Mistaken beliefs about sleep are common and pose a significant health threat, a new study warns.
Among these myths: some people only need five hours of sleep, snoring is harmless and a drink before bedtime helps you fall asleep.
“Sleep is a vital part of life that affects our productivity, mood and general health and well-being,” lead investigator Rebecca Robbins said. “Dispelling myths about sleep promotes healthier sleep habits which, in turn, promote overall better health.”
Robbins is a postdoctoral research fellow in the department of population health at NYU Langone Health in New York City.
For the study, the researchers reviewed more than 8,000 websites to identify the 20 most common beliefs about sleep.
One of the top myths was the claim of some people who insist they can get by on five hours of sleep a night. The study authors said this poses the most serious health risk due the effects of long-term lack of sleep.
Robbins and her colleagues suggested creating a consistent sleep schedule and getting at least seven hours of shut-eye a night.
And don’t assume your snoring is no big deal—that’s another myth, the study team said. While it can be harmless, snoring can be a sign of sleep apnea, a condition in which breathing stops and starts repeatedly during the night. Left untreated, it can lead to heart problems and other illnesses.
The researchers also dispelled the notion that a drink before bed can help you sleep. Alcohol actually makes it harder to achieve deep sleep, which is crucial for proper daytime functioning, they explained in a news release from NYU Langone.
The study was published online recently in the journal Sleep Health.
Study senior investigator Girardin Jean-Louis, a professor in the departments of population health and psychiatry at NYU Langone, said the public needs to be better informed about the importance of sleep.
“For example, by discussing sleep habits with their patients, doctors can help prevent sleep myths from increasing risks for heart disease, obesity and diabetes,” he said in the news release.
Connie Gall, whose fibromyalgia led to her early retirement, has found a new sense of purpose in the adoption and care of older dogs. She’s pictured here with her dog Prince. (Courtesy Spectrum Health Beat)
What do actor Morgan Freeman and Irish singer-songwriter Sinead O’Connor have in common with Connie Gall, a retired college financial aid officer?
All three suffer from fibromyalgia, a chronic pain disorder with debilitating effects.
Gall, 59, has lived with fibromyalgia since 1990. Just four months after having back surgery that year, she was in a car accident that gave her severe whiplash.
The whiplash triggered a series of symptoms: migraines, widespread joint and muscle pain, TMJ trouble, restless legs, burning and cold skin sensations, sleep problems, fatigue, tinnitus and polyneuropathy.
Although Gall’s symptoms began 28 years ago, it wasn’t until 2004 that a rheumatologist connected the dots and diagnosed her with fibromyalgia.
Joshua Brinks, NP, is a family nurse practitioner who works in the Spectrum Health Medical Group East Grand Rapids Family Medicine office and specializes in working with fibromyalgia patients. He and Gall, one of his patients, would like to shed some light on fibromyalgia and debunk some of the common myths associated with it.
Myth No. 1: Fibromyalgia isn’t real, it’s all in your head.
Fact—Fibromyalgia is a central nervous system pain processing disorder.
“It’s a chronic pain syndrome,” Brinks said. “We don’t know what causes it and we don’t have a cure. And so for patients to actually have a name (for their disorder) and to know that … it’s not in their head is very comforting or relieving to them.”
Gall agrees. When she finally found a doctor who “could put a name on what was going on with me, it made me feel validated … and it all started to make sense,” she said. “It’s (your) central nervous system playing games with you.”
In the last decade, more and more health care providers have accepted and acknowledged the reality of fibromyalgia, Brinks said.
“That’s a big step,” he said.
The next challenge is getting more people to understand it.
“It’s hard to explain to people it’s something that’s going on in your brain—that it’s your central nervous system that is controlling how you feel pain,” Gall said.
Myth No. 2: Health care providers diagnose fibromyalgia when they can’t find a “real” diagnosis.
Fact—There are defined diagnostic criteria for fibromyalgia. If a patient meets these criteria and if other diseases are ruled out, the diagnosis is quite clear.
“I can diagnose it in a single visit,” Brinks said, giving two main diagnostic criteria:
Widespread pain above and below the waist on both sides of the body for three months or longer.
Eleven out of 18 classic tender points—again, above and below the waist on both sides of the body.
“There’s no blood test for it, although sometimes we do a blood test to rule out other things that can mimic it,” Brinks said.
Myth No. 3: If your muscles hurt so much, there must be something wrong with them.
Fact—The problem isn’t in the muscles themselves, but in the way the brain is interpreting signals.
