Tuesday, August 31, 2010

Sleep and Your Local Paper

There was an article in today's local paper about the importance of sleep and the usual list of tips for dealing with sleep issues - mainly insomnia. The tips are the standard good sleep hygiene practices advocated by the sleep community and regurgitated by every newspaper and magazine that deals with health topics. Most people I meet have heard of these proper sleep practices, but rarely does anyone practice them on a regular basis. Since many of those people I meet are my patients, we usually spend some time discussing the importance of good sleep habits.

One word of caution - studies do not support sleep hygiene measures as stand alone therapy for the treatment of chronic insomnia. However, that does not mean they should be ignored. On the contrary, they should be part of a more comprehensive treatment treatment program.

For a list of good sleep habits, click on the link to the American Academy of Sleep Medicine's Sleep Education page.

Wednesday, August 25, 2010

Sleep and Noise Makers

A common question I get is if it's healthy to sleep with background noise. Some people feel like they sleep better if there is a background noise to break up the silence.

I explain that some noise can help certain people sleep better. In fact, my family and I all use the Sleep Sound Generator, which generates a soothing white noise. Here is a picture of the unit...



Not all noises are created equal. Constant white noise is better than the changing tones of a television or radio. Before we got the Sleep Sound Generators, we used a CD put on continuous replay that played white noise, like that heard on analog radios in between stations. However, the CD players were unreliable, and the white noise CD lasted only about an hour. When the CD finished playing, the volume would die down over a few seconds until the CD began playing again. This on-off-on again would sometimes wake one of us up. The Sleep Sound Generator plays the same volume of white noise continuously all night long. Now, I miss it if I stay in a hotel and don't have my white noise.

Tuesday, August 17, 2010

Sleep Duration and Cardiovascular Risk Factors

There is an article in the August edition of the Journal of Clinical Sleep Medicine on napping, nighttime sleep, and cardiovascular risk factors in mid-life adults.

The authors measured sleep quantities over 10 nights with a combination of at-home and in-lab testing. They found that adults who nap more often had less nighttime sleep - this makes sense, as your body only needs so much sleep per 24 hour period. The authors also noted that adults who nap more had greater self-reported daytime sleepiness, fatigue, and bodily pain. This makes sense, too, as people who are more tired or in pain might nap more. These results support practicing good sleep hygiene in those patients with insomnia, because eliminating napping can improve nighttime sleep quantity and quality. I tell patients that napping in the daytime will usually take sleep away from them at night.

Finally, the authors noted that adults who napped more frequently had larger waist lines and a bigger body-mass index (BMI). Blood pressure level was not affected by the amount of napping. Therefore, in this study, napping was associated with an increase in some of the cardiovascular risk factors (BMI and waist circumference), but not blood pressure.

Thursday, August 12, 2010

The Delicate Balance of Sleep Duration

Discussing the optimal amount of sleep someone should get each night can be challenging, and the conversation differs based on the problem the patient presents to me with. In those who tend to get too little sleep, they usually report excessive daytime sleepiness or fatigue. I explain that the amount of sleep someone needs can not be altered and that the patient should get as much sleep as needed to feel rested. Sleep deprivation, whether voluntary or from a sleep disorder, can affect mental and physical health.

On the other hand, for patients with primary insomnia, focusing too much on sleep duration or attempts get the coveted 8 hours per night often fuels the insomnia. Most insomniacs are not as sleep-deprived as they think. Plus, the behavioral treatments I use will produce a temporary sleep-deprived state. I use that built up sleep pressure to overcome patients' insomnia.

In other words, the message to my patients about sleep duration can be contradictory at times. Getting too little sleep can be dangerous, even in the short term. But for some with insomnia, focusing on the perceived consequences of insomnia often make the insomnia worse. For these patients, putting less emphasis on sleep and sleep duration can actually help them sleep better.

Sunday, August 8, 2010

FDA Warns Against Quinine for Nocturnal Leg Cramps

The FDA recently issued a second warning against treating nocturnal leg cramps with a quinine product called Qualaquin (quinine sulfate). Using Qualaquin for leg cramps is "off-label" as it is only approved for uncomplicated Malaria infection - a very different disorder than nocturnal leg cramps.

The FDA has been getting reports of bleeding dirorders from Qualaquin use. One of the bleeding disorders has been linked to severe kidney disease.

Nocturnal or night-time leg cramps can be a real sleep destroyer. This disorder is more common in older individuals and can produce very painful muscle cramps, usually in the calves. It can wake someone from sleep, contributing to insomnia. Doctors and patients have used quinine for decades until the past few years, when the FDA warned against its use due to irregular heart beat. Now, there appears to be another reason to be more careful when using quinine for leg cramps.

In some cases, leg cramps that wake people from sleep are due to electrolyte and/or mineral deficiencies, like magnesium or potassium. Replacing those that are deficient can often reduce or eliminate the night-time leg cramps. A simple blood test can help your doctor determine if your electrolyte or mineral levels are too low, and possibly contributing to night-time leg cramps.

Thursday, August 5, 2010

Sleep Duration and Cardiovascular Disease

The August edition of the journal Sleep has an article about the association of sleep duration and cardiovascular disease. It was based on a survey of over 30,000 Americans. The results showed that cardiovascular disease was more common in people who reported that they slept less than or greater than seven hours per night. These results were independent of age, sex, race, ethnicity, smoking, alcohol use, body mass index, physical activity, diabetes, high blood pressure, and depression.

The authors of the study did not determine the reason why sleep duration could affect cardiovascular disease, but they provided some theories. Hormonal and metabolic changes can occur in people who sleep less than seven hours, and these changes could impact cardiovascular health. People who sleep longer than seven hours could be sleeping that long due to an underlying sleep disorder, such as obstructive sleep apnea (OSA). OSA can impact cardiovascular health in a negative way.

Getting seven hours of sleep each night may not prevent you from having a heart attack, but getting the right amount of sleep can be an important part of overall good health.

Monday, August 2, 2010

Weight Loss Surgery in Adolescents

I saw a review of an article published in the Journal of Pediatrics about how weight-loss surgery works to reduce weight in adolescents.

According to the review, the success rate of lifestyle changes and medications in achieving long-standing weight reduction is modest at best. Weight-loss surgery is gaining acceptance as an effective treatment in obese adolescents.

Weight-loss surgery significantly improved obesity-related illnesses like type 2 diabetes, high cholesterol, and high blood pressure. There was no mention of sleep apnea in the review, but that can also improve significantly with weight loss after surgery.

I frequently evaluate adult patients in order to treat any significant obstructive sleep apnea that might make weight-loss surgery more risky. This is exciting news that perhaps adolescents will also have another treatment option in the battle against obesity.