Q&A: Can Poor Sleep Show in the Face?

Can chronic insomnia make you less attractive? speed up the aging of skin? cause irreversible damage to your face?

I heard these concerns as I interviewed insomniacs for my book. But recently I decided to check into them after receiving an email from a woman whose anxiety about her appearance was extreme:

Very worried middle-aged woman

Can chronic insomnia make you less attractive? speed up the aging of skin? cause irreversible damage to your face?

I heard these concerns as I interviewed insomniacs for my book. But recently I decided to check into them after receiving an email from a woman whose anxiety about her appearance was extreme:

 

Ever since it all started eight years ago, my drive has always been an extreme fear of the insomnia’s impact on my physical appearance—especially my face. I just cannot let go of the pain of seeing my face ruined by sleeplessness! . . . Frankly, I look 10 years older than my biological age.

I am so afraid that my face is scarred (it certainly looks that way) and that it cannot recover after all these destructive years!

When we look in the mirror and see drooping eyelids and dark circles under our eyes, do we imagine we look worse than we actually do?

Effects of Sleep Quality on the Skin

There haven’t been any studies comparing the skin of insomniacs with the skin of good sleepers.

But three years ago I blogged about a study involving 60 women, half reporting good quality sleep with a duration of 7–9 hours and the other half reporting poor quality sleep lasting 5 hours or less. (Symptoms of these poor quality sleepers come close to meeting the criteria for a diagnosis of insomnia disorder.)

First the researchers inspected participants’ skin. Then they tested the skin, exposing it to ultraviolet light and subjecting it to a tape-stripping procedure that caused skin barrier disruption. They then observed how long it took participants’ skin to recover from these challenges.

Study Results

Compared with the good sleepers’ skin, the poor sleepers’ skin:

  • Showed more signs of aging skin (e.g., fine lines, uneven pigmentation, flabbiness, and less elasticity)
  • Took significantly more time to recover from the UV light exposure, with redness remaining higher over a period of 3 days

The good sleepers’ skin recovered 30% more quickly than the poor sleepers’ skin.

The study results suggest that insomnia sufferers’ concerns about the health and appearance of our skin are probably valid.

Effects of Sleep Deprivation on the Skin

In another study researchers took photographs to compare the faces of healthy adults in two different situations: (1) when they were well rested and (2) under conditions of sleep deprivation. (Again, acute sleep deprivation is not the same thing as insomnia—and certainly not the same thing as chronic insomnia—but research suggests that insomniacs may suffer from mild sleep deprivation at least some of the time.)

Twenty-three participants, all healthy adults, were photographed in the afternoon after a normal 8-hour night of sleep and again after sleep deprivation (a 5-hour night of sleep followed by 31 hours of continuous wakefulness). The photos were then viewed in a randomized order and rated by 65 untrained observers.

What the Observers Saw

You can probably guess what the results of the study were. Compared with well-rested faces, sleep-deprived faces were perceived as:

  • Less attractive
  • Less healthy
  • More tired

“Apparent tiredness was strongly related to looking less healthy and less attractive,” the researchers wrote. “The fact that untrained observers detected the effects of sleep loss in others” suggests that our sleep history gives rise to signs that can be noted by other people.

In other words, after several bad nights, the pasty complexion and dark circles we notice in the mirror are not just figments of our imagination. Others see them, too—and may judge us as less healthy and less attractive as a result. (Keep in mind, though, that the participants in this study were quite severely sleep deprived when the second round of photos was taken.)

What Can Be Done

If preserving your skin is important, then taking measures to improve your sleep might be one of the best preservatives. CBT for insomnia (or sleep restriction) is the No. 1 treatment for insomnia recommended by sleep experts. Find information about it by clicking “Blog” at the top of this page and typing CBT or sleep restriction in the site search box.

What about products that might help to preserve the skin? A dermatologist once recommended that I use CeraVe Moisturizing Cream. I like it well enough but have no way of knowing if it’s keeping my skin looking younger than it would otherwise be.

