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Circadian science Interviews Shift Work Sleeping troubles

Interview with Dr. Louise O’Brien

Would you mind introducing yourself to our audience—where do you work, what do you do?

I’m Louise O’Brien, an Associate Professor at the Division of Sleep Medicine, Department of Neurology, at the University of Michigan. My work focuses mostly on sleep disruption in pregnant women and its consequences. I’m also interested in treatments and therapies available to intervene to improve the health of women and babies.

Your work largely centers around sleep and its connections to pregnancy and maternal health. What led you to this field of study?

That’s a great question. Going back a long time ago when I was a graduate student, I was really interested in SIDS (Sudden Infant Death Syndrome) and why seemingly healthy babies died suddenly at night. So, I was spending a lot of time monitoring babies overnight to understand what was going on physiologically. That led me to really want to understand more about what happens during sleep, because I realized I’m doing all this nocturnal monitoring, and I really don’t know that much about sleep. That brought me to the United States—to become trained in sleep.

What are some of the things that are really well-known about how sleep affects pregnancy?

I think most pregnant women know that sleep can be quite disrupted during pregnancy. Healthcare professionals can dismiss this as normal, or it’s the body’s way of getting ready for a baby, etc. But I think we’re now learning that certain types of sleep disruption, such as frequent snoring or obstructive sleep apnea can actually lead to poor health outcomes for mom and baby. Poor maternal sleep can lead to high blood pressure or diabetes in the mom, and can also result in poor fetal growth, preterm birth, even an increase in c-section deliveries.

We are learning more and more with the work that we do. For instance, in recent years we’re learning that sleep behaviors, like sleeping on your back, appear to be related to poor outcomes such as stillbirth. A woman who has a stillbirth in late pregnancy has been shown to be more than twice as likely to have fallen asleep on their back. So, this is a relatively new area, and an area that we’re very interested in. I think that behaviors such as sleep position are particularly interesting to me because they can be changed. And If we can change behaviors, that offers an opportunity for intervention that could potentially reduce poor outcomes.

What are some of the current research questions around sleep, circadian rhythms, and pregnancy that are most exciting to you?

I’m becoming really interested in the timing of sleep. A lot of my previous research has been on sleep disorders, like obstructive sleep apnea, which is a medical condition that can be treated. We all sleep, but we don’t all have a sleep disorder. And so, what we’re learning from the general non-pregnant population is, even if we get sufficient sleep (7-8 hours as an adult), if that sleep is mistimed against your body’s natural rhythm there appears to be an increase in blood pressure. So, I’m interested to take those findings to the pregnancy population and to see if mistiming sleep during a critical developmental window for a fetus has adverse consequences which impact the health of the mom , and also the health of the baby. Because we know that what goes on in utero can sometimes have long term effects decades later, potentially even transgenerational, this is an important area that we really don’t know anything about. So the timing of sleep is something I’m really getting interested in. Because, again, we can change it.

The obvious place we see mistimed sleep is in shift workers, but they may not be able to change so easily because they’re working shifts, and they’re working against their body’s natural rhythm. That’s an extreme example, but we know that miscarriage is higher in shift workers than non-shift workers. So the question is, what is mistimed sleep against our body’s natural rhythm really doing?

Since we’re a company that does wearable analytics: What’s the current state-of-the-art for wearable tracking during pregnancy?

It’s not very good. I think with lots of wearables out there that claim to be able to track your sleep, the reality is that none of them are really validated against the gold standard- which is an overnight sleep study. There is an algorithm that has been validated against polysomnography, a type of sleep study, but none have been validated in pregnant women. So, we just really don’t know. While there are lots of things out there that claim to track your sleep, there is nothing out there that tracks it accurately in pregnant women. There is definitely an opportunity for growth in this area, absolutely. Wearables let you look in your app, and it says “REM sleep or deep sleep”, but how accurate is that? We really do not know. So many people have wearables, and I think if we can somehow harness that technology and validate it, then we have a real opportunity to see how sleep across gestation impacts maternal and fetal health. Now this is a window of opportunity. We should be doing this now, because we could then make a huge difference to the lives of mothers and babies if we just had this data.

People sometimes use sleep and circadian rhythms interchangeably, even though they’re not the same. Are there any circadian-specific angles to pregnancy and delivery outcomes that you think are particularly important to call attention to?

I would go back to this idea of mistimed sleep. You can get sufficient sleep and still have poor outcomes, potentially if your sleep is mistimed. We’re learning that in the nonpregnant population now. So, the timing of when we sleep is really important. We already know that getting insufficient sleep is bad for us, but we just assume if we get 7-8 hours of sleep we must be fine. But, if we mistime that, then maybe we’re NOT so fine. I think this is a really interesting area, and how does that relate to pregnancy? We just don’t know, the data is not there. But, I think that this is going to be the next niche area.

Some literature that’s coming out now is adding another layer on top of that. For instance, our diet—WHEN we eat. What’s the impact of eating late at night or mistiming our eating, and how does that affect pregnancy? I think this is a more complicated area that’s going to get a lot of work in the next decade. This is where the field is going to go, and I would like to think that we would be in there somewhere you know, making some inroads into this really important area. I think it’s crucial that we understand what’s going on with our timing, and our eating, and how that’s impacting our own health and the health of that developing baby. Timing is everything, right?

