Canyon Sleep - zzzz Bites

Kids & CPAP

Sat, 24 Sep 2022 20:00:48 GMT

CPAP - Not Just for Adults

When we think of CPAP machine as a treatment for Sleep Apnea, often a vision of a middle-aged man comes to mind; however, kids use CPAP too.

At Canyon Sleep, our youngest patient being successfully treated for their Obstructive Sleep Apnea (OSA) is 18 months old. You must be aware of the possibility of mid-face hypoplasia where the pressure of the mask changes the way in which the face grows. However, with expert care this can be avoided.

We encourage you to watch this great informational video developed for kids about CPAP for some great tips.

Remember: CPAP is not the only option for OSA in your child.

We are happy to see your child for their sleep disordered breathing, to discuss other options , and support your family in this journey.

Melatonin - Think Twice

Fri, 16 Sep 2022 15:37:56 GMT

Does Melatonin help aid sleep? We believe you should think twice before using.

At Canyon Sleep, we get a lot of questions about supplements for sleep and most of the questions revolve around the use of melatonin.

Did you know that large doses of over-the-counter melatonin likely are not safe for long-term nightly use?

Melatonin is a naturally occurring hormone, this is an important distinction, it is not a supplement. It is secreted by the pineal gland, a structure that resides in the brain. However, Melatonin is considered a supplement in the US, and therefore it is not highly regulated. In fact, some products may be mislabeled.

A study in Canada, published in the Journal of Clinical Sleep Medicine, found that some melatonin products contained levels that were 478% higher than what the labels stated. Not only that, but variability within different lots of the product was as high as 465%. Also, 26% of the samples tested included serotonin.

The American Academy of Sleep Medicine published a Health Advisory: Melatonin Use in Children and Adolescents which we feel is important information for parents to read. Check it out

To find out how to get a safer and better night's sleep, contact us.

480-280-0078 or info@canyonsleep.com

Matthew M Troester DO Named AASM Committee Chair

Wed, 11 May 2022 19:19:29 GMT

The prestigious AASM group starts its work in June 2022

We are excited to share that Dr. Troester has been chosen as a Chair for the American Academy of Sleep Medicine (AASM) Scoring Manual Committee.

Dr. Troester has been a part of this committee for several years, and is partly responsible for the last 3 iterations of the scoring manual. He will now help guide the V3.0 iteration to completion. This is one of the standards for scoring of sleep used worldwide.

With this 4th appointment to the team, Dr. Troester's commitment to the AASM and the sleep medicine field continues as he plans to play an important role in advancing the AASM’s mission.

Congratulations, Dr. Troester!

Insomnia Treatment News

Tue, 03 May 2022 14:54:48 GMT

More support for TMS as a successful treatment for insomnia

May Day 2022 is a big day for those of us on the cutting edge of repetitive transcranial magnetic stimulation (rTMS) for insomnia.

As alluded to in other parts of our website and blog about rTMS, most, but not all, of the preliminary data for the use of rTMS specifically for insomnia has been positive.

On May 1, 2022, one of the most prestigious sleep journals, The Journal of Clinical Sleep Medicine, published an article from the Mayo clinic showing that insomnia improves independently of depression in patients who are using rTMS for treatment of their underlying depression.

What this means is that we now have a more solid data point showing that this treatment modality definitively helps patients with insomnia sleep better. Historically, it has been difficult to tease out if depressed patient's insomnia improves as result of the rTMS's effect on their depression. Often times, patients with depression experience insomnia as part of their depression syndrome. So when depression gets better, insomnia, by association, might get better as well. Now, based on the results of this study, we can see that the insomnia improves independently of the depression (i.e. no matter what happened with the patient's mood (improved or not improved), sleep DID improve). Those of us on the cutting edge of this therapy have long suspected this, but it has been difficult to tease this aspect out of prior collections of data.

We are still a bit away from FDA approval for rTMS strictly for insomnia, but this this data point keeps on on track and is a huge leap in the right direction. For our treatment resistant insomnia patients who have been saying, "Mayday, mayday, mayday, please help me sleep," know help is on the way.

Learn more about this study .

If you have any questions about insomnia & TMS, please give us a call.