“The fact is,” Brinks said, “they’ve done studies to look at the muscle fibers, they’ve looked at biopsies, pathology studies—they can’t find anything wrong here.”
So if you have fibromyalgia, you need to “retrain your brain into thinking that if (your) husband gives (you) a hug and that causes pain, it’s not actually causing harm to the tissue,” he said.
Myth No. 4: Fibromyalgia is a syndrome that affects only women.
These statistics match the patient demographics Brinks sees in his practice.
Myth No. 5: Fibromyalgia is rare.
Fact—Experts estimate that more than 5 million adults in the United States have it.
“It’s actually one of the most common pain disorders,” Brinks said.
Myth No. 6: Fibromyalgia is hopelessly untreatable.
Fact—Although fibromyalgia has no cure, several treatments can be helpful. Patients respond best if they keep a positive attitude and try various treatments to find what works for them. Brinks mentioned several:
Education
This is where treatment should start for every patient, said Brinks, who spends extra time helping newly diagnosed patients understand what he knows about fibromyalgia.
Gall advises people to find out as much as they can about their illness and its symptoms.
“One of the things that helped me was to really learn about it,” Gall said. “I found reading about it, understanding what all these things are, it made them less scary.”
Maximize sleep
Almost all patients with fibromyalgia experience non-restorative sleep.
“We don’t necessarily know why, but … the quality of their sleep is not good, so they wake up feeling tired,” Brinks said. The result: intensified pain.
Brinks tries to help patients develop good sleep behaviors and patterns. He also looks for underlying sleep disorders, such as obstructive sleep apnea, and works to treat them.
Low-impact aerobic exercise
Using an elliptical machine, swimming, riding a bike, going for a fast-paced walk—any of these exercises can improve a patient’s sleep and mood, and they can also reduce pain. “Initially it makes your pain a little worse, but then it gets better with time,” Brinks said. Activities like yoga and tai chi can help, too.
Cognitive behavioral therapy
Try a multidisciplinary approach to treatment, Brinks suggested. Working with a therapist or pain psychologist, some patients experience improvement through relaxation and breathing techniques or through guided imagery.
Drug therapy
Brinks often starts patients on a low dose of amitriptyline, which can help improve sleep and pain. He might also prescribe drugs that block the reuptake of serotonin and norepinephrine in the brain, which can help improve a patient’s mood and reduce pain. Some patients also find that anticonvulsant medicines help reduce pain.
The medications’ effectiveness can vary from patient to patient. “Sometimes it’s just one drug, sometimes it’s a combination,” Brinks said.
But narcotics are not in the mix: “Research has shown over and over again that narcotics do not help fibromyalgia,” he said.
Address underlying mood disorders
Treating anxiety and depression, which often go hand in hand with fibromyalgia, can ease the burden of living with the disorder.
Well-balanced diet
Gall is a firm believer in eating right.
“I don’t know what shape I’d be in if I didn’t eat so well,” she said. “If you let that slide, it’s like a domino effect.”
Overall, attitude makes a big difference for people with fibromyalgia, she said.
“I love life. I think this is a pretty cool place to be, and if you’re always talking to the people you run into about the latest thing your doctor has told you to do, that means you’re concentrating on your condition,” she said.
“Except for those days when I’m screaming through those stabbing pains or curled up like a ball with a migraine for three days, I’m going to try to do the rest of life with a smile on my face,” she said.
Brinks said people who have good attitudes and a willingness to try new things will experience better outcomes.
Three P’s
One strategy Brinks recommends is the “three P’s” approach:
Prioritize—“If you have a day off work and you have 12 errands you want to run, you need to shorten that list,” Brinks said. “What are the things that are most important?” If you take on too much, the stress can impact your sleep and “all of that is like the perfect storm for fibromyalgia to flare up,” he said.
Plan—Based on your priorities, think about how you should approach your tasks and what’s reasonable to expect of yourself.
Pace yourself—If you have three errands to run, don’t try to do all of them in the first two hours. Space them out, Brinks said. Gall told of a day when she didn’t pace herself as she prepared the house for a family gathering. She ended up in so much pain, she could hardly enjoy the party.
Above all, Brinks said, don’t let pain rule your life. Recognize there will be good days and bad, and remind your brain that your pain is “not life threatening—it’s annoying and frustrating, but it’s not going to cause terminal illness,” he said.
Still, it may bring about major life changes. For Gall, the pain and other symptoms of fibromyalgia became so bad she eventually had to retire early from a job she loved.
Looking to fill the void, she and her husband began adopting older dogs from animal shelters, giving them a safe home in their later years. The sense of purpose this gives her is a tremendous help, Gall said.
