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The Sounds of Sleep Disturbance

“If you talk to any director, they’ll say music is fifty percent of the movie.” – Hans Zimmer

Sleeping Next to a Big Black Bear

Below is “Aisha’s” story:

It often sounds like I am sleeping next to a big black bear. Like one that is in a deep sleep and is difficult to move or wake up. And the vibration wakes me up and keeps me up. I’ll try to put my earplugs in deeper, try noise machines to drown it out, or hope the whirring sound from the fan helps a bit, but nothing really blocks that deep stirring sound. I’ll ask him to open his mouth to breathe but that rarely happens… he will turn over and face the other way…

We finish our series on Sleep Awareness month with the king of all symptoms – snoring. Snoring is one of those behaviors that indicates not only sleep disturbance for the sleeper, but it greatly affects the sleep partner as well. Sadly, the story above is a common one from a personal friend about their experience with a sleeping partner who snores. Names have been changed for privacy of course.

Mechanically speaking, the Mayo Clinic describes snoring as a, “hoarse or harsh sound that occurs when air flows past relaxed tissues in your throat, causing the tissues to vibrate as you breathe.” As you might suspect, the snoring audio signature is unique and reflective of this. A mix of erratic transients and sustain, these inconsistent wave form lengths represent sound that is unpredictable, which is why we may classify it as a noise and are generally turned off by it, to put it mildly. 

Below is “Catherine’s” story:

Jeff’s snoring started out like a dandelion in your lawn – it was pretty manageable in the beginning. I could ask him to roll over on his side or gently nudge his legs. But now it is pervasive. He snores in every sleep position including while sitting up. He has even snored during a movie in a theater! There is very little wind up, it starts almost immediately and is a constant auditory assault. If you are in our kitchen you can hear his snoring from downstairs.  To cope, I wear silicone ear plugs every night but if I come out of a sleep cycle and I hear it, it can be difficult for me to fall back asleep.  Sometimes I will move to another room because I get so worked up that he is sleeping and I am awake that I need to just leave. 

Snoring can be an indication of a wide variety of health issues for the sleeper, most commonly associated with Obstructive Sleep Apnea (OSA). But it can also create serious problems that affect one’s quality of life: Daytime sleepiness, mood disorders, concentration, increased risk of cardiovascular disease, learning difficulties and car accidents.

Surprisingly, there is also a deep connection between teeth and sleep. In the book, The 8-Hour Sleep Paradox: How We Are Sleeping Our Way to Fatigue, Disease and Unhappiness, by Dr. Mark Burhenne, he succinctly sums up the concept like this: “Everything in your mouth determines how well you breathe at night, and therefore how well you sleep.” Recognized by one of the leading minds in health and wellness, Dr. Mark Hyman, as a “[revolutionary way] we understand and treat our sleep,” we at ProofPilot are very excited to learn more about this relationship moving forward.  Thanks for tuning into our series on Sleep Awareness Month!

The Not So Young and the Restless

According to Junxin Li, et al., as we age, our sleep gets worse on the whole. There are many reasons for this decline in sleep health and an equally wide variety of negative impacts to our overall health when our sleep gets worse.

A common, but as yet unrecognized sleep disorder in adults is called Restless Sleep Disorder (RSD). The Sleep Foundation lists the following as symptoms of RSD:

  • Frequent tossing and turning or waking up without wanting to
  • Loud snoring that involves gasping or choking noises
  • Notable movement of the limbs, getting out of bed, or even sleepwalking
  • Talking or yelling while still sleeping
  • Teeth grinding (sleep-related bruxism)

The problem with these symptoms is that the sleeper is often unaware they are happening, and so cannot even suspect that their sleep was restless. In our audio recording efforts, we noticed that even “tossing and turning” (see below) has an audio signature different from that of the sound sleeper.

There are a wide variety of approaches to improving your sleep. Brynna Connor, MD has an interesting resource here that lays out many of these approaches in five key categories:

  • Medications and Supplements
  • Sleep Hygiene
  • Diet
  • Exercise

For a more prescriptive model, the famous biohacker, Dave Asprey, has come up with “9 Ways to Sleep Better and Wake Up Feeling Like a New Person” It’s an interesting mix of diet, timing, behavior and tracking, all available outside of a medical practice and without prescriptions. Sweet dreams, everyone!

If You Think Counting Sheep is Hard, Try Counting Scratches

Atopic Dermatitis (AD), or eczema, is a condition that affects the skin. Mild versions are common in children and many outgrow it, but for others, it can turn into an extremely difficult, lifelong battle, disrupting everyday life in a way few can appreciate. 

So what does this have to do with sleep? It turns out that itching, and related scratching, can be most severe at night, making sleep disturbance as a symptom of AD. In fact, The Journal of Allergy and Clinical Immunology reports, “After itch, sleep disturbance has been ranked as the second highest factor leading to impaired quality of life.”

Scratching will make your skin raw, sensitive, and swollen, which can turn into thickened patches of cracked, scaly skin. This later becomes itchy again, creating a vicious cycle of cause and effect. Naturally, it is difficult to measure scratching behaviors while sleeping. 