Travel & Sleep

Wed, 23 Feb 2022 19:53:10 GMT

Think about your sleep when you travel

The topic of travel seems to come up a lot lately, typically friends sharing that they cannot wait to start traveling again. With the excitement of a trip, they may overlook a common condition: jet lag .

Let’s start with a basic understanding of circadian rhythms. Your circadian rhythms are your body’s internal clock that signals when you are supposed to feel sleepy or alert. Your body’s clock operates on a roughly 24-hour schedule. It uses sunlight to determine how much of the sleep-promoting hormone melatonin to produce. Melatonin production is high during the evening and very low during the day. As a result, you are alert during the daytime and sleepy at night.

Jet lag, circadian rhythm sleep disorder, happens when you travel across time zones and have trouble adjusting to the new schedule - most common after air travel. When you arrive at your destination, your sleep-wake cycle may still be aligned with the previous time zone.

The severity of the jet lag depends on how many time zones you cross and which direction you traveled. Flying east is usually more difficult of an adjustment than westward travel. It is estimated that it takes one day per time zone for your body clock to fully adjust to local time. Your body may expect to sleep when it is daytime in the new time zone or be awake when you are supposed to sleep.

The good news is that jet lag is temporary. However, you may have a difficult time functioning and even enjoying yourself when you are jet lagged.

Common complaints related to jet lag include:

Trouble falling asleep
Feeling tired or disoriented
Being unable to function normally during the daytime
Mild sickness
Stomach problems
Menstrual symptoms

What can you do to prepare for your trip and minimize jet lag?

Schedule shift: In the weeks before your trip, slowly change the time that you go to sleep as well as the time when you wake up. When the time for the trip comes, your sleep schedule should be relatively close to that of your destination.

Catch some rays: Sunlight is a powerful tool to reset your internal clock. After you reach your destination, make sure to open a window or go outside during the daytime to expose yourself to sunlight. This exposure will help you adjust to the new time zone.

Work out: Some studies have shown that moderate exercise helps adjustment to the new time schedule. Outdoor exercise has the dual advantage of including exposure to sunlight.

Minimize alcohol and caffeine: As tempting as it might be, limit caffeine and alcohol. These substances can interfere with your ability to fall asleep and stay asleep and can lead to dehydration. It is recommended that you avoid these substances while you are traveling across time zones.

When do we suggest talking to us?

There are a few other “remedies” that you can find when you search the internet. We recommend that you discuss these options with a sleep provider before trying any of them.

Bright light therapy: This involves exposure to a special artificial light at certain times to help reinforce your body clock and ease the transition to a new time zone. However, light exposure on the wrong side of the phase response curve in the new destination can cause further misalignment.

Melatonin: Melatonin supplements can help your body adjust to jet lag by adjusting your circadian rhythms. Melatonin is a natural hormone produced by the brain’s pineal gland and considered a signal for when your body is supposed to sleep. Since taking melatonin at the wrong time can cause more of a misalignment, talk to your sleep provider before taking melatonin during your travel.

Sleeping pills: Although not recommended regularly, your doctor can prescribe a sleeping pill to help you get rest at the proper times when you first reach your destination or to help avoid sleep deprivation during the flight. While sleeping pills may help you sleep better as you adjust to the new time zone, they are not necessary and should only be used for a short time. Sleeping medications have side-effects and may cause residual sleepiness after you wake up and abnormal behaviors, such as sleepwalking.

When it comes to jet lag, preparation is key and Canyon Sleep can help. Reach out if you have any questions about jet lag or any other sleep conditions.

Bon Voyage!

Newborn Night Moves

Thu, 02 Dec 2021 15:50:02 GMT

Wanting your newborn to sleep through the night

If you’ve ever attended a mommy and me activity or infant playgroup, you will most likely hear a discussion of SLEEP. You hear which babies are sleeping through the night, how they do it…you’ve probably heard it all. As tired parents with an infant who will not fall asleep, we are often tempted to try anything to soothe her/him so WE can sleep.

One thing many parents do to get them back to sleep is to feed them. While all infants are different, most don't need to be fed at night after 6 months (you should check with your pediatrician to be sure for your baby). Actually a recent study finds that infants who get better sleep have a lower chance of being overweight.

