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Sleep Medicine

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Office workers with more light exposure at work had longer sleep duration, better sleep quality, more physical activity and better quality of life compared to office workers with less light exposure in the workplace.

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Can you be sleep deprived without knowing it? Sleep is not always prioritised however the implications can be devastating. Even one night sleep deprived can be impacting your body on a variety of different levels; physically and psychologically. The only way to know if you are getting consolidated sleep is to monitor with specialised equipment what is happening when you are asleep.

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In what may be the largest study of sleep problems among individuals with multiple sclerosis (MS), researchers at UC Davis have found that widely undiagnosed sleep disorders may be at the root of the most common and disabling symptom of the disease: fatigue. Study paticipant reports of sleep disorder frequency, sleep patterns and complaints of excessive daytime sleepiness suggest that sleep problems may be a hidden epidemic in the MS population.

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A sleep-promoting circuit located deep in the primitive brainstem has revealed how we fall into deep sleep. Discovered by researchers at Harvard School of Medicine and the University of Buffalo School of Medicine and Biomedical Sciences, this is only the second "sleep node" identified in the mammalian brain whose activity appears to be both necessary and sufficient to produce deep sleep.  Using designer genes, researchers were able to 'turn on' specific neurons in the brainstem that result in deep sleep.

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Insomnia can cause chronic inflammation, which can lead to weight gain, hypertension, diabetes, heart disease, and earlier death. This study finds that curing the insomnia reduces the inflammation and hopefully reduces disease. It also found the best way to cure lack of sleep is through the use of a common psychotherapy treatment - cognitive behavioural therapy.

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Getting enough sleep is important to people of any age, but it is especially so for teenagers, with insufficient sleep possibly being linked to obesity as an adult.

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Coping with Shift Work

A look at the body’s response to Shift Work.

A main reason that shift work can be challenging to your health and lifestyle is the fact that your body is so sensitive to changes in circadian rhythms

What are Circadian Rhythms?

Circadian rhythms

Most people have a normal cycle of waking up around 6-7am, going to work from about 9am-5pm, and then becoming sleepy and ready for bed by about 9-10pm.  They will sleep for approximately 8 hours before waking up again.

This process is called a circadian rhythm, and it is this natural rhythm that gets affected when we work shift work or experience jetlag.

Circadian rhythms influence our body temperature, alertness, sleepiness, hunger and most hormones.

Sunlight and other time cues help to set our circadian cycles so that they are consistent from day to day. For most people the length of a complete cycle is very close to 24 hours.

What are the side effects of shift work?

Sleep Deprivation

The obvious side effect from shift working is sleep deprivation. As a night shift worker, your average sleep cycle may be two to four hours shorter than that of a day workers who sleeps at night.

Your day sleep is probably light, interrupted and less likely to make you feel well rested. You may even be experiencing sleep deprivation and insomnia.

The sleep problems you face as a shift worker can be made worse if you already have some kind of sleep disorder (such as narcolepsy or sleep apnoea) and or a schedule that does not allow for you to get enough sleep each day.

If you suspect that you have a sleep problem, even if it existed before you started shift work, see your healthcare professional for advice and treatment.

Diminished Job Performance

Numerous laboratory and field studies show that sleepiness affects a person’s normal functions – memory, mental ability, motor skills and moods.

There are many examples among night workers of serious accidents caused, at least in part, by sleepiness. The cost to society of sleep related accidents is huge.

Social Effects

People often complain about having a difference schedule to their friends and family. People also report feeling unable to ‘get things done’ as their work lives don’t coincide with normal business hours. All of these obstacles can lead to feeling ostracized and detached from the rest of society.

Treatments for Sleep Loss due to Shift Work

There are many different factors that can be looked at to determine the best treatment for you:

  • Where do you work?
    Are you working with people? Machinery? What skills do you employ when you’re at work?
  • Are you a night person or morning person?
    “Night people” may adjust to the night shift better than “morning people”. Older workers in general find it harder to work nights or rotate shifts.

Several treatments appear to help with shift worker’s problems, but the approach likely to help you best depends on your individual needs and circumstances.

Work Schedules

The best work schedule is one that allows you to sleep when you are off duty and be alert when you are on duty, taking into account the above factors.

Work With Your Own Circadian Rhythm

Work schedules that go along with your body’s circadian rhythm by rotating clockwise (from day to evening to night) are helpful.

Your ideal schedule should be determined by your body’s natural sleep needs, why what feels “right” and help your overall work time alertness.

Take Your Breaks

Breaks during work hours may increase your alertness.  There is evidence that breaks may actually increase your productivity and job satisfaction.  Ask your employer to work with you to determine a scheduling change that could improve your job performance and make you feel less tired.

Sleep Schedules

If you are a permanent night shift worker, you should keep a regular (day) sleep schedule seven days a week, even on your days off work. Going back to a typical day schedule during time off will only make it harder for you to sleep during the day when you return to your night shift work.

Rotating Shift Workers

If you are someone who works rotating shifts, try to adjust your sleep schedule so that you will be able to adjust more easily to a new shift time when it happens.

On the last few days of the evening shift, for example, bedtimes and arise time should be delayed by one to two hours. Then you can begin your night shift work already well on the way to being adjusted to the new schedule.

