Wednesday, August 26, 2015

Sleep-related breathing disorders, functional disorders, and anxiety disorders

Here is a fascinating article (at least to me) about a possible link between sleep-related breathing disorders like obstructive sleep apnea and other disorders. The other disorders are classified as "functional", meaning no etiology is agreed upon, such as fibromyalgia, chronic fatigue syndrome, and migraines. The other disorders include anxiety disorders like panic attacks and post-traumatic stress disorder (PTSD).

The researcher that is discussed in article is Dr. Gold at Stony Brook University and has published research studies on this topic. His theories about how mild OSA disorders can worsen functional and anxiety disorders is not without controversy. However, if further research confirms his theories, treatment for OSA may also help these difficult-to-treat disorders.

Wednesday, August 19, 2015

Sleep and memory

Research has shown that sleep is connected to memory. This article discusses research about that topic. I don't have access to the original research study, only the summary article provided in the link. The study setup had participants learn made-up words prior to a night of sleep or the same amount of time awake. The participants were then asked to recall the words after a period of sleep or wakefulness.

The results showed that when compared to wakefulness, sleep helped the participants recall forgotten words. One of the researchers concluded that "sleep almost doubles our chances of remembering previously unrecalled material. The post-sleep boost in memory accessibility may indicate that some memories are sharpened overnight. This supports the notion that, while asleep, we actively rehearse information flagged as important."

Wednesday, August 5, 2015

Sleep and long distance running

This article isn't just about sleep. It's about a runner who does ultra-marathons - typically 50k or 100k races. This runner broke the unofficial record for completing the Appalachian Trail. He finished the 2189 mile journey in only 46 days - this comes out to be 47.5 miles per day! I've ran a marathon and have done many 3-5 night backpacking trips in the Smoky Mountains, but I can't imagine walking or running 47.5 miles per day. What an amazing feat.

The reason I am blogging about this, though, is because the article mentions how the runner only got 4-5 hours of sleep per night. On the last few days, he only got 1-2 hours per night! So this elite athlete could continue to function at his high level even with very little sleep. This fact is interesting because some studies show that athletes perform better when they get plenty of rest. The article doesn't say how much sleep the runner typically gets when not racing. It may be that he only sleeps 5-6 hours on a regular night - so 4-5 hours of sleep would not be that much deprivation.

Wednesday, July 29, 2015

Sleeping with your phone

This article discusses survey data about cell phone use. The results showed that 71% of those surveyed sleep with their cell phone near them. Most have it on their nightstand, but some have it on the bed or even in their hand. The article reports that only 24% of those surveyed keep their phone in a separate room, which is consistent with good sleep hygiene.

I don't agree that keeping your cell phone out of your bedroom is good sleep hygiene. I keep mine next to my nightstand every night. For me, my phone serves as my pager for when I am on call but also as my alarm. The problem with having a cell phone in your bedroom occurs when you use the phone to help you fall asleep, rather than learning to fall asleep on your own. Or if you get texts, email alerts, or calls all night from friends and family - this will disturb your sleep. But just having the phone next to you is not necessarily a problem.

Wednesday, July 22, 2015

Jaw surgery for obstructive sleep apnea

For most people with obstructive sleep apnea (OSA) that is at least moderate severity, CPAP is the most effective treatment option. However, for the right patient, jaw surgery can be very effective as well. The type of jaw surgery that is done is where the oral surgeon breaks the lower (and usually the upper) jaw to reposition it away from the face. This opens up the breathing tube, resulting in less obstruction. There is data showing short term effectiveness of this procedure, but little long term efficacy data. This study does just that.

The study participants were adults who had moderate or severe OSA. Sleep studies were done pre- and post-op jaw surgery, as well as at least 2 years after the surgery. Results showed that the average OSA severity reduced by almost 77% over the long term. And 47% of patients did not meet criteria for OSA post-op. Finally, 83% of patients had mild OSA but no excess sleepiness post-op. Blood pressure was decreased and quality of life increased after the jaw surgery. These improvements in OSA severity and blood pressure occurred despite an increase in weight during the followup period.

Wednesday, July 15, 2015

Napping, impulsivity, and frustration tolerance

Sleep loss can increase the chances of acting impulsively as well as the ability to handle frustration. And for some people, extra sleep can improve frustration tolerance and decrease impulsive behavior. This article is about research on how planned napping may help. I don't have access to the full article, so I can only discuss what's in this article.

The researchers studied 40 adults, ages 18-50 years old. They had the participants keep a regular sleep schedule for three nights and then they completed a series of computer tasks and answered questions. The participants were then randomized to either have a 60 minute nap or watch a nature video before doing the tasks and answering questions again. The results showed that the participants who napped were less impulsive and had better frustration tolerance.

The article attempts to link the study results to workplace productivity but I don't think the study was designed to evaluate that specifically. However, I could see how better-rested employees may perform better. But that productivity advantage may be offset by an hour nap at work!

Monday, July 6, 2015

Sleep as a vital sign

When I was in medical school, the four vital signs were blood pressure, pulse, breathing rate, and temperature. Over the years, pain level has been added to the list of vital signs by some medical practices and hospitals. Here is an interesting article advocating for assessment of sleep during routine medical visits, much like the way vital signs are automatically assessed with each patient encounter.

The authors note how sleep disorders are under-diagnosed, and how sleep disorders can affect so many other areas of a person's health. Also, many non-sleep disorders affect how a patient sleeps. At the end of the article, the authors pose a question as to how to assess a patient's sleep during a routine visit. Unfortunately, there is no rapid objective measure of sleep quality that can be used during a routine visit, like how we measure blood pressure. So an assessment of sleep is subjective, like the assessment of pain. Many non-sleep physicians already ask questions such as "How are you sleeping?". Perhaps having a patient rate their sleep quality on a scale of 1 to 10, similar to how some clinicians assess pain levels? That would be an interesting research project to do.