Upright and Asleep

Do you find yourself so tired in the evening that you nod off to sleep while sitting on the couch or recliner? Perhaps you have a family member or friend that is known to fall asleep watching the TV in their favorite seat. I have worked in home health care for over a decade, and I became very familiar with people telling me they fall asleep in their living room and eventually transition into their beds at some point later in the night (if at all). There are health risks to doing this, so let's sit back, relax, and stay awake as we dive deeper into this subject.

First of all, it's important to talk to your doctor about sleeping with your head elevated - at any time of the day. Many people that have sleep apnea experience improved symptoms of snoring when their head is elevated. Additionally, when people have acid reflux and GERD, gravity helps the process of getting food into the places it needs to go. When it comes to sleep science and getting the maximum gains of refreshing sleep, every human is different, so you need to find what is best for you. On the other hand, I would argue that the best treatment for sleep apnea is working with a doctor to find a recommended treatment modality for airway management based on your specific symptoms. Additionally, for GERD or acid reflux, if you are eating or drinking anything containing calories in the hours before you try to sleep, perhaps this is a great place to start modifying the timing of your food intake to provide your system some relief. When you have food in your stomach that is in need of being broken down by stomach acid, that acid will irritate the lining of your stomach and esophagus. Many people eat/drink later in the day, experience heartburn, and habitually sleep in their recliners in an attempt to minimize their symptoms, and get into a dependence of initiating sleep with a recliner. Meanwhile, they continue the same destructive behavior of digesting food, and using energy on the food breakdown at the time when their body should be using energy on regrowth and repair.

When you sleep in the hours before bedtime, you are contributing to several factors that decrease the quality of your sleep. Your brain washes away adenosine stores that can be used to strengthen the intensity of your sleep drive at the time when you will need it the most. This means that the intensity of your sleep drive is diminished when it is the desired time to fall asleep. Additionally, evening napping disrupts the architecture of deep sleep in two ways. First, by the likelihood that you will eventually transition into bed, getting potential light exposure and stirring up your nervous system with the need to prepare yourself for bed at a point in the night when it's best for your body to remain as calm as possible. Secondly, because you are impairing your brain to get its much-needed slow wave deep sleep that is most often consumed in the first half of the night.

We have a system in our brain, known as the glymphatic system, that functions to clean the brain of unnecessary debris. Like a sewer system, it washes away waste products to cleanse the brain of potential hazards. This system sustains its greatest productivity during sleep, and is most active during slow-wave sleep that you experience in the beginning of the night. When you sleep, your CSF (cerebral spinal fluid) bathes your brain and it gathers debris that surround neurons. Functional imaging of sleeping brains shows that most of this “wash out” of debris of the glymphatic system takes place during slow-wave sleep in the first 4 hours of nighttime sleep.

Now, think about a brain that is sitting up in a recliner in a sleeping state. There is a physical pressure fluid dynamic that is not as efficient as a body laying flat on a bed. Sitting upright in early sleep reduces the potential of this dynamic. As a result, the brain does not get the greatest benefits of this debris clear-out, including beta amyloid plaques so commonly associated with Alzheimer's disease.

The solution: Don't fall asleep in your recliner or on a couch in the early evening. Other things to avoid should be drinking coffee (even decaf coffee contains caffeine), consuming alcohol or other substances, and eating in this time period, which all have deleterious effects on your sleep architecture. If your body feels excessively tired, there are things to do that can help stay awake. Most people need to stretch - this could be a great time to add a dynamic stretching routine. Yoga is an excellent evening practice. Going for a walk outside is also a great option. While walking, your eyes see less overall skylight, naturally reinforcing your internal circadian programming, and priming your body to transition into a deeper sleep when you do go to bed. Intentionally holding out on the initiation of sleep will make your deeper sleep even more efficient for regrowth and repair. Additionally, this deeper slow wave sleep optimizes memory transport where the bits of memory in your short-term memory banks can be distributed to long-term memory storing centers throughout your brain. You don't want to miss out on the incredible advantages of deep slow wave sleep, so take the steps to make this a priority. As noted, please reach out to discuss if you feel like you might need help or if you would like clarification or more information. The first conversation is free, and I love talking about sleep science.

< Older Post Newer Post >

Simple Sleep Assessment

By Ben Mooney • August 9, 2023

Having trouble sleeping? Please consider taking 2-3 minutes to answer the following seven questions. This assessment is from Bastien et al. Insomnia Severity Index, Copyright 2001. Rate the current SEVERITY of any sleep issues, based on your last two weeks of sleep. None Mild Moderate Severe Very 1. Difficulty falling asleep 0 1 2 3 4 2. Difficulty staying asleep 0 1 2 3 4 3. Problem waking up too early 0 1 2 3 4 4. How satisfied/dissatisfied are you with your current sleep patterns? Very Satisfied Very Dissatisfied 0 1 2 3 4 5. To what extent do you consider any potential sleep problems to INTERFERE with your daily functioning (e.g. daytime fatigue, ability to function at work/daily chores, concentration, memory, mood, etc.). Not at all A little Somewhat Much Very Much 0 1 2 3 4 6. How NOTICEABLE to others do you think any potential sleeping issues are in terms of impairing your quality of life? Not at all A little Somewhat Much Very Much 0 1 2 3 4

