Health. Lifestyle. Business. PREVENTIVE HEALTH

THE ULTIMATE SLEEP GUIDE

Discover the importance of sleep for a healthy life and try our easy steps to getting a good night’s sleep:

• Sleep deprivation: as damaging to brain health as binge drinking?• Insomnia: stop counting sheep• Not sleeping well? Try Yoga!• 8 Nutrition strategies to promote a good night’s sleep… and control your weight• Turn it off: why blue light has a dark side

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SLEEP DEPRIVATION: AS DAMAGING TO BRAIN HEALTH AS BINGE DRINKING?

By Dr. Farrell Cahil, PhD. Head of Research, Medisys Health Group

If you are like many Canadians, you’re getting less than six hours of sleep per night. The cumulative health consequences of sleep deprivation are severe – including increased risk of hypertension, diabetes, obesity, depression, heart attack, and stroke1. Sleep deprivation negatively impacts the whole body, but as Dr. Adrian Owen explains further in his exclusive interview with Medisys, no one organ is as severely affected as the brain.

Recent reports suggest that about 1 in 3 Canadians are chronically sleep deprived including adolescence and children, making Canada the 3rd most sleep deprived country on the planet! Not only is sleep deprivation having a devastating impact on our health, some report suggests that sleep deprivation is also costing the Canadian economy about $28.3 billion (CAD) per year due to lost employee productivity. Sleep deprivation has long been associated with acute cognitive impairment; however, more recent findings suggest that both the acute and long-term health implications of sleep deprivation are even broader and more complex than initially believed.

Poor sleep habits have been linked to everything from mental and emotional health issues, to weakened immunity, to increased risk of obesity. When it comes to weight management, sleep is an important hemostatic modulator and the reduction of sleep has been shown to significantly decrease both glucose and fat metabolism while also inappropriately increasing appetite2,3, leading to weight gain. “Sleep plays an important role in regulating the hormones that influence hunger (ghrelin, cortisol, and leptin),” explains Medisys Registered Dietitian Richelle Tabelon, “that’s why sleep deprivation increases appetite and can lead to overeating and weight gain” Tabelon continues. Regular exercise and maintaining a healthy diet will always be important components of weight maintenance – but if you are growing out of your clothes and can’t figure out why, it might be time start getting to bed earlier.

If the prospect of a weakened immune system, mental health disturbances, and increased risk of weight gain, heart disease, and type II diabetes doesn’t make you want to get more sleep, consider this: driving while sleep deprived (the norm for up to 30% of us) is the cognitive impairment equivalent of drunk driving.

Imagine this scenario: You wake up at 5:30am to get an early start on the day because you have a busy week at work. You

work until 8pm to meet a deadline and then catch up with a friend for a bite to eat before driving home. It’s 10:30pm and you have now been awake for 18 hours. Sound familiar? You are about to get behind the wheel, and even without one sip of alcohol you are, from a cognitive impairment perspective, intoxicated4. After just one more hour of being awake, 11:30pm in this case, your cognitive performance would be as impaired as someone with a blood alcohol level of 0.1%. That’s equivalent to an average weight adult male consuming 5-6 drinks (assuming the Canadian standard of 13.6 grams of alcohol per drink). The cognitive impairment effects of long periods of wakefulness and alcohol consumption are cumulative – add even a small glass of wine or beer to the above scenario and by getting behind the wheel you are engaging in extremely risky behaviour.

Research on sleep and cognition has shown that engaging in any cognitively demanding task while sleep deprived is risky – be it a physical like operating a vehicle, or an intellectual one like business-critical decision making (recall the Challenger explosion blamed on certain launch managers having had only two hours of sleep the night previous). Dr. Adrian Owen, a neuroscientist at Western University and the Chief Scientific Officer of Cambridge Brain Sciences — a leading online brain health platform — has been studying the effects of sleep deprivation on the brain. In an exclusive interview with Medisys, Dr. Owen sat with us to answer some of our burning questions about sleep health and the medical impact of sleep deprivation.

Q: What happens to our brains when we don’t get enough sleep?