Recent studies have used activity trackers to try and measure this, but used alone, activity trackers can miss things (scratching with feet) or confuse them with other movements.  Below are audio-visual signals of several kinds of scratching. The first two represent hand scratching, with the first being a more vigorous, intense scratching behavior, while the second is more of a long, drawn out scratch.

These waveforms are longer with less spikes. The length of the waveform shows a long sustain, representing the nails retracting more slowly.

Finally, below we see the audio-visual of a heel scratching a shin, instead of fingernails. What you’ll notice is how the wave forms have several little spikey transients instead of more pronounced transients.  This might be due to the heel being more of a dense, round, and blunt body part  as compared to fingernails. Advanced analytics would do wonders on large data sets here.

Integrative Dermatologist and Immunologist, InYoung Kim, MD, PhD explores this issue in a recent blog.  She covers a wide array of holistic approaches to improve sleep for people with this condition, including some simple things like optimizing one’s sleep environment and wet wraps, all the way to acupuncture and music therapy. Certainly there are effective pharmacologic therapies as well, but health and wellness is determined by more than just medicines, and there are a host of companies looking to provide solutions that complement or possible obviate the need for prescriptions.

Check out this podcast episode from Lilly, during my days at their host, to hear a first hand patient experience and the scientific efforts underway to help address this condition.

How to Know if You're a Mouth Breather

As we established in the opening blog of our series about sleep – The Sounds of Sleep Disturbance – a sound sleeper has a relatively unremarkable audio signature. This is important to understand, because once we know what good sleep should look like, signs of poor sleep or other behaviors that can negatively affect health are easier to detect and therefore prevent or remedy.

Let’s focus on breathing. In our last installment, we showed you the audio-visual signature for a sleeper breathing through their nose (see below). 

Nose breathing has a long waveform with several tiny spikes, typical of sounds that are light in transient and long in sustain. A transient, as used here, is a momentary change in frequency, which is best seen at the initial sound of an audio signal, also known as the “attack.” Heavy transient signals are typically abrasive to the ear and have short sustain. Some examples of heavy transient sounds include: a snare drum, knock at the door, or hand slap. Sounds that have light transients typically feel “pleasant” or “smooth” to the ear. For example, a gentle flute, distant ocean waves, or in this case, nose breathing. 

Mouth breathing on the other hand, looks and sounds different.

 

On close examination, we see a mouth breathing signal has a greater velocity (tempo), more repetitions, a higher amplitude (volume) and sometimes a heavier transient on the second visual form of each couplet – i.e., the exhale. No doubt an expert could better explain these differences (and more) as a reflection of mouth breathing mechanics. And a machine could make much deeper sense of very high volumes of this kind of data, as opposed to the human eye or ear.

While your mouth might be a perfectly good way to breathe, research shows this behavior might be the cause of a number of detrimental conditions, or may be an effect of physical problems like deviated septums or enlarged adenoids. 

A 2013 study in Neuro Report has shown that Mouth Breathing can lead to cardiovascular issues. A 2021 study in Healthcare reports, “changing various habits related to [mouth] breathing is important for cognitive function.” Myofunctional therapist and thought leader, Sarah Hornsby reports, “Most people don’t realize that mouth breathing is a complex health concern that can lead to sleep apnea, speech impediments, and improper facial growth.” Fortunately, she offers 5 tips to help understand and reduce mouth breathing.

A growing number of health and wellness devices have also cropped up to help prevent mouth breathing. One simple one is called mouth tape. The Sleep Foundation offers an interesting look at mouth tape – how it works, risk and benefits, and kinds of tape to consider. 

Come back next week to learn more about how sound can inform what’s happening when you sleep!

Hello Darkness My Old Friend

Does silence have a sound? Why yes, it does. Though it’s more accurate to say that total silence isn’t really something attainable in the everyday world. As such, even a recording of what we might perceive as silent, has an audio, and by extension, a visual signature.

March is Sleep Awareness month. Sleep is most often framed, measured, and understood as a combination of neurological, physiological, and motor phenomena. And so both the scientific and wellness community center much of their research, measurements, and interventions around these concepts. Outside of snoring, few will think about good and bad sleep in terms of distinct audio signatures. What you see below is the image of an audio wave file and accompanying mp3 audio recording of what most would consider a perfectly silent room, adequate for a good night’s sleep. You won’t hear much, but that’s the point.

It would also reflect the status of the sleeper – calm and still. This month ProofPilot will highlight a few concepts related to sleep disturbance through the lens of sound. To be clear, sound shouldn’t be positioned as a be all, end all method that trumps valid concepts of sleep characterization like brainwaves, heart rate, movement, or body temperature. However, it can shed light on some elements of sleep that aren’t perfectly characterized by these concepts.

Like all good science, let’s first set a baseline. We’re going to keep it simple. You’ve seen and heard what a still sleeper in a silent room looks and sounds like. Below is an audio-visual representation of the same “sound sleeper,” focusing on the sound of proper breathing through their nose. More on the importance of this and other topics in our Sleep Awareness series, The Sounds of Sleep Disturbance, over the coming days and weeks.