David Beuther, MD, PhD, isn’t quite sure how to define his presence on social media. He’s online regularly, but he’s not publishing posts or sending friend request. Instead he’s observing, what is being discussed online related to healthcare. While he’s often encouraged by the availability of helpful information that is shared by reliable sources, he’s equally worried how quickly misinformation and unsubstantiated claims can spread — often to those who should instead be receiving care and guidance from their providers.
Among the more troubling viral conversations are those involving supposed strategies to getting a better night’s sleep. “It’s certainly understandable that people are looking for solutions because sometimes it feels like nobody is sleeping very well anymore,” said Beuther, professor of medicine at National Jewish Health, Denver. “And that can range from not getting enough sleep, irregular sleep, poor sleep quality, or insomnia. There are many different things that can contribute to these prevalent problems, and many times the solutions are not quick fixes. Sometimes the solution is spending time with your doctor, but people struggle to find that time these days. And that’s fertile ground for trying to solve problems outside of established proven medical interventions.”
Beuther and others said it’s important for pulmonologists and other clinicians to be aware of the various sleep trends that are becoming popular, whether they’re rooted in online platforms or not, to improve awareness about the dangers being presented to patients, and to help identify symptoms that could be associated with unhealthy “sleepmaxxing hacks.”
Tempting Sleep Trends
More often than not, patients often attempt at-home sleep remedies due to difficulty managing prescribed treatments such as continuous positive airway pressure, bilevel positive airway pressure, and cognitive behavioral therapy.
Common examples of trends today include the use of aerosol or topical essential oils, drinking nonalcoholic “sleepy girl mocktails,” consuming cannabis-based ingestibles, practicing “bed rotting” (spending extended time in bed during times of nonsleep to feel more rested) and — perhaps most likely — mouth taping. Mouth taping is the use of medical or hypoallergenic tape to seal the lips closed during sleep to prevent mouth breathing.
“That’s the trend that I’m most concerned about,” said Beuther. “A lot of these types of trends come and go, but this mouth taping has been out there for well over a year. It’s certainly not a flash in the pan, and many people are doing this. And there’s real serious concern because there isn’t any good evidence that mouth taping does anything to help someone. It could be dangerous.”
Other problematic trends include the overuse of the supplements melatonin and magnesium, two products that might be helpful when used in moderation but have become popular for being taken in excess.
“Melatonin is generally safe; however, taking it at high doses could cause problems,” said Jeffrey Chester, DO, medical director at Ohana Luxury Addiction Treatment Center in Kailua-Kona, Hawaii. “Melatonin could also potentially interact with other drugs like selective serotonin reuptake inhibitors and cause sedation the next day,” he said.
Sudha Tallavajhula, MD, a professor at the McGovern Medical School, University of Texas Health Houston, and medical director of TIRR Memorial Hermann Neurological Sleep Medicine Center in Houston, said pediatric specialists in particular are cautioning against the use of melatonin in children, which can lead to emergent situations if administered incorrectly, and could include additives that are harmful in their own right. “And magnesium is another commonly advertised sleep supplement that can also be harmful at high doses,” said Tallavajhula.
While Beuther said he’s not yet having frequent encounters with patients who are mouth taping, he believes his clinic is a bit of an outlier based on the patient population, which skews toward older adults. “They’re slower to adopt these viral trends,” he said. “Older patients are often more medically experienced and understand better that they’re going to talk to their doctor before doing something because their health has been a problem longer.” He said it also appears that those who are living with more serious chronic lung conditions aren’t typically trying activities that they might read about online without talking to him. “But I have had patients who have asked me about mouth taping,” he said. “It’s been prevalent enough that I feel the need to be able to answer intelligently when patients ask about it and to know what’s out there, what the evidence is showing, and knowing what the concerns are.”
For those patients who have experimented with trends, restricted airflow during sleep can occur with mouth taping while “bed rotting” can lead to disruption in circadian rhythm and lowered sleep drive, said Gunjan Narwani, MD, MS, a neurologist with Houston Methodist Clear Lake Hospital, Nassau Bay, Texas. “For example, in those individuals with nasal obstruction or sleep apnea, mouth taping could seriously affect airflow during sleep, further exacerbating the ability to breathe,” she explained.
While these risks might not be high, especially among younger patients, Beuther worries that breathing could quickly become compromised if any lingering congestion becomes worse after falling asleep. “The mouth is an important relief valve, and everyone gets a cold where we can’t shut our mouth at night because that’s the only way we can breathe,” he said. “The other thing that can happen is there may be increased resistance to breathing at night, which causes increased respiratory effort to get adequate breathing. And that can be disruptive to sleep and can create more negative pressure or almost suctioning in the chest. That increases the risk of reflux and aspiration into the lungs.”