If you’ve found a skin product you like, please share it here

Insomniacs: Are We Dreaming About Sleeplessness?

Rapid eye movement sleep (REM sleep) is when most dreams occur. Episodes of REM sleep also help defuse negative emotions and improve the learning of motor skills.

Until recently, insomnia wasn’t thought to be a problem of REM sleep. Insomnia, the thinking went, was caused mainly by phenomena occurring—or failing to occur—during quiet, or non-REM, sleep: insufficient deep sleep, for example, or wake-like activity occurring in other stages of non-REM sleep, resulting in insufficient or poor sleep.

In the past few years, though, REM sleep has become a suspect in the quest to identify what causes people to wake up frequently in the middle of the night and too early in the morning. (This type of insomnia is called sleep maintenance insomnia). Here’s more about this intriguing proposition.

Insomnia sufferers may be remembering dreams of sleeplessness rather than lying awake for hoursRapid eye movement sleep (REM sleep) is when most dreams occur. Episodes of REM sleep also help defuse negative emotions and improve the learning of motor skills.

Until recently, insomnia wasn’t thought to be a problem of REM sleep. Insomnia, the thinking went, was caused mainly by phenomena occurring—or failing to occur—during quiet, or non-REM, sleep: insufficient deep sleep, for example, or wake-like activity occurring in other stages of non-REM sleep, resulting in insufficient or poor sleep.

But in the past few years, REM sleep has become a suspect in the quest to identify what causes people to wake up frequently in the middle of the night and too early in the morning. (This type of insomnia is called sleep maintenance insomnia). Here’s more about this intriguing proposition.

Do Insomniacs Really Underestimate Sleep Time?

It’s said that insomniacs tend to underestimate the amount of sleep they get. Polysomnography (PSG), the test conducted in the sleep lab, often shows that insomnia sufferers are sleeping more than they think.

Investigators now agree that PSG, as conducted and scored in standard fashion, is too crude a measure to capture what’s going on in disturbed sleep. Finer measures are needed. One such measure involves counting the number of arousals and micro-arousals—brief awakenings—during sleep.

In a seminal study published in 2008, a team of German scientists used PSG, sleep time estimates of study participants, and micro-arousal analysis to ascertain what the differences were between insomniacs and good sleepers. The results showed that compared with good sleepers, insomniacs

  • Got less non-REM and REM sleep overall
  • Experienced more micro-arousals during both non-REM and REM sleep, but the number of micro-arousals during REM sleep was more pronounced: about 2 to 3 times larger than the number experienced by good sleepers. Further, the more REM sleep insomniacs got, the greater was the mismatch between their sleep time as recorded by PSG and the sleep time reported by the insomniacs themselves.

These results suggest that (1) it may be disturbances that occur during REM sleep, more so than during non-REM sleep, that account for the discrepancy between PSG-measured sleep and insomniacs’ perception of their sleep, and (2) disturbed REM sleep may be the main problem for people with sleep maintenance insomnia.

How Disturbed REM Sleep Might Develop

Not much brain activity occurs during non-REM sleep. But REM sleep is marked by a mix of arousal in some parts of the brain and quiescence in other parts. The same group of scientists in a 2012 paper describe REM sleep as “a highly aroused ‘paradoxical’ sleep state requiring a delicate balance of arousing and de-arousing brain activity.” This brain activity involves many different groups of neurons. The over- or underexpression of any of these groups might disturb that “delicate balance,” causing fragmented REM sleep.

This idea fits in with the dominant explanation for chronic insomnia: it’s a manifestation of hyperarousal, which may come about in part due to stress. Stressful life experiences often cause sleep loss. If the poor sleep continues, then sleeplessness and worry about the daytime consequences themselves become stressors and insomnia becomes a chronic affair. The chronic stress accompanying chronic insomnia also leads to changes in the brain. These changes could cause REM sleep fragmentation and disrupted or poor sleep.

