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.

Wednesday, June 17, 2015

Insomnia and empathy

Insomnia can significantly affect your daytime functioning - most with chronic insomnia report daytime tiredness, concentration problems, and irritability. Here is an article about research presented at the annual Sleep meeting in Seattle. Researchers studied how insomnia levels affect healthcare workers ability to feel empathy for their patients. Workers with a sufficiently high insomnia scored demonstrated less empathy than those with lower insomnia scores. The article doesn't specify whether the healthcare workers had temporary insomnia, long term insomnia, or just sleep deprivation from rotating work and call schedules.

Wednesday, June 10, 2015

Micro-CPAP

I've been asked by multiple patients in the past few weeks about this tiny CPAP, the Airing. I don't know anything about it other than what is in this article. It looks interesting, but I have many questions about it. If it gets FDA approval, we will learn much more.

Wednesday, June 3, 2015

Natural history of excessive daytime sleepiness

This article examines the natural history of excessive daytime sleepiness (EDS). In the article, the authors explain that EDS affects about 30% of the general public. They also explain that EDS is associated with certain psychiatric, metabolic, and sleep disorders. I would add that EDS is also a result of insufficient amount of sleep and sedating medications.

In this study, participants had a comprehensive sleep history and physical exam along with an in-lab overnight sleep study at baseline. No daytime sleepiness study, called the Multiple Sleep Latency Test (MSLT), was performed - sleepiness was only determined subjectively. Sleep apnea was defined at a cutoff that is standard for moderate severity - it's not explained why they did not include those with mild sleep apnea, who could be just as sleepy as more severe levels. Finally, follow up was only through telephone interview - no repeat sleep study or physical examination was done. The follow up was 7.5 years after the baseline evaluation, on average. Therefore, there are some important limitations to this study.

Incident EDS was defined as those who had no EDS at baseline but did have it at follow up. Remitted EDS meant those that had EDS at baseline, but not at follow up. And persistent EDS meant those that had EDS at both baseline and follow up. Results showed that incident EDS was 8.2%, and was more commonly associated with male gender, non-Caucasian race, and younger and older age. Depression, sleep apnea, obesity, and diabetes were also associated with incident EDS. Sleep duration less than 5 hours or more than 8 hours was associated with incident EDS. However, insomnia was not associated with incident EDS. Snoring was related to incident EDS, especially in those with sleep apnea.

The persistent EDS rate was 38%, whereas 62% had remitted EDS. Persistent EDS was associated strongest with anemia and insomnia. Individuals with incident or persistent EDS gained significantly more weight when compared to those without EDS. Also, individuals with remitted EDS gained significantly less weight compared to those without EDS.

The authors concluded that obesity, depression, and sleep disorders should be a public health priority to improve EDS.