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In photo: Joshua Dyball



Sleep! It runs the gamut from luxurious to petrifying. For most of us, sleep provides relief, restoration, and reinvigoration. But for some, sleep is a time of anxiety, emotional distress, and exhaustion. 

The development of sleep disorders can be heavily affected by stress levels. According to Dr Craig Rowat of Spine and Sport Bermuda, there is a clear link between stress and diagnosed sleep disorders: 

“Disorders like insomnia and sleep apnea are some of the more common diagnoses that have shown a direct correlation with stress levels. With a person’s stress levels being somewhat subjective to measure, the role of stress can be difficult to measure; however, the presence of Covid-19 provided researchers with a unique opportunity to study stress as it relates to sleep. 

“Researchers examined healthcare workers in hospitals during the Covid-19 outbreak, and were able to compare their sleep habits against data taken from healthcare workers prior to Covid-19 – as this is a highly studied population to begin with. 

“In one study, the prevalence of sleep disorders amongst hospital workers during Covid-19 was 44 percent higher than pre-covid levels. This is a shocking statistic that demonstrates the havoc that stress can cause on your sleep. If you can help tame your stress, there is a good chance you can greatly help your quality of sleep.” 

The very idea of a sleep disorder seems cruel. Sleep is the body’s time to rest, regroup and replenish. Anything that interferes with that process is a major problem. 

Sleep Technician Joshua Dyball, of the Bermuda Center for Sleep Disorders, discusses the most common disorders treated at this local facility: 

“Sleep related breathing disorders are seen most at our facility, and primarily Obstructive Sleep Apnea (OSA). OSA is a disruption in sleep characterised by repetitive episodes of complete or partial upper airway obstruction. Each episode lasts a minimum of 10 seconds and results in a reduction of blood oxygen saturation. Though this is the most common disorder we see, it remains dramatically under diagnosed and, when left untreated, increases the risk for many chronic illnesses and health problems.” 

Mr Dyball expounded on treatments available at the centre: “The most common treatment available for OSA is positive airway pressure (PAP) therapy. This involves the use of a small machine and a mask to deliver pressurised air to your nose, mouth and throat while you sleep, thereby preventing the airway from collapsing. At our facility automatic PAP machines are typically prescribed as they are the most advanced and can determine the amount of pressure required to keep the airway open. 

“A second line of treatment is oral appliance therapy (OAT). These removable devices are custom fabricated by a Sleep Qualified Dentist and are designed to bring the lower jaw forward and open the bite. This increases airway space and allows for less restricted airflow during sleep.” 

For more entrenched sleep disorders, more comprehensive treatments may be necessary: 

“Surgeries are sometimes recommended for people with OSA, or other sleep related breathing disorders, particularly if conservative therapy cannot be tolerated. This can involve removal of tissues at the back of the throat (tonsils, adenoids, part of the soft palate or uvula), repositioning the jaw, or widening the palate. 

“A newer procedure called Hypoglossal Nerve Stimulation uses a pacemaker type device which is implanted in the upper chest and electrically stimulates the tongue nerve throughout sleep to prevent it from obstructing the airway.” 

On the role that stress plays in sleep and sleep disorder management, Mr Dyball is clear: “Both mental and physical stress contribute to the worsening of sleep disorders. Sleep disorders are themselves a source of stress. The sympathetic nervous system is activated during stress, thus preventing the regenerative benefits of healthy sleep. 

“Stress drives a hormone called cortisol which drives our ‘fight or flight’ response which, in turn, hugely curtails our release of melatonin and our ability to relax and prepare for sleep. It can cause insomnia, reduce sleep quality, duration, and much more. 

“Stress management can therefore help with the prevention of some sleep problems, and help to attenuate the worsening of certain symptoms.” 

Of course, when one suffers from a sleep disorder, bedtime itself can be a stressor. Alleviating the stress of sleep-time can go a long way toward starting to get ahead of sleep disorders and getting better quality, effectively restorative, rest. 

Mr Dyball highlights consistency and support when removing stress from the sleep-time routine: 

“Making sleep-time less stressful will be relatively easy for some and a constant challenge for others. My biggest piece of advice when it comes to this is making time for, and prioritizing, sleep. It should be regular and consistent, with a similar wake up time and lay down time each night. Making the environment appealing and inviting is of huge importance, as well as focusing on areas that may need improvement when it comes to sleep hygiene. 

“Speaking to your doctor, counselor, or a cognitive behavioral specialist can substantially help, as well as ensuring that you have support at work, with friends, family, and loved ones.” 

Further tips for sleep disorder sufferers, as well as folks who just want to improve their sleep, include: Making sleep a priority that is just as vital to our lives as food, water and oxygen; creating a comfortable sleeping environment that is dark, cool and quiet; reducing LED and blue light exposure, which will suppress melatonin secretion and can alter circadian rhythm and sleep drive; exercising regularly; and avoiding alcohol and caffeine. 

Finally, Mr Dyball asserted that “the goal is to create an environment that promotes achieving the quality, and quantity, of sleep necessary. Aids are needed to eliminate factors that are preventing regenerative sleep.” 

Helpful websites he recommended include: 

American Academy of Sleep Medicine: 

American Sleep Association: https:// 

The Sleep Foundation: https://www. 

BetterSleep – This is a popular app which incorporates relaxation techniques and good sleep hygiene:” 

There’s no getting around it: Sleep is vital! Better sleep is absolute gold! 

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