On-Call Shift Workers

If you are an on-call shift worker, you are probably aware that your sleep problems are somewhat different from those of a night shift or rotating shift worker. Because on-call workers usually can’t predict work schedules far enough in advance to plan the right sleep/wake schedule, they should try to be well rested at all times.

Napping

Although there is some evidence that sleeping in one longer stretch is better than sleeping in several shorter periods, those of you who can’t get all of your sleep in one stretch may increase your total number of sleep hours by napping.

Napping is especially helpful when naps are taken off-shift, at an appropriate point in your circadian rhythm.  Napping in this case can help offset the sleep loss associated with poor daytime sleep.

Napping During Your Work Shift – Beware of Sleep Inertia

Brief naps taken during a work shift may only increase your alertness for the moment, since your job performance can be slowed at first as a result of sleep inertia (the body’s tendency to want to remain at rest for 15 minutes to an hour after awakening).

You should seriously consider the effects of sleep inertia before you decide to use napping during the work shift (ie. on a break), especially if your job requires you to wake up quickly or react immediately to different situations.

While naps are not a substitute for a regular schedule of normal sleep, they can help you reduce your sleep “debt” and improve your alertness – at least for the time being.

Sleeping Pills

Shift workers often use sleeping pills (also known as hypnotics or sedatives) to override the time of day and make themselves able to sleep, however there are several disadvantages:

  • Results in only partial alertness
  • You may develop a dependence and reduce effectiveness if used long term
  • Only partial improvement in alertness and performance
  • Sleeping pills cannot reset your internal clock

If you think sleeping pills could help you once in a while, talk with your healthcare professional. Over the counter aids is not the best choice to help you sleep since many of them cause drowsiness for several hours after you awaken, which can be unsafe.

Alcohol

Some people believe that alcohol helps them sleep, but that is only because of an initially sleepy feeling they might experience as a result of drinking.

Alcohol is NOT beneficial to sleep. In fact, if you drink alcohol when you are already tired and in the wrong circadian phase the alcohol may have a rebound effect, waking you within a short period of time and making it harder for you to return to sleep.

Stimulants – Eg: Caffeine

Studies have shown that the occasional use of stimulants, such as caffeine, can reduce sleepiness and improve your ability to be alert on a night shift. However, you should avoid caffeine within four hours of your desired bedtime since it can actually cause difficulty falling asleep.

Alternative Therapies

Bright Light Therapy

Bright light therapy is being studied as a way to shift the circadian system and reset the body’s clock. Properly timed exposure to bright lights may help advance or delay the sleep cycle.

Evening exposure to bright light can be used to treat ASPS by shifting the circadian clock to a later hour. Morning exposure to bright light is used to treat DSPS by shifting the circadian clock to an earlier hour.

If you think you suffer from one of these disorders, seek specific advice about this from your healthcare professional.

Supplemental Melatonin

Melatonin is a naturally occurring substance that increases in the bloodstream during the night. Although this form of treatment is experimental, it is believed to help promote sleep onset and rest the biological clock in some situations.

Sleep Hygiene

  • Sleep in a dark, quiet room
  • Use the bedroom only for sleep and sexual activity (not for watching TV or balancing the checkbook)
  • Keep your bedroom temperature cool and comfortable
  • Only go to bed when you are relaxed
  • Have a regular routine for preparing to sleep (brush teeth, put on pyjamas etc)
  • Try to have dark curtains for the bedroom windows or to wear eye shades for sleep
  • Use “white noise” to block out other noises
  • Disconnect - Turning off the phone, disconnecting the doorbell or putting up a “Do Not Disturb” sign can also help you sleep.

Other Measures

Workplace Conditions

There are some factors at work that can affect your alertness, including:

  • Lighting levels and temperature – your workplace should be well lit and cool
  • You and your employer should educate yourselves about the effects of shift work in your workplace and encourage safety and productivity.

Diet

Diet may play a role in good sleep. Shift workers should eat meals that are high in protein and carbohydrates and should avoid fried or hard to digest foods, going to bed hungry or going to bed immediately after eating a large meal.

Tips On How to Sleep Well...

There are some general guidelines that help promote good sleep.

  1. Go to bed only when you are sleepy.
  2. If you are unable to fall asleep after about 20 minute, get out of bed. Leave your bedroom and do something relaxing. Come back to bed only when you are sleepy.
  3. Use your bed for sleep, sex and to recover from illness.
  4. Wake up at the same time every day, including weekends and holidays.
  5. If you have trouble sleeping at night, avoid napping during the daytime. If you need to take a nap, make it less than one hour and take it before 3pm.
  6. Begin rituals to help you relax before bedtime, such as taking a warm bath or reading for a few minutes.
  7. Exercise on a regular basis, but do it earlier in the day.
  8. Maintain a regular daily schedule to keep your brain’s internal clock running smoothly.
  9. Eat a light snack before bedtime, but avoid a big meal.
  10. Avoid caffeine, alcohol and cigarettes late in the day.
  11. Set aside time during the day to get all of your worries out of your system.
  12. Avoid sleeping pills or use them cautiously under the supervision of a doctor.
  13. Never drink alcohol while taking sleeping pills or other medications.
  14. Talk to your doctor or a sleep specialist if you have an ongoing problem related to your sleep.
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