Remembering Dreams of Sleeplessness

The idea of REM sleep fragmentation as a driver of sleep maintenance insomnia also fits with the continuity hypothesis of dreaming, which posits that the content of dreams comes from everyday concerns. Not much research exists on the content of insomniacs’ dreams. What is known is summarized in a paper published in Sleep Medicine Reviews:

  • Compared with normal sleepers, insomniacs tended to experience themselves more negatively in their dreams
  • Problems that occurred in dreams were related to current real-life concerns
  • Health problems also appeared more frequently in insomniacs’ dreams.

People with chronic insomnia are prone to worry about sleep loss and its consequences, and these concerns might well dominate the content of our dreams. And if we’re experiencing lots of micro-arousals as we’re dreaming, the content of those dreams would be more accessible to conscious recall. Instead of actually lying awake for hours at night, sleep maintenance insomniacs might be awakening briefly but often to dreams of sleeplessness, making it feel like we’re sleeping less than we are.

Precisely how REM sleep becomes fragmented remains to be seen. But the finding that REM sleep is significantly unstable in sleep maintenance insomniacs is a step in the right direction.

Does the idea of REM sleep instability as a driver of sleep maintenance insomnia seem plausible to you?

Q&A: Sleep Efficiently for a Better Night’s Rest

A reader—I’ll call her Chantal—wrote in June with questions about insomnia and sleep restriction. A few weeks ago I heard from her again:

I’m now in week 6 of sleep restriction and I have to say my sleep is getting better. I mostly sleep for 5.5 hours a night. When I started it was 3.

But the last couple of nights, I’ve woken up in the middle of the night and had trouble falling back to sleep. I have no idea why I’m waking up. Do you have any tips for staying asleep?

Insomnia sufferers can improve their sleep by spending less time in bedA reader—I’ll call her Chantal—wrote in June with questions about insomnia and sleep restriction. A few weeks ago I heard from her again:

I’m now in week 6 of sleep restriction and I have to say my sleep is getting better. I mostly sleep for 5.5 hours a night. When I started it was 3.

My sleep window starts between 11 and 12 and ends at 6. I was having trouble staying awake until midnight, and by allowing myself to go to bed at 11 (or soon after that) I can fall asleep faster.

But the last couple of nights, I’ve woken up in the middle of the night and had trouble falling back to sleep. I have no idea why I’m waking up. Do you have any tips for staying asleep?

Chantal’s sleep has improved a lot with sleep restriction therapy. She’s nearly doubled her sleep time, going from 3 to 5.5 hours of sleep a night. But now her sleep is interrupted with wake-ups. If she wants to stay asleep at night, she needs to improve her sleep efficiency. Regardless of whether you’re going through sleep restriction therapy, it’s helpful to understand this concept if you want to improve your sleep.

Why Sleep Restriction?

Sleep restriction therapy is an insomnia treatment that consolidates sleep by first limiting time in bed to the actual amount of time a person is sleeping. (That chunk of time is sometimes called the sleep window.) Most insomnia sufferers experience sleep deprivation in the first week or two. But studies show that fairly soon this leads to deeper, more efficient sleep. In the process you gradually enlarge your sleep window until you’re sleeping efficiently and as much as you can.

Sleep Efficiency—What It Is and Why It Matters

Sleep efficiency refers to the percent of time you’re actually sleeping when you’re lying in bed at night. The sleep of good sleepers is highly efficient (i.e., they’re asleep 90% or 95% of the time they’re in bed). They drop off quickly and sleep soundly through the night.

If you have insomnia, your sleep is probably inefficient, interrupted by patches of wakefulness. You may only be sleeping 70% or 75% of the time you’re in bed.

Restricting time in bed will help you (1) fall asleep faster and (2) cut down on sleeplessness in the middle of the night. In other words, your sleep will become more efficient—and efficient sleep is typically sounder and more refreshing.

Calculating Sleep Efficiency

If you go through sleep restriction therapy, you’ll calculate your sleep efficiency at the end of each week. Here’s how to make the calculation:

  • Sleep Efficiency (SE) equals Total Sleep Time (TST) divided by prescribed Time in Bed (TIB) multiplied by 100.
  • The formula looks simpler using abbreviations and symbols: SE = TST ÷ TIB X 100.