Anything else you’d like to highlight, from your own work, or as an area that needs more attention?

One of the things I would like to mention is: how does sleep play into disparity in healthcare and disparities in outcomes? So for instance, we know that minority women have worse outcomes than caucasian women, we also know that minorities in general tend to have poorer sleep. How does this whole sleep, pregnancy, and disparities play together? That’s a little bit unknown at this point. This is another area that I think is really important—is there a role for sleep and addressing sleep issues in being able to improve outcomes for minority pregnant women? Outside of pregnancy, we know that minorities in general have worse sleep than caucasians, especially Black women. We also know that Black women have worse pregnancy outcomes. For instance, they have double the risk of having growth-restricted babies, and also have higher risk of preterm birth. Nobody’s really looked at pulling sleep into that. We’re looking at two parallel angles, and what I think we need to do is bring these things together to see if there is a role for sleep in these poor outcomes. Because if there is, then we can intervene.

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Circadian science Lighting Shift Work

Book of the Month (January)

The Circadian Code by Satchin Panda

In keeping with the theme of new beginnings, this January we introduced a book of the month. Join us as we work our way through books that highlight the importance of circadian and sleep health 😴 Up first: The Circadian Code by Satchin Panda of the Salk Institute for Biological Studies.

We’ve been fans of Dr. Panda’s work for a long time! For more on his research, check out our blog post on time-restricted eating.

Chapter 3: “A healthy lifestyle includes what and when you eat, when and how much you sleep, and when and how often you move. By focusing on the when, you are harnessing the power of your circadian code, which can compensate for those times when you make less than exemplary choices. Better still, by living in alignment with this internal rhythm, you reap even greater benefits that come along with making good lifestyle choices.”

This excerpt is definitely speaking our language. We love anything that sings the praises of a circadian-aware life. At Arcascope, we believe that everyone deserves to reap the benefits of living in alignment with their internal rhythm. Our app, Shift, will make it easy to do just that.

Chapter 4: “A short nap during the day is one way to repay your sleep debt. The only times when napping really works against you are when you are jet-lagged, if you are a true shift worker and you want to sleep at night, or if you are really trying to move your bedtime to earlier in the evening. In these instances, it’s better to build up your propensity to sleep at night, and then reset your clock the next morning. “

A great section to highlight. There’s a ton of focus on enough hours of sleep per day, and not enough focus on when those hours of sleep happen. Naps are great, but if you’re a shift worker or trying to shift your sleep earlier, a nap at the wrong time can throw you off course.

Chapter 4: “Small lighting changes can have a huge impact. I’m not suggesting we spend the evenings in a dark room until we go to bed There are many techniques and products that can help reduce our exposure to blue light. For instance, in the evenings, shut off overhead lights and use table lamps instead.”

Yep, this line resonated with us. Because it’s not all or nothing when it comes to living a healthier #circadian life. You don’t need perfect darkness in your evening home environment or constant sunlight during the day. Moderate, realistic changes to your daily routine can be enough to help put your body’s clock back on the right track, and our recommendations are designed with this principle in mind. We bet you’ll be surprised by how easy it is to live in alignment with your body’s clock and especially how many benefits come from doing so.

Chapter 5: ” Our brain clocks are most sensitive to light, but the clocks in our gut, liver, heart, and kidneys respond directly to food. Therefore, just like the first sight of morning light resets the brain clock and tells it that it’s morning, the first bite or first sip of coffee of the day tells the clocks in our gut, liver, heart, and kidneys to begin the day. If we change our routine from day to day, our clocks get confused.”

It makes sense to think that our bodies might be more prepared to handle food at some times (like when we’re awake), rather than others (like when we’re supposed to be asleep). And the same way light at night confuses and disrupts the central clock in our brain, so too could food around the clock confuse and disrupt the peripheral oscillators in our organs.

Chapter 8: “If you wear blue-light-filtering glasses, then you don’t have to change the light bulbs in your home or find apps for your laptop or television.”

Another reminder of how simple changes to our daily routine, like wearing glasses at certain parts of the day, can help out our body’s clock.

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Shift Work Sleeping troubles

Shift Work Disorder

What Exactly is Shift Work Disorder?

Shift work disorder, or SWD, is a type of circadian rhythm sleep disorder which is caused by working shifts that do not fall within the conventional working hours of around 9 am – 5 pm. These shifts overlap with periods of significant light sensitivity which can cause shift workers to be particularly vulnerable to having dysfunctional circadian rhythms.

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Shift Work

Living with Shift Work

It’s no secret that working night shifts does a number on your body.

From increased risks of cardiovascular disease, diabetes, and cancer, to excessive alcohol consumption and worsened nutritional intake, shift work is associated with a whole host of nightmarish health effects. 

The simple solution would seem to be to get rid of jobs that put people on work schedules that are brutal to their well-being. But society needs 24-hour emergency and healthcare workers to function, which means night shift work is here to stay.

It’d be great if there was a pill you could take to erase shift work’s negative effects. Unfortunately, there’s not much in the way of pharmacological solutions that work for shift workers at present. There is hope, however: non-pill solutions, like changing shift timings and light therapy, can offer relief to shift workers. In this blog post, we’ll cover what we know about what works for shift workers.