Barb's Daily Dose

Sleep Deprivation

This is the dream deprived topic that vexes most new parents. Sleep deprivation. It's pure torture and can lead to lots of unanticipated consequences, like arguing with your partner about who should get up, being irritable with older children/family/coworkers or anyone who you come in to contact with, including people in the grocery store who made the unfortunate mistake of leaving their cart parked in the middle of the aisle. Don't they know I'm in a hurry?

Sleep and Cancer

Another report just out that less sleep increases the risk of cancer in women.

Less sleep is not good

Recently I wrote about a study that found that less sleep is associated with heart attacks. Now more data from the CDC says that it's not just heart attacks, lack of sleep is associated with a number of other health issues. Besides obesity, diabetes, high blood pressure, stroke & depression, researchers at the University of Maryland found an association with cancer.

We need 7 or more hours each night

The study looked at young women who exercise at a moderate to high level. We know from many studies that moderate to high levels of exercise helps decrease the risk of many types of cancers.  Yet, some of the women studied had higher than expected levels of cancer.  What was different in those women?  Ok, time to put on your CSI detective hat, (as I say to my students at Stanford).  

What was different, is that the women who slept less than 7 hours each night had higher rates of cancer!

So, my besides resolving to get my iPod and my water bottle and hit the gym, I'm going to hit the hay a little earlier and stop running on 6 hours of sleep/night.  

Resolve to get more sleep

A recent study found that people who slept more than 5 hours each night, were less likely to have coronary artery disease which is the cause of heart attacks and death. That sounds serious and scary.

Researchers found that more sleep  =  less risk of heart disease. 

Here's how it broke down:

Amount of sleep           Risk of heart disease

 < 5 hours of sleep 27% risk 

5 - 7 hours of sleep 11% risk

> 7 hours of sleep  6% risk

Why this happens

Reseachers don't know for sure, but 2 of the theories are: 

#1 that sleep lowers blood pressure 

#2 more sleep reduces the amount of cortisol (a stress hormone) that's pumping through the body. 

So, even though you've got a lot to do, get a little more shut eye and you'll be around longer to get to your list. I know that you can function on 6 hours, so can I, and I've been doing it for years. The trick is not to just function, but to optimize, and for that an extra half hour to hour a night will improve how you function.

Recent evidence points to lack of sleep causing all sorts of other ailments, from irritability and panic to more frequent outbreaks of herpes, to reduced memory. 

Post Baby Dry Spell

I was just asked if there was a scientific explanation for the loss or decrease of sex drive or libido that some women experience after childbirth if women are breast-feeding? 

I think most moms would say, "Hello!  We're tired."  I think sleep deprivation for all parents is the # 1 factor for their completely normal decline in canoodling. 

There are other factors at play here when women breastfeed. The hormone prolactin that makes milk, inhibits the release of estrogen (our #1 hormone for sexiness and libido.) Remember that there are more estrogen receptors in the vulva (private girl parts, this is my scientific term) than any other place in the body. 

Women who breastfeed may notice that their private girl parts don't look the same as they did in the past. The labia shrinks and things are a little less moist. Some would say Desert Dry. This isn't from a vaginal birth, because it happens for women who had a C-Section. 

What happens is that mother nature doesn't want women to be hot for their partners too soon after giving birth. In order for that baby to have enough milk to survive, it's essential that a mom NOT ENJOY SEX and make another baby, which would decrease milk supply. 

In a nutshell

Prolactin inhibits Estrogen which decreases libido, makes areas Sahara dry, changes arousal patterns and frankly prolongs the time it takes to have an orgasm. Many breastfeeding moms find that having an orgasm takes Forever and they give up and get some sleep. (unless the breast stimulation overrides that, which is another story).

Choices

If you like to bet, when new parents are in the Casino of Love, and given the choice between Sex & Sleep, they choose Sleep more often than Sex. Read more on Sex Versus Sleep

Helping Babies Sleep

Before 6 months

Every baby is different.  Some only need 10-20 minute cat naps, a few times a day, and others thrive on 2 – 3 hour snoozes every few hours.  Babies who are less than 6 months of age are completely different beings from babies who are 6-12 months of age.  Before 6 months, babies change every 1-3 days and their sleep patterns are erratic.  After 6 months, in general if a baby is asleep past 4 pm, they will not go to sleep again until after 10 or 11 pm.  As hard as it is, try to get them to nap and wake before 4pm. 