A: We’ve long known that sleep deprivation negatively impacts alertness and reaction times, but more recent studies5 have concluded that a wider range of brain functions are disrupted by sleep loss, including attention, working memory, and emotional processing. The brain becomes less stable the longer you are awake, diminishing your ability to focus your cognitive resources where they are needed. One study6 scanned the brains of people at rest (but not asleep), and could, with very high accuracy, predict which brains were sleep-deprived and which were not. Interestingly, the sleep-deprived individuals had less overall connectivity between active areas. In other words, researchers could pick out a sleep-deprived individual just by looking at their brain activity at rest – suggesting sleep deprivation causes physiological changes in the brain!

Q: How do you define sleep deprivation and how common is it?

Sleep deprivation is, unfortunately, very common in Canada – it’s estimated that about 30% of Canadian adults get fewer than 6 hours of sleep per night.

In today’s business world, technology allows for many work tasks to be completed anywhere, at any time, using any device. Because of this, there is often pressure – whether it’s real or perceived – for people to put in as many hours of work as possible, even if it means less sleep. In certain professions such as medicine, financial services, legal professions, law enforcement, and aviation, long periods of wakefulness are often requirements of the job. In many cases, there are laws governing required rest times between shifts to protect both the worker and the public. However in some professions, such as medicine, 24 hour or longer shifts are not uncommon – which is particularly concerning from a public health perspective in light of mounting evidence that just 18 hours of wakefulness results in cognitive impairment equivalent to alcohol intoxication.

Regardless of the profession, more and more Canadian adults are working longer hours and sleeping less during the week – and don’t be fooled into thinking that a few ‘catch up sleep’ hours on the weekends are going to make up for the loss. From a neurological perspective, when you lose sleep, consider it gone forever.

Q: What’s the impact of sleep deprivation on Canadian businesses?

A: Sleep deprivation results in increased risk of workplace accidents and injury. The Association of Workers’ Compensation

Boards of Canada (AWCBC) reported 852 workplace deaths in 2015 alone, in addition to the hundreds of thousands of claims processed every year for work-related injuries. Some of the more infamous workplace accidents linked to sleep deprivation include Chernobyl, the Exxon Valdez Oil Spill, and the nuclear incident at Three Mile Island.

Employers may be inclined to reward or encourage an employee who puts in extra hours to meet a deadline. However, even a single long day at work can significantly impair an employee’s judgment, attention, reaction times, vigilance, and working memory7 – putting both the employee and the company at risk. This disrupted cognition due to sleep deprivation adds up over time and leads to widespread reductions in workplace productivity as well as increased risk of errors, omissions and workplace accidents and injuries.

One survey8 of four U.S. companies in various industries found that workers with poor sleep habits were less able to perform work tasks over time, costing the organization thousands of dollars per employee annually in productivity losses. Evidence suggests that inadequate sleep results in a 162% greater chance of a work-related injury9 and a significantly increased risk of motor vehicle crashes10.

It’s important to note that working while sleep deprived isn’t only hazardous within safety sensitive environments. Any executive accountable for business-critical decisions puts the company at risk if making these decisions while sleep deprived.

A word to the wise: Have a team member that worked late to meet a deadline? Don’t give them a bonus, give them time off to sleep!

TO A BETTER NIGHT’S SLEEP

8 STEPS

1. Exercising regularly during the day Physical activity during the day has beneficial effects on sleep the night after, and promotes better sleep as a consistent long-term habit11.

2. Reducing stress Engage in stress-relieving activities including yoga, meditation, warm baths or other activities that help you unwind.

3. Avoiding caffeineLimit caffeine and avoid other sleep disruptors like nicotine (in case you needed another reason to quit), and avoid heavy meals close to bed time.

4. Drinking in moderationAlcohol negatively impacts sleep quality. Alcoholic beverage consumption should be limited to a maximum of 7-9 drinks per week for women and 14 drinks per week for men, not exceeding 1-2 drinks daily (no, you can’t save them up for weekends like Weight Watchers points!). A “drink” is considered to be 12 ounces (341 ml) of beer, 5 ounces (142ml) of wine or 1.5 ounces (43 ml) of spirits.

5. Modifying your bedroom environment Make your bedroom a sleep sanctuary by eliminating light, noise, and excessive heat and by turning off electronic devices before bedtime.

6. Not forcing it If you’re lying awake and sleep just isn’t happening, get out of bed and do something else until you’re tired again.

7. Keeping a consistent sleep schedule Staying up later on weekends can throw off your biological clock and make it harder to sleep well during the rest of the week.

