Specialist gives advice on improving sleep

If you’ve been struggling to get out of bed in the morning, feeling down and lacking energy, you’re not alone.

Dr. Preetha Rosen is a sleep specialist at Gritman Medical Center in Moscow. She said that in the winter, a lack of exposure to daylight can significantly affect the body’s circadian system, which she describes as its “master clock.”

“The clock is so powerful that it influences our sleep-wake rhythm, it also influences our energy levels, our metabolism, our hormonal regulation,” she said.

When that rhythm is misaligned, Rosen said, it can have a profound negative effect on multiple parts of the body, including increased inflammation, obesity, blood sugar, diabetes and even cancer risk.

People who experience severe symptoms that affect their daily functioning are often diagnosed with seasonal affective disorder, or SAD. Symptoms include depression, fatigue, difficulty focusing and trouble sleeping. The disorder is more common among women and at northern latitudes.

For other people, seasonal changes might not bring on a diagnosable disorder. But they can still lead to many of the same symptoms at a lower level.

“Light is not just about sleep-wake. Light is also important for vitamin D. Light has an important mood-enhancing effect,” Rosen said.

People should also be sure to eat vitamin D-rich foods, including fatty fish and other fortified foods, and some may want to consider a supplement in the winter months, especially if they’re often inside during the sunny part of the day. A blood test can determine vitamin D levels, which patients can discuss with their primary care doctor.

Generally, Rosen said, diagnosed SAD is managed by a primary care provider or a psychiatrist. But for both people with SAD and the winter blues, light therapy and prioritizing exposure to daylight is important. Rosen recommends taking breaks for walks during the winter and light therapy, such as dawn simulation lamps that slowly light up a room in the morning.

Sleep and psychiatry are closely linked, Rosen said — one of the most common reasons she sees patients year-round is for insomnia. In those cases, many patients say they struggle to quiet their mind and often rely on medications.

“The question I ask my patients is, ‘OK, so you are on a medication: How long do you plan to take them?’ Right? You can’t be on those medications for the rest of your life,” Rosen said.

Rosen uses tools including cognitive behavioral therapy and sleep diaries with patients to help them form better habits and a better relationship with sleep.

She also recommends patients work to keep a consistent bedtime and wake time — that means even if it’s the weekend, you probably shouldn’t sleep in more than about 30 minutes.

The right schedule differs person to person, so some people might do better with an earlier bedtime than others. But inconsistency throws off the circadian rhythm — which can create problems, including inflammation, poor cognitive function and a weakened immune system.

“Sleep puts its hands into too many physiological processes for us to ignore it,” Rosen said.

That advice does come with a catch. If you find yourself tossing and turning, Rosen said, don’t stay in bed.

“The longer you stay in bed, the longer you’re training your brain that it is OK to be in bed tossing and turning because bed should be only for sleep, right?” Rosen said. “So it’s almost like … some of my patients almost anticipate not going to sleep. That itself drives their anxiety about sleep.”

Sun may be contacted at rsun@lmtribune.com or on Twitter at @Rachel_M_Sun. This report is made possible by the Lewis-Clark Valley Healthcare Foundation in partnership with Northwest Public Broadcasting, the Lewiston Tribune and the Moscow-Pullman Daily News.