Each Child is unique

My feeling is that each parent and child pair is different and that one size does not fit all.  Parents need to find the method to help their child sleep that they are most comfortable with. My number one tip is not to try anything unless both parents are completely committed to finding a method and then sticking with it, because it’s too tempting to change strategies in the middle of the night, when everyone is exhausted, cranky and just want to get back to sleep no matter what the long-term consequences are.

Sleep routines evolve as children develop

It is absolutely, perfectly normal for a 15 - 18 month old toddler to stop sleeping through the night and begin waking at 3 am.  As babies and children grow and develop, their sleep patterns also change.  This is to be expected and planned for.  As children’s brains develop in their toddler years, parents often have to re-visit sleep issues and try new techniques. They are developing more language and more ability to remember events which can lead to waking. Expect sleep disturbances again between age 3 and 4.

What about the 3 am feedings?

 Great question.  Unless your pediatrician has advised that you feed your baby through the night because they are small and / or need the calories, this is not the best way to preserve your sanity.  Sleep deprivation is a form of torture and creates anarchy in a home.  So prevent mood swings, irritability, and postpartum depression by getting enough sleep, and that may mean that you have to rely on the experts who will help you help your child learn to sleep through the night.

Postpartum Depression resources

3 Simple Questions may predict who's at Risk

Recently an article in the Journal of Pediatrics found that 3 simple questions might help providers identify new moms at risk for postpartum depression. For this new screening tool, new mothers were asked to answer "Yes, most of the time," "Yes, some of the time," "Not very often" or "No, never" to the following statements:

1. I have blamed myself unnecessarily when things went wrong.
2. I have felt scared or panicky for not very good reason.
3. I have been anxious or worried for not very good reason.

These questions are modified from a much longer screening questionnaire, the Edinburgh Postnatal Depression Scale (EPDS). I have used this with my patients in the past and found it very helpful. 

Now, we are using a different questionnaire, the Beck Postpartum Depression Predictors Inventory (PDPI). 

In any case, it's my experience that not enough practices use any type of questionnaire. Hopefully, this new shorter version will make it easier and faster to identify moms who are more likely to be depressed and not just experiencing baby blues. 

SIDS, Back to Sleep & Tummy Time

In 1992, the Back to Sleep campaign was started to educate parents about the importance of placing babies on their backs to sleep. It was long suspected that babies who slept on their tummies had a higher incidence of SIDS, or Sudden Infant Death Syndrome.

The Back To Sleep campaign significantly reduced the numbers of babies who died of SIDS. It's a medical breakthrough that has prevented countless families from facing the tragedy of SIDS.

Tummy Time

When babies are placed on their backs to sleep and don't have an opportunity to be on their tummies, some will have misshaped heads and poorly developed neck muscles. So when your baby is awake and happy, roll them over for some Tummy Time.

What to do
• During a diaper change, place your baby on their tummy on a waterproof pad. This also gives their bottoms some air time, which helps prevent diaper rash.
• Be sure to make lots of eye contact, talk and play with your baby.
• Encourage them to look up and use those neck muscles to look around.
• This also helps them figure out how to get their elbows underneath them to push up.
• Be sure to stay with your baby and don't let them fall asleep on their tummies.
• 10-30 minutes is a good goal for each day.
• Change positions if they're not having fun or become cranky
• When you sit on a chair, you can also try placing your baby on their tummy across your legs above your knee and gently pat their backs.

Have fun and let me know what works for you.

Olympic Insomnia

Normally I don’t stay up past 11 to watch extraordinarily fit people vaulting over an impossibly high fixed obstacle, known as a “horse” while spinning, twisting and, whoa, STICKING the landing! Likewise, how many times, can you watch hairless athletes churn through the water like salmon intent on spawning? The answer, is, every single night, and way past my bedtime, which means a bleary eyed morning and fully leaded coffee in the morning.