After decades with fibromyalgia, she’s found the best strategy is to face it with grit and resolve.
“Even if I have to do life in pain every day, ranging from a pain level 3 to a pain level 10, I don’t get to go back and do it again,” she said, “so I’m going to try to be as good at it as I can.”
Has your spouse or a family member ever told you that you alternate between snoring and gasping for breath while you sleep?
For the sake of your heart, it may be time to seek a solution.
Researchers often identify a connection between obstructive sleep apnea and a number of cardiovascular problems.
Wael Berjaoui, MD, a pulmonologist with Spectrum Health Medical Group, describes sleep apnea as an interference of airflow during sleep. This potentially serious disorder is characterized by breathing that repeatedly stops and starts during sleep, and it’s usually associated with a reduction in blood oxygen saturation.
These episodes can prevent restful sleep, often waking a sleeper as he gasps for air.
But there’s also a hidden impact on the heart.
This condition can worsen coronary artery disease. Research has found that patients who have sleep apnea are more likely to have life-threatening outcomes when they have a heart attack.
“Imagine waking up and feeling like someone is trying to choke you. Of course your heart rate and blood pressure will increase,” Dr. Berjaoui said of the association between obstructive sleep apnea and the heart. “Your body thinks it is in distress.”
Research has shown that patients who undergo continuous positive airway pressure therapy will see a decrease in systolic blood pressure, Dr. Berjaoui said, which reduces the potential for progressive damage to arteries and veins, and in turn reduces the incidence of stroke, heart disease and heart failure.
Continuous positive airway pressure, or CPAP, is a treatment that uses mild air pressure, delivered through a lightweight mask, to keep the airways open during sleep.
CPAP treatment also can improve the health of people with heart rhythm problems, particularly those with an irregular heartbeat condition known as atrial fibrillation. Up to 80 percent of people with atrial fibrillation also may suffer from sleep apnea, Dr. Berjaoui said.
“It is much harder to control atrial fibrillation or cure it if you don’t treat the (apnea) first,” he continued. “It is important for patients who have cardiac conditions to be evaluated. …Even without all of the symptoms, a patient still could have sleep apnea and it can compromise their ability to effectively manage something like high blood pressure.”
If a patient requires more than two medications to control high blood pressure, for instance, there is at least a 7-in-10 chance the patient also suffers from sleep apnea, even if he doesn’t have the telltale symptoms of loud snoring or excessive daytime sleepiness.
And while there is an association between sleep apnea and cardiac conditions, Dr. Berjaoui pointed out it is not cause and effect.
The important takeaway: Sleep apnea can affect your ability to manage other conditions, including those affecting the heart.
Dr. Berjaoui said if you’re concerned about the impact of obstructive sleep apnea on your heart, you should talk to one of Spectrum Health’s sleep professionals. They can evaluate your sleep patterns in the sleep lab or in an at-home test.
Her son, Parker, was falling asleep in the car. He couldn’t stay awake during movies. He was failing his third-grade classes.
“His grades did not reflect what we saw his potential would be,” she said. “And I guess that’s kind of where I thought something was wrong.”
Parker’s school thought he might suffer from attention deficit disorder, better known as ADD, but Christina disagreed. She used to work in a hospital and the symptoms didn’t align with her understanding of ADD.
Christina and her husband, Phillip, paid for private testing.
“The psychologist doing the testing said, ‘His IQ did not come back as high as we were expecting. I’ve seen this in the other kids that have sleep apnea,’” Christina recalled.
The psychologist referred the family to John Schuen, MD, a pediatric pulmonologist with Spectrum Health’s Helen DeVos Children’s Hospital, for further testing. Sure enough, a sleep study showed Parker had sleep apnea.
Dr. Schuen recommended two things: surgically removing Parker’s uppermost tonsils, called adenoids, and putting Parker on a CPAP, a machine that helps certain patients sleep.
“His grades went from failing to straight A’s,” Christina said. “His brain was really shutting down from being so tired, so fatigued. …Within a week of being on CPAP, he was like a brand new kid.”
What is sleep apnea?
Sleep apnea is a disorder in which the patient’s breathing stops and starts throughout the night, which disrupts sleep. It affects children and adults in different ways: Children often experience behavioral issues, and adults often struggle with daytime fatigue.
“Clues that give parents a hint is kids’ snoring, gasping, pausing when they breathe, mouth-breathing, odd noises in the middle of sleep like coughing or choking … unusual noises like that,” Dr. Schuen said. “Sometimes there are morning headaches. When I say morning headaches, I mean they have headaches that wake them up in the middle of the night or upon waking up right away in the morning.”