Increased sleep efficiency is good in and of itself. But during sleep restriction, your sleep efficiency is also used to establish your sleep window for the following week:

  • A high sleep efficiency suggests it’s time to enlarge your sleep window.
  • A low sleep efficiency (anything less than 80%) suggests a need to tighten up your sleep window until your sleep is solid again.

Reducing Wake-Ups at Night

Chantal says she’s averaging 5.5 hours of sleep a night but that she’s now having wake-ups. The problem may lie in her variable bedtime (between 11 p.m. and midnight) and the amount of time she’s spending in bed. It’s easy to see if we do the math:

If on most nights she goes to bed at 11 p.m. and gets up at 6 a.m. (for a total of 7 hours in bed), her sleep efficiency may be low: 5.5 ÷ 7 X 100 = 78.6%. Inefficient sleep is characterized by patches of sleeplessness.

In contrast, if on most nights Chantal restricts her time in bed to 6 hours (as would occur if she delayed her bedtime until midnight and got up at 6 a.m., or set her sleep window from 11:30 p.m. to 5:30 a.m.), her sleep efficiency will probably be high: 5.5 ÷ 6 X 100 = 91.7%. She can increase her time in bed by 15 or 20 minutes the following week.

Tightening up her sleep window now may enable Chantal to maintain consolidated sleep as she gradually increases her time in bed.

Bottom Line

If you’re going through sleep restriction, don’t make the mistake of enlarging your sleep window too fast too soon. At the end of each week, calculate your sleep efficiency and adjust your time in bed accordingly. Slow and steady wins this race.

For those who simply want to cut down on middle-of-the-night wake-ups, try spending less time in bed.

 

Easing Worry and Anxiety about Sleep

Insomnia sufferers write to me often with complaints about sleep-related worry and anxiety.

“The more important the next day is to me, the harder it is for me to sleep,” Jessica says. “So I worry about not sleeping and then it turns into a self-fulfilling prophecy.”

Finding a solution to this problem can be tricky. It may require experimentation before you home in on a strategy that works.

Insomnia characterized by worry and anxiety about sleep can be alleviated using psychological and physiological strategiesInsomnia sufferers write to me often with complaints about sleep-related worry and anxiety.

“The more important the next day is to me, the harder it is for me to sleep,” Jessica says. “So I worry about not sleeping and then it turns into a self-fulfilling prophecy.”

“I finally had about 4 good nights after starting sleep restriction (about 11 days ago) but had a horrible night of anxiety last night,” Stacy says. “I was anxious about not being able to continue my good nights of sleeping. I find it hard to practice relaxation exercises when I’m that anxious.”

Achieving a relaxed state conducive to sleep can seem impossible with a mind that’s racing from one fraught thought to another. Likewise, the physiological changes that accompany worry and anxiety—the release of stress hormones, a faster heart rate, bodily warming, tensing muscles—are a better preparation for fight and flight than for relaxation and disengagement.

How to stop obsessing about sleep and sleeplessness is the main concern of many insomniacs, yet finding a solution can be tricky. It may require experimentation before you home in on a strategy that works.

Different Schools of Thought

Research backs a handful of approaches to managing the problem, but even among sleep experts there is no consensus as to which works best. It may depend on the nature of your insomnia and which approach you find more appealing.

Some experts promote a type of talk therapy–called “cognitive restructuring–as effective in reducing worry and anxiety related to sleep. The idea behind it is that sleep-related anxieties develop in part due to the misconceptions people have about sleep and catastrophic thinking about insomnia. Replacing these ways of thinking with attitudes that are more realistic and sleep-supportive should help.

Cognitive restructuring is normally presented as part of cognitive-behavioral therapy for insomnia (CBT-I). It usually involves work with a therapist, who helps you learn to talk yourself out of worries and anxieties about sleep and sleeplessness.