8. Making sleep a priority There will only ever be 24 hours in a day. Between making time to exercise (which is very important), your career, family, spending time with friends, running errands, and working your way through that ever-growing ‘to-do’ list, the only surefire way to get enough sleep is to make it a priority. Set a bet time and stick to it – no ifs, ands, or buts.

Not surprisingly, one of the biggest predictors of healthy sleep habits in adults is healthy sleep habits as a child. If you are a parent or grandparent – set a positive example and encourage the whole family to make sleep a priority!

Q: What’s the next step in learning about how sleep affects the brain?

A: There is still a lot to learn when it comes to sleep and cognition. Despite the mounting body of research linking sleep and brain health, there is still much debate over the details. That’s why we are using the Cambridge Brain Sciences platform to launch The World’s Largest Sleep Study. It’s an unprecedented look at the sleep habits of people all over the world. Through this study we hope to answer some of the most debated questions such as which facet of cognition is most impaired by sleep loss, how much sleep is needed to avoid cognitive impairment, and which professions get the least sleep. We’re hoping through this study we’ll learn everything we need to know so that we can finally put this great debate to bed.

References:1. https://www.ncbi.nlm.nih.gov/books/NBK19961/ 2. Morselli L, Leproult R, Balbo M, Spiegel K. Role of sleep duration in the regulation of glucose metabolism and appetite. Best Pract Res Clin Endocrinol Metab. 2010;24:687–702. 3. Knutson KL. Sleep duration and cardiometabolic risk: a review of the epidemiologic evidence. Best Pract Res Clin Endocrinol Metab. 2010;24:731–743. 4. Williamson, A. M., & Feyer, A. M. (2000). Moderate sleep deprivation produces impairments in cognition and motor performance equivalent to legally prescribed levels of alcohol intoxication. Occupational & Environmental Medicine, 57, 649-655. 5. Krause, A. J., Simon, E. B., Mander, B. A., Greer, S. M., Saletin, J. M., Goldstein-Piekarski, A. N., Walker, M. P. (2017). The sleep-deprived human brain. Nature Reviews Neuroscience. doi: 10.1038/nrn.2017.55 6. Kaufmann, T., Elvsåshagen, T., Alnæs, D., Zak, N., Pedersen, P., Norbom, L. B., Quraishi, S. H., Tagliazucchi, E., Laufs, H., Bjørnerud, A., Malt, U.F., Andreassen, O.A., Roussos, E., Duff, E. P., Smith, S. M., Groote, I. R., & Westlye, L. T. (2016). The brain functional connectome is robustly altered by lack of sleep. Neuroimage, 127, 324-332. 7. Lim & Dinges 8. Rosekind, M. R., Gregory, K. B., Mallis, M. M., Brandt, S. L., Seal, B., & Lerner, D. (2010). The cost of poor sleep: workplace productivity loss and associated costs. Journal of Occupational and Environmental Medicine, 52, 91-98. 9. Uehli, K., Mehta, A. J., Miedinger, D., Hug, K., Schindler, C., Holsboer-Trachsler, E., Leuppi, J. D., & Kunzil, N. (2014). Sleep problems and work injuries: A systematic review and meta-analysis. Sleep Medicine Reviews, 18, 61-73. 10. Barger, L. K., Cade, B. E., Ayas, N. T., Cronin, J. W., Rosner, B., Speizer, F. E., & Czeisler, C. A. (2005). Extended work shifts and the risk of motor vehicle crashes among interns. New England Journal of Medicine, 352, 125-134. 11. Kredlow, M. A., Capozzoli, M. C., Hearon, B. A., Calkins, A. W., & Otto, M. W. (2015). The effects of physical activity on sleep: A meta-analytic review. Journal of Behavioral Medicine. doi: 10.1007/s10865-015-9617-6

Q: What can I do to prevent sleep deprivation?

A: Researchers have identified a number of habits that support better sleep. All which should be tried before turning to over-the-counter sleep medication. Healthy sleep habits include:

What is Insomnia?

Insomnia is a diagnosable disorder that exists when an individual has a significant sleep difficulty (non-restorative sleep or difficulty falling/staying asleep) that persists for at least one month and causes significant daytime symptoms such as fatigue, poor concentration, mood disruption, or difficulty meeting social or occupational demands. Insomnia can be a problem in children, adolescents and adults. It is more common among women, older adults, shift workers, and people with medical or psychological problems. According to the Canadian Sleep Society, about 10% of the adult population in Canada experience persistent insomnia and and additional 20% to 25% reports occasional insomnia symptoms.