There are two types of sleep apnea, Dr. Schuen said. Central sleep apnea is when the brain doesn’t tell the body to breathe.
The more common version, obstructive sleep apnea, is when the patient tries to breath, but something is blocking or obstructing the airwaves. Hence, the name.
About 10 percent of children struggle with persistent, nightly snoring, a sign of sleep apnea. About 3 to 5 percent have obstructive sleep apnea, Dr. Schuen said.
“When kids have obstructive sleep apnea, the most common reason behind the apnea is large tonsils and adenoids,” Dr. Schuen said. “Tonsils and adenoids look like golf balls in the back of your throat. The adenoids, (the uppermost tonsils), sit right above roof of your mouth. You can’t see them without special tools.”
Obesity, which leads to rings of fat in the throat or chest, can also cause obstructive apnea, Dr. Schuen said. But that didn’t apply to Parker.
When children exhibit possible symptoms of apnea, Dr. Schuen orders a sleep study.
“The study is this: We have specially designed rooms to help promote a good night’s sleep and let parents sleep next to the child in the same room,” Dr. Schuen said. “In the pediatric sleep laboratory, our sleep tech places different gizmos and gadgets on the infant or child or teen that let us assess what’s going on during sleep. During the course of the sleep study, we’ll measure an amazing amount of information: 16 different channels look at brain waves, the stage of sleep, how often they wake up, when they wake up, oxygen and carbon dioxide levels, and the sleep positions they’re in when possible apnea events occur.”
“And if they’re not breathing properly, we can determine the type of apnea and how often these events occur.”
Normal people tend to have four to six sleep cycles per night and will wake in between, Dr. Schuen said, but “you’re only awake a millisecond and don’t fully appreciate the fact that you’re awake—then, boom, back to sleep.”
But those with moderate sleep apnea can awake five times per hour, while severe sufferers can have 10 or more micro-arousals per hour.
“With apnea … particularly in kids, they might not always even awaken from sleep,” he said. “But because their oxygenation may suffer, their carbon dioxide levels may rise, or they may just shift their stage of sleep. It deprives them of good sleep.”
Sleep is closely tied to IQ and brain function. A recent study showed that kids who ate seafood slept better, and then performed nearly five points better on IQ tests.
During the daytime, kids who suffer from OSA may include “academic difficulties, problems paying attention, impulsivity and rarely, sleepiness,” Dr. Schuen said.
‘A dramatic improvement’
The sleep study showed Parker suffered from moderate to severe sleep apnea.
In July, Parker had his adenoids removed—“the typical solution,” Dr. Schuen said—but his apnea didn’t improve. Parker still struggled with focus issues and his behavior late in the day deteriorated.
Dr. Schuen ordered a second sleep study in September, which showed Parker still suffered from obstructive apnea.
He decided to put Parker on CPAP, a machine with a nasal mask that’s held in place by headgear. The mask is hooked up to a hose, which pushes air through the lungs and opens up the airways while the user sleeps.
The results for Parker were nearly instantaneous. Within a week, Christina said, Parker’s academic performance and attitude changed.
“He’s just a better child all the way around,” she said. “His behavior is better. He was acting out during that time, and that’s gone away. He was having some anger, especially toward the evening, and that has gone away. He’s sleeping all night long. Before he’d get up several times a night, but not anymore.
“And he can tell, if he goes somewhere and can’t use the CPAP, he comes home and says, ‘I need to wear the CPAP.’ He can tell the difference.”
Parker shared that he often fell asleep in class and couldn’t pay attention.
“I was so tired all the time,” he said. “Now I can stay focused longer. … I can concentrate for an hour now. It used to be 10 minutes.”
Parker loves extreme mountain biking with his father. He enjoys math and gym class. He can tell his body has changed with better sleep.
“I like gym because we get to run around and do fun stuff,” he said. “But I couldn’t really run as fast as everybody because I was so tired.”
Christina, who also suffers from sleep apnea, uses a CPAP machine just like her son. She notices similar improvements when wearing it.
“When I do wear it, I feel like I have more energy,” she said. “When I don’t wear it, I’m really cranky in the morning, even after a full night’s sleep.”
Parker says it’s a relief to no longer struggle in school.
“It made me feel really happy that I’m actually good at something,” he said. “Because I didn’t get much sleep, I couldn’t focus. It was messing me up.”
Learn more about the nationally-recognized pediatric pulmonology and sleep medicine program at Spectrum Health Helen DeVos Children’s Hospital.