Getting your child to sleep can be challenging. Perhaps they can fall asleep, but then they wake in the night. The key to most infant waking is to make sure your baby can fall asleep alone the first time at night, and the best way to do this is to make sure you put your baby down while she/he is still awake so she/he can self soothe to sleep.

If you need help with this, come see us!

Sleep Habits

Wed, 24 Nov 2021 00:58:22 GMT

What do you mean when you say sleep habits?

Historically, health care providers have talked about patient’s sleep hygiene. About 10 years ago, I embarked on a personal mission spurred on by my friend Raphael Payelo, MD (an international sleep superstar based at Stanford) to eliminate the phrase sleep hygiene from the medical vernacular.

No one wants to hear that their hygiene is less than desirable, no matter the context.

Instead, I prefer to talk about good sleep habits.

The most important sleep habit: make sleep a priority - you need to schedule it.

Think of all the things you schedule. You likely make an appointment to get your car serviced, to have your air conditioning system inspected, or to get your hair cut/styled. You know you need to pick up your dry cleaning by 6 pm before they close or grab your dog from the groomer at a specific time. You schedule your day around these mundane tasks; however, it is sleep that gives us the energy to get through the day. Many of us, myself included, sometimes fail to schedule our sleep. For those of us with trouble sleeping, it’s important to not just wait until you feel tired to go to bed. Instead, try to schedule your day around when you plan to go to sleep. Accomplish the tasks of the day while giving yourself some time to unwind before you go to bed. You will be surprised at the results.

Good Sleep Habits:

Do not go to bed if you are not tired.

Do not stay in bed more than 15-20 minutes if you are not sleepy. The worst thing someone who has trouble sleeping can do is stay in bed when not asleep. If you are not asleep after 20 minutes, get out of bed and do some other activity (reading, quiet music, or other non-stimulating activity) until you feel sleepy and want to try again. Repeat this process until you are successful in falling asleep.

Ear plugs and eye patches can be your friends. If you think they will help, use them.

Pick a bed time and an awakening time - stick with it, even on weekends never deviating more than 1 hour when possible.

Keep the house bright in the morning. Keep the house more dimly lit in the evenings.

Avoid caffeine after 2 pm.

When possible, exercise in the morning. Try to avoid exercise after 8 pm.

When possible, give yourself 30-60 minutes to "wind down" at night. This is hard for everyone one, but you need time to decompress at night and if you can find the time for an hour or so before bed to avoid screen time and stimulating activities, it can be very helpful in promoting sleep. If you must work on a computer in the hour before desired sleep onset, try using a blue light filter on your device.

Use your bed (and bedroom) only for sleep. If you do your work, Zooms, schoolwork or whatever in your room or bed and you have trouble sleeping at night, you need to do that work somewhere else.

Keep electronics out of the bedroom as a general rule. If you need white noise (such as a fan or a noise machine) to sleep, make sure it stays on all night.

These are things you can do now to improve your sleep habits; however, for many it is not this easy, and that is where we come in. We look forward to helping you solve your sleep challenges.

Focus on Sleep Neurology

Wed, 10 Nov 2021 14:52:32 GMT

Why Dr. Troester is No Longer Seeing Epilepsy Patients

After nearly 2 decades working at the highest level of cutting edge medical and surgical management of epilepsy and its associated co-morbidities, Dr. Troester is focusing on Sleep Neurology and wellness. Modern management of treatment resistant epilepsy requires a highly specialized team of Epileptologists, Epilepsy Neurosurgeons, Neuroradiologists, Neuropsychologists, Ketogenic dietitians and nursing support staff. In his new practice setting, Dr. Troester chose to focus on Sleep Medicine exclusively as he did not feel that outside of a tertiary referral center, such as Barrow Neurological Institute at Phoenix Children's Hospital, he could continue to provide a similar level of service to patients with epilepsy.

Dr. Troester remains available as a resource for any established primary epilepsy patients and will always help in any way he can, but he has transitioned care of his existing patients to his former partners at Barrow at Phoenix Children's and colleagues at Barrow at St Joseph's Hospital and Medical Center, Mayo Clinic and Banner University where he feels they will get the best possible care.