Focus on Screening
According to the National Sleep Foundation, an estimated 50-70 million Americans experience some type of sleep disorder. The key is appropriately identifying these individuals when they’re in the presence of a healthcare provider, said Beuther.“There’s a lot more need out there that has to be met,” he said. “We have an aging population, and our healthcare system is not doing well in just about every aspect. Patients don’t have the access to care that they need, healthcare is getting more expensive, and as patients get older, there’s an epidemic of multiple chronic conditions. I think a lot of patients are struggling to get help.”
Aside from respiratory conditions including asthma, chronic bronchitis, and chronic obstructive pulmonary disease (COPD), comorbid factors contributing to sleep issues can include congestive heart failure, reflux, sinus issues, arthritis and other types of chronic pain, diabetes, and obesity. “There are a lot of different pulmonary and nonpulmonary problems that can disrupt sleep,” said Beuther. “Sleep problems are not all about weight, but these weight-related issues and the obesity epidemic directly cause a lot of problems. Weight causes a particular problem at night with breathing, the mechanical effect of your lungs, the increased risk of sleep apnea, and the increased risk of reflux.”
Anxiety is also a culprit and can be brought on by several factors, including a tendency to become fixated on one’s sleep struggles. “There’s a lot going on in the world,” Beuther said. “The world moves much faster than it used to. People are much more tied to electronic devices and hits of dopamine from various sources. It seems like we as a society are more anxious.”
With time constraints being felt by providers and patients alike, Beuther and others suggest directly asking about each patient’s sleep to aid diagnosis and raise general awareness about the propensity for sleep problems. “I think we often forget to ask about sleep, or maybe we’re afraid to ask because it can be a long conversation,” said Beuther. “I think what we hear back today about patients’ sleep patterns is a longer and more complicated answer than it used to be. But patients really want to talk about this and, oftentimes, this is a top priority for them. Asking the open-ended question, “How is your sleep?” can start the conversation.”
Narwani said she is quite methodical about how she enters these discussions. “I take detailed histories from my patients about their sleep, including what they may be doing in order to troubleshoot concerns they have with either the quantity or quality of their sleep,” she said. “If I identify behaviors that are lacking in evidence or that may be potentially harmful, I make sure to not only discuss them but also work towards developing strategies to address the problems using more evidence-based methods.”
There are also patients who are adherent with their ongoing sleep therapies who can still experience disturbances as a result of those treatments. “Once we get the durable medical equipment, these artificial devices in your environment can make some things with sleep difficult,” explained Beuther. “You typically have a noisy, heat-generating appliance plugged into your oxygen tubing. And some people have trouble with the tubing because they get tangled in it. Sometimes the equipment generates so much heat that patients can’t keep their room cold.”
While sleep can be improved with effective treatment of existing conditions, there aren’t always easy solutions. Overnight asthma symptoms can be particularly challenging for sleep, said Beuther. “There’s shortness of breath, cough, and waking up needing to use the inhaler,” he said. “There’s that circadian variation where inflammation in the body is at its highest around 3 AM. If asthma is not well controlled, many patients will experience waking up with respiratory symptoms.” General mucus buildup overnight can also disrupt sleep and should be part of the conversation in clinic. “We always want to ask about that because it’s a sign that maybe there’s an opportunity to do better to control conditions,” said Beuther. “It’s really important that we ask about this in asthma, COPD, bronchitis, and other respiratory health issues. Oftentimes, if the condition is very well controlled, patients do better with sleep.”
Need for More Research
For now, there have not been enough valid studies conducted to objectively determine any real benefits to various viral sleep trends.
“There have been numerous small studies that are very poor quality,” said Beuther. “Almost no study of any quality has looked at mouth taping by itself without some other intervention.”
Tallavajhula said some patients might be frustrated to learn that the best advice to improve sleep is to avoid these trends and to implement better sleep hygiene habits, such as lack of food and drink close to bedtime, consistent bedtimes and wake times, behavioral techniques, and to give sleep the priority it deserves by consulting a sleep specialist.
Beuther also suggested environmental adjustments, such as keeping the bedroom quiet and dark as well as not watching TV, reading, or scrolling on a phone soon before bed. “There are different examples of behavioral aspects of sleep,” he said. “The majority of the population does a lousy job of that. Sleep is complicated, and I don’t think laypeople understand it very well.”
Chester, Narwani, and Tallavajhula reported having no relevant financial relationships. Beuther reported being a paid consultant for AstraZeneca.