrest -- so it should be treated. OSA is a very common problem for the general public, and the real money-maker for sleep clinics, and thus easily diagnosed and treated.

Chronic Insomnia is a much, much more difficult condition to treat. I was nearly done-in by a month-long bought of chronic insomnia, and finally had to be hospitalized due to such complications as severe anxiety, depression, , and finally, ceaseless ruminations of suicide. That’s how bad it got. I can fully empathize with the tragic consequences of the sleep-deprived desperation exhibited such celebrities as Michael Jackson, Whitney Houston, and Heath Ledger.

It took two weeks of nightly experiments with various formulations/combinations of heavy-duty “drug cocktails” to stabilize my sleep and mood. Although the intervention worked, these meds are troublesome, and should only be used short-term if possible. I titrated myself off them as much and as soon as possible.

If you have to take them -- you have to -- but there’s a long-term price to pay. From personal experience, I’d strongly recommend avoiding two especially troublesome meds -- Ambien and Zyprexa, if at all possible.

However, if you find yourself suffering from such extreme symptoms as I did, hospitalization is a great idea – it sped up the healing process and the intervention should be considered a necessary Emergency Room situation. Don’t try to “tough it out” or go it alone. Reach out for help.

A Few Things I’ve Learned Along the Way

Natural Supplements: For mild cases of temporary insomnia -- melatonin, valerian root, and l-theanine supplements may help.

Sleep hygiene: it might help in bad-habit or “conditioned” cases. Among the key concepts to try are: a quiet environment (use ear plugs or a “white noise” machine), room and body temperature, and total darkness (use an eye mask).

Also, avoid caffeine, alcohol, exercise, and food too close to bedtime. Avoid over-stimulation from such situations as emotional phone calls, and excessive ruminations about the day’s events or tomorrow’s plans.

Another good trick is to take a warm bath prior to getting into bed. As the body’s temperature cools down, it’s easier to fall asleep.

These CBT techniques work best for very minor, temporary insomnia.

The Effects of Colored Light on Circadian Rhythms, the Light-Dark Cycle, and Melatonin Release:

There’s a theory that “light pollution” profoundly disrupts the natural circadian rhythms/body clock and thus the body’s release of melatonin.

I’m a believer that this theory is very, very valid.

Exposure to bright sunlight for 25 minutes in the morning exposes the body to “blue part” of the light spectrum which inhibits the release of melatonin, and also helps set the natural wake/sleep cycle.

On a side note, on cloudy days -- or for those suffering a bout of Seasonal Affect Disorder (SAD) -- exposure to artificial light from a special blue-light lamp can sometimes bring relief.

I’ve experimented with wearing blue-lensed glasses in the early morning to enhance my wakefulness. These glasses also seem to have an added calming effect on my mood. Although they may make you appear to be a hipster or jazzman, they do seem to be very effective for me.

The biggest factor though, is that later in the evening and night, we subject ourselves to artificial “light pollution” from electric lights, TV screens, computer monitors, light-emitting diodes, etc.

The thing to do here, in the early evening, is to don “blue-blocker” sunglasses (orange or amber colored lenses) which simulate darkness to the body and signal the circadian rhythms to begin a release of melatonin.

I put my “blue-blockers” on when I come home from work, and wear them while using my computer, tablet, reading, and watching TV. They simulate a perpetual sunset.

When I wake in the middle of the night, I also wear them while I read. This very simple device prevents “over-stimulation” from “full-spectrum, white electric light,” and makes it much, much easier to drift back to sleep. I can’t recommend them highly enough for insomniacs.

 What a simple solution – so much better than hypnotic drugs.

An Endorsement of Naps: I love to take an afternoon nap when I can. The best time is naturally, from noon to 3:30 PM. This is the time of a natural lull in alertness in our circadian cycle, but “power napping” is much discouraged by most modern Western work schedules.

I’d nap every day if I could.

More on my other experiments with devices and supplements, later.