Yes, I’ve heard of TiVo, in fact, I do record the NBC coverage, but I still stay up! It’s not just me. People who have never heard about, let alone cared about synchronized diving, are getting 4 hours of sleep because they were compelled to watch every single springboard, 2 ½ pike, twisting, splashless landing.

I’m hearing from patients and friends about this new phenomenon, which I call, Olympic Insomnia, which is characterized by the inability to turn off the TV at a normal hour and get to bed because you might miss the 200 meter women’s backstroke with or the final scores for the floor exercise by Nastia Luikin & Shawn Johnson.

I’m also wondering about a few things.

1. Do the swimmers wax, shave or is the US Swim team paying for laser hair removal?

2. Have you noticed their complete lack of body hair? I’m thinking that any hair produces drag which slows them down 0.01 second, which could be the difference between Gold and Silver.

3. Do they let their hair grow back when they retire from swimming?
a. Does it itch?
b. What about rashes, which wouldn’t look good on TV.

4. What exactly is in the new swimsuits that’s helping these athletes glide over the water like a turbo-propped jet ski?
a. Is it, real fish scales as some might have suggested?

5. How much does it hurt when women gymnasts land directly on their pubic bones, legs straddled to either side, during the balance beam competition? OOWWW! OUCH, I wince every time I witness that scary moment of torture for a few extra hundredths of a point.
a. Is it really worth it?

6. Does everyone know that Kerri Walsh is not sporting a strange jet black tattoo with mysterious meaning, but is wearing a special Kinesio bandage that prevents her arm from flying out of her shoulder and over the volleyball net?

These are what I wonder about before I give in and close my eyes, anticipating the next thrilling events, where I can study how Michael Phelps manages to stay underwater so long and not get water up his nose. And what waterproof makeup is it that Natalie Coughlin wearing? And, what about the ……….

Sex vs. Sleep

Today, I appeared on ABC’s View from the Bay, a fantastic daytime show here in the San Francisco Bay Area. I spoke about how when it comes to a choice between sex and sleep, there is no choice! They’re already asleep. If they can manage to stay awake after reading 3 stories and giving goodnight kisses to their little ones, the most pressing need is for some much needed sleep for themselves.

The last thing they want to do is get sexy and ready for a little fun time with their partners. How is it that couples who used to have sex like rabbits are now passing each other in the hall and can barely manage a kiss goodnight?

Frequency
Yes, there a few couples having plenty of sex, but there are far more that are having sex less than 1 time each week. I have many patients who average sex once each month, and quite a few who haven’t had sex in the last 3 months.

How can that be, you wonder? In many surveys of sexual frequency, many people over-inflate their frequency because they don’t want to be perceived as unusual or abnormal. According to the Kinsey Institute, when people are asked how often they have had sex in the last month, we get a truer picture. Sure there are about 30% of people in their 30’s and 40’s having sex 2- 3 times a week, and 7% having sex 4 times a week or more. What that means that about 60% are having sex less. In fact about 13% report having sex only a few times each year.

Hyper-Vigilance
Many moms that I encounter are in Hyper-Vigilance Mode, where all of their senses are on red-alert making sure that their children aren’t falling down stairs, swallowing small toys, running out into traffic and stopping them from sampling the dog’s food. These moms are mentally and physically exhausted.

My husband says that I snore! I think he’s dreaming.

Isn’t it interesting that no one ever tells us about some of the changes that we might experience in pregnancy? Especially things like this. I must admit that I snored too when I was pregnant. It’s was embarrassing because one night my husband heard me snoring and thought that a raccoon had gotten into our yard and was making noise outside the bedroom window!

I wish that it wasn’t true, but I’m sorry to say, that snoring is a normal and expected change in the late 2nd and early 3rd trimesters. The good news, is that snoring usually resolves after the baby is born, either that or people are so tired and exhausted, that they don’t hear it.

Anyway, here’s why: Women tend to retain fluid at this stage in pregnancy. You may have noticed it in your ankles and your hands and fingers. Swelling also occurs in your face and inside the nasal passages, which causes the air passages to narrow, which then leads to noisy breathing and the snoring. Try sleeping on your side with your head slightly elevated on an extra pillow, that might help. Some of my patients use earplugs.