Sleep

The Southwest Journal of Pulmonary and Critical Care and Sleep publishes articles related to those who treat sleep disorders in sleep medicine from a variety of primary backgrounds, including pulmonology, neurology, psychiatry, psychology, otolaryngology, and dentistry. Manuscripts may be either basic or clinical original investigations or review articles. Potential authors of review articles are encouraged to contact the editors before submission, however, unsolicited review articles will be considered.

Rick Robbins, M.D. Rick Robbins, M.D.

Tips for Circadian Sleep Health While Working from Home

Robin K. Yuan PhD1

Enmanuelle Pardilla-Delgado PhD1,2 

Kirsi-Marja Zitting PhD1

Jeanne F. Duffy MBA, PhD1

 

1Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women’s Hospital and Division of Sleep Medicine, Harvard Medical School; 2Department of Psychiatry, Massachusetts General Hospital,

Boston, MA USA

Sleep is more important now than ever.

Getting enough sleep and maintaining a regular schedule for optimal circadian rhythm health is a challenge for most of us even in the best of times, but the schedule changes and added stress from the COVID-19-19,  pandemic has likely impacted your sleep schedule over the past few weeks. 

Sleep does more than just make us feel better the next day. It allows us to pay close attention, remember new information, and multi-task. Regularity of sleep and wake also maintains the health and optimal function of the circadian timing system (our internal biological clock). Insufficient sleep and irregular sleep-wake schedules can impair our health, weaken our immune system, increase inflammation, and even lead to increased vulnerability to viral illnesses. Given how important regular, sufficient, sleep is for our safety, health, and quality of life, the following tips may help to optimize circadian and sleep health in people now remaining at home.

Tips for optimal sleep and circadian rhythm health for those working from home. 

  • The good news is that if you are working from home, you may now have extra time for sleep! Many of us usually sleep less than our optimal amount, resulting in a chronic sleep debt. Now that you don’t have to commute, use that extra time for sleep to pay off your sleep debt.
  • Many of us habitually cut our sleep short on weeknights and “sleep in” on weekends, which both creates a sleep debt and disrupts our internal biological clock. Working from home may allow you the time and flexibility to keep the same sleep schedule 7 days a week. If you are a night owl and can do your daytime work on your own schedule, embrace the flexibility to sleep at your (later) preferred times every night!
  • Get up around the same time every day. Your wake time is like an anchor to your day and night. Keeping a consistent wake time will help other parts of your day fall into a routine and help you sleep better at night.
  • Get bright light exposure during the day, especially in first hour or two after waking. Morning bright light, when received around the same time every day, is a powerful time signal to our body clock. Bright light has the added benefit of promoting alertness, which is particularly important if you find it difficult to get going in the morning. Try opening curtains to let in direct sunlight as soon as you wake up, taking a short walk outside before breakfast, or drinking your coffee on your balcony or in front of a window. When you are working, try to sit near a window where you can get as much sunlight exposure as possible.
  • Try to make your first social interaction of the day at the same time each morning. When you are following “social distancing”, interacting with others can be difficult, especially if you live alone. Try to have a phone or video call with friends or family at about the same time each morning. Even a quick “hello” and check-in is useful. The other person will probably appreciate the human contact too!
  • Eat your meals around the same time each day, especially breakfast. Eating meals at the same time of the day serves as a time cue and supports a healthy biological clock, which is important for sleep.
  • Exercise around the same time each day and avoid being sedentary for long stretches of time. If possible, exercise outdoors so you can get bright light exposure.
  • Keep daytime and night-time different and separate. Our body clock benefits from keeping day and night clearly distinguished. During daytime, keep your living space full of light and keep active doing your work from home or organizing, cooking, cleaning, and exercising. In the evening, keep the lights dim, block blue light on electronic devices, and do less active things such as watching TV, reading, or a sedentary hobby. Keep a regular pre-bedtime routine to help you unwind and tell your body ‘it’s time to sleep’.
  • Avoid using light-emitting electronic devices (like laptops, tablets, smart phones) for at least 1 hour before your set bedtime. A dim evening environment can help your body naturally produce melatonin and prepare your body for sleep.
  • Make sure your sleep environment is dark and quiet. Use an eye mask or blackout shades, wear earplugs or try a white noise machine or app. If possible, leave your phone in a different room.