Insomnia can be classified as either “primary” or “secondary.” Primary insomnia is diagnosed when sleeplessness cannot be attributed to any other cause, whereas secondary insomnia is diagnosed when it is a symptom of another condition. Sleeplessness in secondary insomnia is often the result of an underlying difficulty with physical health (e.g., obstructive sleep apnea, arthritis or other pain conditions), psychological health (e.g., depression, anxiety), or substances (e.g., prescription medications, alcohol, or recreational drug use).

What treatment options are available?

Key treatments for primary insomnia range from natural supplements such as melatonin and medications such as hypnotics and antidepressants, to psychological interventions such as Cognitive Behavioural Therapy for Insomnia (CBT-I). CBT-I is a structured therapy that involves monitoring and changing cognitive and behavioral factors that cause or

maintain sleep difficulties. Significant improvements in sleep are often achieved after six to eight treatment sessions. Research has shown that CBT-I is as effective in treating insomnia as prescription medications, but the effects are longer lasting.Secondary insomnia is often best treated by treating the underlying cause. If sleeplessness persists after the contributing condition has been treated, additional sleep treatments may be appropriate.

Which treatment is the best for you?

If you are experiencing chronic sleep difficulties, the first step is to talk to your doctor or psychologist. A careful assessment can help to identify whether your sleep difficulty is a primary or secondary insomnia—this will determine the most effective treatment approach for your circumstances. It is also important to consider the pros and cons of pharmacological versus non-pharmacological approaches. While medications can have side effects and many are not intended for long-term use, sleep improvements are often achieved quickly. In contrast, CBT-I requires more effort and time to produce improvements; however, sleep improvements are more durable and the side-effects of medications can be avoided. Selecting treatment options that fit your lifestyle is important—this helps to build motivation to follow through with treatment and achieve optimal results.

Think your insomnia might be the result of too much stress, anxiety or depression? It may be time to talk to someone. To learn more about Medisys services or to book a consultation with one of our licensed and specialized professionals, call us at 1 800-361-3493.

The amount of sleep you need varies widely based on multiple factors including your age, health, lifestyle (including physical and mental exertion), and genetic makeup. For most adults, the right amount falls between 6 to 10 hours/night. Meeting your personal sleep requirements is important for many aspects of health including learning and memory, mood, immunity, cardiovascular health, metabolism and weight, and safety.

Most adults will experience an episode of poor sleep at some point in life, which is often triggered by a stressor. For many adults, sleep difficulties naturally subside as the triggering circumstances resolve – but for others, this is the onset of insomnia.

NOT SLEEPING WELL?

TRY YOGA.In our fast-paced culture, it’s no surprise that so many Canadians experience chronic stress and have difficulty sleeping. In fact, Canada is ranked the 3rd most sleep deprived country in the world, with 30% of us getting less than 6 hours of sleep per night.

Sleep issues and stress often go hand in hand. Not surprisingly, both chronic stress and chronic sleep deprivation have been linked to numerous physical and mental health conditions – from depression and anxiety, to heart disease, obesity, diabetes, gastrointestinal disease, and Alzheimer’s disease amongst others.

In a workplace stress impact publication by the National Institute for Occupational Safety and Health (NIOSH), it was estimated that 60% of workplace absenteeism is stress related, and that the direct cost of stress to employers is about $600/employee per year or $3.5 million annually for a typical large employer. In another study, it was reported that 80% of workers surveyed felt the impact of workplace stress, and that nearly half felt they needed help learning how to manage stress at work. Yoga can be an oasis in the tornado of mental and physical exhaustion in which we can sometimes find ourselves.

According to a study published in Applied Psychophysiology and Biofeedback, yoga could help relieve chronic insomnia. After learning how to practice yoga breathing, meditation and mantra, 20 study participants practiced yoga before bedtime on their own. After 8 weeks, researchers found that the participants had significantly improved sleep efficiency, total sleep time, total wake time, sleep onset latency, and wake time after sleep onset.