Mind/Body Approaches to Curbing Arousal

Other experts suggest that psychological treatments for sleep-related anxieties may not be as effective as treatments that simply help insomniacs learn to relax. Physiological hyperarousal is the main cause of poor sleep, they say, with sleep-related anxiety and worry developing as a result. Treatment should focus on tamping down arousal that gives rise to these sleep-related worries, enabling a stronger and more dependable relaxation response.

  • Relaxation training is recommended as helpful to sleep by the American Academy of Sleep Medicine. It may involve progressive muscle relaxation and/or autogenic training (guided visualization).
  • Mindfulness-based therapies enable people to become more accepting of unpleasant feelings and sensations and, in so doing, alleviate them. Mindfulness meditation has been shown in a handful of studies to help insomnia sufferers by cutting down on pre-sleep arousal, reducing wake time at night, and enhancing sleep quality.
  • Yoga has now been shown in several studies to help insomnia sufferers learn to manage stress and get more sleep. Not only does yoga practice effectively deactivate the stress system. Yoga postures, breathing, and meditation exercises also help people develop more resilience to stress.

Exercise, Anxiety, and Sleep

Still other experts advocate exercise as the best way to relieve the anxious arousal that sabotages sleep. There’s now solid evidence that regular exercise promotes sounder sleep and preliminary evidence that exercise is effective in reducing anxiety. A meta-analysis published in April shows that even a single bout of exercise has a small but significant anxiety-alleviating effect.

Strenuous exercise is the way I calm myself down in times of stress, especially when my old fear of sleeplessness threatens to stage a comeback. The minute I feel that happening, I push myself to work out longer and harder and, most of the time, it helps.

But which kinds of exercise will give you the most bang for the buck? University of Pennsylvania researchers, analyzing data from a huge survey of behaviors affecting health, have found that while walking is associated with better sleep compared with getting no exercise at all, aerobics, calisthenics, biking, gardening, golf, running, weight-lifting, yoga and Pilates are associated with even better sleep.

Consider these strategies if worry and anxiety are feeding your insomnia. Continuing to obsess about sleep and sleeplessness is surely worse than making a good-faith effort to try some of these practices out.

Insomnia: Let’s Stop Blaming the Victim

It’s cruel to blame people for health problems they have little if anything to do with creating. Yet the urge to do so is powerful when the true causes of an affliction remain unknown. In the 20th century many illnesses were seen as psychological or behavioral problems, and insomnia was one.

We’re in the 21st century now, and biology and neuroscience are teaching us that the causes of many chronic disorders and serious diseases are complex. But some people still regard insomnia as stemming from “bad” behavior or as “all in the head.” Here’s my take.

BlamingIt’s cruel to blame people for health problems they have little if anything to do with creating. Yet the urge to do so is powerful when the true causes of an affliction remain unknown. In the 20th century many illnesses were seen as psychological or behavioral problems.

Cancer? A disease of people who repressed their emotions. All that pent-up emotion and hostility just had to find expression some way, and it did so by causing cells to run amok.

AIDS? Brought on by sexual promiscuity.

Narcolepsy? Before the recent discovery of orexins–neurotransmitters that help keep us awake and which are lacking in narcoleptics, making them prone to daytime sleep attacks—narcolepsy was explained as a psychological problem of people who lacked motivation.

Insomnia? It, too, was self-created. “You! Are really the major cause of your own insomnia,” declared self-help author Valerie Moolman in 1968, at a time when sleeplessness was blamed on everything from internalized emotion and a desire for attention to bad habits like worrying and staying out late.

We’ve Come a Long Way, Baby . . . or Have We?

We’re in the 21st century now–century of the brain. Biology and neuroscience are teaching us that the causes of many chronic disorders and serious diseases are complex.

But wait. Near the end of journalist David K. Randall’s new book, Dreamland, Randall states this: “And yet insomnia is a unique and difficult condition to treat because it is self-inflicted.” Self-inflicted? Aren’t we beyond holding people responsible for a sleep disorder most sleep researchers say is based in part upon vulnerabilities predisposed at birth?