Additional information and help. 

  • If you find yourself staying up later each night and sleeping later and later in the morning, you may be developing, a circadian rhythm sleep-wake disorder. You may want to seek help from a sleep specialist if this causes your problems with your work schedule or family.
  • To block blue light from your electronic devices, turn the brightness of the screen to the lowest setting, and turn on apps such as f.lux (multi-platform) or Night Shift on iOSand Macs.
  • General information about circadian rhythm health can be found here.

The authors are supported by NIH grants P01 AG09975 (RKY, KMZ, JFD), R01 AG044416 (JFD), T32 HL07901 (EP-D), F32 HL143893 (RKY), R01 AG054671 (EP-D), and the Milton Fund (KMZ).

Cite as: Yuan RK, Pardilla-Delgado E, Zitting K, Duffy J. Tips for circadian sleep health while working from home. Southwest J Pulm Crit Care. 2020;20(4):126-7. doi: https://doi.org/10.13175/swjpcc023-20 PDF

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Rick Robbins, M.D. Rick Robbins, M.D.

Sleep Board Review Question: Restless Legs

Olabimpe Omobomi, MD MPH

Rohit Budhiraja, MD

Olabimpe Omobomi, MD MPH

Rohit Budhiraja, MD

Division of Sleep Medicine
Brigham and Women’s Hospital
Harvard Medical School
Boston, MA USA

 

Ms. Jones (not her real name) is a 63-year-old woman who states that she gets very fidgety when sitting in a theater, watching a movie or when flying long distances on a plane. She is unable to find words to describe the sensation but she states that moving her legs make them feel better. Lately, she has been getting this feeling almost every night. She reports no leg discomfort in the daytime. 

She denies muscle cramps her legs. She had some recent investigations done by her primary care physician because of complaints of fatigue.

Which of the following will be helpful in the diagnosis and management in this patient? (Click on the correct answer for an explanation-no penalty for guessing, you can go back and try again)

  1. An overnight polysomnogram showing apnea hypopnea index of 1.6 events per hour and no periodic limb movements (PLMs)
  2. Ferritin level of 18 ng/ml (normal range 20-200 ng/ml) 
  3. Serum Bicarbonate of 29 mEq/L (normal range 23-29 mEq/L)
  4. Thyroid Stimulating hormone (TSH) 6 mIU/ml (normal range 0.4-4.8 mIU/ml)

Cite as: Omobomi O, Budhiraja R. Sleep board review question: restless legs. Southwest J Pulm Crit Care. 2018;16(2):81-2. doi: https://doi.org/10.13175/swjpcc028-18 PDF

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Rick Robbins, M.D. Rick Robbins, M.D.

Sleep Board Review Questions: The Late Riser

Tauseef Afaq, MD1

Rohit Budhiraja, MD1,2

1 Department of Medicine, Section of Pulmonary, Allergy, Critical Care and Sleep Medicine, The University of Arizona, Tucson, AZ, 85724, USA. tafaq@deptofmed.arizona.edu

2 Department of Medicine, Southern Arizona Veterans Affairs Health Care System (SAVAHCS), Tucson, AZ 85723, USA. rohit.budhiraja@va.gov

A 22-year-old male presents to Sleep Clinic for sleep onset insomnia and difficulty waking up in the morning.  He plans to begin a new job in a few weeks, which would require him to wake up at 6 AM. He usually goes to sleep at 2 AM and wakes up at 10 AM.  He remembers having this problem through high school and college. He admits to being unable to sleep even if he goes to bed at an earlier time.  He reports sleeping through alarms in the morning.  His sleep log and actigraphy (non-invasive method of monitoring activity) are consistent with delayed sleep phase disorder (DSPD). 

In order to maximally advance the sleep-wake phase in this patient, when should the administration of bright light take place? 

Reference as: Afaq T, Burhiraja R. Sleep board review questions: the late riser. Southwest J Pulm Crit Care 2012;5:176-8. PDF

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