Regular yoga practice can help calm the sympathetic nervous system and reduce the stress hormone; this

in turn helps us regulate body temperature, heart rate, and blood pressure. Yoga has the ability to help quiet the mind, undoing the negative thought patterns that often accompany chronic stress and insomnia.

If you can’t dedicate hours to yoga each week, don’t worry, adding 5-10 minutes per day of deep breathing techniques and 10 minutes per day of yoga can have a significant impact. Deep breathing has the ability to “turn on” and “turn up” our parasympathetic nervous system and slow down body systems (except digestion, which improves and speed up when we are calm and activate our parasympathetic nervous system). Yoga and deep breathing helps brings us back to the present moment. There is no room to think about yesterday or tomorrow, or our never-ending to-do list when we are focusing and concentrating on our next breath. Try the pattern of inhaling slowly, holding the breath for 10 counts, then exhaling.

If you’ve ever been to a yoga class, the practice and benefits of deep, controlled breathing are probably not unfamiliar. For others, it may come as a surprise that deep breathing has proven physical and emotional health benefits – including signaling the body to return to a calm, relaxed state.

Scientists have identified a group of neurons called the pre- Bötzinger complex – dubbed the “breathing pacemaker” – that link respiration and relaxation of the body. When you practice deep, slow, controlled breathing for a set period of time, you stimulate the production of hormones that help relax the body and combat the adrenaline produced when your body is under stress. By soothing your mind and body before going to bed, you get more chances to fall asleep faster and deeper.

Feeling tired and irritable aren’t the only consequences of poor sleep. Getting too little sleep can also sabotage your efforts to shed excess weight. Even a single night of poor sleep can wreak havoc on weight control by slowing metabolism and increasing hunger.

Research shows that compared with normal sleep (8 hours), the body’s resting metabolic rate – the speed at which it burns calories to keep your body functioning at rest – is significantly reduced after a just one night of sleep deprivation.

Study participants also report greater hunger and have higher blood levels of ghrelin, a hormone that stimulates appetite and eating. Sleep loss also leads to higher levels of a stress hormone called cortisol that, when elevated for a prolonged period of time, leads to impaired blood sugar control, high blood pressure, lowered immunity and abdominal obesity.

It’s estimated that one in seven Canadians has difficulty sleeping. Causes of poor sleep (insomnia) include stress, anxiety, depression, restless leg syndrome and sleep apnea. (Sleep apnea occurs when the upper airway gets completely or partially blocked during sleep reducing the amount of oxygen that gets to the lungs, causing you to wake up to breath properly. These breathing pauses, or apneas, can last up to 30 seconds and can happen many times throughout the night.)

Your diet can prevent you from getting a good night’s rest.

Eating the right foods in the evening – and knowing what ones to avoid – can help you get the 7 to 8 hours of sleep you need each night. (Children and teenagers need 9 to 10 hours.) Try those 8 healthy tips to improve your sleep:

1. Cut caffeine. While one or two cups of coffee can boost mental alertness, drinking more can overstimulate your central nervous system and cause insomnia. Yet studies have also found that drinking as few as two small cups of coffee can affect the quality of sleep. Caffeine blocks the action of adenosine, a sleep-inducing brain chemical.

If you have insomnia, cut caffeine eight hours before bedtime. Consume no more than 200 milligrams of caffeine per day. If you think you are sensitive to caffeine, avoid caffeinated beverages. One 8-ounce cup of regular coffee has 80 to 175 milligrams of caffeine; the same amount of tea has 45 milligrams. Other sources of caffeine include cola, energy drinks, dark chocolate and certain over-thecounter pain relievers (e.g. Midol, Excedrin, Anacin).

2. Avoid alcohol. There’s no question that alcohol can disrupt sleep, causing you to wake up in the middle of the night. It also dehydrates you, which can worsen fatigue the next day.

If you have sleep apnea, drinking alcohol can make your throat muscles relax more than normal, increasing the chance that airways get blocked.

If you suffer from insomnia, avoid alcohol for a few weeks to see if your sleep improves. If you do drink, limit your intake to 1 alcoholic drink per day (e.g. 5 ounces of wine, 1.5 ounces of sprits, 12 ounces of beer). Drink alcohol with a meal rather than on an empty stomach.