I don’t think we’ve come that far yet. “I have been made to feel like I must be doing something wrong,” wrote Carol, an insomnia sufferer who reviewed my book, The Savvy Insomniac, just last month, “drinking too much coffee (1 cup in the morning) or not really trying to get to sleep.”

“Bad” Behavior

There are some things we can do that will probably interfere with sleep:

  • Drinking coffee later in the afternoon or in the evening
  • Drinking alcohol right before bed
  • Sleeping late in the morning or taking long naps.

Avoiding these behaviors will likely improve sleep. But many of us already know these things and take them to heart. We hew pretty close to the straight and narrow . . . and still we have trouble sleeping.

Do We Create Insomnia in Our Heads?

Believing we can’t sleep will make sleep more difficult. Fearing insomnia will, too. Yet we don’t develop such beliefs and fears of our own volition. We learn them unconsciously. (See my blog on fear of insomnia.) And once in place, they’re hard to dislodge. (But not impossible. See my blog on laying fear of sleeplessness to rest.)

Even researchers who theorize that chronic insomnia develops in people who think too much about sleep or try too hard to do it are retreating from this claim as more evidence comes in suggesting the underlying cause of insomnia to be excessive arousal of the central nervous system.

Changing habits and mindsets can go a long way toward helping insomniacs sleep. But it’s time we stopped pointing fingers at the sleepless and started looking at insomnia as the multifactorial sleep disorder it truly is.

The Insomnia-Depression Connection Writ Large

Insomnia doesn’t often get front-page coverage, but it did on Tuesday. Benedict Carey of The New York Times reported on a study of people under treatment for depression. The results showed that nearly twice as many subjects were cured of depression when—in addition to taking an antidepressant or a pill placebo—they received cognitive-behavioral therapy (CBT) for insomnia.

It’s time to reassess the relationship between insomnia and depression.

Depression responds to treatment with cognitive behavioral therapy for insomniaInsomnia doesn’t often get front-page coverage, but it did on Tuesday. Benedict Carey of The New York Times reported on a study of people under treatment for depression. The results showed that nearly twice as many subjects were cured of depression when—in addition to taking an antidepressant or a pill placebo—they received cognitive-behavioral therapy (CBT) for insomnia.

It’s time to reassess the relationship between insomnia and depression. Sleep researchers in recent years have noted that the two disorders share biological turf. Compared with people who are healthy, those with insomnia and those with depression tend to get less deep sleep—the type of sleep associated with feelings of restoration. Elevated levels of cortisol, a stress hormone, and interleukin-6, a protein that stimulates the immune response, are also common to people in both groups.

Conventional Thinking About Depression and Sleep

Yet for hundreds of years, insomnia has been viewed as merely a symptom of depression. Just as in the fifteenth and sixteenth centuries sleeplessness was seen as a symptom of melancholia, so insomnia is still regarded by many psychotherapists as a symptom of depression. Treat the depression, the thinking goes, and the insomnia will disappear.

But this strategy does not always work, the authors of the current study concluded in an earlier study published in 2007, which I blogged about in September. Antidepressants may clear up depression, but insomnia often persists.

People I interviewed for The Savvy Insomniac (where I explore insomnia-related disorders and CBT at length) told stories of frustration as they looked for solutions to depression and insomnia. Laura, for example, had trouble sleeping long before she developed depression. Yet when she took her complaints to the doctor, all the doctor did was prescribe an antidepressant. The depression cleared up but the insomnia continued, and her doctor had nothing to suggest.

“Over the years,” Laura said, “they always assumed my insomnia was a symptom of depression rather than seeing it as separate. They don’t even consider the possibility that they’re exclusive with respect to each other.”

A New Perspective

New research is suggesting that insomnia may be a kind of way station to depression, and if results of the current study are confirmed by others soon to follow, they’ll really upset the apple cart. Not only may it be the case that CBT for insomnia helps clear up depression-related sleep problems. It may also true that supplementing traditional depression therapy with CBT for insomnia doubles the chance of recovery from depression.

