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Mayo Clinic Q&A; treating laryngopharyngeal reflux; fitness trackers and sleep data

FITNESS TRACKERS, APPS HAVE LIMITATIONS WHEN IT COMES TO SLEEP

I wear a fitness device that tracks my sleep. It shows that most of my sleep is light sleep and that I rarely am in deep sleep. Is this kind of sleep tracker reliable? If so, is there a way I can get better sleep? I sleep about six or seven hours each night.

When it comes to identifying the difference between light sleep and deep sleep, research has shown that fitness trackers are not accurate. Rather than relying on your device to measure how well you sleep, consider basing your assessment of sleep quality on how you feel when you wake up. If you don't feel well-rested, and it's affecting your daily life, that might prompt a change in your habits or possibly a sleep evaluation.

Wearable fitness trackers and apps that claim to measure sleep have become quite popular. Typically, they display information about sleep and wake time. Some offer assessment of light sleep versus deep sleep, as well as how often you wake up during the night and how long you stay awake. The manufacturers don't share details about the technology these devices use to gather the information, but it appears that most rely on motion detection.

To evaluate the usefulness of wearable trackers and apps, more than 20 research studies have examined the accuracy and validity of the sleep information they generate. The results show that, when compared to polysomnography — considered by sleep medicine specialists to be the gold standard of sleep tests — the devices are largely inaccurate. Their accuracy particularly deteriorates for people who wake up often during the night.

In addition to being unreliable in distinguishing between different sleep stages, the sleep trackers and apps are inexact in their ability to measure the time it takes to fall asleep, overall sleep efficiency and total sleep time. The general problem is that, although the devices are fair to good at detecting when you're asleep, they are poor at determining when you are awake during the night.

A better way to tell if you're getting the sleep you need is to consider how you feel throughout the day. You mention that you usually get six or seven hours of sleep. Based on existing sleep research, the American Academy of Sleep Medicine recommends healthy adults consistently get at least seven hours of sleep a night. If you wake in the morning feeling well-rested and able to function throughout the day, there's probably no need to be concerned.

If, however, you have any of these symptoms, consider seeking medical evaluation: significant difficulty falling asleep or staying asleep, frequent loud snoring, waking up with a gasping or choking sensation, breathing pauses in sleep, frequently waking up, waking in the morning after a full night's sleep not feeling refreshed or with a headache or often feeling sleepy during the day.

Some changes can improve your sleep. Try to maintain a consistent sleep-wake schedule, and make sleep a priority. But don't spend more than about eight hours in bed per day. Avoid caffeine after noon, and limit it to one or two servings. Exercise during the day, but try to do so at least six hours before you go to bed.

Take time to wind down before bed, and establish a daily bedtime routine. Use the bedroom only for sleep and sex. Avoid excess alcohol use and heavy meals before bedtime. Remove electronics from your bedroom, and avoid looking at the clock. When you go to bed, wear comfortable clothing and keep your surroundings dark, cool and quiet. If you can't fall asleep, get out of bed and do a boring activity until you become drowsy.

If you feel persistently sleepy, despite good sleep habits, or if you have other symptoms of sleep problems, make an appointment to see your health care provider. He or she can evaluate your situation and help you decide if a consultation with a sleep specialist may be useful.

Meghna Mansukhani, M.D., Center for Sleep Medicine, Mayo Clinic, Rochester, Minn.

DIET, LIFESTYLE CHANGES MAY EASE LARYNGOPHARYNGEAL REFLUX

My husband had a cough for months and eventually was diagnosed with laryngopharyngeal reflux. What is the best option for treatment? He is still constantly coughing and clearing his throat despite regularly taking omeprazole and antacids.

The medications you mention are standard treatment options often recommended for adults who have laryngopharyngeal reflux, or LPR. But, along with taking medications, if he hasn't already done so, your husband also should consider making diet and lifestyle changes to ease his laryngopharyngeal reflux symptoms. Several complementary therapies may help, too.

Laryngopharyngeal reflux is a form of gastroesophageal reflux disease. Laryngopharyngeal reflux happens when stomach acid and other contents of the stomach flow all the way up the esophagus, into the back of the throat and, in some cases, into the back of the nasal passages. Frequent coughing and throat clearing are common symptoms. People with laryngopharyngeal reflux may feel as if they have something stuck in their throat. Laryngopharyngeal reflux can cause hoarseness and other voice problems, too.

Medications usually can reduce the symptoms of laryngopharyngeal reflux significantly. A class of drugs called proton pump inhibitors are typically the most effective. They work by decreasing the amount of acid the stomach produces. Omeprazole is a type of proton pump inhibitor.

Antacids and medications called histamine antagonists, which also decrease stomach acid, can be used to treat laryngopharyngeal reflux, as well. Medications that increase the movements or contractions of the stomach and bowels, sometimes called pro-motility drugs, may be recommended for people with laryngopharyngeal reflux.

Along with using medication, there are other steps your husband can take to help control laryngopharyngeal reflux. One of the most important is eating a diet that is low in acid. Research has shown that this type of diet often can reduce laryngopharyngeal reflux symptoms.

Examples of low-acid foods are melons, green leafy vegetables, celery and bananas. Foods that people with laryngopharyngeal reflux should avoid include spicy, fried and fatty foods, citrus fruits, tomatoes, chocolate, peppermint, cheese and garlic. Foods that contain caffeine, carbonated beverages and alcohol also can worsen symptoms.

For people with laryngopharyngeal reflux, it helps to eat the largest meal of the day at midday or in the morning, rather than in the evening, and to avoid eating within three hours of bedtime. Don't rush through meals. Take time to eat slowly, without distractions.

Other lifestyle changes that can make a difference for someone with laryngopharyngeal reflux include not smoking, maintaining a healthy weight and reducing and managing stress in healthy ways.

Several complementary therapies also may be useful in managing laryngopharyngeal reflux. For example, some studies suggest that acupuncture, a therapy that involves inserting extremely thin needles through the skin at strategic points on the body, can reduce symptoms.

Taking a probiotic dietary supplement that contains good bacteria similar to bacteria already in your body may ease some symptoms, too, but they aren't for everyone, and different supplements contain different types of probiotics. Before your husband takes a probiotic, he should ask his health care provider about the kind and amount that's right for him.

Finally, voice therapy can be used to treat the effects of laryngopharyngeal reflux. Research has shown that people who take a proton pump inhibitor and participate in voice therapy show faster symptom improvement than people who only take medication.

Encourage your husband to talk to his health care provider about his persistent laryngopharyngeal reflux symptoms. They can discuss additional treatment options and lifestyle changes. In many cases, laryngopharyngeal reflux can be managed successfully.

Amy Rutt, D.O., Otorhinolaryngology, Mayo Clinic, Jacksonville

Mayo Clinic Q & A is an educational resource and doesn't replace regular medical care. E-mail a question to MayoClinicQ&A@mayo.edu. For more information, visitmayoclinic.org. © 2017 Mayo Foundation for Medical Education and Research. Distributed by Tribune Content Agency, LLC. All rights reserved.

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