Saturday, February 26, 2011

Behavioral Treatment of Insomnia in Older Adults

A study was published in the online version of the January issue of the Archives of Internal Medicine about behavioral treatment of insomnia in older adults. Researchers studied 79 adults (mean age 72, 70% women) with chronic insomnia and common other illnesses. They randomly selected half to receive brief behavioral treatment for insomnia (BBTI) or information control (IC). BBTI consisted of two intervention sessions and two telephone calls. The interventions were reducing time in bed, getting up at the same time each day, not going to bed unless sleepy, and not staying in bed unless asleep. IC consisted of printed educational materials and two telephone calls. Both treatments were administered by a nurse clinician.

BBTI produced a response in 67%, whereas IC had a 25% response. The percentage without insomnia after the intervention was 55% with BBTI and 13% with IC. The BBTI group reported better sleep and health after the intervention, had more improved sleep diaries, and had less insomnia when their sleep was studied at home with wrist-watch actigraphy. There was no difference between BBTI and IC on an in-lab sleep study. This makes sense, as many patients do not sleep as well in the lab, as at home - whether they have insomnia or not.

The study authors concluded that BBTI provides a clinically and statistically meaningful improvement in insomnia that is sustained for six months. Also, since BBTI is not readily available, this study showed that it could be delivered by a nurse with no formal sleep training. This means that more patients could receive effective non-pharmacological treatment for their insomnia.

Thursday, February 24, 2011

Isoflavones, Menopause, and Insomnia

Saw an article abstract in the February edition of Menopause about isoflavones, insomnia, and hot flashes in post-menopausal women. Researchers studied 38 post-menopausal women - admittedly a small number. The study was placebo-controlled and double-blinded.

The women participants took either a placebo or 80 mg of isoflavones (found in soybeans) daily for four months. They did sleep studies to determine how much they slept while in bed on the night of the study - called sleep efficiency. I use 85% or more as a cutoff for normal sleep efficiency. This means, that you are asleep 85% or more of the time you are in bed. For the isoflavone group, sleep efficiency went from 77.9% to 83.9%. For the placebo group, sleep efficiency went from 77.6% to 81.2%. The difference between the placebo and isoflavone group was deemed statistically significant. These numbers are very underwhelming and neither placebo nor isoflavone were able to get the sleep efficiency to what I consider the normal level.

Insomnia intensity went down over four months for both the placebo group and the isoflavone group, but the isoflavone group had a greater decrease. Specifically, 95% of the placebo group and 90% of the isoflavone group rated their insomnia as moderate or intense at the beginning of the study. After four months, 63% of the placebo group and 37% of the isoflavone group had moderate or intense insomnia.

Finally, the number of hot flashes experienced trended downward by two months and was statistically less by four months in the isoflavone group than the placebo group. Numbers were not given in the abstract so I don't know how much each group changed by themselves. Apparently, hot flash intensity also was significantly lower in the isoflavone than placebo group - again no numbers were given in the abstract to put this into perspective like for the sleep efficiency data above.

Sunday, February 20, 2011

Obese Children and Sleep Duration

There was a research article in the January issue of Pediatrics about sleep duration and obese children. The authors studied children aged 4 to 10 years old. They measured their body mass index (BMI) and sleep patterns with a home device called actigraphy.

The children averaged 8 hours of sleep per night during the school week, regardless of BMI. Of note, the recommended number of hours of sleep for children those ages is between 10-13 hours. So right off the bat, these kids are sleep-deprived.

On the weekends, children with high BMI's (meaning obesity) tended to sleep shorter duration and have a more irregular sleep pattern than normal-weight kids. The authors interpreted this to mean that obese children did not catch up on sleep as well as thinner kids. The children who slept less and more irregular also had higher levels of insulin, bad cholesterol, and C-reactive protein (associated with heart disease). The authors explain that sleep deprivation is associated with hormonal changes that can increase appetite.

I don't know if the children were matched for other factors like socio-economic status and family history, which could affect weight regardless of sleep duration or sleep pattern.

I wonder if the irregular sleep pattern and shorter sleep duration on the weekends reflects lack of limit-setting of the parents, which could explain obesity more than sleep duration. As I have said in a previous post, childhood obesity is not caused by lack of sleep. Sleep could play a small part, but our children's diet and lack of exercise are the overwhelming contributors.

Wednesday, February 16, 2011

Sleeping With Your Pets Can Make You Sick

I saw a blurb about an article in the Emerging Infectious Diseases Journal that showcases how your pets can transmit diseases to you when you sleep with them next to you in your bed. Diseases mentioned include...

-Bubonic plague - yes, THE plague!
-Cat-scratch fever - apparently you can also get this from being licked by an infected cat, as opposed to being scratched.
-Chagas disease - I've heard of this, but had to look it up. Symptoms include fever, fatigue, body aches, headache, rash, loss of appetite, diarrhea, and vomiting - not good times.

The authors commented that it is rare to get these diseases by sleeping in the same bed as your pet, but it could be a problem for the very young and immuno-compromised people.

In addition to getting sick, sleeping in the same bed as your pet can contribute to insomnia. I recommend to my patients with insomnia to have your pet sleep outside your bedroom if fido or fluffy is disrupting your sleep by sharing your bed.

Sunday, February 6, 2011

Zolpidem use, Balance and Cognition upon awakening

In the January 13th issue of the Journal of the American Geriatrics Society, there is a study about the effects of Zolpidem on balance and cognition upon awakening. Zolpidem is the active ingredient in Ambien and Ambien CR. This study involved 12 older patients (average age 67 years) and 13 younger adults (average age 22 years). All participants were healthy, physically active, and mentally sharp. Balance was assessed by the tandem walk test, where participants walk on a six-inch beam. Cognition was tested by assessing short term memory and processing speed. The researchers studied balance and cognition right before bedtime and 2 hours after falling asleep after the participants took 5mg of Zolpidem. Researchers also studied balance and cognition after all of the participants went to bed two hours later, to study the effects of partial sleep deprivation without taking Zolpidem.

The results showed that 58% of the older adults and 27% of the younger adults had balance problems after taking 5mg of Zolpidem. Cognition was also impaired in both groups, but the decrease in cognition was more pronounced in younger adults than older adults.

This study underscores the importance of using caution with sleeping pills because of the risk of falls in elderly patients that use these medications. The fact that younger adults had more severe cognitive changes is also important. Five milligrams of Zolpidem is the recommended starting dose for patients older than 65, but 10mg is the more common dosage in younger patients. I wonder if the cognitive changes would be more pronounced at the higher dosage in younger adults.