The Physiological Sigh

By Ben Mooney • August 9, 2023

I have grown to love The Huberman Lab Podcast and Breathwork. I had such profound experiences with breathwork that I decided to take the training to become a breathwork facilitator. I believe breath is such a powerful tool to regulate our nervous systems; perhaps one of the most powerful ones we possess. The Physiological Sigh is something that everyone can use in real time. It works, and there is a great biological explanation. Andrew Huberman PhD. talks extensively about the Physiological Sigh in The Huberman Lab, and I am so excited to share this information! If you are stressed, it’s great to get a massage, soak in hot springs, go for a run, or go to yoga, but in reality, you often experience emotional turmoil in the moment. Which is why it's so important to have a tool for that moment. It is very hard to control your mind when you are in intense states of stress. Good luck being intentional or channeling inner wisdom of mindfulness at the exact moment something is driving you crazy. What do you do? Perhaps you have just enough mental capacity to temporarily think about your response before you react. You need a real time tool. I will try not to get too geeky, but there is a great biological component to this. First, a simple explanation: If you want to slow down your heart, lengthen your exhales in relation to the inhales. Calming your nervous system can happen quickly through a long exhale. Priming the exhale with an oxygenated inhale will help deliver oxygen to your blood and eliminate carbon dioxide. Finally, using the skeletal muscles of the diaphragm is a tool to fast-track this process. If this information is good enough, feel free to skip the next three paragraphs, and jump ahead to learn how to incorporate the Physiological Sigh as a reaction to in-the-moment stress. Breath controls heart rate through reactions between sympathetic and parasympathetic nervous systems. When you inhale, your diaphragm moves down as your lungs and heart temporarily expand. As a result, the blood in your heart is at a lower volume than prior to your inhale (in relation to the space in the heart), and your heart moves more slowly. The SA (sinoatrial) node in your heart registers the rate of blood flow, and acts as the pacemaker for your heartbeat. The SA node is constantly trying to achieve a balance of pressure and optimal oxygen distribution of blood throughout your body. A longer inhale causes the SA node to send a signal to your brain that blood is moving more slowly to your heart. The brain sends a return signal to the heart to speed up the heart rate to produce more oxygenated blood flow to muscles throughout your body. Therefore, if you want your heart to beat faster, inhale more vigorously than your exhales. Additionally, if inhales are completed over longer time periods than your exhales, you speed up heart rate. This creates a sympathetic activation response and is a great tool if you need to increase your attention or if you are tired (Journal of General Physiology, 9/13/10 136(3) 237-241, H. Peter Larson). The opposite is also true. If you want to slow down your heart rate and calm yourself, capitalize on the relationship between heart rate, diaphragm, and brain. When you exhale, the diaphragm moves up and gets smaller. The blood volume of the heart is flowing faster through the heart, and the SA node recognizes the faster flow of blood. The SA node sends a message to the brain to slow the heart rate. The parasympathetic nervous system is activated in your brain, via the vagus nerve and baroreceptors in the arteries as well as its relational connection to the diaphragm, and it sends a return signal to slow your heart down. Take a long exhale to calm yourself. Now, let's focus on your lungs for a moment. Think about how you breathe when you experience stress - often it is shallow. You have tiny sacks in your lungs called alveoli. The job of alveoli is to expand and contract as oxygen is inhaled and circulated into your blood. When you are stressed, the alveoli tend to collapse and are not as efficient. Meanwhile, carbon dioxide builds up in your bloodstream, increasing agitation. Your body will want to replenish the blood with rich oxygen and clear out the carbon dioxide at this time. Finally, the diaphragm is unique because it has the ability to be subconsciously controlled through natural processes similar to your spleen, pancreas, intestines, or stomach, AND as mentioned earlier, you can also voluntarily expand and contract your diaphragm with skeletal muscle control. You don't need to think about breathing, but you have the choice to override and manipulate your breath. As a result, you can do double or triple inhales and control the timing of your breathing for speed, capacity, and duration. Through a double inhale, you can efficiently re-inflate the alveoli, and cue your nervous system to focus on intentionally moving out of the shallow breathing pattern. The Physiological Sigh: Double inhale - first for one second, with your second inhale shortly after for ½ to ¾ of a second - to sneak in more air. Hold for several seconds, then perform a long exhale. Through my breathwork training, I learned if you combine your long exhale with a hum or audible sound, and you recruit the superpowers of the vagus nerve (your 10th cranial nerve and the longest and most complex of all cranial nerves) for a deeper calming effect - but this may not be appropriate in the middle of a staff meeting. Repeat this 1-3 times, or more until you gain your desired result or at least enough to find mental clarity to calm your reaction. The double inhale reinflates the alveoli fully in your lungs and the long exhale rids your body of the carbon dioxide, modulating your stress response through slowing your heart rate and calming your nervous system. This is a fast, hard-wired way to lower your internal reaction to stress the moment you experience it. I would recommend practicing it so it becomes immediate. Think of moments where you find yourself to be stressed and imagine using your physiological sigh as you proceed through that moment. Rehearse, rehearse, rehearse so it becomes more instinctual. This can be applied during weight lifting, at times of the day when you intentionally want to relax, as part of a calming routine before sleep, and certainly if you are triggered in the moment of a life stressor.