3. Avoid late night, heavy meals. Eat your evening meal at least three hours before bedtime to prevent digestive upset that can keep you awake.Keep your evening meal light. The more fat you eat at your evening meal, the more likely you are to experience sleep disruptions. If you have heartburn, avoid spicy meals, which can trigger symptoms and prevent a good night’s sleep.

4. Curb fluids. Stop drinking fluids 2 hours before bed to reduce the likelihood of getting up in the night to go to the bathroom.

5. Eat a bedtime snack. A small carbohydrate-rich snack, like a glass of skim milk, a small bowl of cereal, a slice of toast, or a piece of fruit provides the brain with tryptophan, an amino acid used to manufacture serotonin. Among its many effects, serotonin helps facilitate sleep.

6. Lose excess weight. Fat deposits around the upper airway can obstruct breathing during sleep. Losing 10 percent of your body weight –22 pounds for a 220-pound man – cangreatly reduce the number of sleep apnea episodes each night.

7. Get moving. Regular exercise helps you fall asleep faster, promotes weight loss and relieves stress. If you workout in the evening, do so at least three hours before bedtime. Working out right before bed can make falling asleep more difficult.

8. Consider supplements. Valerian is one of the most popular and widely studied herbal remedies for insomnia. It’s thought to promote sleep by interacting with certain brain receptors. The recommended dose of valerian is 400- 900 milligrams per day taken 2 hours before bedtime for up to 28 days. Several nights to a few weeks may be needed for it to work. Short-term use of melatonin may also be effective for improving sleep, especially in older adults. The recommended dose is 0.3 to 5 milligrams at bedtime. Speak to your pharmacist or health care provider to see if either supplement is right for you.

Looking for more healthy nutrition advices adapted to your tastes, lifestyle and goals? Call us at 1 800 361-3493 or email us at bookings@medisys.ca to book a consultation with one of our registered dietitians.

8 NUTRITION STRATEGIES TO PROMOTE A GOOD NIGHT’S SLEEP…AND CONTROL YOUR WEIGHT

Canada is one of the most sleep deprived countries on the planet, with 30% of us getting less than 6 hours of sleep per night. Our modern lifestyles leave little time for relaxation. You would think that due to our exhaustion, many of us would fall asleep as soon as we hit the pillow – but that is often not the case.

Our evening TV watching, emailing, internet searching, social media posting, ipad movie watching and other electronic device habits that we use to unwind at night may actually be working against us when it comes to achieving restful sleep.

Before artificial light was invented, humans spent much of their evening in relative darkness or dim candle light.Daylight keeps our internal clock aligned with the environment, and darkness helps us settle into a good night sleep in the evening. Exposure to blue light in the evening- the type of light emitted by common electronic devices - can disturb our circadian rhythms by decreasing melatonin production, and rob us of much needed sleep. While light of any kind can suppress the secretion of melatonin, blue light is the most powerful suppressor. Blue wavelengths emitted from our electronic device screens as well as energy efficient light bulbs are shown to shorten or disrupt sleep.

Help your children develop healthy sleep habits for life by limiting screen time before bed time

Poor sleep health is associated with a range of health issues including increased risk of certain cancers, cardiovascular disease, depression, obesity, and diabetes. Good quality, and sufficient duration sleep is particularly important for children, who are getting more and more screen time and less and less sleep.

Poor sleep habits has been associated with increased risk of depression, chronic stress, as well as increased likelihood of having a negative self-image. Not surprisingly, insufficient sleep is also linked to daytime fatigue, impeded ability to learn and concentrate, ADHD, hyperactivity, problematic behavior, and lower levels of social skills.

Several studies have reported that earlier bed times and later weekday rising times are positively correlated to better grades. Also, studies show that those with poor grades are more likely to sleep less hours per night, have later bed times, and have more frequent night time wakeups. In teenagers, insufficient sleep has been linked to depression, aggression and anger, and higher levels of stress.

Try these smart sleeping tips that will benefit to your whole family:

• Dim your lights after the sun goes down and turn off electronic devices and bright lights one to two hours before bedtime.

• Enjoy calming activities during the evening that don’t involve staring at screens such as baths, reading, or listening to music, audio books, or practicing meditation.

• Sleep in the darkest room you can, invest in black-out blinds or curtains.

• If night lights are used, use the most dim light possible, or lights with red-hugh vs. blue

• Spend more active time outside during the day (but use sunscreen)