There exists an obvious overlap between sleep disorders and epilepsy and Dr. Troester will continue to work with all such impacted individuals on their sleep disturbances. If you have any questions, please do not hesitate to reach out to us.

Insomnia

Thu, 28 Oct 2021 03:12:12 GMT

Insomnia - You are not alone

For many individuals, Nabokov included, sleep does not come easily. Some of us have trouble escaping our thoughts in the quiet of the night, some of us work multiple jobs or have a particularly demanding one and don’t have adequate sleep opportunities, some of us have body clocks that seem misaligned with what most of those around us are doing, and some of us have neurodevelopmental disabilities (autism spectrum disorder, for example) where we are wired up for sleep completely different than an individual without said challenges.

In Sleep Medicine, we use the International Classification of Sleep Disorders (ICSD) 3, to define insomnia as:

“A persistent difficulty with sleep initiation, duration, consolidation, or quality that occurs despite adequate opportunity and circumstances for sleep, and results in some form of daytime impairment.”

When we see insomnia in younger infants and children , in the absence of a neurodevelopmental challenge (and even sometimes in kids with such challenges), the problem is almost always behavioral insomnia of childhood sleep onset association type . In this disorder, the child simply cannot soothe herself/himself to sleep without outside intervention (a parent, a bottle, a particular toy, etc.). The mechanism to fix this disorder is very simple - teach the child to fall asleep independent of any outside influence. The mechanics of how to do this require a highly personalized, precision management strategy tailored to the situation.

In older children and adults , insomnia typically shows up in three flavors:

Trouble falling asleep - Sleep initiation insomnia
Trouble staying asleep - Sleep maintenance insomnia
Early awakening - Terminal insomnia

Some have a Neapolitan version with a blend of all three flavors.

Older versions of the ICSD described subtypes of insomnia, which while rare to see in a pure form, are useful for discussion purposes.

These subtypes include:

Psychophysiological insomnia: characterized by heightened arousal and learned sleep-prevention associations. These individuals often sleep terribly at home, but fall asleep easily somewhere else or when they are not trying to sleep. If you read about insomnia, and if you are reading this blog in the middle of the night while trying to fall back to sleep, you might have run across the insomnia strategy of instead of trying to fall asleep, try to stay awake. That notion comes from this insomnia subtype.

Idiopathic insomnia: characterized by long standing complaints of sleep difficulties with onsets in early childhood lasting into adulthood. Broadly speaking, these individuals likely have some congenital issue with some loss of function mutation involving neurons in the anterior hypothalamus, the so called ventrolateral preoptic area (VLPO) or some gain of function involving neurons in the ascending arousal system in the brainstem - see blog on sleep state switching.

Paradoxical insomnia: used to be called sleep state misperception - a term I prefer as it defines the condition better. The issue here is that individuals complain of poor sleep, but there is no corroborative evidence of such a disturbance noted on actigraphy, sleep logs or polysomnography. These individuals simply underestimate how much sleep they get on a regular basis.

Inadequate sleep habits: I changed the name from inadequate sleep hygiene in accordance with what I have alluded to in prior blogs that no one wants to hear someone talk about their hygiene. These individuals usually have trouble sleeping at night because they sleep during the day, keep odd sleep hours, lack a routine, use sleep disrupting products like caffeine, tobacco and alcohol close to bed or engage in physical or emotional activities too close to bedtime. These individuals also tend to use their room and their bed for activities other than sleep.

Another useful term that this newer edition of the ICSD mentions, but does not classify as a subtype is insomnia due to a medical or mental disorder . This is just as it sounds, for example someone with bipolar disorder, in a manic cycle who cannot sleep or someone with hyperthyroidism who cannot sleep. This is a diagnosis that applies in particular to those with neurodevelopmental disabilities like autism where their sleep is disrupted because of their autism (the medical condition).

It can be difficult to distinguish between these subtypes, but I have found patients and families often learn from or gain some self reflection upon hearing these definitions and it makes them feel less alone in their diagnosis to know that in a broad sense, what they are experiencing, while unique for her/him, is not as isolating as it might seem.

Remember, you are not alone in your experience - and we are here to help.

To read more about insomnia, visit: www.sleepeducation.org