Now put that in your pipe and smoke it.

If you’ve struggled with depression and insomnia, what treatments have you tried, and have they worked?

Sleep Restriction: Up Close and Personal

Some insomnia sufferers who visit my website head straight for the posts on sleep restriction. So I decided to create a video trailer where I could talk about my own experience of sleep restriction: how off-putting the idea was at first, and the results I later achieved.

Some insomnia sufferers who visit my website head straight for the posts on sleep restriction. So I decided to create a video trailer where I could talk about my own experience of sleep restriction: how off-putting the idea was at first, and the results I later achieved.

I posted the video on Facebook last week and got an interesting comment from a friend (who does not have insomnia himself). To him, the idea of restricting sleep time, and then increasing it bit by bit, did not sound counterintuitive at all. He compared it to the building of strength and dexterity that occurs with physical training, and the development of musical ability that occurs with daily practice on an instrument. The idea of improving sleep through the disciplined restriction of time in bed sounded perfectly reasonable to him.

There’s logic in what he says. Yet to those of us with insomnia, sleep restriction can sound daunting and downright scary. We know what it’s like to struggle with the daytime symptoms of insomnia: the fatigue, mood swings, and days when we can’t put two and two together or remember names. Why choose to subject ourselves to a treatment that involves slogging through a period when our symptoms may get worse?

Yet my own experience—and the experience of other insomniacs I went through group therapy with—suggests the bad days are numbered. By the second week we were already noticing improvements in our sleep and daytime stamina. Some of us found relief even sooner. Watch the video and see if you’re convinced.

As usual, I’d love to hear your comments.

Footbaths to Fight Insomnia?

Dr. Oz’s tip for curing insomnia—wearing heated rice footsies to bed (see my blog last March)—may have led to second- and third-degree burns for TV viewer Frank Dietl, but Oz is not responsible for the injuries, the New York Supreme Court ruled on Oct. 3. Moral of story? Take the advice of tele-evangelist health gurus with a grain of salt.

But let’s get back to the notion that heating the extremities might help to promote sleep. For some of us, this may be a useful strategy.

Foot-bathDr. Oz’s tip for curing insomnia—wearing heated rice footsies to bed (see my blog last March)—may have led to second- and third-degree burns for TV viewer Frank Dietl, but Oz is not responsible for the injuries, the New York Supreme Court ruled on Oct. 3. Judge Saliann Scarpulla dismissed the lawsuit against Oz, saying that there was no “duty of care between a television talk-show host and his vast home-viewing audience.”

Moral of story? Take the advice of tele-evangelist health gurus with a grain of salt. Frankly, some of Dr. Oz’s tips on insomnia sound pretty lame. Eat lots of gelatin to combat sleeplessness? Puh-lease!

But let’s get back to the notion that heating the extremities might help to promote sleep. Particularly in people who normally can’t sleep until late at night, this may be a useful strategy.

Body Temperature and Sleep

The rhythm of your core body temperature has a strong effect on when you feel sleepy; you start feeling sleepy when your temperature is going down. People who have trouble falling asleep until very late may have internal clocks that run on a 25-hour day, a recent study in the Journal of Sleep Research shows, delaying the downturn in temperature and the onset of sleep.

Light exposure in the morning and melatonin supplements in the evening may be the best remedies for people with longer-than-normal circadian temperature periods. But a warm footbath before bed may also help.

Why It May Work

Most heat loss occurs through the hands and feet, and heating the extremities hastens heat loss by dilating blood vessels. This allows for the swift release of body heat and a lowering of core body temperature, in turn helping promote sleep. So hot footbaths and warm socks may be a good idea for people who struggle to fall asleep at a reasonable hour.

But a new study from Taiwan confirms the results of an older study showing that footbaths prior to sleep do not alter sleep patterns in older adults. Heating the extremities may only help with sleep if you’re young or middle aged.

Do you bathe at night and/or wear socks to bed? Have you noticed it has any effect on your sleep?